Cell-based therapy in the management of Class III Miller's recession - A case report with 45-month follow-up.

Miller's Class III gingival recessions (GRs) have always posed a challenge to the clinicians in terms of achieving complete root coverage (CRC). In the present case, a cell-based therapy with autologous fibroblasts seeded onto a Type 1 collagen membrane, through an in-vitro culturing method was utilized. The fibroblasts-seeded membrane was surgically placed under a laterally repositioned flap. The patient presented with a CRC, which was stable even at the postoperative period of 45 months. In addition, a 3-mm substantial gain in the width of keratinized tissue was achieved and maintained throughout the postoperative period. Hence, the results of the cell-seeded therapy emphasize that it can serve as an effective alternative method for the management of Miller's Class III GRs.

Morphological and Chemical Alterations of Root Surface after Er:YAG laser, Nd:YAG Laser Irradiation: A Scanning Electron Microscopic and Infrared Spectroscopy Study.

AIMS AND OBJECTIVES: This study aimed to evaluate the efficacy of Nd:YAG and Er:YAG lasers in removing the smear layer and to study the morphological and chemical alterations of the root surface using scanning electron microscopy (SEM) and infrared (IR) spectroscopy. MATERIAL AND METHODS: Fifty-five extracted upper incisor teeth were collected and 110 specimens of size 3 mm × 4 mm × 1 mm were prepared. For SEM evaluation, these samples were divided into six groups: A, B, and C. Group A comprised five samples that served as control. Groups B and C were further divided into five subgroups and each subgroup comprised five samples. All the specimens within the subgroups of B and C irradiated with 100, 200, 300, 400, and 500 mJ of Er:YAG laser and 211.66, 423.33, 635, 846.66, and 1058.33 J/cm2 of Nd:YAG laser, respectively. The morphological changes of the laser-treated sites were observed qualitatively using an arbitrary scale under SEM. The data obtained were statistically analyzed by one-way analysis of variance (ANOVA) multiple range test by Turkey's honestly significant difference and Mann-Whitney U test. In chemical structural changes, Group D comprised five samples that served as nonirradiated control and Groups E and F were irradiated with the same aforementioned parameter and evaluated using Fourier-transform infrared spectroscopy. RESULTS: Er:YAG laser at 100 mJ effectively removed smear layer without any crater formation. The Nd:YAG laser removed the smear layer at the energy density of 211.66 J/cm2 and 423.33J/cm2. The energy density of 1058.33 J/cm2 showed visible charring and deep crater with increased area of melted and resolidified minerals in SEM. In the chemical changes, IR spectroscopy graph showed the reduction in peak intensity beyond 846.66 J/cm2 of and new absorption band was noticed (2010cm-1 and 2017cm-1) at samples treated with 846.66 and 1058.33 J/cm2 of Nd:YAG laser. CONCLUSION: Er:YAG laser at lower energy density effectively removed smear layer without production of toxic substance as compared with Nd:YAG laser. Thus, Er:YAG laser can be used as an effective root biomodification agent.

Comparative evaluation of soft and hard tissue changes following endosseous implant placement using flap and flapless techniques in the posterior edentulous areas of the mandible-a randomized controlled trial.

BACKGROUND: Dental implant-supported restorations have long been used as a successful modality for replacing missing teeth. There are two well-established methods of implant placement. The traditional approach to implant surgery involves raising a mucoperiosteal flap and the alternative approach does not involve reflecting a flap, each having its own advantages and disadvantages. The purpose of the present study was to compare and evaluate the soft and hard tissue changes around endosseous implants placed using flap and flapless surgery in mandibular posterior edentulous sites over a period of time. MATERIALS AND METHODS: A total of 20 systemically healthy patients with a single edentulous site in the posterior mandible were enrolled in this study and 20 endosseous implants were placed (10 in the flap group and 10 in the flapless group). The peri-implant probing depth was assessed. Radiographic assessment was done for changes in the marginal bone levels at the mesial and distal side of the implant with measurements made at baseline, 6 months, and 12 months. Patient-centered outcomes were assessed by using the visual analogue scale (VAS). All these parameters were statistically analyzed using the Wilcoxon signed-rank test, paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05. RESULTS: Twenty patients were enrolled in the present study and endosseous implants were placed. Eighteen subjects were followed up throughout the study period and two patients were excluded from the study. The mean PD in the flapless group was comparatively less than the flap group at 12 months and was found to be statistically significant. During the observation period of 12 months, reduction of crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less change in the crestal bone height which was statistically significant compared to the flap group. The mean VAS score on day 0 in the flap and flapless group was statistically significant. The flapless group showed significantly less pain when compared to the flap group. CONCLUSION: Although the flapless technique of endosseous implant placement had statistically significant less PD, bone loss, and pain than the flap technique, the difference was found to have uncertain clinical significance.

