Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study

BACKGROUND

The brownish-black pigmentation of the gingiva has been reported in several countries. However, the available literature pertaining to the Asian population suggests that this pigmentation is more predominant in individuals with dark complexion. Although there is available literature on the intensity of gingival pigmentation with different age groups in Japanese and Israel population, no such literature pertaining to age and intensity of melanin pigmentation is available in the Indian population.

AIM

This study aims to observe the intensity of melanin pigmentation in different age groups in the Indian population.

METHODS AND MATERIALS

Intensity of melanin pigmentation was observed by the gingival melanin pigmentation index as given by Ponnaiyan et al. in 250 individuals who were grouped under the age group of 0-5 years, 6-9 years, 10-12 years, 13-15 years, and 16-20 years. Each group comprised 25 individuals.

RESULTS AND CONCLUSION

The results were subjected to statistical analysis so as to observe the intensity of melanin pigmentation at different age groups in the Indian population. It was concluded that with age, the intensity of gingival melanin pigmentation, as well as its distribution to the posterior gingiva was increased. As age increased, gingival pigmentation was more in the attached and interdental papilla, while in the younger age groups, it was confined either only to the interdental, marginal or attached gingival, or both depending on the skin color.

Efficacy of Milk as a Desensitizing Agent for the Treatment of Sensitivity Following Scaling and Root Planing

Background:

Dentine hypersensitivity (DH) is the most common problem encountered by most of the dentists in their day-to-day clinical practice. It is characterized by a sharp pain or discomfort arising as a response to thermal, chemical, or osmotic stimuli and is caused due to exposure of dentine after the enamel or cementum at the root surface has been lost by the treatment, underlying dental and gingival diseases or physiologic wear and tear of the teeth. This further complicates preventive oral hygiene procedures by the patients, which jeopardize periodontal treatment or may as well aid in periodontal treatment failure.

Aim and Objective:

To evaluate the efficacy of commercially available milk as a desensitizing agent for the treatment of sensitivity following scaling and root planing.

Materials and Methods:

Patients were selected randomly for scaling and then assessed for sensitivity. Those patients having DH were divided into two groups, wherein the Group A (test) patients were advised to rinse with commercially available milk at room temperature and those in Group B (control) with a commercially available mouthwash (Sentosil-SF). A four-point verbal rating scale was designed to record the numerical value of DH and were recalled for follow-up on 4^th, 7^th, and 10^th day posttreatment.

Results:

The study demonstrated that there was a considerable reduction in hypersensitivity in both the groups on the 7^th and 10^th day. In the milk group, eight patients showed a complete reduction in hypersensitivity on 7^th day and 13 patients on 10^th day, while in the mouthwash group, five patients showed the same on 7^th day and ten patients on the 10^th day, thus suggesting that more individuals in the milk group were benefited. However, there was no statistically significant difference between the groups in every visit.

Conclusion:

Although there is a vast literature available which suggests the efficacy of commercially available mouthwash in reducing hypersensitivity, this study is the first of its kind which evaluates the efficacy of commercially available milk in reducing sensitivity which is induced postscaling. Considering that milk rinse is cheap and easily available at home, it can be used as a desensitizing agent, and rinsing with milk for few days is effective and stable in quick reduction of hypersensitivity induced by scaling.

Fear and Anxiety among patients treated by scaling in Periodontally healthy subjects

Background: Anxiety and fear experience represent significant problems in dental practice and are the factors that discourage the demand for treatment. They affect the use of health care services, treatment decision-making, and responses to periodontal treatment.Aims and Objectives: The aim of this study was to evaluate fear and anxiety in patients undergoing scaling and root planing.Materials and Methods: Total of 80 patients were selected and grouped into 20-35 yrs and 40-55 yrs and each age group had 20 males and 20 females, so  40 were males and 40 were females. They were given a structured questionnaire dealing with dental fear and dental anxiety to fill. Statistical analysis was done by Tukey’s multiple post hoc, Two-way ANOVA and Chi –square test.Results: The mean dental anxiety score (DAS) for males was 6.67±3.24 and for females it was 6.57±2.30. The mean DAS score for 20-35yrs was 6.025±2.37 and for 40-55yrs it was 7.22±3.02. But statistically significant difference was not found in the DAS scores in both sex and age groups. The mean dental fear survey (DFS) for males was 28.9±9.4 and for females was 30.5±6.56. The mean DFS score for 20-35yrs was 28.42±8.06 and for 40-55yrs it was 30.97±7.89. But this in the DFS scores was also not found statistically significant in both sex and age groups. When DAS and DFS scores were compared, there was a statistically significant correlation.Conclusion: An understanding of the presence of the anxiety and fear can help dentists to understand what patients feel about dental treatment procedures and aid dentist efforts to improve patients care. They should treat patients and seek to avoid fear and anxiety and discomfort in their patients caused by the treatment.Asian Journal of Medical Sciences Vol.8(1) 2017 77-81

