Ancient Seed for Modern Cure - Pomegranate Review of Therapeutic Applications in Periodontics.

Punica granatum (pomegranate), the member of Punicaceae family, is used in the prevention and treatment of health disorders. P. granatum contains diverse range of phytochemicals including ellagic acid, punicalagin, pedunculagin, quercetin, rutin, tannic acid, polyphenol, anthocyanins, and catechins. This review aims at providing an overview of the chemical constituents, antibacterial, anti-inflammatory, and antioxidant properties of P. granatum, and its role in the prevention and treatment of gingival and periodontal diseases.

Cherubism with idiopathic gingival enlargement: A rare case report.

Cherubism is a congenital childhood disease of autosomal dominant inheritance. It is a benign, familial giant cell lesion characterized by gradually progressive painless swelling of the jaws. Idiopathic gingival enlargement is a rare condition and may be associated with some uncommon syndromes. This case report describes an 11-year-old patient with unusual clinical form of gingival enlargement, cherubic facial appearance. Clinical examination revealed the presence of the hyperplastic gingiva, which completely covered all teeth. The bilateral swelling of mandible and the appearance of the sclera beneath the iris suggested cherubism. The diagnosis was confirmed by histopathological examination, which revealed multinucleated giant cells. Computed tomography scan showed multiple osteolytic zones in the mandible. A full mouth gingivectomy was performed in four stages. Lesion healed successfully, and no recurrence observed after 1-year follow-up. There was a marked improvement in esthetics and function through the surgical excision of the overgrowth.

Evaluation of efficacy of probiotic (BIFILAC) on Porphyromonas gingivalis: In vitro study.

BACKGROUND: Periodontitis is inflammation of the periodontium and causes destruction of the connective tissue attachment of the teeth and alveolar bone. Porphyromonas gingivalis is the primary pathogen for the destructive periodontal diseases. The aim of the study is to evaluate the efficacy of probiotic on P. gingivalis. MATERIALS AND METHODS: An in vitro study was done to analyze the effectiveness of probiotic BIFILAC on P. gingivalis was determined using disc diffusion method. The minimum inhibitory concentration for BIFILAC lozenges was also determined using microdilution method. RESULTS: In disc diffusion method, the antibacterial activity of BIFILAC was analyzed using various concentrations such as 2.5, 5, 10, and 20 µg/ml, of which 20 µg/ml was proved to have a maximum inhibitory zone of 22 mm. In microdilution method, concentration ranging from 7.25 to 100 µg/ml was used and 25 µg/ml was found to have the minimum inhibitory effect on P. gingivalis. CONCLUSION: The present in vitro study confirms that probiotic BIFILAC has an antimicrobial effect against P. gingivalis. Thus, proving that BIFILAC probiotic can be used as an adjunctive therapeutic modality in periodontitis.

Evaluation of superoxide dismutase levels in local drug delivery system containing 0.2% curcumin strip as an adjunct to scaling and root planing in chronic periodontitis: A clinical and biochemical study.

AIM: Curcumin has proven properties such as anti-inflammatory, antioxidant, antimicrobial, and it also accelerates wound healing. The purpose of this study was to investigate the level of superoxide dismutase (SOD) enzyme, in gingival crevicular fluid (GCF), and the impact of nonsurgical treatment on the antioxidant profile using 0.2% curcumin strip as local drug delivery. MATERIALS AND METHODS: A total of twenty subjects of age 35-55 years and 15 subjects with chronic periodontitis, each with bilateral 5-6 mm probing pocket depth, were selected for this study. Healthy group consists of 5 sites in which no bleeding on probing, no pocket depth. Group I - It consists of 15 sites with chronic periodontitis, in which scaling and root planing (SRP) was done (control group). Group II - It consists of 15 sites, in which SRP followed by the placement of curcumin strip inside the pocket (SRP + curcumin strip) (test group). GCF collection was done preoperatively and postoperatively after 21 days. The SOD activity was assessed using enzyme-linked immunosorbent assay. RESULTS: In this study, all the clinical parameters were significantly reduced in test and control sites. Further, SOD levels were significantly improved in test sites when compared with control sites. CONCLUSION: Thus, the present study concluded that curcumin strip can be effectively used as an adjunct to SRP in treatment of chronic periodontitis and serves as antioxidant in subgingival environment.

