Assessment of Wound Healing Using MMP-8 Levels in GCF of Diabetics With Chronic Periodontitis After Diode Laser Assisted Flap Surgery.

Background: Inflammatory cytokines like Matrix Metalloproteinases (MMPs) are associated with the destruction observed in periodontal disease (3). There has been evidence of significant increases in MMP levels in patients with systemic disorders, such as Diabetes Mellitus (DM), which is associated with microvascular complications, causing increased MMP activity, directly or indirectly, due to oxidative stress. Objective: The aim of this study was conducted in order to assess wound healing using MMP-8 levels in GCF of diabetics with chronic periodontitis after diode laser assisted flap surgery. Methods: This interventional, comparative clinical trial, was conducted after obtaining approval from the Institutional Ethics Committee (IEC), (Study protocol number: 48/2020), and registered with Clinical Trials Registry of India (CTRI/2022/07/043898). Purposive sampling technique was used to select 30 patients with chronic periodontitis (15 systemically healthy patients, and 15 diabetic patients), who visited the Department of Periodontology. Results: Out of the 30 patients initially selected, 3 patients were lost to follow up and 1 patient was excluded from the study due to lack of compliance towards oral hygiene maintenance. Intragroup comparison of the clinical parameters at baseline and 3 months in both groups was statistically significant (p=0.000). This concludes that there was statistically significant improvement in the periodontal parameters of non-diabetic patients after diode laser assisted flap surgery. Inter-group comparison of the clinical parameters did not show statistical significance at baseline and at 3 months (p > 0.05). It can be concluded that there was comparable changes in the periodontal parameters in both groups after surgery. Conclusion: MMP-8 could be used as a futuristic tool for assessing wound healing especially in diabetics, so that necessary treatment interventions can be undertaken prior to development of any post-op complications. Laser assisted Modified Widman flap showed noteworthy improvement in the clinical parameters in both groups. Thus, proving that laser assisted MWF surgery is a favorable treatment modality, especially in diabetics who are immunocompromised and prone to infections.

Assessment of Wound Healing Using MMP-8 Levels in GCF of Diabetics With Chronic Periodontitis After Diode Laser Assisted Flap Surgery.

Background: Inflammatory cytokines like Matrix Metalloproteinases (MMPs) are associated with the destruction observed in periodontal disease. There has been evidence of significant increases in MMP levels in patients with systemic disorders, such as Diabetes Mellitus (DM), which is associated with microvascular complications, causing increased MMP activity, directly or indirectly, due to oxidative stress. Objective: The aim of this study was conducted in order to assess wound healing using MMP-8 levels in GCF of diabetics with chronic periodontitis after diode laser assisted flap surgery. Methods: This interventional, comparative clinical trial, was conducted after obtaining approval from the Institutional Ethics Committee (IEC), (Study protocol number: 48/2020), and registered with Clinical Trials Registry of India (CTRI/2022/07/043898). Purposive sampling technique was used to select 30 patients with chronic periodontitis (15 systemically healthy patients, and 15 diabetic patients), who visited the Department of Periodontology. Results: Out of the 30 patients initially selected, 3 patients were lost to follow up and 1 patient was excluded from the study due to lack of compliance towards oral hygiene maintenance. Intragroup comparison of the clinical parameters at baseline and 3 months in both groups was statistically significant (p=0.000). This concludes that there was statistically significant improvement in the periodontal parameters of non-diabetic patients after diode laser assisted flap surgery. Inter-group comparison of the clinical parameters did not show statistical significance at baseline and at 3 months (p > 0.05). It can be concluded that there was comparable changes in the periodontal parameters in both groups after surgery. Conclusion: MMP-8 could be used as a futuristic tool for assessing wound healing especially in diabetics, so that necessary treatment interventions can be undertaken prior to development of any post-op complications. Laser assisted Modified Widman flap showed noteworthy improvement in the clinical parameters in both groups. Thus, proving that laser assisted MWF surgery is a favorable treatment modality, especially in diabetics who are immunocompromised and prone to infections.

Role of nonsurgical periodontal therapy on leptin levels and total antioxidant capacity in chronic generalised periodontitis patients - A clinical trial.