Association of genetic variants of mannan-binding (MBL) lectin-2 gene, MBL levels and function in ulcerative colitis and Crohn's disease.

Ulcerative colitis and Crohn's disease are the two major forms of inflammatory bowel disease (IBD). A series of reports have hypothesized interplay of genetic and environmental factors in the pathogenesis of IBD. Polymorphism in the mannan-binding lectin-2 (MBL-2) gene is known to affect the structural assembly and function thereby predisposing subjects to various diseases. The present study was designed to evaluate effect of MBL-2 gene polymorphism on MBL levels and function in IBD patients. Genomic DNA was isolated from blood samples collected from 157 ulcerative colitis, 42 Crohn's disease and 204 control subjects. Genotyping for different polymorphic sites at exon1 of MBL-2 gene was performed by refractory mutation system-PCR and amplification followed by restriction digestion (PCR-RFLP). Serum MBL concentration and C4 deposition levels were estimated using ELISA. Mannan-binding lectin-2 genotypic variants were calculated in IBD and healthy controls. The frequency of single nucleotide polymorphisms at codon 54 was significantly higher in ulcerative colitis patients than controls (P < 0.0001). Ulcerative colitis patients with 'codon 54'-variation showed low serum MBL concentrations coupled with altered MBL function compared to controls. In conclusion, single nucleotide polymorphism in the MBL-2 gene is an important risk factor significantly affecting MBL levels and function in the development of ulcerative colitis among Indians.

Antibacterial and ulcer healing effects of organoselenium compounds in naproxen induced and Helicobacter pylori infected Wistar rat model.

Aim of the present study was to evaluate in vitro toxicity and in vivo antibacterial, anti-inflammatory, antiulcer, and antioxidant activities of two organoselenium compounds, selenocystine (SeCys) and ebselen (Ebs). The study was conducted in experimentally induced ulcers in rodent model infected with Helicobacter pylori (H. pylori). In vitro toxicological studies on normal splenic lymphocytes revealed that SeCys and Ebs were non-toxic to the cells even at 100 µM concentration. Antibacterial activity was observed at 500 µg/mL concentration of either of the compounds against H. pylori. In vivo studies after treatment with SeCys and Ebs (500 µg/kg/day) resulted in significant reduction in ROS production and inhibition of lipid peroxidation in gastric tissue. The antioxidant and anti-inflammatory activities of both the compounds were also confirmed by their ability to lower GSH reduction, to induce the expression of antioxidant genes such as GPx-4, and MnSOD and to suppress inflammatory genes namely COX-2, TNF-α and TGF-ß. In addition, the immunomodulatory activity of both the compounds was evident by enhance of the CD4 levels and maintenance of the IgG, IL-6 and IL-10 levels. Persistent treatment (500 µg/kg, for 28 days) with both the compounds showed considerable (p<0.05) ulcer healing property supporting its role in gastro protection. In conclusion, the results of our study suggest that both SeCys and Ebs possess broad spectrum of activities without any potential toxicity.

Relevance of Helicobacter pylori genotypes in gastric pathology and its association with plasma malondialdehyde and nitric oxide levels.

Persistent infection with Helicobacter pylori confers an increased risk of peptic ulceration and gastric adenocarcinoma. Reactive oxygen and nitrogen species play a crucial role in the progression from normal gastric mucosa to cancer. The aim of the present study was to investigate the plasma malondialdehyde and nitric oxide levels in H. pylori related gastroduodenal diseases and associate their levels with gastric pathology and genotypes of H. pylori. Malondialdehyde and nitric oxide levels in plasma samples of 250 subjects were spectrophotometrically determined. Subsequently, genotypic and histopathological assessment was performed in gastric biopsies obtained during endoscopy. The levels of MDA and NO exceeded in subjects infected with genotype-1 of Hp than those with other genotypes suggesting more precise interaction of highly virulent strains of Hp in eliciting severe tissue damage. In conclusion, the study demonstrates close relationship between the plasma malondialdehyde and nitric oxide levels, gastric histopathology and genotypes of H. pylori.

Anti-unlcer and antimicrobial activities of sodium selenite against Helicobacter pylori: in vitro and in vivo evaluation.

