Periodontal Approaches to Esthetic Dentistry: A Review on Current Trends.

AIM: Thepresent review is to discuss the current trends in periodontal approaches for improving the esthetics in dentistry. BACKGROUND: Esthetics is an essential component of today's dental care. A growing awareness of esthetics has fueled an increase in esthetic demand in dentistry in recent years. The ultimate goal in modern dentistry is to attain "white and pink esthetics" in the esthetically important zone Review results: Current evidence-based periodontal approaches for improving esthetic dentistry are discussed. The periodontal management of esthetics is mainly focused on proper assessment of the case scenario including the associated mucogingival deformities and selection of a proper technique for the correction of the same. CLINICAL SIGNIFICANCE: There is drastic increase in esthetic demand for the dental procedures in recent years. With the evolution of innovative techniques, clinicians can fulfill the patient's esthetic demands. Thus it is important to be updated in this field about the current innovative approaches. CONCLUSION: Newer procedures are being developed all the time and are gradually being integrated into periodontal practice. The practitioner should be mindful that novel approaches are sometimes presented without appropriate clinical research. Our ongoing progress toward better therapeutic approaches should be guided by critical analysis of freshly offered methodologies.

Assessment of membrane-organizing extension spike protein as a biomarker for periodontal disease by comparing its level in gingival crevicular fluid in individuals with and without chronic severe periodontitis - A pilot study.

BACKGROUND: Membrane-organizing extension spike protein (Moesin) is a cytoskeletal protein expressed in the gingival crevicular fluid (GCF) which may play a role in the immune response in periodontal disease. The objective of this study was to evaluate whether Moesin can be used as a biomarker for periodontal disease. MATERIALS AND METHODS: Thirty patients satisfying the required inclusion criteria were selected from those reporting to the out patient (OP) of the department of periodontics and divided into two groups: Group A - systemically healthy controls with no periodontitis and Group B - systemically healthy controls with chronic severe periodontitis. Periodontal parameters were recorded. GCF was collected, and Moesin levels in the two groups were assessed using enzyme-linked immunosorbent assay. Scaling and root planing (SRP) was done in Group B patients who were reviewed, and samples were collected again after 4 weeks and analyzed. RESULTS: At baseline, the mean GCF Moesin level in Group A was 666.95 ± 471.872 pg/ml, while in Group B, it was found to be 27435.35 ± 14179.77 pg/ml, which showed a high statistically significant difference on comparison. The mean GCF Moesin level in patients with chronic severe periodontitis was 27435.35 ± 14179.77 pg/ml at baseline, and on review 1 month after SRP, it was found to have undergone a statistically significant reduction to 27161.23 ± 14161.57 pg/ml (P = 0.001). CONCLUSION: Within the limits of this study, it can be concluded that Moesin can serve as a potential biomarker for periodontal disease.

Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala.

BACKGROUND: The aim of this cross-sectional study was to evaluate the association between stress, salivary cortisol, and periodontitis among the inmates of the central prison. MATERIALS AND METHODS: Seventy inmates were grouped depending on their pocket depth into Group A (pocket depth >4 mm and <6 mm), Group B (at least four sites with pocket depth ≥6 mm), and Group C (pocket depth ≤3 mm). The clinical parameters such as the oral hygiene index-simplified, gingival index, pocket depth, and the clinical attachment levels (CALs) were recorded. Stress was measured using the Depression, Anxiety, and Stress Scale along with prison time served. Saliva samples were collected, and cortisol levels were determined using electrochemiluminescence assay. Chi-square test was used for finding the association between the clinical parameters. The correlation between clinical parameters, stress, salivary cortisol levels, and time served was done using Pearson's rank correlation coefficient. RESULTS: The CALs, the stress score and the salivary cortisol levels were significantly higher in Group B (P < 0.001). Pearson's correlation showed a positive correlation between stress, cortisol level, and pocket depth. A positive correlation which was statistically significant was obtained between salivary cortisol level and prison time served by the inmates. CONCLUSION: Within the limits of this study, it can be concluded that there is a positive relation between stress and periodontal disease. The study suggests that salivary cortisol level can be used as a marker to assess stress.

Comparison of the efficacy of subgingival irrigation with 2% povidone-iodine and tetracycline HCl in subjects with chronic moderate periodontitis: A clinico microbiological study.

