Efficacy of Locally Delivered Aloe Vera Hydrogel in Patients With Chronic Periodontitis: A Prospective Clinical Study.

BACKGROUND: Various herbal and natural products have been used for multiple purposes in medicine due to recent interest and advancements in the field of alternative medicine. For the past few millennia, aloe vera has been used as medicine. Its anti-inflammatory and antibacterial properties have been proven to reduce periodontal disease. AIM: In patients with generalised chronic periodontitis, this study examined the impact of aloe vera hydrogel in conjunction with scaling and root planing (SRP). METHODS: Sixty patients with generalised chronic periodontitis were enrolled in this study and split into two groups: Group 1 (control) - SRP alone (n=30) and Group 2 (test) - Aloe vera hydrogel with SRP (n=30). Clinical parameters related to periodontal disease, such as plaque index (PI), clinical attachment level (CAL), and probing depth (PD) were measured at baseline and three months after the procedure, and the results were compared using Statistical Product and Service Solutions (SPSS, version 23.0; IBM SPSS Statistics for Windows, Armonk, NY) software. A p-value of <0.05 indicated that the result was statistically significant. RESULTS: When comparing both groups' third-month periodontal clinical parameters to the baseline, there was a significant improvement (p<0.05). In the third month, the test group showed better improvement in PD and CAL than the control group (p<0.05). CONCLUSION: The combination of SRP and aloe vera hydrogel greatly improved periodontal clinical parameters. However, studies with long-term follow-up assessing the efficacy of other modes of delivering aloe vera and also its effect on microbiological and immunological parameters are warranted in the future to substantiate these findings.

Biologic Width Following Different Crown Lengthening Procedures: A Six-Month Follow-Up Study.

BACKGROUND: One of the important things to preserve during crown lengthening is the biologic width (BW), recently called supracrestal tissue attachment. A healthy periodontium with adequate BW is very essential for the success of restored teeth. There are various techniques to perform crown lengthening procedures. Most of the studies have focused on assessing the changes in the position of the marginal gingiva and bone as outcome parameters rather than BW. Also, most of the research was done on animal models. AIM: The purpose of this study was to assess the periodontal tissue changes at three months and six months following two different surgical crown lengthening procedures. MATERIALS AND METHODS: Sixty mandibular first molars among 60 patients that required surgical crown lengthening were enrolled in the study and subjected to two different procedures, gingivectomy (Group I; n=30) and apically positioned flap with ostectomy (Group II; n=30). The following parameters were recorded at baseline, three months, and six months, position of free gingival margin (FGM), probing depth (PD), relative attachment level (RAL), bone level (BL), and BW. These measurements were made at three sites in every patient: treated tooth sites (TT), adjacent tooth's adjacent sites (AD), and adjacent tooth's non-adjacent sites (NAD). The data was then subjected to statistical analysis using SPSS software (Version 20.0). Statistical significance was set to p<0.05. RESULTS: When groups I and II were compared at three and six months, there was no statistical difference in terms of position of FGM, PD, and RAL (p>0.05). When BW was compared between the two groups at three and six months, group II showed better reestablishment of BW at any given time period and was statistically significant (p<0.05). CONCLUSION:  Following surgical crown lengthening, the bone level was shifted apically and allowed for the reestablishment of BW. At six months of follow-up, the apically positioned flap with ostectomy was superior in restoring the BW compared to gingivectomy.

Effect of ascorbic acid on cellular respiration with mitochondrial reductase in gingival fibroblast.

Vitamin C or L-ascorbic acid has diverse functions in the body, especially healing promotion in tissue injury via participating in the hydroxylation reactions required for collagen formation. Systemic administration of vitamin C plays an important role on gingival fibroblast proliferation and functions. Whether local or rinsing administration of vitamin C alters gingival fibroblast wound healing behavior remains unclear. Therefore, it is of interest to investigate the effect of vitamin C on gingival fibroblast behavior utilizing cell culture. Primary human gingival fibroblasts isolated from gingival tissue were rinsed with medium containing various concentrations of vitamin C. Cell migration, cell viability was assessed using MTT assay. The viability assay showed >95% live cells, and no significant (P > 0.05) difference in these values was observed at different concentrations at 24 hrs. The levels of cell proliferation were not significantly different among the control and experimental groups in 24 hrs experimental time-points (p > 0.05). Vitamin C is nontoxic and can be used for further experiments to validate for clinical application. This was further confirmed with morphological examination after 24hrs incubation on control and experimental group drugs observed under the phase contrast microscope.

Melatonin as preemptive analgesic for intraoperative pain.

Several anti-inflammatory and analgesic drugs have been used to reduce pain and discomfort during periodontal surgeries. This study evaluates the efficacy of using melatonin and ketorolac for pain prevention during open-flap debridement surgery. This prospective randomized controlled trial was performed in patients who presented with chronic periodontitis after non-surgical periodontal therapy, requiring flap surgery. Group 1: Flap surgery following non-surgical periodontal therapy after one month with no oral administration of analgesic. Group 2: Flap surgery following non-surgical periodontal therapy after one month with oral administration of Ketorolac 400mg one hour prior to the surgery. Group 3: Flap surgery following non-surgical periodontal therapy after one month with oral administration of 2 mg Melatonin one hour prior to the surgery. VAS and FLACC score along with blood pressure, SPO2 and heart rate. Statistical analysis was done using SPSS software. The intragroup comparisons (control-test drug) demonstrated that melatonin and ketorolac showed positive preemptive effect which compared to the control with mean differences significantly different from zero. However, when melatonin and ketorolac were compared there was no significant difference in postoperative pain among patients. The adoption of a preemptive medication protocol using either melatonin or ketorolac may be considered effective for pain and discomfort prevention during and post open-flap debridement surgeries. Melatonin showed similar effect to gold standard ketorolac in terms of its preemptive analgesic effect additional to having anti-inflammatory effect. Further studies are required to standardize the protocol for using melatonin as preemptive analgesic for dental surgical procedures.

Comparison between conventional and micro-assisted periodontal surgery: Case series.

Microsurgery is a minimally invasive procedure that uses a surgical microscope, specially designed equipment, and suture materials. Even though this equipment and expertise of numerous surgeries are required to meet patient esthetic reckoning, doctors must be ready to invest time and effort into becoming familiar with novel surgical methods and devices. The ambition of this case series is to compare conventional macro surgery and microsurgery in terms of clinical approach. This study included four cases, two flap surgery, and two root coverage. Clinical parameters for root coverage, increase in keratinized tissue (KT), gain in clinical attachment level (CAL) and complete root coverage (CRC), dentin hypersensitivity index-Schiff's index and for flap surgery, probing depth, clinical attachment level. Healing and pain analysis were done. There was no significant difference seen between conventional and clinical outcomes of a microsurgical technique such as clinical attachment level, probing depth, increase in KT, gain in clinical attachment level (CAG), and CRC, dentin hypersensitivity index-Schiff's index. When patient-based outcomes such as healing index and Visual Analog Scale, a significant difference was seen. If a microsurgical method is used instead of a traditional macroscopic approach, the early healing index can be significantly improved and there will be less postoperative pain.