Platelet-Rich Fibrin in Non-Surgical Periodontal Therapy: A Split-Mouth Randomized Controlled Clinical Trial.

This clinical trial investigated the efficacy of platelet-rich fibrin (PRF) as an adjunct to conventional scaling and root planing (SRP) in non-surgical periodontal therapy. In a split-mouth randomized controlled trial with 13 patients and 26 periodontal pocket sites, PRF was inserted in test group pockets alongside SRP, while control group pockets received SRP alone. Measurements at baseline and six weeks included probing pocket depths (PPDs), clinical attachment loss (CAL), gingival recession (GR), the plaque index, and the gingivitis index. The wound healing index was assessed at six weeks. The results show statistically significant improvements in the SRP+PRF group compared to SRP alone, demonstrating a better CAL gain (SRP+PRF group: 2.69 ± 0.63; SRP alone group: 4.15 ± 0.69-p-value: 0.001), PPD reduction (SRP+PRF group: 2.62 ± 0.65; SRP alone group: 3.85 ± 0.80-p-value: 0.001), and GR minimization (SRP+PRF group: 0.46 ± 0.62; SRP alone group: 0.81 ± 0.72-p-value: 0.21). The adjunctive use of PRF enhanced healing, reduced pocket depths, decreased tissue morbidity, and minimized gingival recession. This study concludes that PRF placement is effective in 5-6 mm pockets, potentially reducing the number of periodontal treatment sessions needed for pocket closure.

Physiological Gingival Melanin Hyperpigmentation Treatment with Injectable Vitamin C and Scalpel Technique: A Randomised Controlled Clinical Trial.

Harmony between facial complexion and gingival health goes hand in hand. Gingival depigmentation is an aesthetic correction of hyperactive melanocytes in gingival tissues that lead to hyperpigmentation. Current study compares depigmentation, pain scores, and itching with scalpel technique and nonsurgical intramucosal Vitamin C injection. 30 individuals in the age range of 18-40 years conscious of dark gums were randomly allocated to test and control group by lottery method. Thorough Phase I therapy was performed one week before the procedure. Area and intensity of depigmentation were evaluated preoperatively and postoperatively; pain score, itching, and repigmentation percentage were the postoperative parameters. After 24 hrs, test group showed significantly lesser VAS score for pain as compared to control group. There was no statistically significant difference in preoperative area of pigmentation between the test and control group (p=0.936). Postoperatively also, there was no statistically significant difference in area of pigmentation between the test and control group (p=0.932). For comparing area of pigmentation, an independent t-test was applied and Mann-Whitney test was used for differentiating the intensity of pigmentation, repigmentation, and VAS score between the groups. The study concluded that Vitamin C mesotherapy and scalpel technique showed comparable results in reduction of areas and intensity of gingival hyperpigmentation.

Comparative Evaluation of Azadirachta indica (Neem) Chip and Soft Tissue Diode Lasers as a Supplement to Phase I Periodontal Therapy in Localized Chronic Moderate Periodontitis: A Randomized Controlled Clinical Trial.

Introduction: The current trial aimed to assess and compare the efficacy of neem chip and diode laser as a local drug delivery (LDD) agent as a supplement to phase I periodontal therapy in treatment of localized chronic moderate periodontitis. Materials and Methodology. Fourteen systemically healthy participants with 4-6 mm deep periodontal pockets at least in three quadrants (with no alveolar bony defect amenable to respective or regenerative osseous surgery, as seen in orthopantomograph) were selected for the trial. One week after phase I therapy, 10% absorbable chip of neem (commercially prepared by staff of a pharmacy college, Sheriguda, India) was placed in the periodontal pocket on one site, and soft tissue diode laser pocket sterilization was performed on the other site of the arch. Remaining one site was considered as a control. Parameters recorded clinically were plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), and relative attachment level (RAL) measured at baseline, 21st day, and one month postoperatively. Results: Statistically significant improvements were observed in all clinical parameters at one month as compared to baseline for both treatment groups. Conclusion: Neem chip supplemented with phase I therapy showed best improvement in clinical parameters followed by laser supplemented with phase I therapy in comparison to phase I therapy alone at one month follow-up. Clinical Significance. Neem chips are nature's products, affordable without side effects, with a potential to be used as a local drug delivery agent in treating moderate chronic periodontitis.

Thermal Effect of Operatory Room Temperature, Surgical Drill Diameter, and Temperature of Irrigants at Different Depths of Implant Site Preparation - Thermographic Analysis on Goat Mandible.