Reconstruction of Extensive Bucco-Palatal Defects Using Twin Block Grafts: A Clinical Report of the Sandwich Technique in Two Cases

INTRODUCTION

Three-dimensional alveolar ridge defects in the anterior maxilla necessitate bone augmentation before implant placement. Bone volume, contour, and the overlying soft tissue form have to be optimized for an ideal outcome. A large three-dimensional defect needs osteogenic bone to predictably reconstruct the defect. Autogenous bone in the form of block and particulate is the graft of choice in such situations.

CASE SERIES

Two cases are presented here with severe three-dimensional alveolar ridge deficiency in the maxillary right lateral incisor and maxillary canine areas, respectively. Both cases had a three-dimensional bone and contour deficiency. Restorative-driven positioning of the implant necessitated augmentation of the buccal and palatal aspects of the defects. The defects were grafted with autogenous corticocancellous bone blocks harvested from the mandibular symphysis. In both sites, one block was placed on the buccal side and the other on the palatal side, "sandwiching" the host bone and the remainder of the gap filled with particulate autogenous bone. Implants were placed in both cases 5 months after the grafting, and the final restorations were placed 5 months subsequently. The implants and the grafts successfully integrated at the sites with stable bone and soft tissue levels. At the 3-year follow-up, both implants showed stable bone and soft tissue levels.

CONCLUSION

Autogenous corticocancellous block grafts used in a sandwich technique reconstructed the lost bone volume, but also facilitated implant placement and optimal restorative outcomes.

Efficacy of subgingivally delivered atorvastatin and simvastatin as an adjunct to scaling and root planing

BACKGROUND

The current understanding of the pathogenesis of periodontal disease has resulted in adjunctive use of various pharmacologic agents in periodontal therapy. The objective of this investigation was to assess the efficacy of atorvastatin and simvastatin (because of their pleiotropic properties) as an adjunct to dental scaling and root planing (SRP) by local delivery, i.e. placing them subgingivally, in the treatment of chronic periodontitis.

METHODS

Local delivery systems for atorvastatin and simvastatin were prepared in sodium alginate suspension to be administered with calcium chloride solution. Patients diagnosed with chronic periodontitis were grouped as group 1, receiving SRP only (control), group 2, receiving SRP with subgingival delivery of 1.2% simvastatin, and group 3, receiving SRP with subgingival delivery of 1.2% atorvastatin. Clinical parameters and interleukin (IL) 1α levels in the gingival crevicular fluid (GCF) were assessed.

RESULTS

All three groups showed significant reductions in clinical parameters and IL-1α levels in the GCF (p<0.05). However, the test groups did not show any statistically significant difference when compared with control.

CONCLUSIONS

Subgingivally delivered atorvastatin and simvastatin as an adjunct to SRP is efficacious but did not demonstrate any added benefit as compared with SRP alone.

Interlinking Periodontitis and Type 2 Diabetes Mellitus by Assessment of Crevicular Visfatin Levels in Health and in Disease Before and After Initial Periodontal Therapy

INTRODUCTION

Visfatin is a new adipocytokine associated with both chronic periodontitis and type 2 diabetes mellitus independently.

AIM

We aimed to estimate and compare the changes in the levels of visfatin in the Gingival Crevicular Fluid (GCF) of healthy subjects and in subjects with periodontitis with or without controlled Type 2 Diabetes Mellitus (T2DM) after administration of non-surgical periodontal therapy.

MATERIALS AND METHODS

Forty two subjects were equally divided into Group 1 (healthy), Group 2 (systemically healthy with chronic periodontitis), Group 3 (subjects with chronic periodontitis having controlled T2DM). Defined clinical parameters were recorded at baseline and at one month follow-up period. Visfatin was assessed using enzyme linked immunosorbent assay. One way ANOVA and Tukey's multiple post hoc procedures were used. Pearson's correlation coefficient was used for correlation.

