Salvaging the second molar with platelet-rich fibrin and photobiomodulation (970 nm diode laser) following third molar extraction.

Second molars are more susceptible to periodontitis when present adjacent to periodontally hopeless third molars. It is crucial to restore the health of the second molar and to prevent a dry socket after third molar extraction. To ensure complete eradication of infection along with regeneration, mere nonsurgical periodontal therapy might be inadequate. Thus, in this case report, high-level laser therapy (HLLT), advanced-platelet-rich fibrin (A-PRF), and low-level laser therapy (photobiomodulation [PBM]) were adapted to obtain a synergistic effect. HLLT was accomplished for decontamination and clot stabilization following the third molar extraction. Further, A-PRF was placed and irradiated with PBM on 3rd, 7th, 15th, and 21st days, postoperatively. There was reduced clinical probing depth and gain in clinical attachment level with a significant radiographic bone fill distal to second molar at 3 months follow-up. This combined use of HLLT, and PBM along with PRF could be a reliable treatment approach for regeneration, particularly in acute infections.

Augmentation of Peri-implant Keratinized Mucosa Using a Combination of Free Gingival Graft Strip with Xenogeneic Collagen Matrix or Free Gingival Graft Alone: A Randomized Controlled Study.

Purpose: To evaluate the gain in peri-implant keratinized mucosa (KM) using a combination of a free gingival graft (FGG) strip with a xenogeneic collagen matrix (XCM) and compare it to that of an FGG alone. Materials and Methods: This randomized controlled clinical study included a total of 30 patients with a minimal amount of peri-implant KM (≤ 1 mm) in the maxillary and mandibular anterior regions (including the premolars). The study population was divided into two groups using a randomization protocol; group A (n = 15) received a combination of FGG strip and XCM, and group B (n = 15) received FGG only to augment the KM. Clinical parameters included width of KM (WKM) measured at baseline, 1 month, and 6 months; a customized pink esthetic score (PES) measured at baseline and 6 months; and patient morbidity using visual analog scale (VAS) at days 1, 7, and 14 postoperatively. Results: After 1 month, both groups showed statistically significant gain in KM that reduced slightly by the 6-month follow-up but remained statistically significant when compared to baseline. When the gain was compared between the two groups, the difference was not statistically significant. Better esthetic outcomes and lower morbidity were reported in group A compared to group B, and this difference was statistically significant. Conclusions: Within the limitations of the study, it can be concluded that the combination of FGG strip with XCM is a viable alternative to the use of FGG in augmenting peri-implant KM.

Arterial and venous thrombosis in a patient with Covid-19: A unique presentation.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection not only affects the respiratory system but also induces coagulation abnormalities and thrombosis. We report a middle-aged woman who presented during the Covid-19 pandemic with sudden-onset acute left upper limb ischaemia of short duration, with no history of dry cough, breathlessness or fever, and tested positive on TrueNAT for SARS-CoV-2. Later, she developed deep venous thrombosis of the right lower limb during isolation in the hospital.

Efficacy of antimicrobial photodynamic therapy on the tongue surface in the management of halitosis - A real-time polymerase chain reaction analysis.

AIM: To evaluate the additional effect of a single session of antimicrobial photodynamic therapy (aPDT) on the tongue as an adjunct to scaling and root planing (SRP) on most common volatile sulfur-producing microbes such as Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) on 3rd, 7th and 14th day postoperatively using RT-PCR analysis. METHOD AND MATERIALS: Twenty-four patients of either sex, presented with moderate to severe malodor, detected by a portable breath checker (Tanita®) were considered for the study and assigned to group A & B. Scaling and root planning was performed in both the groups, followed by photodynamic therapy on the tongue surface in group A. One percent methylene blue photosensitizer was applied on the middle and posterior thirds of the dorsum of the tongue and irradiated in continuous mode at six different points for 90 s at each point. RESULTS: A significant reduction in Halimeter scores throughout the study period was observed. A significant reduction in the tongue coating score on 3rd and 7th day and the total count of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) on 7th and 14th day was seen in group A (p ≤ 0.05). However, the mean reduction in Treponema denticola (Td) was non-significant in both the groups but a greater fall in the total count was seen in group A compared to group B on all the days (p ≥ 0.05). CONCLUSION: Within the limitations of the study, it was concluded that photodynamic therapy on the tongue along with scaling and root planing was effective in the reduction of malodour and the total count of bacteria responsible for the same. Long-term clinical trials are required to further substantiate the effectiveness of this technique.

Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli's technique.

BACKGROUND: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. AIM: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. MATERIALS AND METHODS: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. STATISTICAL ANALYSIS AND RESULTS: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. CONCLUSION: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.

C, N dual-doped ZnO nanofoams: a potential antimicrobial agent, an efficient visible light photocatalyst and SXAS studies.

It is crucial to develop an environmentally friendly and low-cost method to treat industrial effluent that contains soluble dyes and microbes. Most of the photocatalysts have been studied using an external light source that increases the cost of the purification process of effluent. This study focuses on developing efficient solar photocatalytic nanofoams. The controlled growth of ZnO nanofoams (CNZ nanofoams) in a simple method of thermal oxidation using a soft template is reported. Prepared nanofoams are characterized using X-ray diffraction, scanning electon microscopy and synchrotron soft X-ray absorption spectroscopy. By photocatalysis studies under direct sunlight it was found that within 120 min CNZ nanofoams degraded 99% of the dye. In addition, antimicrobial studies of multi-drug-resistant E. Fergusonii isolated from wastewater was carried out. These antimicrobial results showed a good inhibition zone, indicating that prepared nanofoams are both an effective solar photocatalyst and an antimicrobial agent.

An improved strategy for transferring and adhering thin nanoporous alumina membranes onto conducting transparent electrodes for template assisted electrodeposition of high aspect ratio semiconductor nanowires with increased optical absorption.

This article presents a new method for transferring and enhancing the adhesion of thin nanoporous alumina (NPA) membranes onto non-atomically flat substrates like fluorine-doped tin oxide (FTO) coated glass. The study reports use of glycerol as an additive to reduce the brittleness of the polystyrene filler that was used to fill the pores of the NPA membrane. Additionally, a new reflux-based method is reported here for the complete removal of the polystryrene filler from the porous channels of alumina. The adhesion between an NPA membrane and an underlying electrode was enhanced by electrodepositing a thin (∼40 nm) intermediate layer of the conducting polymer polyaniline (PANI). The PANI layer acts as an efficient electrostatic adhesive between the NPA and the conducting glass electrode and ensures ultra-strong adhesion of the NPA membrane, which can survive the harsh conditions of CdTe nanowire electrodeposition (60 °C temperature and an acidic electrolyte) without delamination for 30 min. The resulting nanowires clearly templated the structure of NPA and displayed free-standing nanowires over a large area with a diameter of around 60 nm, a length of approximately 2.8 µm (aspect ratio ∼47) and an areal density of 5.9 × 1012 nanowires cm-2. Total optical absorption measurement on the free-standing CdTe nanowires exhibited a 45% enhancement over a wavelength range of 350-1400 nm as compared to a CdTe planar thin film of same thickness.

Staged Ridge Split Procedure in the Management of Horizontal Ridge Deficiency Utilizing Piezosurgery.

AIM AND OBJECTIVES: Edentulism is an incapacitating and irretrievable condition which can lead unswervingly to functional limitation, physical, psychological and social handicap. Maintenance of bone after tooth loss to improve retention, function, and performance of the restoration is a challenging task. The existence of a thin edentulous ridge signifies a clinical situation that is more complex for the placement of endosseous implants. Dental rehabilitation of the edentulous ridges with oral implants has become a routine treatment modality in the last few decades with consistent long term results. METHODS: A staged ridge spilt procedure was performed in the maxillary posterior edentulous region employing piezosurgery for the augmentation of horizontal ridge deficiency which was followed by the successful placement of implant supported prosthesis. RESULTS: At the 20 months follow-up, stable results were appreciated with minimal bone loss around the implants. CONCLUSION: This proficient technique precludes the need for a second surgical site for the procurement of graft which in turn decreases patient discomfort. Hence this procedure can be used as an alternative to other strenuous procedures.