Comparative analysis of gingival crevicular fluid a disintegrin and metalloproteinase 8 levels in health and periodontal disease: A clinic-biochemical study.

AIM AND BACKGROUND: A disintegrin and metalloproteinase 8 (ADAM8) is a marker belonging to the class of ADAM family of metalloproteinase which is found to be involved in inflammation and bone resorption in periodontal disease by acting as osteoclast stimulating factor. In several systemic inflammatory diseases, elevated levels of ADAM8 are detected in human serum and other body fluids. Recently, ADAM8 was even detected in gingival crevicular fluid (GCF) of patients with periodontal diseases. Hence, the aim of the study was to estimate the levels of ADAM8 in GCF of healthy and chronic periodontitis subjects. MATERIALS AND METHODS: Periodontal examination and collection of GCF by the extracrevicular method was performed in 30 subjects selected randomly and categorized into two groups. Group I (healthy, n = 15) and Group II (chronic periodontitis, n = 15). ADAM8 levels in GCF were estimated by enzyme-linked immunosorbent assay. RESULTS: ADAM8 was detected in both Group I and II. Highest mean ADAM8 concentration was obtained for Group II, whereas the lowest concentration was seen in Group I. This suggests that ADAM8 levels increase proportionally with the progression of periodontal disease. There was a significant correlation between ADAM8 levels and clinical parameters in the study group. CONCLUSION: The results of our study indicate that the ADAM8 levels in GCF are positively associated with periodontal disease, which may provide a useful tool in monitoring its progression. Nevertheless, further longitudinal studies are required with larger sample sizes in which ADAM8 levels are progressively estimated and compared to baseline values.

LASER curettage as adjunct to SRP, compared to SRP alone, in patients with periodontitis and controlled type 2 diabetes mellitus: A comparative clinical study.

AIM: To compare the effect of scaling and root planning (SRP) alone, and laser curettage as an adjunct to SRP, on the clinical parameters of patients with periodontitis and controlled type 2 diabetes mellitus. MATERIALS AND METHODS: Ten patients were divided into two equal groups in a split-mouth design - Group I: SRP alone, Group II: SRP + laser curettage. The following clinical parameters were recorded: (i) Gingival index (ii) plaque index (iii) sulcular bleeding index (iv) probing depth (PD) and (v) clinical attachment level (CAL). SRP was done in one quadrant using Gracey curettes and in another quadrant SRP plus laser curettage was done. Three weeks after the therapy, the clinical parameters were recorded and the results were analyzed and the percentage of improvement were evaluated. RESULTS: The results of this study indicated that both SRP and SRP + laser curettage were efficient for reducing gingival inflammation and PD. Group II showed more reduction in PD and more gain in CAL than Group I. Mean reduction in PD was 20.22% in Group I and 26.76% in Group II. Mean CAL gain is 32.5% in Group II and 22.34% in Group I. CONCLUSION: In both the groups, gingival inflammation was reduced. When laser curettage was used as adjunct to SRP more reduction in PD and CAL was seen.

Comparative evaluation of depigmentation techniques in split-mouth design with electrocautery and laser.

Excessive gingival pigmentation is a major esthetic concern for many people. Melanin pigmentation is known to be caused by melanin granules within the gingival epithelium. Smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. It is not a medical problem, but it feels unesthetic for the patient and particularly in patients having a very high lip/smile line. Depigmentation is not a clinical indication but a treatment of choice where esthetics is a concern and is desired by the patient. For depigmentation of gingival, different treatment modalities have been reported such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. The present case series describes two simple and effective surgical depigmentation techniques treated with diode laser and electrosurgery.

Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession.

