Efficacy of root coverage with the use of the conventional versus laser-assisted flap technique with platelet-rich fibrin in class I and class II gingival recession: A randomized clinical trial.

BACKGROUND: The coronally advanced flap (CAF) technique is the preferred option in treating recession defects, especially when the attached gingiva is adequate. A laser-assisted vestibular releasing incision after surgery could enhance the outcome. Platelets, when used as adjunctive treatment, have shown good results. However, laser biostimulation post-surgery has not been studied. OBJECTIVES: The present study compared the benefits of using the conventional and laser-assisted flap technique with platelet-rich fibrin (PRF) in the treatment of class I and class II gingival recession. MATERIAL AND METHODS: The study included 24 subjects, both males and females. The participants, diagnosed with Miller's class I and II gingival recession, were categorized into 2 groups: group A (n = 12) treated with CAF and PRF; and group B (n = 12) treated with laser-assisted CAF and PRF. Root coverage (RC), the probing depth (PD), the clinical attachment loss (CAL), and the keratinized tissue width (KTW) were assessed preand 6 months postoperatively. The wound healing index (WHI) and the visual analog scale (VAS) scores were assessed 1 week post-surgery. RESULTS: Most clinical parameters improved significantly within the groups at 6 months postoperatively as compared to baseline (p < 0.05), except for PD and percentage root coverage (PRC). However, when intergroup comparisons were made, it was observed that both groups performed equally well and the differences between them were not significant. CONCLUSIONS: Both treatment modalities improved the clinical parameters post-surgery. However, further trials are warranted to affirm the benefits of the laser-assisted CAF technique.

Comparison of efficacy of probiotics versus tetracycline fibers as adjuvants to scaling and root planing.

CONTEXT: Both gingivitis and periodontitis are due to the detrimental effects of the microbe-laden biofilm. The mainstay of periodontal treatment is, therefore, the disruption of this biofilm by scaling and root planing (SRP). Other treatment protocols such as systemic antimicrobials have been administered as adjuvants after scaling and root planning. However, due to antimicrobial resistance, as well as a shift of the flora from a symbiotic to a dysbiotic one, this mode of treatment has its shortcomings. Thus, local drug delivery has gained prominence as a therapeutic tool. AIMS: The aim of this study is to compare the efficacy of subgingivally delivered probiotics as a monotherapy, in combination with tetracycline fibers, and tetracycline fibers alone after SRP. SETTINGS AND DESIGN: This study was a parallel arm, randomized clinical and microbiological study. Thirty patients with chronic periodontitis aged between 20 and 50 years were selected from the outpatient ward of a tertiary referral care hospital in Hyderabad and equally divided into three groups. MATERIALS AND METHODS: This study was conducted from January 2017 to February 2017 and ethical clearance was obtained from the institutional ethical committee. STATISTICAL ANALYSIS USED: Mean values and standard deviations were calculated for Plaque Index, Sulcular Bleeding Index (SBI), probing depth (PD), and microbial colony-forming units, for all the three groups at different time intervals. Paired "t-test" was used for intragroup comparison and Student's "t-test" for intergroup comparison. Results were regarded as statistically significant when P < 0.05. RESULTS: Intragroup comparison yielded significant improvement in all the variables (P < 0.0001). However, intergroup comparison showed statistically significant differences pertaining to the PD (P < 0.001) and SBI only (P < 0.001), between Group A and Group B and Group B and Group C respectively. CONCLUSIONS: Group A and Group C showed better results than Group B.

Efficacy of an herbal antioxidant as an adjunct to nonsurgical periodontal therapy on procalcitonin levels in smokers with chronic periodontitis.

