Modifications in the Free Gingival Graft Technique: A Systematic Review

Free gingival grafts (FGGs) have developed beyond covering exposed roots to improve the width and thickness of gingival tissue. While traditional FGGs have shown a high success rate and are easy to apply, they have some drawbacks, such as potential aesthetic concerns and bulky appearance. Recent advancements in FGGs have been explored, with different modifications proposed to overcome these limitations, including partly epithelialized FGGs (PE-FGG), gingival unit grafts, and epithelialized subepithelial connective tissue grafts. This systematic review aims to evaluate published case reports that discuss the utilization of modified approaches to FGG treatment and their outcome.

The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers

BACKGROUND

Locally delivered doxycycline is found to be effective in managing periodontitis as an adjunct to scaling and root planing.

AIM

To evaluate the effect of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers and to compare it with scaling and root planing alone.

METHODS

Twelve smokers with chronic periodontitis and a pocket depth (⩾5 mm) on posterior teeth that bleed on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, clinical attachment level (CAL), and probing depth (PD) were recorded at the baseline, 6 and 12 weeks.

RESULTS

Both groups showed a significant reduction in Plaque, Bleeding on Probing and pocket depth at 6th and 12th week from the baseline. A statistically significant gain of attachment was observed in both groups after treatment. Even though the doxycycline group showed slightly higher attachment gain it was not statistically significant compared to the control group.

CONCLUSION

The observations of the study reveal that the additional benefit of topical application of doxycycline as an adjunct to scaling and root planing in smokers is not convincing. However, further clinical studies may be necessary to substantiate the present observations.

Oral hygiene status among orthodontic patients

AIM

The aim of this study was to evaluate the oral hygiene status of patients with fixed orthodontic appliances.

METHODS AND MATERIALS

The following indices were used to evaluate the oral hygiene status of patients in orthodontic treatment: gingival bleeding index (GBI), plaque index (PI), and ortho-plaque index (OPI). A self-administrated questionnaire was prepared covering oral hygiene practice, oral hygiene cleaning aids, and number of visits to a dental hygienist.

RESULTS

Fifty patients (15-30 years old) were selected for the study from among the orthodontic patients treated at the King Saud University College of Dentistry, Riyadh, Saudi Arabia. Results showed that the PI and OPI were high with mean scores of 65.24 (SD 16.43) and 53.56 (SD 8.74) respectively, while the average GBI was a much lower value at 19.14 (SD 7.95). No significant difference was observed between male and female patients for the PI (p=0.925) and for the OPI (p=0.072), but a significant difference was observed for the GBI at the 5 percent significance level (p=0.033). The result of OPI showed that 20 (40 percent) of the patients had fair oral hygiene, whereas 30 (60 percent) had poor oral hygiene. Only 16 (32 percent) of the participants reported visiting the dental hygienist during their orthodontic treatment, while the remaining 34 (68 percent) did not.

CONCLUSIONS

The oral home care of the orthodontic patients surveyed was not at an optimal level, which indicated the need to establish an oral hygiene maintenance program.

CLINICAL SIGNIFICANCE

Inadequate oral home care among orthodontic patients may make them more prone to develop gingivitis during orthodontic treatment. It is, therefore, essential that oral hygiene instructions and a hygiene maintenance program not be overlooked during orthodontic treatment.

Serum immunoglobulin levels in type 2 diabetes patients with chronic periodontitis

AIM

The association between diabetes and periodontal disease has been well documented. Periodontitis is associated with alterations in immune responses in both diabetic and nondiabetic subjects. While diabetes is considered to be a risk factor for periodontal disease progression, few studies have demonstrated an association between the level of glycemic control and periodontal disease. Although poor glycemic control is significantly associated with poor periodontal health, few studies have been performed in Saudi Arabia to evaluate the immune responses in poor and better glycemic control and its effect on periodontal tissue. The aim of this study is to assess serum immunoglobulin levels (IgA, IgG, IgM) in type 2 diabetic (poor control and better control) and nondiabetic subjects with chronic periodontitis.

