Efficacy of Sub-Gingivally Delivered Propolis Nanoparticle in Non-Surgical Management of Periodontal Pocket: A Randomized Clinical Trial.

Naturally sourced products like propolis are commonly employed for the non-surgical treatment of periodontal pockets. The use of nanoparticle formulations of these natural remedies has the potential to improve treatment outcomes. The aim of the present study was to evaluate the efficacy of sub-gingivally delivered propolis nanoparticles in the non-surgical management of periodontal pockets. Forty patients diagnosed with periodontitis presenting at least one periodontal pocket with a probing pocket depth between 4 and 6 mm were selected. Patients were randomly assigned into the control group (n = 20), which received scaling and root planing (SRP) and saline (SRP + Saline), and the test group (n = 20), which received SRP and sub-gingivally delivered propolis nanoparticles (PRO) into the periodontal pocket (SRP + PRO). The clinical parameters recorded were plaque index (PI), gingival index (GI), relative attachment loss (RAL), probing pocket depth (PPD), and bleeding on probing (BOP). They were assessed at baseline, one month, and three months post therapy. The results indicated that there was a significant improvement in clinical parameters (p < 0.05) in the test sites compared with the control sites at the end of the study. The gingival index at one month and three months was found to be significantly better in the SRP + PRO group than the SRP + Saline group, with a p value of <0.001. The BOP, PPD, and RAL showed significant improvement with the SRP + PRO group at the end of the 3-month follow-up with p values of 0.0001, 0.001, and 0.05, respectively. The subgingival delivery of propolis nanoparticles showed promising results as an adjunct to SRP in patients with periodontitis presenting periodontal pockets.

Effectiveness of Hyaluronic Acid Gel Injection with and without PRGF for Management of Interdental Papillary Loss: A Randomized Clinical Trial.

BACKGROUND: To evaluate the effectiveness of hyaluronic acid (HA) gel injection with and without plasma rich in growth factors (PRGF) for the management of interdental papillary loss. METHODS: A single blinded randomized clinical trial was carried out on 21 subjects with 34 sites. Patients within the age group 18-45 years who had Class I and II papillary recession in the maxillary anterior region were selected. The sites involved were randomly assigned to Group HA alone and Group HA + PRGF. The patients were recalled 4 weeks after receiving supragingival and subgingival instrumentation. HA or HA + PRGF was injected into the defective papilla at baseline and at 3 and 6 weeks. Image based measurements of Papillary Width (PW), Papillary Deficient Height (PDH), Deficient Area (DA), Deficient Volume (DV) were registered at baseline, 3 weeks, 6 weeks and 12 weeks. A vernier caliper was used to measure the papillary depth in the impression made using additional silicone impression material pre- and post-intervention. RESULTS: There was a significant improvement in the within-group comparison of PW, PDH, DA and DV in both the groups. Group HA + PRGF showed significantly greater improvement in comparison to Group HA alone in terms of PDH, DA and DV at 6 and 12 weeks. CONCLUSIONS: Even though HA gel has already been established as a promising injectable agent in the minimally invasive treatment of interdental papillary deficiency, PRGF may also have a significant adjuvant effect when used along with HA. Further clinical studies with longer follow up duration, larger sample size and standardization of the tooth shape are required for a better understanding of the adjuvant effect of PRGF when used along with HA.

Self-esteem and oral health-related quality of life of women with periodontal disease - A cross-sectional study.

