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Evaluating and comparing the morphological and histopathological changes induced by erbium:yttrium‐aluminum‐garnet laser and diamond bur on enamel, dentin and pulp tissue
Shamsudeen S.M., Thavarajah R., Joshua E., Rao U.D., Kannan R.
Lasers are used for different types of dental treatments. Using the erbium:yttrium-aluminum-garnet (Er:YAG) laser to remove dental hard tissue is simple, advantageous and influences the type of cavity preparation, whether conventional or conservative in nature. The aim of the present study was to evaluate and compare the morphological and histopathological changes in the enamel, dentin and pulp tissue of the teeth treated by Er:YAG laser and conventional burs.A conventional class I cavity was prepared in orthodontic patients by laser and bur. The teeth were extracted and analyzed for morphological changes using a scanning electron microscope, ground sections and histopathological changes under a light microscope.The time with laser was longer than the conventional methods. The lased cavity showed irregular appearance with absence of smear layer which is suitable for the resin restoration. The ground section and the histopathological study showed no differences between the groups.The Er:YAG laser is effective in the removal of dental hard tissue without damaging the pulp when coupled with ideal energy output. It is widely used in different dental fields. It needs time to be accepted by dentist and patients and further studies are required to explore its advantages.
Immunoexpression of alpha smooth muscle actin correlates with serum transforming growth factor‐β1 levels in oral submucous fibrosis
Singh I., Juneja S., Tandon A., Jain A., Shetty D.C., Sethi A.
The aim of the present study was to correlate the immunoexpression of alpha-smooth muscle actin (α-SMA) for myofibroblasts with the serum levels of transforming growth factor-β1 (TGF-β1) in oral submucous fibrosis (OSMF).A total of 100 cases of histopathologically confirmed OSMF were assessed for α-SMA expression. Clinical data, such as age, sex, mouth opening, and habit history, were obtained for each case. Serum TGF-β1 levels were recorded in 73 patients with the help of enzymelinked immunosorbent assay technique.The staining index of α-SMA increased concomitantly with higher myofibroblast count in the increasing histopathological grades of OSMF (P ≤ .05). Serum TGF-β1 levels were highest in the intermediate grades of OSMF. Clinical parameters, such as mouth opening, cheek flexibility, and tongue protrusion, showed a direct correlation with increasing clinical grades of OSMF.The progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF. Additionally, as myofibroblasts are responsible for producing a variety of factors that are involved in the fibrotic processes; they could be the key link in the pathogenesis of OSMF. Interruption of their development, recruitment, or activation could provide a unique therapeutic target for future treatment options in patients with OSMF.
Comparative evaluation of curcumin and antioxidants in the management of oral submucous fibrosis
Rai A., Kaur M., Gombra V., Hasan S., Kumar N.
The present study aims to evaluate the efficacy and safety of curcumin in both topical and systemic forms for management of oral submucous fibrosis in comparison with the antioxidants.In this randomized parallel-group single-center trial, 119 patients were enrolled. Group I received antioxidants, group II received curcumin in systemic form and group III received curcumin in both systemic and topical forms. The primary outcomes assessed were interincisal mouth opening and burning sensation using a visual analog scale. The secondary outcomes were tongue protrusion and adverse reactions. The response to treatment was analyzed using ANOVA and Fisher's exact test.Significant improvement in mouth opening, burning sensation and tongue protrusion was observed in all groups at 12 weeks. Mean improvement in burning sensation did not show statistical difference across the groups. A significant difference between groups II and III for improvement in mouth opening and groups I and III for improvement in tongue protrusion was noted.When administrated in both systemic and topical forms together, curcumin showed better results in the management of oral submucous fibrosis as compared with the systemic form alone or antioxidants. Curcumin has the potential to emerge as an effective alternative to conventionally prescribed medications.
Tamponade effect of resorbable biological barrier in quality of obturation in primary molar
Kakade A., Shetty H., Santosh A., Mali S., Badnaware S., Deshmukh B., Banthiya K.
