Platelet concentration in platelet concentrates and periodontal regeneration-unscrambling the ambiguity.

CONTEXT: Platelet-rich-plasma (PRP) and Platelet-rich-fibrin (PRF) are extensively used autologous platelet concentrates in periodontal regeneration, and PRF has a better efficacy as compared to PRP. The rationale for this difference has often been attributed to the difference in the structure of the fibrin matrix. However, the effect of concentration of platelets on the regenerative potential of these concentrates is obscure. AIMS: The study was conducted to evaluate and compare, clinically and radiographically, the efficacy of PRF and PRP in the treatment of periodontal endosseous defects and to assess the effect of platelet concentration on periodontal regeneration. MATERIALS AND METHODS: Twenty intrabony defects were selected and divided into two groups randomly by the coin toss method. Group I received PRP and Group II subjects were treated with PRF. The platelet counts in PRP and PRF were analyzed. Clinical and radiological parameters were assessed at baseline and 3, 6, and 9 months postoperatively. STATISTICAL ANALYSIS: Kruskal-Wallis Chi-square test, Wilcoxon signed rank test, t-test, and Spearman's rank correlation were used for statistical analysis of data. RESULTS: There was statistically significant improvement in all the parameters in the two groups except in relation to gingival recession. There was a statistically significant difference between the platelet count in Group I and Group II (P = 0.002). CONCLUSION: PRP and PRF appear to have nearly comparable effects in terms of periodontal regeneration. The concentration of platelets appears to play a paradoxical role in regeneration. The regenerative potential of platelets appears to be optimal within a limited range.

Efficacy of a commercially available multi-herbal formulation in periodontal therapy.

OBJECTIVE: This prospective clinical trial was designed to evaluate the clinical effects of a commercially available powder (Periocare(®) Gum massage powder), containing various herbal medicaments, in the reduction of plaque and gingival inflammation in subjects diagnosed with gingivitis. MATERIALS AND METHODS: Seventy-five subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into the following three groups: Group I - Scaling + Periocare(®) Gum Massage powder, Group II - Periocare(®) Gum Massage powder alone, and Group III - Scaling only. Clinical evaluation was done at baseline, 2 weeks, 4 weeks, and 6 weeks using gingival index, plaque index, and microbiological culturing of plaque samples. RESULTS: Periocare(®) Gum Massage (multi-herbal formulation) powder as an adjunct to mechanical therapy (scaling) showed significant clinical and microbiological improvement in the gingival index and plaque index scores as compared to other groups. Periocare(®) Gum Massage powder as a monotherapy did not prove to be effective for plaque control. CONCLUSION: Periocare(®) Gum Massage may be a useful herbal formulation for chemical plaque control and improvement in plaque scores and gingival status.

Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus) patients in Bangalore city: An epidemiological study.

BACKGROUND: Our objective was to study the prevalence and severity of periodontal disease in type 2 diabetes mellitus (DM) patients in Bangalore city. MATERIALS AND METHODS: Four hundred and eight type 2 DM patients (Study Group) and 100 non-diabetic patients (Control Group) among the age group of 35-75 years were included in the study. The study group was divided based on Glycated hemoglobin levels into well, moderately and poorly controlled. Relevant information regarding age, oral hygiene habits and personal habits was obtained from the patients. Diabetic status and mode of anti-diabetic therapy of the study group was obtained from the hospital records with consent from the patient. Community periodontal index (CPI) was used to assess the periodontal status. The results were statistically evaluated. RESULTS: The mean CPI score and the number of missing teeth was higher in diabetics compared with non-diabetics, and was statistically significant (P=0.000), indicating that prevalence and extent of periodontal disease was more frequent and more severe in diabetic patients. The risk factors like Glycated hemoglobin, duration of diabetes, fasting blood sugar, personal habits and oral hygiene habits showed a positive correlation with periodontal destruction, whereas mode of anti-diabetic therapy showed a negative correlation according to the multiple regression analysis. The odds ratio of a diabetic showing periodontal destruction in comparison with a non-diabetic was 1.97, 2.10 and 2.42 in well, moderately and poorly controlled diabetics, respectively. CONCLUSION: Our study has made an attempt to determine the association between type 2 DM (NIDDM) and periodontal disease in Bangalore city. It was found that type 2 DM (non-insulin-dependent diabetes mellitus [NIDDM]) subjects manifested relatively higher prevalence and severity of periodontal disease as compared with non-diabetics.