CONTEXT: Smokers are at a higher risk of contracting periodontitis. This association is established and reported in many studies. Periodontitis is a polymicrobial disease, wherein smoking is an environmental factor which aggravates the damage caused to the tissues. Procalcitonin (ProCT) is a well-known marker for inflammatory and other infectious diseases and has been assessed in this study. It has been observed that the release of reactive oxygen species (ROS) is exaggerated in smokers. Antioxidants are administered to combat the harmful effects caused by the ROS, and Oxitard™ is a powerful herbal antioxidant that can counteract the action of free radicals. AIMS: As smokers are more prone to tissue injury due to excessive release of ROS, this study aimed to understand the benefits of systemic administration of Oxitard after scaling and root planing (SRP) on serum ProCT levels in smokers with chronic periodontitis (CP). SETTINGS AND DESIGN: This was a randomized interventional study, wherein forty patients participated. MATERIALS AND METHODS: Forty smokers with CP aged, between 35 and 60 years, were equally divided into Group A (SRP + Oxitard) and Group B (SRP only), selected from an outpatient ward of a referral care hospital in Hyderabad. A written informed consent was obtained from all the patients, and the study was approved by the institutional ethical committee (DN0026-15). STATISTICAL ANALYSIS USED: Data were analyzed by GraphPad Prism software version 6.01 (GraphPad software incorporation, California, USA). Comparison within the groups was made by paired t-test and between the groups by unpaired t-test. P < 0.05 was considered of statistical significance. RESULTS: Intragroup assessment showed an improvement in all the variables from baseline to 3 months, which was statistically significant (P < 0.0001). A comparison between the groups, however, yielded better results in Group A (Oxitard + SRP) over Group B. CONCLUSIONS: Oxitard administered systemically for 3 months after SRP was beneficial in improving both clinical and biochemical parameters.

Association of CDKN2BAS gene polymorphism with periodontitis and Coronary Artery Disease from South Indian population.

BACKGROUND: Periodontal disease (PD), a chronic inflammatory disorder mediated by progressive destruction of the oral cavity is one of the key factors for many systemic disorders including Coronary Artery Disease (CAD). The upregulation of CDKN2BAS, a long noncoding RNA gene expression in gingival epithelial cells and gingival fibroblasts of periodontitis shows a strong correlation between the severity of atherosclerosis and PD. Considering the crucial role of CDKN2BAS gene polymorphisms (rs496892 G > A and rs7865618 A > G) and its expression the present study sought to identify the possible association with the disease predisposition in South Indian population. METHODS: For the present case-control study a total of 200 subjects that include 100 PD-CAD patients and 100 controls were recruited with prior consent. Genomic DNA and RNA were extracted and utilized for genotyping via ARMS-PCR and PCR-RFLP, and expression using RT-PCR respectively. RESULTS: The results showed a significant association of both the polymorphisms with that of the disease predisposition. The wild type genotypes (GG: OR-0.37; p-0.001; & AA: OR-0.29; p-0.005) conferred protection against the disease, whereas, the heterozygotes (GA: OR-2.45; p-0.004 & AG: OR-3.41; p-0.0001) conferred risk towards the disease, suggesting the involvement of the variant allele in disease causation. These results were further confirmed by haplotype analysis among A-G block (two variant alleles at both loci) with 2.5 fold risk (OR = 2.49, 95% CI = 1.16-5.36, p = 0.02) and G-G block (single risk allele at rs7865618 locus) with 3-fold risk (OR-3.0; p-0.01) towards the disease, suggesting the dominant involvement of rs7865618 in the disease causation. Though the expression of the CDKN2BAS gene is more in patients than controls, the variant genotypes among patients were evaluated to be down-regulated than the other genotypes. CONCLUSION: The present study concludes that the two selected polymorphisms have significant involvement individually and in interaction with each other in the disease predisposition. The expression studies also suggest that the selected polymorphisms in the 9p21.3 locus affect the CDKN2BAS gene expression. However, the results obtained in the present study should be confirmed with large samples in other ethnic cohorts.

Comparison of effectiveness of low-dose aspirin versus omega-3 fatty acids as adjuvants to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis.

