Modifications in the Free Gingival Graft Technique: A Systematic Review.

Free gingival grafts (FGGs) have developed beyond covering exposed roots to improve the width and thickness of gingival tissue. While traditional FGGs have shown a high success rate and are easy to apply, they have some drawbacks, such as potential aesthetic concerns and bulky appearance. Recent advancements in FGGs have been explored, with different modifications proposed to overcome these limitations, including partly epithelialized FGGs (PE-FGG), gingival unit grafts, and epithelialized subepithelial connective tissue grafts. This systematic review aims to evaluate published case reports that discuss the utilization of modified approaches to FGG treatment and their outcome.

Rutin Gel with Bone Graft Accelerates Bone Formation in a Rabbit Model by Inhibiting MMPs and Enhancing Collagen Activities.

Bone graft techniques are used to compensate for bone loss in areas with deficient regeneration. However, matrix metalloproteases (MMPs) can limit bone formation by degrading extracellular matrices, which are required for bone regrowth. Noteworthily, rutin is a natural flavonoid compound that inhibits the genetic expression of various MMPs. Therefore, rutin may serve as an inexpensive and stable alternative to the growth factors used to accelerate dental bone graft healing. This study aimed to evaluate the potential of mixing rutin gel with allograft bone to accelerate the healing of bone defects in an in vivo rabbit model. Bone defects were surgically induced in New Zealand rabbits (n = 3 per group) and subsequently treated with bone grafts along with rutin or control gel. Overall, treatment with rutin significantly prevented the expression of several MMPs and increased type III collagen in the gingiva around the surgical site. Additionally, rutin-treated animals showed enhanced bone formation with higher bone marrow content in the jawbone defect area compared with the control group. Taken together, these findings demonstrate that rutin gel, when added to bone grafts, quickly enhances bone formation and may serve as a suitable alternative to expensive growth factors for the same purpose.

Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series.

OBJECTIVES: The purpose of this prospective clinical trial was to examine the clinical and patient outcomes following esthetic reconstruction of interdental papilla loss in anterior teeth, using an injectable, non-animal-based, hyaluronic acid gel. MATERIALS AND METHODS: Ten systemically healthy adults, with at least one anterior site with class I or II interdental papilla loss, were recruited. Following local anesthesia, ∼0.2 ml of hyaluronic acid gel was injected directly into the base of the papilla. The injection was repeated twice 21 days later. Patients were seen monthly for follow-up. Lost papilla surface area was calculated from digital clinical photographs taken at baseline and at 4 and 6 months postoperatively. Differences in lost papilla surface area between baseline and postoperative time points were statistically analyzed. Participants completed questionnaires (satisfaction surveys). RESULTS: Seventeen sites (13 maxillary, 4 mandibular) were treated in 9 females who completed the study. The lost inderdental papilla area at baseline and at the 4- and 6-month postoperative visits was 1.2 ± 1.8 mm(2) (mean ± SD), 0.6 ± 0.9 mm(2), and 0.7 ± 0.7 mm(2), respectively. Differences between baseline and postoperative visits were statistically significant (p < 0.0001). Two thirds of the patients would choose to undergo the procedure again. CONCLUSIONS: Use of hyaluronic acid gel to treat interdental papilla loss resulted in significant improvement at 6 months. Patients expressed satisfaction with the obtained improvement and dissatisfaction with the associated procedure discomfort. CLINICAL RELEVANCE: Treatment of interdental papilla loss (black triangle) by hyaluronic acid gel injection appears a promising modality to address this esthetic patient concern.

The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers.

BACKGROUND: Locally delivered doxycycline is found to be effective in managing periodontitis as an adjunct to scaling and root planing. AIM: To evaluate the effect of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers and to compare it with scaling and root planing alone. METHODS: Twelve smokers with chronic periodontitis and a pocket depth (⩾5 mm) on posterior teeth that bleed on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, clinical attachment level (CAL), and probing depth (PD) were recorded at the baseline, 6 and 12 weeks. RESULTS: Both groups showed a significant reduction in Plaque, Bleeding on Probing and pocket depth at 6th and 12th week from the baseline. A statistically significant gain of attachment was observed in both groups after treatment. Even though the doxycycline group showed slightly higher attachment gain it was not statistically significant compared to the control group. CONCLUSION: The observations of the study reveal that the additional benefit of topical application of doxycycline as an adjunct to scaling and root planing in smokers is not convincing. However, further clinical studies may be necessary to substantiate the present observations.

Oral hygiene status among orthodontic patients.

