Additional benefits of titanium platelet-rich fibrin (T-PRF) with a coronally advanced flap (CAF) for recession coverage: A case series.

BACKGROUND: Platelet concentrates (PCs) are a boon in the field of dentistry. Various generations of PCs have been tried and utilized in different treatment methods, such as intrabony defect therapy, root coverage procedures, oral surgical procedures, and palatal wound healing. Titanium-prepared platelet-rich fibrin (T-PRF) is a third-generation PC that is prepared in medical-grade titanium tubes and achieves good healing in the field of periodontics. OBJECTIVES: Not many studies have been performed utilizing T-PRF in the treatment of gingival recession (GR). The present case series study aimed to evaluate the efficacy of T-PRF in the treatment of Cairo's Type 1 GR defects. MATERIAL AND METHODS: A total of 20 patients with 34 Cairo's Type 1 GR defects were recruited. The surgical sites were treated using the trapezoidal coronally advanced flap (CAF) technique and T-PRF as a biomaterial underneath the flap. The plaque index (PI) and the gingival index (GI), recession depth (RD) and recession width (RW), as well as the width of keratinized tissue (WKT), were measured at baseline and 6 months postoperatively. The obtained values were subjected to statistical analysis. The values were presented as mean (M) and standard deviation (SD), the paired t test was performed to measure all the parameters, and a p-value <0.05 was considered to be statistically significant. RESULTS: The changes observed 6 months after the use of T-PRF were non-significant for PI (p = 0.053) and significant for GI (p = 0.016) as compared to the baseline. Significant reductions (p < 0.001) were noted for RD and RW, as well as a significant increase in WKT and a mean root coverage (MRC) of 91%. CONCLUSIONS: Titanium-prepared platelet-rich fibrin can be used as a biomaterial for the treatment of GR defects, as it eliminates the possible silica contamination, as in the case of leukocyte-platelet-rich fibrin (L-PRF), and the need for a second surgical site, as with subepithelial connective tissue graft (SCTG). Moreover, the use of T-PRF results in a thicker membrane formation, and titanium tubes can be reused after proper sterilization.

Evaluation of biologic width re-establishment using CHU aesthetic gauges in crown lengthening cases- a clinical study.

Background: Present study was performed to assess the biologic width relocation by performing aesthetic crown lengthening with the help of Chu aesthetic gauges. Methods: The study included 192 teeth from 17 individuals, of which 64 teeth underwent crown lengthening (Treated site- TS) and 128 of which shared a proximal surface (Adjacent site -AS, Non-Adjacent site- NAS) with the surgery site. The clinical parameters Plaque index (PI), gingival index (GI), gingival margin position (PGM), relative attachment level (RAL), bone sounding (BS), biological width (BW), and probing depth (PD) were recorded. The clinical recordings were made at three different times: at baseline, 3 and 6 months post-operatively. Statistical analysis was performed using one way ANOVA and for pair wise comparisons post hoc Tukey test was used. Data was expressed in mean and standard deviations. P < 0.05 was considered statistically significant. Results: PI and GI showed significant difference (p = 0.000*) at all time intervals. PGM and RAL were significant from baseline to 3 months, baseline to 6 months (p = 0.000*) while non-significance (p > 0.05) was recorded at 3-6 months comparison for PGM, RAL, BS, BW and PD. Conclusion: Present study concluded that usage of Chu Aesthetic gauges help in controlled removal of soft and hard tissues, biologic width and gingival margin position got stabilized within 3 months and final prosthesis can be advised after 3 months of surgery.

Evaluation of association between potential stress markers and periodontal health in medical and dental students: A questionnaire-based study.

Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress on periodontium through questionnaire and serum cortisol level. Subjects and Methods: Two hundred medical and dental undergraduates were recruited for the study. Case group included 82 examination going and control group had 79 nonexam going students. Their stress level was evaluated using a standard questionnaire (perceived stress scale). Gingival index, periodontal disease index, bleeding on probing index, serum cortisol level, and serum alpha-amylase level were also measured. Statistical Analysis Used: Bivariate correlations and multiple regression tests were done. Results: A positive correlation was found among stress scores, salivary cortisol, alpha-amylase, and periodontal disease measures. Conclusion: Periodontitis can be related to immunologic changes related to psychological states.

Comparison of blood parameters between periodontitis patients and healthy participants: A cross-sectional hematological study.