A Radiographic Classification for Retrograde Peri-implantitis.

BACKGROUND: Retrograde peri-implantitis (RPI) is an inflammatory disease that affects the apical part of an osseointegrated implant, while the coronal portion of the implant sustains a normal bone-to-implant interface. It is a diagnostic and therapeutic dilemma for implantologists. There is lack of a standard classification system and a definite treatment algorithm for the same. This article aims to introduce a classification system for RPI based on the radiographic amount of bone loss around an implant apex. MATERIALS AND METHODS: A search of PubMed database was conducted with the keywords "retrograde peri-implantitis" and "implant periapical lesion." Preoperative intraoral periapical (IOPA) radiographs of implants with RPI in case reports/case series were compiled. A total of 54 lOPAs from 36 articles were compiled and were assessed. RESULTS: Three different classes were proposed. The amount of bone loss from the apex of the implant to the most coronal part of radiolucency was calculated as a percentage of the total implant length and classified into one of the three classes: Mild, moderate, and advanced. Treatment options and prognosis have been suggested for each class. CONCLUSION: The proposed classification may allow for an easy and reproducible radiographic assessment of the RPI lesion and may serve as a guideline to prognosis and treatment planning.

Comparative evaluation of free gingival graft and AlloDerm(®) in enhancing the width of attached gingival: A clinical study.

BACKGROUND: The presence of an adequate width of keratinized tissue is important to maintain a healthy dentogingival junction. In case of inadequate width of attached gingiva, the gingival augmentation procedure has been performed classically using the patient's own masticatory mucosa and more recently, using an acellular dermal allograft as the donor material. AIMS: The aim of the clinical study was to evaluate and compare the effectiveness of free gingival graft (FGG) and acellular dermal matrix (ADM) allograft in the ability to increase the zone of attached gingiva. MATERIALS AND METHODS: Fifteen patients with 30 sites showing the inadequate width of attached gingiva (≤1 mm) were enrolled for the split-mouth study. The width of keratinized gingiva and other clinical parameters were recorded at baseline and 12(th) month postoperatively. STATISTICAL ANALYSIS: The difference in clinical parameters within the group was assessed by Wilcoxon signed rank test. However, Mann-Whitney U-test was used to analyze the differences between test and control groups. RESULTS: The width of attached gingiva increased significantly (P < 0.01) following both the treatments but comparatively lesser gain with ADM allograft (2.13 mm vs. 4.8 mm). ADM site had significantly more shrinkage (76.6%) than FGG site (49.7%). Though FGG was found to be more effective, clinicians can prefer ADM allograft because of its certain advantages over the FGG. CONCLUSION: ADM allograft has resulted in sufficient increase in width of attached gingiva although lesser than FGG. Considering the disadvantages of FGG, it can be concluded that ADM allograft can be used as an alternative to FGG in increasing width of attached gingival in certain clinical situations.

Charge Carrier Transport Mechanism Based on Stable Low Voltage Organic Bistable Memory Device.

A solution processed two terminal organic bistable memory device was fabricated utilizing films of polymethyl methacrylate PMMA/ZnO/PMMA on top of ITO coated glass. Electrical characterization of the device structure showed that the two terminal device exhibited favorable switching characteristics with an ON/OFF ratio greater than 1 x 10(4) when the voltage was swept between - 2 V and +3 V. The device maintained its state after removal of the bias voltage. The device did not show degradation after a 1-h retention test at 120 degrees C. The memory functionality was consistent even after fifty cycles of operation. The charge transport switching mechanism is discussed on the basis of carrier transport mechanism and our analysis of the data shows that the charge carrier trans- port mechanism of the device during the writing process can be explained by thermionic emission (TE) and space-charge-limited-current (SCLC) mechanism models while erasing process could be explained by the FN tunneling mechanism. This demonstration provides a class of memory devices with the potential for low-cost, low-power consumption applications, such as a digital memory cell.

