Comparative Evaluation of Sclerostin Levels in Gingival Crevicular Fluid in the Treatment of Chronic Periodontitis Patients Using Diode Laser as an Adjunct to Scaling and Root Planing: A Clinico-biochemical Study.

AIMS: Sclerostin is an inhibitor of bone formation, and laser irradiation enhances osteoblast proliferation. The objective of this study was to assess and compare the gingival crevicular fluid (GCF) sclerostin level and clinical parameters of chronic periodontitis patients following the application of diode laser (810 nm) as an adjunct to scaling and root planing (SRP). SUBJECTS AND METHODS: Fifteen systemically healthy chronic periodontitis patients (age 35-55 years) with probing pocket depth ≥5mm were included in this split-mouth study. SRP and pocket irradiation with diode laser were done in the test group and SRP alone in the control group at baseline. Low-level laser therapy application and saline irrigation were done in both the groups, respectively, in the 2nd and 3rd visits. Two microliters of GCF samples was collected from both the groups at baseline before treatment and on the 90th day for the assessment of sclerostin concentration. RESULTS: This study showed a statistically significant reduction of clinical parameters in the test and control groups at the end of 3 months. Both the groups showed a statistically significant reduction of sclerostin levels in GCF after 3 months, in which the test group (125.80 ± 28.21 to 82.80 ± 9.31) showed a highly significant reduction (P = 0.000). CONCLUSIONS: The adjunctive use of laser had shown a beneficial effect in terms of clinical parameters and osteoblast proliferation by the reduction in the levels of sclerostin in GCF. From the observations of this study, it can be concluded that the therapeutic effectiveness of diode laser as an adjunct to SRP is having a beneficial effect and sclerostin can be used as a potent biomarker.

Laser-Assisted Depigmentation-An Introspection of the Science, Techniques, and Perceptions.

BACKGROUND: Gingival hyperpigmentation is a major concern for a significant number of patients, as a relevant aesthetic or cosmetic need. Oral melanin pigmentation is considered to be multifactorial and could be related to physiological or even pathological reasons and can be the consequence of a variety of local or systemic factors. This pigmentation varies individually across races or age groups and is without any gender predilection. Evidence gleaned from literature is presented from case-control studies and from the authors' own research work in prospective, split-mouth, double-blinded, clinical trials comparing treatment modalities in effecting depigmentation. METHODS: A systematic review of published articles, using suitable assay criteria, was carried out to formulate a consensus on laser-assisted modalities. A total of 295 published sources were subject to critical analysis and resulted in six papers that were subject to data scrutiny. Additionally, evidence is presented on clinical protocols and treatment outcomes. RESULTS: Analysis of randomized clinical studies identified the use of two laser wavelength groups-near infrared diode and erbium group of mid-infrared lasers. Several areas of analysis were examined, and inconsistent degrees of significance were obtained to establish which laser group was optimal and if they were any better than scalpel depigmentation. CONCLUSION: A definitive conclusion is wanting as studies with scientific and standardized protocols of evaluation are yet to provide a take on comparative assessments between different techniques of depigmentation.

Low-level laser therapy: A novel therapeutic approach to temporomandibular disorder - A randomized, double-blinded, placebo-controlled trial.

AIMS AND OBJECTIVE: The objective of this study was to assess the effectiveness of low-level laser therapy (LLLT)/low intensity laser therapy (LILT) in the management of temporomandibular joint (TMJ) pain in a random and double-blind research design. MATERIALS AND METHODS: TMJ pain patients, randomly assigned into two groups: Group 1 (n = 20) and Group 2 (n = 20), received 2-3 treatments per week for 8 sessions of active LILT with diode laser (gallium aluminum arsenide, 810 nm, 0.1 W). Measures of TMJ pain during function were evaluated at baseline, after completion of 8 sessions of laser treatment, and 30 days after the final laser therapy. RESULTS: At the final treatment point, within-group, pain reduction was observed in both active LLLT and placebo groups at day 0 (P = 0.000), 8th session (P = 0.000), and 1 month (P = 0.001). Between the groups, there is no significant difference at day 0 (P = 0.214), 8th session (P = 0.806), and 1 month (P = 0.230). Significant increased mouth opening was observed in both Group 1 and Group 2 (P = 0.006 and P = 0.021, respectively) after treatment. However, no significant difference was found between the two groups (P = 0.330). Furthermore, significant improvement in clicking was recorded before and after treatment both in Group 1 (P = 0.000) and Group 2 (P = 0.001). CONCLUSION: The study suggests that LLLT is not better than placebo at reducing TMJ pain during function. It may be assumed that a more tailored application of LLLT should be developed to take into account the multifactorial aspect of the disorder.

