Isolated lesions of gingiva: A case series and review.

Isolated lesions of gingiva arise in succession to the hyperinflammatory reactions in response to the underlying local irritants. Despite their overlapping clinical and histological features, these lesions are distinctive regarding their biological behavior. Recurrence has been reported after surgical excision because of the incomplete removal of underlying local irritants. This article describes the clinical and histological features of four localized gingival lesions, adding a note on their molecular pathogenesis and surgical management.

An alternative maxillary sinus lift technique - sinu lift system.

OBJECTIVES: Maxillary sinus augmentation surgical techniques have evolved greatly allowing successful placement of dental implants in the atrophic posterior maxillary region. The purpose of the present study is to evaluate the clinical and radiological outcomes and postoperative morbidity of sinus floor elevation procedures performed using the minimally invasive surgical technique the Sinu lift system. MATERIALS AND METHODS: Sinus lift procedure was done using the sinu lift system by a transcrestal approach and bone augmentation was done on ten systemically healthy patients using ß- tricalcium phosphate and platelet rich plasma mix. The study was evaluated upto six months period with bone related parameters being assessed at base line using CT scan, OPG and after six months the results were analysed using SPSS Version 18.0 software (p < 0.01 (0.005). Wilcoxson signed rank sum test was used to correlate between preoperative and postoperative measurements. Implant placements were done at the desired area of sinus augmentation with a two year follow up. (Nobel Biocare, Nobel Biocare Holding AG, Zürich-Flughafen, Switzerland) Results: The augmented sites had a significant increase in the bone parameters at the desired grafted region. The mean gain in bone height as observed in CT Scan had revealed increased measurements from 5.80mm±0.98 to 10.20mm±1.68 at the sixth month evaluation. This was statistically significant (0.005). Clinically, no complications were observed during or after the surgical procedure. CONCLUSION: Within the limitations of this study, the Sinu lift system with a controlled working action resulted in high procedural success and this procedure may be an alternative to the currently used surgical methods.

Evaluation of circulatory and salivary levels of heat shock protein 60 in periodontal health and disease.

BACKGROUND: Self-antigens such as heat shock protein 60 (HSP 60) have recently been implicated in the periodontal disease pathogenesis. There is scant evidence regarding HSP 60 levels in circulation and saliva following periodontal disease and its possible relation to systemic inflammation. AIM OF THE STUDY: The aim was to evaluate the circulatory and salivary levels of HSP 60 in periodontal health and disease and to correlate it with high sensitivity C-reactive protein (hs-CRP). MATERIALS AND METHODS: Forty-five peripheral blood samples were collected from two groups of patients (periodontally healthy - Group A [22 patients] and periodontal disease - Group B [23 patients]). Serum, cell lysates, and saliva samples were used to detect HSP 60 levels in both groups by enzyme linked immunosorbent assay technique. Measurement of hs-CRP was performed using an immunoturbidimetric assay. Statistical analysis was done using the student t-test and Pearson's correlation. RESULTS: Circulatory HSP 60 was significantly increased in periodontal disease compared to health (P - 0.038). There was a significant correlation between the totals circulating HSP 60 and hs-CRP (P - 0.052), but there was no significant correlation between the salivary HSP 60 and hs-CRP levels in periodontal disease. CONCLUSION: Circulating HSP 60 levels may play a role in the systemic inflammatory state produced by periodontal disease. Salivary HSP 60 may not be used as a surrogate to determine systemic inflammation.

Plasticity of T helper cell subsets: Implications in periodontal disease.

T helper (Th) cells have an important role in host defence as well in the pathogenesis of periodontal disease. Th cells differentiate from naive cells into various subsets, each of which is associated with a set of inducing and effector cytokines. Previously, it was thought that this differentiation was an irreversible event. Recent evidence suggest that even differentiated Th cells, retain the flexibility to transform from one lineage to another, a phenomenon referred to as plasticity. This plasticity is thought to be brought about by epigenetic modifications that are regulated by external and internal signals in the micro-environment of these cells. The factors and mechanisms which affect the plasticity of these cells and their potential role in the etio-pathogenesis of periodontal disease has been described in this article.

Mathematical analysis of furcation angle in extracted mandibular molars.