BACKGROUND: This study was performed to evaluate and compare the clinical and antimicrobial efficacy of subgingival irrigation with tetracycline and povidone-iodine as an adjunct to nonsurgical periodontal therapy. MATERIALS AND METHODS: Twenty subjects with chronic moderate periodontitis were recruited in this split-mouth study with probing pocket depth of >3 and ≤5 mm and clinical attachment loss of 3-4 mm in relation to 16, 36, and 46. In each subject, three selected periodontal pockets were assigned to receive one out of three irrigants (1) sterile water (control) in 16; (2) tetracycline at 10 mg/ml in 36; (3) 2% povidone-iodine in 46, and these sites were designated as Group A, Group B, and Group C, respectively. Plaque score, gingival score, pocket probing depth, and clinical attachment level were evaluated before treatment and at 1 and 3 months posttreatment. Multiplex polymerase chain reaction was used to detect Porphyromonas gingivalis and Tannerella forsythensis which have been implicated as the major risk factors for periodontal disease. Subgingival plaque collected before treatment and at 1 and 3 months posttreatment. Data were analysed using ANOVA and repeated measure ANOVA. Results were considered significant if P < 0.05. RESULTS: Clinical and microbiological parameters were reduced posttreatment, the reduction being significantly higher in Group B compared to Group C. CONCLUSION: It can be concluded that chemical and mechanical therapies were of slight benefit in the treatment of chronic moderate periodontitis, and there was an adjunctive effect of significance when scaling and root planing was combined with a single subgingival irrigation with tetracycline or povidone-iodine in lower concentration.

Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis.

INTRODUCTION: It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. AIM: To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation, using clinical parameters like gingival index (GI), oral hygiene index-simplified (OHIS), probing pocket depth (PPD), clinical attachment level (CAL) and bone density (BD). Also, to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density (BD). DESIGN AND SETTINGS: A nonrandomised clinical trial done in Amrita School of dentistry, Kochi, India. MATERIALS AND METHODS: Group A taking vitamin D (250IU/day) and calcium (500 mg/day) supplementation, and Group B were not taking oral supplementation. All subjects had at least one or more teeth with chronic moderate periodontitis. Digital Orthopantomogram images were taken to assess bone density. Data were collected at baseline and three months. STATISTICAL ANALYSIS USED: OHI-S, GI, PPD, CAL, and Bone Densities (BD) were calculated per group. Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test. Intragroup comparison of parameters at recall interval was done using Paired sample t-test. The results were considered statistically significant when p-value was <0.05. RESULTS: Both Groups showed significant change in the periodontal parameters and bone density after three months and intragroup comparison showed highly significant results for vitamin D group in relation to GI, OHI S and bone density. CONCLUSION: Calcium and vitamin D supplementation has got a positive effect on periodontal health and it can be used as an adjunct to non surgical periodontal therapy.

Comparison of glycated hemoglobin levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy.

BACKGROUND: Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is to compare HbA1c levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy. METHODS: This comparative study was done on individuals without diabetes who were 35 to 65 years old. Group A consisted of 30 individuals without periodontitis, and group B consisted of 30 individuals with periodontitis. Body mass indices and clinical parameters, including oral hygiene index-simplified (OHI-S) score, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and HbA1c level, of all participants were recorded. All participants received non-surgical periodontal therapy (scaling and root planing). After 3 months, all participants were reexamined, and clinical parameters and HbA1c levels were evaluated and compared to baseline values. RESULTS: There were significant differences between group A and group B in regard to baseline OHI-S, GI, PD, and HbA1c (P <0.05). There was no clinical attachment loss in group A, either at baseline or after 3 months. At the end of 3 months, group B showed improvement in all clinical parameters (P <0.05) and their HbA1c levels also significantly decreased (P <0.05), although the values never reached those of group A. CONCLUSION: The HbA1c levels of individuals without diabetes and with periodontitis (group B) were significantly reduced 3 months after non-surgical periodontal therapy, although they never reached the same levels as those of the individuals without diabetes or periodontitis (group A).

Comparison of Salivary TIMP-1 Levels in Periodontally Involved and Healthy Controls and the Response to Nonsurgical Periodontal Therapy.

Background. Periodontal disease is a chronic inflammatory condition affecting the supporting structures of the dentition. Periodontal destruction is an outcome of the imbalance between matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases (TIMPs). We wanted to prove the hypothesis that salivary TIPM-1 level will vary in different people. A decrease in TIMP-1 level could make them more susceptible to periodontitis whereas a normal level could prevent increased tissue destruction thereby inhibiting the progression from gingivitis to periodontitis. This could probably pave the way for TIPM-1 to be a specific salivary biomarker and serve as a useful diagnostic and therapeutic tool in periodontitis. Methods. Whole unstimulated saliva of 2 ml was collected from twenty-five periodontally healthy and twenty-seven systemically healthy subjects with periodontitis. Clinical parameters recorded at baseline and reevaluated after four weeks in subjects with periodontitis following nonsurgical periodontal therapy were gingival index (GI), oral hygiene index-Simplified (OHI-S), probing pocket depth, and clinical attachment level (CAL). Salivary TIMP-1 levels in both were analyzed using a commercially available ELISA kit.