Ashita Uppoor

Clinical and radiographic evaluation of Nano-crystalline hydroxyapatite bone graft (Sybograf) in combination with bioresorbable collagen membrane (Periocol) in periodontal intrabony defects.

Background: Nanosized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline Hydroxyapatite (NcHA) bind to bone and stimulate bone healing by stimulation of osteoblast activity. The present study aims to explore the clinical and radiographical outcome of NcHA bonegraft (Sybograf®) with collagen membrane (Periocol®), in comparison with open flap debridement (OFD), in the treatment of intrabony periodontal defects. Materials and Methods: A parallel-group, randomized, controlled clinical trial was designed to conduct the study. Eighteen intrabony defects in 14 systemically healthy patients aged between 25 to 65 years were randomly assigned to test and control group. The plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site, NcHA bone graft and collagen membrane was placed, whereas at the control site, only OFD was done. Recall appointments were made at 7 days, 30 days, and then at 3 months and 6 months. Results: The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm (P=0.007) and CAL gain was 2.77±1.09 mm (P=0.007). In the test group, the mean PPD reduction of 4.33±0.5 mm (P=0.006) and mean gain in CAL was 3.77±0.66 mm (P=0.006) at 6 months. The mean increase in REC was 0.55±0.72 mm (P=0.025) in test, and 0.44±0.52 mm (P=0.046) in control group. The mean gain in radiographic defect fill was 2.07±0.67 mm (P=0.008) in test and 0.91±0.21 mm (P=0.007) in control group. Conclusion: The nanocrystalline hydroxyapatite bone graft in combination with collagen membrane demonstrated clinical advantages beyond that achieved by OFD alone.

Periodontitis and Alzheimer’s disease: oral systemic link still on the rise?

Over the past few years, there has been a rapid rise in the older segments of the world population, which has brought along with it a major health concern: dementia. Alzheimers disease, considered to be the most common cause of dementia, has become a prospect feared by the elderly. Inflammation of the brain is strongly implicated in Alzheimers disease which could be enhanced by systemic inflammation. Periodontitis being a chronic inflammatory condition, which can cause systemic inflammation, the question is whether chronic periodontitis can initiate or hasten the rate of progression of Alzheimers disease in susceptible individuals. In this article, the authors outline the proposed oral systemic link between periodontitis and Alzheimers disease.

Parkinson's disease and periodontitis - the missing link? A review.

OBJECTIVE In this article an attempt has been made to postulate a possible link between Parkinsons disease and periodontal disease. BACKGROUND Various systemic diseases such as cardiac disease, diabetes, renal diseases, low birth weight and Alzheimers disease have been proposed to be linked with periodontal disease on the basis of systemic inflammation. Parkinsons disease is a chronic progressive neurodegenerative disorder with multifactorial aetiology. Until now, periodontal disease and Parkinsons disease has been linked only on the basis of poor motor and cognitive control in Parkinsons patient which leads to poor oral health maintenance. Evidence now suggests that chronic neuroinflammation is consistently associated with the pathophysiology of Parkinsons disease. Also, recently, systemic inflammation has been suggested as one of the contributing factors for neurodegeneration. MATERIAL AND METHODS Dental and medical literature especially those dealing with neurosciences were selected which highlighted the link between systemic inflammation and infection. RESULTS So far there is no direct evidence implicating an effect of periodontitis in the pathogenesis of Parkinsons disease. To clarify this link, studies on population based case-control or cohort design are needed. This would be especially significant in the present era where there is paucity for preventive measures as far as a cognitive disorder such as Parkinsons disease is concerned. CONCLUSION We cannot cure Parkinsons disease, but if in future this missing link is established, an attempt can be made to prevent it by tackling one of its possible contributors (periodontitis) for systemic inflammation by simple preventive oral hygiene measures.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments - an in vitro profilometric and SeM study

Objectives The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). Material and Methods 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLITM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. Results The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. Conclusion Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

Redefining the role of dendritic cells in periodontics

A properly functioning adaptive immune system signifies the best features of life. It is diverse beyond compare, tolerant without fail, and capable of behaving appropriately with a myriad of infections and other challenges. Dendritic cells (DCs) are required to explain how this remarkable system is energized and directed. DCs consist of a family of antigen presenting cells, which are bone-marrow-derived cells that patrol all tissues of the body with the possible exceptions of the brain and testes. DCs function to capture bacteria and other pathogens for processing and presentation to T cells in the secondary lymphoid organs. They serve as an essential link between innate and adaptive immune systems and induce both primary and secondary immune responses. As a result of progress worldwide, there is now evidence of a central role for dendritic cells in initiating antigen-specific immunity and tolerance. This review addresses the origins and migration of DCs to target sites, their basic biology and plasticity in playing a key role in periodontal diseases, and finally, selected strategies being pursued to harness its ability to prevent periodontal diseases.

Oral Candida Carriage and Morphotype Differentiation in Chronic Periodontitis Patients with and without Diabetes in the Indian Sub-Continent

The aim of this study was to assess the oral Candida carriage and morphotype differentiation of Candida species in chronic periodontitis patients, with and without diabetes mellitus. This cross sectional study included 30 subjects in the age range of 40–60 years, who were divided into two groups: 15 chronic periodontitis only (CP) patients, and 15 chronic periodontitis patients with diabetes (CPD). Clinical measurements included plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and fasting blood sugar level (FBS). The unstimulated whole saliva samples were collected for fungal analysis. Candida carriage was analyzed by measuring colony forming units (CFU) following the culture of samples. Qualitative morphotype differentiation of Candida species from yeast to hyphal form was analyzed using Periodic acid-Schiff (PAS) staining. There was no statistically significant difference between CP and CPD groups for the periodontal parameters. However, a significantly higher Candida species CFU count was found in CPD (0.33 ± 0.23) as compared to CP (0.05 ± 0.04) group. This pilot study suggests that the occurrence of Candida species is higher in the saliva of chronic periodontitis patients with diabetes as compared to patients with chronic periodontitis alone.

