Lip repositioning with or without myotomy: a systematic review

Excessive gingival display is an esthetic issue that is commonly managed by different procedures. Lip repositioning is a modality to address concerns of affected patients. The aim of this review was to investigate the scientific evidence on outcomes and long-term stability of lip repositioning surgery with or without myotomy. The electronic search was conducted in three databases: MEDLINE, Embase, and the Cochrane Library up to October 2019.No publication status, language, or time restrictions were applied. The electronic search was complemented by a manual search of the reference lists.Three hundred thirty-eight studies were screened by title, and 16 articles remained for data extraction. The included studies assessed the lip repositioning procedure in 144 patients aged between 15-59 years (134 females and 10 males). Based on the available data, lip repositioning with myotomy/muscle containment can be a successful treatment for minor discrepancies in gingival display in selected cases. However, further well-organized controlled clinical trials are recommended to derive a conclusion about the long-term stability compared with other alternatives.

Efficacy of conventional laser irradiation versus a new method for gingival depigmentation [sieve method]: a clinical trial

Introduction: Diode laser irradiation has recently shown promising results for treatment of gingival pigmentation. This study sought to compare the efficacy of 2 diode laser irradiation protocols for treatment of gingival pigmentations, namely the conventional method and the sieve method

Methods: In this split-mouth clinical trial, 15 patients with gingival pigmentation were selected and their pigmentation intensity was determined using Dummett's oral pigmentation index [DOPI] in different dental regions. Diode laser [980 nm wavelength and 2 W power] was irradiated through a stipple pattern [sieve method] and conventionally in the other side of the mouth. Level of pain and satisfaction with the outcome [both patient and periodontist] were measured using a 0-10 visual analog scale [VAS] for both methods. Patients were followed up at 2 weeks, one month and 3 months. Pigmentation levels were compared using repeated measures of analysis of variance [ANOVA]. The difference in level of pain and satisfaction between the 2 groups was analyzed by sample t test and general estimate equation model

Results: No significant differences were found regarding the reduction of pigmentation scores and pain and scores between the 2 groups. The difference in satisfaction with the results at the three time points was significant in both conventional and sieve methods in patients [P = 0.001] and periodontists [P = 0.015]

Conclusion: Diode laser irradiation in both methods successfully eliminated gingival pigmentations. The sieve method was comparable to conventional technique, offering no additional advantage

Using diode laser for soft tissue incision of oral cavity

The purpose of this case report is to analyze the results of vestibuleplasty around an over-denture based on dental implants to determine the evidence on the effectiveness of laser-assisted surgery and soft tissue management in implant dentistry. The patient in this case report was a 57 year- old male who was completely edentulous, with a mandibular over denture based on 4 standard implants suffering from pain on chewing, and a general discomfort, especially in anterior segment. He received a standard gingival augmentation surgery which failed to create sufficient vestibular depth. A laser-assisted vestibuloplasty was done to make the environment suitable for making a new overdenture. There were clinically significant improvements in vestibular depth and peri implant soft tissue situation by laser. Also, bleeding during surgery was well controlled; the patient's discomfort and pain were less than the first operation done with gingival graft. Based on our clinical data and review of the literature, an evidence-based approach to the use of lasers for the management of soft tissue in oral surgery is necessary. Simply, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. However, improved hemostasis and patient's satisfaction can be considered as advantages of adjunctive laser therapy in some clinical situations like vestibuloplasty

[Comparison of the clinical efficacy of scaling and root planning with and without topical application of vitamin E via tray method for treatment of chronic periodontitis: a randomized clinical trial]

Microbial plaque is the main cause of periodontal disease. Production of free oxygen radicals is an immune system mechanism to destroy invading microorganisms which per se results in further destruction of periodontal tissues. The present study sought to assess the efficacy of anti-oxidant application [vitamin E] as an adjuvant treatment following scaling and root planning in periodontal patients. For this randomized clinical trial 10 patients aged 30 to 50 years suffering from moderate to severe periodontitis with no systemic disease were selected. After scaling and root planning, 5% vitamin E for one side and placebo for the opposite side were poured in a maxillary custom tray and placed inside the mouth. Type of treatment did not have a significant effect on the understudy factors. However, time had a significant effect on the majority of indices. Healing was significantly better at week 4 following initiation of treatment compared to week 2. The values in proximal and radicular sites were -0.151, p=0.002 and -0.31, p=0.001 for pocket depth, -0.217, p=0.002 and -0.401, p=0.001 for CAL, -4.188, p=0.001 and -0.391, p=0.272 for BOP and -0.219, p=0.05 for GI, respectively. The present study showed that the effect of time was greater than the type of treatment on improvement of indices

