Comparing efficacies of autologous platelet concentrate preparations as mono-therapeutic agents in intra-bony defects through systematic review and meta-analysis.

Aim: This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF (Plasma Rich in Growth Factors) in comparison to OFD (Open Flap Debridement) alone for treating Intrabony defects, by calculating pooled effect sizes. Background: Relevant randomized controlled trials on humans were searched in PUBMED, COCHRANE CENTRAL, and GOOGLE SCHOLAR. Mean differences (MD) of Clinical Attachment level (CAL), Probing Pocket depth (PPD), and Defect Depth Reduction (DDR) between the Experimental and Control groups were used for calculating pooled effect sizes. Risk of bias was assessed using Cochrane's tool, and publication bias was evaluated through Funnel plots, Trim & Fill Method, and Rosenthal's Fail-Safe N Test. Review result: A total of 23 studies were identified for qualitative and quantitative analysis. These studies were categorized into PRF, PRP, and PRGF groups based on the type of APC used. PRF showed the highest CAL gain (1.60 mm, 95% CI = 0.963-2.232 mm, P < 0.001, I2 = 93.83%) and PPD reduction (1.76 mm, 95% CI = 1.056 to 2.446, P < 0.001, I2 = 96.05%). However, PRP exhibited the greatest DDR (3.42 mm, 95% CI = -13.67 to -20.50, P = 0.011, I2 = 87.27%). PRF and PRP demonstrated large effect sizes, while PRGF showed a small effect size. Conclusion: The use of PRF, PRP, and PRGF showed advantages in treating intrabony defects. However, caution is advised when interpreting the results due to heterogeneity and publication bias among the studies.

Association between rheumatoid arthritis and periodontitis in an adult population - A cross sectional study.

BACKGROUND: This investigation was aimed to analyse the existence of an association between rheumatoid arthritis and periodontitis among Indian subjects. MATERIAL AND METHODS: This observational study included a total of 110 individuals between 18-78 years of age, which were divided equally into RA (Rheumatoid Arthritis) and NRA (Non-Rheumatoid Arthritis) groups. General, Oral and a complete Periodontal examination included recording of Gingival Index (GI), Plaque index (PI), Pocket Probing Depth (PPD), Clinical attachment level (CAL) in a questionnaire form. Laboratory and rheumatologcal parameters like C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and Disease Activity Score 28(DAS 28), Health Assessment Questionnaire-Disability Index (HAQ), Rheumatoid factor (RF) were also respectively estimated. RESULTS: Prevalence of moderate or severe periodontitis was higher in RA than in NRA group. (41.8% vs 23.6%, p= 0.047). Periodontal structural damage represented by clinical attachment level was more in RA patients (2.89 mm v/s 2.54mm, p=0.261). Mean score of HAQ was co-related significantly in patients with CAL ≥ 2mm than with CAL < 2mm (0.69 v/s 0.455, p=0.0415). Through logistic regression analysis, periodontitis and CAL were related to RA with OR (Odds Ratio) of 2.1 and 2.89 respectively. CONCLUSIONS: Indian RA patients have higher odds for periodontitis and CAL may act as a risk indicator for RA. Key words:Chronic periodontitis, rheumatoid arthritis, disease activity score 28, health assessment questionnaire, rheumatoid factor, c-reactive protein , erythrocyte sedimentation rate.

Efficacy of autologous stem cells for bone regeneration during endosseous dental implants insertion - A systematic review of human studies.

