Evaluating the Efficacy of Platelet-Rich Fibrin Matrix versus Subepithelial Connective Tissue Grafts in Dental Root Coverage: A Comparative Study Using Modified Ruben's Technique.

BACKGROUND Dental root coverage, crucial in managing gingival recessions, traditionally utilizes subepithelial connective tissue grafts. However, this approach has limitations such as donor site morbidity and graft availability. Recent studies have introduced platelet-rich fibrin (PRF) as an alternative, leveraging its regenerative potential and growth factors. Despite the promise, comparative assessments between PRF and conventional grafts remain limited. This research probes whether PRF, when used beneath a modified Ruben's mixed flap, could provide comparable or superior dental root coverage than a subepithelial connective tissue graft. MATERIAL AND METHODS We enrolled 30 patients exhibiting Miller's class I and II recession in this comparative case series. Patients were randomly assigned to receive either a connective tissue graft (15 patients) or a PRF matrix (15 patients), both covered by a modified Ruben's mixed flap. RESULTS Clinical parameters, including full mouth plaque scores, bleeding scores, probing sulcus depth, clinical attachment level, gingival position assessment, width, and thickness of attached gingiva, were assessed in both the control and test groups at baseline, 6 months, and 12 months post-surgery. Significant differences were observed at all intervals.At the 12-month mark, the control group (connective tissue graft) achieved 91% complete root coverage, while the test group (PRF matrix) achieved 86%. However, this difference was not statistically significant. CONCLUSIONS The study outcomes suggest comparable gains in root coverage and attached gingiva between the connective tissue graft and PRF matrix groups. Thus, the results support our hypothesis that a subepithelial PRF matrix can serve as a viable alternative to a subepithelial connective tissue graft for treating dental root coverage.

Efficacy of Two Different Hydrodynamic Sinus Lift Systems for Atraumatic Elevation in Immediate Implant Placement.

Purpose: To evaluate the efficacy of two hydrodynamic sinus lifting procedures and to successfully place immediate implants in maxillary posterior sites that have a compromised native bone as a result of periodontal or endodontic disease. Patients and Methods: A total of 26 patient sites were enrolled with 13 sites each in the Minimally Invasive Antral Membrane Balloon Elevation (MIAMBE) and Drill Integrated Hydrodynamics for the transcrestal sinus floor elevation (DIHSFE) groups who received transcrestal sinus floor elevation followed by immediate implant placement. Clinical parameters such as sinus membrane perforations, nasal bleeding, postoperative sinusitis, VAS scores at Day-7 for pain and discomfort, primary implant stability and time taken were evaluated. Results: The DIHSFE had greater sinus membrane perforations and incidence of nasal bleeding when compared with MIAMBE with (p = 0.066) and (p = 0.141). Post-operative sinusitis was evident in both the groups with (p = 0.619). The mean VAS score was statistically significant between both the groups (p ≤ 0.005). The insertion torque values, and mean time taken for surgical procedure was not statistically significant between groups. Conclusion: The present study highlighted that MIAMBE is superior to DIHSFE in its ability to cause less severe patient morbidities and post-operative complications.

Treatment of Gingival Recession Defects with Pouch and Tunnel Technique Using Connective Tissue Graft and Lyophilized Chorion Membrane in Smokers.

BACKGROUND The chorion membrane has been used for several decades as an allograft in tissue repair and various periodontal regenerative procedures. The present study, conducted at a single center in India, aimed to evaluate and compare the clinical outcomes of 26 gingival recession sites in chronic smokers treated using a pouch and tunnel technique with connective tissue graft (CTG) and lyophilized chorion membrane (LCM). MATERIAL AND METHODS The study included 22 smokers with 26 sites of recession defect, with Miller's class I and class II gingival recession, which were allotted into control and test groups. The control group (13 sites) was treated with CTG, and the test group (13 sites) was treated with LCM. Clinical parameters like recession depth, recession width, relative clinical attachment level (RCAL), relative gingival position, width of attached gingiva, and width of keratinized gingiva were recorded at baseline and 6 months postoperatively. Visual analogue scores for pain and wound-healing index scores were assessed in the first week after surgery. RESULTS All clinical parameters showed significant improvements from baseline to 6 months postoperatively in the control and test groups. Recession width, RCAL, width of attached gingiva, and width of keratinized gingiva demonstrated significant differences, whereas mean root coverage percentage and recession depth did not show any significant differences between the study groups at 6 months postoperatively. CONCLUSIONS This study supports the role of LCM allograft as a scaffold to promote soft tissue regeneration and has demonstrated a favorable role for its use in root coverage procedures in patients who smoke.