CONTEXT: Periodontitis and diabetes are universally prevalent diseases which are interlinked with each other. Inflammatory products released both by the microorganisms, and the host plays a pivotal role in causing both the diseases. Pentraxins are acute-phase proteins which are often found to be elevated in inflammatory states. Anti-inflammatory agents have a very important role to play in curbing infection of which, aspirin and omega-3 fatty acids (O3FAs) are being administered often nowadays. Nonsurgical periodontal therapy (NSPT) remains the gold standard of treatment, and other agents have been used as adjuvants only, to increase the efficacy of treatment. AIMS: This study compares the effects of low-dose aspirin versus O3FAs when used as adjuvants to NSPT in patients with diabetes and chronic periodontitis. SETTINGS AND DESIGN: A total of 42 patients (mean age of 30-65 years) from a diabetic center who were diagnosed with Type II diabetes and chronic periodontitis were included in the study. MATERIALS AND METHODS: This study was done in the department of periodontics of a tertiary referral care hospital in Hyderabad, in collaboration with a reputed diabetic center. STATISTICAL ANALYSIS USED: Intragroup comparison was done using the paired t-test for continuous data and Wilcoxon signed-rank test for score data. Intergroup comparison was compiled using independent t-test. All P < 0.05 were considered statistically significant. RESULTS: Intragroup comparison at baseline and 3 months after NSPT showed statistically significant results (P < 0.001) in all the three groups pertaining to the clinical (gingival index, probing pocket depth, and clinical attachment level) and biochemical (glycosylated hemoglobin and pentraxin) parameters. However, the intergroup comparison showed a significant improvement in Group II related to pentraxin levels only (P < 0.001). CONCLUSIONS: O3FAs proved to be better than low-dose aspirin and placebo after NSPT.

Estimation of Pentraxin 3 and Porphyromonas Gingivalis Levels in Patients with Rheumatoid Arthritis and Periodontitis- An Observational Study.

INTRODUCTION: Periodontal diseases are inflammatory in nature involving interplay between the bacterial plaque and the micro-organisms, with the response of the host playing a pivotal role in either attenuating or eliminating the disease. Rheumatoid Arthritis (RA) is also a chronic inflammatory disease which shares common risk factors with periodontitis. Porphyromonas Gingivalis and Pentraxin 3 (an acute inflammatory protein) have been observed to be associated with both the diseases. AIM: This study was done to determine if there was any association between Pophyromonas Gingivalis and Pentraxin 3 levels in patients with RA and Chronic Periodontitis in comparison with Healthy controls. MATERIALS AND METHODS: This observational study was conducted on 90 subjects (42 Males and 48 Females) aged between 30-60 years. The subjects were selected from the out patient ward of a tertiary referral care hospital. The selected subjects were equally divided into three groups. Group I: Comprising of 30 patients with RA and chronic periodontitis who were in turn, subdivided into Group I- A (n=15) -Patients just diagnosed with RA and Group I- B (n=15) Patients under medications for more than three months. Group II: Patients with Chronic Periodontitis (n=30) and Group III: Healthy Controls (n=30) Intergroup comparison for continuous data was done by One-way analysis of variance test followed by Bonferroni's post-hoc test. Intragroup comparison for continuous data was done by paired t-test. RESULTS: Intergroup comparison between Group I and Group II did not show any statistical difference pertaining to the clinical parameters except for the Gingival Index (GI) which was found to be higher in Group II (Mean= 2.07) when compared to Group I (Mean=1.59). Intragroup comparison between Group IA and Group IB was statistically significant for GI, Plaque Index (PI), and Clinical Attachment Levels (CAL). Intragroup comparison between Group I-A and Group I-B showed that both Porphyromonas gingivalis and Pentraxin 3 Levels were higher in Group I- A. CONCLUSION: In this study, it was observed that there was a positive association between Porphyromonas gingivalis and Pentraxin 3 levels in patients with rheumatoid arthritis and periodontitis.

Effect of Autologous Platelet Rich Fibrin in Human Mandibular Molar Grade II Furcation Defects- A Randomized Clinical Trial.