Background: Bacteria and their products involved in periodontitis evoke an immunoinflammatory response in the host tissue. Inflammatory diseases, such as periodontitis, are often not just a local event, but may have systemic ramifications, including elevations in the numbers of circulating leukocytes, acute-phase proteins and oxidative stress markers. It is now emerging that also erythrocytes are affected by chronic inflammatory diseases. This phenomenon, named "anemia of inflammation," is not caused by marrow deficiencies or other diseases. The present study aimed to assess whether there was any relation between chronic periodontitis and hematological parameters. Materials and Methods: A total of 80 patients were included in the study and were divided into the healthy and periodontitis groups. Blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes, platelets, red blood cell (RBC) distribution width (RDW), mean corpuscular volume (MCV), platelet count and neutrophil-leukocyte ratio (NLR). Further, the values were gathered and subjected to statistical analysis. Unpaired t-test was performed to assess the statistical significance between the groups and P < 0.05 and < 0.001 were considered to be statistically significant. Results: Results show statistically significant difference seen in leukocytes, lymphocytes, RDW, MCV, platelet count and NLR which was higher in patients with periodontitis, all other parameters are nonsignificant. Conclusion: Thus, within limitations, it can be concluded that increased levels of leukocytes, lymphocytes, RDW, MCV, platelet count and NLR depict the inflammatory state and destructive nature of periodontitis.

Influence of maternal periodontitis on adverse pregnancy outcome: An observational study.

Background: Adverse pregnancy outcome is due to deviation from the normal physiological and immunological process. There is conflicting evidence in support of maternal periodontitis as a risk factor for preterm low birth weight (PTLBW). Thus, the aim of the present study is to evaluate the correlation between PTLBW and periodontitis in postpartum mothers based on clinical and microbiological parameters. Materials and Methods: An observational retrospective study was conducted. A total of 103 women with singleton births were included in the study, which was divided into two groups, i.e., Group I-PTLBW and Group II-normal term normal birth weight (NTNBW). Clinical parameters such as oral hygiene index simplified, gingival bleeding index (BOP %), periodontal probing depth (PPD) and and clinical attachment loss (CAL) were recorded on the next day of postpartum. Two samples from each group, i.e., placental extract and the subgingival plaque were collected and transported to the laboratory in an anaerobic medium for microbiological analysis. The statistical analysis was performed using an unpaired t-test and Wilcoxon Mann-Whitney U-test. The P < 0.001 was considered statistically significant. Results: PTLBW group showed significantly higher amounts of periodontal destruction in terms of clinical parameters. The pathogens were also in higher quantities in the PTLBW group compared to the NTNBW group. Conclusion: Periodontitis is related to PTLBW in pregnant women of the studied population. Maternal oral hygiene status delivering PTLBW babies are compromised compared to mothers delivering NTNBW babies. Hence, periodontitis during pregnancy phase is an important health concern for the growing fetus.

Predictable Treatment of Gingival Recession Using Titanium Prepared Platelet-Rich Fibrin in Combination with Coronally Advanced Flap.

Treatment for receding gums is always a challenging task for a periodontist. To fulfill this, many surgical techniques such as free gingival grafts, connective tissue grafts, pedicle flaps, and lateral sliding flaps have been used. For better prevention of relapse of these procedures and to improve the gingival biotype, various biomaterials such as platelet-rich fibrin, collagen matrix, and amnion chorion membranes have been additionally utilized. Due to advancements in preparation of platelet concentrates titanium platelet-rich fibrin, a third-generation platelet concentrate was introduced. Unlike other biomaterials, it has thicker fibrin meshwork with greater cellular entrapment and thicker membrane. Present case reports depict the usage of titanium platelet-rich fibrin as a biomaterial along with coronally advanced flap in the treatment of millers Class-I gingival recessions. Patients were followed up to 6 months after performing recession coverage treatments.

Evaluation of titanium-prepared platelet-rich fibrin and leucocyte platelet-rich fibrin in the treatment of intra-bony defects: A randomized clinical trial.

Background. Various treatment modalities, such as leucocyte platelet-rich fibrin (L-PRF), bone grafts, and membranes, have been used for the restoration of lost periodontal tissues. Titanium-prepared platelet-rich fibrin (T-PRF) has attracted attention for its proper haemocompatibility, thick fibrin meshwork, and long resorption time. The present study aimed to evaluate the effectiveness of T-PRF and L-PRF in the management of intra-bony defects based on clinical and radiographic criteria. Methods. Twenty-six subjects with 34 intra-bony 3- walled defects were divided into two groups (n=17) and treated with T-PRF or L-PRF. Clinical and radiographic measurements were recorded at baseline and 6- , 3- and 9- month intervals and tabulated on Microsoft Excel spreadsheets. For intra- and intergroup comparisons, paired and unpaired t-tests were performed. P<0.05 was set as statistically significant Results. Intra-group comparisons revealed statistically significant differences (P<0.05) from baseline in both groups regarding clinical measurements. On intergroup comparison, the T-PRF group exhibited a significantly higher defect fill compared to the L-PRF group (P<0.05). Conclusion. Within the limits of the present study, T-PRF seems to be a better alternative to L-PRF in the treatment of intra-bony defects.

Surgical Correction of Congenital Double Lip.