Comparison of the efficacy of chlorhexidine varnish and chip in the treatment of chronic periodontitis.

BACKGROUND: The purpose of this study was to clinically evaluate the benefits of sub gingival chlorhexidine (CHX) varnish and biodegradable CHX chip application used as an adjunct to scaling and root planning (SRP) as combined therapy and also to compare the effect of combined therapy with SRP alone. MATERIALS AND METHODS: Fifteen patients with at least three sites with a probing pocket depth (PPD) of 5-8 mm were considered. Following baseline evaluation, all three sites were subjected for SRP. After completing SRP, each site was randomly subjected for CHX varnish, CHX chip application and the 3(rd) site was left without any medication as a control. Clinical parameters such as sulcus bleeding index, plaque index, bleeding on probing (BOP), PPD, and clinical attachment level (CAL) were recorded at baseline, 1 month and 3 months post-operatively. RESULTS: All three groups presented with an improvement in clinical parameters compared to baseline. The mean reduction in PPD was 2.4 mm in SRP sites, 2.5 mm in SRP + CHX varnish sites and 2.8 mm in SRP + CHX chip sites. The mean gain in CAL was 2.4 mm in SRP sites, 2.3 mm in SRP + CHX varnish sites and 2.8 mm SRP + CHX chip sites. INTERPRETATION AND CONCLUSION: The present study indicated that application of CHX varnish and placement of CHX chip as an adjunct to SRP produced a clinically significant reduction in the PPD, BOP and a gain in CAL at 30(th) day and 90(th) day from baseline when compared to SRP alone. The results though were not statistically significant.

Modified semilunar coronally advanced flap: A case series.

Dentists traditionally think of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. The goal of gingival esthetics is to maintain normal healthy gingival appearance around teeth that must be restored. Gingival recession represents a significant concern for patients and a therapeutic problem for the clinician. Root coverage is the goal of periodontal plastic surgery when treating gingival recessions in the esthetic zone. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures have been described each demonstrating a variable degree of success. This case report presents to you the treatment outcomes and predictability of modified semilunar coronally advanced flap (Kamran Haghighat) techniques described for the treatment of recession defects on single and multiple adjacent teeth, respectively.

Comparative evaluation of oxygen saturation levels using pulse oxymeter during nonsurgical and surgical periodontal therapy in chronic periodontitis patients.

BACKGROUND AND AIM: Monitoring is the global method of observation and data recording in relation to body organ and system function that afford constant information to ensure continuous evalutation of the patient's physical condition. Basic monitoring provides essential information for assessing the vital signs, both circulatory and respiratory, and fundamentally comprises the control of blood pressure (BP) and heart rate (HR) and rhythm. Pulse oxymetry is used to record HR and oxygen saturation. The objective of the study was to assess and compare hemodynamic changes by monitoring oxygen saturation level changes during periodontal surgical and nonsurgical therapy. MATERIALS AND METHODS: A cross-sectional observational study was conducted in 30 chronic periodontitis patients. Patients were divided into two groups; Group A consisted of 15 patients undergoing surgical periodontal therapy, Group B consisted of 15 patients undergoing nonsurgical periodontal therapy. The hemodynamic changes were evaluated by monitoring HR and oxygen saturation level using pulse oxymeter (SaO2). HR and SaO2 were monitored continuously and registered pre-operatively, i.e. 10 minutes before the procedure, intra-operatively and postoperatively, i.e. 10 minutes after the procedure. One-way analysis of variance test (ANOVA) was performed for data analysis. RESULTS: Both the groups showed a slight fall in oxygen saturation levels intraoperatively, but within the normal range. More decrease in oxygen saturation levels was observed in nonsurgical periodontal therapy as compared to surgical periodontal therapy at intraoperative levels. The differences in the values were statistically significant. There was no statistical difference seen in the postoperative and preoperative values. CONCLUSION: Most of the hemodynamic changes induced during the periodontal therapy were within normal limits, taking into consideration the anxiety and stress produced by the surgical intervention. The hemodynamic change was more in nonsurgical as compared to surgical periodontal therapy.