INTRODUCTION: The Furcation of multirooted teeth is difficult region to gain access for treatment due to their complex anatomy. Modifications have been made in the periodontal instrument armamentarium to facilitate treatment of furcations. Moreover, many new materials have been introduced to attempt regeneration in the furcation defects. AIM: This study evaluated the role of Platelet Rich Fibrin (PRF) in comparison with allograft and Guided Tissue Regeneration (GTR) in the treatment of Grade II mandibular molar furcations. MATERIALS AND METHODS: This was a parallel arm prospective randomized, interventional trial (NCT 02430519) conducted on 22 patients, with Grade II mandibular furcation defects. Patients were divided into two equal groups. Group A, were treated by the placement of PRF as a graft and as a membrane while in Group B, the defects were treated by the placement of allograft and Healiguide collagen membrane. Clinical parameters {Plaque Index (PI), Probing Depth (PD), Relative Vertical Clinical Attachment Level (RVCAL), Relative Horizontal Clinical Attachment Level (RHCAL), Gingival Marginal Level(GML), and amount of Bonefill using Radio-Visiography (RVGBF)}, were estimated at baseline and nine months postoperatively. Comparison between the groups was analysed by using independent sample t-test, whereas, paired t-test was used to assess the mean values within the groups. RESULTS: The intergroup comparison for PI, PD, RHCAL, GML, was statistically not significant. Pertaining to RVCAL, there was a statistically significant difference at nine months (p-value=0.04) in Group A. Also, there was a statistically significant difference related to RVGBF (p-value=0.006) in Group A at nine months. CONCLUSION: The efficacy of PRF should be ascertained by conducting more studies with a larger sample size, on a long term basis, in patients with molar Grade II furcation defects.

Calcitonin receptor gene polymorphisms at codon 447 in patients with osteoporosis and chronic periodontitis in South Indian population - An observational study.

CONTEXT: Chronic periodontitis and osteoporosis are multifactorial diseases which share common risk factors. Interactions between genetic and other factors determine the likely hood of osteoporotic fractures and chronic periodontitis. Calcitonin receptor (CTR) gene polymorphism is one of the important factors which contribute to the development of osteoporosis and chronic periodontitis. AIMS: This study highlights the association of CTR gene polymorphisms at codon 447 in patients with osteoporosis and chronic periodontitis and healthy controls in south Indian population. SETTINGS AND DESIGN: The study was designed as a case-control retrospective, observational clinical trial which was conducted to assess the role of CTR gene polymorphism in patients with osteoporosis and periodontitis as well as in healthy controls. MATERIALS AND METHODS: A total of 50 subjects were taken into the study comprising of 20 healthy and 30 osteoporotic subjects with chronic periodontitis between the age group of 30-55 years. Within the limitations of our study, only 50 subjects were taken in the study due to the strict sampling method (Patients who were just diagnosed with osteoporosis and periodontitis and hence not taking any medication). 2 ml of blood sample was collected in ethylenediamine tetra acetic acid containing vials, and polymerase chain reaction was run to identify CTR gene polymorphism. STATISTICAL ANALYSIS USED: Statistical analysis was done by student t-test. Pertaining to C > T allele pattern there was a significant difference between the test and control group. RESULTS: A significant difference was observed between the test and control group in relation to the C > T allele pattern. Patients showing TT genotype distribution had greater periodontal destruction and lower bone-mineral density compared to CT genotype distribution followed by CC genotype distribution indicating TT homozygotes are more prone to the development of osteoporosis with increased risk of fracture and loss of alveolar bone. Males and females showed equal susceptibility to osteoporosis and chronic periodontitis. CONCLUSIONS: CTR polymorphism at codon 447 may be associated with osteoporosis and chronic periodontitis.

Effect of Alendronate with ß - TCP Bone Substitute in Surgical Therapy of Periodontal Intra-Osseous Defects: A Randomized Controlled Clinical Trial.

