Root coverage with the restoration of non-carious cervical lesions: A systematic review and meta-analysis.

The progression of non-carious cervical lesions (NCCLs) leads to gingival recession (GR), which is restored with restorative materials, using different periodontal plastic surgery procedures. There is no consensus on which technique is superior to others. Therefore, the present systematic review aimed to assess the effectiveness of root coverage (RC) procedures in the restored and unrestored NCCLs in terms of clinical and patient-centered outcomes.We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) while searching 5 databases in addition to the gray literature. The Medical Subject Headings (MeSH) terms and keywords in the title and abstract fields, as well as in headings, were used to search the existing literature for the relevant publications on the effectiveness of RC procedures with the restoration of NCCLs over the past 3 decades (January 1990-July 2021). After applying the inclusion and exclusion criteria, 13 articles were read in full and critically analyzed. The quality analysis was performed using the Cochrane RevMan software.A total of 222 potentially relevant titles and abstracts were found after the initial electronic and manual search, and after removing duplicates. Applying the inclusion and exclusion criteria yielded 23 publications that were further analyzed for relevance and applicability. Following critical analysis, 13 publications were used for validity assessment and data extraction.In the teeth with NCCLs and GR, the restoration of NCCLs does not affect the percentage RC. However, it significantly decreases dentin hypersensitivity, and the patients' perception of esthetics and satisfaction.

Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series.

Dental trauma is the most frequently encountered injury that requires immediate attention. Several procedures are available to manage broken teeth afflicted by trauma but the choice of procedure depends upon structural, functional, and esthetic considerations. The goal is to choose the least invasive, immediate, and simple technique that can meet the patient's expectations. The aim of this case series is to present a minimal intervention approach as a primary treatment option for the reattachment of trauma-induced fractured coronal tooth fragments, to preserve and enhance function, esthetics, and structure.

Association between periodontitis and cognitive impairment in adults.

DESIGN: To summarize the data on association between periodontal diseases and cognitive impairment in adults this systematic review scrutinized various observational studies till September 2021. This review was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines. The authors used PECO framework question,: population-Adults (18 years or older), exposure-adults suffering from periodontitis, comparator-adult group without periodontitis, outcome-adults at high risk for cognitive impairment. CASE/CONTROL SELECTION: Search for the literature was conducted on PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search was limited to human studies with no limitation to year of publication prior to September 2021. Search terms used were related to gingiva, oral bacteria like Porphyromonas gingivalis, gum inflammation, periodontitis, dementia, neuroinflammation, cognitive impairment, Alzheimer's disease, Parkinson disease. Following research, all the studies providing association between periodontal diseases and neurodegenerative diseases with quantitative measures were included in the study. Non-human studies, studies on patients below 18 year old, studies related to influence of treatment and in subjects already suffering from neurological disease were excluded. After removing duplicates, eligible studies were identified and data extracted by two reviewers to make ensure inter examiner reliability and to prevent data entry errors. Data from the studies were tabulated as study design, sample characteristics, diagnosis, exposure biomarkers/measures, outcomes and results. DATA ANALYSIS: Methodological quality of studies was assessed by adapted Newcastle-Ottawa scale. Selection of study groups, comparability and exposure/outcome were used as parameters. Case-control and cohort studies were considered as high-quality studies if six or more stars were awarded out of nine maximum stars and four or more stars for cross-sectional studies out of six stars. Comparability among the groups was studied by taking into account primary factors for Alzheimer's disease such as age and sex and secondary factors like hypertension, osteoarthritis, depression, diabetes mellitus, and cerebrovascular disease. For cohort studies, 10 year follow up and dropout of <10% was considered to be successful. RESULTS: A total of 3693 studies were identified by two independent reviewers and finally 11 studies were included in the final analysis. Six cohort studies, three cross-sectional and two case-control studies were included after excluding remaining studies. Bias in studies was assessed by adapted Newcastle-Ottawa Scale. All included studies were of high methodological quality. Association between periodontitis and cognitive impairment was determined by using different criteria like International classification of disease, clinical measurement of periodontitis subjects, inflammatory biomarkers, microbes and antibodies. It was suggested that subjects with chronic periodontitis since 8 years or more, are at a higher risk of having dementia. Clinical measures of periodontal disease like probing depth, clinical attachment loss, alveolar bone loss were found to be positively associated with cognitive impairment. Inflammatory biomarkers and pre-existing elevated levels of serum IgG specific to periodontopathogens was reported to be associated with cognitive impairment. Within the limitations of the study, the authors concluded that though the patients with long-standing periodontitis are at greater risk for developing cognitive impairment by neurodegenerative diseases, the mechanism by which periodontitis can lead to cognitive impairment is still vague. CONCLUSIONS: Evidence suggests a strong association between periodontitis and cognitive impairment. Still further studies should be done to explore the mechanism involved.

Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. MATERIAL AND METHODS: A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. RESULTS: A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. CONCLUSION: PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.

Does nonsurgical periodontal therapy improve glycemic control?

DATA SOURCES: The authors searched Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo. Additionally, grey literature was also searched with no restrictions regarding date of publication and journal up to March 2022. The search was conducted by two pre-calibrated independent reviewers using AMSTAR 2 and PRISMA checklists. Both MeSH terms, relevant free text and their combinations were utilised to conduct the search. STUDY SELECTION: The authors screened the articles on the basis of their titles and abstracts. Duplicates were removed. Full-text publications were evaluated. Any disagreement was resolved by discussion amongst themselves or with a third reviewer. Only the systematic reviews that included RCTs and CCTs were included involving the articles comparing nonsurgical periodontal treatment alone vs no treatment or nonsurgical periodontal treatment with adjunctive therapeutic modality (antibiotics, laser) vs no treatment or nonsurgical periodontal therapy alone. PICO method was used to define the inclusion criteria and changes in glycated haemoglobin post-intervention 3 months was taken as primary outcome. All the articles with the use of adjunctive therapy other than antibiotics (local or systemic) or laser were excluded. The selection was restricted to English only. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by two reviewers. For each systematic review and each study, mean and standard deviation of glycated hemoglobin level at each follow-up, number of patients both in intervention and control group, type of diabetes, design of study, follow-up period, number of comparisons in meta-analysis, quality assessment of systematic review was assessed by 16 items AMSTAR 2 (Assessment of Multiple Systematic Reviews) and 27 itemed PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) checklist. JADAD scale was used to assess the risk of bias for included RCTs. Q test was used to calculate statistical heterogeneity and percentage of variation by I2 Index. Both Fixed (Mantel-Haenszel [Peto] test) and random (Dersimonian-Laird test) models were used to estimate individual study. Funnel plot and Egger's linear regression methods were used to evaluate publication bias. RESULTS: Following initial electronic and hand search, 1062 articles were screened for title and abstract and 112 articles were considered for full text eligibility. Finally, 16 systematic reviews were considered for qualitative synthesis of results. 16 systematic reviews described 30 unique meta-analyses. Publication bias was assessed in nine out of 16 systematic reviews. Compared to control or non-treatment group, nonsurgical periodontal therapy resulted in statistically significant mean difference of -0.49% HBA1c reduction at 3 months (p = 0.0041), -0.38% (p = 0.0851). The effect of periodontal therapy with antibiotics compared to NSPT alone was not statistically significant (CI -0.32-0.06, 3 months; CI -0.31-0.53, 6 month). The effect of NSPT and laser vs NSPT for HbA1c was not statistically significant (CI -0.73-0.17, 3-4 month). CONCLUSIONS: Based on included systematic reviews and limitations within the study, nonsurgical periodontal therapy is an effective treatment modality in glycaemic control in diabetic patients in terms of HbA1c reduction both at 3 months and 6 months follow-up. The adjunctive therapies like antibiotic administration whether local or systemic and use of lasers with NSPT does not show statistically significant differences as compared to NSPT alone. However, these findings are based on analysis of available literature based on systematic reviews on this subject.

