Root coverage with apical tunnel approach using propolis as a root conditioning agent: A case report with 2-year follow-up and review of the literature.

OBJECTIVES: One of the main challenges in performing root coverage is patient discomfort and donor site morbidity. This case report presents a minimally invasive apical tunnel surgical technique, with propolis for root conditioning, to correct gingival recession defects without harvesting donor grafts, flap elevation, or sutures. Propolis is a natural anti-infective, anti-inflammatory, and antioxidant agent. MATERIAL AND METHODS: A 58-year-old woman with no significant medical history was presented for root coverage of her upper left canine and first premolar with recession type (RT)1A (+). Propolis was used as a root conditioning agent to promote soft tissue coverage via an apical tunnel approach. During the apical tunnel approach, a small apical hole was made 6 mm below the mucogingival junction, and the mucosa and associated attached gingiva was away from the tooth so the flap could be repositioned coronally. Collagen matrix was used as a soft tissue graft material. RESULTS: At the 2-month, 6-month, 8-month, and 2-year follow-up, complete root coverage was achieved for both teeth. No bleeding on probing was noticed nor recurrent GRs at the treated sites. CONCLUSION: Without incisions, donor site reflection, or flaps, the apical tunnel approach can be successfully used to cover the exposed roots. Additionally, propolis is a potential root conditioning agent during soft tissue graft procedure due to its anti-inflammatory and antioxidant properties.

Gingival Depigmentation Using Microneedling Technique With Topical Vitamin C: A Prospective Case Series.

Introduction Gingival pigmentation is mainly physiological due to the production of melanin. This study aimed to evaluate the effectiveness of a microneedling technique using topical ascorbic acid in treating gingival hyperpigmentation. Methods A case-series study was established, and 16 out of 42 participants enrolled in this study according to the inclusion and exclusion criteria. A microneedling technique was performed using a Dermapen instrument, followed by the topical application of ascorbic acid on the pigmented gingiva. Variations in the Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) scores were considered for each patient. A one-month follow-up was conducted on all patients. Results All the reported cases demonstrated noticeable improvement at the end of the sessions. Moreover, seven patients showed complete depigmentation of the gingiva. Analysis using paired T-tests showed a statistically significant lower post-treatment DOPI score with a mean difference of 1.8 ± 0.7, 95% CI: 0.17-1.49. Similarly, the HMI score was lower post-treatment with a mean difference of 3.1 ± 0.7, 95% CI: 2.74-3.50. Conclusions Microneedling combined with topical ascorbic acid is a novel, non-invasive dental technique that can effectively treat gingival hyperpigmentation.

The effectiveness of microneedling technique using coconut and sesame oils on the severity of gingival inflammation and plaque accumulation: A randomized clinical trial.

OBJECTIVES: In our research, we evaluated the effect of coconut and sesame oils using the microneedling technique on gingival inflammation and plaque accumulation among patients with gingivitis by creating microholes in the gingiva to facilitate the concentration and entrance of the oils through gingival tissues. MATERIALS AND METHODS: Twenty-four patients with clinically diagnosed plaque-induced gingivitis were selected from Vision dental hospital, Riyadh, KSA, and assigned to one of three groups randomly; group A consisted of eight participants who were treated with dermapen and topical coconut oil, group B had eight participants who were treated with dermapen and topical sesame oil, and group C involved eight patients who received periodontal mechanical treatment only. Postintervention gingival status and plaque status for all participants were assessed using a modified average gingival index and a plaque index at Weeks 1, 2, and 4. RESULTS: Groups A and B experienced highly significant reductions in gingival indices, while group C showed reduced scores but was not significantly notable. On the contrary, the three studied groups exhibited no significant difference in the reduction of plaque indices when compared altogether. CONCLUSION: Our study demonstrated an effective novel technique that revealed a noticeable improvement in gingival status and a reduction in the average gingival index and plaque index.

A Successful Esthetic Approach of Gingival Depigmentation Using Microneedling Technique and Ascorbic Acid (Vitamin C).