METHODS AND MATERIALS

A total of 105 female patients were included in the study and they were divided into three groups, with 35 patients in each group. Group 1 was comprised of cases of diabetes exhibiting better control (HbA1c</=9%) and Group 2 was comprised of cases of diabetes exhibiting poorer control (HbA1c>9%). The third group was comprised of nondiabetic subjects with chronic periodontitis. In this study, clinical examination included plaque index, bleeding on probing, probing pocket depth, and attachment level (measured in all three groups). Serum immunoglobulin (IgA, IgG, IgM) levels were estimated and compared to the levels estimated for diabetic controls.

RESULTS

Mean plaque index, bleeding index, and probing pocket depth showed no significant differences among the three groups. However, mean clinical attachment loss was significantly higher for Group 2 as compared to Groups 1 and 3. IgA and IgG levels were found to be significantly higher in Group 2 (poorly controlled diabetes) as compared to Group 1 (better control) and Group 3 (control group). There is a positive correlation between CAL and IgA and IgG, whereas there is a negative correlation between CAL and IgM.

CONCLUSION

The present study indicates that poor glycemic control may be associated with the increase in IgA and IgG serum antibodies. Elevated antibody levels may explain why poorly controlled diabetes exacerbates periodontal disease.

CLINICAL SIGNIFICANCE

These findings demonstrate the importance of the immune system as well as good glycemic control, especially in patients diagnosed with periodontitis. The changes observed in immune response may be the cause or the effect of periodontal disease in diabetic patients. The increased incidence of periodontitis in diabetic patients suggests that the alteration in immune response may contribute to the pathogenesis of periodontitis in patients with poorly controlled diabetes.

Evaluation of periodontal status in subjects with hyperlipidemia

AIM

The aim of this study was to evaluate the periodontal status in subjects with hyperlipidemia and to determine whether there is any association between hyperlipidemia and periodontal disease.

METHODS AND MATERIALS

Sixty female patients were enrolled in the study; group one is hyperlipidemic patients (30 subjects) and group 2 is systemically fit patients within the same age group (control; 30 subjects). In both groups body mass index (BMI) and clinical parameters were measured; plaque index (PI), bleeding on probing (BOP), pocket depth (PPD) as well as clinical attachment level (CAL) and biochemical parameters, including plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels, were evaluated.

RESULTS

The mean values of BMI, PPD, CAL, PI (%), and BOP (%) for the hyperlipidemia group were significantly higher than those for the control group. Total cholesterol and LDL-C levels were significantly and positively associated with CAL. Plasma triglyceride level was significantly associated with PPD and CAL.

CONCLUSIONS

The results of our study showed that female patients with hyperlipidemia had higher values of periodontal parameters compared to control individuals. However, in the future studies with larger sample sizes in mixed gender populations are needed to determine the association between hyperlipidemia and periodontal disease.

CLINICAL SIGNIFICANCE

The results of our study showed that female patients with hyperlipidemia might manifest clinically higher values of periodontal parameters compared to nonlipdemic individuals. However, due to the small sample size of this study the exact association between hyperlipidemia and periodontal disease is still uncertain. Care has to be taken with a hyperlipidemia patients and advice can be given to them for periodic periodontal checkup.

Evaluation of the relationship between type 2 diabetes and periodontal disease

The association between periodontal disease and diabetes mellitus has been explored by many researchers over the years. Periodontal signs and symptoms are now recognized as the 'sixth complication of diabetes'. The objective of the present study was to investigate the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severity of periodontal disease. A total of 126 Saudi female patients diagnosed with type 2 Diabetes were examined. Group I (better control with Hb A1 c less than 9%) included 74 patients, and Group II (poor control with Hb A1c more than 9%) included 52 subjects. The periodontal parameters recorded were plaque index, bleeding index, presence of calculus, pocket depth measurement and clinical attachment level. These parameters were evaluated in a randomized half mouth examination on four sites of each tooth (mesial, distal, buccal and lingual). The results of this study showed that the age, duration of diabetes, percentage of plaque index and bleeding index showed no significant difference between the two groups. In contrast, there was a significantly higher percentage of calculus, PD > or = 4 mm and loss of attachment level (3-4 mm) in the poorly controlled diabetic patients, as compared to the better-controlled group. The result obtained showed a significant association of the loss of attachment level (3-4 mm) with periodontal disease in poorly controlled diabetic patients, as compared to better-controlled patients. Poor-control diabetics (group II) exhibited an increased percentage of calculus and greater risk for periodontitis.