Double lip is an unusual clinical finding, considered to be a developmental anomaly, and usually involving the upper lip more frequently than the lower lip. It may be seen in isolation or in association with Ascher's syndrome. It is caused by excessive areolar tissue and noninflammatory labial mucosa gland hyperplasia of pars villosa. During smiling, the lip is retracted, and the mucosa is positioned over the maxillary teeth, resulting in "cupid's bow" appearance. The incidence of this anomaly is not known. It has been reported in cleft patients, following lip trauma, and as a consequence of lip-biting habits. It might pose esthetic or functional problems and may be a reason for psychological stress to the affected individual because of over shown hyperplastic lip tissue. Surgical treatment is indicated for the correction of this disfigurement. Various surgical techniques have been suggested to address the double upper lip anomaly. All of these involve the excision of excessive mucosa and the underlying tissue. This case series puts forward the surgical management of this rare anomaly in a relatively simple manner. Double lip is a subject of interest to the dental clinicians because they usually are the first professionals to detect, identify, and treat this uncommon condition.

Novel method of determining the periodontal regenerative capacity of T­PRF and L­PRF: An immunohistochemical study.

BACKGROUND: Platelet-rich fibrin (PRF) plays an important role in the regeneration of the lost periodontal tissues. Immunohistochemistry (IHC) is the most sensitive staining technique for the identification and localization of specific cells. There are few studies in the available literature which use IHC to compare PRF prepared from titanium and silica glass tubes. OBJECTIVES: The aim of the study was to use IHC to evaluate and compare cells present in the PRF membrane prepared from titanium and silica glass tubes. MATERIAL AND METHODS: Blood was drawn from 10 healthy volunteers and PRF was prepared from titanium and silica glass tubes. Immunohistochemical staining for the localization, distribution and pattern of cells present in PRF with the CD 3, CD 15, CD 20, CD 34, CD 61, and CD 163 antibodies was carried out. A statistical analysis including the χ2 test, independent t-test and unpaired t-test was performed to determine significant differences. RESULTS: There were significantly more T cells, B­lymphocytes and platelets, with a strongly positive staining in terms of the cell distribution and the labeling index in the T-PRF group in comparison with the L-PRF group. However, in terms of localization, a stronger positive staining was obtained with platelets in the T-PRF group and stem cells in the L-PRF group. In terms of the cell pattern, a significantly stronger positive staining was obtained by neutrophils in the L-PRF group and B­lymphocytes in the T­PRF group. CONCLUSIONS: Titanium PRF has the edge over PRF prepared from silica glass tubes, and emerged as a better alternative for use in the field of periodontal regeneration.

Different Regenerative Responses of Two Platelet Concentrates in the Treatment of Human Periodontal Infrabony Defects: A Clinico-Radiographic Study.

BACKGROUND: Platelet concentrates usage in the treatment of intrabony defects has been improved due to advancement of research. Many generation of platelet concentrates were used, but research regarding advanced platelet-rich fibrin (A-PRF) regarding periodontal treatment is scanty. AIM: The purpose of the study was to evaluate and compare PRF and A-PRF in the treatment of human periodontal infrabony defects (IBDs) both clinically and radiographically. MATERIALS AND METHODS: Twenty-eight patients having IBDs were divided into Group A (PRF) and Group B (A-PRF). Clinical parameters such as plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months and radiographic examination at baseline and 6 months were also recorded to evaluate defect fill, resolution, and change in the alveolar crest height. Then, all the data were tabulated in a Microsoft Excel sheet and subjected to statistical analysis. Mean and standard deviations of the clinical and radiographic parameters were calculated, and unpaired t-test was performed to assess intergroup comparison at different time intervals. RESULTS: Intragroup comparison showed statistically significant improvement in PPD and CAL at 3 and 6 months while statistically significant improvement was observed in mean defect fill and resolution in Group B. CONCLUSION: Individually, both the materials have shown promising results. However, statistically, PRF group (Group A) showed better treatment outcome in terms of bone fill and A-PRF group (Group B) in terms of soft tissue healing.

Aerosol, a health hazard during ultrasonic scaling: A clinico-microbiological study.

