Evaluation of bone apposition on surface modified titanium implant in experimental animal model: A systematic review and meta-analysis.

Purpose: To evaluate the response of peri-implant bone to smooth (machined) surface and surface-modified dental implants in healthy experimental animal models. Materials and Methods: Systematic electronic search was done for using PUBMED, SCOPUS, WEB OF SCIENCE, and EMBASE databases for potentially relevant records from the last 20 years. Duplicate screening and data extraction were performed to formulate the evidence tables and meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The outcome criteria were: 1. Bone Implant Contact (BIC) in percentage, 2. Removal Torque Values (RTV) in Ncm, 3. Implant stability Quotient (ISQ), Quality assessment was done using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines and SYRCLE RoB (Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias) tool. Results: Results were expressed as pooled mean difference for the respective groups viz. sandblasted and acid etched, laser modified, acid etched and anodized surface. The surface modified implants revealed somewhat higher BIC over machined surface (P < 0.01). Forest plot were drawn for all the outcome variables. Conclusions: Within the limitations of this study, the authors found a higher degree of osseointegration pertaining to bone to implant interface, RTV, and implant stability quotient (ISQ) with surface modified procedures which seemed to promote bone formation around peri-implant tissue during the early stages of healing. After analyzing all 37 included publications for the outcome of interest (BIC%, RTV, ISQ), a positive outcome was obtained for both subtractive and additive implant surface modifying procedures over machined implant surfaces when the data were pooled together. More advanced research work on healthy animal models needs to be investigated to review the impact of surface modifications on dental implant osseointegration.

Indian Society of Periodontology Good Clinical Practice Recommendations for Peri-implant Care.

Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri-implant diseases and manage the existing peri-implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral health-care delivery across the country. The current clinical practice recommendations focused on peri-implant care to bridge the gap between academic theory and clinical practice by compiling evidence-based suggestions for preventing and treating peri-implant diseases. Twenty-eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri-implant health and maintenance, peri-implant mucositis, and peri-implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home-care recommendations regarding maintaining peri-implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence-based, integrated, and comprehensive peri-implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well-being of implant patients and ensure the long-term success of implant therapy.

Role of Chitosan Hydrogels in Clinical Dentistry.

Biopolymers are organic polymers that can be treated into intricate designs with porous characteristics that mimic essential biologic components. Due to their superior biosafety, biodegradability, biocompatibility, etc., they have been utilized immensely in biomedical engineering, regeneration, and drug delivery. To obtain the greatest number of results, a literature search was undertaken in scientific search engines utilizing keywords. Chitosan is used in a variety of medical sectors, with the goal of emphasizing its applications and benefits in the clinical dental industry. Chitosan can be dissolved in liquid form and combined with other substances to create a variety of products, including fibers, hydrogels, membranes, microspheres, resins, sponges, pastes, tablets, and micro granules. Chitosan has been studied in a variety of dental applications. Chitosan is used in the prevention of caries and wear, in pulpotomy to accelerate osteogenesis in guided tissue regeneration due to its hemostatic property, and primarily to benefit from its antimicrobial activity by adding it to materials, such as glass ionomer cement, calcium hydroxide, and adhesive systems. With its antibacterial activity and biocompatibility, chitosan is leading the pack as a promising ingredient in the production of dental materials. The current review provides an update on the background, fundamentals, and wide range of uses of chitosan and its gels in dental science.

Is periodontal infection a risk factor for thromboembolic disease? A systematic review.