Aim: The aim of this study is to assess the effect of periodontal disease on self-esteem and oral health-related quality of life (OHRQoL) in women. Materials and Methods: A cross-sectional study was conducted among 522 women (mean age - 38.92 ± 14.3 years). Oral hygiene status, plaque level, gingival inflammation, probing depth, and periodontal status were assessed. The self-esteem was assessed using a Rosenberg Self-esteem Scale, and the OHRQoL was measured using a 14-item oral health impact profile (OHIP-14) questionnaire. Results: Younger, employed women with higher income had significantly better OHRQoL and self-esteem. Women with healthy periodontium had better OHRQoL. Probing depth and community periodontal index scores were found to have a significant positive correlation with most of the sub-scale items and total OHIP-14 score in women with low self-esteem. Women with good OHRQoL and normal self-esteem were seen to be maintaining significantly better oral hygiene. No such statistically significant difference was observed in women with low self-esteem. Multiple regression analysis for the prediction of OHIP-14 score indicated that the best model included probing depth as the only statistically significant predictor (P = 0.002). Conclusion: Periodontal disease has a significant negative impact on self-esteem and OHRQoL in women.

Fractal Dimension as a Tool for Assessment of Dental Implant Stability-A Scoping Review.

A lot of modalities for assessing implant stability are available for clinicians, but they fail to assess trabecular changes as they are solely dependent on the operator's skills. The use of Fractal Dimension (FD) has evolved to be used as a measure for trabecular changes depicting implant stability before and after implant placement. The objective of this systematic review was to qualitatively analyse the available scientific literature describing the use of FD as a tool to measure implant stability on the basis of trabecular changes. An electronic search in PubMed, Web of Science and Scopus was carried out using relevant keywords, such as: fractal dimension; fractal analysis; dental implants; implant stability; osseointegration, etc. Studies reporting the use of FD as a tool to measure implant stability were included and subjected to qualitative analysis using ROBINS-I and Cochrane risk of bias assessment criteria. Fourteen studies were included in this review. Results showed that FD was found to be used solely as a measure of implant stability in seven studies, out of which six studies showed an increment in FD values. The majority of studies concluded with a statistical correlation between FD and respective other assessment methods used. FD may not serve as a sole indicator of implant stability; however, it can be used as an adjunct to conventional methods along with additional fractal factors.

Aloe vera mouthwashes can be a natural alternative to chemically formulated ones - A randomized-controlled trial.

Objectives: To evaluate the antiplaque and antibacterial efficacy of commercially available mouthwashes containing aloe vera (AV), hydrogen peroxide (HP), and cetylpyridinium chloride (CPC) in a 4-day plaque regrowth study. Methods: Plaque score and salivary samples were assessed (Day-0 and Day-4) in 96 participants in a randomised, double-blind prospective parallel-arm 4-day plaque regrowth study. Participants were divided into five groups who refrained from engaging in regular oral hygiene measures during the study period and used commercially available mouthwashes containing AV, HP, and CPC as test products with distilled water (DW) and chlorhexidine (CHX) mouthwash as negative and positive controls, respectively. Salivary bacterial count was expressed as colony-forming units (CFU) (culture method). Results: There was a significant difference both in plaque score (p < 0.001) and in CFU (p < 0.001) among the study mouthwashes at Day-4. The plaque score and CFU of AV were significantly higher and lower than those of CHX and DW, respectively. The plaque score of HP was significantly higher than that of AV (p = 0.016) and CPC (p < 0.001). No significant difference was observed between AV and CPC (p = 0.70). Moreover, the CFU of HP was significantly higher than that of CPC (p = 0.04). There was no statistically significant difference between the CFU of mouthwashes containing AV and HP (p = 0.912) or AV and CPC (p = 0.280). No significant difference was seen in the inhibition of plaque and salivary bacterial count between AV, HP, and CPC. Conclusion: The antiplaque and antibacterial efficacy of commercially available AV mouthwash was similar to that of CPC and significantly better than that of HP mouthwash and can be a natural alternative to chemically formulated mouthwashes.

Bio-mimicked guided tissue regeneration/guided bone regeneration membranes with hierarchical structured surfaces replicated from teak leaf exhibits enhanced bioactivity.