Abstract We examined sodium selenite, an inorganic selenium supplement, for its ulcer healing properties and antimicrobial activity against gastric pathogen Helicobacter pylori. Minimum inhibitory concentrations (MIC) were determined using disk diffusion and flow cytometry. The studies were performed over a concentration range of 1 microg/ml to 500 microg/ml sodium selenite. Mild activity was seen at 10 microg/ml and 50 microg/ml, a moderate response at 100 microg/ml and strong response at 500 microg/ml with a MIC value of 10 microg/ml. The compound was found to be active at low pH without any resistance after 10 passages. Flow cytometry data showed a characteristic shift of the viability peak in comparison with the control, thereby confirming the bactericidal effects of sodium selenite. Sodium selenite administered in Wistar rats, pre-ulcerated with naproxen and infected with H. pylori, showed ulcer healing and anti-H. pylori activity at a concentration range of 10-50 microg/rat; however concentrations of 100 microg/rat and 500 microg/rat were found to be toxic in the in vivo studies. In conclusion, sodium selenite shows both ulcer healing and anti-H. pylori activity at a low concentration (10 microg/rat) without toxicity.

Does elective re-siting of intravenous cannulae decrease peripheral thrombophlebitis? A randomized controlled study.

BACKGROUND: Peripheral venous thrombophlebitis (PVT) is a common complication of intravenous cannulation, occurring in about 30% of patients. We evaluated the effect of elective re-siting of intravenous cannulae every 48 hours on the incidence and severity of PVT in patients receiving intravenous fluids/drugs. METHODS: We randomized 42 patients who were admitted for major abdominal surgery to either the control or study group (n = 21 in either group). Informed consent was obtained from all of them. Cannulae in the control group were removed only if the site became painful, the cannula got dislodged or there were signs and symptoms suggestive of PVT, namely pain, erythema, swelling, excessive warmth or a palpable venous cord. Cannulae in the study group were changed and re-sited electively every 48 hours. All the patients were examined every 24 hours for signs and symptoms of PVT at the current and previous sites of infusion. RESULTS: The incidence of PVT was 100% (21/21) in the control group and only 9.5% (2/21) in the study group (p < 0.0001). The severity of PVT was also less in the study group compared with that in the control group. Day-wise correlation of the incidence of PVT showed that 82.6% of the episodes of PVT occurred on day 3. CONCLUSION: Elective re-siting of intravenous cannulae every 48 hours results in a significant reduction in the incidence and severity of PVT. We recommend that this should be adopted as standard practice in managing all patients who require prolonged intravenous therapy.

Simplified and versatile method for bisulfite-based DNA methylation analysis of small amounts of DNA.

Epigenetic alterations of gene function play a central role in the pathogenesis of many tumors and in the process of aging. Abnormal methylation at transcriptional sites of genes results in epigenetic silencing of the genes that protect against tumor formation or that repair DNA. To date, several studies have analyzed methylation status by oligonucleotide arrays, restriction analysis (COBRA), methylation-specific amplification, and sequence analysis. This requires high concentration of bisulfite-treated DNA, which mandates use of commercially available expensive kits, and is an often laborious and time-consuming task. In this article, we report a simplified high-throughput method, which can serve as a surrogate for screening methylation profiles of various genes and has high sensitivity compared with the other methods described previously.

Prognostic significance of genotyping Helicobacter pylori infection in patients in younger age groups with gastric cancer.

BACKGROUND: Malignant tumours of the stomach are common, but the incidence of stomach cancer varies from country to country, probably a result of genetic, epigenetic and environmental factors. Stomach cancer often occurs in older people whose stomachs produce only small quantities of acid. Although infection with Helicobacter pylori has been proven beyond doubt in the aetiopathogenesis of various gastric disorders, not much is known about the genotypes of H pylori infection in early-onset gastric cancer. AIM: To ascertain the genotypes of H pylori in gastric cancer. METHODS: Ninety-two patients were separated into three groups on the basis of their endoscopic findings: group 1, gastric cancer; group 2, gastric ulcer; group 3, non-ulcer dyspepsia. Gastric biopsy specimens were obtained for culture and DNA isolation; additional specimens were taken from subjects with gastric cancer for histopathological analysis. Amplification was performed using specific oligonucleotide primers to obtain genotypic data. Four samples from each group were randomly selected for sequence analysis. RESULTS: Genotypic analysis showed cagT+ve/hrgA+ve/cagA+ve/cagE+ve/vacAs1+ve to be highly prevalent in 79% of cases of H pylori infection. This genotype was found in 88% of subjects in group 1 and 78% in group 2. Intestinal-type adenocarcinoma was found in 35 subjects (83%), 32 (9%) of which harboured this genotype. Sequence analysis showed no significant strain-specific variations. CONCLUSIONS: Certain genotypes of H pylori have higher predictive value for the development of intestinal-type carcinoma at an early age. Genotyping of H pylori may well be a useful tool for screening people at increased risk of developing malignancy.