Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by necrotising granulomatous inflammation of upper and lower respiratory tract, vasculitis and glomerulonephritis. This ailment may present with cough, haemoptysis, sinusitis, nasal deformity, skin lesions, malaise, fever, anorexia, and weight loss. Oral manifestation includes strawberry gingivitis, which is a pathognomonic clinical presentation. Here, we present a case of GPA in gingiva as the first manifestation. Clinical examination of the oral cavity revealed granular, erythematous gingival enlargement in the lower anterior teeth region involving papilla, marginal and attached gingiva with shiny and pebbled surface. Histopathological examination showed pseudoepitheliomatous hyperplasia with vasculitis and inflammation in the connective tissue, neutrophilic infiltration and abscess formation with haemorrhage were noted. Laboratory investigations revealed Proteinase 3 (PR3) antigen and Glomerular basement membrane (GBM) antigen were positive. Clinical, histopathological and laboratory investigations enabled the diagnosis of Granulomatosis with Polyangiitis. We present this rare case report of GPA with primary manifestation in gingiva.

Comparative Evaluation of Chitosan Chlorhexidine Mouthwash in Plaque Control: A Preliminary Randomized Controlled Clinical Trial.

AIMS: The purpose of the present study was to compare the effect of a new mouth wash formulation consisting of chlorhexidine and chitosan on dental plaque and its reduction to that of chlorhexidine or chitosan alone. MATERIALS AND METHODS: This study was a single-blind randomized clinical trial with a parallel group design of 3 months duration. Patients (20-40 years) who fulfilled the inclusion and exclusion criteria were assigned equally to group 1: chlorhexidine (0.2%), group 2: chitosan (0.5%) or group 3: chlorhexidine - chitosan combination group. The clinical parameters were recorded at baseline, 6weeks and at 3months. All patients received thorough oral prophylaxis and were instructed to rinse with 10ml of mouthwash twice daily for 1 minute. RESULTS: The combination of chitosan and chlorhexidine showed a statistically significant reduction (p less than0.05) in plaque indices from baseline at all time intervals when compared to that of chlorhexidine or chitosan alone. CONCLUSIONS: Our study demonstrates that by unifying the properties of chitosan and chlorhexidine may result in a superior antiplaque effect than that of chlorhexidine alone.

Treatment of Multiple Mandibular Gingival Recession Defects Using MCAT Technique and SCTG With and Without rhPDGF-BB: A Randomized Controlled Clinical Trial.

The aim of this randomized controlled trial was to compare the clinical outcomes of modified coronally advanced tunnel technique (MCAT) with subepithelial connective tissue graft (SCTG) with and without recombinant human platelet-derived growth factor-BB (rhPDGF-BB) for mandibular multiple recessions. Twenty-four Miller Class I and III recessions were randomly assigned to a group: test (MCAT+SCTG+rhPDGF-BB) or control (MCAT+SCTG). After 6 months, mean recession-depth reduction was higher in the test group (2.08 ± 0.90 mm) than the control (1.83 ± 0.93 mm). Mean root coverage was achieved, favoring the test group (82.6% ± 23.69%) instead of the control (56.2% ± 28.55%). Complete root coverage for the test group was 58.3%, which was significantly superior to control (16.7%). The use of rhPDGF-BB+SCTG using MCAT offered an advantage of a minimally invasive, predictable method for achieving optimal outcomes.

Multiple Recession Coverage Using Pericardium Membrane.

Anatomical characteristics, periodontal diseases and toothbrushing trauma make the management of multiple, adjacent, recession-type defects (MARTDs) particularly challenging. Even though connective tissue grafting is considered the gold standard in management, it has limitations, such as a second surgical site and limited amount of donor graft. Porcine pericardium membrane (PPM) is a reliable soft-tissue substitute with a three-dimensional collagen network that exhibits better stability, slow degradation, high-tear resistance, good handling properties and enhanced vascularization. This article describes the use of PPM, along with modified coronally advanced flap (Zucchelli's technique), in treating Millers Class I and II gingival recession in a 38-year-old male patient. Satisfactory outcomes were observed in gingival recession depth and clinical attachment loss from the baseline to six months postoperative. Two-thirds of the sites showed 100% root coverage. The mean root coverage achieved was 88.8%. A significant increase in the width of keratinized tissue was observed after six months of followup. The PPM was safe and healed uneventfully.

Treatment of Multiple Gingival Recessions Using a Minimally Invasive Coronally Advanced Tunnel: A Randomized Controlled Clinical Trial.

