Antimicrobial Properties and Substantivity of Gentamicin, Amoxicillin and Metronidazole (GAM) Antibiotic Solution with Chitosan as a Root Canal Irrigant - A Preliminary Study.

Irrigation is one of the steps that is very crucial in a high-quality endodontic treatment. Hence, irrigant with good substantivity is essential which must not only be effective for the dissolution of the organic tissues but also effectively eliminate bacterial contamination. The aim of the study was to investigate and compare the antimicrobial efficacy of gentamicin, amoxicillin, and metronidazole (GAM) antibiotic solution, chitosan and their combination (GAMC), and analyze their sustained release property. Mueller-Hinton agar medium was inoculated with E. faecalis. The medicaments were then poured at the center of the plate in the prepared wells and incubated at 37°C. Antibacterial property of each medicament was evaluated by measuring the diameter of the zone of inhibition at the end of 48 hours. The substantivity of GAM antibiotic solution and the GAMC was checked using an ultraviolet spectrophotometer. The GAMC demonstrated the strongest antimicrobial activity and good sustained-release properties. Distilled water showed no activity, and chlorhexidine acted as the positive control. Conclusion: The combination of gentamicin, amoxicillin, and metronidazole (GAM) solution with chitosan (GAMC) can be used as an alternative intracanal irrigant as it was found to be a potent antibacterial agent.

An Overview of Chitosan and Its Role in Periodontics.

Chitosan is a biopolymer with numerous biological properties such as antibacterial, anti-inflammatory, and wound healing. Chitosan also stimulates cell proliferation and osteogenesis and thus used as a scaffold material in tissue engineering. The physical proprieties of chitosan such as biocompatibility and biodegradability give promising results in periodontal therapies. This review gives an updated explanation of the applications of chitosan in dentistry and periodontics. Furthermore, the review demonstrates the actions of chitosan in detail and its role in the regeneration of periodontal structures.

A Case of Keloid.

Keloids are unorganized proliferation of fibrous tissue, usually arising from a site of injury, due to an aberrant healing process. Clinically, it presents as an ugly scar tissue on the skin and shows genetic predilection. They cause esthetic, physical, and psychological disturbances in the affected individuals. Such patients require special precautions during the normal surgical procedures. Keloid treatment is prone to a high degree of resistance and recurrence. In this article, one such a case is reported along with a review of the literature discussing the nature of the lesion, treatment options, and the recommended precautions.

Comparison of Time-kill Assay to Evaluate the Antimicrobial Efficacy of Garlic (Allium sativum) and Guava (Psidium guajava) Extracts on Periodontal Pathogens.

BACKGROUND: The role of Gram-negative anaerobic periodontal pathogens in periodontal diseases has led to the loss of tooth-supporting structures. These diseases can be prevented by the inhibition of bacterial biofilm on the tooth surfaces. Many treatment modalities have been tried to prevent periodontal diseases. With the rise in resistance to synthetic antimicrobials, there is a requirement to develop natural antimicrobials for the control of periodontitis. AIM: The aim of the study was to evaluate and compare the efficacy of garlic (Allium sativum) and guava (Psidium guajava) extracts on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans using time-kill assay. MATERIALS AND METHODS: Aqueous garlic extract (AGaE), ethanolic garlic extract (EGaE), aqueous guava extract (AGuE), and ethanolic guava extract (EGuE) were prepared. Time-kill assays were performed on P. gingivalis and A. actinomycetemcomitans. The aqueous and ethanolic extracts of guava and garlic were compared to assess the maximum bactericidal potency. RESULTS: The comparison of time-kill assay of AGaE and AGuE on P. gingivalis showed a statistically significant difference at 2 h (t = 5.29, P < 0.01), 4 h (t = -4.867, P < 0.01), and 6 h (t = -3.647, P < 0.001). The comparison of time-kill assay of EGaE and EGuE on A. actinomycetemcomitans showed a statistically significant difference at 2 h (t = 4.54, P < 0.01) and highly significant difference at 4 h (t = 6.57, P < 0.001). CONCLUSIONS: The, judicious use of these phytomedicinal products could be cost-effective and also the adverse effects caused due to the long-term usage of synthetic antimicrobials can be avoided.

