Effect of low intensity ultra sound on bone regeneration and healing: a systematic review

ABSTRACT Objective: Low Intensity Pulsed Ultra Sound (LIPUS) is found to have stimulatory effect on bone healing and regeneration. This review aimed to assess whether LIPUS enhances bone regeneration and healing in terms of efficiency in improving clinical, radiographic, histologic parameters or serum and tissue biomarkers. Methods: A comprehensive search based on PRISMA guidelines with pre-determined eligibility criteria was conducted to identify randomized controlled clinical trials evaluating effectiveness of Low intensity pulsed ultrasound in bone regeneration and healing. The title and abstract of the entries in all languages yielded from the PubMed, Google scholar and Cochrane library were screened. Results: 14 eligible Randomized controlled trials testing the effectiveness of LIPUS was evaluated. More heterogeneity was seen in the screened studies with respect to sample characteristics, type of bone and outcome measures. The studies that screened histological parameters state that LIPUS is significantly beneficial than control. In terms of time for radiographic union, most of the studies stated that LIPUS was more effective than control but numberof studies are very few. Whereas studies which evaluated parameters such as healing time and radiographic union were showing highly inconsistent results regarding effectiveness of LIPUS. Conclusion: This review cannot give a definitive conclusion that LIPUS is effective in bone healing with respect to clinical parameters but a positive influence on radiographical and histological parameters in bone healing and regeneration is promising to pursue future research.

Periodontal vaccines: a systematic review / Vacinas periodontais: uma revisão sistemática

Background: vaccination is the best known application of immunology to human health. Effective vaccines have successfully eradicated the prevalence of several infectious diseases that were common less than a generation ago. The success of Periodontal vaccines is still elusive due to the complexity of periodontal pathogens that have multiple serotypes. No periodontal vaccine trials have satisfied all the requirements such as preventing colonization of pathogens, protection against tissue destruction and alveolar bone loss, elicit immunoglobulins for phagocytosis, stimulation of T-helper cells. This review aims to discuss the various immunization strategies attempted so far. Objective: this review aims to discuss the various in-vitro and in vivo studies that present supporting evidence for the feasibility of formulating a prophylactic periodontal vaccine that could emerge as an adjunct to mechanical therapy in the future. Material and Methods: an extensive literature Search was performed in electronic databases, such as PUBMED, Cochrane central register of controlled trials, Google scholar and science direct using various search terms such as " periodontal vaccines", " porphyromonas gingivalis", "chronic periodontitis", " genomic vaccine ", " recombinant vaccine", "immune response", " vaccination against periodontal bacteria". No limits and language restriction were applied during the electronic search to include all the possible animal studies, clinical trials in the potential relevant article search phase of the systematic review. Conclusion: Studies evaluating Porphyromonas gingivalis are the most common and the structures showing the most potential as a vaccine candidate are Outer membrane proteins, fimbriae and gingipains, the structure having the least potential is Lipopolysaccharide. (AU)

Fundamentação: a vacinação é a aplicação mais conhecida da imunologia à saúde humana. As vacinas eficazes erradicaram com sucesso a prevalência de várias doenças infecciosas que eram comuns há menos de uma geração atrás. O sucesso das vacinas periodontais ainda é ilusório devido à complexidade de patógenos periodontais que possuem múltiplos sorotipos. Nenhum estudo de vacina periodontal atendeu a todos os requisitos, como prevenção da colonização de patógenos, proteção contra destruição de tecidos e perda óssea alveolar, estimulação de imunoglobulinas para fagocitose, estimulação de células T auxiliares. Esta revisão tem como objetivo discutir as várias estratégias de imunização tentadas até o momento. Objetivo: esta revisão tem como objetivo discutir os vários estudos in vitro e in vivo que apresentam evidências de apoio à viabilidade de formular uma vacina periodontal profilática que possa emergir como um complemento da terapia mecânica no futuro. Material e Métodos: Foi realizada uma extensa pesquisa bibliográfica em bancos de dados eletrônicos, como PUBMED, registro central de ensaios controlados Cochrane, Google Acadêmico e science direct, usando vários termos de pesquisa como "vacinas periodontais", "porphyromonas gingivalis", "periodontite crônica" , "Vacina genômica", "vacina recombinante", "resposta imune", "vacinação contra bactérias periodontais". Nenhum limite e restrição de idioma foi aplicado durante a busca eletrônica para incluir todos os possíveis estudos em animais e ensaios clínicos na fase de busca de artigos potencialmente relevantes da revisão sistemática. Conclusão: Estudos avaliando Porphyromonas gingivalis são os mais comuns e as estruturas que mostram maior potencial como candidato a vacina são proteínas de membrana externa, fímbrias e gengivinas, a estrutura com o menor potencial é lipopolissacarídeo.(AU)