Broken appointment behavior in a dental school environment

The present study was designed to determine the prevalence of broken appointments of female and male patients scheduled for third, fourth, and fifth year dental students. Data was obtained from computers used for patient scheduling at two campuses of the dental college. The proportion of broken appointments at these facilities was computed using the X2 -test to determine a difference between males and females. Results showed that male patients (14.9%) had a higher proportion of broken appointments than female patients (12.4%). Such differences among gender was statistically significant (p=4.218). The highest percentage of broken appointments was during December of 2001. Thirty four percent of these broken appointments were in the Restorative Clinic at the Darraiyah Campus (DUC) serving primarily male patients and 24% in the Removable Partial Denture Clinic at the Malaz Campus (MUC) serving only female patients. It was concluded the percentage of broken appointment s is considered to be unacceptable because of the negative impact on student learning and, ultimately, their academic progress.

Clinical evaluation of cervical dentin sensitivity (CDS) in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC)

AIM

The objective of this study was to compare the prevalence, severity and distribution of CDS in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC) and to correlate them to possible causal factors.

MATERIAL AND METHODS

2 groups of patients aged 20-60 years recruited from GDC (144) and PSC (151) were evaluated for CDS by means of a questionnaire and intraoral clinical examinations. Furthermore, gingival recession and plaque scores were recorded at the same visit.

RESULTS

The results showed that patients referred to PSC had a significantly higher prevalence of CDS (60.3%) than those examined at GDC (42.4%) (p<0.001). Also, mean plaque scores of PSC patients (1.87 +/- 0.88) was found to be significantly higher than that of GDC (1.44 +/- 0.7) (p<0.01). The occurrence and extent of gingival recession associated with hypersensitive teeth was significantly higher in PSC than GDC patients (p<0.01), with a 5% incidence of severe recession (5 mm) in PSC only. The association of periodontal disease and periodontal treatment to the high prevalence of CDS and gingival recession in PSC patients would suggest their role in predisposition to hypersensitivity. The distribution of CDS in tooth types revealed that upper molars and lower anteriors of PSC patients were mainly affected, and followed by, to a lesser extent, lower right canine and right first molars of GDC patients.

CONCLUSION

The prevalence of CDS among our periodontal patients appears somewhat lower than that reported in periodontal specialty clinics of earlier studies but still higher than those reported in other dental populations. This indicates that periodontal disease and its treatments may increase the occurrence of hypersensitivity.

Prevalence and distribution of dentin hypersensitivity and plaque in a dental hospital population

OBJECTIVE

Dentin hypersensitivity (DH) is a commonly reported dental problem. Conflicting results on the degree of plaque accumulation at sites with DH have been reported. Therefore, the prevalence and distribution of DH and dental plaque were studied in a dental hospital population.

METHOD AND MATERIALS

A total of 302 adult patients were examined for the presence of DH by means of a questionnaire and intraoral examinations. Oral hygiene was measured by Silness and Löe's Plaque Index.

RESULTS

The overall prevalence of DH was 52.6%. Significantly more women complained of DH than men. Dentin hypersensitivity and Plaque Index scores were found to be significantly higher in the older age group than in younger groups. Spearman's correlation test revealed no correlation for DH with plaque. About half of the patients reported DH for a duration of within 1 month, while 23% claimed that their DH lasted for 1 to 5 years. Approximately 64% of the patients reported that sensitivity did not interfere with their ability to eat, drink, or brush their teeth, with slight to moderate discomfort, while 11.4% had a severe concern, thereby avoiding these activities most of the time. Of the patients, 17% received professional treatment, while 25% used desensitizing toothpastes. Dentin hypersensitivity was found in all types of teeth, but was most common in first molars and mandibular incisors and canines.