RESULTS

Significant increase in the visfatin levels was seen with the highest values observed in diabetes with periodontal disease. Visfatin responded to non-surgical periodontal therapy as observed by significant decrease in levels after one month but even at this period diabetics showed the highest levels.

CONCLUSION

Visfatin levels are highest in individuals with both periodontal disease and diabetes even after periodontal therapy. Individuals with T2DM may be at higher risk of developing periodontal disease.

Rehabilitation of a missing ear with an implant retained auricular prosthesis

Burns can leave a patient with a severely debilitating disability even after treatment. The objectives of burn rehabilitation are to minimize the adverse effects caused by the injury while rehabilitating the patient's physical and psychological well-being, maximizing social integration. Long-term success of maxillofacial prostheses mainly depends on the retention. Extra oral implant retained prostheses have proved to be a predictable treatment option for maxillofacial rehabilitation. Replacement of a severely deformed external ear with burned tissues may be satisfactorily accomplished by a cosmetic prosthesis anchored by implants integrated in the skull. The use of such implants is now a well-recognized method for creating a stable result in maxillofacial rehabilitation. This case report describes a safe, simple and economical method for the rehabilitation of a patient with missing right auricle using an implant supported silicone prosthesis. The implant was placed in the mastoid region of the temporal bone. Reconstruction of the ear was done with auricular silicone prosthesis, retained using magnets incorporated in an autopolymerizing resin shim to decrease the weight of the prosthesis on a single implant. This method eliminates the need of tedious laboratory procedures and exact casting and fitting requirements of a metal substructure while minimizing the overall weight and cost of the prosthesis while maintaining adequate support, esthetics and retention of the prosthesis.

Evaluation of soft tissue marginal stability achieved after excision with a conventional technique in comparison with laser excision: A pilot study

BACKGROUND

Soft tissue excision around natural teeth is carried out to increase the clinical crown lengths, expose the caries apical to the gingival margins and to correct irregular and un-esthetic soft-tissue contours.

AIMS

The study was carried out with an aim to evaluate the stability of the soft tissue margins after excision either with a laser or scalpel.

MATERIALS AND METHODS

A total of 20 patients indicated for soft tissue excision for correcting soft tissue discrepancies were selected. The patients with thick gingival biotype were included in the study. They were grouped randomly into excision by laser or scalpel methods. The change in the soft tissue positions from the time of excision to 1-month follow-up were evaluated immediate postoperatively, after 2 weeks and after 1-month postrestoration.

RESULTS

The soft tissues remained stable in the laser group at 1-month follow-up, in contrast to the scalpel group and were found to be statistically significant, (Student's t-test) (P < 0.05).

CONCLUSION

The soft tissue margins are more stable and stay at the point they were excised with lasers when compared with scalpel.

Evaluation of holy basil mouthwash as an adjunctive plaque control agent in a four day plaque regrowth model

Objectives: Various antibacterial and antiplaque agents are used in chemical plaque control but none are without their shortcomings. Chlorhexidine considered a gold standard, also has an array of side effects. To overcome these, numerous herbal extracts have been tried and tested and one among them is holy basil. The present study evaluated the antibacterial efficacy of holy basil in vitro against some periodontopathogens and its antiplaque effect in vivo. Study Design: Thirty periodontally healthy volunteers were randomly divided into three groups and refrained from all mechanical oral hygiene measures for 4 days and used one of the randomly assigned mouthwash (1- chlorhexidine; 2- holy basil; and 3- sterile water [placebo]) twice daily. The Plaque Index (PI) was assessed at days 0 and 5. Aqueous extract of holy basil was tested against Prevotella intermedia (P. intermedia) and Fusobacterium nucleatum (F.nucleatum). Results: Holy basil extract showed inhibition of both the tested periodontopathogens (P.intermedia and F.nucleatum) at various concentrations. In all groups, the PI increased from baseline to day 5. There was a statistically significant difference (p < .05) between the chlorhexidine and placebo rinse and the holy basil and placebo rinse, but no statistically significant difference was found between the chlorhexidine and holy basil rinse with respect to PI. Conclusions: These results indicate that the holy basil mouthwash has an antiplaque effect and is efficacious against P. intermedia and F. nucleatum strains in vitro. Hence holy basil mouthwash may have potential as an antiplaque mouthwash with prophylactic benefits.