A study to assess and compare the peripheral blood neutrophil chemotaxis in smokers and non smokers with healthy periodontium, gingivitis, and chronic periodontitis.

BACKGROUND: Chronic periodontitis is the inflammation within the supporting tissues of the teeth resulting in attachment loss and bone loss. There are certain environmental factors such as smoking that can modify the host response to plaque organisms; hence can account for the aggressive progression of the disease. Smokers show a decreased expression of clinical inflammation even in the presence of abundant plaque accumulation. Neutrophils are the predominant host defense cells which protect the periodontal tissues from plaque organisms, deficiencies of neutrophil function, such as chemotaxis and phagocytosis, often result in increased susceptibility to periodontitis. Smoking can induce alteration in the neutrophil function; therefore, it is of importance to know the changes caused by smoking on neutrophil chemotaxis. This study will provide an essential basis for evaluating the role of nicotine in pathogenesis of periodontal disease by assessing the neutrophil activity. MATERIALS AND METHODS: A total of 60 smokers and 60 non smokers were examined for this study. Both the groups included 20 subjects with gingivitis, periodontitis, and healthy periodontium. The periodontal status of the study subjects were assessed by gingival index, Russels periodontal index, sulcus bleeding index, and clinical attachment level. The blood sample was taken from each individual for the chemotactic analysis using agarose method. RESULTS: In this study, there was a significant decrease in the neutrophil chemotaxis in smokers with gingivitis, periodontitis, and healthy periodontium, compared to non smokers with similar findings. CONCLUSION: Delayed neutrophil chemotaxis was found in smokers compared to non smokers with same periodontal status.

Efficacy of dexamethasone pulse therapy in progressive systemic sclerosis.

BACKGROUND: Systemic sclerosis is a disease of unknown etiology for which no specific treatment is effective. Pulse therapy with corticosteroids has been tried for various autoimmune disorders with minimal side effects. We undertook this study to determine the efficacy of dexamethasone pulse therapy in progressive systemic sclerosis (PSS). METHODS: Five women with PSS between the ages 30 and 60 years, received 100 mg dexamethasone in 500 mL of 5% dextrose by slow intravenous infusion over 3 hours for 3 consecutive days, once a month. RESULTS: All patients had symptomatic and clinical improvement. The vital capacity improved in three and posttreatment histopathologic regression was seen in two patients. CONCLUSIONS: Dexamethasone pulse therapy may provide an additional option for treating systemic sclerosis.

Discovery of short, 3'-cholesterol-modified DNA duplexes with unique antitumor cell activity.

A new class of modified oligodeoxynucleotides with unique, selective cytotoxic properties has been discovered. Self-complementary, 3'-cholesterol-modified oligodeoxynucleotides caused morphology changes and death in certain cancer cell lines, whereas other cell lines were unaffected. Susceptible cells were killed in a dose-dependent manner at submicromolar concentrations. Optimum potency was exhibited by phosphodiester duplexes approximately 10 base pairs in length, and base composition was important only in the context of duplex stability. Phosphorothioate analogues were less potent. Although the molecular mechanism of action of these unique compounds is not yet known, they offer potential applications in cancer therapy and in studies of cell death. In addition, the path toward elucidation of the structure-based biological activity of these oligonucleotides should be especially instructive for researchers studying sequence-specific effects.