Histological evaluation of decellularization of freeze dried and chemically treated indigenously prepared bovine pericardium membrane.

Decellularization is regarded as a xenogenic antigen-reduction technique because it effectively eliminates all cellular and nuclear components while mitigating any negative impact on the composition, biological functionality, and structural integrity of the remaining extracellular matrix. This study aimed to histologically evaluate native, freeze dried and chemically decellularized bovine pericardium membrane. Also, this study focused on preservation of extracellular matrix after decellularization. Bovine pericardium membrane was decellularized by freeze thaw cycle followed by freeze drying and 1% sodium dodecyl sulphate. Unprocessed pericardium was used as control. The effectiveness of Decellularization was assessed based on the reduction of histologically visible nuclei. Decellularization by freeze thaw cycle followed by freeze drying resulted in 17.84% reduction in nuclei content and decellularization by sodium dodecyl sulphate results in 92% reduction in nuclei content compare to control group. Picrosirius red staining for freeze dried group displayed loosely organised, thin collagen bundles that exhibit reddish-yellow birefringence and sodium dodecyl sulfate group revealed dense collagen bundles that are parallelly organised and compact, exhibiting reddish-yellow birefringence and showed good structural integrity. These results suggested that the sodium do decyl sulfate showed optimal decellularization results with better extracellular matrix preservation. It may be a suitable protocol for producing a suitable scaffold for periodontal tissue regeneration.

Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study.

Managing furcation defects constitutes a problem in successful periodontal therapy. Guided tissue regeneration (GTR) is the mainstay for the management of such defects but is expensive. This study makes use of indigenously prepared demineralized freeze-dried bone allograft (DFDBA) and amniotic membrane (AM) as a cost-effective alternative. The purpose of the study was to compare the clinical outcome of grade II and III furcation defects with and without using indigenous DFDBA and AM prepared at Central Tissue Bank, MAIDS. 18 systemically healthy patients with chronic periodontitis displaying either grade II or III furcation defects were treated with open flap debridement (OFD) + intramarrow penetration (IMP) (control group) and OFD + IMP + DFDBA + AM (test group). The clinical and radiographic parameters were recorded at 3 and 6 months postoperatively. All parameters were statistically analyzed. Both treatment modalities resulted in improvement in all clinical variables evaluated. Radiographic dimensions evaluating bone fill showed a statistically significant difference in the test group compared to the control group. Within the limitations of this study, data suggest GTR using indigenously prepared DFDBA and amniotic membrane to be an economical and viable option for treating furcation defects.

Effect of gamma and Ultraviolet-C sterilization on BMP-7 level of indigenously prepared demineralized freeze-dried bone allograft.

The presence of bone morphogenetic proteins in demineralized freeze-dried bone allograft (DFDBA) are responsible for developing hard tissues in intraosseous defects. The most common mode of sterilization of bone allografts, i.e., Gamma rays, have dramatic effects on the structural and biological properties of DFDBA, leading to loss of BMPs. Ultraviolet-C radiation is a newer approach to sterilize biodegradable scaffolds, which is simple to use and ensures efficient sterilization. However, UV-C radiation has not yet been effectively studied to sterilize bone allografts. This study aimed to compare and evaluate the effectiveness of Gamma and Ultraviolet-C rays in sterilizing indigenously prepared DFDBA and assess their effect on the quantity of BMP-7 present in the allograft. DFDBA samples from non-irradiated, gamma irradiated, and UV-C irradiated groups were tested for BMP-7 level and samples sterilized with gamma and UV-C rays were analysed for sterility testing. The estimated mean BMP-7 level was highest in non-irradiated DFDBA samples, followed by UV-C irradiated, and the lowest in gamma irradiated samples. Our study concluded that UV-C rays effectively sterilized DFDBA as indicated by negative sterility test and comprised lesser degradation of BMP-7 than gamma irradiation.

Effect of periodontal disease on electromyographic activity of muscles of mastication: A cross-sectional study.