Is periodontal therapy an effective treatment modality for preventing or managing cardiovascular disease in patients with periodontitis?

DATA SOURCES: Cochrane Oral Health Information specialist searched databases: Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane diary, MEDLINE Ovid, Embase Ovid, CINAHL EBSCO and Open Grey up to 17 November 2021 without language, publication status or year restriction. Additionally, Chinese Bio Medical Literature Database, China National Knowledge Infrastructure and VIP database were searched up to 4 March 2022. For ongoing trials, the US National Institutes of Health Trials Register, the World Health Organization (WHO) Clinical Trials Registry Platform (up to 17 November 2021), and Sciencepaper Online (up to 4 March 2022) were also searched. A reference list of included studies, hand searching for important journals, and Chinese professional journals in the relevant field was performed until March 2022. STUDY SELECTION: Authors screened the articles on the basis of their titles and abstracts. Duplicates were removed. Full-text publications were evaluated. Any disagreement was resolved by discussion amongst themselves or in consultation with a third reviewer. Only randomised controlled trials assessing the effects of periodontal treatment on participants having chronic periodontitis with cardiovascular disease (CVD) (secondary prevention) or without cardiovascular disease (primary prevention) with minimum follow-up of one year were considered. Patients having known genetic or congenital heart defects, other sources of inflammation, aggressive periodontitis, or were pregnant and/or lactating were excluded. Subgingival scaling and root planning (SRP) with or without combination of systemic antibiotics with or without active remedies were compared with supragingival scaling, mouth rinse, or no periodontal treatment. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by two independent reviewers in duplicate. A formal, customised pilot-based data extraction form was used to capture data. Overall risk of bias for each study was categorised as low, medium, and high. For trials having missing data or unclear data, clarification from the authors were sought by mail. Testing for heterogeneity was planned by I2 test. For dichotomous data, fixed-effect model (Mantel-Haenszel) was used; and for continuous data, mean difference and 95% confidence intervals were used as measures of treatment effect. For time-to-event data, Peto or inverse variance method was used. Sensitivity and subgroup analysis was planned to test the stability of conclusion. RESULTS: Following initial electronic and hand search, 1690 articles were screened for title and abstract and 82 articles were considered for full-text eligibility. Finally, two studies out of the reported six articles were included in this review for qualitative synthesis of results, and no study was included in the quantitative analysis. Publication bias was determined using funnel plots which were further assessed using dichotomous and continuous outcome. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low certainty evidence. Scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death (Peto odds ratio [OR] 7.48, 95% confidence interval [CI] 0.15 to 376.98), or all CVD-related death (Peto OR 7.48, 95% CI 0.15 to 376.98). The possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events (Peto OR 7.77, 95% CI 1.07 to 56.1) compared with supragingival scaling measured at 12-month follow-up was observed. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planning plus oral hygiene instruction or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). As cardiovascular events had been measured for different time periods between 6 and 25 months, and only 37 participants were available with at least one-year follow-up, the data was not sufficiently robust for inclusion in the review. The study did not evaluate all-cause death and all CVD-related death. Conclusions about the effects of periodontal therapy on secondary prevention of CVD were not drawn. CONCLUSIONS: There is very limited evidence assessing the impact of periodontal therapy on the prevention of cardiovascular disease, and it is insufficient to generate any implications for practice. Further trials are needed before reliable conclusions can be drawn.

Association of periodontitis and gingivitis with stroke: A systematic review and meta-analysis.

