Harjit Kaur

Duration of reappearance of gingival melanin pigmentation after surgical removal - A clinical study

Background: In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. Materials and Methods: A method of de-epithelialization of the pigmented gingiva using Kirkland’s gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964. Results: The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark-complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant. Conclusion: As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.

Comparative evaluation of the antiplaque effectiveness of green tea catechin mouthwash with chlorhexidine gluconate

Aim: The aim of this study is to compare the antiplaque efficacy of green tea catechin mouthwash with chlorhexidine gluconate mouthwash. Materials and Methods: A single blinded cross-over study was conducted among 30 participants in the age group of 18-25 years. The mouthwash samples for the study were previously labeled assigning the letters: A (0.25% of green tea catechin mouthwash) and B (0.12% of chlorhexidine mouthwash). The study subjects were randomly divided into two groups of 15 each and the study was divided into two phases. In phase I, the mouthwash A was given to one group and other group was given mouthwash B. After a 15 day washout period, in phase II, both groups were given other mouthwash. At the end of each phase of 1 week, plaque score was recorded by using Turesky modification of the Quigley-Hein plaque index. Results: The plaque scores were compared and the difference between the green tea catechin and chlorhexidine mouthwash was determined by t-test. The difference between plaque scores were not statistically significant (P > 0.05). The results showed that both the groups that is green tea catechin mouthwash (0.25%) and chlorhexidine mouthwash (0.12%) have comparable results in plaque reduction. Conclusion: This study supports the effectiveness of green tea catechin mouthwash as an antiplaque agent. It should be explored as a cost-effective, long-term antiplaque rinse with prophylactic benefits.

Comparison of Nano-Sized Hydroxyapatite and β-Tricalcium Phosphate in the Treatment of Human Periodontal Intrabony Defects

BACKGROUND Since the advent of nanotechnology, various materials have been introduced for the treatment of the bone defects which have shown promising results. AIM The purpose of this study was to compare the effect of nano-sized Hydroxyapatite (NHA) and β-Tricalcium Phosphate (β-TCP) in the treatment of human periodontal defects. MATERIALS AND METHODS Tweleve patients with a total of 24 sites which were almost identical as determined clinically and radiographically were selected for the study. The selected sites were treated with access flap surgery were divided into two groups: Group I was treated with NHA and Group II treated with β-TCP. Following clinical and radiographic parameters were recorded at baseline, 3 months and 6 months post operatively: 1) Probing pocket depth (PPD); 2)Clinical attachment level (CAL); 3) Gingival recession (GR); 4) Radiographic Defect Depth. RESULTS Groups showed statistically significant improvements in soft and hard tissue parameters after 3 months and 6 months. Greater reduction in PPD, gain in CAL and Radiographic Defect Fill (RDF) was seen in Group I after three months whereas after six months were no statistically significant difference was seen with regard to soft and hard tissue measurements. CONCLUSION Within limits of the study, both NHA and β-TCP have proved to be beneficial in the management of periodontal defects. Treatment of intrabony periodontal defects with NHA leads to significant improvement in early clinical and radiographic outcomes as compared to β-TCP.

Multiple myeloma presenting as gingival hyperplasia

Multiple myeloma is a malignant neoplasm that is characterized by a monoclonal proliferation of plasma cells. Oral and maxillofacial manifestations as an initial sign or symptom of multiple myeloma are rare. A 58-year-old male patient presented with generalized gingival enlargement for last 6 months. Based on clinical presentation, a diagnosis of gingival hyperplasia was made. After Phase I therapy, excisional biopsy was taken in anterior mandibular region and excised tissue was sent for histopathological examination. The histopathology report revealed a lining of stratified squamous epithelium with foci of ulceration. The subepithelial zone showed infiltration by sheets of mainly binucleate and multinucleate plasma cells, few cells being less differentiated. Rounded cytoplasmic inclusion bodies were identified in many of these cells. After a series of clinical investigations, a case of “multiple myeloma” was diagnosed. Patient presenting with generalized gingival hyperplasia should be worked up for systemic disease like multiple myeloma.

