Vestibular Incision Subperiosteal Tunnel Access Technique with Platelet-Rich Fibrin Compared to Subepithelial Connective Tissue Graft for the Treatment of Multiple Gingival Recessions: A Randomized Controlled Clinical Trial.

BACKGROUND: The aim of this study was to compare the effectiveness of root coverage through vestibular incision subperiosteal tunnel access (VISTA) technique using platelet rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) in multiple gingival recessions. MATERIALS AND METHODS: A total of 20 patients with multiple gingival recessions were included, and 10 subjects were randomly allocated to test group (VISTA with PRF) and 10 patients to control group (VISTA with SCTG). Clinical parameters were recorded at baseline, 3 months, and 6 months. Patient's response toward the treatment was also assessed by questionnaire. RESULTS: All the clinical parameters in the study have showed better results in test group when compared to control group after a follow up period of 6 months with statistical significance. CONCLUSION: The results of the present study suggested that multiple gingival recessions can be successfully treated with both procedures, but better root coverage and a greater increase in keratinized tissue were achieved with the VISTA technique with SCTG. All the patients in both groups felt it was worth undergoing the treatment.

Melanocyte Response Following Depigmentation by Cryosurgery and Mucosal Excision: A Comparative Clinical and Histopathological Study.

AIMS: The main aim of this study was to evaluate the melanocyte response following depigmentation by cryosurgery and mucosal excision at both clinical and histopathological levels during 6 months. SUBJECTS AND METHODS: A total of 15 individuals, aged 25-45 years with hyperpigmentation on the facial aspect of the gingiva present in the esthetic zone were included. A split-mouth approach was used, wherein one side received depigmentation by a scalpel and the other side received cryotherapy, with the choice of the therapy and side chosen by the spin of the coin. For determining the melanocyte assay, a small amount of gingival tissue that was excised was studied under a special staining technique, i.e., Masson-Fontana method for melanin, a histochemistry procedure which determines the activity of melanin both quantitatively and qualitatively. Clinical and histological observations for the intensity of pigmentation were recorded at baseline and 6 months after surgery. STATISTICAL ANALYSIS USED: Paired and unpaired t-test. Results: The mean value of the Dummett Oral Pigmentation Index (DOPI) was 2.44 ± 0.51 at baseline; following depigmentation with scalpel technique, the mean DOPI was 1.05 ± 0.23 at 6 months; and there was a statistically significant difference in the mean DOPI when compared with that of the baseline (P = 0.001). Following depigmentation with cryosurgery technique, the mean DOPI was 0.33 ± 0.48 at 6 months which also varied statistically significantly with that of the baseline (P = 0.001). The mean value of melanin histopathological count (MHC) was 95.53 ± 9.03 at baseline; following depigmentation with the scalpel technique, the mean DOPI was 89.49 ± 7.56 at 6 months, which was not statistically significant (P = 0.795). Following depigmentation with the cryosurgery technique, the mean MHC was 75.38 ± 5.63 at 6 months, which was not statistically significant (P = 0.285). CONCLUSIONS: The mean histologic count of the melanocytes, which accounts for the re-pigmentation process has shown low recurrence values in cryosurgery over the scalpel technique even though the difference was not statistically significant.

Evaluation of the Efficacy of a 1:1 Mixture of ß-TCP and rhPDGF-BB in the Surgical Management of Two- and Three-Wall Intraosseous Defects: A Prospective Clinical Trial.

The aim of this split-mouth clinical and radiographic study was to evaluate and compare the regenerative potential of a combination of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and beta tricalcium phosphate (ß-TCP) to the established technique of bone grafting with ß-TCP alone in the surgical management of intraosseous defects. A total of 24 sites in 12 subjects with intraosseous defects were included and randomly divided into test (rhPDGF-BB + ß-TCP) and control (ß-TCP alone) sites. Clinical parameters were recorded at baseline, 3 months, and 6 months. Radiographic parameters were evaluated at baseline and 6 months. Both groups showed statistically significant reductions of all clinical parameters. Intergroup comparison demonstrated a significantly greater probing pocket depth reduction and clinical attachment level gain in the test group. The mean percentage defect fill was significantly greater in the test group than in the control group at 3 and 6 months, and greater improvement in defect angle was also evident in the test group. Although both groups showed definitive improvements in all parameters, the test group showed significantly better results when used to treat human periodontal intraosseous defects.