BACKGROUND: Stroke is among the leading causes of morbidity and mortality. Chronic inflammatory conditions may lead to atherosclerosis and a subsequent stroke. OBJECTIVES: This systematic review and meta-analysis aimed to review the association of periodontitis and gingivitis with stroke. METHODS: An electronic search of PubMed, Ovid EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Database of Abstracts and Reviews of Effects (DARE), and various clinical trial registries was conducted to include studies published up to February 2022. Data was retrieved by 2 independent reviewers. The Stata software, v. 13, was used to conduct a meta-analysis. RESULTS: Thirteen studies stated an association between periodontitis, determined based on clinical attachment loss (CAL), and stroke. Meanwhile, 6 studies described an association between gingivitis, determined based on the gingival index (GI), and stroke. Out of the 6 studies on gingivitis, 5 also investigated CAL, which means the meta-analysis included 14 studies in total. The total number of participants from the included studies was 35,937, and they were all above 17 years of age. There was a significant association between periodontitis and gingivitis and stroke and its all types. There was a significant association between periodontitis and stroke and its all types in 13 studies (ES (effect size): 1.32; 95% CI (confidence interval): 1.04-1.60), and between gingivitis and all stroke types in 6 studies (ES: 1.17; 95% CI: 0.42-1.92). CONCLUSIONS: This systematic review indicated a significant association between stroke and periodontal disease in case-control, cohort and cross-sectional studies. The findings need to be further substantiated in prospective cohort studies with an optimal sample size.

Inflammatory myofibroblastic tumor of anterior maxillary gingiva: An unusual clinical presentation.

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm with variable clinical presentation. We hereby present a case of a 27-year-old female who presented to us with an unsuspecting gingival overgrowth in her anterior gingiva. This article aims to describe IMT as a rare intraoral entity which may involve the anterior maxillary gingiva, involving or sparing the underlying bone, as only a handful of such cases have been reported so far. Surgical excision is the mainstay of treatment. Biopsy and histopathological examination of even the smallest lesions is a must. Timely diagnosis and intervention can prevent severe morbidity that can arise if these lesions are left undiagnosed as aggressive management of lesions that become extensive is mandatory.

Efficacy of microsurgery in treatment of localized or multiple gingival recession: A systematic review.

OBJECTIVE: To address the clinical question whether microsurgery hold an advantage in terms of clinical and patient oriented outcome over conventional macrosurgical procedures in the treatment of gingival recession. MATERIAL AND METHODS: A Literature search on MEDLINE, SCOPUS, EMBASE (Excerpta Medica Database) via Ovid and Cochrane library was conducted in order to investigate clinical studies on efficacy of microsurgery in the treatment of localized or multiple gingival recession as compared to conventional macrosurgical procedures. Publications before May 2020 and grey literature was searched without any language restrictions. Primary outcome considered was change in recession depth and mean root coverage. Whereas, change in clinical attachment level, Change in keratinized tissue, patient oriented outcome like esthetics, pain and discomfort were the secondary outcome. Based on inclusion criteria ten studies were included in systematic review. Data was extracted and analyzed. RESULTS AND CONCLUSION: All the included studies showed improvement in the mean percentage of root coverage or mean root coverage (primary outcome) when microsurgical approach was used. Predictability of complete root coverage is better with microsurgical instrumentation but results are not statistically significant. As far as patient centered outcome is concerned, there is no evidence for recommendation of microsurgery.

Diagnosis and treatment considerations of atypical oral pain in tuberous sclerosis.

Diagnosis and management of non-specific, atypical, and non-dental pain are challenging. We hereby report a case of a 23-year-old female who presented with a complaint of intermittent dull ache over her lower front anterior teeth with no radiographic findings. She was diagnosed after history, imaging, and neurology consultation and treated conservatively with complete remission of symptoms. Proper history and counseling are mandatory for all patients. It is important to recognize patients with underlying neurological conditions and take adequate interdepartmental consultation before labeling complaints psychogenic or carrying out unwarranted dental treatment.

Autologous platelet-rich derivatives along with alloplastic bone substitute in the management of complex perio-endo cases.