Background: Venous thromboembolism (VTE) is a rising major health problem comprising pulmonary embolism (PE) and deep vein thrombosis. It is of concern due to premature mortality, increased morbidity, and associated healthcare costs and hospitalization. Periodontitis can increase the risk of VTE by way of systemic inflammation induced by infection that can contribute to hypercoagulability and platelet aggregation. This systematic review aims to synthesize all the evidence concerning periodontal infection as a risk factor for thromboembolic disease. Materials and Methods: A search for articles published from 1967 till December 2020 was conducted in the PubMed (MEDLINE), Scopus, and EMBASE data bases. Results: Five hundred and five articles were retrieved after running search strategies in PubMed, Scopus, and EMBASE search databases. Based on the inclusion criteria, three clinical studies, two case series, and ten case reports were included for qualitative analysis. The presence of periodontal disease was reported to influence the occurrence of venous thromboembolic disease with a statistical significance of <0.010. Case series and case reports of septic PE due to periodontal disease showed complete resolution of lung lesions and subsiding of symptoms after dental treatment and antimicrobial therapy. Conclusions: The results of this systematic review suggested for an association between periodontal disease and the incidence of thromboembolic disease. As most of the included/available studies are case series and case reports, the strength of evidence is weak. Evidence generated from well-designed longitudinal controlled clinical trials may be helpful to further assess the strength of the association.

ISP good clinical practice recommendations for gum care.

Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to "Gum Care for All", is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.

Psoriasis and Periodontitis: Exploring an association or lack thereof.

OBJECTIVES: Psoriasis is a common, chronic, non-communicable skin disease with no clear etiology or cure. Periodontitis is a chronic inflammatory condition which is now known to significantly influence various systemic diseases as an established risk factor. This study aimed at comparatively evaluating the periodontal status of Psoriatic patients vis. a vis. that of age and gender matched systemically healthy volunteers. An attempt was also made to explore a possible association, if any, amongst the two diseases. MATERIALS AND METHODS: Forty two residents of Chandigarh, suffering from Psoriasis and attending the Psoriasis Clinic of Department of Dermatology & Venereology, Post Graduate Institute of Medical Education & Research, Chandigarh were recruited over a period of 10 months (Case group) and their periodontal status was compared with forty two age and gender matched systemically healthy volunteers (Control group) randomly selected from the Out Patient Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, India. Their serum IL-33 levels were evaluated and compared in an attempt to identify an underlying common pathological pathway. RESULTS: The periodontal status was comparable in the two groups in terms of the debris index (p = 0.932), calculus index (p = 0.088), plaque index (p = 0.097), and mean clinical attachment loss (p = 0.401). A higher bleeding points index was recorded amongst healthy individuals as compared to the Psoriasis group, the difference being statistically significant (p = 0.001). The mean number of teeth were more in the Psoriasis group as compared to the healthy group (p=0.034). IL 33 levels were also not significantly different (p = 0.491). CONCLUSION: Contrary to currently available evidence in literature, the study did not find a statistically significant association between Psoriasis and Inflammatory Periodontal Disease.

Immediate implant placement in periodontally infected sites- A systematic review and meta-analysis.

Aims: The purpose of this meta-analysis is to systematically evaluate published evidence literature pertaining to report the differences in the survival rate of immediate implant placement in infected sites and non-infected sites. Materials and methods: After the application of the search strategy in PUBMED, SCOPUS, and EMBASE research databases, a total of 1864 papers were found. Titles and abstracts were screened, yielding 77 full-text papers. After the overall assessment, 23 articles were recruited based on the inclusion criteria for analysis of data. Results: Out of 23 studies, 14 studies were combined to assess the risk ratio of survival rate of immediate implant placement between infected and non-infected sites, depicting no significant difference on the survival rate. Further pooled estimate of proportion of survival rates were 0.98 suggesting 98% survival rate of immediate implants placed in infected sockets when 9 retrospective and prospective studies (no control studies) were combined. These findings demonstrate that successful outcomes can be expected for immediate implants when placed into infected extraction sockets. Conclusions: Within the limitations of this systematic review, equal predictability for successful osseointegration and long-term functioning of immediate implants was found in infected as well as in healthy extraction sites, but astringent antiseptic environment is mandatory for wound healing of immediate implants.

Association between nonalcoholic fatty liver disease and inflammatory periodontal disease: A case­control study.

BACKGROUND: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. AIM: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. SETTINGS AND DESIGN: Tertiary health care center, cross-sectional case-control observational study. MATERIALS AND METHODS: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. STATISTICAL DATA ANALYSIS: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). RESULTS: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. CONCLUSION: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.

Comparative evaluation of stress levels before, during, and after periodontal surgical procedures with and without nitrous oxide-oxygen inhalation sedation.

