Comparative Evaluation of Conventional Therapy With and Without Use of Diode Laser (DL) in the Treatment of Chronic Generalized Periodontitis: A Clinico-Microbiological Study.

INTRODUCTION: Chronic periodontitis is caused by a persistent and expanding interaction between a subgingival pathogenic microbial biofilm and the host immune system. The host's reaction to local factors directly influences the inflammation and bone loss that result from these interactions. Depending on variables like the severity of soft tissue damage and bone loss, treatment options can range from nonsurgical to surgical. Nonsurgical treatments are frequently used as the first-line therapy for inflammatory periodontal disease. In fact, careful scaling and root planing (SRP), a nonsurgical treatment, has been extensively studied and shown to be a highly predictable and effective therapy. According to recent research, using a diode laser (DL) in addition to standard SRP may reduce bacterial count and reinfection significantly. Laser therapy could be helpful in treating periodontal disease because of its antibacterial and detoxifying effects. The goal of this study is to investigate whether using a DL in addition to conventional flap surgery enhances patient outcomes for those with chronic generalized periodontitis. MATERIALS AND METHODS: The 12 participants in this split-mouth trial with chronic generalized periodontitis were the main subject of the study. All of them had probing pocket depths (PPDs) of at least 5 mm after the initial phase of treatment. Each patient in the control group (Group A) and test group (Group B) received a conventional flap after being randomly assigned to one of the groups. Group B underwent a conventional flap with a 980 nm DL, whereas those in Group A did not receive any DL therapy. Periodontal pockets in both groups were evaluated at baseline, 45 days, and 90 days after a sub-gingival plaque test. Quantitative real-time polymerase chain reactions were used to examine the presence of red complex organisms in the plaque sample. RESULTS: From baseline to 45 days and then to 90 days, clinical attachment loss (CAL), plaque index (PI), and gingival index (GI) all significantly decreased. However, results from 45 days to 90 days were statistically non-significant, with the exception of the GI, where Group B results were significantly different from Group A results from 45 days to 90 days. On the other hand, when a DL was combined with conventional flap surgery in the test group, the quantity of red complex bacteria was significantly decreased. CONCLUSION: When DL was used in conjunction with conventional flap surgery, the results showed that CAL, PI, and GI were all significantly reduced while the quantity of red complex bacteria was also significantly decreased.

Comparative Evaluation of the Crestal Bone Level Around Pre- and Post-loaded Immediate Endoosseous Implants Using Cone-Beam Computed Tomography: A Clinico-Radiographic Study.

Introduction  Dental implants replace missing teeth. Dental implants are surgically placed tooth root replacements that secure prosthetic teeth and bridges. Branemark's original dental implant technique included a mesiobuccal flap and a two-stage approach, needing 6-8 months of recovery following extraction, sterile conditions, machined titanium implants, 3-6 months without stress for osseointegration, and a detachable temporary prosthesis. The restoration would usually be ready a year following the implant surgery. Implant treatment seeks the best function, aesthetics, and complication risk. Implant therapy with low patient morbidity and fast extraction-to-restoration times is a secondary target. Instantaneous implant insertion has made implant dentistry more convenient for patients and clinicians. This study measures bone height before, after, and one month after implant placement using cone-beam computed tomography (CBCT). Materials and Methods Participants were selected from oral evaluation candidates. This investigation included 11 people missing front maxillary or mandibular teeth or root components. Diagnostic castings determined the interarch connection before surgery. Alginate maxillary and mandibular arch imprints were cast in Type III dental stone for diagnosis. CBCT scans were taken pre-operatively, post-implant, and post-prosthesis. After the tooth was removed, the empty socket was cleaned up with curettes. An intraoral periapical radiograph and manual probing were done to determine the implant's size. The implant was removed for examination after three months, and healing abutments and gingival formers were placed. Finally, fins were placed. The CBCT images also captured the bone height around the implants. The soft tissue parameters were recorded and evaluated at baseline and one-month following prosthetic loading as plaque index (PI). Radiographic evaluation was done at baseline and one-month following functional loading using CBCT. After one month following functional loading, crestal bone levels were measured again with the help of CBCT using Image J software (National Institutes of Health, Bethesda, Maryland, US). Results The sample population had an average age of 42.81 years, with a standard deviation of 13.44 years. Using a paired t-test, we found that the mean PI dropped significantly from pre-loading levels to one-month post-loading levels, with a p-value of less than 0.001. The mean crestal bone level (mesial) evaluated by CBCT at baseline and one-month post-loading was 2.52 ± 1.97 mm and 1.17 ± 1.31 mm, respectively. The mean difference between mean crestal bone loss (distal) at baseline and one-month post-loading was 0.94 ± 1.89 mm, which was not statistically significant. The mean difference between mean crestal bone loss (buccal) at baseline and one-month post-loading was 1.82 ± 1.60 mm, which was statistically significant. The mean difference between mean crestal bone loss (lingual) at baseline and one-month post-loading was 1.91 ± 1.53 which was statistically significant. Conclusion CBCT provides all the diagnostic data needed for implant placement; hence, it is recommended.