BACKGROUND: Drilling of the implant site results in transient rise in temperature of the surrounding bone disrupting the bone healing process and implant stability. Overproduction of heat due to various factors at osteotomy site needs to be controlled as it hampers the final outcome of the procedure. PURPOSE: The purpose of this study was to evaluate various factors related to implant drills responsible for heat generation and temperature rise during osteotomy. MATERIALS AND METHODS: A total of 64 bone specimens with dimensions of 15 mm × 15 mm were obtained from goat mandibles and were equally divided into Groups A and B with operating room temperature maintained at 25°C and 30°C, respectively. Osteotomies were performed using drills with diameters (4.2 mm and 5.6 mm) at various drilling depths (10 mm and 13 mm) with external saline irrigation temperatures (4°C and 25°C). Temperature change was recorded by laser thermometer. RESULTS: The surgical drill depths, diameters, and room temperatures made no differences in temperatures at implant drilling sites whereas the temperatures of the irrigants provide sufficient heat control during drilling. CONCLUSION: Cooled saline provides beneficial effects in controlling the temperatures of osteotomy sites as compared to saline used at room temperature during implant site preparation.

Nitric oxide and inflammatory periodontal disease.

Free radicals are species capable of independent existence that contain 1 or more unpaired electrons. These species are beneficial to the host if secreted in appropriate amounts, and may act as powerful antibacterial agents or help in the regulation of vascular tone in the endothelium. In healthy individuals, there is an appropriate balance between free radicals and their scavengers. This balance can be shifted to an unhealthy pro-oxidant state when the production of free radicals is increased, resulting in serious cell damage leading to progressive inflammatory diseases of the periodontium and periapical tissues, and/or precancerous and cancerous lesions of the oral cavity. Free radicals can be important biomarkers for these diseases when clinical symptoms are not present. Nitric oxide (NO) is a free radical gas and an inflammatory biomarker. The aim of this paper is to present the role of NO in periodontal health and inflammation.

Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

Diagnosis and management of focal reactive overgrowths of gingiva--a case series.

Localized overgrowths of gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG). These growths are reactive in nature. They occur in response to chronic, low grade irritation caused by plaque or any other irritant. Etiology, clinical features and treatment modes of these lesions are the same with slight variations. The present case series describes five different cases of FROG where the lesions were treated by surgical excision under local anesthesia followed by a three month re-evaluation where no recurrences were observed.

Desquamative gingivitis: what's behind it? A case report.

Desquamative gingivitis (DG) is a clinical term used to describe red, painful, glazed, friable gingiva. It may be a manifestation of a mucocutaneous condition, such as lichen planus or other vesiculobulous disorders. Dentists must be aware of this rare clinical entity in order to distinguish DG from the far more common plaque-induced gingivitis. This case is unique in that it involves oral lichen planus and chronic DG, which may be secondary to plaque or a manifestation of the oral lichen planus. Intraoral examination and biopsy reports revealed features of chronic DG and oral reticular lichen planus.

Does stress predispose to periodontal disease?

UNLABELLED: The relationship of a sound mind to the maintenance of a healthy body has been recognized throughout most of recorded history. The term 'stress' is used to describe adverse emotions or reactions to unpleasant experiences. Individuals with high levels of stress and poor coping skills experience twice as much periodontal disease as compared to those with minimal stress and good coping skills. Although stress may predispose an individual to more destruction from periodontitis, the presence of periodontal pathogens remains the essential aetiologic factor. This review presents a summary of stress, discussing how it can predispose an individual to periodontal disease. CLINICAL RELEVANCE: Stress, which is a universal phenomenon, is implicated to have various systemic effects besides being a risk factor for periodontal disease. This article elucidates the relationship between psycho-social stress and destructive periodontal disease.

Exuberant Oral Myiasis Caused by Musca domestica (Housefly).

Tissues of oral cavity, when invaded by the parasitic larvae of houseflies, the condition is called as oral myiasis. It is a rare disease that is most common in developing countries and is associated with conditions leading to persistent mouth opening along with poor oral hygiene, suppurative lesions, severe halitosis and maxillofacial trauma. A case of exuberant oral myiasis in a 42-year-old female patient is described here. She reported with swelling, pain, mobility of teeth and foul odor. Diagnosis was based primarily on history and clinical features. Management included use of turpentine oil, mechanical removal of larvae followed by extraction of mobile teeth and curettage along with supportive antibiotic and analgesic therapy. Supportive nutritional supplements and timely institution of treatment encompassing removal of the offending larvae and carious teeth with proper education and motivation of the patient including oral hygiene instructions led to the resolution of these lesions.