INTRODUCTION: Periodontitis causes oxidative stress and reduce total antioxidant levels. The aim of this study was to determine the effect of non-surgical periodontal treatment on leptin levels and total antioxidant capacity in chronic periodontitis. MATERIALS AND METHODS: A total of 35 chronic periodontitis (ChP) patients and 35 systemically and periodontal healthy subjects were enrolled in this study. Further, the ChP group received nonsurgical periodontal therapy (NSPT). Leptin and total antioxidant capacity (TAOC) was measured in serum and saliva samples at baseline, 3 months and 6 months after non-surgical periodontal therapy. Clinical parameters measured were measured at baseline, 1, 3 and 6 months interval. RESULTS: The mean serum leptin and TAOC levels in control group were significantly higher compared to chronic periodontitis group (p < 0.05). The control group had lower mean salivary leptin levels and higher mean salivary TAOC levels as compared to periodontitis group(p < 0.05). Clinical parameters were improved in ChP group post therapy (p < 0.05). However, the periodontal treatment showed insignificant changes in serum and salivary leptin and TAOC levels. CONCLUSION: Chronic periodontitis is significantly associated with serum and salivary TAOC and leptin levels. Non surgical periodontal therapy didn't alter the local and systemic TAOC and leptin levels.

Efficacy of Preprocedural Boric Acid Mouthrinse in Reducing Viable Bacteria in Dental Aerosols Produced during Ultrasonic Scaling.

INTRODUCTION: Aerosols and droplets contaminated with bacteria and blood are produced during ultrasonic scaling. Measures to control aerosol contamination in dental clinics are recommended by the Centers for Disease Control and Prevention. This study aimed to evaluate the efficacy of preprocedural boric acid (BA) mouthrinse in reducing bacterial contamination in dental aerosols generated during ultrasonic scaling. MATERIALS AND METHODS: This was a randomised clinical trial in 90 systemically healthy subjects (25-55 yrs) diagnosed with chronic periodontitis who were allocated into three groups of 30 subjects each to receive, Group A - 0.12% chlorhexidine (CHX), Group B - 0.75% BA and Group C-water, as a preprocedural rinse for 1 min. The aerosol generated while performing ultrasonic scaling for 30 min was collected at three locations on blood agar plates. Incubation of the blood agar plates at 37°C for next 48 h for aerobic culture was performed and subsequently colony-forming units (CFUs) were counted. RESULTS: CFUs in Group A were significantly reduced compared with Group B (P < 0.001). When we compare CFUs in all the three groups, CFUs in Groups A and B were statistically significantly reduced compared with Group C (P < 0.001). Furthermore, it was also observed that the assistant's chest area had lowest CFUs whereas patient's chest area had highest. CONCLUSION: This study recommends routine use of preprocedural mouthrinse as a measure to reduce bacterial aerosols generated during ultrasonic scaling and that 0.12% CHX gluconate is more effective than 0.75% BA mouthwash in reducing CFUs count.

Evaluation of a curcumin-containing mucoadhesive film for periodontal postsurgical pain control.

BACKGROUND: Management of pain and discomfort is important to make the postoperative period as pleasant as possible. Nonsteroidal anti-inflammatory drugs are traditionally prescribed; however, they are associated with numerous side effects. As a result, nutraceuticals such as curcumin are widely used for its well-known safety and medicinal values. Hence, the aim of this study is to evaluate the efficacy of a curcumin mucoadhesive film for postsurgical pain control. MATERIALS AND METHODS: This was a split-mouth study, consisting of 15 systemically healthy patients with 30 sites, who were randomly allocated into test (curcumin mucoadhesive film) and control (placebo mucoadhesive film) groups using coin toss method. A questionnaire was given to patients to evaluate the postoperative pain and swelling and the number of rescue medications taken. Statistical analyses used were Friedman test, Wilcoxon signed-rank test, and McNemar's test. RESULTS: No adverse effects were reported and healing was uneventful in all patients. The Numerical rating scale pain score showed significantly lesser pain at 1, 2, 3, 4, 5, and 24 h in the test group. Significantly more number of analgesics was consumed in total in the control group than that in the test group. CONCLUSION: Within the limitations of this study, it may be concluded that curcumin mucoadhesive film showed promising results in reducing postoperative pain and swelling over a period of 1 week, hence showing its analgesic effect after periodontal surgeries.