Key words:Antibacterial agent, basil, Fusobacterium nucleatum, mouthwashes, Prevotella intermedia.

A short-term evaluation of the relationship between plasma ascorbic acid levels and periodontal disease in systemically healthy and type 2 diabetes mellitus subjects

BACKGROUND

Deficient ascorbic acid levels (AALs) and Type 2 diabetes mellitus (T2DM) are associated with periodontal disease. This study evaluated the relationship between plasma AAL and periodontitis in systemically healthy and T2DM subjects, which to the best of our knowledge is being reported for the first time.

METHODS

One hundred twenty subjects were categorized into four groups of 30 each as group 1: without periodontal disease; group 2: chronic gingivitis; group 3: chronic periodontitis, and group 4: chronic periodontitis and freshly diagnosed T2DM. Plaque index (PlI), sulcus bleeding index (SBI), and probing pocket depths (PPDs) were evaluated. Venous blood was evaluated for plasma AAL spectrophotometrically. Randomized subjects were subgrouped within groups 2-4, to receive either scaling and root planing (SRP) with dietary supplementation (450 mg) of ascorbic acid (AA) for two weeks or only SRP. After two weeks, the clinical parameters were reassessed. Tukey's multiple post hoc procedures and paired t test were used with the level of statistical significance adjusted to p ≤ .05.

RESULTS

AAL plasma levels were significantly greater in group 1 than in group 2 (p = .0007) and in group 4 (p = .0003). A significant reduction in the SBI was seen in the subgroups that received dietary supplementation of vitamin C within group 2 (p = .0012) and group 4 (p = .036).

CONCLUSIONS

Plasma AAL is below the normal range in systemically healthy subjects with gingivitis and diabetics with periodontitis. Dietary AA supplementation with SRP improves the SBI in subjects with gingivitis and diabetics with periodontitis.

Salivary and gingival crevicular fluid histatin in periodontal health and disease

Objectives: Histatin, with its anti bacterial, anti protease, and wound closure stimulating property might influence the pathogenesis of periodontal disease. This study assessed the presence of histatin in gingival crevicular fluid (GCF); the levels of salivary and GCF histatin in periodontal disease. Material and methods: It was a cross sectional study that included systemically healthy forty five subjects (22 males and 23 females) between the age group of 20 to 45 years. Based on Gingival Index (Loe and Silness ,1963) and Russell’s Periodontal Index they were grouped as 15 healthy (Group 1), 15 gingivitis (Group 2), and 15 periodontitis (Group 3) subjects. Whole pooled unstimulated saliva was collected by asking the patient to spit in a sterile container and GCF samples were collected using a micropipette from all the subjects. Histatin levels were assessed using Enzyme Linked Immunosorbent Assay (ELISA). The intergroup comparison was done by ANOVA and Mann Whitney U Test was done for pair wise comparison. Results: The results of this study show that histatin is present in saliva and gingival crevicular fluid. When the salivary histatin levels were compared it was found that the levels of histatin increase from health to periodontitis but the levels of histatin in the gingival crevicular fluid and saliva had no correlation with severity of periodontal disease as there was no statistically significant difference between the three groups. Conclusions: It can be concluded that histatin cannot be used as a potential marker of periodontal disease.

Key words:Periodontal disease, histatin, gingival crevicular fluid, saliva, gingival index, periodontal index, enzyme linked immunosorbent assay.

Comparative evaluation of diode laser, stannous fluoride gel, and potassium nitrate gel in the treatment of dentinal hypersensitivity

The aim of the present study was to compare the efficacy of diode laser (DL) with stannous fluoride and potassium nitrate gels in the treatment of dentinal hypersensitivity (DH). Fifty-four subjects, ages 25-45, having 2 adjacent teeth sensitive to air blast stimulation were included. The subjects were divided randomly into 3 groups (n= 18): Group A, subjects treated with DL; Group B, subjects treated with 0.4% stannous fluoride gel; and Group C, subjects treated with 5% potassium nitrate gel. Each group was evaluated at baseline; at weekly intervals for 2 consecutive weeks; and at 1, 3, and 6 months. All 3 groups showed decreases in the DH scores between baseline and 6 months This was more pronounced in Group A at all time intervals. When the 3 groups were compared between baseline and Week 1, there was a statistically significant decrease across all 3 groups between (P = 0.0020). The greatest difference in the DH scores between baseline and Week 1 was in Group A, compared to Groups B and C. The 940 nm DL was not only efficacious, but also brought about improved immediate relief as compared to stannous fluoride and potassium nitrate gels in the reduction of DH.

