Association Between Gingival Crevicular Fluid Leptin Levels and Periodontal Status - A Biochemical Study on Indian Patients.

AIM: The present study was carried out to evaluate and compare the gingival crevicular fluid (GCF) concentrations of leptin in periodontally healthy and diseased subjects, to compare GCF leptin levels with respect to Body Mass Index (BMI) among the study groups and essentially to obtain an insight into leptin's possible role in the initiation and progression of periodontal disease. MATERIALS AND METHODS: A total of 60 subjects; both males and females, based on their body mass index were selected for the study. They were categorized into three groups of 20 subjects each, based on their periodontal status, as follows: Group I (clinically healthy periodontium); Group II (gingivitis); Group III (chronic periodontitis). GCF samples of 1 µl were collected extra-crevicularly using black color-coded 1-5 µl calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available ELISA kit. RESULTS: The concentration of leptin in GCF of patients in Group I (2272.25 pg/mL) was statistically higher (p < 0.001) than in those of Group II (1421.86 pg/mL) and Group III (1160.67 pg/mL). No statistically significant difference was found when comparing the mean values of leptin between BMI groups in each study group. CONCLUSION: As periodontal disease progressed, there was a substantial decrease in the gingival crevicular fluid leptin concentration. This suggests a protective role of leptin with regard to periodontal health.

A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation.

AIMS: The purpose of this study was to compare the clinical efficacy of subepithelial connective tissue graft and acellular dermal matrix graft associated with coronally repositioned flap in the treatment of Miller's class I and II gingival recession, 6 months postoperatively. SETTINGS AND DESIGN: Ten patients with bilateral Miller's class I or class II gingival recession were randomly divided into two groups using a split-mouth study design. MATERIALS AND METHODS: Group I (10 sites) was treated with subepithelial connective tissue graft along with coronally repositioned flap and Group II (10 sites) treated with acellular dermal matrix graft along with coronally repositioned flap. Clinical parameters like recession height and width, probing pocket depth, clinical attachment level, and width of keratinized gingiva were evaluated at baseline, 90(th) day, and 180(th) day for both groups. The percentage of root coverage was calculated based on the comparison of the recession height from 0 to 180(th) day in both Groups I and II. STATISTICAL ANALYSIS USED: Intragroup parameters at different time points were measured using the Wilcoxon signed rank test and Mann-Whitney U test was employed to analyze the differences between test and control groups. RESULTS: There was no statistically significant difference in recession height and width, gain in CAL, and increase in the width of keratinized gingiva between the two groups on the 180(th) day. Both procedures showed clinically and statistically significant root coverage (Group I 96%, Group II 89.1%) on the 180(th) day. CONCLUSIONS: The results indicate that coverage of denuded root with both subepithelial connective tissue autograft and acellular dermal matrix allograft are very predictable procedures, which were stable for 6 months postoperatively.

Efficacy of guided bone regeneration using composite bone graft and resorbable collagen membrane in Seibert's Class I ridge defects: radiological evaluation.

The purpose of the study was to evaluate radiologically the efficacy of guided bone regeneration using composite bone graft (autogenous bone graft and anorganic bovine bone graft [Bio-Oss]) along with resorbable collagen membrane (BioMend Extend) in the augmentation of Seibert's class I ridge defects in maxilla. Bone width was evaluated using computerized tomography at day 0 and at day 180 at 2 mm, 4 mm, and 6 mm from the crest. There was a statistically significant increase in bone width between day 0 and day 180 at 2 mm, 4 mm, and 6 mm from the crest. The results of the study demonstrated an increase in bone width of Seibert's class I ridge defects in the maxilla of the study patients.

Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy.