Mucormycosis diagnosis revisited: Current and emerging diagnostic methodologies for the invasive fungal infection (Review).

Mucormycosis, which is a life threatening condition, is one of the side effects experienced by post-COVID-19 patients. Early identification and timely treatment are essential to stop the dissemination of the disease, since invasive mucormycosis has a very high fatality rate and significant disease dispersion. Conventional diagnostic techniques, including clinical diagnosis, serology, histopathology and radiology, have limitations in diagnosing the disease at an early stage. This warrants the need for advanced diagnostic tools such as nucleic acid diagnostics, advanced serological tests (ELISpot), PCR (pan-Mucorale test) and multiplex PCR. These techniques have been introduced to identify this invasive fungal infection at an incipient stage, thereby helping clinicians to prevent adverse outcomes. The use of biosensors and micro-needle based diagnostic methodologies will pave the way for devising more point-of-care tests that can be employed for the detection of mucormycosis at an incipient stage. The present review discusses the current techniques available and their drawbacks, and the usefulness of advanced diagnostic tools. Furthermore, the possibility of using future diagnostic methods for the diagnosis of mucormycosis is highlighted.

Role of miRNA-155 in the regulation of osteoclast differentiation mediated by MITF in stage III/IV periodontitis: a case-control study.

BACKGROUND: Monocyte-macrophage lineage cells are committed towards osteoclast differentiation in vitro by the downregulation of microphthalmia-induced transcription factor (MITF) by miRNA-155. Therefore, we aimed to evaluate miRNA-155 expression and explore the regulation of MITF by miRNA-155 during osteoclastogenesis in periodontitis. MATERIALS AND METHODS: Ninety-eight subjects were recruited and categorized into the following: group I (cases)-systemically healthy with localized stage III/IV periodontitis (N = 49) and group II (controls)-systemically and periodontally healthy (N = 49). Gingival tissue samples were procured and qRT-PCR analysis was carried out for relative gene expression. RESULTS: The mean ΔCT of miRNA-155 expression was -1.04 ± 2.26 and -0.01 ± 1.4 respectively for groups I and II. There was a statistically significant difference in the miRNA-155 expression (P ≤ 0.01) between the groups. The mean ΔCT of MITF expression for groups I and II was 4.15± 2.16 and 3.51± 1.57 respectively with no significant difference (P > 0.01) between the groups. In the periodontitis group, miRNA-155 expression increased by fivefolds (P ≤ 0.01) whereas MITF expression showed no significant difference in the fold change between the groups (P > 0.01). The site-specific clinical parameters showed a statistically significant strong negative and positive correlation with the ΔCT and fold change values of miRNA-155 respectively in the total 98 samples (P < 0.01). miRNA-155 was able to discriminate between periodontal health and disease with a diagnostic accuracy of 96.9% (95%CI: 91.38-98.95) and the AUC was 0.98 (95%CI: 0.97-1.0, SE = 0.008, P < 0.001) in ROC analysis with a sensitivity of 93.8% (95%CI: 83.48-97.9) and specificity of 100% (95%CI: 92.73-100). CONCLUSIONS: miRNA-155 was dysregulated and upregulated by fivefolds in periodontal disease. It can be used as a potential biomarker to discriminate between periodontal health and disease. No difference in the MITF gene expression was demonstrated between periodontal health and disease. The result suggested that miRNA-155 does not affect the expression of MITF gene in the process of osteoclastogenesis in localized stage III/IV periodontitis within this study design and limitations.

Effect of microsurgical technique for root coverage using modified coronally advanced flap with connective tissue graft- Randomized controlled clinical trial.