Successful management of phenytoin and phenobarbitone induced gingival enlargement: A multimodal approach.

Medication-related gingival enlargement is a common reactionary phenomenon that occurs with the use of several types of therapeutic agents, including antiepileptic drugs (AEDs). This disorder has been documented since 1939, shortly after the introduction of phenytoin. In the present case, a concise review of literature concerning the etiopathogenesis and management of AEDs (phenobarbitone and phenytoin) induced gingival enlargement has been described. It is vital that not only the periodontist, but also dental surgeons and medical practitioners should become aware of the potential etiologic agents, characteristic features, and the differential diagnosis of drug induced gingival enlargement in order to be able to prevent, diagnose and successfully manage the condition.

Role of platelet-rich-fibrin in enhancing palatal wound healing after free graft.

Platelet-rich fibrin has long been used as a wound healing therapy in skin wounds and recently evidence has suggested its usage in oral cavity for different treatment procedures. This article proposes an overview of use of platelet-rich fibrin in management of complicated oral wounds. Excessive hemorrhage of the donor area, necrosis of epithelium, and morbidity associated with donor site have been described as the possible complications after harvesting subepithelial connective tissue graft, but little has been mentioned about their management. The article includes a case report of a 45-year-old male patient who showed a delayed wound healing after subepithelial connective tissue graft harvestation, which was treated with platelet-rich fibrin.

Clinical evaluation of regenerative potential of type I collagen membrane along with xenogenic bone graft in the treatment of periodontal intrabony defects assessed with surgical re-entry and radiographic linear and densitometric analysis.

BACKGROUND AND OBJECTIVES: The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of type I collagen (GTR membrane) and xenogenic bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects. MATERIALS AND METHODS: Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD + collagen membrane + bone graft (Test) or OFD alone (Control). The clinical efficacy of two treatment modalities was evaluated at 9 month postoperatively by clinical, radiographical, and intrasurgical (re-entry) parameters. The measurements included probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), bone fill (BF), bone density (BD) and intra bony component (INTRA). RESULTS: The mean reduction in PD at 0-9 month was 3.3±0.82 mm and CAL gain of 3.40±1.51 mm occurred in the collagen membrane + bone graft (Test) group; corresponding values for OFD (Control) were 2.20±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographical and intra-surgical (re-entry) post operative evaluation was made. All improvement in different parameters was statistically significant (P< 0.01). INTERPRETATION AND CONCLUSION: Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

Low molecular weight chitosans: preparation with the aid of papain and characterization.

Low molecular weight chitosans (LMWC) of different molecular weight (4.1-5.6 kDa) were obtained by the depolymerization of chitosan using papain (from Carica papaya latex, EC. 3.4.22.2) at optimum conditions of pH 3.5 and 37 degrees C for 1-5 h. Scanning electron microscopy (SEM) showed approximately 15-fold decrease in the particle size after depolymerization. Decrease in the molecular weight was associated with decrease in the degree of acetylation (DA) as evidenced by circular dichroism (CD), FT-IR and solid-state CP-MAS 13C-NMR data. X-ray diffraction pattern revealed slight decrease in the crystallinity index (CrI) whereas the 13C-NMR data showed molecular inhomogeneity. LMWC showed lytic effect towards Bacillus cereus and Escherichia coli more efficiently than native chitosan. The growth inhibitory effect was maximal towards B. cereus, with minimum inhibitory concentration (MIC) of 0.01% (w/v).

Cryosurgery for prostate cancer: improved glandular ablation by use of 6 to 8 cryoprobes.