CONCLUSION

Because there was no correlation for DH with plaque, a careful assessment of the etiologic or predisposing factors must be considered before attempting the management of patients complaining of hypersensitive teeth.

The utility of a single glucometer measurement of fasting capillary blood glucose in the prevalence determination of diabetes mellitus in an urban adult Palestinian population

This paper aims to evaluate the utility of a single glucometer fasting capillary blood glucose (FCBG) measurement in determining the prevalence of diabetes mellitus in a homogeneous adult population. FCBG measurements were compared with results of the oral glucose tolerance test (OGTT) in 445 subjects aged 30-65 years in an urban cross-sectional study in Old Ramallah. Prevalence of diabetes, sensitivity, specificity and predictive values were calculated at different cut-off levels of FCBG, using OGTT as the reference. The prevalence of OGTT-diagnosed diabetes was 2.7%, while it varied considerably using different cut-off levels of FCBG. The sensitivity of a single glucometer (Exac Tech II) measurement of FCBG at the cut-off level of 6.7 mmol 1(-1) was 33.3%, with a specificity of 98.8%. Using the cut-off level of 6.1 mmol 1(-1) as suggested by the 1998 provisional report of a WHO consultation, the sensitivity increased to 41.7%. At a cut-off level of 5.6 mmol 1(-1), a sensitivity of 66.6% was reached, but the specificity decreased slightly. It can be concluded that a single glucometer measurement of FCBG in an adult population is not useful in determining the prevalence of diabetes mellitus.

Type 2 diabetes mellitus, impaired glucose tolerance and associated factors in a rural Palestinian village

AIMS

To investigate the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and to identify risk factors associated with diabetes in a rural Palestinian village.

METHODS

A cross-sectional, population-based study investigating 500 adults aged 30-65 years (response rate 85%) determined the diabetes status using the oral glucose tolerance test (OGTT). A standard questionnaire, a simple clinical examination and laboratory tests assessed blood lipids, blood pressure, waist-to-hip ratio (WHR), body mass index (BMI) and other risk factors for diabetes

RESULTS

The prevalence of Type 2 diabetes was 9.8% (95% confidence interval 7.3-12.3) and IGT 8.6% (6.1-11.1), while the prevalence standardized to the European population was 11.6% (8.8-14.4) for Type 2 diabetes and 10.3% (7.6-13.0) for IGT. Age, positive family history, high triglycerides level, and high WHR were significantly associated with Type 2 diabetes.

CONCLUSIONS

Of the factors associated with diabetes, WHR and triglycerides levels are potentially modifiable, and should be addressed by preventive health activities. The high prevalence of Type 2 diabetes mellitus and its potential increase as a result of the ageing of the Palestinian population constitutes a major public health problem.

Prevalence of diabetes mellitus and impaired glucose tolerance in a rural Palestinian population

The prevalence of diabetes mellitus and impaired glucose tolerance was investigated in a cross-sectional population-based study in a rural Palestinian population of 500 females and males aged 30-65 years. The prevalence of diabetes was 9.6% and 10.0% in females and males respectively. The prevalence of impaired glucose tolerance was 8.6%; 10.3% in females, 6.2% in males. The prevalence of total glucose intolerance (diabetes mellitus + impaired glucose tolerance) was 18.4%. Our study provides the first baseline data on diabetes mellitus and impaired glucose tolerance in Palestine. The results indicate a high prevalence of glucose intolerance, information that is essential for the implementation of national planning and service provision.

The effect of smoking on periodontal conditions assessed by CPITN

One hundred eighty subjects were examined to assess the effect of smoking on periodontal conditions by community periodontal index for treatment needs (CPITN). All subjects were interviewed regarding their oral hygiene habits. Data were entered to the computer and statistical analysis system (SAS) was utilised. Results showed that the frequency of smokers is 31% where 25.9% of this were male. Smokers use toothbrush in performing their oral hygiene more than non-smokers. Results also showed that periodontal conditions as measured by CPITN were not significantly different between smokers and non-smokers. However, further studies with more sensitive periodontal indices are recommended in the future to assess the differences between both groups.