Evaluation of Frictional Forces Generated between Three Different Ligation Methods with Four Different Sizes of Orthodontic Archwires: An In vitro Study.

AIM: This in vitro study was done to evaluate and compare the frictional forces produced by a passive self-ligating bracket (SLB) and two types of elastomeric ligatures (unconventional elastomeric ligatures [UELs] and conventional elastomeric ligatures [CELs]) on a conventional bracket used with four types of wires. MATERIALS: In this in vitro study, 8 numbers of conventional preadjusted edgewise appliance stainless steel brackets and 4 numbers of passive SLBs were tested. Four types of archwires and two types of ligatures were tested. Brackets were divided into three groups - Group I, Group II, and Group III. All the three groups were further divided into four subgroups based on different archwires. METHODS: Custom-made mounting jig was specially constructed for this study - upper member and lower member. After the samples were mounted, traction test was conducted using universal testing machine and readings were tabulated for all specimens. The variables in each group were subjected to one-way analysis of variance. RESULTS: All the three groups were tested for its total friction, static friction, and kinetic friction. SLBs showed a static mean little lower and had kinetic mean little greater than conventional bracket with unconventional module. CONCLUSION: UELs on conventional brackets and SLBs are able to produce lower frictional force when compared with CELs on conventional brackets.

Therapeutic Dimensions of Bisphosphonates: A Clinical Update.

Bisphosphonates (BPs) are a commonly used class of drugs for the treatment of bone disorders. An extensive review of BPs with their clinical efficacy and safety profile is unavailable. This study aimed to review the available literature on BPs, summarize their role in clinical therapy, and emphasize their safety profile. Authors reviewed the existing literature using the Google Scholar, PubMed, and Micromedex databases and analyzed the collected articles. BPs are the preferred medication for osteoporosis and other similar conditions owing to their efficient antiosteoclastic activity. Few of them are available in oral dosage forms; hence, they are patient-friendly. The mechanism of action, common adverse effects and their clinical applications, precautions and warnings pertaining to the route of administration, and safety profiles have been discussed in this manuscript. The common adverse effects are majorly related to the gastrointestinal, cardiovascular, and endocrine system. Upon chronic usage, patients may experience serious problems like osteonecrosis of the jaw and atypical bone fractures. Although BPs are effective and safe, they may cause GI adverse effects and rare cases of osteonecrosis. Patient counseling could prove beneficial in early identification and prevention of the adverse effects associated with BPs.

Focus on periodontal engineering by 3D printing technology ­ a systematic review / Enfoque en la ingeniería periodontal mediante la tecnología de impresión 3D: una revisión sistemática

Three-dimensional (3D) bioprinting of cells is an emerging area of research but has not been explored yet in the context of periodontal tissue engineering. Objetive: This study reports on the optimization of the 3D bioprinting scaffolds and tissues used that could be applied clinically to seniors for the regenerative purpose to meet individual patient treatment needs. Material and Methods: We methodically explored the printability of various tissues (dentin pulp stem/progenitor cells, periodontal ligament stem/progenitor cells, alveolar bone stem/progenitor cells, advanced platelet-rich fibrin and injected platelet-rich fibrin) and scaffolds using 3D printers pertaining only to periodontal defects. The influence of different printing parameters with the help of scaffold to promote periodontal regeneration and to replace the lost structure has been evaluated. Results: This systematic evaluation enabled the selection of the most suited printing conditions for achieving high printing resolution, dimensional stability, and cell viability for 3D bioprinting of periodontal ligament cells. Conclusion: The optimized bioprinting system is the first step towards the reproducible manufacturing of cell laden, space maintaining scaffolds for the treatment of periodontal lesions.