Adrenomedullin, periodontitis, diabetes-unraveling the equivocal relationship: A clinicobiochemical cross-sectional study.

CONTEXT: Antimicrobial proteins and peptides constitute a diverse class of host-defense molecules that act early to combat invasion and infection with bacteria and other microorganisms. Among the various antimicrobial peptides in the oral cavity, adrenomedullin (ADM), a cationic peptide, is found in gingival crevicular fluids (GCFs) in amounts twice as high in periodontal disease sites as healthy sites. Studies have also shown that plasma levels of ADM increased in patients with type 2 diabetes mellitus as compared with controls. AIMS: This clinico-biochemical study was undertaken to try to decipher the probable link between ADM, diabetes and periodontitis. MATERIALS AND METHODS: The study comprised of 90 patients who were divided into three groups based on community periodontal index scores and diabetes status. Probing pocket depth and clinical attachment level were measured in all subjects. GCF was collected from all the participants using micropipettes and blood samples were collected from subjects in Groups III, for analysis of glycated hemoglobin. ADM levels were measured in GCF samples by the enzyme-linked immunosorbent assay. STATISTICAL ANALYSIS USED: The data obtained were subjected to analysis of variance, Bonferroni test and Pearson's correlation. RESULTS: An increase in GCF levels of ADM from periodontal health to disease and in periodontitis patients with type 2 diabetes was noted. CONCLUSIONS: Increase in GCF levels of ADM from periodontal health to disease and in periodontitis patients with type 2 diabetes reinforces the perio-systemic interlink concept.

Treatment of an intrabony osseous lesion associated with a palatoradicular groove.

Various root developmental anomalies like palatoradicular groove (PRG) have been associated with worsening of periodontal condition. The aim of the present case report is to describe the regenerative surgical treatment of periodontal and osseous lesion associated with the subgingival extension of PRG. A 23-year-old female patient reported with pain in upper incisor teeth region. On clinical and radiological examination, a deep endosseous defect was found distal to maxillary right lateral incisor that was etiologically associated with the presence of a PRG. Treatment procedures consisted of: Regenerative periodontal therapy using Guided tissue regeneration (GTR) and hydroxyapatite (HA) bone graft and 2) flattening of the radicular portion of the palatal groove. The clinical examination at 1 year revealed shallow residual probing depth (3 mm) and no increase in gingival recession. The radiographic examination showed reduction in the radiolucency suggesting bone fill. A PRG may serve as a pathway for the development of a periodontal osseous defect. The combination of GTR and HA may be clinically and radiographically efficacious in the treatment of such a defect.

Two-step procedure for root coverage using a free gingival graft and a subepthelial connective tissue graft.

Gingival recession is a multifaceted problem, for which several treatment options are available. Both epithelized and subepithelial connective tissue grafts offer predictable solutions for the treatment of gingival recession.The case report involved a 30-year-old man with gingival recession of 8 mm on 41 (Miller's class II recession). Before surgery, full mouth scaling and polishing were performed. Recession height, width, probing depth, clinical attachment level (CAL), and width of the attached gingiva (WAG) were measured at the baseline, two months postoperatively, and six months postoperatively. Four weeks after scaling, the first step of increasing the width of the attached gingiva was carried out, using a free gingival graft. Two months after this step, the subepithelial connective tissue was harvested from the palate and placed in relation to 41, to cover the residual defect.Two months postoperatively, there was a 3 mm gain in WAG and 35% root coverage. Six months postoperatively there was a significant increase in WAG, CAL; and reduction in height and width of recession (root coverage achieved was 75%). These results suggested that this two-stage surgical procedure could be successful for root coverage in case of deep recession and lack of attached gingiva in the mandibular anterior region.