Salivary free hemoglobin and lactate dehydrogenase as biomarkers for periodontal disease in smokers.

OBJECTIVE: The purpose of the present study was to compare levels of the biomarkers lactate dehydrogenase (LDH) and free hemoglobin in the saliva of different groups of smokers for early diagnosis of periodontitis and their clinical relevance for use as a screening tool. METHOD AND MATERIALS: Eighty cigarette smokers were divided into light (< 10 cigarettes/day) moderate (10 to 19 cigarettes/day) and heavy (≥ 20 cigarettes/day) smokers. Stimulated saliva samples were obtained by the expectoration method and evaluated for LDH and free hemoglobin levels. Clinical parameters were recorded after saliva collection using the modified Community Periodontal Index (CPI). RESULTS: Salivary free hemoglobin level was higher in light smokers compared to heavy smokers (mean 363.89 ± 295 µmol/L in light vs mean 79.55 ± 37.41 µmol/L in heavy, P = .001) and positively correlated with CPI score. There was no control group to prevent bias with free hemoglobin results in healthy individuals. Salivary LDH levels were higher in light smokers (411.24 ± 18.62 IU/L) compared to heavy smokers (313.26 ± 23.98 IU/L). However, a significant correlation between free hemoglobin, LDH, and CPI score (clinical parameters) was seen between the three groups of smokers (P < .01). CONCLUSIONS: Within the limitations of this observational study, there was a progressive reduction in free hemoglobin and LDH levels from light smokers to heavy smokers. However, the severity of periodontal disease conditions increased as the severity of smoking habit increased.

Platelet-Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial.

BACKGROUND: Platelet-rich fibrin (PRF) is an autologous non-transfusional hemo-component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD). METHODS: Twenty-six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI). RESULTS: The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group. CONCLUSION: The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.

Long-term effect of Lactobacillus brevis CD2 (Inersan®) and/or doxycycline in aggressive periodontitis.

CONTEXT: The over usage and broad use of antibiotics resulted in the emergence of resistant microorganisms to the drugs which also disturb the indigenous microflora, which include the Lactobacillus in the oral cavity. Hence, it is preferred to avoid the use of antibiotics. AIMS: The hypothesis tested in this study was that 14 days of treatment with Lactobacillus brevis CD2 lozenges, L. brevis CD2 with oral doxycycline, or doxycycline alone would have a beneficial effect on periodontal health after 5 months. SETTINGS AND DESIGN: It was a randomized clinical trial. MATERIALS AND METHODS: Eighteen nonsmoking patients aged 14-35 years, with aggressive periodontitis, were randomized to receive 14 days of treatment with L. brevis CD2 lozenges (two lozenges daily), L. brevis CD2 lozenges with oral doxycycline (100 mg tablet once daily), or doxycycline alone. Saliva samples were taken on day 0, 2 weeks, 2 months, and 5 months. Clinical parameters (plaque index, gingival index, probing pocket depth, and clinical attachment level) and microbiological parameters (lactobacilli and Aggregatibacter actinomycetemcomitans) were evaluated. STATISTICAL ANALYSIS USED: Changes between groups were evaluated using repeated measure analysis of variance. RESULTS: All clinical parameters shown to be numerically improved at 5 months when compared with baseline in all the three groups. The improvement (P < 0.01) in gingival index was statistically significant, and the intergroup results were also statistically significant (P < 0.01). CONCLUSIONS: Fourteen days of treatment with lozenges having L. brevis CD2 have a lasting effect on clinical measures of aggressive periodontitis, particularly gingival index. This effect appears to be equivalent to that produced by doxycycline.

Management of chronic luxated central incisor with hopeless prognosis.

Traumatic injuries are the most studied yet most challenging for a dentist. Extrusive luxation injuries are usually managed by repositioning tooth in the original position and pulp sensibility is evaluated at regular periodic intervals. However, when injuries are chronic, tooth is necrotic with compromised periodontal support, treatment is a challenge. Intentional replantation utilizing growth factors in fibrin rich network of platelet rich fibrin can be a treatment modality in such patients where other restorative modalities to establish function-esthetics rehabilitation is not possible.