AIM: This study aims to compare surface electromyographic activities (EMG) of four muscles, that is anterior temporalis (AT), masseter (MST), sternocleidomastoid (SCM) and anterior belly of digastric (ABD), between chronic periodontitis patients and periodontally healthy individuals as well as to correlate these EMG findings with periodontal parameters. METHODS: Thirty chronic periodontitis patients were recruited in Group I and 30 periodontally healthy individuals in Group II. Clenching and resting EMG for 4 muscles (AT, MST, SCM and ABD) were recorded for each participant. These EMG values were compared between the groups and correlated with periodontal parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment loss). RESULTS: Resting EMG (rEMG) showed no significant difference between the groups for any muscle. Clenching EMG (cEMG) values were significantly lower in Group I than Group II for AT and MST (P = .001), but not so for SCM and ABD. Within Group I, AT and MST showed a significant negative correlation of cEMG with probing depth and clinical attachment loss (P < .05). CONCLUSION: Electrical muscle activities of AT and MST are lower in chronic periodontitis than periodontally healthy individuals.

Effect of antibiotic impregnation time on the release of gentamicin from cryopreserved allograft bone chips: an in vitro study.

Freezing is the most common method for storing bones until use in skeletal reconstruction. However, the effect of freezing at different temperatures on antibiotic delivery from antibiotic-coated bone chips has not been evaluated. In this study, we compared antibiotic delivery in vitro from gentamicin-coated human bone stored at different temperatures impregnated for different time periods. Bone chips obtained from human femur heads were chemically cleaned and mixed with gentamicin sulfate solution for 1 h and 10 h respectively. Samples of both groups were cryopreserved for 4 months at - 20 °C, 4 months at - 80 °C, or evaluated immediately without freezing. Antibiotic release from the bone chips was measured using Bacillus subtilis as an indicator strain. Zones of inhibition and rates of gentamicin were higher for the samples impregnated for 10 h as compared to 1 h. There was no significant difference between non-cryopreservation, cryopreservation at different temperatures of - 20 and - 80 °C on the release of gentamicin from bone chips even after storage for 4 months.

Effectiveness of anterior middle superior alveolar injection using a computer-controlled local anesthetic delivery system for maxillary periodontal flap surgery.

BACKGROUND: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. METHODS: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. RESULTS: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. CONCLUSIONS: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.

Comparative evaluation of bioburden and sterility of indigenously prepared bone allograft with and without gentamicin.

During bone allograft processing, despite stringent donor screening and use of aseptic techniques, microbial invasion may occur due to the porous nature of the graft and cause potentially fatal infections. The aim of the present study was to prepare bone allograft with and without gentamicin and to compare bioburden and sterility in the obtained grafts to evaluate the role of antibiotic in enhancing graft safety. Fifty samples of demineralized freeze-dried bone allograft were prepared from suitable donors according to international standards. Randomly selected 25 samples were placed in 8 mg gentamicin/gram bone solution for 1 h. Packaging and sealing was done to ensure no microbial ingress during transportation. 40 samples were selected for bioburden testing. Remaining 10 were subjected to 25 kGy gamma radiation and tested for sterility. Microbiological evaluation revealed no evidence of colony forming units in all the samples of both the groups (Bioburden = 0). Post-radiation sterility testing also revealed no bacterial colony in the tested samples from both the groups. Favorable results validate the processing protocol while comparable results in both groups indicate no additive benefit of gentamicin addition. Nil bioburden may be used in further studies to determine a lower radiation dose to achieve adequate sterility and minimize the disadvantages of radiation like collagen cross-linking and decreased osteoinductive capacity.

Root coverage by modified coronally advanced flap with and without platelet-rich fibrin: A clinical study.

BACKGROUND: Marginal gingival recession can cause major functional and esthetic problems. Advanced flaps are the simplest, yet unpredictable procedures for managing these conditions. The predictability of root coverage can be increased by combining coronally advanced flap (CAF) or its modified approach with other regenerative techniques. OBJECTIVE: To ascertain the potential benefits of platelet-rich fibrin (PRF) on modified CAF for the treatment of gingival recession. MATERIALS AND METHODS: Study comprised of 12 patients with Millers' class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split-mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months. RESULTS: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits. CONCLUSION: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.

Association between periodontal disease and gestational diabetes mellitus-A prospective cohort study.