A gingival depigmentation is a periodontal plastic procedure that is performed in order to remove melanocytic pigmentation. A variety of different modalities have been proposed for removing hyperpigmentation involving surgical scraping, gingival autograft, cryotherapy, electrosurgery, and lasers. However, the microneedling technique is a nonsurgical procedure that creates microholes to facilitate the penetration of topical medications across the connective tissues. Case Description. A healthy female patient aged 25 years with a pigmented gingiva seeking gingival depigmentation. On examination, a dark brown ribbon of hyperpigmentation was observed within the mandibular attached gingiva. The case was diagnosed as physiological moderate gingival pigmentation (pigmentation index score = 3). The patient was interested in achieving aesthetic results with minimally invasive, nonexpensive procedures. Based on the patient's concerns, the microneedling technique using vitamin C was suggested and consented. We used a dermapen device to microneedle the gingiva until bleeding pinpoints were observed; then, topical ascorbic acid was applied. After 3 days, our outcomes revealed an excellent aesthetic pink gingival appearance. Conclusions and Practical Implications. Compared to other minimally invasive techniques, our technique is less expensive and more risk-free. Our novel technique of using dermapen and topical ascorbic acid has shown promising results to our case which gives new perspectives for its application in gingival depigmentation.

Treatment of gingival recession defects using non-invasive pinhole technique with propolis application, a case report.

INTRODUCTION AND IMPORTANCE: Despite the considerable surgical techniques that have been done for the root coverage, surgical difficulties, time, and patients' discomfort are still the main obstacles. However, the morbidity associated with the secondary graft sites has generated interest in new modalities to achieve the esthetic and functional requirements without complications, to reach patient comfort and satisfaction. In our study, we used a recent novel surgical technique which is called the pinhole surgical technique as it is a minimally invasive treatment that reverses gingival recession without using donor graft, flap elevation, or sutures. In this study, we also used propolis for root conditioning as it is a natural anti-infective, anti-inflammatory, and anti-oxidant agent. PRESENTATION OF THE CASE: A 58-year-old systemically healthy female patient was referred to our periodontal clinics for the root coverage of the upper left canine and the first premolar which were diagnosed as Class II and Class I Miller's classification respectively. A pinhole surgical technique was done using propolis for root conditioning. A pinhole was created and the gingiva was pushed downwards until reaching the desired position coronally with the aid of collagen strips. Then, propolis was applied again postoperatively to enhance healing. CLINICAL DISCUSSION: Pinhole surgical technique can immediately cover exposed roots without incisions, donor site or flap reflection. In addition, the use of propolis in root conditioning showed positive results. This is due to its antioxidant and anti-inflammatory effects. CONCLUSION: Pinhole surgical technique using propolis is a promising modality that reaches the periodontist ambition for gingival recession defects.

Does Chemically Modified Curcumin Control the Progression of Periodontitis? A Systematic Review.

BACKGROUND: Recently, pharmacologic approaches have been seen in utilizing matrix metalloproteinase inhibitors (MMP-I) to prohibit the destruction of connective tissue accompanied by erythrogenic inflammatory diseases such as periodontitis. However, curcumin characteristics have been described to be effective in reducing inflammatory mediators and matrix metalloproteinase (MMP). But, due to its poor solubility and bioavailability, a chemically modified curcumin (CMC 2.24) has been used. OBJECTIVE: The purpose of this research is to review and analyze the animal attempts which investigate the impact of CMC2.24 on periodontitis. MATERIALS AND METHODS: Our study was based on reviewing the English preclinical studies using CMC2.24 on an induced periodontal disease which were published up to 2020, only randomized control trials (RCTs) were included. Databases were used from electronic websites including PubMed, ScienceDirect, and Google scholar. RESULTS: Seven experimental trials involving 162 rats and 8 dogs were included in the present systematic review. Six studies investigated LPS-induced experimental periodontitis, two of them worked on diabetes-associated periodontitis, while one study worked on naturally occurring periodontitis. All included studies revealed that CMC 2.24 reduced alveolar bone loss as well as inhibited the MMP. CONCLUSION: Collectively, we concluded that CMC 2.24 has significant implications in prohibiting the progression of bone loss.

Dental education in the Arabic language vs English language: A survey among Arab dentists.