Availability of adequate quantity and quality of bone is prerequisite for longevity and survival of endosseous dental implants. Most of the clinicians face with the problem of lack of bone due to long-standing edentulism during this treatment modality. Conventional therapies with the use of various types of bone grafts and membranes have provided clinicians with unpredictable and compromised results. Cell-based therapies utilizing undifferentiated cells, that have the potential to differentiate into various cell types including osteoblastic lineages, have demonstrated through various previously conducted in-vitro and animal studies, a successful formation of bone in a predictable manner. Thus the main objective of this review was to evaluate the effectiveness of these therapies when applied on human subjects. A search was carried out in MEDLINE (via PubMed) and Cochrane CENTRAL databases for completed randomized and non-randomised clinical trials utilizing stem cell-based therapies with histologic and radiographic analysis written in English up to January 2019. This search of the literature yielded 10 studies meeting the inclusion and exclusion criteria. In all these studies, stem cells were primarily used to achieve bone augmentation during insertion of endosseous dental implants. Results of these therapies conducted on human subjects have shown a positive impact on bone regeneration, in particular, therapies utilizing bone marrow and adipose tissue derived stem cells. But the clinicians need to examine the efficacy, safety, feasibility of these therapies while treating large size defects or planning for shorter healing period and early loading of dental implants.

Antimicrobial effects of various platelet rich concentrates-vibes from in-vitro studies-a systematic review.

AIM: The aim of the current review was to outline the existing information related to antimicrobial properties of various platelet concentrates, as experimented in various in-vitro studies. BACKGROUND: One of the most interesting recent landmarks in the field of biological therapy has been the discovery that platelets, in addition to being capable of releasing hundreds of proteins and growth factors, can also release immunomodulatory agents with antimicrobial activity. Several international research groups have reported antimicrobial activities in both human platelets and other types of platelet rich plasma preparations. REVIEW RESULT: This review was carried-out pursuing a systematic approach. An electronic search was conducted on MEDLINE and GOOGLE SCHOLAR databases using suitable search terminologies. It included preclinical studies which assessed the antimicrobial activity of Autologous Platelet Concentrates(APC).Ten in-vitro studies and one animal study, which investigated APC effects on various microorganisms, were included. Almost in all the included in-vitro studies, it was found that complete breakdown of microbial load could not be achieved by any of the APC preparations but there occurred a reduction in the growth of microorganisms. Thus APCs displayed a bacteriostatic rather than bacteriocidal activity.The only animal study included in this review which had both in-vitro and in-vivo evaluation, also showed reduction of infection caused by different microorganisms. CONCLUSION: Although the precise mechanism of synergy with microbial pathogens needs further validation, platelet concentrates proved to have antimicrobial properties.

Poor periodontal health as a risk factor for development of pre-eclampsia in pregnant women.

AIMS: Periodontal disease has been considered a systemic exposure implicated in a higher risk of adverse pregnancy outcomes. The aim of the present study was to determine whether maternal oral health is associated with an increased risk of pre-eclampsia. SUBJECTS AND METHODS: A case-control study was conducted which included 40 pregnant women patients admitted to the Department of Obstetrics and Gynecology, J.N. Medical College, A.M.U, Aligarh. Pre-eclampsia was defined as classic triad of hypertension, proteinuria and symptoms such as swelling/edema esp. in hands and face, headache, visual changes etc., A periodontal examination was done during 48 h after child delivery. Maternal oral status was evaluated using gingival index by Loe and Silness, oral hygiene index (simplified) by greene and vermillion and periodontal pockets and clinical attachment level (CAL). STATISTICAL ANALYSIS: Null hypothesis that no difference exist between the two groups (pre-eclamptic and non-pre-eclamptic Group) was calculated using paired t-test, Chi-square and Mann-Whitney U statistical tests using SPSS 11.5 (Statistical Package for Social sciences, Chicago). P < 0.05 was considered to be statistically significant. RESULTS: The amount of gingival inflammation, oral hygiene levels, pocket depth and CALs as measured by their respective indices were higher in the pre-eclamptic group when compared to non-pre-eclamptic group. Furthermore CAL was significantly increased in the test group. This study showed that pre-eclamptic cases were more likely to develop periodontal disease (P < 0.05). 30% of the test group and 65% of the case group had periodontal disease (P < 0.05) which had shown that pre-eclamptic cases were 4.33 times more likely to have periodontal disease (odds ratio = 4.33). CONCLUSIONS: Maternal oral status was determined to be associated with an increased risk of pre-eclampsia.