AIM: This study aimed to determine the association between periodontal disease and gestational diabetes mellitus (GDM) and the effect of this association on pregnancy outcome in North Indian population. MATERIALS AND METHODS: A total of 584 primigravidae were recruited at 12-14 weeks of gestation. Their periodontal examination was carried out along with 75 g oral glucose load test at the time of recruitment. GDM was diagnosed as per the DIPSI (The Diabetes in Pregnancy Study group India) guidelines (≥140 mg/dl). Women with normal plasma glucose values underwent a repeat 75 g oral glucose load test at 24-28 weeks of gestation. All patients were followed up for pregnancy outcomes. RESULTS: Of 584 primigravida, 184 (31.5%) had gingivitis and 148 (25.3%) had periodontitis. Overall, 332 (56.8%) pregnant women had periodontal disease. It was associated with GDM with adjusted hazard ratio (aHR) of 2.85 (95%CI = 1.47-5.53). The occurrence of pre-eclampsia was associated with periodontal disease with aHR of 2.20 (95%CI = 0.86-5.60). If primigravidae had periodontal disease along with GDM, the risk of pre-eclampsia had shown increased aHR of 18.79 (95% CI = 7.45-47.40). CONCLUSIONS: The study shows a significant association of periodontal disease with GDM and an increased risk of developing pre-eclampsia due to this association.

Leukemic gingival enlargement: A case report and review of literature.

The oral cavity manifests signs of various systemic diseases. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Occasionally, oral signs can be an expression of systemic conditions such as endocrine imbalance, nutritional deficiencies and blood disorders. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. Oral changes maybe the first and only presenting features in leukemia patients, making it imperative for the dentist to diagnose the disease accurately.

Gingival Tissue Response Following Placement of a Light Cure Dressing and a Non-eugenol Dressing after Periodontal Flap Procedure: A Comparative Clinical Study.

AIM: The aim was to compare the gingival tissue response following placement of a light cure dressing (Barricaid®) and a non-eugenol periodontal dressing (Coe-Pak™) after periodontal flap procedure. This was carried out by evaluating plaque deposition underneath both the dressings, healing response and the patient preference for each. MATERIALS AND METHODS: A total of 12 patients with chronic generalized periodontitis requiring surgery in at least two different quadrants were enrolled for this split-mouth study. After periodontal flap surgery, Coe-Pak™ was placed in the quadrant assigned to Group I and Barricaid® was placed in the other quadrant assigned to Group II. Clinical parameters were recorded on day 7 and day 14. Patient comfort and pain levels were also evaluated by a questionnaire. RESULTS: There were no statistically significant differences in wound healing and the clinical gingival parameters between two groups. The only significant difference was found in the plaque attached underneath the dressing, with Coe-Pak™ showing greater plaque accumulation than Barricaid®. Seventy five (75) % of the patients preferred Barricaid® over Coe-Pak™, based on its appearance and taste. CONCLUSION: The non-eugenol dressing seemed to retain more plaque on its undersurface than light-cure dressing. However, this did not have much influence on the healing outcome and clinical gingival parameters, which were optimal and comparable in both groups. The greater number of patients showed a preference for light cure dressing, based on its superior esthetics and taste.

Comparison of anxiety and pain perceived with conventional and computerized local anesthesia delivery systems for different stages of anesthesia delivery in maxillary and mandibular nerve blocks.

BACKGROUND: Fear of local anesthesia (LA) is a significant impediment to dental care as many patients delay or avoid treatment to avert pain. Computer-controlled local anesthetic delivery system (CCLAD), with constant and controlled rate of flow, present a painless alternative. The present study aimed to compare anxiety and pain perceived with conventional and computerized systems, for different stages of anesthesia delivery when administering various nerve blocks. METHODS: One hundred patients requiring bilateral LA participated in the study. One side was anesthetized using one system and the contralateral side was anesthetized using the other, in two separate appointments. Patients assigned anxiety scores on a 5-point scale and used the visual analogue scale (VAS) for pain determination at needle insertion, during delivery of anesthetic solution, immediately after injection, and at the end of the periodontal procedure. Each patient's preference for the delivery system of future injections was also recorded. RESULTS: Patients reported significantly lower anxiety levels with CCLAD compared to the syringe. Significantly lower mean VAS scores for anesthesia deposition, pain immediately after, and at the end of the periodontal procedure were also noted. However, pain at needle insertion was comparable between the two systems, with no statistical significance. Overall, 64.4% patients preferred CCLAD for future anesthesia. CONCLUSION: Lower pain perceived with CCLAD and higher preference for the system suggest that CCLAD should replace conventional syringes to allow pain-free dental treatment.

Healing of self-inflicted thermal injury of palatal mucosa by low-level laser therapy.

