A Minimally Invasive Technique for the Management of Physiologic Gingival Melanin Hyperpigmentation: A Case Series.

An attractive smile enhances an individual's self-confidence. The overall harmony of a smile can be attributed to the interplay of the teeth's shape, color, and position along with the gingival tissue. Gingival pigmentation is observed across all human races, exhibiting variations from one race to another. Typically, gingival hyperpigmentation results from the abnormal buildup of melanin in the gingival tissue, imparting a dark appearance on the gums. Various procedures, collectively known as gingival depigmentation, are employed to address gingival hyperpigmentation. While the initial outcomes of depigmentation procedures are often promising, one common issue associated with them is the potential for re-pigmentation. This article aims to evaluate the clinical effectiveness and patient-reported outcomes of intraepidermal (oral mesotherapy) vitamin C injection for nonsurgical management of physiologic gingival melanin hyperpigmentation.

Assessment of clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in the management of periodontitis - a split mouth randomized clinical trial.

Aim of this study is to assess the clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in management of periodontitis. Type of study is a Split mouth clinical trial in which a total of 13 patients were recruited based on specific inclusion and exclusion criteria. In each participant, random allocation of selected sites into test and control in contralateral quadrants was done. Clinical parameters such as probing depth and clinical attachment loss was measured in control and test sites using occlusal stents. Flap surgery was carried out 6 weeks after phase I therapy and the selected contralateral sites with a probing depth of > 5mm were subjected to surgical therapy. In a test quadrant, 445 nm diode laser with a power of 0.8 W, CW mode, 320 µm fiber, in non-contact mode was used as an adjunct to flap surgery. Primary outcome variable assessed was change in PPD between baseline, pre-operative, 1-, 3- and 6-months post-surgery. Secondary outcomes variables assessed were Clinical attachment loss at baseline, pre-operative, 1, 3 and 6 months, visual analog scale at days 3 and 7 and patient satisfaction index at day 7 post surgery. Surgery for the second site (Test/control) in the contralateral quadrants was performed 1 week after the first surgery. A higher reduction in probing depth and gain in CAL was observed in test site at 1, 3 and 6 months follow up amongst all the included participants. VAS score was lower at the test site as compared to the control sites. PSI scores were similar in both the sites. The adjunctive use of 445nm diode laser to surgical periodontal therapy contributed to improved short term clinical outcomes as assessed at the end of 6 months post- surgery. VAS score indicative of post -surgical discomfort were also lower for the laser treated sites. Hence adjunctive use of laser (445 nm wavelength) can be recommended for achieving more predictable clinical outcomes.

A Minimally Invasive Approach to Managing Isolated Gingival Recession.

Gingival recession (GR), the apical shift of the gingival margin, results in root surface exposure. Its etiology is multifactorial, including teeth position within the dental arch, bony dehiscence, alveolar mucosa thickness, incorrect toothbrushing, orthodontic treatment, and periodontal disease. Coronally advanced flap (CAF) with a subepithelial connective tissue graft (SCTG) is the gold standard for managing GR. With the introduction of minimally invasive surgery, various techniques proposed for managing GR minimize patient morbidity and maximize surgical outcomes. The present case report is that of a 26-year-old male patient with the primary complaint of sensitivity in the upper right and left back teeth regions. Emdogain was used with SCTG for managing recession on the left side and with the xenogeneic collagen matrix (Mucograft) to cover recession on the right side. Post-operative healing was uneventful, with significant recession reduction and an increase in the width of the attached gingiva at both sites. GR, apart from posing as an esthetic complication, also results in tooth sensitivity. This makes the management of GR very important for which multiple treatment modalities are available. The current case report highlights the success of the minimally invasive tunneling technique in managing isolated GR.

LASER Assisted Excision of Solitary Neurofibroma in the Gingiva.

Neurofibromatosis (NF) is a genetic disorder that presents as benign tumours of the nervous system originating from the nerve sheath. It is of three types: Type I, Type II and Schwannomatosis. Type I Neurofibromatosis or von Recklinghausen's disease is the most common type of neurofibromatosis seen and it accounts for 90% of all cases seen. It can be seen as light brown pigmentation spots (Café-au-lait) on the skin and multiple small tumours among the nerves. Oral manifestations of NF are very rare and can be seen as sessile lesion in the tongue or the gingiva. The major complaints of the oral manifestations include difficulty in speech and mastication which it results in progression of periodontal disease. Here, we present a case report of Type I NF which presented as a sessile lesion in the right maxillary gingiva, for which we performed an excisional biopsy using LASER.

An In-vitro Assessment of the Physical and Chemical Properties of Toothbrush Bristle Following Decontamination by Three Different Methods: A Pilot Study.

Background Toothbrushes are the most commonly used mechanical plaque control methods, and they are said to harbor microorganisms if not stored properly following usage. Objective An assessment of the influence of a decontaminating agent (sterile water (control)/chlorhexidine mouthwash/herbal mouthwash) on the properties of toothbrush bristles following storage for 24 hrs by means of scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Methodology The study involves a total of 24 slim soft toothbrushes (six samples per group) with different decontaminating agents: Group 1: Vented container, Group 2: Sterile water, Group 3: 0.2% Chlorhexidine mouthwash, and Group 4: Herbal mouthwash. The toothbrushes were stored in their respective containers for 24 hours, following which, snippets of toothbrush bristles were collected and tested for the evaluation of wear using SEM and the biochemical alteration occurring in the bristles was assessed using FTIR. Results and conclusion The Group 2 and Group 3 samples showed significant wear (Score 2) under SEM evaluation, and FTIR spectroscopy evaluation revealed that changes occur in the fingerprint region of infrared spectroscopy owing to chemical bond alteration following decontamination. Considering the benefits we acquire in terms of microbial load reduction, decontamination is recommended, though it might necessitate frequent changing of toothbrushes.

A Present Day Approach to Crown Lengthening - Piezosurgery.

Maintaining a healthy periodontium during restorative procedures is an indispensable condition for achieving optimal functioning and esthetics. Thus, the knowledge of anatomy, influence of the restorative material and its complement on periodontium is vital. Difficulty in maintaining adequate biological width (BW) is a frequent problem encountered in this type of reconstruction. Crown lengthening is commonly used to maintain the dentogingival complex in optimal conditions and to correct aesthetic defects through a smile design. Piezosurgery, which uses a modulated ultrasonic frequency, permits highly precise and safe cutting of hard tissue. Because of its highly selective and accurate nature, its use may be extended to more complex surgical and interdisciplinary cases. In this case report, we present the contemporary use of piezosurgery for crown lengthening procedure.