The Morphometrical and Histopathological Changes which were Observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report.

We are presenting 2 cases where ozone therapy was used in the form of ozonated oil on an exophytic fibrous gingival lesion. A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva. This gingival lesion was treated with 2ml of ozonated oil, thrice daily for one week. After the ozone therapy, the postoperative outcomes were measured and analyzed. Finally, the lesion was subjected to an excisional biopsy and a histopathological evaluation. After the ozone therapy, the patient revealed that there was less pain. On examination of the lesion, an improvement was observed in the clinical sign of the inflammation and also a reduction in the surface ulceration. During the final biopsy, less bleeding was observed. The morphometrical analysis showed a reduction in the size of the lesion. The histopathological analysis showed a reduction in the collagen fibres and in the inflammatory cells in the connective tissue stroma. Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions. The observed benefits in present case report needs to be verified in future with well-controlled clinical trials.

Cytomorphometric analysis of the gingival epithelium in type 2 diabetic patients with and without smoking habit.

BACKGROUND: It has been shown that cigarette smoking as well as diabetes mellitus can produce cytomorphometric alterations in oral epithelial cells with the significant increase in the nuclear area (NA) and significant decrease in the cytoplasmic/nuclear ratio in comparison to healthy control. However, the synergistic effect of tobacco smoking and diabetes on the morphology of gingival epithelial cells is not been explored until date. AIM: This study was carried out to investigate the effects of diabetes and the synergistic effects of smoking and diabetes on the cytomorphometry of gingival epithelium. MATERIALS AND METHODS: Gingival smears were collected from 30 male subjects diagnosed with type 2 diabetes with (n = 10) or without history of smoking habit (n = 10). Healthy subjects with no history of smoking or diabetes served as the control group (n = 10). The smears were stained using Papanicolaou procedure. The cellular (CA) and nuclear areas (NA) were measured using image analysis software. One-way ANOVA and Tukey-HSD procedure (at P = 0.05) were used to analyze all the parametric variables. RESULTS: A statistically significant (P < 0.001) increase in NA and N:C ratio in smoker diabetic group was observed compared to the non-smoker diabetic group and the control group. The non-smoker diabetic group also showed significant increase. CONCLUSIONS: There were significant alterations in the cellular pattern of gingival mucosa cells in a non-smoker diabetic, but the alteration was to a greater extent in smoker diabetics demonstrating a synergistic effect of smoking and diabetes on gingival mucosa.

Evaluation of the effect of probiotic (inersan®) alone, combination of probiotic with doxycycline and doxycycline alone on aggressive periodontitis - a clinical and microbiological study.

INTRODUCTION: The purpose of the present study was to evaluate the effect of a probiotic (Inersan®) alone, a combination of the probiotic with doxycycline and doxycycline alone on aggressive periodontitis patients. METHODS: Thirty patients who satisfied the inclusion and exclusion criteria, were assigned to one of the above mentioned three groups by using block randomization. The clinical and the microbiological parameters were recorded on day 0, at 2 weeks and at 2 months. On day 0, before recording the clinical parameters, 0.5 ml of unstimulated saliva was collected for the evaluation of the microbiological parameters. The clinical parameters which were recorded were the plaque index, the gingival index, the probing pocket depth and the clinical attachment level. The microbiological parameters which were recorded were Lactobacilli and Aggregatibacter actinomycetemcomitans. After this, Scaling and Root Planing (SRP) was performed on day 0. Two weeks after the SRP, the patients were recalled for the saliva sample collection and for the evaluation of the clinical parameters. On the same day, medications were given to the patients to be taken for fourteen days according to the group which they belonged to (Group A - probiotic alone, Group B - a combination of the probiotic with doxycycline, Group C - doxycycline alone). The patients were then recalled at two months for the saliva sample collection and for the evaluation of the clinical parameters. RESULTS: The administration of the probiotic alone, a combination of the probiotic with doxycycline and doxycycline alone, resulted in a decrease in the plaque index, the gingival index, the probing pocket depth and the clinical attachment level at 2 months, which was statistically significant (p < 0.05). The A. actinomycetemcomitans count tended to decrease in all the three groups at 2 months, which was statistically non-significant (p > 0.05). The Lactobacilli count tended to increase significantly in the probiotic alone group (p < 0.05). CONCLUSION: Probiotics have a future in the treatment of aggressive periodontitis, as antibiotics are prescribed most of the time. These antibiotics can lead to the emergence of drug resistant micro-organisms and they can also disturb the beneficial microflora of the body. Thus, as an alternative to antibiotics, probiotics can be used, as they repopulate the beneficial microflora and reduce the pathogenic bacteria.