Bio-mimicked GTR/GBR membranes with hierarchical structured surfaces were developed by direct and indirect replication of teak leaf surface. The membranes were fabricated using solvent casting method with customized templates. The surfaces obtained were those with micro-trichomes (MTS) and micro-depression (MDS) that resembled a whorling pattern. Structural details of the fabricated membrane surfaces were studied under stereomicroscope and scanning electron microscopy. Surface roughness, water wetting angle, water uptake, and degradation properties of the membranes were examined. The effects of the micro-patterned hierarchical structure on in vitro bioactivities of human osteoblast-like cells (MG63) and human gingival fibroblast cells HGF1-RT1 were studied. In vivo study carried out on rat skulls to assess the response of surrounding tissues for 4 weeks showed that the bio-mimicked MTS and MDS membrane surfaces enhanced the cell proliferation. The proliferation significantly increased with increasing surface roughness and decreasing contact angle. There was also an evidence of rapid new bone maturation with membranes with MTS. It is thus suggested that the teak leaf mimicked whorling patterned hierarchical structured surface is an important design for enhancing bioactivity.

Maternal periodontal status, oral inflammatory load, and systemic inflammation are associated with low infant birth weight.

BACKGROUND: Periodontal disease and pregnancy outcomes have been claimed to be associated with conflicting reports. The purpose of this study was to prospectively examine the association between maternal periodontal status, oral inflammatory load and serum C- reactive protein (CRP) level, and infant birth weight. METHODS: A total of 156 pregnant women (age 26.62 ± 3.93 years) within the gestational age group of 13 to 32 weeks participated in this cross-sectional study. Oral inflammatory load (OIL) was assessed in a salivary rinse sample using fluorescence microscopy. Clinical periodontal parameters were recorded and serum C-reactive protein level (CRP) was assessed. Participants were followed till delivery, details of parturition and infant birth weight (IBW) was recorded. RESULTS: OIL was significantly more in participants with mild and moderate periodontitis as compared to those with gingivitis in mid and late stages of pregnancy. Periodontal and systemic inflammatory parameters were positively correlated. A significant negative correlation was found between IBW and OIL (P = 0.006) and serum CRP (P < 0.001). The GI score (P = 0.039), BOP% (P = 0.023), serum CRP level (P < 0.001) and oral polymorphonuclear neutrophil (oPMN) count (P < 0.001) was significantly more in mothers delivering babies with low IBW. A multiple linear regression analysis showed that only oPMN (ß = - 0.244, P = 0.021) and serum CRP (ß = - 0.226, P = 0.019) were included in the best model (R2  = 0.12, F(3,152) = 7.15, P < 0.001) for significantly predicting the infant birth weight. CONCLUSIONS: Poor maternal periodontal status, increased oral inflammatory load and increased systemic inflammation have an adverse effect on infant birth weight.

Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial.

The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score < 1.5, were randomly allocated by using computer generated random sequence, into two groups, one treated with intra-pocket application of PRGF adjunct to SRP and other with SRP alone. The clinical outcomes like pocket depth (PD), relative attachment level (RAL) and sulcus bleeding index (SBI) were assessed at baseline, 3 months and 6 months. Twenty two patients (44 sites) were analyzed at the end of 6 month follow-up, using SPSS 20.0v software. There was a significant statistical difference observed between both the groups favouring SRP +PRGF group in terms of PD (p = 0.007) and RAL (p = 0.021) at the end of 6 month follow-up. Also there was a statistical significant difference (< 0.001) at all time points compared to baseline, for all parameters in intra-group comparison. Moreover, the sites with PD>4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level.

Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial

Abstract The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score < 1.5, were randomly allocated by using computer generated random sequence, into two groups, one treated with intra-pocket application of PRGF adjunct to SRP and other with SRP alone. The clinical outcomes like pocket depth (PD), relative attachment level (RAL) and sulcus bleeding index (SBI) were assessed at baseline, 3 months and 6 months. Twenty two patients (44 sites) were analyzed at the end of 6 month follow-up, using SPSS 20.0v software. There was a significant statistical difference observed between both the groups favouring SRP +PRGF group in terms of PD (p = 0.007) and RAL (p = 0.021) at the end of 6 month follow-up. Also there was a statistical significant difference (< 0.001) at all time points compared to baseline, for all parameters in intra-group comparison. Moreover, the sites with PD>4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level.