Background: The aim of the study was to compare the root coverage percentage and other clinical outcomes in Millers Class I and Class II gingival recessions (GR) treated with modified coronally advanced flap (MCAF) combined with connective tissue graft (CTG) using macro and microsurgical approaches. Materials and Methods: In this controlled clinical trial, a total of 32 Miller's Class I and Class II GR defects were randomly assigned to the control and test groups (16 in each group). All the patients were treated with MCAF with CTG as the root coverage procedure. For the control and test groups, the procedure was performed using a macro and microsurgical approach, respectively. Clinical parameters were assessed at baseline and in 6th month. Wilcoxon signed-rank test was used to compare the values between baseline and 6 months. Statistical significance was set at P < 0.05. 1 week after surgery, wound healing index (WHI) and Visual Analog Scale (VAS) scores were recorded. Results: Intragroup comparisons revealed significant improvement in all the parameters in both the groups at 6 months. The proportion of root coverage achieved in the control and test groups was 78% and 86%, respectively. At 6 months, the root coverage percentage between the study groups showed no significant difference (P = 0.207). Intergroup analysis of WHI and VAS scores showed better healing and less postoperative pain in the microsurgical group compared to macrosurgical group (P < 0.05). Conclusion: At 6 months, there were no significant differences in root coverage percentage or other clinical parameters between the groups based on whether a macro or microsurgical method was used. However, better wound healing, less pain, and discomfort were observed in the microsurgical group.

Interdental Papillary Reconstruction by Microtunnelling Technique Using Autologous Biomatrices-A Randomised Controlled Clinical Trial.

Background and objectives: The study aimed to evaluate and compare the amount of papillary gain and black triangle height reduction after intervention with a microtunnelling technique with either Connective tissue graft (CTG) or Platelet-rich fibrin (PRF) as a biomatrix at 6 months using a microsurgical approach. Materials and Methods: Twenty-six patients with interdental papillary loss were included in the study. The patients were selected randomly for the study groups with thirteen patients in each group: a control group where CTG was utilised as a matrix, and a test group where PRF was utilised as a matrix, for interdental papillary reconstruction. A microtunnelling technique was performed for both the study groups under a surgical microscope. The primary parameters assessed were interdental Papillary height (PH) and Black triangle height (BTH) at baseline, with secondary parameters Visual analogue score by dentist (VAS-D) and patient (VAS-P) assessed at 6 months. Results: Both the control and test groups showed a significant reduction in BTH within their respective group at six months (p < 0.05). The gain in papillary height significantly improved only in the CTG group at 6 months. However, significant differences could not be demonstrated for any of the variables such as BTH (p value = 0.582) and PH (p-value = 0.892) between the study groups at 6 months. Conclusions: IDP reconstruction utilising a microtunnelling approach with CTG or PRF was successful without any significant differences between the groups for the parameters assessed at 6 months.

The Effect of Laser Micro Grooved Platform Switched Implants and Abutments on Early Crestal Bone Levels and Peri-Implant Soft Tissues Post 1 Year Loading among Diabetic Patients-A Controlled Clinical Trial.

Background and Objectives: The study aimed to compare the mean crestal bone level (CBL) and peri-implant soft tissue parameters in laser micro-grooved (LMG) platform switched implants and abutments (I&A) post 1 year of functional loading among non-diabetic and type II diabetic individuals. Materials and methods: Patients with an edentulous site having minimum bone height and width of ≥13 mm and ≥6 mm, respectively, were divided into two groups: (i) Non-diabetic-8 (control) and (ii) diabetic-8 (test). LMG Implants were placed and loaded immediately with a provisional prosthesis. Mean crestal bone level (MCBL) was evaluated radiographically at baseline and at 1 year. Peri-implant attachment level (PIAL) and relative position of the gingival margin (R-PGM) were recorded. Implant stability quotient (ISQ) level and implant survival rate (ISR) were evaluated at 1 year. Results: Early MCBL within the groups 1 year postloading was similar both mesially and distally (control-0.00 to 0.16 mm and 0.00 to 0.17 mm, respectively; test-0.00 to 0.21 mm and 0.00 to 0.22 mm, respectively) with statistical significance (p ≤ 0.003, p ≤ 0.001 and p ≤ 0.001, p ≤ 0.001, respectively). However, intergroup comparison showed no significant difference statistically in the MCBL in 1 year post functional loading. The peri-implant soft tissue parameters showed no significant difference between the groups. ISQ level between both groups did not reveal any significant changes (p ≤ 0.92), and ISR was 100%. Conclusions: LMG Implants resulted in minimal and comparable early crestal bone loss and soft tissue changes post 1 year of functional loading in moderately controlled diabetic and non-diabetic individuals, suggesting that this could be a reliable system for use in systemically compromised individuals.

