A meta-analysis of amnion membrane in gingival recession.

This systematic review was conducted to evaluate the effects of Amniotic Membrane (AM) as compared with other treatment modalities on the clinical outcomes, in gingival recession defects. Only Randomized controlled clinical trials published before 2020 were included. Studies were divided into 5 subgroups (1) Coronally advanced flap (CAF)+AM v/s Chorion membrane (CM) (2) CAF+AM v/s CAF+PRF (3) CAF+AM v/s CAF+Collagen membrane (4) CAF+AM v/s CAF (5) CAF+AM v/s CAF+ Subepithelial connective tissue graft (SCTG). Studies were evaluated for Recession Depth (RD) (Primary outcome); Clinical Attachment Level (CAL), Recession Width (RW) and Width of Keratinized Gingiva (WKG) (Secondary outcomes). The inverse variance approach was utilised in fixed or random effect models for the meta-analysis, which were chosen based on heterogeneity. Results suggested that the use of AM membrane showed comparable results in improving RD, RW, or CAL in the treatment of Miller Class-I and Class-II gingival recession compared to the other treatment modalities. However, CAF+AM resulted in statistically significant improvement in RD and RW than CAF+SCTG, though CAL gain was statistically more with CAF+SCTG. However, increase of WKG was found to be statistically significantly more in all the other treatment modalities as compared to CAF+AM. With properties like self-adherence, bioavailability and presence of growth factors AM with CAF can produce good aesthetic root coverage comparable to SCTG and PRF, where width of keratinized gingiva is adequate.

Comparative evaluation of regenerative potential of injectable platelet-rich fibrin and platelet-rich fibrin with demineralized freeze-dried bone allograft in the treatment of intrabony defects: A randomized controlled clinical study.

Background: Injectable platelet-rich fibrin (i-PRF) being in liquid form keeps graft particles clumped together forming agglutinated steak of bone graft. It has been shown to contain more platelets and long-term deliverance of growth factors in comparison with platelet-rich fibrin (PRF). Aim: The aim of the present study was to assess regenerative potential of i-PRF and comparing it with PRF, along with demineralized freeze-dried bone allograft (DFDBA) in the treatment of intrabony alveolar defects. Materials and Method: Thirty defect sites in 15 patients with bilateral intrabony defects were assigned randomly into two groups (Group I (Control group)- DFDBA + PRF and Group II (Test group)-DFDBA + i-PRF). Gingival index (GI), plaque index (PI), pocket probing depth (PPD), and relative attachment level (RAL) were recorded at baseline, 3 months, and 6 months. Linear bone growth (LBG) was recorded radiographically at baseline and 6 months. Statistical Analysis: ANOVA test and post hoc Tukey test were used to assess intragroup comparison of clinical parameters. Paired t-test was used to assess intragroup comparison of the radiographic parameter. Unpaired t-test was used to assess intergroup variations in all the clinical as well as radiographic parameters. Results: Statistically significant PPD reduction (P = 0.005) and RAL gain (P = 0.003) were found in Group II than in Group I, and no significant difference was found in other parameters. Percentage LBG was higher in Group II than Group I but the difference was not statistically significant. Conclusion: i-PRF with DFDBA showed more favorable results as compared to PRF with DFDBA in the management of intrabony periodontal defects.

Treatment of gingival class I or class II recession using subepithelial connective tissue graft and acellular dermal matrix allograft.

The present randomized control was conducted clinically to evaluate the effectiveness of Acellular Dermal Matrix Allograft (ADMA) and Subepithelial Connective Tissue Graft (SCTG) in combination with Coronally Positioned Flap (CPF) in the treatment of Miller's class I and II multiple gingival recession in aesthetic areas. A total of 20 patients aged between 18 to 40 years were selected for this study, meeting all the criteria for inclusion. 10 patients were treated with ADMA and 10 patients with SCTG in combination with CPF. Various clinical parameters were assessed viz. probing pocket depth (PPD), clinical attachment level (CAL), gingival recession height (RH) and width of keratinized gingiva (WKG) at baseline and 6 months after surgery. The mean RH at baseline in the control and test groups was 3.05 ±0 .55(mean± SD) and 2.60 ±.99 respectively. At 3 months the mean RH was found to be 1.60±0.74 and 1.05 ± .60 in the control and test group respectively. The mean percentage of root coverage (MRC%) at 6 months in the control and test group was 65.69 ±26.52 (mean± SD) and 65.54 ±.9.16 respectively but no statistically significant difference was seen between the two groups. The results of the study suggest that the combination of both subepithelial connective tissue graft and acellular dermal matrix graft with a coronally positioned flap can produce an equivalent amount of esthetic root coverage.