OBJECTIVES: To describe and assess the efficacy for increased glandular destruction by using 6 to 8 cryoprobes in place of the traditional 5 probes. METHODS: In April 1996, a revised method for cryosurgery was begun that uses 6 to 8 cryoprobes, and by July 1997, 81 men had been treated. This group was compared retrospectively to our last 82 cases done before April 1996 using 5 cryoprobes. All cases were consecutive. To ensure that the groups were similar, comparison was performed of entrance prostate-specific antigen (PSA), clinical stage, and Gleason score. Six months after cryosurgery, PSA and residual epithelial acini were compared between the two groups. RESULTS: The two groups were comparable for all the above parameters (P >0.05). The degree of overall glandular kill was greater for the 6 to 8-probe method (P = 0.023). Complete glandular ablation for the 5-probe and 6 to 8-probe methods was 39% and 53%, respectively, and the difference was not significant (P = 0.072). However, when one combined the complete glandular ablation group with the none to few residual acini group, 67.5% for the 5-probe method and 88.9% for the 6 to 8-probe method, a significant difference was found (P = 0.001). The odds of having many remaining acini versus having none to few were 3.5 times greater in the 5-probe group than in the 6 to 8-probe group. The mean and median PSA for the 5- and 6 to 8-probe groups were 0.19 and 0.1 versus 0.11 and 0.07 ng/mL, respectively, a significant difference (P = 0.02). No difference was found in rates of tumor persistence or complications. CONCLUSIONS: A revised method for cryosurgery using 6 to 8 cryoprobes has proved to be more effective for near-glandular ablation than the traditional 5-probe method. It was easily applied, had a wide margin of safety, and even shortened learning time. These innovations have permitted a closer approach to the goal of complete glandular destruction.

Acute pulmonary embolism: diagnosis with MR angiography.

PURPOSE: To prospectively evaluate pulmonary magnetic (MR) angiography as a diagnostic examination for acute pulmonary embolism (PE). MATERIALS AND METHODS: Thirty-six consecutive patients (19 women, 17 men; age range, 28-84 years) underwent pulmonary digital subtraction angiography (DSA) and pulmonary MR angiography. MR angiograms were obtained during suspended respiration and the pulmonary arterial phase of gadolinium-based contrast medium injection. A steady-state gradient-recalled-echo sequence with free induction decay sampling was used. DSA studies were interpreted for the presence of acute PE by two independent radiologists; an adjudicator made the final decision on discordant interpretations. RESULTS: By using DSA, a total of 19 acute pulmonary emboli were depicted in 13 patients. Prospectively, 13 of these emboli were depicted by using MR angiography. MR angiography missed six emboli: Four required the DSA adjudicator to make the decision, and one was in a patient whose MR angiogram was acquired during breathing. Four of these six emboli were small subsegmental emboli, and two were segmental. CONCLUSION: Performed without pulmonary arterial catheterization, iodinated contrast media, or ionizing radiation, pulmonary MR angiography had a high accuracy for depicting lobar and segmental emboli, but was unable to depict four of five subsegmental emboli.

Preparation and characterization of pH-sensitive proteinoid microspheres for the oral delivery of methotrexate.

Prot A7, a polypeptidic proteinoid composed of seven different amino acids, was synthesized and microspheres of 1-5 microm size were prepared by the self-assembly process. The morphological characterization of the microspheres was carried out using optical microscopy and SEM (scanning electron microscopy). Emphasis also has been made on studying the mechanism behind the microsphere formation and to relate it with the conformation of the polypeptide. These self-assembled microspheres were found to be pH-sensitive in aqueous medium. The suitability of the Prot A7 microspheres as a carrier for gastric irritant drugs was verified by choosing methotrexate (MTX) as a model drug. MTX was entrapped in proteinoid microspheres and its utility for the oral delivery system was verified by carrying out the drug dissolution studies in simulated gastric medium (pH 1.2) and neutral medium of the blood (pH 7) under physiological conditions. The pH responsive dissolution behaviour of the microspheres was clarified.