The Efficacy of Low-Level Laser Therapy Combined with Single Flap Periodontal Surgery in the Management of Intrabony Periodontal Defects: A Randomized Controlled Trial.

This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.

Rationale for anxiety associated with dental visits during the COVID-19 pandemic among the general public - an observational study.

BACKGROUND: The effect of COVID-19 on various facets such as physical, psychological, financial, social, and so on has been investigated extensively. However, the wariness influencing the decision to visit the dentist during this pandemic has received relatively little attention in Indian scenario. The study sought to investigate the general public's anxiety regarding visiting a dentist during the COVID-19 pandemic, including the factors that possibly contribute towards this apprehension among Indian nationals. METHODS: Structured questionnaire based cross sectional observational study. Completed responses were received from 259 individuals. Information was collected on demographic details, medical history, history of COVID-19 infection, history of dental problems, anxiety associated with dental visit and reason for dental visit during the pandemic, whether vaccinated and expecting the dentist to be vaccinated. Apprehension or concerns regarding dental visits were acquired via nine closed-ended questions with dichotomous responses. RESULTS: During the pandemic, 25.9% had dental problems, 24.7% visited the dentist and 81% were anxious about dental visits. 72.6% were concerned about contracting infection from the clinic, 81.5% were concerned about contracting infection in the waiting area, and 87.3% were concerned about whether the clinicians/assistants would meticulously follow standard operating protocols, 88% were concerned about disinfection between patients and 75.7% expressed concern on higher treatment charges due to the pandemic. CONCLUSIONS: The general public is concerned about disease transmission in the dentist's office and increased treatment costs, both of which could have a negative impact on the use of dental services during this COVID-19 pandemic.

Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial.

The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was −0.31 ± 0.11 mm (mesial) and −0.28 ± 0.09 mm (distal); and in the test group was −0.35 ± 0.11 mm (mesial) and −0.33 ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants.

The influence of laser-microgrooved implant and abutment surfaces on mean crestal bone levels and peri-implant soft tissue healing: a 3-year longitudinal randomized controlled clinical trial.

PURPOSE: The study aimed to compare clinical and radiographic parameters of peri-implant site of laser-microgrooved implants with either laser-microgrooved or regular machined prosthetic abutment post 3 years of early loading. METHOD: Twenty edentulous sites of systemically and periodontally healthy individuals were allocated into two groups in this prospective, two-armed, randomized double-blinded clinical trial in 1:1 ratio, wherein each site received laser-microgrooved implants with either laser-microgrooved or machined prosthetic abutments. Outcome measures included full-mouth plaque (FMPS%) and bleeding score (FMBS%), site-specific plaque (SPS%) and bleeding score (SBS%), peri-implant sulcus depth (PISD mm), and mean crestal bone loss (MCBL mm) evaluated at baseline (6 weeks), 1 and 3 years post-early loading. Mean and standard deviation of all parameters were estimated, between groups and at different time points using independent and paired t-test, respectively, Normality was checked using Kolmogorov-Smirnov test and Shapiro-Wilk test, P value ≤ 0.05 was considered as statistically significant. RESULTS: Three-year follow-up of test group showed statistically significant reduction in SPS, SBS, PISD (P value ≤ 0.001). The MCBL reduced from 1.93 mm to 0.61 mm (P value ≤ 0.001); in other words, a bone gain of 0.15 mm was obtained in the test group. CONCLUSION: Within the limitations of the present study, laser-microgrooved implants loaded with laser-microgrooved prosthetic abutments showed superior results clinically and radiographically when compared to loading with machined abutments.

