Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial.

BACKGROUND: Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome. OBJECTIVE: To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing. MATERIAL AND METHODS: Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60 years with probing pocket depth of ≥ 6 mm and clinical attachment level of ≥5 mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks. RESULTS: A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group. CONCLUSION: AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.

Evaluation of Platelet-Rich Fibrin Matrix as a Regenerative Material in the Surgical Management of Human Periodontal Intraosseous Defects - A Randomized Controlled Trial.

Background: Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects. Materials and Methods: Fifteen patients (age: 30-55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction. Results: The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%). Conclusion: PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.

A comparative evaluation of the effect of platelet rich fibrin matrix with and without peripheral blood mesenchymal stem cells on dental implant stability: A randomized controlled clinical trial.

Technological advances in the field of implantology have led to the concept of surface modifications to enhance implant stability by utilization of current concepts of tissue engineering and materials such as platelet concentrates and stem cells. The purpose of the present randomized controlled clinical trial was to evaluate and compare the effect of platelet rich fibrin matrix (PRFM) with and without peripheral blood mesenchymal stem cells (PBMSCs) on implant stability; by assessing the bone to implant contact (BIC) using resonance frequency analysis (RFA), insertion torque and also to establish and correlate the same with implant stability quotient (ISQ). A total of 15 patients with 30 sites ensuring a minimum of two dental implants adjacently placed in an edentulous area; with the age group of 25-50 years of both the sexes were categorized into Group 1 (dental implant with PRFM) and Group 2 (dental implant with PBMSCs embedded in PRFM). Insertion torque values at the time of dental implant placement and ISQ using RFA was recorded at 1 week, 1 month, and 3 months post operatively. There was no significant difference (p = 0.81) in Insertion torque values between both the groups (G1 and G2). Platelet rich fibrin matrix along with PBMSCs enhanced implant stability as higher and statistically significant ISQ values were noted at 1 week (p = 0.18), 1 month (p ≤ 0.001), and 3 months (p ≤ 0.001) intervals in the G2 group. Platelet rich fibrin matrix and PBMSCs showed promising results as a potential regenerative material for increasing and enhancing BIC and hence implant stability.

Peripheral Blood Mesenchymal Stem Cells and Platelet Rich Fibrin Matrix in the Management of Class II Gingival Recession: A Case Report.

The treatment of gingival recession is a frequent demand due to aesthetic concern, root caries, and /or root hypersensitivity. The purpose of this case study was to evaluate the success and predictability of coronally advanced flap (CAF) in combination with peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix(PRFM) for the management of Miller's Class II gingival recession. CAF followed by placement of PBMSCs and PRFM was performed on a male patient, aged 25 years having Miller's Class II gingival recession of 5-6 mm on the upper left canine, premolars and molars. The patient was followed up for 3 months. Root coverage of 60.0% and clinical attachment gain of 3 mm were evident following 3 months of follow-up. This novel technique showed an effective way to increase the width of attached gingiva and treat gingival recession.

A Comparative and a Qualitative Analysis of Patient's Motivations, Expectations and Satisfaction with Dental Implants.

INTRODUCTION: Dental Implants are the norm of today's prosthetic and restorative dentistry but, is it the answer for edentulism that can affect both individual's appearance and functioning, therefore having an impact on the psychological and the social well being of the person is an ongoing quest. Also, patient's beliefs and personal expectations for dental implants vary, which may influence the treatment outcome, thus emphasizing the importance of a good clinician-patient communication. Hence in this study a qualitative analysis was carried out with an earnest attempt to gain an insight into patient's motivations, personal expectations, satisfaction and impact of clinician's motivation for implant maintenance. AIM: To learn about patient's expectations and their level of satisfaction from dental implants. To know the impact of clinician's instructions and motivation for implant maintenance, with the patient's level of understanding and compare the level of motivation for implant maintenance and care provided by a dentist with Bachelor's degree to a dentist with a Master's degree. MATERIALS AND METHODS: A 30 systemically healthy patients who had undergone implant treatment (aged 25-65 years) were considered and divided into two groups: Group A: 15 patients in whom implant placement was done by a dentist with Bachelor's degree (24 years, 18 years in general and implant practice respectively) and Group B: 15 patients in whom implant placement was done by a dentist with a Master's degree (Periodontics; 20 years,17 years in general and implant practice respectively). A qualitative analysis with the help of appropriate questionnaires comprising of multiple choice questions specifically designed for this purpose and few open ended questions was carried out with an earnest attempt to gain an insight into patient's motivations, personal expectations, satisfaction and impact of clinician's motivation for implant maintenance. RESULTS: Patients motivations for seeking implants and their expectations of treatment differed. Dental implants had met the patient's pre-treatment expectations and they were satisfied. Variations in the knowledge on the maintenance of the implants by the patients and the kind of maintenance care provided by the dentists varied between the two groups. CONCLUSION: In regard to the patient's compliance towards dental implants, a clinician must ensure that patient's understand the different demands.

Prevalence of enamel projections and its co-relation with furcation involvement in maxillary and mandibular molars: A study on dry skull.