Physical properties of obturating materials have a direct effect on the quality of obturation; less viscous material will tend to extrude beyond the apex. We hypothesize that the use of absorbable gelatin sponge (AGS) can prevent the extrusion of these materials. This study aimed to evaluate the quality of obturation in root canals filled with iodoform-calcium hydroxide (Metapex) premixed paste and Metapex with AGS (MAGS) in primary molars.This in vivo study comprised 60 primary mandibular molars which after instrumentation were divided into 2 groups according to the obturation material used, Metapex and MAGS, followed by radiographic evaluation to assess the quality of the obturation. The χ2 -test was applied for statistical analysis.There was a statistically significant difference between Metapex and MAGS groups in achieving optimum obturation (P < .001). Metapex and MAGS exhibited 86.65% and 38.88% optimum obturation respectively. The overfilling of root canals effectively reduced from 38.88% to 4.44%.The addition of AGS to Metapex causes a "tamponade effect", which reduces the tendency of Metapex to extrude beyond the root apex. Root canal obturation using a modified filling paste like MAGS is effective in obtaining optimum obturation in primary teeth.
Immunohistochemical expression of tumor necrosis factor‐like weak inducer of apoptosis and fibroblast growth factor‐inducible immediate early response protein 14 in oral squamous cell carcinoma and its implications
Acharya S., Prabhu P., Patil V.S., Acharya A.B., Nikhil K.
To study the expression of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and fibroblast growth factor-inducible immediate early response protein 14 (Fn14) in oral squamous cell carcinoma (OSCC), to elucidate the possible role of TWEAK-Fn14 in OSCC development.Immunohistochemistry for TWEAK-Fn14 was performed on 61 oral mucosal samples: healthy oral mucosa (HOM; N = 15); oral dysplastic lesions (ODL; N = 15); and OSCC (N = 31). Extent of staining (ES) and immunoreactive score (IRS) were assessed. The data was statistically analyzed.All OSCC expressed TWEAK, and the Fn14 expression was noted in 90% of OSCC. A significant difference in the TWEAK and Fn14 expression was noted among the groups. ES and IRS of TWEAK-Fn14 significantly increased in OSCC compared with ODL and HOM. ES of TWEAK was significantly higher than Fn14 in all 3 groups. ES of TWEAK-Fn14 was significantly higher at the invasive tumor front (ITF) than in the whole tumor. TWEAK-Fn14 showed a significant association with clinicopathological parameters of prognostic significance.Findings suggest that TWEAK and Fn14 may participate in the growth and progression of OSCC. Increased expression of TWEAK-Fn14 at the ITF may facilitate increased proliferation, altered differentiation and invasion.
Evaluation of SOX2 and podoplanin expression in oral epithelial dysplasia and its correlation with malignant transformation
Verma V., Chandrashekar C.
Oral carcinogenesis cascade is a complex process, characterized by variable numbers of genetic and epigenetic alterations of various genes with manifold roles that could serve as biological hallmarks. This study was undertaken to assess the protein expression of SOX2 and podoplanin in oral epithelial dysplasia and correlate the expression with clinicopathological parameters and risk of malignant transformation.SOX2 and podoplanin expression were analyzed in 60 cases of oral epithelial dysplasia. The association between SOX2 and podoplanin expression with various clinicopathological parameters and transformation to oral cancer was analyzed.A higher Histoscore was seen in 55% of moderate and 30% of severe dysplasia. 25% of the cases showed a negative podoplanin expression and 30% of patients had higher podoplanin expression (score 2 and 3). Though there was significant association of both SOX2 and podoplanin expression with the degree of dysplasia, the association of their expression with transformation to oral squamous cell carcinoma did not reach statistical significance.Alteration in SOX2 and podoplanin is likely an important event in head and neck carcinogenesis; however, their expression may be valuable only in a few cases of oral epithelial dysplasia to assess the risk of malignant transformation.