A clinical study of the effect of calcium sodium phosphosilicate on dentin hypersensitivity

Objective: Dentinal hypersensitivity is a commonly encountered problem with varied treatment options for its management. A large number of home use products have been tested and used for the management of dentinal hypersensitivity. This 8 week clinical trial investigates the temporal efficacy of commercially available calcium sodium phosphosilicate containing toothpaste in comparison to a potassium nitrate containing toothpaste. Methods: A total 20 subjects between the ages of 18 to 65 years were screened for a visual analogue score (VAS) for sensitivity of 5 or more by testing with a cold stimulus and randomly divided into test and positive control groups. Baseline sensitivity VAS scores to air evaporative stimulus were recorded for minimum two teeth. The subjects were prescribed respective dentifrices and revaluated for sensitivity scores at 2, 4 and 8 weeks. Results:The study demonstrated reduction in symptoms for all treatment groups from baseline to 2, 4 and 8 weeks. The calcium sodium phosphosilicate group showed a higher degree of effectiveness at reducing hypersensitivity to air evaporative stimulus at 2 weeks, than commercially available potassium nitrate. However, there was no significant difference in scores of subjects using the calcium sodium phosphosilicate toothpaste as compared to potassium nitrate at 4 weeks and 8 weeks. Conclusion: Calcium sodium phosphosilicate showed greater reduction in sensitivity compared to potassium nitrate at an earlier stage which is of high clinical value. However, based on the findings of the present study long term effects of calcium sodium phosphosilicate seem to be less promising than previously claimed.

Key words:Dentinal desensitizing agents, dentinal hypersensitivity, toothpaste, pain measurement.

Measurement of gingival thickness using digital vernier caliper and ultrasonographic method: a comparative study

BACKGROUND

The measurement of the thickness of the gingival tissues has been done using different techniques. Trans-gingival probing with a graduated probe, use of vernier calipers, ultrasonography and cone-beam computed tomography (CBCT), have all been tried, but no one technique has been shown to be consistent and better than the others. The present study was done to evaluate and compare the gingival thickness as measured with a digital vernier caliper and ultrasonography.

METHODS

A total of 30 systemically healthy, non-smokers were included in the study. The gingival measurements were made and recorded from the maxillary and mandibular lateral incisor areas at 2 locations: (a) at a point apical to the free gingival groove; and (b) at a point immediately coronal to the muco-gingival junction.

RESULTS

The mean gingival thickness ranged from 0.56 to 1.02 mm. Males had a significantly thicker gingiva as compared to females (P < 0.10). Significant differences were not observed when the measurements made using the digital vernier caliper and those made with ultrasonography were compared.

CONCLUSIONS

The thickness of the gingiva was in the range of 0.56-1.02 mm. A digital vernier caliper and ultrasonography both can be used to assess the gingival thickness with equal accuracy.

Determination of thickness of palatal mucosa

BACKGROUND

The palatal masticatory mucosa is widely used as a donor material in periodontal plastic surgery. The thickness of graft tissue is an important factor for the graft survival. The purpose of this study was to determine the thickness of palatal mucosa by a bone sounding technique. The association of age and gender with the thickness of palatal mucosa was also examined.

MATERIALS AND METHODS

Twenty four healthy subjects had participated in the study. The younger age group of 16-30 years consisted of 12 subjects of 7 females and 5 males, and the older age group of 31-54 years consisted of 12 subjects, of 5 females and 7 males. A bone sounding method using a periodontal probe was done to assess the thickness of palatal mucosa at 15 measurement sites defined according to the gingival margin and palatal line. Mann-Whitney test was used to determine the difference in mucosal thickness between both the groups.

RESULTS

The younger age group had thinner mucosa ranged from 2 to 3.1 mm in thickness than the older age group which ranged from 3.2 to 3.7 mm. In the same age group, females had thinner mucosa than males in the same age group. The mean thickness of palatal masticatory mucosa ranged from 2.5 to 3.7 mm.

CONCLUSION

The younger subjects had thinner mucosa than older subjects. The canine and premolar areas appeared to be the most appropriate donor site for grafting procedures.