Combined endodontic periodontal lesion is one of the most challenging dental conditions as making a definite diagnosis and henceforth treatment plan is a daunting task. The prognosis of complex lesion involving both endodontic and periodontic components is complex, but success rate can be improved with regenerative therapies. However, there is paucity of literature regarding its effectiveness in the clinical scenario as only few case reports have been documented in literature for the use of platelet-rich derivatives in regenerative osseous surgery requiring both endodontic and periodontal treatment. We are hereby presenting three cases requiring both endo and perio treatment. The first two cases involve mandibular first molar and maxillary first molar, respectively. The third case involves maxillary central incisor. In all the cases, first, endodontic treatment was initiated, then open flap curettage along with alloplastic bone substitutes was done. Platelet-rich fibrin and platelet-rich plasma were used along with. Three of the treated cases showed significant improvement radiographically and clinically. There was gain in clinical attachment, reduction in probing depth, and radiographic bone fill. Autologous platelet-rich derivative can be used in combination with alloplastic bone substitute for the management of endo-perio cases. Further long-term studies are needed to explore the clinical effectiveness of platelet-rich derivatives and predicting the probability of success of periodontal therapy.

Free Gingival Graft as a Single Step Procedure for Treatment of Mandibular Miller Class I and II Recession Defects.

BACKGROUND: Gingival recession is a frequent issue encountered by both the clinician and the patient. This study was aimed to assess the predictability of the free gingival graft as a single step procedure in terms of root coverage and aesthetics in Miller Class I and II mandibular gingival recession. METHODS: Ten patients (4 males, 6 females) aged 25-30 years with a total of 12 mandibular sites having Miller class I and II recession were selected. All recession sites were treated with single step free gingival graft procedure. Clinical parameters like recession depth, recession width, width of attached gingiva, probing depth and clinical attachment level were recorded at baseline, 6 and 9 months. Visual analog score at 1, 6 and 9 months postoperatively was provided. RESULTS: There was a reduction in mean recession depth from 3.66±1.20 to 0.91±0.99 mm suggesting coverage of 82% over a period of 9 months. There was statistically significant gain in clinical attachment level and width of attached gingiva. Aesthetically, it was acceptable by patients as measured by visual analog scores. CONCLUSION: Free gingival graft as a single step procedure is acceptable in terms of root coverage and aesthetics.

Grinspan syndrome with periodontitis: Coincidence or correlation?

Grinspan syndrome is a syndromic complex which comprises a triad of hypertension, diabetes, and oral lichen planus. It remains an enigmatic condition that whether it is separate entity or drug-induced lichenoid reaction emerging due to medications used to treat hypertension and diabetes. Diabetes is related to long-term hyperglycinemia leading to accelerated destruction of both nonmineralized connective tissue and bone leading to periodontitis. Moreover, there is also a possible link between cardiovascular disease and periodontitis. Here, we are presenting a case with the symptomatic triad fulfilling the diagnostic criteria of Grinspan syndrome. A 50-year-old female with type 2 diabetes mellitus and vascular hypertension came with the chief complaint of bleeding gums and severe burning sensation of the oral cavity. In addition, she was having generalized alveolar bone loss and clinical attachment loss. To the best of our knowledge, this coexistence has not been reported earlier. This needs further evaluation so that the preventive measures can be taken at early stage.

Osteoporosis and Periodontitis in Postmenopausal Women: A Systematic Review.

This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral density (BMD) and clinical attachment loss, respectively. The Pubmed, Cochrane central, EMBASE, and Google Scholar were searched from year 1990 to 2015 for studies on association between chronic periodontitis and osteoporosis. Studies measuring osteoporosis in terms of central BMD and periodontitis in terms of clinical attachment level were studied. Data were extracted and descriptive analysis was performed. Screening of 1188 articles resulted in 24 articles for review after reading the titles and abstracts. Fifteen studies were shortlisted for inclusion in systematic review. Ten of these studies showed an association between periodontitis and osteoporosis. It implies that patients with severe periodontitis should also be evaluated for systemic bone health and vice versa.

The influence of smoking on the levels of matrix metalloproteinase-8 and periodontal parameters in smoker and nonsmoker patients with chronic periodontitis: A clinicobiochemical study.