Cytomegalovirus occurrence in chronic periodontitis and in carcinoma of the cervix: an exploratory study.

AIMS: To explore the following in a group of carcinoma cervix patients with chronic periodontitis: The possible association of the Human Cytomegalovirus (HCMV) in chronic periodontitis and carcinoma of the cervix by examining the presence of HCMV (Human Cytomegalovirus) in saliva, Gingival Crevicular Fluid (G.C.F.) and in cervical biopsy samples and by comparing the clinical parameters among the Human Cytomegalovirus(HCMV) detected and the undetected sites. The possible association of chronic periodontitis and carcinoma of the cervix by assessing the common occurrence of HCMV in saliva, GCF and cervical biopsies. MATERIAL AND METHODS: Sixteen female subjects who were aged 35 to 65 years, who were diagnosed with carcinoma of the cervix were selected. All the subjects underwent a clinical evaluation for their periodontal conditions. Cervical biopsies, saliva and GCF samples were obtained from all the participants and these were subjected to HCMV detection by using the nested PCR method. RESULTS: HCMV has been detected in the cervical biopsies of 68.75 % patients, in the GCF samples of 75 % patients and in the saliva samples of 37.5 % patients. The clinical parameters i.e. probing pocket depth (P<0.008) and the clinical attachment level (P<0.026) were statistically significant in the GCF samples of the sites which were positive for HCMV as compared to those in the sites which were negative for HCMV. In 56% patients, HCMV was detected in both the cervical biopsies and the GCF samples. In 25% patients, HCMV was detected in both the cervical biopsies and the saliva samples. CONCLUSION: The results are suggestive of a possible association of the HCMV occurrence in chronic periodontitis and a possible association of the HCMV occurrence and carcinoma of the cervix. An association between chronic periodontitis and carcinoma of the cervix cannot be elucidated with the available data, since the values are statistically insignificant. Hence, further research incorporating systemic inflammatory parameters would be necessary.

Frenectomy: a review with the reports of surgical techniques.

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy.The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller's technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported.

Comparative evaluation of a bioabsorbable collagen membrane and connective tissue graft in the treatment of localized gingival recession: A clinical study.

BACKGROUND: Gingival recession (GR) can result in root sensitivity, esthetic concern to the patient, and predilection to root caries. The purpose of this randomized clinical study was to evaluate (1) the effect of guided tissue regeneration (GTR) procedure using a bioabsorbable collagen membrane, in comparison to autogenous subepithelial connective tissue graft (SCTG) for root coverage in localized gingival recession defects; and (2) the change in width of keratinized gingiva following these two procedures. MATERIALS AND METHODS: A total of 10 cases, showing at least two localized Miller's Class I or Class II gingival recession, participated in this study. In a split mouth design, the pairs of defects were randomly assigned for treatment with either SCTG (SCTG Group) or GTR-based collagen membrane (GTRC Group). Both the grafts were covered with coronally advanced flap. Recession depth (RD), recession width (RW), width of keratinized gingiva (KG), probing depth (PD), relative attachment level (RAL), plaque index (PI), and gingival index (GI) were recorded at baseline, 3 and 6 months postoperatively. RESULTS: Six months following root coverage procedures, the mean root coverage was found to be 84.84% ± 16.81% and 84.0% ± 15.19% in SCTG Group and GTRC Group, respectively. The mean keratinized gingival width increase was 1.50 ± 0.70 mm and 2.30 ± 0.67 mm in the SCTG and GTRC group, respectively, which was not statistically significant. CONCLUSION: It may be concluded that resorbable collagen membrane can be a reliable alternative to autogenous connective tissue graft in the treatment of gingival recession.