Comparative evaluation of vestibular incision subperiosteal tunnel access with platelet-rich fibrin and connective tissue graft in the management of multiple gingival recession defects: A randomized clinical study.

BACKGROUND: The etiology of gingival recession is often multifactorial. Wide array of surgical techniques are available to manage gingival recession. The aim of the present study was to compare, minimally invasive approach (vestibular incision subperiosteal tunnel access [VISTA]), in combination with platelet-rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple recession defects in maxillary anterior region. MATERIALS AND METHODS: A total of 32 sites from 10 systemically healthy controls were allocated randomly to VISTA with PRF (VISTA + PRF) and VISTA with CTG (VISTA + CTG). Plaque index, gingival index, Probing probing pocket depth (PPD), relative attachment level (RAL), recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and percentage of root coverage (%RC) were calculated at 6 months postoperatively. RESULTS: Results showed significant improvement in mean PPD, RAL, RD, RW, and KTW. %RC in VISTA + PRF and VISTA + CTG was 83.25% ± 25.02% and 86.43% ± 22.79%, respectively, at 6 months. There were no significant differences in the parameters between the VISTA + PRF and VISTA + CTG groups. CONCLUSION: VISTA is a minimally invasive surgical approach, which can be combined with CTG or PRF in the management of Miller's Class I and Class II recession defects, with predictable outcomes. There were significant improvements in the clinical parameters from baseline to 6 months in both the groups. To match with the CTG, which is the gold standard procedure, PRF can be used as an alternative for treating multiple recession defects.

Improvement in awareness levels and periodontal health among patients undergoing fixed orthodontic appliance therapy with established gingivitis and periodontal health maintenance program: a questionnaire based study / Mejora de los niveles de conciencia y salud periodontal entre pacientes sometidos a terapia con aparatos de ortodoncia fijos con gingivitis establecida y programa de mantenimiento de la salud periodontal: un estudio basado en cuestionarios

Objetive: Home oral care practices in patients undergoing orthodontic therapy are often ineffective in maintaining optimal plaque control. The aim of the present study was to assess the effectiveness of periodontal maintenance program in subjects with established gingivitis undergoing fixed orthodontic appliance therapy for one year. Material and Methods: Forty patients undergoing fixed orthodontic appliance therapy with established chronic gingivitis were recruited for the study. As a part of a periodontal maintenance program, a pre-validated structured questionnaire evaluating oral hygiene and periodontal health was administered at the baseline as well as at the end of the study. At the baseline Gingival Bleeding Index, Gingival Index, and Bonded Bracket Plaque Index scores were recorded, Scaling and polishing procedure was performed followed by a customised Oral Hygiene Advice (OHA) session was conducted for all the study subjects. Clinical indices were assessed and OHA was conducted at the 3rd, 6th, 9th, and 12th months of orthodontic treatment visits. Results: There was significant improvement in the clinical indices and awareness regarding oral hygiene and periodontal health level in the patients at the end of the 12th month. Conclusion: The periodontal maintenance program appeared to be effective in improving the periodontal health and awareness health awareness level about oral hygiene among patients undergoing fixed orthodontic therapy at the end of 12 months in our study population.

Objetivo: Las prácticas de cuidado bucal en el hogar en pacientes sometidos a terapia de ortodoncia suelen ser ineficaces para mantener un control óptimo de la placa. El objetivo del presente estudio fue evaluar la efectividad del programa de mantenimiento periodontal en sujetos con gingivitis establecida sometidos a terapia con aparatos de ortodoncia fijos durante un año. Material y Métodos: Se reclutó para el estudio a 40 pacientes sometidos a terapia con aparatos de ortodoncia fijos y con gingivitis crónica establecida. Como parte de un programa de mantenimiento periodontal, se administró un cuestionario estructurado pre-validado que evaluaba la higiene bucal y la salud periodontal al inicio y al final del estudio. En la línea de base, se registraron las puntuaciones del índice de sangrado gingival, el índice gingival y el índice de placa de soporte adherido, se realizó el procedimiento de raspado y pulido seguido de una sesión personalizada de consejos de higiene oral (CHO) para todos los sujetos del estudio. Se evaluaron los índices clínicos y se llevó a cabo la CHO a los 3, 6, 9 y 12 meses durante las visitas de tratamiento de ortodoncia. Resultados: Hubo una mejora significativa en los índices clínicos y la conciencia sobre la higiene oral y el nivel de salud periodontal en los pacientes al final del 12º mes. Conclusión: El programa de mantenimiento periodontal pareció ser eficaz para mejorar la salud periodontal y el nivel de conciencia de la salud sobre la higiene bucal entre los pacientes sometidos a terapia de ortodoncia fija al final de los 12 meses en nuestra población de estudio.