AIM: The aim of this study was to determine whether the addition of an autologous platelet rich fibrin (PRF) membrane to a coronally advanced flap (CAF) would improve the clinical outcome in terms of root coverage, in the treatment of isolated gingival recession. MATERIALS AND METHODS: Systemically healthy 20 subjects each with single Miller's class I or II buccal recession defect were randomly assigned to control (CAF) or test (CAF + PRF) group. Clinical outcome was determined by measuring the following clinical parameters such as recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (WKT), gingival thickness (GTH), plaque index (PI), and gingival index (GI) at baseline, 3(rd), and 6(th) month postsurgery. RESULTS: The root coverage was 65.00 ± 44.47% in the control group and 74.16 ± 28.98% in the test group at 6(th) month, with no statistically significant difference between them. Similarly, CAL, PD, and WKT between the groups were not statistically significant. Conversely, there was statistically significant increase in GTH in the test group. CONCLUSION: CAF is a predictable treatment for isolated Miller's class I and II recession defects. The addition of PRF to CAF provided no added advantage in terms of root coverage except for an increase in GTH.

Periodontal management of gingival enlargement associated with Sturge-Weber syndrome.

The Sturge-Weber syndrome is a rare uncommon neurocutaneous disorders with angiomas involving the leptomeninges (Leptomeningeal Angiomas) and skin of the face, typically in the ophthalmic (V1) and maxillary (V2) distributions of the trigeminal nerve. The cutaneous angioma is called a Port-Wine Stain. It is commonly referred to as "Sturge-Weber syndrome after Sturge and Weber who first described this affliction in 1879. This article present a case of Sturge-Weber syndrome associated with gingival enlargement, its management and follow-up results.

Awareness of dental office medical emergencies among dental interns in southern India: an analytical study.

Medical emergencies in dental practices are common, and specific training and skills are needed to manage the situations. Dental curricula provide training in basic life support in medical emergency management. In India, the internship is the final stage before graduation, and the interns are future practitioners. Managing emergency situations increases the confidence level among new graduates. Training and skill improvement through various training programs on medical emergencies will improve the quality of dental practice, and it is beneficial to the patients. Knowledge of medical emergencies by dental interns is important since they go for practice without supervision. This study was conducted to assess the awareness and knowledge of medical emergencies among dental interns in the southern part of India. Based on the results, dental curricula need to include more rigorous training in emergency management.

Collagen with simvastatin promotes cell metabolism in osteoblast-like SaOS-2 cells.

BACKGROUND: Simvastatin (SMV) is one of the cholesterol-lowering pharmacological drugs. Recent studies demonstrate that it has a bone stimulatory effect. The present study was designed to investigate the effect of SMV along with collagen membrane on osteoblast-like SaOS-2 cells and also to standardize the dosage of SMV to be incorporated into the collagen membrane to achieve regeneration. MATERIALS AND METHODS: SMV at doses of 0.5, 1, 1.5, and 2 mg was incorporated into the collagen membrane and cell metabolism was assessed by (3-[4,5-dimethylthiazolyl-2]-2,5-diphenyltetrazolium bromide) (MTT) assay for 24 h. RESULTS: SMV enhanced cell metabolism dose dependently at 24-h time and the maximum effect was obtained at a concentration of 1.5 mg of SMV. CONCLUSION: These results indicate that collagen with 1.5 mg SMV exhibits positive effect on cell metabolism of human osteoblast-like SaOS-2 cells.

Successful treatment of osseous lesion associated with palatoradicular groove using local drug delivery and guided tissue regeneration: A report of two cases.

Developmental grooves are not rare and often appear on maxillary lateral and central incisors and are an important predisposing factor to localized periodontal disease. Various techniques have been adopted to eliminate the groove and regenerate lost periodontium. This report of two cases describes the technique of using the local drug delivery system with chlorehexidine and the guided tissue regeneration (GTR) to control the disease progression and regeneration.

Pink esthetics in periodontics - Gingival depigmentation: A case series.

Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of "black gums" are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.

Statins: A new era in local drug delivery.