Mast cell expression in oral lichen planus: A systematic review
Vadivel J.K., Govindarajan M., Somasundaram E., Muthukrishnan A.
Lichen planus is a common chronic, inflammatory, immune-mediated mucocutaneous disorder affecting the skin and mucosa. The role of mast cells in the genesis of lichen planus has been debated. Establishing a definitive part played by mast cells and its degranulation would possibly provide a permanent, cost-effective treatment modality for oral lichen planus (OLP). This review aims to study the expression of mast cells qualitatively and quantitatively in OLP. The research questions were framed to assess the mast cell count, localization within the epithelium basement membrane zone and degranulation of mast cells. We performed a systematic search of PubMed, Medline, Cochrane and Web of Science. We found a total of 120 studies from which 12 were found suitable for the review. There is a marked increase in the number of mast cells in OLP. The mast cells were seen in increased numbers in the epithelial and connective tissue junction at areas of basement membrane disruption. There was also an increase in the degranulation of mast cells. It is evident that there is an increase in the mast cell number in lichen planus and its subsequent degranulation.
Oral mucositis and microbial colonization in oral cancer patients undergoing radiotherapy and chemotherapy: A prospective analysis in a tertiary care dental hospital
Subramaniam N., Muthukrishnan A.
The ulcerative phase of oral mucositis following radiotherapy/chemotherapy for oral cancer colonizes bacteria, fungi and viruses. The role of a microbiota, specifically bacterial colonization in oral mucositis, is still unclear, and there is no existing data that correlates the shift in the bacterial colonization with mucositis severity. The aim of this study was to assess the bacterial colonization and study the MCR-1 (mobilized colistin resistance), VIM2 (β-lactam resistance), TET(K) (tetracycline resistance) and blaKPC (carbapenem resistance) genes' expression in isolated facultative anaerobes at 3 time points in oral mucositis patients undergoing radiotherapy and concomitant radiochemotherapy.A total of 24 oral cancer patients were divided into 2 groups: A (N = 12) undergoing radiotherapy; and B (N = 12) undergoing radiochemotherapy. Saliva was collected from all patients at 3 time intervals during the treatment. The isolated bacterial colonies were subjected to gene expression and analysis.Staphylococcus aureus (22%), Staphylococcus epidermidis (29%), Pseudomonas aeruginosa (28%), Escherichia coli (25%) and Klebsiella pneumoniae (26%) are the facultative anaerobes isolated from saliva. The bacterial isolates obtained during and at the end of therapy appeared to express a higher level of antibiotic-resistance genes (VIM2, MCR-1, TET[K], blaKPC ) than those isolated at the onset of therapy.Bacterial colonization and gene expression varied during different stages of mucositis.
Socket‐shield technique for implant placement to stabilize the facial gingival and osseous architecture: A systematic review
Mourya A., Mishra S.K., Gaddale R., Chowdhary R.
The aim of the present study was to establish the efficacy of the socket-shield technique (SST) for the stabilization of the facial gingival and osseous architecture. An electronic search including the Cochrane databases, EBSCOhost, Medline/PubMed and Web of Science was performed. Articles related to SST for placing dental implants were included. Articles and abstracts not written in English were excluded. The initial literature search resulted in 113 articles related to questions raised. Hand searching of the journals related to implants and cross-referencing related to SST within the selected articles resulted in 1 more paper. Finally, 20 full texts and abstract of 1 article were included in the present systematic review: 11 case reports, 6 case series, 1 human randomized control trial (RCT), 1 technical report and 2 animal RCT. Recent modifications in SST, along with long follow-up studies with increased sample size, provided promising results. This systematic review still recommends that SST should not be used in routine clinical practise until a higher level of evidence established. Further RCT on SST are required to establish the clinical efficacy of this technique.
The Periodontal‐Cardiovascular alliance: Evaluation of miRNA‐146a in subgingival plaque samples of chronic periodontitis patients with and without coronary heart disease
Yagnik K., Mahendra J., Kurian V.M.