Microbial Assessment of Two Different Abutment Designs in Peri-implant Sulcus and Implant Abutment Interface: A Case Control Postloading Study.

This study evaluates the microbial colonization in the peri-implant sulci and in implant-abutment interfaces of Laser-Lok implants (BioHorizons) with laser-microgrooved abutments (test group) and machined abutments (control group) 18 months after functional loading Real-time polymerase chain reaction revealed significantly greater total and specific microbial load in both the peri-implant sulcus and implant-abutment interface in the control group (P ≤ .05) Similarly, there was a significant reduction in the radiographic crestal bone loss in the test group (P ≤ .05) In total, 14 patients were assessed for clinical and radiographic parameters and microbial evaluation Peptostreptococcus micros and Porphyromonas gingivalis were positively correlated with site-specific plaque scores and bleeding scores, and mean crestal bone loss, respectively Hence, the authors propose using Laser-Lok implants with laser-microgrooved abutments to reduce microbial colonization and consequently preserve the crestal bone levels.

Comparison of Connective Tissue Graft and Platelet Rich Fibrin as Matrices in A Novel Papillary Augmentation Access: A Randomized Controlled Clinical Trial.

OBJECTIVE: The present study was a randomized controlled clinical trial with the aim of evaluating the increase in papillary height and reduction in black triangle height obtained by the novel papillary augmentation access with either connective tissue graft (CTG) or platelet-rich fibrin (PRF) as matrix from baseline to 6 months. MATERIALS AND METHODS: A total number of 20 sites with Nordland and Tarnow's Class I, I-II and II interdental papillary loss were recruited into the study. The sites were randomly allocated with 10 sites per group into either: Group A (control group) or Group B (test group) which utilizes the same technique with CTG or PRF as matrix, respectively. The clinical parameters such as PPD (probing pocket depth) and CAL (clinical attachment level) at the surgical site, plaque score (FMPS), bleeding scores (FMBS), interdental papillary height (PH) and black triangle height (BTH), along with visual analog score by dentist (VAS-D) and by patient (VAS-P) were evaluated at baseline and at 6 months. RESULTS: In both CTG and PRF groups, all the primary and secondary outcome variables such as PH, BTH, VAS-D and VAS-P showed statistically significant improvement from baseline to 6 months (p ≤0.05) within the group. On comparison at 6 months, there were no differences in the papillary height between the groups. However, the BTH has significantly reduced in the CTG group than the PRF group. Similarly, the VAS-D significantly improved in the CTG group than the PRF group (p = 0.010) at 6 months. CONCLUSION: The study demonstrates that the proposed papillary augmentation access with CTG and PRF was successful in managing the unaesthetic interdental papillary loss, with CTG showing better results in terms of reduction of black triangle than PRF.

Elevated levels of cyclooxygenase 1 and 2 in human cyclosporine induced gingival overgrowth.

OBJECTIVE: This study was carried out to immuno-localize and estimate the levels of cyclooxygenase 1 and 2 in human gingival tissue samples from healthy individuals, chronic periodontitis patients and patients with cyclosporine induced gingival overgrowth. METHODS: Group I consisted of individuals with healthy gingiva (n=6), Group II - cyclosporine induced gingival overgrowth (n=9) and Group III - chronic periodontitis patients (n=6). Gingival tissue samples were collected from subjects of all the three groups. COX-1, COX-2 levels were estimated in tissue homogenates by enzyme activity assay. Immuno-localization for COX-1 and COX-2 was also done in sections of gingival tissue. RESULTS: The study results demonstrated a significantly higher mean levels of COX-1 and 2 in drug induced gingival overgrowth samples (p<0.05). COX-1 and COX-2 was localized to epithelium and connective tissue in human gingival tissue sections from cyclosporine induced gingival overgrowth. CONCLUSION: Cyclooxygenase enzymes appear to be potential mediators involved in the pathogenesis of cyclosporine induced gingival overgrowth.