La bioimpresión tridimensional (3D) de células es un área emergente de investigación, pero aún no se ha explorado en el contexto de la ingeniería de tejidos periodontales. Objetivo: Este estudio informa sobre la optimización de los tejidos y andamios de bioimpresión 3D utilizados que podrían aplicarse a personas mayores en el entorno clínico con fines regenerativos para satisfacer las necesidades de tratamiento de cada paciente. Material y Métodos: Exploramos metódicamente la capacidad de impresión de varios tejidos (células madre / progenitoras de la pulpa de dentina, células madre / progenitoras del ligamento periodontal, células madre / progenitoras de hueso alveolar, fibrina rica en plaquetas avanzada y fibrina rica en plaquetas inyectada) y andamios utilizando impresoras 3D que pertenecen solo a defectos periodontales. Se ha evaluado la influencia de diferentes parámetros de impresión con la ayuda de andamios para promover la regeneración periodontal y reemplazar la estructura perdida. Resultados: Esta evaluación sistemática permitió la selección de las condiciones de impresión más adecuadas para lograr una alta resolución de impresión, estabilidad dimensional y viabilidad celular para la bioimpresión 3D de células del ligamento periodontal. Conclusión: El sistema de bioimpresión optimizado es el primer paso hacia la fabricación reproducible de andamios de mantenimiento de espacio cargados de células para el tratamiento de lesiones periodontales

Efficacy of Psidium guajava and Allium sativum Extracts as Antimicrobial Agents against Periodontal Pathogens.

BACKGROUND: The accumulation and maturation of bacterial plaque at the gingival margin is widely recognized as the primary etiological factor in the development of chronic periodontitis. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. AIM: The aim of this study was to evaluate the efficacy of Psidium guajava (guava) and Allium sativum (garlic) on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. MATERIALS AND METHODS: Aqueous guava extract (AGvE), ethanolic guava extract (EGvE), aqueous garlic extract (AGE), and ethanolic garlic extract (EGE) were prepared. The inhibitory effects of these extracts for the periodontal pathogens were tested by agar well diffusion method. Minimal inhibitory concentration (MIC) of the aqueous and ethanol extracts of guava and garlic was determined by macrobroth dilution method. Minimum bactericidal concentration (MBC) was done to observe the bactericidal effect of the guava and garlic extracts against the organisms. RESULTS: Of the AGE, 25, 50, and 75 µL showed 16, 20, and 25 mm zone of inhibition, respectively, on P. gingivalis. The AGE showed greater bacteriostatic activity against the P. gingivalis with MIC determined at 16.6 µL/mL. MIC determined for AGvE and EGvE was at 75 µL/mL concentration for P. gingivalis, whereas EGvE showed the activity at 75 µL/mL on P. gingivalis. MIC determined for AGvE was at 50 µL/mL, whereas MIC determined for EGvE was at 3.12 µL/mL for A. actinomycetemcomitans. CONCLUSION: P. guajava and A. sativum displayed a significant antibacterial effect. A. sativum was found to be most effective against P. gingivalis, whereas P. guajava showed the highest efficacy on A. actinomycetemcomitans.

Embracing Personalized Medicine in Dentistry.

AIM: The aim of this systematic review was to evaluate the number of articles in the area of personalized medicine specific to dentistry. MATERIALS AND METHODS: Electronic search using three databases was performed using PubMed, Embase, and Scopus search. RESULTS: Results suggest that there is a definite need for more awareness and research pertaining to this specific area. CONCLUSION: With this background, the authors have written a comprehensive review on applications of personalized medicine in various branches of dentistry.

Periodontal Accelerated Osteogenic Orthodontics Technique for Rapid Orthodontic Tooth Movement: A Systematic Review.