Effect of phase I periodontal therapy on pro-coagulant state in chronic periodontitis patients--a clinical and haematological study.

STATEMENT OF THE PROBLEM: The increase in white blood cell count (WBC) and platelet count due to systemic inflammation and infection is considered a risk factor for cardiovascular diseases. These parameters increase in periodontal disease. A decrease in WBC and platelet counts by periodontal therapy may decrease the risk for cardiovascular disease. PURPOSE OF THE STUDY: The present study is a treatment intervention model to investigate the effect of non-surgical periodontal therapy on total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count in patients with chronic periodontitis. MATERIALS AND METHODS: Thirty systemically healthy patients were included in the study. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), TLC, DLC, platelet count, bleeding time (BT) and clotting time (CT) were evaluated at baseline and at two weeks after phase I therapy. RESULTS: A statistically highly significant decrease in the percentage of sites exhibiting BOP was observed, i.e., from 78.1% at baseline to 18.1% two weeks postoperatively (p = 0.000). There was also a statistically significant decrease in TLC from 7595/mm3 at baseline to 6690/mm3 two weeks following phase I therapy (p = 0.02). There was also a statistically highly significant decrease in platelet count from 2.1 lac/mm3 preoperatively to 1.9 lac/mm3 at two weeks postoperatively (p = 0.003). CONCLUSION: The present study depicts the importance of periodontal therapy to reduce the TLC and platelet count, thereby possibly decreasing the risk for the development of cardiovascular disease by lowering the established risk factors for periodontal atherosclerosis.

Management of phenytoin-induced gingival enlargement: a case report.

Gingival enlargements may adversely affect speech, mastication, tooth eruption, and esthetics. These enlargements can occur as a result of the administration of certain anticonvulsants, immunosuppressants, and calcium channel blockers. The present case report describes the treatment of a patient with a phenytoin-induced gingival enlargement. A case of gingival enlargement should be treated in a step-wise manner, including consultation with the patient's physician, substitution of the drug, nonsurgical therapy, surgical therapy (if needed), and supportive periodontal therapy after every 3 months. In this case, healing was uneventful, and no recurrences occurred 3 months postoperatively.

Comparative evaluation of anti-plaque efficacy of herbal and 0.2% chlorhexidine gluconate mouthwash in a 4-day plaque re-growth study.

BACKGROUND: Chlorhexidine gluconate mouthwash has earned eponym of gold standard to treat and/or prevent periodontal disease. However, it has been reported to have local side-effects on long-term use. To explore a herbal alternative, the present study was carried out with an aim to compare the anti-plaque efficacy of a herbal mouthwash with 0.2% chlorhexidine gluconate mouthwash and normal saline. MATERIALS AND METHODS: It was an examiner-blinded, parallel designed clinical trial, in which 90 pre-clinical dental students with gingival index (GI) ≤1 were enrolled. To begin with, GI and plaque index (PI) were recorded. Then, baseline plaque scores were brought to zero by professionally cleaning the teeth with scaling and polishing. After that, randomized 3 groups were made (of 30 subjects each - after excluding the drop-outs) who were refrained from regular mechanical oral hygiene measures. Subjects were asked to swish with respective mouthwash (0.2% chlorhexidine gluconate mouthwash, herbal mouthwash, or normal saline) as per therapeutic dose for 4 days. Then, GI and PI scores were re-evaluated on 5(th) day by the same investigator, and the differences were compared statistically by ANOVA and Student's 't'-test. RESULTS AND OBSERVATIONS: Least post-rinsing GI and PI scores were demonstrated with 0.2% chlorhexidine gluconate mouthwash, followed by herbal mouthwash and highest scores with normal saline. The difference of post-rinsing PI scores between the chlorhexidine and herbal mouthwash groups was statistically non-significant, whereas this difference was significant between chlorhexidine and saline groups, and the difference between herbal and saline groups was non-significant. It was concluded that 0.2% chlorhexidine gluconate mouthwash remains the best anti-plaque agent. However, when socio-economic factor and/or side-effects of chlorhexidine need consideration, presently tested herbal mouthwash may be considered as a good alternative.

Achieving better esthetics by gingival de-pigmentation: report of three cases with a review of the literature.

A smile expresses a feeling of joy and success and also reveals self-confidence and kindness in an individual. A holistic smile is dictated not only by the shape, position and color of the teeth but also by the health of the gingival tissues. Gingival appearance is an important component of an attractive smile. Melonin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of gingiva. Although physiologic and ethnic melanin pigmentation is not a medical problem, complaints about "black gums" are common. For de-pigmentation of gingiva, different treatment modalities have been reported such as bur abrasion, scraping with scalpel, partial thickness flap, gingivectomy, cryotherapy, electrosurgery, lasers, free gingival autografting, sub-epithelial connective tissue graft and combination techniques. In the present case reports, scalpel surgery and electrosurgery were performed for gingival de-pigmentation, which are simple and effective. The esthetic results were pleasing and healing was uneventful. Patients were satisfied with the outcome at three month follow-up as evidenced from their feedback.

