A Comparative Evaluation of Efficacy of Root Surface Biomodification using MTAD, MTAD+I-PRF on Adhesion of Fibrin Clot to Dentin Sem Study.

Root biomodifiers help in removing the smear layer following mechanical debridement. In this context, we evaluated and compared the in vitro efficacy of MTAD, MTAD+I-PRF, and phosphate-buffered saline-conditioned dentin surfaces by examining the distribution of the fibrin network using scanning electron microscopy. It was concluded that MTAD can serve as a potentially useful root conditioner/biomodifier. Further, the adjunct of MTAD+I-P resulted in more fibrin network linkage on the dentinal surface when compared to MTAD alone which can be of great utility in Advanced Regenerative Therapy.

Effects of Probiotics Mouthwash on Levels of Red Complex Bacteria in Chronic Periodontitis Patients: A Clinico-microbiological Study.

AIM: The red complex includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are recognized as the most important pathogens and are the indicators of infection in chronic periodontal disease. This study was to assess the levels of red complex bacteria in chronic periodontitis patients following treatment with probiotic mouthwash. MATERIALS AND METHODS: Twenty chronic periodontitis patients with ages ranging from 18 to 55 years were recruited for the study. The control group was given placebo mouthwash and the study group was given probiotic mouthwash. After clinical monitoring and scaling and root planing, the collected plaque samples at baseline and 14th day were transferred for microbiological analysis by transport media for Conventional Multiplex Polymerase Chain Reaction. RESULTS: On the 14th day, all the clinical parameters were significantly reduced in the study group with gingival index (p = 0.003 HS) and plaque index (p = 0.001 VHS). In the study group, there was significant bacterial cell reduction with T. denticola (p = 0.041 S) and T. forsythia (p = 0.037 S). CONCLUSION: In patients with chronic periodontitis, treatment with probiotic mouthwash significantly reduces the levels of red complex bacteria. CLINICAL SIGNIFICANCE: The use of probiotic mouthwash could be a useful adjunct to scaling and root planing in chronic periodontitis.

Esthetic Evaluation of Maxillary Anterior Immediate Implant with Provisionalization with or without Bone Grafting.

AIM: Immediate implant in the esthetic zone is a treatment of choice. However, much research regarding immediate implant provisionalization lacked in the literature. Hence, our study was conducted with an aim to assess the changes in the soft tissue, hard tissue, and esthetic outcomes following immediate implants with provisionalization with or without bone grafting. MATERIALS AND METHODS: Twenty patients with a mean age between 18 and 55 years referred to the department of periodontology, for immediate implant placement in maxillary anterior region were included in the study. Patients were enrolled into two groups. Group I (test group) included patients with immediate implant placement with provisionalization with bone grafting. Group II (control group) included patients with immediate implant placement with provisionalization without bone grafting. Cement-retained provisional restoration was fitted over temporary abutment for 6 months of healing period. After 6 months of implant placement, definite crown was delivered. RESULTS: The results of our study showed the least resorption of buccal cortical plate and good amount of bone gain in both the groups in terms of horizontal alveolar dimensional changes. The mean amount of horizontal alveolar gain in group I was 1.12 mm at 2 mm, 1.08 mm at 4 mm, and 0.85 mm at 6 mm; in group II, it was 0.97 mm at 2 mm, 1.4 mm at 4 mm, and 0.93 mm at 6 mm. CONCLUSION: This study showed a significantly better outcome in both the groups in terms of all the parameters when compared from baseline but the mean differences between the two groups were not very significant. The study concluded that immediate implant with provisionalization with or without bone grafting has maintained stability of soft tissues as well as hard tissues and has also given better esthetic outcomes. CLINICAL SIGNIFICANCE: The findings of this study proved that immediate implant placement with provisionalization with bone grafting is a predictable treatment modality that maintains the three-dimensional stability of alveolar bone and integrity of soft tissue and gives acceptable esthetics. Hence, this technique promises to fulfill both functional and esthetic concerns of the patient.

Sublingual Piroxicam as Preemptive Analgesia in Single Implant Surgery.

