Using a Composite Graft of Natural 15% Chitosan Gel in the Management of Intrabony Defects: A Case Series.

INTRODUCTION: The purpose of this study was to compare effects of smoking and smokeless forms of tobacco consumption (tobacco chewing) on periodontal disease parameters and response of these subjects to non-surgical periodontal therapy. MATERIALS AND METHODS: Ten patients aged between 30 and 55 years with intrabony defects greater than or equal to 3 mm and pocket probing depth (PPD) greater than or equal to 5 mm were selected. All participants received chitosan gel (15% w/v) plus bovine porous bone mineral as a composite bone graft. Clinical and radiographic measurements were recorded at baseline, 3 months after healing and at 6 and 9 months. Significance was set at 0.05. RESULTS: After nine months, all the defects treated with this combination showed PPD reduction of 5.30 ± 0.822 mm, relative clinical attachment level (CAL) gain of 5.80 ± 0.499 mm, reduction in intrabony defect (IBD) depth of 3.00 ± 0.497 mm and defect resolution of 78.32 ± 5.80 %, all of which were statistically significant. CONCLUSION: Within the limits of this study, this case series study suggests that chitosan gel, along with bovine porous bone mineral, has a promising role to play in periodontal regeneration.

Repositioning of a pathologically migrated tooth using autologous platelet-rich plasma: a case report with 3-year follow-up.

An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.

The versatile subepithelial connective tissue graft: a literature update.

Harmony between hard and soft tissue morphologies is essential for form, function, and a good esthetic outlook. Replacement grafts for correction of soft tissue defects around the teeth have become important to periodontal plastic and implant surgical procedures. Among a multitude of surgical techniques and graft materials reported in literature, the subepithelial connective tissue graft (SCTG) has gained wide popularity and acceptance. The purpose of this article is to acquaint clinicians with the current understanding of the versatile SCTG. Key factors associated with graft harvesting as well as applications, limitations, and complications of SCTGs are discussed. This connective tissue has shown excellent short- and long-term stability, is easily available, and is economical to use. The SCTG should be considered as an alternative in all periodontal reconstruction surgeries.

The Autosomal Dominant Inheritance of Hereditary Gingival Fibromatosis: A Case Report.

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by progressive and varying degrees of gingival overgrowth. Oral manifestations vary from minimal to generalized enlargement, and HGF may occur as an isolated disorder or a feature of a syndrome. Unaesthetic appearance and functional impairment due to excessive gingival tissue dictate the need for surgical intervention. This article describes a family with three generations afflicted with a non-syndromic form of HGF with distinctive clinical, histological characteristics. Further, it highlights the need for genetic analysis and appropriate surgical technique to manage gingival enlargement and avoid recurrence.

Gingival crevicular fluid and interleukin-23 concentration in systemically healthy subjects: their relationship in periodontal health and disease.

BACKGROUND AND OBJECTIVE: There is a substantial magnitude of data implicating the role of interleukin-23 (IL-23) in the initiation and progression of periodontal disease. The main aim of this study was to evaluate the levels of IL-23 in the gingival crevicular fluid of systemically healthy subjects in periodontal health and disease. In addition, we explored the effectiveness of periodontal interventional therapy on the levels of IL-23 in subjects with chronic periodontitis to obtain a deeper insight into the possible role of IL-23 in three separate periodontal conditions in three different populations. MATERIAL AND METHODS: In this study, 54 individuals, satisfying the study inclusion and exclusion criteria, were recruited. They were categorically divided, on the basis of gingival index, probing pocket depth and relative attachment loss, into three groups: Group 1 (patients with a clinically healthy periodontium, n = 18); Group 2 (patients with gingivitis, n = 18); and Group 3a (patients with chronic periodontitis, n = 18). Samples taken from all 18 subjects of Group 3a, 3 mo after the initial therapy, constituted Group 3b. All clinical parameters were recorded at baseline and 3 mo after scaling and root planing. Gingival crevicular fluid samples were obtained in which the IL-23 concentration was measured using ELISA. RESULTS: The highest mean IL-23 concentration in gingival crevicular fluid was found for Group 3a (16448.69 pg/mL) and the lowest for Group 1 (2565.28 pg/mL). The mean IL-23 concentrations in Group 2 (5425 pg/mL) and Group 3b (6272.22 pg/mL) lay between the maximum and minimum values. This implies a positive correlation between the gingival crevicular fluid IL-23 concentration and relative attachment loss (p < 0.05). CONCLUSION: A noteworthy increase in the gingival crevicular fluid IL-23 concentration was seen that was proportional to the amount of periodontal tissue damage. As the IL-23 concentration in gingival crevicular fluid is directly proportional to the severity of the periodontal affliction, it can be speculated that IL-23 has a possible role in the pathogenesis of periodontal disease.