CONTEXT: Periodontal surgical procedures produce varying degree of stress in all patients. Nitrous oxide-oxygen inhalation sedation is very effective for adult patients with mild-to-moderate anxiety due to dental procedures and needle phobia. AIM: The present study was designed to perform periodontal surgical procedures under nitrous oxide-oxygen inhalation sedation and assess whether this technique actually reduces stress physiologically, in comparison to local anesthesia alone (LA) during lengthy periodontal surgical procedures. SETTINGS AND DESIGN: This was a randomized, split-mouth, cross-over study. MATERIALS AND METHODS: A total of 16 patients were selected for this randomized, split-mouth, cross-over study. One surgical session (SS) was performed under local anesthesia aided by nitrous oxide-oxygen inhalation sedation, and the other SS was performed on the contralateral quadrant under LA. For each session, blood samples to measure and evaluate serum cortisol levels were obtained, and vital parameters including blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were monitored before, during, and after periodontal surgical procedures. STATISTICAL ANALYSIS USED: Paired t-test and repeated measure ANOVA. RESULTS: The findings of the present study revealed a statistically significant decrease in serum cortisol levels, blood pressure and pulse rate and a statistically significant increase in respiratory rate and arterial blood oxygen saturation during periodontal surgical procedures under nitrous oxide inhalation sedation. CONCLUSION: Nitrous oxide-oxygen inhalation sedation for periodontal surgical procedures is capable of reducing stress physiologically, in comparison to LA during lengthy periodontal surgical procedures.

The Gender Bender effect in Periodontal Immune Response.

BACKGROUND: The gender and sex of an individual is known to have a significant bearing on the immune system, responsible for protection against infections and disease. Contemporary evidence suggests there exists a sexual dimorphism in the hetero immune as well as autoimmune responses in human beings and females show stronger and more vigorous immune responses to antigenic stimulations, e.g infectious diseases and vaccination. The evidence supportive to gender based heterogeneity in immune responses specifically in context of periodontal disease, is mounting in contemporary literature. METHOD: A thorough and methodical search for related scientific publications have been accomplished by using different key words and terms like sex or gender based immune differences in periodontal disease, both by manual methods and on various electronic databases. Primary research articles, narrative and systematic reviews of good quality, relevant to the subject were included. RESULTS: The aggregate effects of the factors related to gender such as the steroid hormones as well as gene based differences in both sexes as supported by published literature are in line with the observed variation in susceptibility for chronic periodontitis in both genders , with males showing more risk for disease than women. CONCLUSION: Gender as a risk factor for periodontal disease needs to identified, its underlying mechanisms to contribute needs to be revealed, so that novel strategies for risk assessment, disease identification and individualized therapeutic approaches can be developed for optimized patient care.

Effect of citric acid, tetracycline, and doxycycline on instrumented periodontally involved root surfaces: A SEM study.

BACKGROUND: A surface smear layer consisting of organic and inorganic material is formed on the root surface following mechanical instrumentation and may inhibit the formation of new connective tissue attachment to the root surface. Modification of the tooth surface by root conditioning has resulted in improved connective tissue attachment and has advanced the goal of reconstructive periodontal treatment. AIM: The aim of this study was to compare the effects of citric acid, tetracycline, and doxycycline on the instrumented periodontally involved root surfaces in vitro using a scanning electron microscope. SETTINGS AND DESIGN: A total of 45 dentin samples obtained from 15 extracted, scaled, and root planed teeth were divided into three groups. MATERIALS AND METHODS: The root conditioning agents were applied with cotton pellets using the Passive burnishing technique for 5 minutes. The samples were then examined by the scanning electron microscope. STATISTICAL ANALYSIS USED: The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). For all quantitative variables means and standard deviations were calculated and compared. For more than two groups ANOVA was applied. For multiple comparisons post hoc tests with Bonferroni correction was used. RESULTS: Upon statistical analysis the root conditioning agents used in this study were found to be effective in removing the smear layer, uncovering and widening the dentin tubules and unmasking the dentin collagen matrix. CONCLUSION: Tetracycline HCl was found to be the best root conditioner among the three agents used.