Clinical Evaluation of Coronally Advanced Flap With or Without Advance-Platelet Rich Fibrin Membrane in the Treatment of Miller's Class-II Localized Gingival Recession: A Clinical Study.

INTRODUCTION:  Periodontal treatment focuses on maintaining a patient's natural teeth and gums. The gingival margin recedes to a point apical to the tooth in 20%-100% of people. Coronally advanced flap (CAF) is one of several effective treatments for this condition. This surgery covers the tooth root with gingiva. The predictability of this surgery depends on the blood supply, donor tissue, and surgical skills. Platelet concentrates, which include platelet-rich fibrin (PRF), majority of the time is used for various regenerative therapies. Since no bovine thrombin or anticoagulant is needed, its manufacturing is simpler, cheaper, and less biochemically modified than PRP. Platelet-rich fibrin (PRF) is a fibrin matrix that progressively releases platelet cells and cytokines. AIM: The present study aimed to evaluate the efficacy of CAF with and without A-PRF in the treatment of Miller's class-II localized gingival recession. MATERIALS AND METHODS: Twenty patients were chosen who had Miller's class-II localized gingival recession. A random number generator was used to place patients into either the "test" or "control" group. Treatment for both Groups A and B included a coronally advanced flap, but only Group A additionally got autologous platelet-rich fibrin (A-PRF). After receiving a detailed explanation of the treatment process, the patient signed an informed consent form. Complete medical and dental histories were taken to see whether there were any absolute or relative contraindications. RESULTS:  Following treatment with either method in the current study, gingival thickness improved considerably. The percentage of root coverage did not change considerably between the two groups. The clinical result might likely have been different if other factors, such as platelet concentration and PRF consistency, had been examined in the current investigation. Furthermore, there was no histological examination of the healing process. As a result, we are unsure of the extent to which PRF affects how effectively connective tissue attaches. CONCLUSION: The additional use of A-PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of A-PRF membranes significantly reduced the recession depth.

Nanosponges- Versatile Platform as Drug Carrier.

BACKGROUND: Recently, nano-drug delivery systems have become an integral part of the most novel drug delivery systems and have gained considerable importance owing to various advantages such as carriers for poorly soluble drugs, targeting molecules at the desired site, protection from degradation etc. Objective: One of the most studied areas of nanotechnology is nanosponges. The objective of this review was to extensively summarize the various strategies for the preparation, characterization and applications of nanosponges. METHODS: In the current mini-review, we conducted a systemic search of the literature and patent inventions focusing on nanosponges. The summary of the search was inclusive of various aspects of nanosponges, such as drug characteristics to be considered while incorporating in nanosponges, other crucial additives during formulation of nanosponges, methods of preparation, characterization and applications of nanosponges in pharmaceuticals. RESULTS: Nanosponges are nanocarriers for both lipophilic and hydrophilic drugs. These are prepared by different methods such as emulsion-solvent evaporation, solvent method, melting method, ultrasound assisted method etc., and all these methods were less time consuming, more economical and evaluated by sophisticated techniques available for routine analysis. These are among the most feasible alternative to address several formulation difficulties associated with the physicochemical properties of the drug. The porous nature and small particle size are vital properties of the nanosponges that contribute crucially to correcting the drawbacks of the drug. The properties of the nanosponges can be enhanced when combined with cyclodextrins. Extensive research work has been carried out in past to explore cyclodextrin based nanosponges. Besides, it is also used for smart targeting of tumors and for drug release in a sustainable pattern. Nanosponges can be prepared by simple methods. These can be tuned to release the drug by different routes so as to achieve the maximum benefits of the drug. CONCLUSION: Huge amount of research has been carried out on nanosponges as drug carrier. The method of preparation and characterization of nanosponges are quite economical and routinely available. Owing to potential benefits and probable applications, these can be used as efficient carriers for certain drugs. The authors expect that the current review will guide the investigation of the nanosponges as nanodrug delivery systems.