AIMS: Even though worldwide evidences tend to prove that smoking adversely influences periodontal health, there are few studies demonstrating the effect of levels of salivary matrix metalloproteinase-8 (MMP-8) in smokers. This study aimed to compare and quantify the levels of MMP-8 in smokers and also to evaluate the effect of smoking on periodontal indices in smokers and nonsmokers with chronic periodontitis. METHODS: A total number of 60 subjects were selected for the study and were divided into three groups: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of 20 subjects. Saliva sample was collected for the estimation of MMP-8 by enzyme-linked immunosorbent assay (ELISA) method using Quantikine human total MMP-8 immunoassay kit. RESULTS: The levels of the salivary MMP-8 of group III was highest followed by group II and group I, the least. The other periodontal indices, viz. plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), were highest for group III, except for gingival index (GI). CONCLUSION: This study suggests that MMP-8 is involved in periodontal destruction associated with smoking. Additionally, smoking exerts disastrous effects on immune response and can affect the pathogenesis of disease; hence, smoking results in increased severity of periodontal destruction.

The effect of type 2 diabetes mellitus and smoking on periodontal parameters and salivary matrix metalloproteinase-8 levels.

The present study was carried out to evaluate the effect of type 2 diabetes mellitus (DM) and smoking on periodontal parameters and on the levels of salivary matrix metalloproteinase (MMP-8). One hundred and twenty five subjects were divided into five groups: group 1, systemically and periodontally healthy subjects (n = 25); group 2, systemically healthy subjects but with chronic periodontitis (n = 25); group 3, subjects with type 2 DM and chronic periodontitis (n = 25); group 4, smokers with chronic periodontitis (n = 25); group 5, diabetic-smokers with chronic periodontitis (n = 25). MMP-8 level in saliva was estimated by enzyme linked immunosorbent assay (ELISA) using Quantikine human total MMP-8 immunoassay kit. The result showed that the clinical periodontal parameters and the mean levels of the salivary MMP-8 were significantly higher for diabetic-smokers than other study groups. A highly significant positive correlation (r) between MMP-8 and periodontal parameters was also observed in diabetic-smoker patients. The findings suggest that diabetic-smokers have increased periodontal breakdown and are associated with an increased extent and severity of periodontitis. (J Oral Sci 58, 1-6, 2016).

The influence of type 2 diabetes mellitus on salivary matrix metalloproteinase-8 levels and periodontal parameters: A study in an Indian population.

OBJECTIVE: Although many studies reported more severe periodontal disease and the existing proinflammatory conditions in patients with diabetes but only few have examined the effect of type 2 diabetes mellitus (DM) on salivary matrix metalloproteinase-8 (MMP-8) level and other periodontal parameters. This study aims to evaluate the effect of type 2 DM on salivary MMP-8 levels and periodontal parameters, which might be useful in monitoring periodontal disease in diabetes. MATERIALS AND METHODS: A total of 90 subjects were selected for the study and were divided into three groups: Group I included 30 healthy subjects; Group II included 30 subjects without type 2 DM but with chronic periodontitis, and Group III included 30 subjects with type 2 DM and chronic periodontitis. Periodontal parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were taken. The salivary MMP-8 level was estimated by Quantikine Human total MMP-8 immunoassay kit using ELISA method. RESULTS: The mean value of the salivary MMP-8 of Group III was highest followed by Group II and Group I, the least. The other periodontal parameters PI, GI, PPD, CAL, was comparatively highest for Group III. CONCLUSION: This study suggests that diabetes is associated with an increased prevalence, extent, and severity of periodontitis. Furthermore, the increased levels of MMP-8 indicate the influence of diabetes on their salivary concentration.

Unusual cases of transmigrated mandibular canines.

Transmigration, an extremely rare anomaly that happens almost exclusively with mandibular canines, is defined as a pre-eruptive migration across the midline. It can lead to various restorative, surgical, orthodontic, and interceptive problems. This condition usually is not related to any painful symptoms and cannot be detected on clinical examination. This article presents 3 cases of transmigration. In 1 case, the right canine was involved, which is considered to be especially rare. This case series also highlights the importance of early diagnosis for the interceptive treatment of transmigration.