AIMS AND OBJECTIVES: The purpose of this study was to assess the clinical and microbiological effects of a newly developed root-conditioning gel system containing tetracycline and a mixture of tetracycline and citric acid on non-surgical periodontal therapy. MATERIALS AND METHODS: Four anterior teeth from four quadrants with a probing depth of 4-6 mm, in each of the 20 subjects with chronic periodontitis, were subjected to four different modalities of treatment. A total of 80 teeths were divided into four groups of 20 teeth each taken from separate quadrants, on the basis of one of the following four treatments: (1) Root planning alone in first quadrant (RP group); (2) tetracycline-containing gel in the second quadrant (TCG group); (3) root planning plus tetracycline-containing gel in third quadrant (RP + TCG group); (4) root planning plus a mixture of tetracycline and citric acid-containing gel in fourth quadrant (RP + TC-CAG group). Plaque index (PI), sulcular bleeding index, probing pocket depth, and clinical attachment level were measured for 0 day, 8 th week, and 12 th week, respectively. Subgingival plaque samples from each site were collected at the same visits and examined with dark field microscope for proportions of motile rods and spirochetes. RESULTS: From 0 day to 12 th week, PI, sulcular bleeding index, probing pocket depth, and clinical attachment levels decreased significantly in all the groups. From 0 day to 12 th week, RP + TC-CAG group showed a significantly higher change in the PI score. From 0 day to 12 th week, RP group showed a significantly higher change in sulcular bleeding index score. A significant decrease in probing pocket depth and gain in clinical attachment level was noted at 12 th week in RP + TC-CAG group compared to the other groups. A significant decrease in the proportion of motile rods was found primarily in the RP + TC-CAG group. There was a decrease in the proportion of spirochetes in all the groups. CONCLUSION: The results indicated that the use of a mixture of tetracycline and citric acid-containing gel was effective in improving gingival health and in changing subgingival microflora.

An overview of frenal attachments.

Frenal attachments are thin folds of mucous membrane with enclosed muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum. Most often, during the oral examination of the patient the dentist gives very little importance to the frenum, for assessing its morpholology and attachment. However, it has been seen that an abnormal frenum can be an indicator of a syndrome. This paper highlights the different frenal attachments seen in association with various syndromic as well as non-syndromic conditions.

Role of green tea as an antioxidant in periodontal disease: The Asian paradox.

Green tea is a popular beverage nowadays and intake of green tea polyphenols has shown preventive effect against cancer and cardiovascular disease in experimental and epidemiologic studies. Several studies have suggested that green tea catechins, such as epigallocatechin gallate, inhibit periodontal pathogens and reduce the destruction of periodontal tissue. This paper aims to review the role of green tea in inflammatory diseases, especially in periodontal diseases.

Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial.

BACKGROUND: Oil pulling therapy has been used extensively as a traditional Indian folk remedy for many years for strengthening teeth, gums, and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat, and cracked lips. AIMS: The aims of this study were to evaluate the effect of oil pulling with sesame oil on halitosis and the microorganisms that could be responsible for it and to compare its efficacy with chlorhexidine mouthwash. MATERIALS AND METHODS: Group I (oil pulling) and group II (chlorhexidine) included 10 adolescents each. The following parameters were assessed: marginal gingival index, plaque index, organoleptic breath assessment (ORG 1), self-assessment of breath (ORG 2), and BANA test from tongue coating samples on days 0 and 14 of the experimental period. RESULTS: The comparisons of the pre and post therapy values of plaque and modified gingival index score showed a statistically significant difference (P = 0.005 and 0.007, respectively) in group I and II. There was a definite reduction in the ORG 1, ORG 2, scores and BANA test score in both groups I and II. CONCLUSIONS: Oil pulling therapy has been equally effective like chlorhexidine on halitosis and organisms, associated with halitosis.

Mechanism of oil-pulling therapy - in vitro study.

BACKGROUND: Oil pulling has been used extensively as a traditional Indian folk remedy without scientific proof for many years for strengthening teeth, gums and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat and cracked lips. AIM: The aim of this study was to evaluate the antibacterial activity of sesame oil and lignans isolated from sesame oil on oral microorganisms and to check whether saponification or emulsification occurs during oil-pulling therapy. MATERIALS AND METHODS: The in vitro study was carried out in three different phases: (1) Antibacterial activity of the lignans and sesame oil were tested by minimum inhibitory concentration assay by agar dilution method and agar well diffusion method, respectively. (2) Increase in free fatty acid level of oil and the quantity of sodium hydroxide (NaOH) used up in the titration are good indicators of saponification process. This was assessed using analytical tests for vegetable oils. (3) Swished oil was observed under light microscope to assess the status of the oil, presence of microorganisms, oral debris and foreign bodies. RESULTS: Sesamin and sesamolin isolated from sesame oil did not have any antibacterial effect against oral microorganisms like Streptococcus mutans, Streptococcus mitis and Streptococcus viridans. Emulsification of sesame oil occurs during oil-pulling therapy. Increased consumption of NaOH in titration is a definite indication of a possible saponification process. CONCLUSION: The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.

Therapeutic effects of proanthocyanidins on the pathogenesis of periodontitis--an overview.