AIM: The aim of this study is to evaluate the efficacy of sublingual piroxicam as a preemptive analgesic agent in patients undergoing single implant surgery. MATERIALS AND METHODS: This was a prospective triple-blind placebo-controlled trial that involved 40 patients presented for the placement of a single endosteal implant in the posterior maxillary arch. Patients were randomly allocated to one of the following groups. Group I (study) who received sublingual piroxicam 40 mg 1 hour prior to the surgical procedure and group II (control) received placebo 1 hour before the surgery, both the groups received sublingual piroxicam 20 mg tablet twice a day on the first and the second postoperative day and once a day on the postoperative day 3. Visual analog scores for measuring pain intensity were assessed at postoperative 1 hour, 6 hours, days 1, 3, and 5. Facial swelling was measured and evaluated during the first, third, and fifth postoperative days using the digital vernier caliper. The Mann-Whitney U test was used to make between-group comparisons. The Wilcoxon-signed rank test was used to make within-group comparisons. RESULTS: At all-time intervals, both mean pain and mean swelling scores were higher in controls as compared with those of cases. The difference between the two groups was also statistically significant at all-time intervals for both parameters except for pain at 1 hour. CONCLUSION: Our findings suggest that preoperative sublingual piroxicam is more effective for controlling postoperative pain and swelling after surgical implant placement than only postoperative administration.

Revelation of Viral - Bacterial Interrelationship in Aggressive Periodontitis via Polymerase Chain Reaction: A Microbiological Study.

BACKGROUND: Periodontal disease is one of the most common and complex disease affecting mankind. Being multifactorial in etiology it encompasses a variety of infectious entities with various unique microbial constellations and immune responses. A bacteriologic cause alone seems insufficient in explaining several clinical features of the periodontal disease. Recent studies suggest that periodontal herpes viruses comprise an important source of triggering periodontal tissue destruction. The following study aims to assess human cytomegalovirus (HCMV), Epstein-Barr virus (EBV-I) interaction with the established periodontopathic bacteriae, Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in pathogenesis of aggressive periodontitis (AgP) using Hotstart polymerase chain reaction (PCR). MATERIALS AND METHODS: A total of 30 subjects, 15 with AgP and 15 healthy controls contributed random subgingival plaque samples. PCR methodology was used to identify the subgingival herpesviruses, Pg, and Aa. Yates corrected Chi-square test was employed to identify a statistical association between herpesviruses and periodontopathic bacteriae. RESULTS: Findings suggested that viruses may be pertinent to disease progression. The prevalence of the periodontopathic bacteria Aa was found in 53.33% (P = 0.0168, S) and Pg in 40% (P = 0.2155, NS) of the AgP patients. Herpesviruses, HCMV and EBV-I were found to have a prevalence of 46.67% (P = 0.039, S) and 40% (P = 0.084, NS). The viral and bacterial co-infection was found to be 77.78% (P = 0.0002, S) with Aa and HCMV. CONCLUSION: The present data reveals, viruses may exert periodontopathic effect by causing local immunosupression which may set a stage for the subgingival colonization and multiplication of periodontal bacteriae. Further studies are needed to develop an understanding into the significance of herpesviruses in human periodontitis which, may allow for improved diagnosis, more specific therapy and ultimately disease prevention.

Determination of clinical biologic width in chronic generalized periodontitis and healthy periodontium: A clinico-radiographical study.

BACKGROUND: The dimensions of dentogingival junction have been evaluated from autopsy jaw specimens. Previous studies demonstrated variability in histologic biologic width (BW) in periodontal health and mild periodontitis. Few studies have been done on the measurement of clinical BW in periodontitis. BW variation provides implications for selection of surgical or nonsurgical approaches. The purpose of this study was to determine clinical BW in periodontal health and chronic generalized periodontitis and to compare it with histologic dimensions of BW. MATERIALS AND METHODS: A total of 20 subjects with chronic generalized periodontitis and 20 subjects with healthy periodontium were included in the present study. Plaque index and community periodontal index of treatment needs were scored; moreover, probing depth (PD) and clinical attachment level were measured. Full mouth intraoral periapical radiographs were taken, and digitalized images were obtained to measure the crestal bone level using computerized software. RESULTS: Clinical BW was significantly greater in both healthy and periodontitis groups than previously reported histologic BW of 2.04 mm (P < 0.001). The mean clinical BW was 3.98 mm. CONCLUSION: Mean clinical BW in both groups was significantly greater than histologic BW and sites with shallow PDs demonstrated greatest BW, suggesting that these sites may be at increased risk for losing significant attachment during surgical procedures.

C-reactive Protein as Predict of Increased Carotid Intima Media Thickness in Patients with Chronic Periodontitis.