Red complex: Polymicrobial conglomerate in oral flora: A review.

Oral diseases are the complex host responses composed of a broad array of inflammatory cells, and cytokines, chemokines, and mediators derived from the cells resident in the gingival tissues, as well as from the emigrating inflammatory cells. A chronic polymicrobial challenge to the local host tissues triggers this response, which under certain circumstances, and in a subset of the population, leads to the progressing soft and hard tissue destruction that characterizes periodontitis. The red complex has been proposed as a pathogenic consortium, consisting of P. gingivalis, T. denticola, and T. forsythia. This review has attempted to examine the virulence potential and determinants of these commensal opportunists.

Oral hygiene status, oral hygiene practices and periodontal health of brick kiln workers of Odisha.

AIM AND OBJECTIVE: The aim of this study was to assess the oral hygiene status, oral hygiene practices, and periodontal health among brick kiln workers of Odisha. MATERIALS AND METHODS: Four hundred and eight subjects (300 males and 108 females) between the ages of 22 and 65 years with mean age of 33.44 ± 2.34 years working in various brick kilns in the district of Khordha, Odisha, participated in the survey. Data were collected through personal interview and clinical examinations. RESULTS: Overall prevalence of periodontal diseases among brick kiln workers was 86.27%. There was a statistically significant difference in the distribution of Community periodontal index (CPI) (P < 0.001) and loss of attachment score scores (P < 0.001). Periodontal disease was significantly associated with age, oral hygiene status, practices, and tissues abuse habits. Most of the workers were males (59%), in the age group of 30-40 years (40.69%), having only a primary level of education (75.98%) and were married (80.88%). Majority of the workers brushed their teeth once daily (78.9%) with toothbrush (51.5%) and used toothpaste (41.2%). Most of them were found to be consuming paan or gutkha as compared to cigarette or beedi smoking. Among the subjects with a CPI >2, higher prevalence of periodontal disease was seen in subjects older than 50 years of age (86.7%), those brushing once daily only (75.2%), brushing with finger (82.8%), with higher frequency and duration of consumption of tobacco and alcohol, and having a poor oral hygiene (85.5%). CONCLUSION: The survey among brick kiln workers revealed that the oral hygiene status was poor, they had ill-informed oral hygiene practices and most of them were suffering from periodontal disease.

Miniscrew Implants for Intrusion of Supraerupted Molar: A Noninvasive Approach for Space Regaining.

Inadequate interocclusal space often leads to difficulty in prosthetic rehabilitation. Dental implant-indicated sites are governed by various factors which include bone availability, adequate mesiodistal width, and most importantly, adequate interocclusal space for proper prosthetic design on the dental implant. The use of miniscrew implant with coil spring for regaining interocclusal space would be an advantageous procedure for biomechanical intrusion of supraerupted teeth, rather than treating the same with invasive clinical crown reduction/intentional endodontic treatment. This case report describes the use of miniscrew implant with coiled spring on a supraerupted maxillary molar for interocclusal space regaining, to facilitate proper prosthetic rehabilitation in the dental implant site.

Simultaneous occurrence of pyogenic granuloma at multiple sites associated with bone loss: Report of a rare case.

Pyogenic granuloma (PG) is a reactive hyperplasia of connective tissue that occurs in response to low-grade local irritation, traumatic injury, foreign materials, or hormonal causes and rarely associated with bone loss. Although solitary PG is a common lesion in the orofacial region, presence of multiple such lesions at the same time with associated bone loss is rare. In addition, repeated recurrences of such lesions sometimes frustrate the clinician. This article presents a rare case of simultaneous occurrence of PG at multiple sites associated with bone loss in a young female and its management.