Alveolar ridge augmentation--a case series.

This study presents case reports of patients with osseous defects who were treated with autogenous bone grafts from the symphysis region, alloplast grafts with barrier membrane, and the use of free gingival onlay grafts for alveolar ridge augmentation. The patients were followed for a period of six months.

Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: a subject-blind randomised clinical study.

PURPOSE: Dentine hypersensitivity is one of the most frequently recorded complaints of dental discomfort. Current evidence implicates patent dentinal tubules in hypersensitive dentine, and it follows that one effective way to reduce dentine sensitivity is to occlude the dentinal tubules. The purpose of this study was to compare the efficacy of two different desensitising agents, Cervitec varnish and Gluma varnish. MATERIALS AND METHODS: Two hundred fifty patients self-reporting dentine hypersensitivity completed the paired split mouth randomised, subject-blind study. Each participant had a minimum of two sensitive teeth in at least two different quadrants and displaying a response of ≥3 cm to an evaporative stimulus. The hypersensitivity levels were measured with a tactile stimulus (scratchometer), thermal stimulus (cold water test), and an evaporative stimulus (air blast test) using a visual analogue scale. The teeth were evaluated immediately after treatment, and at 4 and 12 weeks after application of the chlorhexidine-containing varnish Cervitec and the glutaraldehyde-containing varnish, Gluma Desensitizer. RESULTS: Statistical analysis indicated that both the desensitising varnishes were effective in alleviating dentine hypersensitivity at all time intervals compared to baseline. There was a highly statistically significantly greater reduction in dentine hypersensitivity to evaporative stimulus, cold stimulus, and tactile stimulus after application of Cervitec than after Gluma Desensitizer (P < 0.001). CONCLUSION: Both the varnishes have a therapeutic potential to alleviate dentine hypersensitivity at all time intervals compared to baseline. However, Cervitec varnish is more efficacious in reducing dentine hypersensitivity than Gluma varnish at both 4 weeks and 12 weeks post-treatment.

Leptin levels in gingival crevicular fluid in periodontal health and disease.

BACKGROUND AND OBJECTIVE: A high concentration of leptin is associated with healthy gingival tissue, and the concentration of leptin decreases as periodontal disease progresses. However, to date, the leptin concentration in gingival crevicular fluid has not been documented. Hence, the present study was carried out to explore the presence of leptin in gingival crevicular fluid in periodontal health and disease, and to probe further into its possible role in periodontal disease progression. MATERIAL AND METHODS: A total of 45 adult patients were selected, based on their body mass index, for the study. They were categorized into three groups of 15 patients each, based on their periodontal tissue status, as follows: group I (clinically healthy gingiva with no loss of attachment); group II (chronic gingivitis with no loss of attachment); and group III (chronic periodontitis). Gingival crevicular fluid samples of 1 microL were collected extracrevicularly using white color-coded 1-5 microL calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available enzyme-linked immunosorbent assay kit. RESULTS: The concentration of leptin in gingival crevicular fluid of patients in group I (2292.69 pg/mL) was statistically higher (p < 0.05) than in those of groups II (1409.95 pg/mL) and III (1071.89 pg/mL). This suggests a negative correlation of gingival crevicular fluid leptin concentration with clinical attachment loss (p < 0.05). CONCLUSION: As periodontal tissue destruction increased, there was a substantial decrease in gingival crevicular fluid leptin concentration. This observation extends our knowledge of the protective role of leptin in periodontal health.

Gingival crevicular fluid and serum leptin: their relationship to periodontal health and disease.