To quantify the levels of miRNA-146a in subgingival plaque samples, and correlate with periodontal and cardiac parameters, in chronic periodontitis patients with and without coronary heart disease.The study involved 90 subjects; 30 patients with chronic periodontitis and coronary heart disease (CP + CHD) as part of Group I; group II comprising 30 with chronic periodontitis alone (CP); and group III comprising 30 systemically healthy controls. Demographic variables, periodontal parameters such as plaque index, bleeding on probing, probing pocket depth and clinical attachment levels, cardiac parameters such as total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride levels, and systolic and diastolic blood pressure were recorded from the patients. miRNA-146a level was analyzed in subgingival plaque samples by real-time polymerase chain reaction assay and correlated with periodontal and cardiac parameters.miRNA-146a showed the highest levels in the CP + CHD group and also showed a positive correlation with body mass index, and periodontal and cardiac parameters.miRNA-146a is involved in the pathogenesis of both periodontitis and coronary heart disease.
Association of vitamin D receptor gene polymorphism ( rs10735810 ) and chronic periodontitis
Murthykumar K., Arjunkumar R., Jayaseelan V.P.
The aim of the present study was to analyze the association between vitamin D receptor (VDR) (rs10735810) gene polymorphism and chronic periodontitis (CP).A total of 100 subjects were recruited for this study, which included 50 CP and 50 healthy controls. Genomic DNA was extracted from the whole blood collected from the subjects. DNA was amplified using specific primers flanking the FokI region of the VDR gene (rs10735810). The amplicon was further subjected to genotyping using restriction fragment length polymorphism (RFLP) using the FokI enzyme. The genotype obtained based on RFLP pattern was recorded and used for statistical analysis. The distribution of genotypes and allele frequencies in the chronic periodontitis and control groups were compared using the χ2 -test.The CP group displayed the highest frequency of CT (20%) and TT (6%) genotypes when compared with the control subjects. Allele frequency was found to be similar in both groups. The C allele was found to be predominant in the study population compared with the T allele.The present study denotes that the VDR polymorphism (rs10735810) is not associated with CP in the study group analyzed.
Ki67, CD105 and α‐smooth muscle actin expression in disease progression model of oral submucous fibrosis
Gadbail A.R., Chaudhary M.S., Sarode S.C., Gondivkar S.M., Belekar L., Mankar‐Gadbail M.P., Dande R., Tekade S.A., Yuwanati M.B., Patil S.
The aim of this study was to investigate the expression of Ki67, CD105 and α-smooth muscle actin (α-SMA) expression in oral submucous fibrosis (OSF) and oral squamous cell carcinoma in the background of OSF (OSCC-SMF).The study was carried out on paraffin-embedded tissues of 30 normal oral mucosa (NOM), 50 OSF cases and 105 OSCC-SMF. The immunohistochemistry was carried out to evaluate the expression of Ki67, CD105 and α-SMA antigen.Ki67 labelling index (LI), CD105 and α-SMA expression showed increasing trend from NOM, low-risk epithelial dysplasia (LRED), high-risk epithelial dysplasia (HRED), well-differentiated squamous cell carcinoma (WDSCC), moderately differentiated squamous cell carcinoma to poorly differentiated squamous cell carcinoma. However, there was no significant difference of α-SMA expression between HRED and WDSCC. In OSCC-SMF, Ki67 LI, CD105 and α-SMA were significantly higher in advanced clinical TNM stage, metastasis and less than 3 years patient survival as compared with early clinical TNM stage, non-metastasis and 3 years or more patient survival.Ki67 LI, α-SMA and CD105 expression alone or together correspond with the disease progression model of SMF. Hence, expression of these markers can be used as a predictive marker of clinical outcome of OSCC-SMF.
