Comparative Evaluation of Coronally Advanced Flap with and without Bioactive Glass Putty in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

BACKGROUND: The need-of-the-hour is a material that can support coronally advanced flap (CAF) procedures in treatment of gingival recession. Recent literature shows that various bone substitutes are being used for this procedure. This study clinically evaluates the outcomes of CAF with and without bioactive glass putty (NovaBone®) in terms of root coverage, gains in keratinized tissue height, and root coverage esthetic score in multiple gingival recession defects. METHODS: Ten healthy patients (age range 18-45 years) with multiple bilateral (n = 40 test 20; control 20) and comparable Miller's Class I or Class II gingival recession defects were selected. The defects were randomly assigned by a computer-generated list to either test (CAF + bioactive glass putty) or control (CAF alone) groups. Clinical parameters included gingival recession (GR), probing pocket depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), root coverage esthetic score (RES) evaluated at baseline and at 6 months post-surgery CAF with or without bioactive glass putty. RESULTS: Six months post-surgery all clinical parameters showed significant reductions. Gingival recession showed significant reduction both in test and control groups (2.0 ± 0.47 mm and 2.3 ± 0.48 mm, respectively; p < 0.05) with no intergroup difference. The exposed root was covered by 72% (test) and 79% (control). CAL gain was also significant in both groups (test: 2.7 ± 0.67 mm; control: 2.8 ± 0.78 mm; p < 0.05) with no intergroup difference. Keratinized tissue height gain was significant in both the groups (test group: 1.2 ± 0.42 mm; control group: 0.9 ± 0.57 mm) with no intergroup difference. Also, the RES was significant for both the test and control groups (7.2 ± 2.78 and 7.7 ± 1.41 respectively) with no intergroup differences. CONCLUSIONS: In isolated Class I/II GR defects, CAF associated with bioactive glass putty provided no significant difference in root coverage, CAL, KTH or RES compared to CAF alone. However, statistically significant gains were seen in all the parameters in both groups as compared to baseline. We refute the claims of the recent studies using a bone substitute for root coverage. Further long-term clinical trials are warranted to substantiate our results.

To pack or not to pack: the current status of periodontal dressings.

Surgical wound dressings have been employed over several centuries for the purpose of protection of surgical sites, to prevent postoperative infection and to accelerate healing. Periodontal dressings, also known as periodontal packs, provide similar benefits when applied after periodontal surgical procedures. They can broadly be categorized as eugenol-based dressings and noneugenol dressings. Over the years, many modifications have been made to the composition of such dressings to improve their physical and therapeutic properties. Controversies surrounding the rationale for their use, advantages and disadvantages of the most commonly employed periodontal dressings and their current status in clinical practice are described in this comprehensive review. From the evidence-based literature presented here, we have also attempted to answer the question of whether there is a universal need for the application of periodontal dressings.

Relationship between periodontitis and systemic diseases: leptin, a new biomarker?

BACKGROUND: Leptin is a polypeptide hormone associated with the occurrence of legion of diseases including obesity, cardiovascular diseases, and diabetes. Periodontitis, that is, inflammation of the periodontium has also been linked to a number of systemic manifestations. AIM: The aim of the present study was to analyze the role of leptin as a biomarker linking periodontitis with obesity, cardiovascular diseases, and diabetes. SETTING AND DESIGN: The inclusion criteria included, clinical trials available in English language; studies involving human participants; studies relating leptin and periodontal diseases to either obesity, cardiovascular diseases or diabetes. Exclusion criteria enlisted manuscripts in language other than English; if they were case reports, narrative reviews, personal communication, conference presentations, editorial and expert opinion; experiments not involving humans. METHODS: We performed a literature search encompassing the time period from January 2000 to May 2013. A systematic search of the Cochrane Library and the Medline through PubMed was performed using the selected keywords/phrases "leptin and periodontitis," "leptin and periodontal diseases," "leptin, periodontitis and obesity," "leptin, periodontitis and cardiovascular diseases," and "leptin, periodontitis, and diabetes." RESULT: A total of 23 studies was obtained using the selected keywords/phrases. On screening, the chosen studies seven fulfilled the inclusion criteria. Four demonstrated association of leptin with periodontitis and obesity. One study associated cardiovascular diseases and periodontitis through leptin whereas two were found linking leptin, periodontitis, and diabetes mellitus. CONCLUSION: We could find some positive consociation between the serum concentration of leptin, periodontitis, and systemic diseases including obesity and cardiovascular diseases. The results were conflicting when its relation with diabetes mellitus type 2 was examined, as one study favored the association whereas the other one claimed that there was no effect on the levels of leptin.

A review on different modes and methods for yielding a pentose sugar: xylitol.

Xylitol, a five-carbon polyalcohol, holds a substantial place in the cure and prevention of a number of diseases. The foremost reason for its lesser usage in day-to-day practice is its cost. The method employed on large scale production of this polyol, i.e. chemical reduction, uses extensive machinery and expensive chemicals thus increasing the basic cost of the sugar. Yield of xylitol by other methods including fermentation and enzymatic production is far less than chemical reduction. We did a literature analysis and briefed out the various experiments carried out till date and concluded on the required studies for improving its production and lowering down its cost.

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.

Pentraxins as key disease markers for periodontal diagnosis.

Periodontal diseases are characterized by a complex set of biologic interactions between a diverse and dynamic microbial ecosystem and the host's multifaceted and responsive immune and inflammatory machinery. Such interactions between microbial pathogens and various host response systems play a critical role in the development and progression of periodontal disease via the release of inflammatory and immune mediators. Advances in periodontal disease diagnostic are moving toward methods whereby periodontal risk can be identified and quantified by detecting such inflammatory mediators in its sequential pathophysiology. Pentraxins (PTXs) are classical mediators of inflammation and markers of acute-phase reaction. They are a super family of multifunctional molecules characterized by multimeric structure, divided into "short" PTXs and "long" PTXs. C-reactive protein (CRP) and pentraxin-3 (PTX3) are prototypic molecules of the short and long PTX family, respectively. Evidence suggests that PTXs acts as a non-redundant component of the humoral arm of innate immunity, downstream of, and complementary to, cellular recognition, as well as a tuner of inflammation. CRP is a cheaper biomarker and more readily available in everyday clinical practice compared with other inflammatory markers, on the other hand, PTX3 is believed to be the true independent indicator of disease activity and could have clinical implication in diagnosing the "at site" inflammatory status of the periodontal disease. These pentraxins are sensitive and specific in the diagnosis and prognosis of chronic diseases. Thus the pentraxins could be used as preferred biomarkers in periodontal disease diagnosis.

Recurrent aphthous stomatitis: a review.

Recurrent aphthous stomatitis (RAS) is a common clinical condition producing painful ulcerations in oral cavity. The diagnosis of RAS is based on well-defined clinical characteristics but the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current concepts and knowledge of the etiology, pathogenesis, and management of RAS.