Effect of Initial Periodontal Therapy on Salivary Trefoil Factor (TFF3) in otherwise Healthy Patients with Gingivitis and Chronic Periodontitis.

BACKGROUND: The search for an ideal biomarker which can determine the current disease status that predicts the sites and individuals with increased susceptibility to periodontal disease has been going on since a long time. One such group of molecules which have been investigated recently are the trefoil factors, and the present study aims to determine the role of salivary trefoil factor 3 (TFF3) in periodontitis and gingivitis patients. MATERIALS AND METHODS: A total of fifty participants, of which 25 were diagnosed with moderate-to-severe periodontitis and 25 with chronic gingivitis were included in the study. The routine periodontal parameters were recorded at baseline and at 6 weeks which included plaque index, gingival index, bleeding index, probing depth, and clinical attachment level. The saliva samples were collected from both the groups at baseline and 6 weeks after nonsurgical periodontal therapy and analyzed by enzyme-linked immunosorbent assay to estimate the concentration of trefoil factor 3. RESULTS: All the periodontal parameters improved at 6-week reevaluation in both the groups. There was a significant change in the TFF3 levels in the periodontitis group from baseline to 6 weeks, and the concentrations were found to be higher following nonsurgical therapy, whereas the quantum of change in the gingivitis group was negligible. The levels of TFF3 remained unchanged in those periodontitis participants who required surgical intervention at the 6th-week reevaluation. CONCLUSION: The estimation of TFF3 levels may aid in decision-making in the treatment strategy of patients with moderate-to-severe periodontitis.

Effect of Diode Laser-assisted Flap Surgery on Postoperative Healing and Clinical Parameters: A Randomized Controlled Clinical Trial.

BACKGROUND AND OBJECTIVES: Lasers have been widely used because of several potential benefits such as antibacterial effect and stimulation of wound healing. In addition, lasers help in hemostasis and delaying epithelial migration which may facilitate the outcome of flap surgery. Hence, this study is aimed to investigate the adjunctive effect of diode laser irradiation on conventional access flap surgery in the treatment of periodontal disease. MATERIALS AND METHODS: A total of 23 patients requiring periodontal flap surgery in two sextants with probing pocket depth ≥5 mm in at least three teeth post-phase I therapy were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while conventional access flap surgery was done in the control quadrant. Procedural pain and tissue response of the patients were evaluated at 3, 7, and 14 days postoperatively. Clinical parameters including probing depth, clinical attachment level, plaque index, and gingival index were recorded at baseline, 3 months, and 6 months following treatment. RESULTS: There is no significant difference between the groups with respect to healing response of tissues; however, patients experienced more pain in test sites compared to control sites. Intragroup comparisons showed a statistically significant reduction of all clinical parameters from baseline to 6 months without any significant difference between the groups. CONCLUSION: Overall within the limitations of the study, diode lasers did not show any significant added benefits over conventional access flap surgery.

Ribonucleic acid interference induced gene knockdown.

Despite major advances in periodontal regeneration over the past three decades, complete regeneration of the lost periodontium on a regular and predictable basis in humans has still remained elusive. The identification of stem cells in the periodontal ligament together with the growing concept of tissue engineering has opened new vistas in periodontal regenerative medicine. In this regard, ribonucleic acid interference (RNAi) opens a new gate way for a novel RNA based approach in periodontal management. This paper aims to summarize the current opinion on the mechanisms underlying RNAi, in vitro and in vivo existing applications in the dental research, which could lead to their future use in periodontal regeneration.

Severe gingival enlargement associated with aggressive periodontitis.

Enlargement of the gingiva can be due to various causes. Most prevalent are the inflammatory type and drug-induced type of gingival hyperplasia. However, sever enlargement associated with an aggressive type of periodontitis is an infrequent finding. Reported here is a case of a female patient aged 18 years who presented with severe enlargement of the maxillary and mandibular gingiva. Examination revealed enlargement extending up to the incisal edge of all the teeth and also an associated generalized loss of attachment with radiographic evidence of reduced bone height resembling an aggressive type of periodontitis. There were no associated systemic signs and symptoms or any family history except that there was generalized vitiligo of the skin and oral mucous membrane. The case was treated by gross electrosection of the gingiva.

The use of a natural osteoconductive porous bone mineral (Bio-Oss™) in infrabony periodontal defects.

AIM: The aim of the present study was to evaluate the efficacy of a bovine derived xenograft Bio-Oss™ and to compare with open flap debridement in human infrabony periodontal defects. MATERIALS AND METHODS: Twelve healthy patients (5 males, 7 females; aged 30-50 years), with no systemic disease with moderate to severe periodontitis were treated. Surgically defects were included only if presence of two or more vertical osseous defects as verified by radiographs with associated probing pocket depth of ≥5.0 mm following non-surgical therapy. Final selection included 24 defects. The defects were randomly assigned treatment with bovine derived xenograft Bio-Oss™ as experimental sites or open flap debridement as control sites. Soft tissue and hard tissue measurements were recorded on the day of surgery and six months post-operatively. RESULTS: The results showed significant difference statistically between experimental and control sites in all measurements. Soft tissue measurements for the experimental sites included probing pocket depth reduction of 4.33±0.651 mm and attachment gain of 2.92±0.9003 mm, while the control sites showed a probing pocket depth reduction of 2.92±0.669 mm and a attachment gain of 0.583±0.515 mm. Osseous measurements showed bone fill of 1.936±1.046 mm (54.065±12.642%) for experimental sites and 0.02±0.01 mm (0.534±0.384%) for the control sites. Defect resolution was 50.75% for the experimental sites and 5.45% for the control sites. CONCLUSION: Bio-Oss™ is a bone graft material of considerable promise. However, further long term clinical studies with histological evaluation are warranted.

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.

Epidemiology of gingival recession and risk indicators in dental hospital population of Bhimavaram.

OBJECTIVE: Gingival recession (GR) is a common manifestation in most populations, and is considered as an early sign of periodontal disease. GR is an intriguing condition where various factors play an important role in its etiology. Only few studies have been undertaken to assess the prevalence and risk factors for GR in patients visiting dental hospitals. The aim of this study is not only to estimate prevalence, severity, and extent of GR in hospital population, of Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, but also to assess the potential risk factors for the same. MATERIALS AND METHODS: In this study, 2837 patients were examined of which 627 were included into the study. The age range was 16-80 years. Subjects were interviewed using a structural questionnaire, and full mouth clinical examination was done to assess recession. RESULTS: Of all subjects examined 45.6%, 16.2% of individuals and 13%, 4.8% of teeth per individual showed GR >3 mm. Prevalence and severity of recession was correlated with age. Recession was present but recession threshold ≥3 and ≥5 mm affected only small percentage of teeth in subjects younger than 45 years. Mandibular incisors showed the highest prevalence of GR ≥1 mm with 61% of teeth being affected. Smoking and presence of supragingival calculus were most significantly associated localized and generalized recession. CONCLUSION: Prevalence of periodontal disease is high among this population based on the presence of gingival recession in most the individuals. High prevalence of GR is significantly associated with supragingival calculus and smoking habits. This suggests a need to improve their periodontal condition through education, motivation, and improving their periodontal health.

Relevance of gingival crevice fluid components in assessment of periodontal disease - A critical analysis.

Monitoring infections which are episodic, site specific, localized or generalized, initiated by a number of microorganisms and assessed with measurement devices that have inherent shortcomings presents a difficult task. The lack of precise clinical criteria for assessment of periodontal disease has led to a search for alternative means of determining active disease sites, predicting future sites of breakdown and evaluating response to therapy. This paper highlights the potential array of biomarkers present in gingival crevice fluid (GCF) and provides an insight of which of these factors has the greatest diagnostic potential. The rationale behind using GCF as sampling source is also described. Finally it discusses the possible use of predictive chair side diagnostic tests in periodontitis.