Periodontitis is a bacterially induced chronic inflammatory disease that destroys the connective tissue and bone that support teeth. Bacteria initiates periodontitis and destruction of the alveolar bone and periodontal connective tissue is clearly observed. But, the events occuring between these two points of time remain obscure and this study focusses on these aspects. The proanthocyanidins (PC) have variable pharmacological and nutraceutical benefits including improvement of ischemic cardiovascular disease, prevention of atherosclerosis and antiarthritic, anticancer and antimicrobial activities. The benefits associated with the antioxidant activity of PC have been evaluated both in vivo and in vitro. But, reports on the ameliorative effects of PC on oral diseases and specifically on periodontitis are very few. Hence, a novel attempt is made to review the possible protective effects of PC and its mechanism of action in periodontitis and also to show whether PC could be developed as a therapeutic agent for periodontitis.

Effect of a volatile smoke component (acrolein) on human gingival fibroblasts: An in vitro study.

AIM: Tobacco and some of its volatile and non-volatile components have been found to affect many types of cells including human gingival fibroblasts. The aim of this present study was to estimate the effect of acrolein, a volatile fraction of cigarette smoke on the attachment, proliferation and ultra structure of human gingival fibroblasts in culture. MATERIALS AND METHODS: Human gingival fibroblasts strains obtained from healthy subjects aged 20-30 years, were grown to confluency and utilized between 3(rd) -6(th) passages. The cell cultures seeded in 96 well microtitration plates at a density of 45,000 cells/well were incubated with acrolein at concentrations of 10(-4), 3×10(-5) and 10(-5) . Attachment ability was evaluated after three hours using Neubauer hemocytometer. For the proliferation assay cell cultures seeded at a density of 10,000 cells/well were incubated at concentrations of 10(-4), 3×10(-5), 10(-5), 3×10(-6), 10(-6) and cell count determined after 5 days using a hemocytometer. Cell morphology was examined under phase contrast microscope. RESULTS: Acrolein produced a dose-dependent cytotoxic effect on human gingival fibroblasts with complete inhibition of attachment and proliferation at higher concentrations. CONCLUSION: This supports the hypothesis that cigarette smoke is a great risk factor in the development and progression of periodontal disease.

Genetic polymorphisms in periodontal diseases: an overview.

Periodontitis is a multi-factorial disease; several risk and susceptibility factors are proposed in its natural history. Genetics is considered a susceptibility factor in relation to periodontitis. This article is a nonsystematic review of literature and focuses on the role of genetic polymorphisms in periodontal diseases.

In vitro studies on inhibitory effect of proanthocyanidins in modulation of neutrophils and macrophages.

The role of proanthocyanidins (PC), a novel flavonoid extracted from grape seeds was studied in vitro in the modulation of neutrophil and macrophage function. We attempted to assess the levels of non-enzymatic and enzymatic mediators in the presence or absence of PC in 4-phorbol-12-beta-myristate-13-acetate (PMA)-stimulated neutrophils isolated from humans and rats, E. coli endotoxin-stimulated macrophages and macrophages isolated from E. coli endotoxin-induced experimental periodontitis in rats. Addition of PC at a concentration of 50 microg/ml effectively blocked the release of reactive oxygen species (ROS) and reactive nitrogen species (RNS) and exhibited a marked inhibition of myeloperoxidase (MPO) and lysosomal enzymes (p<0.001), as compared to PMA-stimulated neutrophils (human and rats) and neutrophils isolated from experimental periodontitis in rats. The levels of ROS, RNS and lysosomal enzymes were found to be elevated (p<0.001) and addition of PC significantly (p<0.001) reduced these levels as compared to those from E. coli endotoxin-stimulatedmacrophages from rats and macrophages isolated from experimental periodontitis in rats (p<0.001). Thus, the study demonstrated that PC decreased the levels of ROS and RNS and also inhibited the MPO and lysosomal enzymes activities in experimental periodontitis in rats. In addition, this study clearly indicated that PC could be developed as an effective antiinflammatory agent.

A new technique for root coverage using buccal fat pad--a short case report.

Gingival recession presents a multifactorial etiology that may be associated with anatomical, physiologic, or pathologic factors. Several surgical techniques are described to manage the gingival recession. The buccal fat pad is a specialized organized fat tissue that maintains its volume and structure over a long period of time. It can also serve as a well-vascularized, readily obtainable local flap for reconstructive purposes as root coverage for severe recession defects, increasing the dimensions of keratinized mucosa. The aim of this case report is to establish a new technique for root coverage using pedicled buccal fat pad in Miller Class III recession on the maxillary right first molar.

Protective effect of proanthocyanidins on endotoxin induced experimental periodontitis in rats.