Oral candidal carriage correlates with CD4 + cell count but not with HIV and highly active antiretroviral therapy status
Sah P., Patel P., Chandrashekar C., Martena S., Ballal M., Hegde M., Guddattu V., Murdoch C., Sharma M., Radhakrishnan R.
The occurrence of oropharyngeal candidiasis (OPC) may be influenced by oral candidal carriage (OCC). Although OPC is strongly associated with low CD4+ cell count (400-700 cells/mm3 ) and a lack of highly active antiretroviral therapy (HAART), the effect of these two parameters on OCC is debatable. We investigated the oral candidal carriage, species diversity, antifungal susceptibility and the association of OCC with CD4+ cell count and HAART.Oral candidal isolates from 120 HIV+ patients (60 receiving and 60 not receiving HAART) and 60 healthy controls were quantified, and their species determined using standard culture and biochemical methods, followed by antifungal susceptibility testing using the agar dilution method.The OCC was significantly higher in HIV+ patients; Candida albicans was the most frequently isolated species in both groups, followed by Candida tropicalis. Candidal density carriage correlated significantly with CD4+ cell count, but not with HIV and HAART status. Among the isolates from HIV+ patients, 35.4% showed reduced susceptibility to fluconazole.HIV status results in significantly elevated rates of OCC C albicans remains the predominant pathogen, although other species are emerging rapidly. Resistance to fluconazole is on the rise, and more efficient treatment strategies need to be implemented.
Effect of non‐surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic periodontitis and chronic periodontitis patients with type 2 diabetes mellitus
Ahuja C.R., Kolte A.P., Kolte R.A., Gupta M., Chari S.
The aim of the present study was to evaluate the effect of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) and serum leptin levels and glycemic status in periodontally healthy patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM).Ninety patients were divided into three groups: periodontally healthy (group 1), CP (group 2) and CP with T2DM (group 3). The groups were evaluated for clinical parameters of probing pocket depth (PPD), clinical attachment level (CAL), plaque index, gingival index, biochemical parameters of GCF, serum leptin levels, and glycemic status pre- and post-NSPT.The baseline PPD and CAL for group 2 was 4.98 ± 0.49 mm and 5.35 ± 0.55 mm, respectively; for group 3 it was 5.60 ± 0.38 mm and 6.01 ± 0.38 mm, respectively. There was a considerable reduction in these parameters post-NSPT, with group 2 showing better resolution. Pretreatment serum leptin levels revealed increasing values from group 1 to group 3 and decreasing GCF values from group 3 to group 1, exhibiting an inverse relationship. Group 3 also showed an improvement in glycemic status post-NSPT.NSPT was effective in improving clinical parameters, increasing GCF, reducing serum leptin levels, and also improving glycemic status in patients with CP and CP with T2DM.
Effect of oral health behavior and demographic variables on gingival health in 11-16-year-old school children in Chandigarh, India: A cross-sectional study
Sharma U., Gill N., Gulati A., Passi S., Verma L., Bal I.S., Arora R., Agnihotri A., Gauba K.
The aims of the present study were to assess the prevalence and pattern of gingival bleeding on probing (BOP) and to evaluate the effect of oral health behavior and demographic determinants on gingival health in 11-16-year-old school children in Chandigarh, India.A cross-sectional study, using stratified random sampling, was conducted across two age groups, 11-13 years and 14-16 years, and two socioeconomic strata: upper and lower. The World Health Organization (WHO) Oral Health Questionnaire for Children was used to record the data, and the WHO Community Periodontal Index (modified) was used to assess gingival BOP.Among all the 2294 children examined, an estimated 54.2% had gingival BOP. The odds of BOP were also higher in the younger age group (odds ratio [OR]: 1.261, 95% confidence interval [CI]: 1.068-1.487, P = 0.006), higher for boys (OR: 1.200, 95% CI: 1.017-1.416, P = 0.031), and lower in the upper strata (OR: 0.805, 95% CI: 0.682-0.951, P = 0.011). Gingival BOP was 58.5% in the mandibular and 41.5% in the maxillary arch (P < 0.0001); χ2 -test found tooth cleaning frequency to be a significant contributing factor for gingival BOP (P = 0.014).An inverse co-relation of gingival BOP with age, socioeconomic status, and a higher prevalence in boys was observed, necessitating periodic preventive dental education, particularly focusing on the target group. Additionally, early screening and prompt treatment to intercept the disease is advocated.