INTRODUCTION: Alendronate (ALN), an aminobisphosphonate, inhibits osteoclastic bone resorption and also stimulates osteogenesis. Beta-Tricalcium Phosphate (ß-TCP) is an osteoconductive graft material which provides a scaffold for bone formation and also a widely used drug delivery vehicle for growth factors and antibiotics. Drug delivery vehicles, like ß-TCP, improve the potency of the drugs by specific local site delivery of the drug, optimal release characteristics and easy handling. AIM: The aim of the this study was to evaluate the bone formation potential of 400µg ALN delivered in ß-TCP in the treatment of periodontal intra-osseous defects. MATERIALS AND METHODS: Thirty patients with periodontal defects were randomly assigned to 400µg ALN + ß-TCP + Saline (test) group and ß-TCP + Saline (active-control) group. Clinical parameters like Clinical Attachment Level (CAL) gain, Probing Depth (PD) reduction, post-operative Gingival Recession (GR) were assessed from the baseline, 3 months and 6 months recordings. Radiographic parameters like Linear Bone Growth (LBG), Percentage Bone Fill (%BF), and change in alveolar crest height (ACH) were assessed from baseline and 6 months radiographs. RESULTS: Mean measurements in the ALN test group for CAL gain (3.4 ± 0.74 mm), PD reduction (4.33 ± 0.82 mm), LBG (2.88 ± 0.88 mm), and %BF (51.98 ± 15.84%) were significantly greater with a p-value <0.05 compared to the mean measurements of CAL gain (2.20 ± 0.86 mm), PD reduction (3.20 ± 1.15 mm), LBG (1.70 ± 0.39 mm), and %BF (30.35 ± 6.88%) of the control group. There was mild alveolar crestal apposition (0.32 ± 0.68 mm) in the ALN test group and mild alveolar crestal resorption (-0.24 ± 0.40 mm) in the control group. CONCLUSION: 400µg ALN combined with ß-TCP bone graft material was effective in improving soft tissue parameters, inhibiting alveolar crestal resorption and enhancing bone formation, compared to ß-TCP alone.

Gingival squamous cell carcinoma: A diagnostic impediment.

Oral squamous cell carcinomas represent 3% of cancers in men and 2% of cancers in women. More than 90% of oral cancer occurs in people older than 45 years Lesions of gingiva account for approximately 10% of the oral squamous cell carcinomas and may present clinically as an area of ulceration, exophytic mass, or red/white speckled patches. The proximity to the underlying periosteum may invite early bone invasion. Carcinoma of gingiva constitutes an extremely important group of neoplasms as the lesion frequently mimics the reactive and inflammatory conditions affecting the periodontium, delaying the diagnosis and making the prognosis of the patient poorer. A rare case of gingival squamous cell carcinoma has been reported here, in a 40 Year old male patient. Careful recording of the case history and results of clinical examination, radiographic, and laboratory investigations, along with a critical review of similar conditions led to the diagnosis, and treatment was initiated.

Mouth: A portal to the body.

Periodontal disease is now increasingly believed to play a significant part in various systemic conditions. Likewise these systemic diseases and their severity have been found to have an impact on the morbidity of periodontal disease. A number of mechanisms specific to such interlink have been proposed and later established in numerous studies. The disorders with such bidirectional link with periodontal disease include cardiovascular, respiratory, neurological, and connective tissue diseases. The periodontal - systemic interlink has a vibrant effect on the management aspects and is of paramount topical interest to clinicians. We review the pertaining literature (Google scholar and pubmed).

Probiotics and prebiotics in periodontal therapy.

There has been a paradigm shift toward ecological and microbial community-based approach in understanding oral diseases. A marked improvement in gastrointestinal health has been reported after using probiotic bacteria and/or prebiotic supplements,which has prompted much interest in the use of this approach for oral applications. Treatment of periodontal disease in recent years has moved toward an antibiotic/antimicrobial model of disease management. With increase in the incidence of resistance to antibiotics, probiotics may be a promising area of research in periodontal therapy. This paper reviews the evidences for the use of probiotics or prebiotics for the prevention of dental caries or periodontal diseases, and also adresses the risk associated with their prolonged use. Many questions have been raised pertaining to the benefits of probiotic administration, as the role of probiotics in periodontics is still in infancy, and a complete understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics is essential to assess their long-term consequences for oral health and disease.

Osteoporosis: "A risk factor for periodontitis".

Aging is one of the major health challenges today. Most of the diseases related to aging, lead to significantly increased morbidity and mortality and higher public expenditure of funds. The interconnection between socio-economic conditions and social vulnerability is reflected in precarious states of health with prominence of high rates of osteoporosis and periodontal disease.Both these diseases have been highlighted in public health because of the impact caused by bone fracture and tooth loss. Thus, the elderly could help live a healthier and more meaningful life with the prevention of these diseases.