Patient-centric periodontal research: A pioneering application of patient-reported outcome measures.

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes. Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient. In this context, patient-centric periodontal research (PCPR) is an approach that considers the patient´s feedback concerning their functional status, experience, clinical outcomes, and accessibility to their treatments. It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief, cultural background, and social and economic factors. However, literature has shown that the incorporation of "patient-centric outcome" components considerably enhances the validity and applicability of research findings. Variations in the results of different studies might be due to the use of different and non-standardized assessment tools. To overcome this problem, this editorial enlists various reliable tools available in the literature. In conclusion, we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Platelet rich fibrin is not a barrier membrane! Or is it?

Platelet-rich fibrin (PRF) is widely used in dentistry and other fields of medicine, and its use has become popular in dental implantology. In several published studies, PRF has been used as a barrier membrane. A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation, such as epithelial cells. Among the basic requirements of a 'barrier membrane, occlusivity, stiffness, and space maintenance are the criteria that PRF primarily lacks; therefore, it does not fall under the category of barrier membranes. However, there is evidence that PRF membranes are useful in significantly improving wound healing. Does the PRF membrane act as a barrier? Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane, or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology? This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

Synoptic review on existing and potential sources for bias in dental research methodology with methods on their prevention and remedies.

The results of years of dental study serve as the foundation for the practise of medicine and, for that matter, dentistry. Doctors may have their own preferences for techniques and materials, but whether directly or indirectly, their decisions are influenced by systematic reviews and meta-analyses. However, due to poorly conducted or presented research, this very basic foundation may not be reliable. Bias in research is one of several factors that might make study results or research itself unreliable. Bias can be introduced into research at many stages, deliberately or unknowingly. Bias can appear at any point during the research process, even before the study itself begins. There are many biases in research, but some of them are more relevant to dentistry research than others. Because it is said that "eyes see what the mind knows", it is essential to have a complete understanding of the different types of bias, how and when they get entrenched, and what steps may be taken to prevent or lessen them if they do occur. This comprehensive summary of bias in dentistry research is provided by this synoptic review. The goal is to identify gaps and measures that have been taken-or that should have been taken-by providing both descriptive and evaluative summaries, as well as examples from the literature, when needed.

Effect of low-level laser therapy on wound healing and patients' response after scalpel gingivectomy: A randomized clinical split-mouth study.

BACKGROUND: Low-level laser therapy (LLLT) is based on the principle of biostimulation or biomodulation effect. LLLT after gingivectomy has resulted in better wound healing because of its action on collagen synthesis, angiogenesis, and growth factor release. AIM: The aim of this split-mouth controlled clinical trial was to assess the effect of LLLT, using diode laser (InGaAsP), on wound healing and patients' response after scalpel gingivectomy. MATERIALS AND METHODS: Forty patients with gingival enlargement in the maxillary and mandibular anterior region (bilaterally symmetrical) were included in the study. After gingivectomy, a diode laser (InGaAsP) was randomly applied to one side of the surgical area on the 1st, 3rd, and 7th day postoperatively. The surgical areas were disclosed by a solution (Alpha Plac®) to visualize the areas where the epithelium was absent. Comparison of the surface areas on the LLLT-applied sites and controls was made clinically by visualizing the stained area by two examiners. RESULTS: LLLT-applied sites had significantly lower stained areas signifying improved wound healing compared with the controls on the postoperative 7th and 30th day. CONCLUSION: Within the limitations of this study, the results indicated that LLLT might improve wound healing after gingivectomy.

Influence of External Chromophore on Cutting Efficacy of 940 nm Diode Laser: An In vitro Animal Tissue Study.

BACKGROUND: High-power level lasers used in health sciences have important photothermal effect. The maximum absorption of the diode laser correlates with the absorption range of hemoglobin, suggesting that red color may be the required chromophore. Hence, we hypothesized that by providing artificial external red chromophore, we can improve the cutting efficiency of diode laser in noninflamed tissue. The aim of the present study was to assess the efficacy and collateral thermal damage produced by a 940 nm diode laser on stained and unstained porcine tissue sample. MATERIALS AND METHODS: Eight porcine meat samples of specific dimensions were divided into four groups of two pieces each. Group I was stained with beetroot extract, Group II stained with 3% erythrosine dye, Group III stained with hibiscus extract, and Group IV left unstained. A 940 nm diode laser was used at 1.2 W in an intermittent wave mode, to make a standardized dimension incision in all the samples. One sample from each group was stored in 10% formalin and sent for histopathological examination to evaluate the depth and width of incision and amount of lateral thermal damage. The other sample from each group was observed under video profilometer to evaluate the surface characteristics. RESULTS: Staining of tissues with external chromophore using 3% erythrosine dye improved the efficacy of 940 nm diode laser, as evidenced from the sharper, wider cuts and clean incision with minimal charring as compared to beetroot, hibiscus, and saline. CONCLUSION: The use of staining can be an adjunct to the lasers in improvement of efficacy.

Evolution, current status and advances in application of platelet concentrate in periodontics and implantology.

Platelet concentrates (PC) [platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] are frequently used for surgical procedures in medical and dental fields, particularly in oral and maxillofacial surgery, plastic surgery and sports medicine. The objective of all these technologies is to extract all the elements from a blood sample that could be used to improve healing and promote tissue regeneration. Although leukocyte rich and leukocyte poor PRP's have their own place in literature, the importance of non-platelet components in a platelet concentrate remains a mystery. PC have come a long way since its first appearance in 1954 to the T-PRF, A-PRF and i-PRF introduced recently. These PC find varied applications successfully in periodontics and implant dentistry as well. However, the technique of preparation, standing time, transfer process, temperature of centrifuge, vibration, etc., are the various factors for the mixed results reported in the literature. Until the introduction of a proper classification of terminologies, the PC were known by different names in different countries and by different commercial companies which also created a lot of confusion. This review intends to clarify all these confusion by briefing the exact evolution of PC, their preparation techniques, recent advances and their various clinical and technical aspects and applications.

Gingival enlargements: Differential diagnosis and review of literature.

Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized (isolated, discrete, regional) or generalized gingival enlargement.

Esthetic crown lengthening with depigmentation using an 810 nm GaAlAs diode laser.

Hyperpigmentation of gingiva becomes more pronounced if it is associated with "gummy smile." Correction of gummy smile and depigmentation together are key to complete patient satisfaction. An 810 nm (1.5 W, pulsed) GaAlAs diode laser was used to achieve the desired results in a 22-year-old female patient. The 6-month follow-up results showed excellent color and contour of the gingiva. Mere depigmentation without correcting gummy smile may look cosmetically good but esthetically unacceptable. Diode laser was used as it is known to be an excellent tool as compared with other conventional surgical procedures in terms of patient and operator comfort.