Association between periodontal pathogens and coronary artery disease: a case-control study

We sought to answer the questions about the role of inflammatory factors in the formation of pathological lesions in the endothelium of the coronary vessels and also the role of host-based bacteria, including chronic periodontitis, in the clot formation in the blood vessels, all of which destabilize the atherosclerotic plaque. This case-control study was done on 40 patients who underwent elective coronary artery bypass grafting surgery [CABG] with the need of coronary endarterectomy. In Group A, patients had chronic periodontitis and group B consisted of patients without it. Both groups were well matched regarding their demographic data. The subgingival plaque was collected by a sterile curette from periodontal pockets >/= 5mm and CAL >/= 4mm. Also, atherosclerotic plaque was collected during the coronary endarterectomy surgery from all of the 40 patients. The specimens were assessed using the PCR technique to detect the specific bacteria responsible for chronic periodontitis such as actinobacillus actinomycetemcomitans [Aa], prevotella intermedia [Pi], porphyromonas gingivalis [Pg], Tanerella forsythensis [Tf], Treponema denticola [Td], and fusobacterium nucleatum [Fn]. In the atherosclerotic plaque of group A patients, Aa was identified in 18 [90%], Pg in 16 [80%], Tf in 13[65%],Td in 11 [55%], Pi in 10 [50%], and Fn in 6 [30%] specimens, whereas in group B the incidence was significantly lower [p< 0.0001]. In the subgingival plaque of group A, Aa and Tf were found in all 20 individuals and Pg, Pi, Td and Fn were identified in 19 specimens [95%]. The differences in the incidence of Aa and Pg in two plaque samples were not significant, but the two plaque samples showed significant differences regarding the incidence of the other pathogens [Pi: p<0.001, Tf: p<0.008, Td: p<0.003 and Fn :p<0.0001]. In the present study, the same organisms were found in both coronary atherosclerotic and subgingival plaques. The findings support the potential role of the periodontopathogenic bacteria species in some steps of the atherosclerotic process as a contributor that worsens this disease. However, further studies are required to achieve more definite results regarding the role of periodontal diseases in the atherosclerotic disease, focusing on patients' background variables

[Evaluation of the prevalence and causes of halitosis]

Evaluation of the prevalence and causes of bad breath [Halitosis] has engaged mans mind for centuries. In ancient medical literature, there have been some remarks about halitosis as well as suggestions for its treatment. Halitosis is not a disease by itself. This condition is a symptom of disease. Halitosis can be produced by three factors: Intra-and extra oral factor, and delusional halitosis. The aim of the investigation was to evaluate the prevalence and causes of halitosis. Four hundred patients referring to oral medicine clinics of the dental school of Yazd participated in this study. Prevalence of halitosis was 28%. 29% of these subjects were female and 28% were male. There was no significant difference between males and females [P> 0.05]. The most common intra oral causes of halitosis were dental carries [89%], food-impaction and other retentive factors [72%], periodontal pocket [71%] and coated tongue [60%]. Sinusitis [60%] was the most common extra oral cause of halitosis. The correlation between different age groups and halitosis was not significant [P>0.05]. The correlation between education and halitosis was also not significant [P>0.05]. This study also revealed that 68% of patients were aware of their bad breath. The most common causes of halitosis are intra oral, which can be prevented by appropriate treatment, education and increased public awareness

Evaluation of association between hyperlipidemia and periodontitis

Hyperlipidemia is a major risk factor for cardiovascular disease. In recent years some evidence has been presented regarding the association between periodontal and cardiovascular diseases. The aim of this study was the evaluation of association between hyperlipidemia and periodontitis. In this case-control study, levels of plasma lipids in 40 subjects with periodontitis [CPITN score III or IV] were measured and compared with 40 age and sex matched controls. Data were analyzed using t-student test with P<0.05 as the limit of significance. Total cholesterol [CHL] and triglyceride [TG] were significantly higher in case group compared with control group. [P=0.045 and P=0.016 respectively]. HDL and LDL cholesterols were higher in cases but showed no significant differences with controls. The relative frequency of pathologic values of CHL and TG were significantly greater in cases compared with control group [P=0.005 and P=0.001 respectively]. Based on the findings of this study, hyperlipidemia may be associated with periodontitis in medically healthy peoples but whether periodontitis causes an increase in levels of serum lipids or whether hyperlipidemia is a risk factor for both periodontitis and cardiovascular disease need to be further investigated