Data on inter-locking nail in humeral shaft fractures among Indian patients.

Humeral shaft fractures are commonly seen orthopaedics injuries. Open reduction with internal fixation (ORIF) with plating is a gold standard procedure despite various issues such as infection, radial nerve palsy and no-nunion. Close reduction with interlocking nails (ILN) is not a very popular procedure. Therefore, it is of interest to collect data on the significance of interlocking nail in different pattern of humerus shaft fracture. 30 patients with closed humeral shaft fracture participated in this study. The fractures were classified according to their descriptive location as proximal, middle and distal. All surgeries were performed by a single surgeon familiar with the ILN procedure. All patients had appropriate clinical, radiological and pre and postoperative assessment. Data on patients were collected at 2, 6weeks, 12weeks, 18 weeks and 6 months. 19 cases with middle third and distal third fractures were united within 10-14 weeks. 6 cases of proximal shaft fracture were united in 14-18 weeks. According to Rodri ´guez-Merchant criteria - Middle shaft fracture has shown good results (n=9, 75%) followed by distal third shaft fracture (n=6, 60%) and proximal third fracture (n=1, 12.5%). Though there is decrease in mean ASES score in all three groups of fractures but the Mid shaft fracture has shown significant decline in ASES score suggesting improvement in pain and ROM after 6 months. Thus, ILN of humerus is a simple and a safe procedure for treating fractures of middle and distal third shaft humerus. However, this study does not support ILN for the management of proximal third humerus fracture.

Data on the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians.

Grade II furcation defect has a great potential for regeneration. Attempts have been made to regenerate lost periodontium in furcation defects through variety of approaches. A total of 22 patients with Grade II furcation defect were examined. The patients were sequentially grouped into three groups namely, (Group A) subepithelial connective tissue graft as a barrier membrane, (Group B) bovine bone graft material Bio-OssTM and (Group C) with the combination of the two. The treatment modalities show that there was a strong improvement in the resolution of the grade II furcation defects. The reduction in horizontal furcation defect measurement was 20.63% for group A. The change was found to be moderate (p=0.023*). The % change is 20.97% for group B and it is statistically significance (p = 0.001**). The % change was 20.78% in Group C with a good statistical significance (p=0.003**). Complete obliteration of the defect clinically and radio-graphically was observed for grade II furcation defect. Thus, the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians is documented in this report.

Known data on applied regenerative medicine in tendon healing.

Tendons and ligaments are important structures in the musculoskeletal system. Ligaments connect various bones and provide stability in complex movements of joints in the knee. Tendon is made of dense connective tissue and transmits the force of contraction from muscle to bone. They are injured due to direct trauma in sports or roadside accidents. Tendon healing after repair is often poor due to the formation of fibro vascular scar tissues with low mechanical property. Regenerative techniques such as PRP (platelet-rich plasma), stem cells, scaffolds, gene therapy, cell sheets, and scaffolds help augment repair and regenerate tissue in this context. Therefore, it is of interest to document known data (repair process, tissue regeneration, mechanical strength, and clinical outcome) on applied regenerative medicine in tendon healing.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

OBJECTIVE: Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure. MATERIAL AND METHODS: We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria. RESULT: Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient. CONCLUSION: Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Linking periodontal disease with obesity and blood glucose.

It is of interest to evaluate the association of obesity and blood glucose level with periodontitis. Patients (150 with age range 26-68 years) were included based on WHO obesity criteria, undiagnosed for periodontitis, with Body Mass Index (BMI) ≥ 30 and systemically healthy. These patients underwent periodontal examination followed by blood analysis for lipid profile and blood sugar level. The periodontal status was determined using parameters such as Plaque index (PI), gingival index (GI), Probing depth (PPD) and Clinical attachment loss (CAL). 103 (68.7%) patients had >190 of triglyceride values. Data shows that periodontitis has no statistical significance with total cholesterol, HDL, LDL and moderate significance with VLDL, triglycerides. Glycemic control of the patients is assessed using postprandial blood sugar (PPBS) and Fasting Blood Sugar (FBS). Data shows that 129(86.6%) had FBS (mg/dl) <100 and 21 (14.0%) had FBS (mg/dl) >100. So the number of patients with FBS (mg/dl) < 100 were more i.e., 129 (86.6%). The PPBS values were in 136 (90.7%) had PPBS (mg/dl) <140 and only 14(9.3%) had PPBS (mg/dl) >140 group of patients were said have glucose intolerance. Thus, there is no change in lipid profile with established periodontitis in obese individuals. However, altered glycemic control is observed.