BACKGROUND: The objectives of this study were to investigate the incidence of cervical enamel projection (CEP) in molars of Indian dry human skulls and to evaluate its relationship with furcation involvement (FI). MATERIALS AND METHODS: The material consisted of 944 upper and lower first, second and third permanent molars from 89 Indian dry human skulls. CEPs were investigated from the buccal aspect of the tooth and classified according to a system describeddescribed by Masters and Hoskins. FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest millimeter. Any measurement ≥2 mm was considered to have positive FI. RESULTS: The results showed that CEPs was found more frequently in the mandibular than in the maxillary molars (2:1). The highest incidence of CEP was found in the mandibular second molar (14.7%) followed by the maxillary second molar (14.6%). The mandibular third molar showed the lowest incidence (5.5%). The association between CEP and FI (87.5%) was statistically significant. This favors the view of the possible role played by such anomalies in the progression of periodontal diseases. CEP in male skulls (77.4%) was significantly more prevalent than in female skulls (20.4%). No significant difference was found between the right and left side of maxillary and mandibular teeth with CEP and FI. CONCLUSION: The findings suggested the role of CEPs as a local contributing factor in localized chronic periodontitis and FI in molars. Detailed examination as well as early diagnosis of periodontal disease at the region of furcation is clinically very important.

Effect of phase I periodontal therapy on pro-coagulant state in chronic periodontitis patients--a clinical and haematological study.

STATEMENT OF THE PROBLEM: The increase in white blood cell count (WBC) and platelet count due to systemic inflammation and infection is considered a risk factor for cardiovascular diseases. These parameters increase in periodontal disease. A decrease in WBC and platelet counts by periodontal therapy may decrease the risk for cardiovascular disease. PURPOSE OF THE STUDY: The present study is a treatment intervention model to investigate the effect of non-surgical periodontal therapy on total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count in patients with chronic periodontitis. MATERIALS AND METHODS: Thirty systemically healthy patients were included in the study. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), TLC, DLC, platelet count, bleeding time (BT) and clotting time (CT) were evaluated at baseline and at two weeks after phase I therapy. RESULTS: A statistically highly significant decrease in the percentage of sites exhibiting BOP was observed, i.e., from 78.1% at baseline to 18.1% two weeks postoperatively (p = 0.000). There was also a statistically significant decrease in TLC from 7595/mm3 at baseline to 6690/mm3 two weeks following phase I therapy (p = 0.02). There was also a statistically highly significant decrease in platelet count from 2.1 lac/mm3 preoperatively to 1.9 lac/mm3 at two weeks postoperatively (p = 0.003). CONCLUSION: The present study depicts the importance of periodontal therapy to reduce the TLC and platelet count, thereby possibly decreasing the risk for the development of cardiovascular disease by lowering the established risk factors for periodontal atherosclerosis.

Modified frenectomy: a review of 3 cases with concerns for esthetics.

The maxillary labial frenum is a normal anatomical structure in the oral cavity. An abnormal labial frenum causes localized gingival recession and midline diastema, both of which can interfere with oral hygiene procedures, and eventually affect esthetics. When the frenum maintains its high papillary attachment, frenectomy is the treatment of choice. Though this technique has undergone many modifications, the zone of attachment and esthetics in the anterior maxillary region have been neglected. This article highlights a new frenectomy technique that results in good esthetics, excellent color match, gain in attached gingiva, and healing by primary intention at the site of thick, extensive abnormal frena.

Effect of lycopene in the treatment of periodontal disease: a clinical study.

PURPOSE: Several epidemiologic studies have suggested a role of tomato products in decreasing the risk of the development of diseases related to oxidative stress (cancer and other chronic diseases). Oxidative stress may result in periodontal tissue damage either directly or indirectly. Lycopene, a powerful antioxidant and the main carotenoid in tomato products possesses the greatest quenching ability of singlet oxygen among the various carotenoids and is effective in protecting blood lymphocytes from NOO-radical damage. Hence, the aim of the present study is to compare the effect of systemically administered lycopene as an adjunct to scaling and root planing in patients with gingivitis and periodontitis. MATERIALS AND METHODS: Twenty systemically healthy patients were involved in a randomized, double-blind, parallel study and based on their clinical signs were divided into two groups of mild to moderate periodontitis (A) and moderate gingivitis (B). The subjects under the groups A and B were randomly distributed between the two treatment groups: test group (n = 5), 4 mg lycopene/day for 2 weeks with oral prophylaxis (full mouth scaling and root planing (SRP) completed within 24 hours) and controls (n = 5), receiving only oral prophylaxis. Pre- and post-therapeutic periodontal parameters were evaluated. RESULTS: In group A, statistically significant improvement in CAL was reported in test group as compared to control group. In group B, the difference between pretreatment and post-treatment bleeding on probing scores was found to be statistically non-significant in both groups. CONCLUSION: Results show that lycopene is a promising treatment modality as an adjunct to full mouth SRP of the oral cavity in patients with moderate periodontal disease. CLINICAL SIGNIFICANCE: Modulation of the free radical production seems to be essential for the inhibition of tissue destruction, and treatment with antioxidants, like lycopene, which is the most potent among them will block the production of free ROS or its effects might prove to be therapeutically valuable.

Amlodipine- induced gingival overgrowth: a case report.

Drug-induced gingival overgrowth occurs in genetically susceptibIe individuals as a side effect of various drugs. There is a gross disfiguring enlargement of gingiva mostly in the anterior region leading to difficulty in mastication, speech and maintenance of oral hygiene. In this case report, amlodipine-induced gingival enlargement and its management are discussed. Drug substituion, appropriate non-surgical and surgical treatment along with excellent plaque control lead to the regression and prevention of recurrence of drug-induced gingival overgrowth.

Crouzon syndrome--A case report.

Crouzon syndrome is a genetic disorder also known as branchial arch syndrome. Specifically, this syndrome affects the first branchial (or pharyngeal) arch, the precursor of the maxilla and mandible. Since the branchial arches are important developmental features in a growing embryo, disturbances in their development create lasting and widespread effects. Previously referred to as craniofacial dysostosis, the disorder is characterized by a number of clinical features; to date, it has no known single, initiating defect to account for all its characteristics. This article presents a case report of a 10-year-old boy with classical skeletal and soft tissue features of Crouzon syndrome.