Bone Sparing Effects of Bisphosphonates in Cyclosporine-induced Alveolar Bone Loss: An Animal Study.

Various pharmacological agents are known to create an imbalance in the normal physiology of bone remodeling. Cyclosporine-A (Cs-A) is one of the drugs that is widely used in transplantation and has its main side effect as gingival hyperplasia and alveolar bone loss by their action on the inflammatory mediators. Bisphosphonates are a new class of drugs that inhibit bone resorption by decreasing the osteoclast activity and number. The aim of this study was to evaluate the effect of concomitant administration of alendronate on Cs-A-induced alveolar bone loss in a rat model.

Effectiveness of two different herbal toothpaste formulations in the reduction of plaque and gingival inflammation in patients with established gingivitis - A randomized controlled trial.

BACKGROUND: Plant based toothpastes have received great attention in reducing gingival inflammation. Studies show contrasting results regarding the effectiveness of these toothpastes. In the present study, the effectiveness of two herbal tooth paste formulations in the reduction of plaque and gingival inflammation was assessed. Nicotine content in the toothpastes was assessed using GCMS. MATERIAL AND METHODS: 50 patients with established gingivitis were included in the study. The subjects were randomly assigned to either the test (Parodontax®) or the control (Colgate® herbal) group. There were 5 drop outs in the study in the control group after baseline examination. No prophylaxis was undertaken prior to commencement of the study, and no attempt was made to modify the participant's oral hygiene habits. A brief case history was recorded at baseline. The Turesky (1970) modification of the Quigley, Hein (1962) Plaque index (PI), the Loe and Silness (1963) Gingival Index (GI). Unstimulated salivary samples were collected at baseline and 30th day and the pH was measured using a salivary pH meter (CL-51B; Systronics New Delhi, India).Comparisons (intergroup and intragroup) were analysed by the t-test. Groups were also compared regarding age by means of t test, and association between group and sex was verified by means of the chi-square test. All statistical tests employed a level of significance of α = 0.05. There were reports of presence of nicotine and its derivatives in herbal toothpaste after the study was nearing completion. Hence we assessed for the presence of nicotine in both the toothpaste using the methods described by Aggarwal et al.24. RESULTS: When the two groups (test and control groups) were evaluated, after 30 days, the test group presented an average 21.08% reduction in plaque and the control group showed 31.85% reduction in plaque scores. The mean reduction in gingival index (GI) scores was 25.92% and 19.14% in the test and control groups respectively. There was no significant difference between the groups in GI, PI and salivary pH levels. There was no evidence of nicotine or related compounds in both the tooth paste. CONCLUSION: Both herbal based dentifrices reduce plaque levels and gingival inflammation. But, it did not alter the pH of the saliva. However, there were no additional benefits of the Parodontax® toothpaste over Colgate® Herbal toothpaste. There was no evidence of nicotine or related compounds in both herbal toothpaste.

Oral health knowledge deficit: A barrier for seeking periodontal therapy? A pilot study.

CONTEXT: In developing countries many chronic conditions including periodontitis are on the rise. Oral health attitudes and beliefs are important factors affecting oral health behavior. AIMS: The aim of this pilot study was to assess the existing knowledge about periodontal disease and its impact on treatment seeking behavior in a group of population visiting the out-patient Department of Periodontics, Yenepoya Dental College, India. This study also attempted to identify deficit in the knowledge if present. SETTINGS AND DESIGN: This is a written questionnaire based pilot study. 143 subjects (89 male and 54 female) agreed to participate in the study. Simple random sampling was used for recruitment. SUBJECTS AND METHODS: A written questionnaire consisting of 18 questions was given to the patients. Only one correct answer was present and the score given was + 1. The knowledge of the subjects was reflected by their ability to select a correct answer from the number of distractors (multiple choices, prespecified answers). STATISTICAL ANALYSIS USED: SPSS software version 15.0 is used for all statistical analysis. The Chi-square test was employed to assess the passive knowledge of the participants in relation to their age. RESULTS: We found a deficit in the knowledge in all the topics investigated. No consistent relationship between age and gender was found. Female respondents had better knowledge about oral hygiene compared to males. CONCLUSION: We made an attempt to assess the knowledge of periodontitis among the participants of this study. Knowledge deficit was found in the population surveyed. This knowledge deficit could be one of the reasons why patients do not seek periodontal treatment routinely unless there are acute symptoms. There is urgent need to educate the patients about the periodontal disease, the need for the treatment of periodontitis and advanced treatment modalities available.