Diagnosis and management of bilateral nasolabial cysts.

Nasolabial cysts are painless, submucosal, non-odontogenic jaw cysts presenting as soft tissue swellings in the maxillary anterior mucolabial fold lateral to midline, leading to elevation of nasal ala. Present case documents bilateral nasolabial cysts in a 69-year-old Asian female patient. In the present case, extraoral swelling of maxillary lip and elevation of nasal ala was observed on right side of the face. Intraorally, soft and fluctuant bilateral cysts were observed. Straw-colored fluid was aspirated from the right cyst. Radiographically, erosion of bone in a "cupping" fashion was observed in the region of left cyst. The cysts were enucleated using intraoral approach. Histopathology of the right-sided cyst revealed a cystic cavity lined by stratified squamous cells along with a few mucosal cells. At few places, stratified squamous and pseudostratified columnar epithelia with many cilia and goblet cells were also evident. Capsule was loosely arranged with fibrous tissue and chronic inflammatory infiltrate. Left-sided cystic specimen showed two or more layered stratified squamous lining epithelium with thin capsule. Diagnosis of bilateral nasolabial/nasoalveolar cysts was confirmed.

Effect of lycopene in the treatment of periodontal disease: a clinical study.

PURPOSE: Several epidemiologic studies have suggested a role of tomato products in decreasing the risk of the development of diseases related to oxidative stress (cancer and other chronic diseases). Oxidative stress may result in periodontal tissue damage either directly or indirectly. Lycopene, a powerful antioxidant and the main carotenoid in tomato products possesses the greatest quenching ability of singlet oxygen among the various carotenoids and is effective in protecting blood lymphocytes from NOO-radical damage. Hence, the aim of the present study is to compare the effect of systemically administered lycopene as an adjunct to scaling and root planing in patients with gingivitis and periodontitis. MATERIALS AND METHODS: Twenty systemically healthy patients were involved in a randomized, double-blind, parallel study and based on their clinical signs were divided into two groups of mild to moderate periodontitis (A) and moderate gingivitis (B). The subjects under the groups A and B were randomly distributed between the two treatment groups: test group (n = 5), 4 mg lycopene/day for 2 weeks with oral prophylaxis (full mouth scaling and root planing (SRP) completed within 24 hours) and controls (n = 5), receiving only oral prophylaxis. Pre- and post-therapeutic periodontal parameters were evaluated. RESULTS: In group A, statistically significant improvement in CAL was reported in test group as compared to control group. In group B, the difference between pretreatment and post-treatment bleeding on probing scores was found to be statistically non-significant in both groups. CONCLUSION: Results show that lycopene is a promising treatment modality as an adjunct to full mouth SRP of the oral cavity in patients with moderate periodontal disease. CLINICAL SIGNIFICANCE: Modulation of the free radical production seems to be essential for the inhibition of tissue destruction, and treatment with antioxidants, like lycopene, which is the most potent among them will block the production of free ROS or its effects might prove to be therapeutically valuable.

Quantitative evaluation of serum fucose in oral squamous cell carcinoma patients.

BACKGROUND: Cancer, a disorder of cellular behavior is characterized by the alteration of serum glycoproteins, which are composed of different monosaccharides. One of the monosaccharides is l-fucose, a methyl pentose, which is the terminal sugar in most of the plasma glycoproteins. Elevated levels of protein-bound fucose have been reported in various disease states as well as in malignancies. AIM: To ascertain the role of serum fucose as a biomarker and to correlate with other studies for its effective clinical application. MATERIALS AND METHOD: T0 he study was carried out on 67 subjects, including 14 healthy individuals and 53 oral squamous cell carcinoma cases. The serum fucose level estimation was done based on the method as adopted by Winzler using cysteine reagent. Statistical analysis included Chi-square test, Karl Pearson correlation test and Student's t test to evaluate the significance and variability of values between groups. RESULTS: Serum fucose levels were independent of age and sex. However, there was significant increase in mean serum fucose level of oral squamous cell carcinoma patients compared with healthy controls. The results correlated well with other studies. CONCLUSION: Serum fucose can be used as an effective diagnostic biomarker in oral squamous cell carcinoma patients.