AIM: The aim of this study was to evaluate the oral hygiene status of patients with fixed orthodontic appliances. METHODS AND MATERIALS: The following indices were used to evaluate the oral hygiene status of patients in orthodontic treatment: gingival bleeding index (GBI), plaque index (PI), and ortho-plaque index (OPI). A self-administrated questionnaire was prepared covering oral hygiene practice, oral hygiene cleaning aids, and number of visits to a dental hygienist. RESULTS: Fifty patients (15-30 years old) were selected for the study from among the orthodontic patients treated at the King Saud University College of Dentistry, Riyadh, Saudi Arabia. Results showed that the PI and OPI were high with mean scores of 65.24 (SD 16.43) and 53.56 (SD 8.74) respectively, while the average GBI was a much lower value at 19.14 (SD 7.95). No significant difference was observed between male and female patients for the PI (p=0.925) and for the OPI (p=0.072), but a significant difference was observed for the GBI at the 5 percent significance level (p=0.033). The result of OPI showed that 20 (40 percent) of the patients had fair oral hygiene, whereas 30 (60 percent) had poor oral hygiene. Only 16 (32 percent) of the participants reported visiting the dental hygienist during their orthodontic treatment, while the remaining 34 (68 percent) did not. CONCLUSIONS: The oral home care of the orthodontic patients surveyed was not at an optimal level, which indicated the need to establish an oral hygiene maintenance program. CLINICAL SIGNIFICANCE: Inadequate oral home care among orthodontic patients may make them more prone to develop gingivitis during orthodontic treatment. It is, therefore, essential that oral hygiene instructions and a hygiene maintenance program not be overlooked during orthodontic treatment.

Serum immunoglobulin levels in type 2 diabetes patients with chronic periodontitis.

AIM: The association between diabetes and periodontal disease has been well documented. Periodontitis is associated with alterations in immune responses in both diabetic and nondiabetic subjects. While diabetes is considered to be a risk factor for periodontal disease progression, few studies have demonstrated an association between the level of glycemic control and periodontal disease. Although poor glycemic control is significantly associated with poor periodontal health, few studies have been performed in Saudi Arabia to evaluate the immune responses in poor and better glycemic control and its effect on periodontal tissue. The aim of this study is to assess serum immunoglobulin levels (IgA, IgG, IgM) in type 2 diabetic (poor control and better control) and nondiabetic subjects with chronic periodontitis. METHODS AND MATERIALS: A total of 105 female patients were included in the study and they were divided into three groups, with 35 patients in each group. Group 1 was comprised of cases of diabetes exhibiting better control (HbA1c9%). The third group was comprised of nondiabetic subjects with chronic periodontitis. In this study, clinical examination included plaque index, bleeding on probing, probing pocket depth, and attachment level (measured in all three groups). Serum immunoglobulin (IgA, IgG, IgM) levels were estimated and compared to the levels estimated for diabetic controls. RESULTS: Mean plaque index, bleeding index, and probing pocket depth showed no significant differences among the three groups. However, mean clinical attachment loss was significantly higher for Group 2 as compared to Groups 1 and 3. IgA and IgG levels were found to be significantly higher in Group 2 (poorly controlled diabetes) as compared to Group 1 (better control) and Group 3 (control group). There is a positive correlation between CAL and IgA and IgG, whereas there is a negative correlation between CAL and IgM. CONCLUSION: The present study indicates that poor glycemic control may be associated with the increase in IgA and IgG serum antibodies. Elevated antibody levels may explain why poorly controlled diabetes exacerbates periodontal disease. CLINICAL SIGNIFICANCE: These findings demonstrate the importance of the immune system as well as good glycemic control, especially in patients diagnosed with periodontitis. The changes observed in immune response may be the cause or the effect of periodontal disease in diabetic patients. The increased incidence of periodontitis in diabetic patients suggests that the alteration in immune response may contribute to the pathogenesis of periodontitis in patients with poorly controlled diabetes.

Evaluation of periodontal status in subjects with hyperlipidemia.

AIM: The aim of this study was to evaluate the periodontal status in subjects with hyperlipidemia and to determine whether there is any association between hyperlipidemia and periodontal disease. METHODS AND MATERIALS: Sixty female patients were enrolled in the study; group one is hyperlipidemic patients (30 subjects) and group 2 is systemically fit patients within the same age group (control; 30 subjects). In both groups body mass index (BMI) and clinical parameters were measured; plaque index (PI), bleeding on probing (BOP), pocket depth (PPD) as well as clinical attachment level (CAL) and biochemical parameters, including plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels, were evaluated. RESULTS: The mean values of BMI, PPD, CAL, PI (%), and BOP (%) for the hyperlipidemia group were significantly higher than those for the control group. Total cholesterol and LDL-C levels were significantly and positively associated with CAL. Plasma triglyceride level was significantly associated with PPD and CAL. CONCLUSIONS: The results of our study showed that female patients with hyperlipidemia had higher values of periodontal parameters compared to control individuals. However, in the future studies with larger sample sizes in mixed gender populations are needed to determine the association between hyperlipidemia and periodontal disease. CLINICAL SIGNIFICANCE: The results of our study showed that female patients with hyperlipidemia might manifest clinically higher values of periodontal parameters compared to nonlipdemic individuals. However, due to the small sample size of this study the exact association between hyperlipidemia and periodontal disease is still uncertain. Care has to be taken with a hyperlipidemia patients and advice can be given to them for periodic periodontal checkup.

Evaluation of the relationship between type 2 diabetes and periodontal disease.