Unconventional dentistry in India - an insight into the traditional methods.

Unconventional medicine (UM) has been known and practised since the recorded history of civilization. Some unconventional practices may be viewed as "the continuity of traditions, religious beliefs, and even quackery that non-specialists practice." These practices have been associated with religious beliefs and the spiritual domain as well as with the physical domain. In ancient Old World civilizations, UM was performed by skilled experts or wise men; in today's Western civilization, practitioners may or may not be licensed, and some are charlatans. Dentistry, like medicine, is a traditional, science-based, highly regulated healthcare profession that serves increasingly sophisticated and demanding clients. Today, traditional dental practice is dealing with an array of challenges to the established professional system; these challenges are generally termed "alternative" (or complementary, unconventional, or integrative). Genuine alternatives are comparable methods of equal value that have met scientific and regulatory criteria for safety and effectiveness. Because "alternative care" has become politicized and is often a misnomer - referring to practices that are not alternative to, complementary to, or integrating with conventional health care - the more accurate term "unconventional" is used.

Evaluation of periodontal status in alcoholic liver cirrhosis patients: a comparative study.

AIM: Bacterial infections are common complicating findings in course of liver cirrhosis, most of them being Gram-negative. Similarly periodontal pathogens are also mostly Gram-negative bacteria hence the objective was to evaluate the periodontal status in alcoholic liver cirrhosis patients and to compare the periodontal status of alcoholic liver cirrhosis patients in: a. Smokers with periodontitis and b. Nonsmokers with periodontitis. MATERIALS AND METHODS: A total of 150 patients made up the sample of this study. The sample size was divided into four groups. The first two groups comprised of 50 patients each comprising of patients with periodontitis who were nonsmokers and patients with periodontitis who were smokers respectively and the next two groups comprised of 25 patients each, which included patients diagnosed as suffering from alcoholic liver cirrhosis who are nonsmokers and patients diagnosed as suffering from alcoholic liver cirrhosis who are smokers. Screening examination included a proper medical history, dental history and Russell's periodontal index was done to evaluate and compare the periodontal status among the selected groups. RESULTS: The data obtained was subjected to statistical analysis using the ANOVA Fisher's F-test. Multiple group comparisons were made using the Tukey's HSD test. CONCLUSION: Conclusions that can be drawn from this study are: 1. Alcoholic liver cirrhosis patients demonstrated greater alveolar bone loss and increased periodontal destruction. 2. There is very high statistically significant difference on periodontal destruction in alcoholic liver cirrhosis patients (with or without smokers) when compared to the control group. CLINICAL SIGNIFICANCE: Periodontal diseases are bacterial infections associated with a bacterial load or insult to the host that elicits a strong inflammatory response cumulating to produce significant pathologic alterations in the systemic status of the host. Alcoholic liver cirrhosis patients as a consequence of liver dysfunction have elevated levels of serum cytokines. These are involved in the destructive process of periodontal disease probably through enhancement of collagenase and metalloproteinase activity. Hence, a study has been planned to evaluate periodontal status in patients with alcoholic liver cirrhosis.

Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus.

BACKGROUND AND OBJECTIVES: A healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft subjects, especially in those with cleft lip, alveolus and palate (CLAP), maintenance of oral hygiene is a difficult task for the patients because of the patent oro-nasal communication. Crowding of teeth in cleft patients is a common finding, especially in those with CLAP and those with cleft palate (CP). In the case of multiple tooth-malpositions, transverse deficiency, arch length deficiency and primary cross-bite; periodontal trauma increases and is detrimental to periodontal health. According to literature, a critical periodontal situation was found in patients with CLAP. Hence a study was conducted to analyze the periodontal status of patients with cleft lip (CL); those with cleft palate; and those with cleft lip, alveolus and palate. MATERIALS AND METHODS: The present study consisted of 60 cleft subjects divided into 3 groups: those with cleft lip; those with cleft palate; and those with cleft lip, alveolus and palate. Subjects with permanent dentition were selected, and the clinical examination included determination of oral hygiene status using Oral Hygiene Index - Simplified (OHI-S) index and periodontal status using community periodontal index (CPI). RESULTS: Statistically significant increase in the periodontal disease in the CLAP group as compared with the other 2 groups, and the oral hygiene was seen to be generally poor with the CLAP group. INTERPRETATION AND CONCLUSION: Individuals with clefts are more prone to periodontal disease due to the presence of cleft, which causes retention of food in the defect sites and inability to maintain good oral hygiene; but the severity of periodontal disease is more if the defect is large and involving the lip, alveolus and palate.