BACKGROUND: C-reactive protein (CRP) - a prototypic marker of inflammation has been shown to be elevated in chronic periodontitis (CP) and also been shown to predict cardiovascular events. Increased carotid intima media thickness (CIMT) has been recently recognized as surrogate marker for atherosclerosis. In this context, we studied to correlate between CIMT and CRP in CP and to know whether CRP predicts the cardiovascular risk in CP. MATERIALS AND METHODS: The study consisted of 30 systemically healthy subjects aged over 40 years - 15 subjects with CP as cases and 15 subjects with no periodontitis as controls. All subjects were subjected to measurement of CRP levels and CIMT in addition to detailed periodontal evaluation. Quantitative determination of CRP was done by turbidimetric immunoassay. IMT of the common carotid arteries was estimated bilaterally using B-mode ultrasound at 6 sites. Positive CRP was defined as more than 10 mg/l. RESULTS: Mean CRP levels were significantly higher in subjects with CP (19.58 ± 17.03), then in non CP (NCP) (5.54 ± 1.63, P < 0.004). Mean CIMT value was significantly higher in subjects with CP (1.09 ± 0.45) than in NCP (0.57 ± 0.06, P < 0.001) and all periodontal indices correlated well with CIMT. Further, there was significant correlation between CRP and increased CIMT in subjects with CP (r = 0.863, P < 0.001). CONCLUSIONS: The present study indicates CRP as a possible underlying pathway in the association between periodontal disease and the observed CIMT. CRP can be used as a risk predictor for atherosclerosis in patients with CP.

Anterior deep bite malocclusion treated with connecticut intrusion arch: biomechanical consideration.

Most Class II division 2 malocclusion manifest a severe deep bite, the orthodontic correction of deep overbite can be achieved with several mechanisms one such mechanics is true intrusion of anterior teeth. Deep overbite correction by intrusion of anterior teeth affords a number of advantages which includes simplifying control of the vertical dimension and allowing forward rotation of mandible to aid in Class II correction. It also aid in correction of a high gingival smile line. This case report presents the patient of a 14-year-old boy with Class II division 2 subdivision malocclusion treated with connecticut intrusion arch and also highlights the biomechanical aspect of this appliance. Intrusion of anterior teeth is difficult. An appropriate, effective and clinically manageable biomechanical system is required. The treatment approach shown in this case can treat the deep overbite precisely with incisor intrusion. The article shows the versatility of Connecticut Intrusion Arch and by applying the sound biomechanical principles we can execute the planned mechanics with minimal side effects.

Potential effect of neutrophil functional disorders on pathogenesis of aggressive periodontitis.

INTRODUCTION: Leukocytes play a key role in maintaining the balance between an effective host defence response to microorganisms and periodontal tissue destruction. Neutrophil dysfunction has been associated with increased susceptibility to periodontal diseases. We undertook this study to determine to what extent neutrophil dysfunction constitutes to the pathogenesis of aggressive periodontitis (AgP) in tropical country like ours. MATERIALS AND METHODS: Age- and sex-matched groups consisting of 20 subjects each of generalized aggressive periodontitis (GAP)-cases and nonperiodontitis (NP)-controls. diabetes mellitus, HIV infection, prolonged antibiotic use and smoking were excluded. Each neutrophil function was assessed using the chemotactic assay using case in, phagocytosis assay, candidacidal assay (for intracellular killing) and NBT assay (for respiratory burst failure). STATISTICAL ANALYSIS USED: Student's t-test, Fisher's exact test and Chi-square test. RESULTS: In the study 17 out of 20 subjects (85%) had at least one abnormal neutrophil assay either hypofunctional or hyperfunctional of which 16 (80%) had hypofunctional assays and 8 (40%) had hyperfunctional assays. Defective phagocytosis was the commonest (50%) followed by chemotactic defect (45%), defective respiratory burst (40%) and defective intracellular killing (30%). Mean of chemotaxis assay was significantly less in AgP when compared to controls (103 vs 129 µm, p=0.002), similarly for phagocytic defect (3.45 vs 4.65, p≤0.001) and with candidacidal assay (26.80 vs 37.35, p<0.001). CONCLUSION: The prevalence of neutrophil dysfunction, predominantly hypofunctional, was significantly very high in GAP patients with few even having hyperactive respiratory burst function. Multiple level neutrophil defects could account for the aggressive nature of AgP even in apparently healthy subjects.