BACKGROUND: Multi-rooted teeth with furcation involvement exhibit a poorer prognosis when compared to single rooted teeth. The furcation angle (formed by the divergent roots and the roof) may exert a considerable influence on the accessibility for both home care maintenance and instrumentation during periodontal therapy. As there are few anatomy based reports, the furcation angle has not yet been delineated. MATERIALS AND METHODS: Furcation angle (FA) was mathematically evaluated in extracted mandibular first and second molar teeth, using the Computer-aided design - computer-aided manufacturing technology. RESULTS: THE FURCATIONS WERE DIVIDED INTO THREE GROUPS (GROUP I: <30°, Group II: 30°-60°, Group III: >60°) based on the furcation angle and their prevalence. The first molar showed greater prevalence of group II FA, while second molar showed a greater prevalence of group III FA. CONCLUSION: Linear, two dimensional measurements may not accurately reflect the complexities of the furcation area which exhibits considerable intermolar and intramolar (buccal and lingual furcations of second molar) variation.

Association between interleukin-1 gene polymorphism and severity of chronic periodontitis in a south Indian population group.

BACKGROUND: Periodontitis is a bacterial disease modified by multiple factors. Interleukin-1 (IL-1) is a key regulator of the host response and a major modulator of extracellular matrix catabolism and bone resorption. It has been reported that variations in IL-1 gene are associated with increased susceptibility to periodontitis. The aims of the study were 1) to analyze the distribution of single nucleotide polymorphism of IL-1 (IL-1A-+4845 and IL-1B-+3954) and 2) to correlate the association of the composite genotype with the severity of chronic periodontitis. MATERIALS AND METHODS: Sixty patients aged above 35 years were selected. Following a periodontal examination, using the clinical parameters plaque index, gingival bleeding index, probing depth, and clinical attachment loss (CAL), the selected subjects were categorized into four groups of differing disease severity based on CAL. Five milliliters of venous blood was drawn. DNA was isolated by phenol chloroform method. Amplification of IL-1A+4845 and IL-1B+3954 was done by polymerase chain reaction (PCR). Detection of genotype was done using restriction fragment length polymorphism using the enzymes FnU4HI for IL-1A and TaqI for IL-1B. The results obtained were analyzed statistically. RESULTS: The frequencies of IL-1A-+4845 and IL-1B-+3954were significantly greater in severe periodontitis patients. The distribution of composite genotype (allele 2 of IL-1A+4845and allele 2 of IL-1B+3954) also correlated with the severity of periodontitis. Genotype-positive subjects had a higher mean bleeding index (%) when compared to genotype-negative patients. But no correlation was observed between mean plaque level among genotype-positive and -negative subjects. CONCLUSION: IL-1 gene polymorphism IL-1A+4845, IL-1B+3954 and composite genotype is an indicator of susceptibility to severe periodontitis in adults.

Correlation of glucose level among venous, gingival and finger-prick blood samples in diabetic patients.

It is essential for a dental surgeon or a periodontist to detect blood glucose level for patients whose signs and symptoms are suggestive of diabetes. Seventy patients in the age group of 40 to 80 years of either sex were selected for the study. The study population included patients with type 1 or type 2 diabetes mellitus. Venous blood was used as a control group, whereas gingival blood and finger-prick blood constituted the study groups I and II, respectively. The percentage deviations of gingival blood glucose level measurements and finger-prick blood glucose level measurements from the standard venous blood glucose level measurements were recorded, which showed that 72.86% of gingival and 68.57% of finger-prick blood glucose level measurements were found to be within ±15% of the standard venous blood glucose level measurements. All values exhibited significant correlations among each other, but correlations between glucose values obtained using venous and gingival blood samples were higher than the correlations between glucose values obtained using venous and finger-prick blood samples.

T-helper cells in the etiopathogenesis of periodontal disease: A mini review.

Our traditional understanding of the T-helper (Th)1/Th2 paradigm in periodontal disease has undergone considerable changes in recent years. This review focuses on the Th subsets, including the recently identified cells of the CD4 lineage, their activation pathways and effector function in periodontal disease. The roles of Th17 and regulatory T (Treg) cells in disease pathogenesis have been explored. Newer Th subsets such as Th9 and Th22 cells and their potential role in periodontal disease have also been outlined.

Antibacterial activity of polyphenols of garcinia indica.

The aim of present work is to study the antibacterial activity of polyphenols isolated from the ethyl acetate soluble of methanol extract of stem bark of Garcinia indica against Staphylococcus aureus, Salmonella typhi and Escherichia coli by paper disc method. The results showed good antibacterial activity against S. aureus at higher concentrations, moderate at lower concentrations, against S. typhi moderate at higher concentrations but no activity against E. coli even at higher concentration for flavononylflavone. With proauthocyanin S. Aureus, S. Typhi and E. coli showed good antibacterial activity at higher concentration only.

Periodontitis and bone mineral density among pre and post menopausal women: A comparative study.