AIM: The aim of this review was to analyze the data in the available literature regarding aspects of periodontally accelerated orthodontic therapy such as reduction in treatment time, variation in surgical techniques, and patient satisfaction. MATERIALS AND METHODS: An internet-based search was performed for the articles published between January 2008 and August 2018 using keywords periodontal accelerated orthodontic tooth movement, corticotomy, bone grafting, tooth movement, and treatment duration. A total of 84 articles were obtained from MEDLINE and Embase search engines, of which 31 articles were eligible to be included for the systematic review. RESULTS: On analysis, it was observed that the earlier studies were predominantly pertaining to case reports. In the later part of the decade considered in this review, it was observed that the emphasis was given to clinical and animal studies. CONCLUSIONS: Most of the studies included in the review concluded that there was a significant reduction in orthodontic treatment duration using periodontal accelerated techniques compared to conventional orthodontic treatment.

Evaluation of Sagittal Changes in Class II Div 2 Patients with Decelerating Phase of Growth by PowerScope Appliance: A Retrospective Cephalometric Investigation.

BACKGROUND: Restricted mandibular growth is observed in Class II Div 2 malocclusions. The fixed functional appliances are used to effect the skeletal changes in patients with end stages of skeletal maturity. AIM: This cephalometric study aimed to distinguish the skeletal and dental corrections done in the mandible on skeletal Class II Div 2 subjects when treated with PowerScope appliance (American Orthodontics, Sheboygan, WI). MATERIALS AND METHODS: This is a cephalometric study based on the retrospective data. The patients selected for this study were with Class II Div 2 malocclusion and assessed to be in decelerating phase of skeletal growth. A total of 12 patients were selected after applying inclusion and exclusion criteria. A PowerScope was placed after incisor correction and followed up till Class I molar relation was achieved. The initial values (T1) at the time of placement of the appliance and the final values at the end of the molar correction (T2) were noted. The cephalometric parameters at T1 and T2 were assessed using sagittal occlusal (SO) analysis by Pancherz. The paired Student's t-test was used to analyze pre- and posttreatment changes. RESULTS: There was sufficient lengthening of the mandible (4.38 mm). Both the dental and skeletal alterations were observed in the mandible. These changes were marked compared to the maxilla. The pre- and posttreatment changes were statistically significant for the mandibular skeletal changes (P < 0.001) as well as mandibular incisor proclination (P < 0.001). CONCLUSION: The PowerScope can be used as a propeller for sagittal mandibular correction in Class II Div 2 patients.

A Newly Proposed Regression Equation for Mixed Dentition Analysis Using the Sum of the Width of Permanent Mandibular Central Incisors and Permanent Mandibular First Molars as a Predictor of Width of Unerupted Canine and Premolars

Objective: To determine linear regression equation to predict the mesiodistal widths of the permanent canines and premolars based on the sum of the widths of the two permanent mandibular first molars and two mandibular central incisors. Material and Methods: The sample consisted of 800 (400 males and 400 females) permanent dentition casts of Chhattisgarh population. Mesiodistal crown widths of teeth were measured with digital caliper. The correlation and linear regression equations between the calculated four teeth (two permanent mandibular first molars and two central incisors) and the canine-premolars segments of both the arches were developed. Results: No significant differences were found in right and left side of the arch. Sexual dimorphism was significant in teeth sizes with higher mesiodistal dimension in males. A good correlation values varying from 0.51 to 0.67 was found. New standardized regression equations were formulated for the prediction of the mesiodistal widths of unerupted canines and premolars for Chhattisgarh population. Conclusion: Calculating mesiodistal widths of unerupted canine and premolars with help of two permanent mandibular molars and two mandibular central incisors, which erupt early in the oral cavity, can be an alternative and best predictor for the mixed dentition analysis.

A New Regression Equation Proposed For Mixed Dentition Analysis in Chhattisgarh, Central India Population