Efficacy of calcium sodium phosphosilicate in managing dentinal hypersensitivity

A large number of home use products have been tested and used for managing dentinal hypersensitivity. This eight-week clinical trial compared the temporal efficacy of a commercially available toothpaste containing calcium sodium phosphosilicate to that of a toothpaste containing potassium nitrate. For this study, 20 subjects (age 18 - 65) were screened using a visual analog scale (VAS) for sensitivity to a cold stimulus. Baseline VAS sensitivity scores to tactile stimulus were recorded for a minimum of two teeth per patient. Dentifrices were prescribed for all patients and sensitivity scores were re-evaluated at two, four, and eight weeks. Though both groups showed significant reductions in sensitivity scores, only at eight weeks was there a marginally significant difference (p = 0.0551) in sensitivity scores between the test group and the positive control group.

Periodontal disease and anemias associated with Crohn's disease. A case report

Crohn's disease (CD) is an inflammatory bowel disease with oral findings, including periodontal manifestations. Anemias, such as iron deficiency and anemia of chronic disease (ACD), are the most common hematologic complications of CD. Periodontitis has systemic effects, and may tend toward anemia, which can be explained by depressed erythropoiesis. In the report presented here, the authors review a case of Crohn's disease diagnosed 10 years previous to the patient presenting with a changing anemic profile and periodontal disease. A discussion of patient and disease management is included.

Comparison of radiovisiography and digital volume tomography to direct surgical measurements in the detection of infrabony defects

OBJECTIVES

To compare the linear measurements of Radiovisiography (RVG) and Digital volume tomography (DVT) to direct surgical measurements in the detection of periodontal infrabony defects.

STUDY DESIGN

RVG and DVT images were taken prior to periodontal surgery for 28 infrabony periodontal defects. After defect debridement, direct bony defect measurements were made from the cemento enamel junction (CEJ) to the base of the defect (CEJ-BD) and to the alveolar crest (CEJ-AC) with a periodontal probe. These same measurements were made on the RVG and DVT images and then compared to the direct surgical values.

RESULTS

DVT correlated strongly with surgical measurements, whereas RVG correlated less favorably (P=0.0109, P=0.0193 respectively).No significant difference for CEJ-AC (P=0.0599) was seen between DVT and surgical measurements; however, there was a significant difference for the distance CEJ-BD (P=0.0105).

CONCLUSION

DVT technique is significantly more accurate than RVG in the detection of infrabony periodontal defects. Key words:Tomography, volume computed, dental radiovisiography, periodontal diseases.

Platelet-rich plasma. A review

Platelet-rich plasma has been used in periodontal therapy because of its biologic characteristics in promoting wound healing and regeneration. Platelet-rich plasma, growth factors in platelet-rich plasma, their mechanism of action, probable role in wound healing, preparation of platelet-rich plasma and its activation are reviewed to provide insights into the role of this entity in wound healing and regeneration.

Efficacy of locally-delivered doxycycline microspheres in chronic localized periodontitis and on Porphyromonas gingivalis

AIM

This study aimed to assess the efficacy and effect of locally-delivered doxycycline microspheres with scaling and root planing in periodontal pocket therapy and on Porphyromonas gingivalis, respectively.

METHODS

Twenty sites with a probing pocket depth of 4-6 mm were divided into two groups: a control group consisting of scaling and root planing, with one application of doxycycline microspheres only at baseline, and a test group consisting of scaling and root planing, with an application of doxycycline microspheres at baseline and 1 and 3 months. Clinical readings included the plaque index, gingival index, probing pocket depth, and relative attachment level. Rapid polymerase chain reaction method was used for the detection of P. gingivalis.

RESULTS

A statistically-significant reduction in probing pocket depth and attachment gain was found in both groups; the test group showed a significant reduction in probing pocket depth and attachment gain compared with the control at 3 and 6 months. P. gingivalis cell count in the test group was significantly reduced at all the time periods, except from 1 to 3 months.

CONCLUSION

Local drug delivery of doxycycline microspheres significantly improved the treatment outcomes in periodontal pocket therapy and reduced P. gingivalis in the periodontal pocket.