OBJECTIVE: The aim of this study was to explore the language difficulties encountered by Arabic dental students and dentists in some aspects of their dental education and to determine their attitude towards the Arabization of the medical curriculum. MATERIALS AND METHODS: A web-based self-administered questionnaire with 14 multiple-choice questions was designed and distributed online via google forms in the Arabic language. The online link was sent randomly to Arabic dental students, dental academic staff, and dental practitioners. The survey questions explored language problems during reading, attending lectures and scientific conferences, preparing scientific researches, taking deferent exams, and the attitudes towards Arabization. Descriptive statistics and Chi-square tests were used to analyze the responses to the questions. RESULTS: There were 378 respondents for this study. Nevertheless, paying high attention to the importance of English language as the global language of communication, (70.6%) of the respondents believed that studying in Arabic is a basic requirement for the Arabs. Near percentage agreed that mastering their mother tongue is much easier than to acquire another language, which further facilitates studying and improves understanding. More than (65%) of the subjects preferred a mixture of both languages for attending lectures, conferences, and exams. But (68.3%) said that they use English when they search for any subject related to dentistry. CONCLUSION: There has been a consensus on the need for receiving knowledge in the Arabic language, and the importance of studying the mother tongue for enhancing understanding and memorization. The results demonstrated that the idea of teaching some dental courses in Arabic is not impossible and it might be the key to improve dental study for the Arabs. Consequently, a majority stated that there were obstacles in teaching dentistry in fully Arabic language due to the dominance of English language internationally and the weak possibilities of Arabization and translation in the Arab world.

Body mass index and periodontal health status among young Saudi adults: a cross-sectional study.

BACKGROUND: Obesity has been suggested as a risk factor for periodontal disease. Despite the high prevalence of obesity and over-weight among Saudi population, no study has assessed whether there is an association between periodontal health status and body mass index (BMI). OBJECTIVES: Assess the association between BMI and other variables with periodontal health status among young Saudi adults. DESIGN: Analytical, hospital-based cross-sectional study. SETTING: University dental hospital, Riyadh. PATIENTS AND METHODS: All dental students aged 21-35 years who met inclusion criteria were invited to participate in the study. Periodontal health status was assessed by the plaque index (PI), gingival index (GI) and community periodontal index (CPI) scores. Biometric measurements included weight, height and BMI. Multiple logistic regression was used to assess the association of independent variables with periodontal disease (CPI>2 vs CPI ≤2) and multiple linear regression models to assess associations with PI and GI. MAIN OUTCOME MEASURES: Periodontal health by BMI and other variables. SAMPLE SIZE: 308. RESULTS: Of 700 participants invited, 380 participated for a response rate of 54.2%. Slightly more than half of the obese subjects 54 (52%) did not brush their teeth regularly. The mean (standard deviation) PI and GI scores were significantly higher among the obese (PI score: 1.54 [0.45]); GI score: 1.52 [0.51]) and overweight (PI score: 1.36 [0.47]) and (GI score: 1.42 [0.57]) subjects when compared with subjects with normal weight (PI score: 1.27 [0.51]); (GI score: 1.31 [0.48]); ( P<.05). No significant differences were seen between BMI groups in CPI scores. There were also no significant differences in the mean number and percentage of sextants between different BMI groups. The only signficant factor for periodontal disease in the multivariable analysis was toothbrushing. CONCLUSION: The present study shows a significant positive correlation between BMI and PI and GI scores. However, no statistically significant association was found between BMI and periodontal health status. LIMITATION: Cross-sectional, so not possible to assess the association of oral health and BMI over time. CONFLICT OF INTEREST: None.

Correlation of ABO Blood Groups and Rh Factor with The Severity of Generalized Chronic Periodontitis: Across Sectional Study in Riyadh, Saudi Arabia.

BACKGROUND: The development of periodontal diseases depends on the presence of causative microorganisms, host immunity and risk factors. Although variability present among the types of periodontal diseases, all are represented to a shared interaction between host and bacteria. ABO blood groups are the most investigated erythrocyte antigen system. However, limited investigations have been conducted to explore the alliance between ABO blood groups and periodontal diseases. AIM: Our purpose was to explore any possible association between the severity of chronic periodontitis with ABO blood groups and Rh factor. METHODS: A cross-sectional study was carried out on 205 patients out of 1126 generalised chronic periodontitis patients (GCP) who were referred to Al-Farabi Colleges, Riyadh, Saudi Arabia. They were categorized into; group I (mild), group II (moderate) and group III (sever). RESULTS: The patients with blood group O were at a greater risk to develop GCP irrespective of its severity, followed by those with blood group A, B, and AB. The dispensation of the Rh factor in all groups exhibited a significantly greater distribution of Rh positive. CONCLUSION: Genetic factors such as ABO blood group antigens may act as a risk influencer that affects the progression and severity of the chronic periodontitis.

A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: A case report.