The pathogenesis of periodontitis involves anaerobic oral bacteria as well as the host response to infection and several drugs have been developed which can curtail these deleterious effects. Proanthocyanidin, a novel flavanoid extracted from grape seeds, has been shown to provide a significant therapeutic effect on endotoxin (Escherichia coli) induced experimental periodontitis in rats. In this study, protective action of different doses of proanthocyanidins was investigated in blood by assaying the reactive oxygen species such as hydrogen peroxide, superoxide anion, myeloperoxidase and lipid peroxides, lysosomal enzyme activities such as cathepsin B, cathepsin D, beta-glucuronidase and acid phosphatase, nonenzymatic antioxidants such as ascorbic acid, alpha-tocopherol, ceruloplasmin, reduced glutathione and antioxidant enzymes such as catalase, superoxide dismutase, glutathione peroxidase and glutathione-s-transferase. Experimental periodontitis rats showed a reduction in body weight and body weight gain could be noticed when they were administered proanthocyanidins. The levels of reactive oxygen species and lysosomal enzymes were found to increase whereas antioxidant levels were decreased significantly in experimental periodontitis. Proanthocyanidins at an effective dose of 30 mg/kg body weight, sc, for 30 days effected a decrease in serum reactive oxygen species, lipid peroxides, lysosomal enzymes, acute phase proteins and an increase in antioxidant levels. Histopathological evidence of experimental periodontitis showed cellular infiltration of inflammatory cells while proanthocyanidin treated groups demonstrated only scattered inflammatory cells and blood vessels. Thus, the results showed that dietary supplementation of proanthocyanidin enhanced the host resistance as well as the inhibition of the biological and mechanical irritants involved in the onset of gingivitis and the progression of periodontal disease.

Effect of oil pulling on plaque induced gingivitis: a randomized, controlled, triple-blind study.

BACKGROUND: Oil pulling has been used extensively as a traditional Indian folk remedy for many years for strengthening teeth, gums, and the jaw and to prevent decay, oral malodor, bleeding gums, dryness of the throat, and cracked lips. AIMS: The aim of this study was to evaluate the effect of oil pulling with sesame oil on plaque-induced gingivitis and to compare its efficacy with chlorhexidine mouthwash. MATERIALS AND METHODS: A total of 20 age-matched adolescent boys with plaque-induced gingivitis were selected for this study. They were divided randomly into the study or oil pulling group (Group I) and the control or chlorhexidine group (Group II) with 10 subjects in each group. Plaque index and modified gingival index scores were recorded for the 20 subjects and baseline plaque samples were also collected. The plaque samples were used to identify the microorganisms and to measure the total colony count of the aerobic microorganisms present. The study group was subjected to oil pulling with sesame oil and the control group was given chlorhexidine mouthwash everyday in the morning before brushing. Reassessment of the index scores and collection of plaque for measuring the colony count of the aerobic microorganisms was done after 10 days. RESULTS: There was a statistically significant reduction of the pre- and post-values of the plaque and modified gingival index scores in both the study and control groups (P < 0.001 in both). There was a considerable reduction in the total colony count of aerobic microorganisms present in both the groups. CONCLUSION: The oil pulling therapy showed a reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis.

Evaluation of C-reactive protein and interleukin-6 in the peripheral blood of patients with chronic periodontitis.

AIMS AND OBJECTIVES: The aim of the present study was to investigate systemic levels of inflammatory markers of cardiovascular diseases like C-reactive protein and interleukin-6 in patients with chronic periodontitis, in comparison to periodontally healthy individuals. MATERIALS AND METHODS: A total of 42 individuals, both males and females above the age of 30 years, were included in the study. Healthy controls (Group I, n = 14), chronic localized periodontitis (Group II, n = 14), and chronic generalized periodontitis (Group III, n = 14), all without any medical disorder, were recruited. Peripheral blood samples were taken and C-reactive protein (CRP) levels were estimated in the serum samples by using the Particle-Enhanced Turbidimetric Immunoassay (PETIA) technique. Serum samples of Interleukin-6 (IL-6) were assayed by using the Chemiluminescent Immunoassay (IMMULITE) technique. RESULTS: When mean CRP levels were compared between the groups, group III showed statistical significance when compared to group I (P = 0.04). Group III had a higher median IL-6 level (6.35 pg/mL) than Group II (< 5.0 pg/mL) and group I (< 5.0 pg/mL). Differences in median values of IL-6 were not statistically significant in any group (P = 0.29). CONCLUSION: Periodontitis results in higher systemic levels of CRP and IL-6. These elevated inflammatory factors may increase inflammatory activity in atherosclerotic lesions and potentially increasing the risk for cardiovascular events.