Comparison of three different apex locators in determining the working length of mandibular first molar teeth with irreversible pulpitis compared with an intraoral periapical radiograph: A block randomized, controlled, clinical trial
Vanitha S., Sherwood I.A.
The aim of the present study was to assess the clinical accuracy APEX and 0.5 marks of three different apex locators - iPex II, Root ZX, and Apex ID - before and after canal preparation in the mandibular first molar.Sixty patients between the ages of 13-60 years participated in the study. After access gaining and canal preparation stages files were inserted with the apex locator clip attached until the electronic apex locators (EALs) shows readings of APEX and 0.5 marks and same is confirmed with periapical radiographs. Eighteen apex locator readings were recorded from each tooth, and 1080 readings were obtained from the 60 patients.Differences among readings from apex locators and radiographic readings were assessed using paired t test. Only in two patients (1 male and 1 female) were the APEX mark readings different from the radiograph estimation. When the 0.5 mark readings of three different EALs were compared with each other, we could observe that the readings from Root ZX differed significantly (P < 0.05).In the present study, we observed the negligible differences in readings between the EAL at the APEX mark readings, coinciding with the radiographic observation. Clinically, we recommend the apical foramen be located with the apex locators' APEX mark readings prior to identifying the apical constriction position.
Differential expression of periostin, sclerostin, receptor activator of nuclear factor-κB, and receptor activator of nuclear factor-κB ligand genes in severe chronic periodontitis
Sankardas P.A., Lavu V., Lakakula B.V., Rao S.R.
The aim of the present study was to determine and compare the expression profile of periostin (POSTN), sclerostin (SOST), receptor activator nuclear factor-κB (RANK), and RANK ligand (RANKL) genes in gingival tissue samples collected from healthy gingiva (control) and severe chronic periodontitis sites.Fifty systemically-healthy individuals was enrolled in the present case-control study. Gingival tissue samples were obtained from healthy gingiva (N = 25) and sites with severe chronic periodontitis (N = 25). Total RNA was isolated from all the tissues. cDNA conversion was then performed using a reverse transcription polymerase chain reaction (PCR) program. Real-time PCR and SYBR green method were used to determine the expression levels of SOST, POSTN, RANK, and RANKL genes.An elevated expression (3.5-4-fold) of SOST, RANK, and RANKL genes, with a concomitant reduced expression of the POSTN gene, was identified in severe chronic periodontitis. The intergroup difference between the mean delta cyclic threshold values showed statistical significance at P
Effect of systemic long-term, low-dose aspirin on periodontal status and soluble CD14 in gingival crevicular fluid: a case-control study
Bali S.K., Madaiah H., Dharmapalan J., Janarthanam S., Tarannum F.
In the present study, we evaluated the effect of systemic long-term, low-dose aspirin on the periodontal status and gingival crevicular fluid (GCF) concentrations of aspirin-triggered lipoxins (ATL) and soluble CD14 (sCD14).The study group consisted of 45 patients who were on long-term, low-dose aspirin therapy, and the control group included patients not on aspirin therapy. Mean bleeding index, plaque index (PI), probing depth (PD), and clinical attachment loss (CAL) were recorded. GCF samples were analyzed for concentrations of ATL, and sCD14 using enzyme-linked immunosorbent assay method.The means of PI, PD, and CAL were higher for the control group compared to the study group. The mean concentration of ATL was significantly higher for the study group (49.13 ± 37.39 ng/mL). The mean concentration of sCD14 was higher in the control group (5.75 ± 3.91 μg/mL). There was a negative correlation in the study group between concentrations of ATL with PD (r = -0.54) and CAL (r = -0.123). There was a positive correlation between sCD14 and CAL (r = 0.047) in the study group. A negative correlation was also observed between concentrations of sCD14 and ATL (r = -0.134) in the study group.The results indicate better periodontal status among long-term aspirin users compared to non-aspirin users.