Use of an implant o-ring attachment for the tooth supported mandibular overdenture: a clinical report

Retention of a mandibular denture can be achieved by an implant-retained or natural tooth-retained bar and stud attachment in the anterior segment of the mandible. The same design principles holds true for both implant-retained and tooth-retained methods of anchoring the bar and stud attachment. A simple and cost effective treatment for more complex implant overdenture is the concept of conventional tooth-retained overdentures. When few firm teeth still remain in a compromised dentition, preservation of these teeth for overdentures can improve retention and stability. The authors present a clinical report of a patient treated with a mandibular tooth-borne overdenture with bar and O-ring attachment. A splinted bar supported the prosthesis and an O-ring retained the denture.

Use of an Implant O-Ring Attachment for the Tooth Supported Mandibular Overdenture: A Clinical Report

Retention of a mandibular denture can be achieved by an implant-retained or natural toothretained bar and stud attachment in the anterior segment of the mandible. The same design principles holds true for both implant-retained and tooth-retained methods of anchoring the bar and stud attachment. A simple and cost effective treatment for more complex implant overdenture is the concept of conventional tooth-retained overdentures. When few firm teeth still remain in a compromised dentition, preservation of these teeth for overdentures can improve retention and stability. The authors present a clinical report of a patient treated with a mandibular tooth-borne overdenture with bar and O-ring attachment. A splinted bar supported the prosthesis and an O-ring retained the denture. (Eur J Dent 2011;5:331-336)

An evaluation of platelet-rich plasma without thrombin activation with or without anorganic bone mineral in the treatment of human periodontal intrabony defects

The efficacy of platelet-rich plasma (PRP) in periodontal regeneration is not well understood and the definite clinical viability of blood derived platelets lacks clarity. Also, the use of thrombin for platelet activation is disputed. Hence, the purpose of this study was to evaluate the efficacy of blood derived platelets without thrombin activation, alone or in combination with bovine anorganic bone mineral (ABM), in the treatment of human periodontal intrabony defects. PRP was prepared using a simple tabletop centrifuge and activated using calcium chloride without the addition of thrombin. This PRP was used alone (in Group A) and in combination with bovine ABM (in Group B) in the treatment of human periodontal angular defects. Both the control and the test groups showed definite improvement in clinical parameters. On comparison, however, there was a statistically significant improvement in the probing pocket depths and relative attachment level in Group B over Group A at 3 and 6 months intervals, whereas at the end of 9 months this difference was not statistically significant. There was no statistically significant difference between the groups with respect to the relative defect depth. Within the limitations of this study and the type of PRP used, i.e. without thrombin mediated activation, it can be concluded that both PRP and PRP combined with bovine ABM results in significant clinical improvement. Albeit statistically insignificant, there is a preponderance of better clinical results with the addition of ABM to PRP. Further studies need to be carried out on a larger sample size to confirm the results of the present study.

The antiplaque efficacy of pomegranate mouthrinse

OBJECTIVE

to evaluate the effect of a pomegranate-containing mouthrinse on plaque, determine whether it has any adverse effects, and evaluate its antibacterial properties against selected periodontopathogens in vitro.

METHOD AND MATERIALS

thirty periodontally healthy volunteers, randomly divided into three groups, refrained from all mechanical oral hygiene measures for 4 days and used one of the randomly assigned mouthrinses (A, pomegranate; B, chlorhexidine; or C, distilled water [placebo]) twice daily. The Plaque Index (PI) was assessed at days 0 and 5. Adverse effects were also evaluated. Pomegranate extract was tested against Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.).

RESULTS

in all groups, the PI significantly increased from the baseline to day 5 (P < .1). The pomegranate mouthrinse created no adverse effects. There was a statistically significant difference (P < .05) between the chlorhexidine and placebo rinse and the pomegranate and placebo rinse, but no statistically significant difference was found between the chlorhexidine and pomegranate rinse with respect to the PI. Pomegranate extract showed inhibition of all three strains of periodontopathogens at various concentrations.

CONCLUSION

these results indicate that the pomegranate mouthrinse has an antiplaque effect. Pomegranate extract is efficacious against A.a., P.g., and P.i. strains in vitro. Pomegranate mouthrinse should be explored as a long-term antiplaque rinse with prophylactic benefits.

Salivary and gingival crevicular fluid melatonin in periodontal health and disease

BACKGROUND

Melatonin, with its antioxidant properties, plays a pertinent role in influencing the pathogenesis of periodontal disease. This study aims to detect the presence of melatonin in gingival crevicular fluid (GCF) and to assess the levels of salivary and GCF melatonin in periodontal disease and show the correlation between salivary and GCF melatonin.

