The evaluation of doxycycline controlled release gel versus doxycycline controlled release implant in the management of periodontitis.

BACKGROUND: Investigators have sought different methods to deliver antimicrobials to periodontal pockets. This study was designed to assess the efficacy of locally made doxycycline gel versus locally made doxycycline implant as biodegradable controlled local delivery systems, by evaluating the pharmacological drug release and improvement in gingival status, gain in attachment, and reduction in pocket depth. MATERIALS AND METHODS: Thirty patients with localized periodontal pockets ≥5 mm were randomly divided into three groups. The first group received the doxycycline gel, the second the doxycycline implant, and the third received only scaling and root planing (the control group). The patients in the first two groups were selected for the drug release. Clinical parameters such as gingival index, plaque index, probing depth, and attachment levels were recorded at baseline and the 90(th) day. Gingival crevicular fluid (GCF) and saliva samples were collected 1 hour following gel and implant placement and then on the 10(th), 30(th), and 60(th) days. RESULTS: There was a statistically significant difference in the release of doxycycline from the gel when compared with the implant in the GCF and saliva on the 10(th) and 30(th) days. All the three groups showed improvement in clinical parameters. The improvements in both gel and implant groups were greater when compared with the control group with no statistically significant difference between the implant and gel systems. CONCLUSION: The use of local delivery of doxycycline through gel and Implant media further enhances the positive changes obtained following scaling and root planing. The release of doxycycline from the implant and the gel was comparable.

Manual toothbrushing reinforced with audiovisual instruction versus powered toothbrushing among institutionalized mentally challenged subjects--a randomized cross-over clinical trial.

AIM: To assess and compare the effectiveness of Manual toothbrushing reinforced with audiovisual instructions with powered toothbrushing, among the institutionalized mentally challenged individuals under supervision of trained caretakers. MATERIALS AND METHODS: A randomized cross over clinical trial of 6 months duration which included 16 subjects consisting of two phases of three months, for each of the 2 groups. In group A subjects were given manual toothbrushes with audio-visual aid followed by the powered toothbrushes & vice versa for group B. All subjects were instructed by trained care takers. An evaluation of the plaque & gingival scores was done at the end of 1, 2 & 3 months for both the groups. RESULTS: Phase I showed statistically significant decrease in mean plaque scores (p=0.037) but insignificant mean gingival scores (p=0.189) in group A at end of 3 months. In phase II, statistically insignificant decrease in mean plaque & gingival scores were recorded at end of 3 months. In group B a statistically significant decrease in both plaque (p=0.002) & gingival (p=0.001) was found at end in both phases. Comparison of mean plaque & gingival scores of manual & powered toothbrushes at different intervals in both groups were statistically insignificant. CONCLUSION: For mentally challenged individuals, manual toothbrushes reinforced with audio-visual instructions for brushing may be comparable to the use of powered toothbrushes.

Periodontal management of a patient with severe aplastic anemia: a case report.

This article describes the periodontal management of a patient with severe aplastic anemia. A 51-year-old female patient was hospitalized with aplastic anemia and was referred for the management of her cyclosporine-induced gingival enlargement and bleeding from her gums. She also complained of pain in the palatal area and the mandibular anterior region. The patient was managed successfully with supra- and subgingival instrumentation, local drug delivery (LDD), electrosurgery, repeated oral hygiene instruction, and constant supervision. The treatment resulted in dramatic improvement in the patient's oral health and quality of life. This report highlights the importance of nonsurgical therapy followed by electrosurgery for the management of residual gingival enlargement.

Association of trauma from occlusion with localized gingival recession in mandibular anterior teeth.

BACKGROUND: There have been passing references in history that excessive occlusal forces might be a causative factor in gingival recession. The purpose of the present cross-sectional study was to explore the role of trauma from occlusion on the development of gingival recession. METHODS: Three hundred patients reporting to the department of Periodontics were screened for the presence of gingival recession in the lower incisors. A single trained examiner carried out clinical examination for signs of trauma from occlusion, such as fremitus test, presence of wear facets and mobility. The data were analyzed by chi square test. RESULTS: No statistically significant relationship was observed between the presence of a positive fremitus and wear facets with gingival recession. However, a significant association was observed between patients who experienced mobility and gingival recession. CONCLUSION: There does appear to be a relationship between fremitus and tooth wear with gingival recession based on the results of the present study, though not conclusive. However, the sign of tooth mobility, which is a feature of trauma from occlusion, appeared to be a predictor of positive association with gingival recession.