AIM: The aim of the study was to assess the relationship between bone mineral density and periodontitis in premenopausal and postmenopausal women. MATERIALS AND METHODS: Twenty women between the age group of 45-55 years were selected for this study. Ten premenopausal women with healthy periodontium constituted the control group and 10 postmenopausal women with ≥2mm of clinical attachment loss in >30% of sites constituted the study group. All patients were assessed for plaque index, probing depth and clinical attachment loss. Radiographs (six IOPA and two posterior bitewing) were taken and assessed for interproximal alveolar bone loss. The patients were scanned to assess the bone mineral density of lumbar spine (L2) and femur using dual energy X-ray absorptiometry (DEXA). RESULTS: The bone mineral densities of lumbar spine (L2) and femur were significantly lower in the study group than the control group. Osteopenia of the lumbar spine and femur was observed in 60% whereas osteoporosis of lumbar spine was observed in 30% of cases in study group. CONCLUSION: Increased proportion of osteopenia and osteoporosis cases of lumbar spine and femur in postmenopausal women with periodontitis suggests that there is association between bone mineral density and periodontitis.

Retrograde peri-implantitis.

Retrograde peri-implantitis constitutes an important cause for implant failure. Retrograde peri-implantitis may sometimes prove difficult to identify and hence institution of early treatment may not be possible. This paper presents a report of four cases of (the implant placed developing to) retrograde peri-implantitis. Three of these implants were successfully restored to their fully functional state while one was lost due to extensive damage. The paper highlights the importance of recognizing the etiopathogenic mechanisms, preoperative assessment, and a strong postoperative maintenance protocol to avoid retrograde peri-implant inflammation.

5-Hydroxydictamnine, a new alkaloid from Atalantia monophylla.

A new furoquinoline alkaloid, 5-hydroxydictamnine, along with ß-sitosterol was isolated from the heartwood of Atalantia monophylla. The structure of this alkaloid was established by chemical and spectral evidences together with a nuclear overhauser effect (NOE) experiment.

Clinical and histological evaluation of two dressing materials in the healing of palatal wounds.

BACKGROUND: Free gingival grafts have been used extensively for gingival augmentation procedures, but are associated with postoperative morbidity because of the open palatal wound. This study compares the clinical efficiency of two dressing materials, a non-eugenol-based dressing (Coe-Pak™) and a collagen dressing (Colla Cote(®)) on palatal wound healing. MATERIALS AND METHODS: Thirty-two patients in the age group of 25-50 years, who required gingival augmentation, were selected. Free gingival graft was harvested from the palatal mucosa and the wound was then protected using Coe-pak(®) in control group and Colla Cote(®) in test group. The subjective parameters pain and burning sensation were recorded on the 2(nd) and 7(th) day and the objective parameters colour and consistency were recorded on the 7(th) and 42(nd) day, using a visual analog scale. Thickness of the mucosa was measured using K file at baseline and 42(nd) day. Histological examination was done on 42(nd) day. RESULTS: The subjective and objective parameters showed significant improvement in the test group when compared to control group. Histologically, there was a greater evidence of collagen formation and turn over in the test group than control group. CONCLUSIONS: Collagen-based dressing may thus offer significantly greater advantages over the traditional non-eugenol dressings.

Immunohistological analysis of CD1a langerhans cells and CD57 natural killer cells in healthy and diseased human gingival tissue: A comparative study.

BACKGROUND: Cell interaction between dendritic cells (DC) and natural killer (NK) cells in the periodontal milieu is not yet fully known, although these cells are individually known to contribute to the pathogenesis of periodontal disease. MATERIALS AND METHODS: Fifty subjects (25 males and 25 females) were included in the study. The subjects were divided into three groups: Group A comprised 16 subjects with clinically healthy gingiva; group B 17 subjects with gingivitis; and group C 17 subjects with gingivitis; and group C 17 subjects with moderate periodontitis (PPD >/= 5 mm and CAL >/= 3 mm in at least six sites). Gingival samples were collected and immunohistochemical study was done using CD57 and CD1a antibody. Statistical analysis was done using analysis of variance (ANOVA), followed by Tukey-Kramer multiple comparison for CD1a and Tukey's highly significant difference (HSD) test for CD57. RESULTS AND CONCLUSION: The study showed an inverse relationship between the CD1a(+) (langerhans) cells and CD57(+) (natural killer) cells. There was a significant increase in CD57(+) cells and reduction in CD1a levels as periodontal disease progressed. The significant reduction in CD1a levels in periodontal disease when compared to health could possibly be a result of NK cells down regulating it. Reduction in CD1a levels may result in a low inflammatory response subsequently resulting in tissue destruction.