Efficacy and Safety of Ayurveda interventions in the management of conjunctivitis: A systematic review and meta-analysis.

BACKGROUND: Conjunctivitis is the inflammation of the conjunctiva. Although data on clinical efficacy and safety of various ayurvedic treatments in conjunctivitis is published, systematic review is not done. This systematic review and meta-analysis aims to evaluate the efficacy and safety of ayurvedic treatments in conjunctivitis. METHODS: A literature search of the Cochrane Library (Cochrane central register of controlled trials: issue 6 of 12, June 2018), Pub Med, AYUSH research portal (Govt. of India), DHARA portal, Google scholar and online clinical trials registers was done. Randomized controlled trials (RCTs), quasi-randomized controlled trials (QRCTs), controlled clinical trials (CCTs) and multiple arms clinical trials were identified in which Ayurveda treatments with any dose, type, schedule, drug, dosage form, and advised Pathayapathya (lifestyle changes) were selected. RESULTS: We identified 13 eligible RCTs, five CCTs and two multiple arms clinical trials which includes a total of 816 participants. Meta analysis of data from five trials showed that ayurvedic treatments benefitted more compared with non-ayurveda interventions in symptoms like itching (SMD = -0.98, 95% CI (-1.30,-0.65) p < 0.00001, I2 = 38%), pain (SMD = -0.57, 95% CI (-0.87, -0.29, P = 0.0001, I2 = 0%), ropy discharge (SMD = -1.02, 95% CI(-1.45, -0.59), P < 0.00001, I2 = 0%), conjunctival congestion (SMD = -0.67, 95% CI (-0.91, -0.43), p < 0.00001, I2 = 0%), foreign body sensation (SMD = -0.68, 95% CI(-1.06, -0.29), p = 0.0006, I2 = 46%, Fig. 8) and lid heaviness (SMD = -0.66, 95% CI(- 0.98, -0.33), p < 0.0001, I2 = 0%). CONCLUSIONS: Although some findings confirm the benefit of ayurveda as opposed to non ayurveda for the treatment of conjunctivitis, since the studies have high risk of bias and are of lower quality, the findings could not be generalized. There is a need for high quality studies in ayurveda in this regard. PROSPERO REGISTRATION: CRD42019129436.

Heme oxygenase-1, a novel target for the treatment of diabetic complications: focus on diabetic peripheral neuropathy.

Diabetic neuropathy is a complex disorder induced by long standing diabetes. Many signaling pathways and transcription factors have been proposed to be involved in the development and progression of related processes. Years of research points to critical role of oxidative stress, neuroinflammation and apoptosis in the pathogenesis of neuropathy in diabetes. Heme oxygenase-1 (HO-1) is heat-shock protein induced under conditions of different kinds of stress and has been implicated in cellular defense against oxidative stress. HO-1 degrades heme to biliverdin, carbon monoxide (CO) and free iron. Biliverdin and CO are gaining particular interest because these two have been found to mediate most of anti-inflammatory, antioxidant and anti-apoptotic effects of HO-1. Although extensively studied in different kinds of cancers and cardiovascular conditions, role of HO-1 in diabetic neuropathy is still under investigation. In this paper, we review the unique therapeutic potential of HO-1 and its role in mitigating various pathological processes that lead to diabetic neuropathy. This review also highlights the therapeutic approaches such as pharmacological and natural inducers of HO-1, gene delivery of HO-1 or its reaction products that in future, could lead to progression of HO-1 activators through the preclinical stages of drug development to clinical trials.