Periodontal health status in pan chewers with or without the use of tobacco.

BACKGROUND: Betel nut and tobacco chewing is a common practice in south-east Asia. In India, betel nut is commonly chewed in the form of pan, with or without tobacco. Numerous studies have shown the carcinogenic potential of betel nut and tobacco. Betel nut and tobacco are also known to have deleterious effects on the oral tissues. PURPOSE: The aim of our study was to evaluate and compare the periodontal effects of pan chewing with or without the use of tobacco as an ingredient. MATERIALS AND METHODS: The periodontal status of 300 subjects (150 subjects were pan chewers with tobacco and 150 subjects were pan chewers without tobacco) was evaluated using the community periodontal index (CPI). The subjects were selected by the stratified random sampling method. The oral hygiene status of the subjects was evaluated using the simplified oral hygiene index. RESULTS: CPI code-4, with a probing depth of 6 mm or more, was seen in 30% of pan chewers with tobacco compared with 7.3% of pan chewers without tobacco. It was found that pan chewers with tobacco had 4.7 times more risk of having pockets than pan chewers without tobacco. The higher codes of loss of attachment were seen in pan chewers with tobacco compared with pan chewers without tobacco. It was found that pan chewers with tobacco had 7 times more risk of having loss of attachment when compared with the pan chewers without tobacco. CONCLUSIONS: The results show higher incidence of periodontal diseases in pan chewers who use tobacco compared with pan chewers who do not use tobacco. Based on the results, it was concluded that, although betel nut has deleterious effects on the periodontium, the addition of tobacco leads to a synergistic effect between betel nut and tobacco on the periodontal tissues.

Trypan blue exclusion principle in the evaluation of fibroblast attachment in vitro using V79 cells on the conditioned root surface.

OBJECTIVE: Various studies have shown that the root surface condition may play an important role in wound healing. Root surface demineralization has been shown to promote the establishment of new connective tissue attachment. Various agents, including citric acid, ethylenediaminetetraacetic acid (EDTA), and tetracycline, have been used to try to achieve a root surface that is biocompatible with the adjacent periodontal cells. Traditional in vitro studies have used periodontal ligament fibroblasts and scanning electron microscopic studies to check the efficacy of these root-conditioning agents. The objective of this study was to assess the efficacy of trypan blue to evaluate fibroblast attachment in an in vitro model using V79 fibroblasts (embryonic Chinese hamster lung fibroblasts) on root specimens treated by citric acid, EDTA, and tetracycline. METHOD AND MATERIALS: Citric acid-, EDTA-, and tetracycline-treated root specimens were placed in cultures of V79 cells and in human periodontal ligament cells, which acted as a control. The treated root specimens were removed from the cultures after 4 weeks and immediately treated with 1% trypan blue. Trypan blue was selected because it can stain only nonvital tissues. RESULTS: The root specimens placed in V79 and human periodontal ligament cultures showed unstained areas, indicating the presence of vital cells, in contrast to the stained areas, which represented the areas devoid of cells. CONCLUSION: This in vitro screening model based on the trypan blue exclusion principle may be used for immediate evaluation of the efficacy of various root-conditioning agents. V79 cells may be used as an alternative to human periodontal ligament fibroblasts in the evaluation of the efficacy of root conditioning agents.

Labial veneers in the management of desquamative gingivitis: report of a case.

Desquamative gingivitis is a condition characterized by intense erythema, ulceration, and desquamation of the free and attached gingiva. Approximately 50% of desquamative gingivitis cases occur on the gingival tissues though it is not uncommon at other intraoral and extraoral sites. Though topical corticosteroids are considered the mainstays in the treatment of desquamative gingivitis, the inability of these medicaments to be in contact with the affected sites for longer duration has been implicated as a factor in reducing the efficacy of this mode of treatment. The case presented here is of a 24-year old male with desquamative gingivitis of 3 years duration. Topical corticosteroid therapy using custom-made acrylic veneers was utilized in the patient with remarkable results. This paper highlights the use of acrylic labial veneers over the gingival tissue as a vehicle for delivering medication and as a way to improve aesthetics.