Objective: To develop and propose a new regression for mixed dentition analysis in Chhattisgarh, Central India population. Material and Methods: The permanent dentition dental casts of 800 (400 males and 400 females) Chhattisgarh subjects were selected. Digital caliper was used to measure the mesiodistal crown widths of teeth. The linear regression equations and correlation between four mandibular incisors and the canine-premolars segments of maxillary and mandibular arches were developed (modified Tanaka-Johnston equation) and proposed for Chhattisgarh population. Results: New standardized regression equations were formulated to predict the mesiodistal widths of unerupted canines and premolars especially for Chhattisgarh, Central India population. The equation in males for maxillary arch was Y = 11.90 + 0.39 (X) and for mandibular arch was Y = 12.23 + 0.36 (X). Similarly, the equation in females for maxillary arch was Y = 14.40 + 0.26 (X) and for mandibular arch was Y= 10.26 + 0.43 (X). A significant sexual dimorphism in teeth sizes was seen with higher mesio distal dimension in males in Chhattisgarh population. Conclusion: Sum of the mesiodistal diameter of permanent mandibular incisors can be used reliably to predict/estimate the sum of mesiodistal diameters of unerupted canines and premolars with the new regression equations.

Management of horizontally impacted dilacerated lateral incisor.

Impaction of maxillary lateral incisor with odontome and retained deciduous tooth is not often seen in regular dental practice. Impaction of anterior teeth cause generalized spacing which affects the esthetics of the face. Here we report a case of an 18-year-old patient with horizontally impacted dilacerated lateral incisor, which was bought into occlusion with the help of orthodontic tooth movement within a span of 18 months.

Estimation of alkaline phosphatase in the gingival crevicular fluid during orthodontic tooth movement in premolar extraction cases to predict therapeutic progression.

OBJECTIVES: The objective was to estimate the level of alkaline phosphatase (ALP) in gingival crevicular fluid (GCF) during en-masse retraction stage of orthodontic tooth movement. MATERIALS AND METHODS: 10 patients in the age group of 15-20 years participated in this study. GCF was sampled from the distal surface of the canine and mesial surface of the second premolar on day 0, 1, 7, 14, 21, and 28 postorthodontic treatment. RESULTS: A marked fall in the level of ALP was evident following force application. A progressive decreasing trend in ALP activity on both distal aspect of canine and mesial aspect of the second premolar was observed. The fall in ALP was more on distal aspect canine when compared to the mesial aspect of the second premolar. CONCLUSIONS: Measure of ALP activity in GCF could be an indicator of the biochemical and cellular alterations in bone turnover and hence rate the amount of tooth movement following orthodontic force application.

The assessment of sagittal changes with twin block appliance in patients with decelerating growth phase.

INTRODUCTION: The main reason for seeking orthodontic treatment for Class II malocclusions is aesthetic improvement. Growth modification treatment procedures offer better results for a patient with significant potential growth. AIM: The aim of this cephalometric clinical study was to distinguish skeletal and dental corrections on skeletal class II division I growing subjects with Twin Block therapy (TB) and the changes were assessed using SO-analysis by Pancherz. MATERIALS AND METHODS: Strict diagnostic protocol viz. growing individuals with horizontal growth pattern, skeletal class II due to retrognathic mandible with positive VTO, bilateral class II molar relation, minimal crowding in either arch or overjet more than 5mm was used. Out of 28 selected cases,17 patients received TB therapy and 11 patients were maintained as control group. Standard removable TB appliances with lower incisor capping were delivered to treatment group. The horizontal advancement was about 8mm and 2-3mm vertical opening between the upper and lower central incisors were maintained for all the cases. The mean time interval between the initial (T1)and post treatment (T2) cephalograms of Twin-Block group was 11 month,with a range of 8 month to 13 month. In the control group, the mean time interval between the first (C1)and second (C2) cephalometric films was 12 month,with a range of 10 month to 14 month.T1and T2 cephalograms were traced and S-O analysis was used to segregate dental and skeletal effects. STATISTICAL ANALYSIS: SPSS software was used for statistical analysis. RESULTS: Skeletal Changes: In this study, the mean movement of maxilla was 0.67mm which represents significant restriction of forward maxillary growth in contrast to control groups. Dental Changes: In this study the maxillary molars appear to move distally with a mean value of 0.13mm. Comparing this to the movement of maxillary jaw base itself, maxillary distal movement of molar is less. But still it contributes to Class II correction. CONCLUSION: The overjet reduction and molar relation correction are more skeletal in nature.