METHODS

Forty-five subjects, based on the gingival and Russell periodontal indexes, were grouped as 15 healthy subjects (group 1), 15 subjects with gingivitis (group 2), and 15 subjects with periodontitis (group 3). Saliva and GCF samples were collected from all subjects. Melatonin levels were assessed using an enzyme-linked immunosorbent assay. The paired-sample test was used to correlate between saliva and GCF.

RESULTS

Melatonin was present in GCF (mean: 1.54 pg/ml) with significantly less concentration compared to that of saliva (mean: 2.17 pg/ml). Salivary and GCF melatonin levels were reduced to the lowest concentrations in patients with chronic periodontitis (salivary melatonin: 0.07 pg/ml; GCF melatonin: 0.06 pg/ml; P <0.05), which were inversely proportional to the clinical indices. There was no significant correlation between salivary and GCF melatonin levels (P >0.05).

CONCLUSIONS

Melatonin was expressed in GCF. Salivary and GCF melatonin levels varied from clinically healthy subjects (group 1) to subjects with periodontitis (group 3). Both salivary and GCF melatonin levels decreased in group 3 subjects compared to group 1 subjects, indicating that melatonin may have a protective role against periodontal disease, although further research is required to validate this hypothesis.

Status of association studies linking diabetes mellitus and periodontal disease in India

BACKGROUND

The prevalence of diabetes mellitus (DM) and periodontal disease / periodontitis (PD) is high, and the association of these two as risk factors influencing each other has been recognized and is extensively documented. However, a majority of these association studies have been done in developed countries and / or in developing countries other than India.

OBJECTIVE

To review, quantify and qualify the status of the published indexed scientific literature regarding the bidirectional association of DM and PD in India.

METHOD

An internet search of the literature was conducted to examine relevant association studies of DM and PD in India. As a matter of interest, the related articles were searched manually from one non-indexed national (India) publication of periodontology until October 2008. Specific focus was on indexed literature and only these were considered for the review.

RESULT

Eleven pertinent indexed publications addressing the concern with regard to population in India were identified. Most of them were in agreement with the accepted mechanisms involving these two diseases, but more supported a unidirectional view of interaction, that is, advocating the role of DM in a worsened periodontal condition. One study with an opposite view was recognised.

CONCLUSION

The paucity of such research in India, which will be a hub of diabetics in the near future, reflects the need to make available a strong body of evidence in the indexed literature relating not only to DM and its 'sixth complication', PD, but also the strong influence of PD on DM.

Hyaluronan-containing mouthwash as an adjunctive plaque-control agent

PURPOSE

Hyaluronan, commonly known as hyaluronic acid, has been shown to have anti-inflammatory action, bacteriostatic effect and antioxidant properties, thus making its use as a long-term anti-plaque and anti-gingivitis agent an appealing proposition. The aim of the present study was to evaluate the efficacy of 0.025% hyaluronan-containing mouthwash in comparison with 0.2% chlorhexidine and a water-based mouthwash and also to evaluate its antibacterial efficacy on isolated strains of periodontopathogens.

MATERIALS AND METHODS

Forty-five volunteers in a hospital setting were recruited. A single-blinded, parallel design, randomised controlled trial was carried out and the 4-day plaque re-growth model was used to study the efficacy of the three mouthwashes. Microbiological and clinical evaluation was performed by culturing and using dental indices, respectively. The three mouthwashes used in the present study were commercially available 0.025% sodium hyaluronate, 0.2% chlorhexidine and a water-based rinse (negative control). Effects of the three mouthwashes were tested on the growth of isolated strains of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa) and Prevotella intermedia (Pi).

RESULTS

In vitro, hyaluronan had a distinct effect on the growth of Aa and Pi with no effect on the growth of Pg. In vivo, the differences between the individual rinse solutions and the water-based solution showed significantly less plaque regrowth with respect to both chlorhexidine (P = 0.033) and hyaluronan (P = 0.045) when compared to the negative control. The difference between chlorhexidine and hyaluronan was not statistically significant (P = 0.69).

CONCLUSIONS

Hyaluronan (0.025%)-containing mouthwash was comparable to chlorhexidine (0.2%) in inhibiting plaque growth in vivo, and it significantly reduced the growth of Aa and Pi in vitro