Farrukh Faraz

Effect of periodontal therapy on lactoferrin levels in gingival crevicular fluid.

BACKGROUND The aim of this study was to evaluate lactoferrin quantification as a sensitive and objective method of detecting the degree of periodontal inflammation, oxidative stress and to monitor the effects of periodontal therapy. METHODS Fifty subjects were divided into two groups based on gingival index, probing pocket depth, clinical attachment loss and alveolar bone loss: healthy group and periodontitis group with generalized chronic periodontitis. Non-surgical periodontal therapy was rendered and crevicular fluid samples collected at baseline and four weeks after therapy for lactoferrin quantification using enzyme linked immunosorbent assay. The correlation between clinical parameters and lactoferrin levels was drawn and analysed for both groups. RESULTS The mean level of crevicular lactoferrin in the periodontitis group was 1857.21 ng/ml. The mean level decreased to 1415.03 ng/ml after treatment. The lowest lactoferrin concentration was seen in the healthy group (75.34 ng/ml). All clinical parameters correlated positively with lactoferrin levels. CONCLUSIONS The lactoferrin level was higher in the periodontitis group compared to the healthy group, and reduced with periodontal therapy. Higher levels were associated with higher values of clinical parameters, both before and after therapy. The data indicates that Lactoferrin plays an important role in periodontal disease and crevicular lactoferrin quantification can be a marker for detecting periodontal inflammation, oxidative stress and monitoring periodontal therapy.

Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser

BACKGROUND Traditional periodontal open flap debridement (OFD) results in reduced pocket depth (PD), clinical attachment loss (CAL), gingival recession (GR) and postoperative pain and discomfort. The quest to overcome these shortcomings has led to research into Er,Cr:YSGG laser assisted pocket therapy (ELAPT). This study was designed to compare the clinical outcomes of ELAPT versus OFD. METHODS Fifteen patients with a PD of ≥5 mm and ≤8 mm at two sites were selected. Test sites (Group 1) were treated by ELAPT and the control (Group 2) by OFD. Clinical parameters were recorded at baseline, 3 and 6 months and included Plaque Index (PI), Gingival Index (GI), modified Sulcular Bleeding Index (mSBI), PD, CAL and GR. RESULTS Both treatments produced a reduction in PI, GI, mSBI and PD, an increase in GR, and a gain in CAL at 3 and 6 months. The mean gain of CAL in Group 1 at 3 and 6 months (1.60 ± 0.78 and 1.80 ± 0.63) was similar (p > 0.05) to the value of Group 2 (1.93 ± 0.88 and 2.00 ± 0.54). GR increased significantly (p < 0.05) only in Group 2 at 3 and 6 months (1.80 ± 0.56 and 1.87 ± 0.64) compared to Group 1 (0.50 ± 0.68 and 0.60 ± 0.74). CONCLUSIONS ELAPT compared with OFD results in similar CAL gains with less GR and significant reductions in PD, GI and mSBI, and may be considered as an alternative to surgical therapy.

Haim-Munk syndrome.

Haim-Munk syndrome is an extremely rare autosomal recessive disorder of keratinization characterized clinically by palmoplantar hyperkeratosis, severe early onset periodontitis, onychogryphosis, pes planus, arachnodactyly, and acro-osteolysis. Recently, germline mutations in the lysosomal protease cathepsin C gene have been identified as the underlying genetic defect in Haim-Munk syndrome and in the clinically related disorders, such as Papillon-Lefèvre syndrome and prepubertal periodontitis. The periodontal disease associated with these syndromes is particularly aggressive and unresponsive to traditional periodontal therapies. As a result, most patients become edentulous by 15 years of age. This case report describes a patient with the cardinal features of Haim-Munk syndrome.

Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study

Aim: The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT) on wound healing after depigmentation procedure. Materials and Methods: In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site) using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine) on the 3rd, 7th, and 15th day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. Results: At day 3, test site showed 1.26 ± 0.23 mm2 and control site showed 1.45 ± 0.21 mm2 stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm2 and 1.12 ± 0.25 mm2 stain uptake, whereas the control site showed 1.37 ± 25 mm2 and 1.29 ± 0.28 mm2 staining, respectively, which were not statistically significant. Conclusion: Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3rd day. On the 7th and 15th day, the difference in healing was not statistically significant.

Viruses: Bystanders of periodontal disease

Bacterial etiology of periodontal disease is an established fact today. However, despite advances in the field of pharmacology with advent of newer and better antibiotics prevalence of the disease could not be abated. Moreover, unpredictable remissions and indefinite pattern in a single host force us to go back to the exact etiology of the disease. Present is a short review highlighting the role and plausible mechanisms by which viruses can affect the development of periodontal disease. This broadens our concept and will help establish a better treatment protocol for periodontal disease.

Role of Cone Beam Computed Tomography in Rehabilitation of a Traumatised Deficient Maxillary Alveolar Ridge Using Symphyseal Block Graft Placement

Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.

Adjunctive use of antimicrobial photodynamic therapy in periodontal treatment of a patient susceptible to osteoradionecrosis

Photodynamic therapy (PDT) has emerged as an adjunct to conventional periodontal therapy since its antimicrobial effect has been discovered. The oral health of patients with head and neck cancer undergoing radiotherapy or those who have completed such treatment deteriorates as oral tissues, including the periodontium, are adversely affected. Vascular changes, in particular, predispose the periodontium for degeneration and also reduce the potential of tissues to regenerate following periodontal surgery. Since periodontal surgical procedures or extraction of teeth carries the risk of osteoradionecrosis (ORN) in such cases, a conservative approach with nonsurgical measures is preferred for the treatment of periodontal diseases. This report highlights a case of treatment of localized chronic periodontitis around endodontically treated teeth in a patient with history of radiotherapy for the treatment of oral cancer. In addition to mechanical debridement, PDT was used to disinfect the moderately deep periodontal pockets, resulting in significant improvement. No complication was observed after therapy and good periodontal health has been maintained for the last 18 months.

Orthodontic Elastic Embedded in Gingiva for 7 Years

Dental materials especially orthodontic elastics often get embedded in gingival tissues due to iatrogenic factors. If retained for a long time, inflammatory response starts as asymptomatic crestal bone loss and may progress to severe periodontal abscess. Unsupported orthodontic elastics used for diastema closure may result in exfoliation of teeth, while elastic separators may get embedded in interdental gingiva if banding is performed without removing it. These cases of negligence are detrimental for survival of affected teeth. This paper highlights a case of orthodontic elastic embedded in interproximal gingiva of a 23-year-old healthy female for 7 years after completion of fixed orthodontic treatment. Surprisingly, there was no clinical sign of inflammation around elastic band and it was removed easily without any local anaesthesia. However, mild crestal bone loss was observed on periapical radiograph. The gingiva healed completely after sub gingival debridement.

Leukemic gingival enlargement: A case report and review of literature

The oral cavity manifests signs of various systemic diseases. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Occasionally, oral signs can be an expression of systemic conditions such as endocrine imbalance, nutritional deficiencies and blood disorders. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. Oral changes maybe the first and only presenting features in leukemia patients, making it imperative for the dentist to diagnose the disease accurately.

Er, Cr:YSGG laser for the treatment of ankyloglossia.

Ankyloglossia or tongue-tie is the result of a short and tight lingual frenum causing difficulty in speech, feeding problems in infants due to the limitation of tongue movement. This report presents a case of a 22-year-old female with tongue-tie who complained of difficulty in speech following which she underwent frenectomy procedure with erbium, chromium: yattrium-scandium-gallium-garnet laser without any complications. She was referred to the speech therapist after the procedure.