Aesthetic Papillary Reconstruction – A Case Report of a New Technique Using Connective Tissue Graft.

Lost interdental papilla- commonly known as ‘black triangles’ are of great concern from the aesthetic as well as phonetics point of view when occurs in the anterior maxillary region. This causes an enormous effect on the self esteem of a person. The correction of lost interdental papillae is however one of the most challenging periodontal plastic surgical procedures as the interdental papilla is an end organ and does not have a blood supply of its own. Various techniques have been proposed with varied success rate for its management. We elicit a case report of papillary reconstruction in this article using connective tissue graft by undermining the gingiva-papillary unit to preserve the papillary blood supply.

Analysis of association of TaqI VDR gene polymorphism with the chronic periodontitis in Dravidian ethnicity.

AIM: The aim of this study is to analyze the association of TaqI vitamin D receptor (VDR) gene polymorphism with the chronic periodontitis (CP) in Dravidian ethnicity. MATERIALS AND METHODS: A total of 120 subjects were recruited for this study, which included 60 CP and 60 healthy controls. TaqI VDR gene polymorphism was analyzed using specific primers and amplified by polymerase chain reaction (PCR) and visualized under 2% agarose gel. RESULTS: Our study results showed that Tt and tt genotype had a higher frequency of occurrence in CP compared with controls. Similarly, t allele was found to be associated with CP. CONCLUSION: Our study concludes that TaqI VDR gene polymorphism is associated with CP in Dravidian ethnicity.

Comparative analysis of presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1) in cases of chronic periodontitis and aggressive periodontitis with controls.

Aim : The aim of the present study was to evaluate the presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1)viruses in sub gingival plaque of chronic periodontitis (groupA), aggressive periodontitis patients (group B), periodontally healthy controls (group C) and to compare the clinical parameters between virus negative and positive sites in each of these groups. Materials and Methods : Sixty subjects were included in the study and equally divided into the 3 groups (group A - 20, group B - 20, group C - 20). Sub gingival plaque samples were obtained from the 3 deepest periodontal pocket sites in case of subjects suffering from periodontitis, and from one random bleeding site per quadrant in healthy groups. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD) and clinical loss of attachment (CAL) were recorded. Viral Deoxyribonucleic acid (DNA) was extracted using Proteinase-K DNA Extraction method, and the presence of CMV and EBV-1 was detected by polymerase chain reaction and 2% agarose gel. Results: Results of our study showed a 45% prevalence of CMV and EBV-1 in Aggressive periodontitis cases. Prevalence of CMV in chronic periodontitis and healthy subjects was 20% and 10%, respectively; while for EBV-1 it was 25% and 0%, respectively. In terms of comparison of the clinical parameters with virus presence, both CMV and EBV-1 positive sites showed a significantly higher mean pocket depth compared to virus negative sites. Conclusion: Our studyshowed that the prevalence of EBV1 was higher in chronic and aggressive periodontitis subjects compared to controls and the prevalence of CMV was higher in aggressive periodontitis patients. The virus positive sites showed higher pocket depth compared to virus negative sites.

Treatment of human periodontal infrabony defects with hydroxyapatite+ β tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial.