BACKGROUND & AIMS: Leptin is a pleiotrophic hormone produced by adipose tissue and it plays an important role in protection of the host from inflammation and infection. The purpose of this study is to determine the presence of leptin in gingival crevicular fluid (GCF) and serum samples and to find out their association, if any. METHODS: Forty two subjects were selected based on their body mass index and were divided into three groups of 14 each; healthy (Group I), chronic gingivitis (Group II) and chronic periodontitis (Group III). GCF samples (by microcapillary pipettes) and serum samples (by venipuncture) were collected to estimate the levels of leptin using enzyme linked immunosorbent assay kit. RESULTS: The highest mean leptin concentration in GCF was obtained for Group I (2658 pg/ml) and the least for Group III (1312 pg/ml). In contrast, the lowest serum leptin concentration was obtained for the Group I (8783 pg/ml), and the highest for Group III (12082 pg/ml). This suggests a negative correlation of GCF leptin concentration and a positive correlation of serum leptin concentration as the clinical attachment level progresses (p<0.05). CONCLUSION: These results suggest that greater the periodontal destruction, lesser is the GCF leptin concentration and greater the serum leptin concentration.

Primary tuberculosis clinically presenting as gingival enlargement: a case report.

Tuberculosis is a chronic systemic granulomatous disease which rarely affects the oral cavity. Oral lesions can be either primary or secondary to systemic tuberculosis, the former being rare. This is a never-before reported case of primary tuberculosis presenting as a localized diffuse gingival enlargement in an 11-year-old Indian female patient. The diagnosis was reached through identification of positive histopathological features, Tuberculin test results, presence of anti-tubercular antibodies confirmed by a polymerase chain reaction. In view of the recent increase in the incidence of tuberculosis and the prevalence of the same, it is reasonable to include tuberculosis in the differential diagnosis of gingival enlargements. This is essential to avoid any serious complications for both the clinician and patient due to a delay in the diagnosis of such a rare but plausible oral condition.

Gene therapy in periodontics: a review and future implications.

New advancements in gene therapy continue to have a significant impact on dentistry since 1995. At the same time, periodontal disease has attracted the attention of scholars and research scientists as a global concern. With a better understanding of disease progression and new advancement in biological science, gene therapy has emerged to enhance existing therapy and has radically recast approaches to the management of periodontal disease. Since the advent of gene therapy in dentistry, significant progress has been made to control periodontal disease and reconstruct the dentoalveolar apparatus. However, to date, gene therapy methods have not been developed to control periodontal disease due to its multifactorial origin, complex genetic predisposition, and risk associated with it. This review article provides a brief insight into the ever-expanding field of gene therapy and its possible future implication in the field of periodontics. Most of the modalities described in this article are more theoretical and still in infancy stage except for genetically fabricated materials used for regenerative purposes.

Peri-implant papilla reconstruction: realities and limitations.

In recent years, esthetic demands in dentistry have been climbing ever higher, driven by an enhanced awareness of beauty and physical appearance. Because gingival esthetics has become an important factor in the overall success of most implant-supported restorations, the loss of the peri-implant papilla leads to an esthetic handicap known as black hole disease. Today, one of the most challenging aspects of periodontal reconstructive surgery is to obtain a predictable peri-implant papilla in the esthetic zone. Starting with the facts about the morphology of the peri-implant tissues, to the various parameters influencing papilla reconstruction around implants, this article gives a brief overview of various papilla preservation and reconstruction techniques around implants.

Plasma cell granuloma of gingiva.

An exceedingly rare case of gingival plasma cell granuloma is reported in a 40-year old female patient. The case presented as an exophytic mass of gingiva, clinically resembling traumatic fibroma. Histopathologic findings revealed dense sheets of plasma cells infiltrate. Immunohistochemistry for kappa and lambda light chains showed polyclonal (benign) staining pattern confirming a diagnosis of plasma cell granuloma. It is important to recognise this peculiar lesion because of its highly unusual incidence in involving the periodontium. Clinical features are usually suggestive of traumatic fibroma (benign) but histopathologicaly in early stages it closely resembles plasmacytoma (malignant). This case highlights the need to biopsy unusual lesions to rule out potential neoplasms and also emphasizes the need to submit all the excised tissue for histological examination regardless of clinical impression and/or perceived surgical success. Only by such practice can rare lesion of this type be diagnosed and their incidence studied.

Tissue engineering: prospect for regenerating periodontal tissues.

New advancements in technological fields, continually has had a major impact on dental practice. The emergence of tissue engineering and biomimetic concepts has enhanced the predictability of existing therapy and also has radically recast approaches towards the dentoalveolar reconstruction. Tissue engineering in the simplest sense is a combination of material sciences and biology to repair tissues and organs which will unquestionably offer an exciting therapeutic alternative that have never been available before. This article is a brief introduction to the ever expanding field of tissue engineering and its possible implication in periodontal regeneration.