Effect of a controlled release device containing minocycline microspheres on the treatment of chronic periodontitis: A comparative study.

INTRODUCTION: Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes. The aim of this study was to evaluate the efficacy and safety of locally administered minocycline microspheres (Arestin) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A total of 60 sites from 15 patients in the age group of 35-50 years, who had periodontal pockets measuring 5-8 mm and had been diagnosed with chronic periodontitis, were selected for the study. The selected groups were randomly assigned to either the control group (group A) or the treatment/test group (group B). Only scaling and root planing were done at the base line visit for the control sites followed by local application of Arestin (1 mg). Clinical parameters such as plaque index, gingival index, and gingival bleeding index were recorded at baseline, day 30, day 90, and day 180 in the selected sites of both the groups. Probing pocket depth also was recorded at baseline, day 90, and day 180 for both the groups. RESULTS: A statistically significant reduction was observed in both groups. Group B showed better results than Group A and these differences were statistically significant. CONCLUSION: The results of this study clearly indicate that treatment with scaling and root planing plus minocycline microspheres (Arestin) is more effective and safer than scaling and root planing alone in reducing the signs of chronic periodontitis.

Soft tissue preservation and crestal bone loss around single-tooth implants.

Maintenance of interdental soft tissue and the need for esthetics are being increasingly recognized as important criteria for implant success. Statistically significant correlations have been found between the incidence of implant failure and vertical bone loss adjacent to implants. Thus, it is widely recognized that peri-implant bone resorption before loading may compromise implant success. This study aims to evaluate the effect of flap elevation on peri-implant bone loss during the healing period. Twenty sites around 10 implants were included in the study, and the effect of 2 different flap designs on the crestal height of bone was evaluated. The results of the study have shown that flap elevation can lead to increased bone loss during the healing period, with statistically significant results up to the 90-day period.

Subepithelial connective tissue grafts for the coverage of denuded root surfaces: a clinical report.

AIMS AND OBJECTIVES: The aim of this study is to determine the effectiveness of subepithelial connective tissue grafts (SCTG) in the coverage of denuded roots. MATERIALS AND METHODS: A total of 16 sites with > or =2 mm of recession height were included in the study for treatment with SCTG. The clinical parameters, such as recession height, recession width, width of keratinized gingiva, probing pocket depth, and clinical attachment level were measured at the baseline, third month, and at the end of the study [sixth month]. The defects were treated with a coronally positioned pedicle graft combined with connective tissue graft. RESULTS: Out of 16 sites treated with SCTG, 11 sites showed complete (100%) root coverage; the mean root coverage obtained was 87.5%. There was a statistically significant reduction in recession height, recession width, and probing pocket depth. There was also a statistically significant increase in the width of keratinized gingiva and also a gain in clinical attachment level. The postoperative results were both clinically and statistically significant ( P 0.05). CONCLUSION: From this study, it may be concluded that SCTG is a safe and effective method for the coverage of denuded roots.

Effect of three commercial mouth rinses on cultured human gingival fibroblast: an in vitro study.

AIM: To examine the effect of three commercial mouth rinses (Hexidine 0.2%, Listerine Cool Mint, Betadine 1%) upon cultured human gingival fibroblast proliferation. MATERIALS AND METHODS: Human gingival fibroblasts were cultured and incubated in Dulbecco's Minimum Eagle's Medium containing Chlorhexidine, Listerine, Povidone-Iodine at varying concentrations (1%, 2%, 5%, 10%, 20% and 100% of the given solution) at 37 degrees C for 1, 5 and 15 min. Control cells received an equal volume of Dulbecco's Minimum Eagle's Medium without adding mouth rinses, for similar duration of exposure at 37 degrees C. Following incubation the media were removed, cells were washed twice with medium, supplemented with 10% Fetal Bovine Serum, and fibroblasts in the test and control group were allowed to recover in the same media for 24 h. RESULTS: In all the three groups, the proliferation inhibition was dependent on the concentration of solublized mouth rinses in the cell culture but independent of the duration of exposure to all three mouth rinses. The results showed that all three solutions were toxic to cultured human gingival fibroblasts, Chlorhexidine being the most cytotoxic. It was seen that at dilute concentrations (1% and 2% of given solutions) Listerine was more cytotoxic than Chlorhexidine and Povidone-Iodine. CONCLUSION: These results suggest that Chlorhexidine, Listerine and Povidone-Iodine are capable of inducing a dose-dependent reduction in cellular proliferation of fibroblasts. The results presented are interesting, but to know the clinical significance, further studies are needed.