Background: The present study was aimed at comparing the clinical effectiveness of two regenerative techniques - platelet rich plasma (PRP) + bone graft (HA + β TCP) versus bone graft (HA + β TCP) + normal saline in the treatment of periodontal intrabony defects. Materials and Methods: Ten patients diagnosed with chronic periodontitis were enrolled in a randomized split mouth clinical trial. Following phase I therapy the sites were randomly assigned to the test group - PRP + bone graft (HA + β TCP) and control group - saline + bone graft (HA + β TCP). Clinical parameters recorded at baseline and 6 months included plaque index, probing pocket depth, relative attachment levels, and relative gingival margin levels. Hard tissue evaluation was done using digital radiography to evaluate the image intensity and therefore the radioopacity of a desired region of interest in the intrabony defect. Pre- and postoperative comparisons were made between the treatment groups at 6 months. Results: Test group sites showed a significantly higher reduction in pocket depth compared to control group sites. Test group sites showed a significantly higher amount of radioopacity in the regions of interest, indicative of better graft remodeling, compared to control group sites. Conclusion: (HA + β TCP) bone graft appears to be a beneficial material in the treatment of human periodontal intrabony defects. When combined with platelet-rich plasma there is a significantly higher reduction in probing pocket depth, higher gain in attachment levels and higher amount of radio-density seen in the intrabony defects.

Prevalence of TT Virus in patients with chronic periodontitis, patients with aggressive periodontitis and healthy controls: a pilot study

Torque teno virus (TTV), a novel DNA virus resides in peripheral blood mononuclear cells and replicates when these cells get activated. The TTV replication shifts the immunobalance. Aim: To determine the presence of TTV in the gingiva of patients with aggressive periodontitis, patients withchronic periodontitis, and healthy controls, and to correlate the presence of TTV with probing pocket depth and clinical attachment level. Methods: Forty-two subjects (22 males and 20 females)aged 21 to 55 years were recruited for this study. Subjects were stratified into aggressive periodontitis (Group I), chronic periodontitis (Group II) and healthy controls (Group III). Gingival tissue biopsy was taken from all the subjects and the presence of TTV was analyzed using PCR and 2% agarose gel electrophoresis. Results: TTV was identified in half of the subjects and more number of subjects with periodontitis have TT virus compared to controls. There was significant association between presence of TT virus and pocket depth, clinical attachment level. Conclusions: The findings from the present study shows that there was no significant association between TT virus and periodontitis, even though it was isolated from more number of subjects with aggressive periodontitis, and TTV was associated with pocket depth and clinical attachment level. These findings need to be investigated in further studies.

Management of mucous membrane pemphigoid with dapsone plus weekly steroid injections in a young patient: a case report / Tratamento de penfigóide membranoso mucoso com dapsona e injeções semanais de esteróide em um paciente jovem: relato de caso

Purpose: Mucous Membrane Pemphigoid (MMP) is an autoimmune subepithelial blistering disorder usually affecting older individuals. This paper describes the pharmacological management of MMP in a young patient. Case description: A 23 year-old woman showed erythematous ulcerative gingiva in the maxillary palatal region and around the retromolar region. A perilesional excisional biopsy was done, and the histologic and immunohistochemical analysis confirmed the clinical diagnosis of MMP as the cause of desquamative gingivitis in this patient. The patient was treated with topical steroids plus daily Dapsone 100 mg and weekly steroid injections (40 mg). The lesions began to resolve after 12 weeks of therapy. Conclusion: This case of MMP in a young female patient was effectively managed with a combination therapy of topical steroids, Dapsone and steroid injections.

Objetivo: O penfigóide membranoso mucoso (PMM) é uma desordem autoimume subeptelial bolhosa que geralmente afeta indivíduos mais velhos. Este relato de caso descreve a abordagem farmacológica do PMM em uma paciente jovem. Descrição do caso: Uma paciente do sexo feminino, com 23 anos de idade, apresentava a gengiva eritematosa e ulcerada na região palatina e na região retromolar. A biópsia excisional total foi realizada e as análises histológica e de imuno-histoquímica confirmaram o diagnóstico clínico de PMM como causa da gengivite descamativa nesta paciente. A paciente foi tratada com esteróides tópicos, Dapsona 100 mg diariamente e injeções de esteróides mensais (40 mg). A resolução das lesões se iniciou após 12 semanas de terapia medicamentosa. Conclusão: Este caso de PMM em uma paciente jovem foi efetivamente tratado com uma terapia combinada de esteróides tópicos, Dapsona e injeções de esteróides.