Collagen: Basis of Life

Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals, making up about 25% of the whole-body protein content. Collagens represent a large family of proteins and at least 28 different collagen types have been described so far which are genetically, chemically and immunologically distinct. All collagens are composed of three polypeptide alpha chains coiled around each other to form the triple-helix configuration, which are stabilized by numerous hydrogen bonds. The primary structural motif of mature collagen is (Gly-X-Pro/Hyp) n . Every third residue is glycine, which is preceded by either a prolyl or a hydroxyprolyl residue. Collagen biosynthesis takes place both intra and extracellularly. It is synthesized by fibroblasts, chondroblasts, osteoblasts and other cells. Degradation of collagen also involves two pathways, the major intracellular collagenase independent and the extracellular collagenase mediated. Collagen related diseases such as osteogenesis imperfecta, ehler danlos syndrome, scurvy, epidermolysis bullosa, collagenopathy most commonly arise from mutations in the collagen genes or the genes encoding some of the enzymes involved in the post-translational modifications in normal collagen production. Through this is a review article, we aim to discuss the various aspects of collagen and its clinical implications in periodontal health and disease.

Root conditioning in periodontology - Revisited

Objective: Root surfaces of periodontitis-affected teeth are hypermineralized and contaminated with cytotoxic and other biologically active substances. To achieve complete decontamination of the tooth surfaces, various methods including root conditioning following scaling and root planning are present. The main objective of this article is to throw light on the different root conditioning agents used and the goals accomplished by root conditioning in the field of periodontology. Materials and Methods: 20 human maxillary anterior teeth indicated for extraction due to chronic periodontitis were collected and root planned. The teeth were sectioned and specimens were divided into two groups — Group I and II. Group I dentin specimens were treated with EDTA and group II specimens were treated with tetracycline HCl solution at concentration of 10% by active burnishing technique for 3 minutes. The root surface samples were then examined by scanning electron microscope (SEM). Results: The results of the study showed that EDTA and tetracycline HCl were equally effective in removing the smear layer. It was observed that the total and patent dentinal tubules were more in number in teeth treated with tetracycline as compared to EDTA group. However, EDTA was found to be much more effective as root conditioning agent because it enlarged the diameter of dentinal tubules more than that of tetracycline HCl. Conclusion: Results of in-vitro study showed that both the agents are good root conditioning agents if applied in addition to periodontal therapy. However, further studies are required to establish the in-vivo importance of EDTA and tetracycline HCL as root conditioners.

To compare the gingival melanin repigmentation after diode laser application and surgical removal

Aim: The aim of the present study is to compare the gingival melanin repigmentation after diode laser application and surgical removal done by scraping with Kirkland knife. Materials and Methods: This study was a randomized split-mouth study where 10 patients presenting with unattractive, diffuse, dark brown to black gingival discoloration on the facial aspect of the maxillary gingiva were treated by diode laser application and surgical removal and followed up for 3-, 6-, and 9-month intervals. Results: The results showed a statistically significant difference in repigmentation between the groups at the interval of 3 months (P = 0.040), but the difference was statistically not significant at 6 months (P = 0.118) and 9 months (P = 0.146). On surgically treated sites, all cases showed repigmentation of the gingiva, but in laser treated, there were two individuals which did not show repigmentation of the gingiva even at the end of 9-month observation time. Conclusion: The incidence of repigmentation was slightly less in laser-treated sites as compared to surgical depigmentation although the difference was statistically significant only up to 3 months.

Classification systems of gingival recession: An update

Gingival recession is defined as “the displacement of marginal tissue apical to the cementoenamel junction (CEJ)”. Various classifications have been proposed to classify gingival recession. Millers classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. This article outlines the limitations of present classification systems and also the new classifications that have been proposed to classify gingival recession.

Submandibular Salivary Sialolith: A Case Report with Review of Literature

Sialolithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions, resulting in salivary ectasia and subsequent dilatation of the salivary gland. The majority of sialoliths occurs in the submandibular gland or its duct and is a common cause of acute and chronic infections. Majority of salivary stones are less symptomatic or cause minimal discomfort but the larger stones may interfere with the flow of saliva and cause pain and swelling. Sialoliths are calcified organic matter that is formed within the secretory system of the major salivary glands. Salivary gland calculi account for the most common disease of the salivary glands, and may range from tiny particles to several centimeters in length. This case report describes a patient presenting with submandibular gland sialolith

Probes and probing – the gold standard of Periodontal Assessment

Periodontal probes remain most important tool for evaluating periodontal status and gingival health. Currently, parameters such as probing pocket depth (PD), clinical attachment level and bleeding on probing are generally used to estimate severity of inflammation and response to treatment but evaluation of these parameters is greatly influenced by the use of the periodontal probe. Therefore, there has been considerable interest in research of the mechanics and functions of the probe in order to improve its effect. This article briefly describes various types and functions of periodontal probes.