Risk Assessment in Long-term Survival Rates of Dental Implants: A Prospective Clinical Study.

AIM: The present study was done to analyze the risk factors associated with dental implants in its survival rate. MATERIALS AND METHODS: The present study was conducted on 208 patients with 425 dental implants placed. Patients were divided into four groups: group I (diabetes), group II (periodontitis), group III (smoking), and group IV (bruxism). All patients were followed for 8 to 10 years for the survival rates. RESULTS: Out of 425 dental implants, 145 were inserted in 72 males and 280 in 136 females. The difference was significant (p = 0.01). Group I had 16 males and 36 females, group II had 20 males and 32 females, group III had 28 males and 24 females, and group IV had 8 males and 44 females. The difference was statistically significant (p < 0.05). Out of 425 implants, 90 (21.17%) had failures: 24 dental implants (29%) in group I, 22 dental implants (15.2%) group II, 34 dental implants (27%) in group III, and 10 dental implants (13%) in group IV showed failure. The difference was significant (p < 0.05). Success rate was 70.7% in group I, 83.3% in group II, 80.9% in group III, and 86.3% in group IV. The difference was nonsignificant (p > 0.05). CONCLUSION: Diabetes, periodontitis, bruxism, and smoking are among various causative factors which affect the survival rate of dental implants. These are risk factors leading to implant failures. CLINICAL SIGNIFICANCE: Diabetes, periodontitis, bruxism, and smoking are among various causative factors which affect the survival rate of dental implants.

Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series.

Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions.

"Diabetes and gum disease: the diabolic duo".

BACKGROUND: Diabetes and periodontitis have long been linked in the dental literature but have never been substantiated. Periodontitis is an oral infection affecting the tooth-supporting tissues. Although the etiology for this condition is bacterial plaque, the host immune response may also mediate destruction of the periodontal tissues. Diabetes mellitus is intricately related to the development, progression and severity of periodontitis. The literature is abundant with studies depicting this association. DISCUSSION: Diabetes mellitus (DM) is a complex disease with varying degrees of systemic and oral complications. The periodontium is also a target for diabetic damage. In recent years, a link between periodontitis and diabetes mellitus has been postulated. The present review highlights the relationship between diabetes mellitus and periodontitis. The potential mechanisms involved in the development of periodontitis in diabetic patients, influence of periodontitis on diabetes and the role of TNF-α, a prime inflammatory mediator linking both of them have been discussed. CONCLUSION: Diabetes clearly increases the risk of periodontal diseases, and biologically plausible mechanisms have been demonstrated in abundance. Less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. It is possible that periodontal diseases may serve as initiators or propagators of insulin resistance in a way similar to obesity, thereby aggravating glycemic control.

Peripheral Ossifying fibroma: a clinical report.

Most localized growths on the gingiva are considered to be reactive rather than neoplastic in nature. The authors describe a 20-year-old male patient with a peripheral ossifying fibroma in the maxilla exhibiting significant size with the disease duration of one year. The signs of recurrence in spite of thorough excision a debridement exposed the need for further study of the causes of recurrence. Clinical, radiographical, and histological characteristics are discussed.

The potential role of probiotics in periodontal health

Introduction : Probiotics represent an area in which bacterial interaction with the hosts is being put to practical and therapeutic use. The mechanism of action of probiotics is related to its ability to compete with pathogenic microorganisms for adhesion sites, to antagonize these pathogens or to modulate the host's immune response. Therefore, changing the actual composition of plaque from an inflammatory cytokine-rich environment to a more benign environment dominated by neutral or even helpful organisms can contribute to overall systemic health.Objective: This non systematic review summarizes the currently available data on the potential benefits of probiotics for periodontal health. Literature review: Current and relevant references were selected in order to summarize the studies conducted so far on probiotics in preventing and treating oral infections. Conclusion: Probiotics as a treatment modality deserves to be explored further with long term studies with specific focus on its role in prevention.