Periodontitis is an inflammatory disease of the supporting tissues of the teeth, caused by a group of specific microorganisms. Aggressive forms of periodontitis can be localized or generalized. The concept that localized problem sites may be treated by local drug delivery appears attractive as the antimicrobial agent is delivered within periodontal pockets and the therapy is targeted on specific pathogenic microorganisms. Periodontitis can result in bone resorption creating bony defects, which may cause tooth loss. Various drugs have been studied using local delivery to improve the periodontal health and to achieve periodontal regeneration. Local delivery of antimicrobial agents using controlled release systems should be considered as adjunctive to mechanical debridement for the treatment of localized forms of periodontal destruction. Pharmacological agents offer great promise in this direction. Simvastatin, used for the treatment of hypercholesterolemia, is a universally accepted and relatively inexpensive drug. Local application of simvastatin has been shown to stimulate bone formation in rodents both in vitro and in vivo and in human periodontal ligament cells in vitro. This article reviews the effects of simvastatin as a local delivery and examines its potential role in periodontal regenerative therapy.

Lasers in periodontics.

Laser is one of the most captivating technologies in dental practice since Theodore Maiman in 1960 invented the ruby laser. Lasers in dentistry have revolutionized several areas of treatment in the last three and a half decades of the 20(th) century. Introduced as an alternative to mechanical cutting device, laser has now become an instrument of choice in many dental applications. Evidence suggests its use in initial periodontal therapy, surgery, and more recently, its utility in salvaging implant opens up a wide range of applications. More research with better designs are a necessity before lasers can become a part of dental armamentarium. This paper gives an insight to laser in periodontics.

Host modulation by therapeutic agents.

Periodontal disease susceptible group present advanced periodontal breakdown even though they achieve a high standard of oral hygiene. Various destructive enzymes and inflammatory mediators are involved in destruction. These are elevated in case of periodontal destruction. Host modulation aims at bringing these enzymes and mediators to normal level. Doxycycline, nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, nitrous oxide (NO) synthase inhibitors, recombinant human interleukin-11 (rhIL-11), omega-3 fatty acid, mouse anti-human interleukin-6 receptor antibody (MRA), mitogen-activated protein kinase (MAPK) inhibitors, nuclear factor-kappa B (NF-kb) inhibitors, osteoprotegerin, and tumor necrosis factor antagonist (TNF-α) are some of the therapeutic agents that have host modulation properties.

Bugs that debugs: Probiotics.

The oral cavity harbors a diverse array of bacterial species. There are more than 600 species that colonize in the oral cavity. These include a lot of organisms that are not commonly known to reside in the gastrointestinal (GI) tract and also are more familiar: Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus fermentum, Lactobacillus plantarum, Lactobacillus rhamnosus, and Lactobacillus salivarius. The balance of all these microorganisms can easily be disturbed and a prevalence of pathogenic organisms can lead to various oral health problems including dental caries, periodontitis, and halitosis.

Evaluation of anti-plaque microbial activity of Azadirachta indica (neem oil) in vitro: A pilot study.

BACKGROUND: Probably microbial plaque is the main etiology for periodontal tissue inflammation. Various chemical agents have been evaluated over the years with respect to their antimicrobial effects in the oral cavity. However, all are associated with side effects that prohibit regular long-term use. Therefore, the effectiveness of Azadirachta indica (neem) against plaque formation is considered to be vital, with lesser side effects. The aim of the present study is to evaluate and prove the antimicrobial activity of neem using plaque samples. MATERIALS AND METHODS: Culture was prepared using brain heart infusion broth reagent. Dental plaque samples were used for that. Kirby-Bauer antimicrobial susceptibility test procedure was carried away with the sample. Neem oil was kept in the agar plate with culture and the diameter of inhibition zones was calculated. RESULTS: Results showed inhibition zones on the agar plate around neem oil. CONCLUSION: Study shows definite antiplaque activity of neem oil.

The application of bone morphogenetic proteins to periodontal and peri-implant tissue regeneration: A literature review.

Progress in understanding the role of bone morphogenetic proteins (BMPs) in craniofacial and tooth development and the demonstration of stem cells in periodontal ligament have set the stage for periodontal regenerative therapy and tissue engineering. Furthermore, recent approval by the Food and Drug Administration of recombinant human BMPs for accelerating bone fusion in slow-healing fractures indicates that this protein family may prove useful in designing regenerative treatments in periodontics. In the near term, these advances are likely to be applied to periodontal surgery; ultimately, they may facilitate approaches to regenerating whole lost periodontal structures.