CONTEXT: Ultrasonic scaling is a routinely used treatment to remove plaque and calculus from tooth surfaces. These scalers use water as a coolant which is splattered during the vibration of the tip. The splatter when mixed with saliva and plaque of the patients causes the aerosol highly infectious and acts as a major risk factor for transmission of the disease. In spite of necessary protection, sometimes, the operator might get infected because of the infectious nature of the splatter. AIM: To evaluate the aerosol contamination produced during ultrasonic scaling by the help of microbiological analysis. MATERIALS AND METHODS: This clinico-microbiological study consisted of twenty patients. Two agar plates were used for each patient; the first was kept at the center of the operatory room 20 min before the treatment while the second agar plate was kept 40 cm away from the patient's chest during the treatment. Both the agar plates were sent for microbiological analysis. STATISTICAL ANALYSIS: The statistical analysis was done with the help of STATA 11.0 (StataCorp. 2013. Stata Statistical Software, Release 13. College Station, TX: StataCorp LP, 4905 Lakeway Drive College Station, Texas, USA). Statistical software was used for data analysis and the P < 0.001 was considered to be statistically significant. RESULTS: The results for bacterial count were highly significant when compared before and during the treatment. The Gram staining showed the presence of Staphylococcus and Streptococcus species in high numbers. CONCLUSIONS: The aerosols and splatters produced during dental procedures have the potential to spread infection to dental personnel. Therefore, proper precautions should be taken to minimize the risk of infection to the operator.

Assessment of Corticotomy Facilitated Tooth Movement and Changes in Alveolar Bone Thickness - A CT Scan Study.

INTRODUCTION: Corticotomy is an effective method of accelerating the orthodontic treatment. The aim of this study was to compare the treatment time for the extraction space closure, between corticotomy assisted and conventional orthodontic tooth movement and to check the alveolar bone thickness before and after corticotomy procedure in the corticotomy group. SETTINGS AND DESIGN: Cross-sectional clinical study. MATERIALS AND METHODS: Twenty patients (age>15 y) requiring orthodontic treatment with upper anterior retraction in the extraction space of 1(st) premolar were selected and were randomised into control and corticotomy group each group consisted of 10 subjects. Pre retraction, corticotomy was performed in the maxillary anterior segment. The pre and post retraction CT scans were recorded and the thickness of the alveolar plates were measured at crestal level (S1), mid root level (S2) and apical level (S3) PreTreatment (T1). The same measurements were repeated after incisor retraction was completed PostTreatment (T2). STATISTICAL ANALYSIS: Student's t-test, Pearson correlation coefficient. RESULTS: There was a significant difference in retraction time (days) between control and corticotomy groups (p<0.001). Also, there were significant difference in total alveolar bone thickness at the crest region for all the four incisor teeth (p<0.05). A significant difference was observed in total alveolar bone thickness at the S2 and S3 level for 11, 21 and 11, 12 and 22 (p<0.05) respectively. CONCLUSION: Alveolar corticotomies not only accelerates the orthodontic treatment but, also provides the advantage of increased alveolar width to support the teeth and overlying structures.

Comparative evaluation of decalcified freeze dried bone allograft with and without local doxycycline in non-contained human periodontal infrabony defects.

BACKGROUND: Doxycycline has been advocated as useful adjuncts in periodontal therapy not only due to their antimicrobial actions, but also to their recently recognized anti-collagenolytic, anti-inflammatory, osteoclast inhibitory and fibroblast stimulating property. The purpose of the present cohort study was to evaluate the regenerative outcomes of bone graft with or without local doxycycline in non-contained infrabony periodontal defects. MATERIALS AND METHODS: 16 one or two wall infrabony defects, in 11 patients suffering from moderate to severe chronic periodontitis, aged 35-60 years, were randomly divided for bone graft, alone (control) and with doxycycline (test) for the study. At baseline, after 3 months and after 6 months of post-operative period, pocket probing depth (PPD), clinical attachment level (CAL), radiological bone fill (RBF) and alveolar height reduction were recorded. Analysis of variance and Newman-Keuls post-hoc test were used or statistical analysis. A two-tailed probability (P) value P < 0.05 was considered to be statistically significant. RESULTS: For the control group PPD reduction 2.00 ± 0.18 mm, CAL gain 1.38 ± 0.17 mm, RBF 0.63 ± 0.27 mm (18.0%) was observed while in the test group PPD reduction 2.00 ± 0.38 mm, CAL gain 1.25 ± 0.31 mm, RBF 0.75 ± 0.31 mm (20.7%) was evaluated. While alveolar height reduction for the control group and test group was 13% and 12.5% respectively. CONCLUSION: The study confirmed no added benefits of local doxycycline, as compared with bone graft alone, for regeneration of non-contained human periodontal infrabony defects.

Probiotics in periodontal health and disease.

Macfarlane Burnett stated in 1962 that "By the late twentieth century, we can anticipate the virtual elimination of infectious diseases as a significant factor in social life". Probiotics have become of interest to researchers in recent times. Time has come to shift the paradigm of treatment from specific bacteria elimination to altering bacterial ecology by probiotics. The development of resistance to a range of antibiotics by some important pathogens has raised the possibility of a return to the pre-antibiotic dark ages. Here, probiotics provide an effective alternative way, which is economical and natural to combat periodontal disease. Thus, a mere change in diet by including probiotic foods may halt, retard, or even significantly delay the pathogenesis of periodontal diseases, promoting a healthy lifestyle to fight periodontal infections.