INTRODUCTION: A gummy smile (GS) affects the esthetic and the psychological status as it usually decreases the self-confidence leading to hidden or controlling the smile. A smile with more than 2 mm exposed gingiva is called gummy smile. It may be due to one or more of the following etiologies; altered passive eruption of teeth, dentoalveolar extrusion, vertical maxillary excess, and short or hyperactive lip muscles. The treatment of gummy smile should be planned according to its cause/causes. The purpose of this case report was to highlight the ability of combined treatment of gingivectomy and Botox injection technique in managing a severe gummy smile. Also, techniques, advantages, disadvantages, indication and contraindications of Botulinum toxin (BT) are discussed at the literacy. PRESENTATION OF THE CASE: A 24 year old female patient with a severe gummy smile was refereed to the periodontal clinics of our institution. Clinical examination revealed that she has a GS of an 11-12 mm gingival exposed area that was indicated for orthognathic surgery. The GS was treated by a gingivectomy surgery to increase the clinical crowns of upper anterior teeth and the use of Botox injections. The treatment showed remarkable and satisfactory results instead of doing extensive surgery. DISCUSSION AND CONCLUSION: It is important to assess the patients' esthetic expectations and show the possible therapeutic solutions that fit him. We revealed that BT is considered as one of the minimally invasive, quick and affordable modalities that can replace extensive surgical procedures for corrections of sever GS.

Evaluation of photodynamic therapy in treatment of oral erosive lichen planus in comparison with topically applied corticosteroids.

BACKGROUND: The treatment of erosive oral lichen planus represents a therapeutic challenge. Despite numerous existing remedies, some of these treatments display disappointing results. Since it is a chronic disease with no current cure, the best treatment should target mainly the reduction of the duration and severity of symptomatic outbreaks with minimal side effects. To date, corticosteroids remain the first choice of treatment for oral lichen planus (OLP) patients. Although, topical corticosteroids have been found to be the safest and the most successful agents in the treatment of OLP, their prolonged use may cause mucosal problems and may lead to systemic complications. Recently, the use of photodynamic therapy has been well introduced in the treatment of oral diseases. Our clinical study was done to evaluate clinically the effect of photodynamic therapy mediated by methylene blue (MB-PDT) on signs and symptoms of erosive oral lichen planus (EOLP) lesions in comparison with the conventional topical corticosteroids (TC) treatment. The present work tried this recent modality of treatment to overcome the disadvantages of TC. MATERIAL AND METHODS: Twenty patients with clinical and histological diagnosis of EOLP were selected from Oral Medicine and periodontology department in Faculty of Dentistry, Alexandria University in a randomized parallel study design. They were divided into two groups; group A (control group) involved ten patients who were instructed to use the conventional TC (kenakort A-orabase). While, group B (study group) contained ten patients who received PDT using diode laser 660nm mediated by methylene blue (MB). RESULTS: Both groups presented statistically significant difference from baseline to follow up periods. But, the MB-PDT in treatment of EOLP showed more remarkable reduction in pain and lesion scores in comparison with corticosteroids treatment. CONCLUSION: The results of this study allow the conclusion that the MB-PDT is considered to be a better treatment for OELP in comparison with TC because it is much more effective in pain reduction and lesion regression.

Photodynamic therapy in treatment of oral lichen planus.

Oral lichen planus (OLP) is a relatively common chronic immunologic mucocutaneous disorder. Although there are many presenting treatments, some of them proved its failure. Recently, the use of photodynamic therapy (PDT) has been expanding due to its numerous advantages, as it is safe, convenient, and non-invasive and has toxic effect towards selective tissues. This article provides comprehensive review on OLP, its etiology, clinical features and recent non-pharmacological treatments. We also describe the topical PDT and its mechanisms. Our purpose was to evaluate the efficacy of PDT in treatment of OLP through collecting the data of the related clinical studies. We searched in PubMed website for the clinical studies that were reported from 2000 to 2014 using specific keywords: "photodynamic therapy" and "treatment of oral lichen planus". Inclusion criteria were English publications only were concerned. In the selected studies of photodynamic treatment, adult patients (more than 20 years) were conducted and the OLP lesions were clinically and histologically confirmed. Exclusion criteria were classical and pharmacological treatments of OLP were excluded and also the using of PDT on skin lesions of lichen planus. We established five clinical studies in this review where all of them reported improvement and effectiveness of PDT in treatment of OLP lesions. The main outcome of comparing the related clinical studies is that the photodynamic is considered as a safe, effective and promising treatment modality for OLP.