OBJECTIVE: To investigate the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severity of periodontal disease (PD). METHODS: One hundred and twenty-six Saudi diabetic females, aged 35-70 years, attending the Diabetic Center of King Abdul-Aziz Hospital, Riyadh, Saudi Arabia were included in the study. In Group I (better control with hemoglobin A1c (HbA1c) <9%) we assigned 74 subjects and in Group II (poor control with HbA1c >9%) 52 subjects. The periodontal parameters recorded were plaque index, bleeding index, presence of calculus, pocket depth measurement, and clinical attachment level. These parameters were evaluated in a randomized half mouth examination. RESULTS: Age, duration of diabetes, percentage of plaque index and bleeding index showed no significant difference between the 2 groups. In contrast, there was a significantly higher percentage of calculus, PD > or = 4 mm and loss of attachment level (3-4 mm) in the poorly controlled diabetic patients, as compared to the better-controlled group. CONCLUSION: There was a significant association of the loss of attachment level (3-4 mm) with PD in poorly controlled diabetic patients, as compared to better-controlled patients. Poor-control diabetics (Group II) exhibited an increased percentage of calculus and greater risk for periodontitis.

Prevalence of medically compromised patients referred for periodontal treatment to a teaching hospital in Central Saudi Arabia.

OBJECTIVE: Many patients seeking dental care have a significant medical condition that may alter both the course of their oral disease and the treatment provided. The aim of this study was to assess the systemic diseases profile of patients with periodontal diseases for specialized periodontal treatment. METHODS: Seven hundred and forty-three patient's medical records were screened from the Periodontal Clinics and referred to the College of Dentistry, King Saud University, a teaching hospital in Riyadh, Kingdom of Saudi Arabia for a special care during the period from January 2002 to June 2002. RESULTS: One hundred and sixty-seven were males while 576 were females. The age ranged was from 18-64 years. Approximately 90% of the patients were systemically healthy. The remaining 10% of the patients were with different systemic diseases or sequelae. Diabetes mellitus, hypertension, asthma and rheumatic fever were most commonly present. Thirty-one (4.2%) of the medically compromised were diabetic. Hypertension was reported in 9 (1.2%) patients. Rheumatic fever and asthma were equally present in 7 (0.9%) patients. Periodontal diseases were equally prevalent in both male and female patients. Approximately 50% of the patients had moderate periodontitis while severe periodontitis was common among 9% of the male and female patients. CONCLUSION: Diabetes and heart related conditions were most common among the specialist patients referred for periodontal treatment. The advanced periodontitis was prevalent among 9% of the patients. It is recommended that physicians are become more familiar with the systemic associations to periodontal diseases. The dental practitioners should be well versed in the interplay between oral and systemic disease. More extensive knowledge of oral and physical medicine will be needed in order to provide quality care and appropriate treatment of patients with periodontal diseases suffering with systemic conditions.

Broken appointment behavior in a dental school environment.

The present study was designed to determine the prevalence of broken appointments of female and male patients scheduled for third, fourth, and fifth year dental students. Data was obtained from computers used for patient scheduling at two campuses of the dental college. The proportion of broken appointments at these facilities was computed using the X2 -test to determine a difference between males and females. Results showed that male patients (14.9%) had a higher proportion of broken appointments than female patients (12.4%). Such differences among gender was statistically significant (p=4.218). The highest percentage of broken appointments was during December of 2001. Thirty four percent of these broken appointments were in the Restorative Clinic at the Darraiyah Campus (DUC) serving primarily male patients and 24% in the Removable Partial Denture Clinic at the Malaz Campus (MUC) serving only female patients. It was concluded the percentage of broken appointment s is considered to be unacceptable because of the negative impact on student learning and, ultimately, their academic progress.

Clinical evaluation of cervical dentin sensitivity (CDS) in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC).

AIM: The objective of this study was to compare the prevalence, severity and distribution of CDS in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC) and to correlate them to possible causal factors. MATERIAL AND METHODS: 2 groups of patients aged 20-60 years recruited from GDC (144) and PSC (151) were evaluated for CDS by means of a questionnaire and intraoral clinical examinations. Furthermore, gingival recession and plaque scores were recorded at the same visit. RESULTS: The results showed that patients referred to PSC had a significantly higher prevalence of CDS (60.3%) than those examined at GDC (42.4%) (p<0.001). Also, mean plaque scores of PSC patients (1.87 +/- 0.88) was found to be significantly higher than that of GDC (1.44 +/- 0.7) (p<0.01). The occurrence and extent of gingival recession associated with hypersensitive teeth was significantly higher in PSC than GDC patients (p<0.01), with a 5% incidence of severe recession (5 mm) in PSC only. The association of periodontal disease and periodontal treatment to the high prevalence of CDS and gingival recession in PSC patients would suggest their role in predisposition to hypersensitivity. The distribution of CDS in tooth types revealed that upper molars and lower anteriors of PSC patients were mainly affected, and followed by, to a lesser extent, lower right canine and right first molars of GDC patients. CONCLUSION: The prevalence of CDS among our periodontal patients appears somewhat lower than that reported in periodontal specialty clinics of earlier studies but still higher than those reported in other dental populations. This indicates that periodontal disease and its treatments may increase the occurrence of hypersensitivity.