Classification systems for gingival recession and suggestion of a new classification system.

BACKGROUND: Gingival recession is one of the most usual esthetic concerns associated with the periodontal tissues. Classification of such condition is important to diagnose, determine the prognosis, and frame the treatment plan. Various classifications have been put forward since decades to classify gingival recession. Miller's classification is the widely used classification among all classifications, but certain drawbacks have been noted in this classification. Therefore, an effort is made to review most commonly used classification systems for gingival recession, and their drawbacks further come up with a proposal of new classification system for gingival recession.

To Splint or Not to Splint: The Current Status of Periodontal Splinting.

Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient's comfort. Splints are used to over-come all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics. Although splinting has been used since ancient times, it has been a topic of controversy because of its ill effects on oral health, including poor oral hygiene and adverse effects on supporting teeth. There have been considerable advancements in the materials used for splinting, resulting in fewer ill effects. This article is intended to provide the clinicians with an updated overview of splinting, types and classification of splints, with their indications, contraindications,rationale and effects on oral health.

Association of Postmenopausal Osteoporosis and Periodontal Disease: A Double-Blind Case-Control Study.

BACKGROUND: Both osteoporosis (OP) and periodontitis are chronic inflammatory diseases associated with bone loss mediated by local and systemic factors. The two diseases share common risk factors. Previous studies have suggested that OP in itself is a predisposing factor for periodontal tissue destruction in postmenopausal women. However, only a moderate correlation has been shown between the two conditions. In this study, we compared the severity of periodontal disease in postmenopausal osteoporotic women and postmenopausal women without OP. MATERIALS AND METHODS: The study group consisted of 100 postmenopausal women in the age group of 50-65 years: Group 1 (50 osteoporotic) and Group 2 (50 non-osteoporotic women). Periodontal parameters included sulcus bleeding index, oral hygiene index simplified, probing pocket depth (PPD), and clinical attachment loss (CAL), interproximal alveolar bone loss (ABL), and number of missing teeth. The correlation of periodontal disease status with systemic bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. RESULTS: The results indicated that osteoporotic (Group 1) women had a significantly greater PPD, CAL, and ABL when compared with the non-osteoporotic Group 2 (P < 0.0001). There was no significant correlation between BMD and various parameters between the groups. CONCLUSIONS: Within the limitations of the present study it was noted that postmenopausal OP is associated with an increased incidence and severity of periodontal disease. Educating postmenopausal osteoporotic women regarding the importance of good oral care should be part of their management regime. Hence, it could be inferred a possibility of a probable relationship between OP and periodontal disease, but long-term prospective studies are warranted in the future in order to provide definitive evidence.

Resistin: a potential biomarker for periodontitis influenced diabetes mellitus and diabetes induced periodontitis.

Biomarkers are highly specific and sensitive indicators of disease activity. Resistin is a recently discovered adipocytokine, having a potent biomarker quality. Initially resistin was thought to be produced by adipocytes alone; however, emerging evidence suggests that it is also produced in abundance by various cells of the immunoinflammatory system, indicating its role in various chronic inflammatory diseases. Data suggests that resistin plays a role in obesity, insulin resistance, cardiovascular diseases, and periodontitis. Resistin derived its name from the original observation that it induced insulin resistance (resist-in: resist insulin) in mice and is downregulated in mature murine adipocytes cultured in the presence of insulin sensitizing drugs like thiazolidinediones. It is well recognized that obesity, is associated with insulin resistance and diabetes. A three-way relationship has been established between diabetes, obesity and periodontitis. Recent evidence also suggests an association between obesity and increased risk for periodontitis. Our previous research showed incremental elevation of resistin with periodontal disease activity and a reduced level of resistin, after periodontal therapy. Thus resistin would be one of the molecular links connecting obesity, periodontitis, and diabetes and may serve as a marker that links periodontal disease with other systemic diseases. A Medline/PubMed search was carried out for keywords "Diabetes Mellitus," "Periodontitis," and "Resistin," and all relevant research papers from 1990 in English were shortlisted and finalized based on their importance. This review provides an insight into the biological action of resistin and its possible role in periodontitis influenced diabetes mellitus and diabetes induced periodontitis.

Distinction of Mohr's syndrome from OFD type I: case report and review of the literature.

The Oralfacialdigital Syndromes (OFD) results from the pleiotropic effect of a morphogenetic impairment affecting almost invariably the mouth, face and digits. In view of the different modes of inheritance and the different prognoses of the most common OFDs; OFD I, and II, it is important to establish a correct diagnosis in these patients. A case of type II OFD syndrome is being reported and the distinguishing clinico-radiological features with type I are compared. This case reports also reviews the various other types of OFD and their distinguishing characteristics and emphasizes the early diagnosis and treatment of the same.

Intentional replantation of periodontally compromised hopeless tooth.

Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation.

Herpes zoster of trigeminal nerve after dental extraction.

Herpes zoster is an uncommon acute viral infection caused by reactivation of varicella zoster virus. During the prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge for the dentist. Practicing dentist may carry out emergency treatment that might result in irreversible damage or may delay the appropriate treatment. With an ever-increasing number of elderly and immunocompromised patients reporting to the dentist, the dental profession can expect to encounter an increased number of herpes zoster patients. Dentist must be familiar with the presenting signs and symptoms of patients experiencing the prodromal manifestations of herpes zoster of the trigeminal nerve. This article focuses on the difficulties in management of such cases, and one such case is reported here.

Evaluation of serum resistin levels in periodontal health and disease and effects of non surgical periodontal therapy on its levels.

BACKGROUND: Resistin and adiponectin are the adipokines secreted by adipocytes and various inflammatory cells. These adipokines are known to play an important role in insulin resistance. The aim of this study was to determine the serum resistin levels in periodontal health and disease and also, to determine the effect of nonsurgical periodontal therapy on its levels. METHODS: A total of 40 patients (20 Males and 20 Females; age range 20-50 years) participated in the study. Subjects were categorized as healthy (group 1; Controls) and chronic periodontitis (group 2; Study) groups based on their periodontal status. Periodontal parameters (Plaque index (PI), Gingival index (GI), Bleeding index (BI), Probing pocket depth (PPD), Clinical attachment loss (CAL)) together with serum resistin levels were assessed at baseline and between 6-8 weeks following nonsurgical periodontal therapy for subjects in group 2 and only at baseline in group 1. Sera were tested in duplicate (single run), and the results were averaged. RESULTS: Study group showed higher (1.89 ± 1.83 ng/ml) serum resistin levels, compared to control group (1.35 ± 0.70 ng/ml). However, this difference was not statistically significant (P = 0.227). Also, resistin levels decreased following nonsurgical periodontal therapy but, this decrease failed to show any statistical significance, with pretreatment levels being 1.89 ± 1.83 ng/ml and post treatment levels being 1.59 ± 1.01 ng/ml (P = 0.386). CONCLUSION: Observations of the present study revealed that there was not much difference in the serum resistin levels between the cases and the controls. Also the decrease in the resistin levels following nonsurgical periodontal therapy did not show any statistical significance.