Self-inflicted injury to oral mucosa is a rare entity. These injuries can be premeditated, accidental, or can result from an abnormal habit. These uncommon gingival injuries can sometimes test the clinician's diagnostic abilities as well as treatment planning skills. In conventional treatment, removal of etiology and application of topical drugs is usually sufficient for healing. However, some cases require alternative or adjunctive wound healing methods. Low-level laser therapy (LLLT) has been reported to be effective in pain management and improvement in wound healing through promotion, fortification, and commissioning of cellular cycle to generate productive and substitute cells. This report presents a case of 25-year-old female with complaints of a painful, nonhealing wound on the palate for last 6 months. She had an unusual habit of keeping burning matchsticks in her mouth. Although she had quit the habit 2 months ago after psychiatric counseling, the wound on her palate did not show any improvement in symptoms. Based on the history and clinical findings, diagnosis of chronic wound by self-inflicted thermal injury was made. LLLT was administered on the wound every 48 hours for next 10 days. The burn wound healed completely after five applications of LLLT.

Diode Laser Assisted Excision and Low Level Laser Therapy in the Management of Mucus Extravasation Cysts: A Case Series.

Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts.

Viruses: Bystanders of periodontal disease.

Bacterial etiology of periodontal disease is an established fact today. However, despite advances in the field of pharmacology with advent of newer and better antibiotics prevalence of the disease could not be abated. Moreover, unpredictable remissions and indefinite pattern in a single host force us to go back to the exact etiology of the disease. Present is a short review highlighting the role and plausible mechanisms by which viruses can affect the development of periodontal disease. This broadens our concept and will help establish a better treatment protocol for periodontal disease.

Congenital Double Lip: A Rare Deformity Treated Surgically.

Lip is an important aspect of facial features affecting ones personality. A deformity of the lip characterized by excessive tissue sagging below the usual giving it thicker wider appearance is referred to as double lip. It is a rare occurrence with a proposed male predilection. This article is a report of a 20 years old male with this deformity who presented with the complaint of difficult speech and poor aesthetics. There was no other history patient being systemically healthy. It was successively treated with a simple surgical technique without recurrence over a period of 12 months.

Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study.

AIM: The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT) on wound healing after depigmentation procedure. MATERIALS AND METHODS: In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site) using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine) on the 3(rd), 7(th), and 15(th) day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. RESULTS: At day 3, test site showed 1.26 ± 0.23 mm(2) and control site showed 1.45 ± 0.21 mm(2) stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm(2) and 1.12 ± 0.25 mm(2) stain uptake, whereas the control site showed 1.37 ± 25 mm(2) and 1.29 ± 0.28 mm(2) staining, respectively, which were not statistically significant. CONCLUSION: Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3(rd) day. On the 7(th) and 15(th) day, the difference in healing was not statistically significant.

Effect of Antimicrobial Photodynamic Therapy as an Adjunct to Nonsurgical Treatment of Deep Periodontal Pockets: A Clinical Study.

Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatment. Scaling and root planing (SRP) alone may not suffice in cases where surgical therapy cannot be undertaken. Various recent studies have suggested the use of antimicrobial Photodynamic Therapy (aPDT) for the management of periodontal infections. The aim of this study was to evaluate the effects of using aPDT along with SRP, compared to SRP alone for the management of deep periodontal pockets. Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals. Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group). Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.

Evaluation of the Effects of Er,Cr:YSGG Laser, Ultrasonic Scaler and Curette on Root Surface Profile Using Surface Analyser and Scanning Electron Microscope: An In Vitro Study.

Introduction: The periodontal therapy is primarily targeted at removal of dental plaque and plaque retentive factors. Although the thorough removal of adherent plaque, calculus and infected root cementum is desirable, it is not always achieved by conventional modalities. To accomplish more efficient results several alternative devices have been used. Lasers are one of the most promising modalities for nonsurgical periodontal treatment as they can achieve excellent tissue ablation with strong bactericidal and detoxification effects. Methods: Thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A (n = 30) was taken as control and no instrumentation was performed. Part B (n = 30) was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser. Part C (n = 30) was treated by piezoelectric ultrasonic scaler. Part D (n = 30) was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average (Ra) value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope (SEM). The means across the groups were statistically compared with control using Dunnett test. Results: Among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness (mean Ra value of 4.14 µm) as compared to ultrasonic scaler (1.727 µm) and curette group (1.22 µm). However, surface with smear layer were found to be maximum (50%) in curette treated samples and minimum (20%) in laser treated ones. Maximum cracks (83.34%) were produced by ultrasonic scaler, and minimum (43.33%) by curettes. Crater formation was maximum (50%) in laser treated samples and minimum (3.33%) in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes. Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects.