Jothi M Varghese

Platelet-rich fibrin as an adjunct to palatal wound healing after harvesting a free gingival graft: A case series

Background: Owing to its stimulatory effect on angiogenesis and epithelialization, platelet-rich fibrin (PRF) is an excellent material for enhancing wound healing. The use of PRF dressings may be a simple and effective method of reducing the morbidity associated with donor sites of autogenous free gingival grafts (FGGs). The purpose of this case series is to document the beneficial role of PRF in the healing of FGG donor sites. Materials and Methods: A total of 18 patients treated with FGGs could be classified into two groups. PRF was prepared, compressed and used to dress the palatal wound followed by a periodontal pack in one group (10 patients) and only a periodontal pack was used in the other group (8 patients). Post-operative healing was assessed clinically at 7, 14 and 21 days and the morbidity was assessed qualitatively by an interview. Results: Sites where PRF was used showed complete wound closure by 14 days and these patients reported lesser post-operative morbidity than patients in whom PRF was not used. Conclusions: PRF as a dressing is an effective method of enhancing the healing of the palatal donor site and consequently reducing the post-operative morbidity.

Efficacy of Human Chorion Membrane Allograft for Recession Coverage: A Case Series

BACKGROUND Membranes of human placentas have been used in the field of medicine for skin grafts, treatment of burns, and ulcerated skin conditions with great success. The use of placenta allografts in dentistry is a more recent development, with the first commercial product being made available in 2008. The unique inherent biologic properties in placenta allografts enhance wound healing and may propagate regeneration. METHODS Ten healthy adult patients presenting with 21 Miller Class I gingival recession (GR) defects (isolated or adjacent multiple) were surgically treated with a modified coronally advanced flap and chorion membrane for root coverage. Clinical parameters measured at baseline, 3 months, and 6 months were probing depth, clinical attachment level, GR height, width of keratinized gingiva, and assessment of gingival biotype. Statistical analysis was performed to compare the treatment outcomes at the follow-up intervals. RESULTS The results showed statistically significant (P <0.001) improvements in all clinical parameters at the 3- and 6-month follow-ups. The mean percentage of root coverage at the end of 6 months was 89.92% ± 15.59%, and 14 of 21 treated GR defects showed 100% root coverage. The gingival biotype also showed a thick biotype in nine sites that had an initial thin biotype. CONCLUSIONS Fetal membranes possess distinctive properties that can be harnessed to promote periodontal healing. The chorion membrane covered by a modified coronally advanced flap is a new approach that has shown promising results in terms of root coverage, increased width of keratinized tissue, and thickness of the gingival biotype.

Patient safety: Preventing aspiration

Sir, I am a newly qualified dentist and despite my limited experience I have noticed different opinions on when to apply fluoride varnish. Delivering better oral health guidelines1 recommend that all children should have fluoride varnish applied at least twice yearly, including even those at low caries risk, whilst children with known caries risk factors are recommended additional applications. However, there are certain medical contraindications specified by SDCEP guidelines2 and manufacturers. I have noticed two different approaches to application of fluoride varnish, the first in which every child that attended for an examination appointment had fluoride varnish applied providing there were no co-operation issues, a specific request by the patient or guardian requesting not to apply fluoride varnish or in the case of a medical contraindication (checked by asking the patient and their accompanying guardian). However, during my dental core training year in a community dental setting I was advised that fluoride varnish could not be applied to children under 16 unless parental consent is obtained prior. Fluoride varnish application was therefore much lower as many children attended regular dental examinations with grandparents or siblings etc. I understand that there has been a documented case of a Type 1 hypersensitivity reaction to colophony which is present within Duraphat varnish in which the patient developed allergic contact stomatitis.3 However, the patient in question had a known allergy to sticking plasters and therefore had a known risk of having an allergy to colophony so wouldn’t have had fluoride varnish applied under current SDCEP recommendations. A recent randomised controlled trial conducted in South Wales involving 1,016 children aged 6-7 years old recruited over 2011–13 followed up over a 36-month period by Chestnutt et al. concluded that six-monthly applications of fluoride varnish on all surfaces of caries-free first permanent molars resulted in a caries preventative effect that is not significantly different to placement and maintenance of fissure sealants on the occlusal surfaces of caries-free first permanent molars in children.4 Fluoride varnish also exhibits advantages such as being quick and easy to apply and a less complex intervention than fissure sealants whilst not requiring any maintenance. It is due to the above reasons I believe perhaps we should be considering the use of fluoride varnishes that are colophony free or booking patients in solely for application of fluoride varnish once clarification of medical history from a parent and parental consent has been obtained. R. Khehra, South Wales

An in vitro study to evaluate the demineralizing effect of maleic acid and cell attachment on cemental surface

Introduction: Root biomodifying agents are adjuncts to periodontal regeneration. Aim: This study evaluates the demineralization effect of a chelating agent, maleic acid (MA) when used as a root biomodifier on the cemental surface. Materials and Methods: Thirty single-rooted anterior teeth were selected for this study. The teeth were decoronated and split longitudinally to form sixty radicular halves. They were randomly assigned to four groups of 15 fragments each according to the demineralizing agents used and treatment time of 1 and 3 min. Group 1 treated with 50% citric acid (CA) solution at pH 1, Group 2 treated with 17% ethylenediaminetetraacetic acid (EDTA) solution at pH 7. Group 3 treated with 7% MA at pH 1.3 and Group 4 treated with saline. The specimens were then prepared to view under scanning electron microscopy (SEM). To study the adherence of cells on the root surface, human periodontal ligament cells were cultured and were placed in plates containing root halves, and cell adherence was viewed using SEM. The data were statistically analyzed by Pearsons Chi-square test (χ2) to evaluate the effect of the each test agent. A significance level was set at P< 0.05. Results: All the three test agents were successful in eliminating smear layer at both time intervals. Intergroup comparison at both time intervals demonstrated, MA to have a better smear layer removal ability than CA and EDTA. Conclusion: This particular study provided preliminary evidence on the demineralizing effect of 7% MA when used as a root conditioning agent.

Isolated gingival overgrowths: A review of case series

Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.

Web Yourself to Cease Bleeding

The presence of dust or cob webs, instigate us to quickly pick up the broom and sweep it off. But, hidden amid the grime may be substances of profound value. The ancient Greeks applied cobwebs directly to wounds. Sounds spooky rite? Spider-web silk has attracted the interest of several researchers in recent years because it displays a unique combination of high tensile strength, high breaking strain and ultra low weight. All spider species spin their silk and uses them for a variety of purposes like dragline for safety, web building to trap their prey and also thick cocoon is used by female spiders for protecting their eggs.

A pre-prosthetic soft tissue augmentation using a simplified technique

Despite the increased demands for single tooth implants, many patients still opt for fixed partial dentures to close the edentulous spaces . Prior to the replacement of missing teeth, aesthetic and physiologic corrections of edentulous areas are critical pre-requisites. This case describes a simple method to enhance a localized buccal ridge defect and create an emergence profile in relation to the maxillary right premolar region, prior to the construction of a fixed partial denture. This technique involved using a connective tissue and platelet rich fibrin membrane for soft tissue augmentation, so as to obtain a natural form and maintain a healthy periodontium. Clinical Relevance to Interdisciplinary Dentistry Role of pre-prosthetic periodontal surgery to achieve improved aesthetics. Use of Connective tissue graft and PRF for a more predictable outcome. This simple technique enabled the simultaneous preparation and augmentation of the ridge.