Corona Virus (COVID-19) and its Impact on Health Care Workers.

Pandemics always come up with various life-threatening issues. COVID-19 outbreak came up with the same issues along with certain other problems involving public, administrative and healthcare sector concerns. It resembled the SARS outbreak but posed such challenges against the world that are uneasy to handle. The disease which started from Wuhan, China has now affected almost every country in a ruthless manner. Healthcare workers are working day and night just to protect the citizens despite being at high-risk exposure and they are being aimed by the virus due to shortage of Personal Protection Equipment kits. Not only this, but they are being brutally harassed by the patients themselves. Social, economic, psychiatric and many other factors are responsible for deteriorating the health of these frontline healthcare workers who are now being allegedly regarded as "Healthcare Warriors".

Corona virus (Covid-19) - ITS implications in pediatric orthopedic care.

The recent spread of severe acute respiratory syndrome coronavirus (SARS-CoV2) and its associated coronavirus disease has gripped the entire international community and has caused widespread public health concerns due to the unavailability of treatment to this deadly disease. The COVID -19 has affected healthcare workers badly in the world with front line health care providers has a mortality rate of 1.4%. But in countries like Italy, it has gone up to 9%. To this date, there are no universal guidelines for musculoskeletal (MSK) care in the face of the coronavirus pandemic. Health care professionals, including orthopedic surgeons may encounter patients with suspected or confirmed COVID -19 infections and will have to act diligently not only to provide care but at the same time to prevent the spread of infection. During the lockdown period in INDIA we collected data of patients who came to an emergency in our hospital. Out of 81 patients, 40 patients were of pediatric trauma with a percentage of 49% making it highly significant. Thus, in this article, we tried to summarize current recommendations and our institutional guidelines for diagnosing and managing a pediatric orthopedic patient in the COVID-19 pandemic.

Patients Prescribed Anakinra for Acute Gout Have Baseline Increased Burden of Hyperuricemia, Tophi, and Comorbidities, and Ultimate All-Cause Mortality.

OBJECTIVE: The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra. METHODS: Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient's first rheumatology encounter was studied by factor analysis for variables associated with later anakinra. RESULTS: At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52], P = .003), serum urate ([10.6 mg/dL] vs controls [7.6 mg/dL], P < .0001), and East Asian descent ([7/13] vs [16/52], P = .041). The anakinra group had higher ultimate all-cause mortality ([6/13] vs controls [7/52], relative risk [RR] = 3.43, 95% confidence interval [CI] = 1.39-8.48, P = .0076). Factor analysis showed baseline visit palpable tophus and statin use to be most strongly associated with later anakinra use. Increased mortality of anakinra users, as per a factorial analysis, was linked more strongly to comorbidities than to anakinra. CONCLUSIONS: At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription.

Metal-Organic Framework Showing Selective and Sensitive Detection of Exogenous and Endogenous Formaldehyde.

In this work, we report a new hydrazine-functionalized Al(III)- based metal-organic framework having MIL-53 (MIL = Material of Institute Lavoisier) framework topology for the sensitive and selective detection of formaldehyde (FA). The phase purity of the thermally activated and as-synthesized forms of the material was examined by X-ray powder diffraction experiments, Fourier transform infrared spectroscopy, and thermogravimetric analysis. The desolvated material (1') showed great potential for the selective sensing of FA in the existence of other potentially competitive aldehydes in both aqueous and 10 mM HEPES buffer (pH = 7.4) media. The fluorescence "turn-on" behavior of the reaction-based probe can be ascribed to the inhibition of the photoinduced electron transfer process (from the hydrazine group to the phenyl ring) because of the formation of the hydrazone moiety. The detection limit of the probe toward FA in HEPES buffer is 8.37 µM (0.25 ppm), which lies below the intracellular concentration of FA (100-400 µM). A very short response time (1 min) has been displayed by 1' for FA sensing. Moreover, a remarkable enhancement in the emission intensity (sevenfold and fourfold in aqueous and HEPES buffer media, respectively) of 1' was observed after 1 min of FA addition. Furthermore, the ability of the probe to detect FA in the vapor phase was demonstrated. Interestingly, the material is also capable to detect endogenous FA in cancer cells. All the above discussed features clearly reveal that the present material has a huge potential for selective recognition of FA in both real water and biological samples.