AIM: : The purpose of this trial was to evaluate the outcome of a modification of pin hole surgical technique which consists of a minimally invasive coronally advanced tunnel technique (MI-CAT) with orthodontic buttons and suturing in the treatment of multiple recession type defects. MATERIALS AND METHODS: Twelve systemically healthy patients (79 sites) aged between 22 - 55 years with Miller's Class I and II multiple recession defects were treated with minimally invasive coronally advanced tunnel technique. Thirty-nine sites were randomly assigned to a control group and the other 40 sites to the test group. In the test group, in addition to the MICAT procedure, buttons and suspensory silk sutures were used for the stabilization of the advanced flap. Clinical parameters were assessed at baseline, 3 weeks, 6 weeks and 6 months after surgery. RESULTS: A total of 79 recessions were treated. Complete root coverage from baseline to 6 months was 56% in the control group and 73% in the test group. Mean root coverage was 82.4% in the control group and 85.7% in the test group. Root coverage aesthetic scores of 9.3/10 and 9.4/10 were noted in the control and test group respectively. CONCLUSION: Six months post-surgical evaluation showed that minimally invasive coronally advanced tunnel technique with orthodontic buttons and suturing was effective and predictable for the treatment of multiple recession type defects. The clinical outcomes were similar to that of the control group with no statistical difference between the two groups.

Low Level Laser Therapy in the Treatment of Intra-Osseous Defect- A Case Report.

Low level laser has been documented in literature to promote wound healing by reducing postoperative inflammation, oedema and reduces pain. This case report demonstrates the safe and positive outcome of LLLT in conjunction with demineralised bone matrix of bovine origin in the surgical treatment of a periodontal infrabony defect. After surgical defect debridement, low level semiconductor diode laser (GaAlAr) was delivered for 5 minutes to the inner margins of flap in contact mode and the defect was irradiated with LLLT in a non-contact mode for 10 minutes. Demineralised bone matrix graft was used as a bone grafting material. Repeat irradiation was done for the next 5 days on the outer buccal and lingual flap surfaces. A CAL gain of 4 mm and 37% bone fill was noted radiographically at end of 12 months. LLLT can be used as an adjunct to periodontal regeneration.

Solitary neurofibroma: a rare occurrence on gingiva.

Neurofibromas-benign, slow-growing nerve sheath neoplasms composed of Schwann cells, perineural cells, and fibroblasts-are common neurogenic tumors on skin but uncommon intraorally. A diagnosis of neurofibroma can be established by clinical and histologic examinations. This case report describes an unusual presentation of solitary neurofibroma on the lingual gingiva of the mandibular posterior region of a 22-year-old woman. The patient exhibited no systemic manifestations of neurofibromatosis. Excisional biopsy of the intraoral neurofibroma was performed. Histologically, the neoplasm showed lesional cells arranged in the form of interlacing fascicles. The cells were elongated and had dark-staining, wavy nuclei, ample cytoplasm, and distinct cell borders, all characteristic of Schwann cells. Based on the histopathologic findings, a final diagnosis of neurofibroma was made. The patient returned for periodic reexamination after excision of the tumor, and there was no recurrence after 15 months.

Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study.

INTRODUCTION: PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched. AIM: The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP). SETTINGS AND DESIGN: The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India. MATERIALS AND METHODS: In a split-mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days. RESULTS: In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups. CONCLUSION: The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.

Attachment and Differentiation of Human Umbilical Cord Stem Cells on to the Tooth Root Surface with and without the Use of Fibroblast Growth Factor-An In Vitro Study.

BACKGROUND AND OBJECTIVES: The purpose of this first of its kind study was to analyse the growth, development and attachment of cultured human umbilical cord stem cells alone or supplemented with basic Fibroblast Growth Factor (bFGF) on both healthy and periodontally diseased tooth surfaces in vitro. METHODS: Four groups of 12 root surface scaffolds each were classified as Group I- healthy root surfaces; Group II- periodontally diseased; Group III- Healthy with bFGF and Group IV- periodontally diseased root with bFGF. bFGF was applied in the concentration of 8 ng/ml on to the surface followed by incubation of cultured human umbilical cord stem cells (hUCMSCs) on the scaffolds. Scanning electron microscopy observations were made on 14(th) and 21(st) days to assess the proliferation and morphology of cells attached on the tooth surface. RESULTS: Cultured hUCMSCs demonstrated adhesion to tooth root scaffold. All the groups showed a significant increase in the number of cell attachment from 14(th) day to 21(st) day. The groups with bFGF showed a significant increase in attachment of cells when compared to the groups without bFGF. The cells showed an increase in number of flat cells from 14th day to 21st day in all the groups indicating an increased maturity of cells. Periodontally diseased groups had less maturity of cells than healthy groups. The groups supplemented with bFGF, had more mature cells than the groups without bFGF. CONCLUSIONS: hUCMSCs have the propensity to differentiate into cells that have the capacity to bind to root surfaces. hUCMSCs incubated with bFGF showed better proliferation and attachment to tooth root surfaces. The role of hUCMSCs can be further explored for periodontal regeneration.

Human periodontal ligament fibroblast response to rhPDGF-BB application on periodontally diseased root surfaces-in vitro.

The aim of the present study was to evaluate the influence of recombinant platelet derived growth factor-BB (rhPDGF-BB) on the cellular proliferation, morphology and adherence of human periodontal ligament fibroblasts (PLFs) to the root surfaces of periodontally diseased and healthy human teeth roots at two different time periods. Primary cell cultures of PLFs were obtained from clinically healthy premolar or mandibular third molar teeth. 11 scaffolds were prepared from healthy teeth for group-1 (Healthy Substrates), 33 scaffolds were prepared from periodontally diseased teeth, which were further divided in Group-2 - Periodontally diseased substrates, Group-3 - Scaled and Root planed (SRP) substrates, Group-4 - SRP + rhPDGF-BB (50 ng/ml). Groups were further subdivided into two groups (n = 5 scaffolds per subgroup) and PLFs were incubated on the scaffolds for three and seven days, topographical assessment was done on the remaining substrate. Cell morphology and counting was assessed under a scanning electron microscope at 350× on day three and seven and statistically compared with the Mann-Whitney U test and the Kruskal-Wallis test. On day three, Group 1 showed least number of cells attached, whereas maximum number of cells were attached on Group 3 (SRP only) substrates. For day 7, Group 1 and Group 4 showed increase in the number of cells from day 3 to 7, while number of cells attached/substrate reduced drastically for Group 2 and 3 substrates. Group 3 and 4 showed better adhesion and proliferation of PLFs as compared to Group 1 and 2. Group-1 and Group-4 showed predominantly spindle cells with flat appearance, Group-3 showed stellate cells and Group-2 showed predominantly distorted spindle shaped cells. The results of this in-vitro study indicates that rhPDGF-BB plays a significant role as an adjunct to periodontal therapy in influencing maturity, attachment and proliferation of PLFs.

Periodontal disease classification: controversies, limitations and the road ahead--a proposed new classification.

History teaches us that a great deal of effort is put forward in giving birth to a classification system, only to have it be quickly contradicted or condemned. Though we have made great strides towards the understanding of periodontitis in general, the bitter truth is that we have not hit the bull's eye on the true nature of etiopathogenesis. Until then any classification based on infectious etiology would be a misfit. Aclassification that is easy to understand and based on treatment needs would be more apt at this juncture. This article is aimed at discussing the present American Academy of Periodontology 1999 classification and to suggest a new and simplified classification.

Cryosurgical Treatment of Gingival Melanin Pigmentation - A 30-Month Follow-Up Case Report.

INTRODUCTION: Cryosurgery is a branch of therapeutics that makes use of local freezing for the controlled destruction or removal of living tissues. Cryosurgery has been tried with satisfactory results for gingival depigmentation. However, documented evidence in the literature is extremely limited. The present case report describes the successful management of excessive gingival pigmentation by cryosurgery. The patient underwent follow-up for 30 months. CASE PRESENTATION: A 21-year-old South Indian dark-skinned female presented with dark brown to black gingival melanin pigmentation. The darkly pigmented gingiva had been present since birth. Cryosurgery using nitrous oxide and gas expansion cryoprobe cooled to -70°C was used for the depigmentation. The depigmentation was performed from maxillary right cuspid to maxillary left cuspid in a single appointment. The patient reported no adverse effects and no repigmentation of the treated areas for a period of 30 months. CONCLUSIONS: Cryosurgery is an easy procedure, with lack of bleeding and scar formation. The esthetic outcome may be maintained for 30 months as shown in the present case. Cryosurgery can be considered a desirable treatment option for gingival depigmentation.

Fibrin glue application in conjunction with tetracycline hydrochloride root conditioning and semilunar coronally repositioned flap in the treatment of gingival recession.

The purpose of this case report is to present the results of Fibrin Adhesive System (FAS) application, a topical biological tissue adhesive in the treatment of maxillary buccal recessions. A 40-year-old male patient presented with a pair of class I buccal recession defects on maxillary cuspids. Clinical parameters were recorded at baseline, 1 month, and 3 months. Semilunar coronally repositioned flap (Tarnow's technique), root debridement, root conditioning with tetracycline hydrochloride solution and one of the defect was treated with FAS application. Significant recession, height reduction, and attachment gain were observed with the FAS application defect site. About 50% of root coverage was noted in the FAS-treated defect and almost no root coverage in the defect site with no FAS application. Semilunar coronally repositioned flap with FAS application is an effective procedure for root coverage in anterior teeth. The addition of FAS improves the amount of root coverage, especially in relatively shallow defects.