A comparative evaluation of management of melanin pigmented gingiva using a scalpel and laser

Objective: There are only a few case reports in the literature evaluating the effects of the diode laser on gingival melanin pigmentation. This study was performed to evaluate the efficacy of melanin depigmentation using a scalpel and diode lasers based on effective removal of gingival pigmentation, recurrence, and patient acceptability. Study Design: Gingival melanin pigmentation at the anterior maxillary or mandibular gingiva at 20 sites from 7 patients was included. Pigmented areas were measured on pre-and post-operative 1 and 6 months using Dummett Oral Pigmentation Index. This was a split mouth study where gingival depigmentation was carried out using a scalpel and diode laser. For one quadrant scalpel techniques were used and for other quadrant laser ablation was done. Results: Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Statistical analysis of the data revealed a significant difference between pre- and post-operative measurements of pigmented area. No significant changes in pigmentation were seen between 1 and 6 months follow-up with both the procedures. Conclusion: Application of diode laser appears to be an effective and safe method for the elimination of gingival melanin pigmentation. Clinical Relevance To Interdisciplinary Dentistry Esthetics plays an important role in treatment planning

Comparative Evaluation of the Efficacy of Bioactive Ceramic Composite Granules Alone and in Combination with Platelet Rich Fibrin in the Treatment of Mandibular Class II Furcation Defects: A Clinical and Radiographic Study

INTRODUCTION Predictable closure of furcation defects with bone grafts, Guided Tissue Regeneration (GTR) and a combination of the two has remained an elusive goal so far. Hence, evaluation of biomimetic agents as candidate technologies for periodontal regeneration merit due consideration. In this study, Choukrouns Platelet Rich Fibrin (PRF), a second generation platelet concentrate, is combined with bone graft to examine if the addition enhances the therapeutic potential of bone graft in the management of Class II furcation defects. AIM To evaluate and compare the clinical effectiveness of Bioactive Ceramic Composite Granules (BCCG) alone and in combination with PRF in the treatment of mandibular Class II furcation defects. MATERIALS AND METHODS Twenty mandibular Class II furcation defects in 16 systemically healthy patients were randomly allocated to test and control groups. Test sites were treated with PRF and bone graft, while control sites were treated with BCCG alone. Soft tissue parameters (probing pocket depth and clinical attachment loss), hard tissue parameters (vertical and horizontal depth of furcation defects) and radiographic parameter (radiographic alveolar bone density) were measured at baseline and six months post surgery. Statistical analysis was performed using Wilcoxon signed rank test for intragroup comparison of parameters and Mann-Whitney U test for intergroup comparison. RESULTS Statistically significant improvement was observed in the test group compared to the control group with respect to all the measured parameters. However, complete furcation closure was not observed at any of the treated sites. CONCLUSION Adjunctive use of PRF with bone graft may be a more effective treatment modality in the management of mandibular Class II furcation defects when compared to bone graft alone.

Quantification of intraosseous bone defects by conventional versus 3dimensional imaging techniques - an in vivo study.

Background:- The aim of this prospective cross sectional study was to determine the accuracy of CBCT in quantifying intra-osseous periodontal bone defects. Methods:- 5 patients with intra-bony defects were selected and 10 defects were assessed. A total of 60 measurements were performed.Periapical radiographs and Cone beam CT scan images were obtained. Height and depth of each defects was measured using appropriate software. Direct measurements were done during surgical interventions using a periodontal probe and were considered the standard reference. Measurements made by all three modalities were compared to each other. Results:- Linear measurements for all defects revealed no statistical differences between CBCT and direct intra-surgical measurements with respect to the height as well as the depth of the defect. There was a significant difference when comparing peri-apical radiographs to the other two methods. IOPA measurements were only 74.3% accurate as compared to the standard intra-surgical whereas the CBCT measurements were 86.5%. Conclusion:- All three modalities proved to be useful for identifying interproximal periodontal defect but CBCT took the lead with better accuracy in reproducing the clinical measurement of intra-bony periodontal bone defects and better visualization of the extent of the defect.

HIV and Periodontal Disease: Redemption or Resurrection

Human immunodeficiency virus (HIV) infection, a major medical crisis that has hit families, communities & nations across the world, remains a major health concern of unprecedented dimension. Mounting evidence suggests that co-infections and inflammation may result in re-activation of latent virus and blunt the success of Highly Active Anti-retroviral Therapy (HAART). Periodontal diseases are chronic multibacterial infections that can result in significant bacterial & inflammatory load in the body and HIV infection has been found to be associated with various forms of periodontal diseases. Besides Immune Reconstitution Inflammatory Syndrome (IRIS), following HAART, may also lead to increased frequency of periodontal disease among these patients. If co-infections & inflammation can increase the risk of HIV reactivation, can periodontitis in an HIV infected individual lead to HIV re-activation. This question remains unanswered, but initial evidence suggests a probable role of periodontitis in HIV re-activation. The clinical implication of such a role is that, periodontitis being most often preventable and definitely treatable, every attempt should be made to prevent and promptly treat this disease in individuals with HIV infection.