The role of subepithelial connective tissue graft for reconstruction of interdental papilla: Clinical study.

BACKGROUND: The ideal goal of periodontal therapy is regeneration of the lost periodontium. However regeneration of the lost interdental papilla has been elusive. Therefore the ability of rebuilding lost papillae in the maxillary segment has become one of the major challenges in periodontal plastic surgery. OBJECTIVES OF THE STUDY: To evaluate the success and predictability of surgical technique using a sub epithelial connective tissue graft interposed in a coronally displaced flap to reconstruct the lost interdental papillae. METHODS: The purpose of this study is to evaluate the success and predictability of a surgical technique using a subepithelial connective tissue graft from the palate with coronally displaced flap to regenerate the lost interdental papilla in 11 systemically healthy patients. RESULTS: Post treatment follow up show statistically significant results from baseline to 3months and 6 months. CONCLUSION: The present study attempted a single surgical procedure to reconstruct the lost interdental papilla using subepithelial connective tissue graft interposed in coronally displaced flap in 11 patients with Tarnow's class-II papillary recessions. At the end of 6 months it was found that the sites demonstrated significantly superior results as determined by percentage of reduction in the area of the black triangle both clinically (60.26%) and on the model (54.29%). CLINICAL IMPLICATIONS: Although complete regeneration of interdental papilla was not achieved, the results of this study demonstrate that a predictable and an esthetically pleasing surgical outcome can be achieved in one attempt for class II papillary recessions.

Treatment of multiple gingival recessions with vista technique: A case series.

Gingival recession is a common manifestation in most populations. Gingival recession is clinically manifested by an apical displacement of the gingival tissues, leading to root surface exposure. Gingival recession may be a concern for patients for a number of reasons such as root hypersensitivity, erosion, root caries, and esthetics (Wennstrom 1996). Recently, new techniques have been suggested for the surgical treatment of multiple adjacent recession type defects. These are mainly derived from the coronally advanced flap, a supraperiosteal envelope technique in combination with a subepithelial connective tissue graft, or its evolution as a tunnel technique. The current case reports introduce a novel, minimally invasive approach applicable for both isolated recession defects as well as multiple contiguous defects in the maxillary anterior region. Access to the surgical site is obtained by means of an approach referred to as vestibular incision subperiosteal tunnel access.

A randomised study to compare salivary pH, calcium, phosphate and calculus formation after using anticavity dentifrices containing Recaldent(®) and functionalized tri-calcium phosphate.

AIMS: The aim of this study was to estimate the pH of saliva, concentration of calcium and inorganic phosphate, and calculus formation before and after usage of Recaldent(®) (GC Tooth Mousse Plus™), Functionalized Tricalcium Phosphate (3M ESPE ClinPro™ Tooth Crème) and standard dentifrice (Colgate dental cream). SETTINGS AND DESIGN: Randomized double-blind study. MATERIALS AND METHODS: A total of 50 subjects were recruited, the subjects were assessed at their first visit, on the 21(st) day and on the 42(nd) day. At the first visit, scaling was carried out and oral hygiene instructions were given. After 21 days, the subjects were given coded dentifrices where the operator and the subjects both were unaware of the type of dentifrice. Clinical parameters assessed were Plaque index, Gingival index, and Calculus index. Salivary samples were obtained to measure calcium, phosphate levels, and pH at 21(st) day and 42(nd) day. STATISTICAL ANALYSIS: ANOVA test, t-test, Mann-Whitney test, Kruskal-Wallis test. RESULTS: The mean salivary calcium level and mean salivary phosphate level were higher in Group III (functionalized tricalcium phosphate (3M ESPE ClinPro™ Tooth Creme) as compared to Group II (Recaldent(®) GC Tooth Mousse Plus™) and Group I (Colgate dental cream) on the 42(nd) day after using dentifrices, which was statistically significant. This showed that the usage of remineralizing dentifrices led to an increase in the salivary calcium, phosphate, and pH but it did not reach the level of super saturation of the ions caused by elevated pH which could lead to calculus formation. CONCLUSIONS: Thought here was a statistically significant increase in salivary calcium and phosphate level in all three groups from baseline to 42(nd) day, there was no calculus formation.