Cone-beam computed tomographic and histological investigation of regenerative endodontic procedure in an immature mandibular second premolar with chronic apical abscess
Shetty H., Shetty S., Kakade A., Desai R., Zhang C.F., Neelakantan P.
The aim of the present study was to investigate the tissue generated after regenerative endodontic procedure (REP) in the root canal space of an immature mandibular second premolar with pulp necrosis and chronic apical abscess using cone-beam computed tomographic (CBCT) and histological methods.REP was performed in an immature mandibular second premolar. At the 3-year follow up, CBCT scans were taken to evaluate the outcome of treatment. As the tooth was not restorable to function, it was extracted and processed for histological examination.CBCT showed a reduction in size of the periradicular radiolucency, with a marginal increase in root length. Apical closure and thickening of the root canal walls were apparent. Histologically, the root canal space was filled with minimally-inflamed fibrous connective tissue. Some cementum-like mineralized connective tissue was evident on the internal canal walls. The apical third showed cementum-like deposits at the apex and the outer canal walls, without dentin formation.The present study of a structurally-failed tooth with prior REP demonstrates that the tissue formed within the root canal space was fibrous connective tissue with cementum-like deposition in the canal space. No evidence of dentin- or pulp-like tissue was found.
Comparative evaluation of subgingivally‐delivered 1% metformin and Aloe vera gel in the treatment of intrabony defects in chronic periodontitis patients: A randomized, controlled clinical trial
Kurian I.G., Dileep P., Ipshita S., Pradeep A.R.
The aim of the current study was to explore the effectiveness of locally-delivered 1% metformin (MtF) and Aloe vera (AV) gel as an adjunct to scaling and root planning (SRP) in the treatment of intrabony defects in chronic periodontitis patients.A total of 90 volunteers were randomly assigned to three treatment groups: (a) SRP + placebo gel; (b) SRP + 1% MtF gel; and (c) SRP + AV gel. Clinical parameters, including gingival index (GI), bleeding on probing (BoP), pocket probing depth (PPD), and clinical attachment level (CAL), were recorded at baseline, and 6 and 12 months. The radiological assessment of bone defect fill was done at 6 and 12 months.GI, BoP, PPD, and CAL improved in all the groups; however, the mean PPD reduction, CAL gain, and percentage of bone fill was found to be greater in the MtF and AV groups than the placebo group at all visits.Local delivery of 1% MtF and AV gel stimulates a significant PPD reduction, CAL gain, and improved bone fill and regeneration when compared with placebo gel. Results were significantly better with the use of 1% MtF gel than AV gel.
One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial
Ipshita S., Kurian I.G., Dileep P., Kumar S., Singh P., Pradeep A.R.
Alendronate (ALN) has antiresorptive and osteostimulative properties. The major component of aloe vera (AV) gel is acemannan, which has been found to have osteogenic properties. The aim of the present study is to explore the effectiveness of 1% ALN and AV gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with class II furcation defects.Ninety volunteers were randomly assigned to three treatment groups: (a) SRP plus placebo gel; (b) SRP plus 1% ALN gel; and (c) SRP plus AV gel. Clinical and radiographic parameters were recorded at baseline and at 6 and 12 months.The mean probing depth reduction and relative horizontal clinical attachment level (CAL) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12 months. Furthermore, a significantly greater mean percentage of defect depth reduction (DDR) was found in the ALN group (38.09 ± 9.53, 44.86 ± 6.29) than the AV groups (11.94 ± 15.10, 14.59 ± 25.49) at 6 and 12 months, respectively.ALN showed significant improvement in all clinical parameters, along with greater DDR, compared to AV in the treatment of class II furcation defects as an adjunct to SRP.
Treatment of gingival recession using a coronally‐advanced flap procedure with or without placental membrane
George S.G., Kanakamedala A.K., Mahendra J., Kareem N., Mahendra L., Jerry J.J.
The aim of the present study was to compare the treatment of gingival recession defects using a coronally-advanced flap procedure with or without placental membrane.Sixty teeth in 15 patients with single and multiple Miller's class I and II gingival recession defects bilaterally in the anterior and premolar region of the maxilla and mandible were divided into two groups. In group I (control), 30 recession defects were treated with coronally-advanced flap alone using Zucchelli's technique. In group II (test), 30 recession defects were treated with coronally-advanced flap along with placental membrane. Probing depth, height of the gingival recession (HGR), clinical attachment level (CAL), width of the gingival recession, and width of the keratinized tissue (WKT) were recorded at baseline and 3 and 6 months after the surgical procedures.There was a statistically-significant reduction in the HGR, gain in the CAL, and WKT in group II compared to group I.Coronally-advanced flap with placental allograft provides a reliable technique for root coverage when compared to coronally-advanced flap alone.
Sub‐epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome
Yadav A.P., Kulloli A., Shetty S., Ligade S.S., Martande S.S., Gholkar M.J.
The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.
Association between dental visiting and missing teeth: Estimation using propensity score adjustment
Bhat M., Do L.G., Roberts‐Thomson K.
The aim of the present study was to determine the association between dental visiting and missing teeth using propensity score (PS) adjustment to control for confounding bias, and to compare the estimates with those obtained from traditional regression models.A population-based study was conducted on adults aged 35-54 years in India. Multistage stratified cluster random sampling was used. Data were collected through interviews and oral examinations. The exposure factor was 'dental visiting', and the outcome was number of missing teeth. Sociodemographic factors, oral hygiene practices, periodontal disease, and caries experience were the covariates. Inverse probability weight (IPW) calculated from the PS for dental visiting from a logistic regression model was used to balance the covariates. The association between dental visiting and missing teeth was estimated from log-binomial regression models with and without using IPW.Of the 873 participants, 77.7% visited a dentist. The ≥1 missing teeth prevalence was 65.3%. Post-IPW adjustment covariate standardized bias between groups with or without dental visit was lower than the pre-IPW adjustment. Those who visited a dentist had an adjusted prevalence ratio of 2.40 when IPW was used, and 2.03 when IPW was not used.Dental visiting was strongly associated with missing teeth in this rural population.
Interleukin-34 levels in gingival crevicular fluid and plasma in periodontal health and disease with and without type-2 diabetes mellitus
Guruprasad C.N., Pradeep A.R.
The aim of the present study was to evaluate and correlate the levels of interleukin-34 (IL-34) in gingival crevicular fluid (GCF) and plasma in chronic periodontitis (CP) patients with and without type-2 diabetes mellitus (DM).A total of 175 patients were divided into five groups: (a) group I had 35 periodontally-healthy patients; (b) group II had 35 chronic gingivitis patients; (c) group III had 35 CP patients without type-2 DM; (d) group IV had 35 CP patients with type-2 DM; and (e) group V had 35 type-2 DM patients without CP. The GCF and plasma levels of IL-34 were quantified using enzyme-linked immunosorbent assay. Clinical and systemic parameters, such as gingival index, probing pocket depth, clinical attachment loss, and glycated hemoglobin levels, were evaluated.The mean IL-34 concentration in GCF and plasma was highest for group IV, followed by groups III, V, and II, and lowest in group I. The difference between them was statistically significant (P < .05). There was a positive correlation between IL-34 concentration in GCF and plasma in the study groups, with the exception of group I, for which there was a negative correlation.IL-34 can be considered a possible GCF and plasma inflammatory biomarker of periodontal disease progression and DM.
