Pushpendra Kumar Verma

Doxycycline poly e-caprolactone nanofibers in patients with chronic periodontitis - a clinical evaluation.

AIM To develop a low-dose controlled-release delivery system for the treatment of periodontal infections. A new sustained release drug system of Poly e-caprolactone (PCL) nanofibers containing doxycycline (DOX) was successfully electrospun and evaluated clinically for periodontal diseases. The retentive doxycycline nanofibres were shown to provide a controlled delivery of the drug. MATERIAL AND METHODS Nanofibers were prepared with DOX in PCL by electrospinning technique. The drug-coated nanofibres provided sustained effect up to a period of 11 days (264 h) and followed first order release. Forty sites in 7 patients (4 females and 3 males) with chronic periodontitis (5-8mm probing depth) were allocated in 2 experimental treatment groups, Group A-SRP (Scaling and Root Planing) + DOX nanofibers and Group B -SRP (Scaling and Root Planing) alone (control group). All these patients were evaluated clinically for probing depth (PD), plaque index (PI) and gingival index (GI). RESULTS Both the treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PD, PI and GI. CONCLUSION Combination of SRP (Scaling and Root Planing) + DOX nanofibers (Group A) resulted in added benefits compared to the control group.

Evaluation of metronidazole nanofibers in patients with chronic periodontitis: A clinical study

Aim: Prevention of periodontal disease progression is the primary goal of periodontal therapy. When conventional therapy is found to be inadequate in achieving periodontal health in chronic periodontitis, local antimicrobial agents are used as an adjunct to scaling and root planing (SRP), which produces encouraging results. In the present study, an attempt was made to develop a low-dose controlled-release delivery system for the treatment of periodontal infections. A new sustained release drug system of poly e-caprolactone (PCL) nanofibers containing metronidazole (MET) was successfully electrospun and evaluated clinically for periodontal diseases. The retentive nanofibres were shown to provide a controlled delivery of the drugs. Materials and Methods: Nanofibers were prepared with MET in PCL by electrospinning technique. The drug-coated nanofibers provided sustained effect up to a period of 11 days (264 h) and followed first-order release. Forty sites in seven patients (four females and three males) with chronic periodontitis (5–8 mm probing depth) were allocated in two experimental treatment groups: Group A treated with SRP + MET nanofibers and Group B treated with SRP alone (control group). All these patients were evaluated clinically for probing depth (PD), plaque index (PI), and gingival index (GI). Results: Both the treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PD, PI, and GI. Conclusion: Combination of SRP + MET nanofibers (Group A) resulted in added benefits, compared to the control group.

Pyogenic Granuloma - Hyperplastic Lesion of the Gingiva: Case Reports

Pyogenic granuloma is a reactive hyperplasia of connective tissue in response to local irritants. It is a tumourlike growth of the oral cavity, frequently located surrounding the anterior teeth or skin that is considered to be neoplastic in nature. It usually arises in response to various stimuli such as low-grade local irritation, traumatic injury, hormonal factors, or certain kinds of drugs. Histologically, the surface epithelium may be intact, or may show foci of ulcerations or even exhibiting hyperkeratosis. It overlies a mass of dense connective tissue composed of significant amounts of mature collagen. Gingiva is the most common site affected followed by buccal mucosa, tongue and lips. Pyogenic granuloma in general, does not occur when excised along with the base and its causative factors. This paper presents some cases of a pyogenic granuloma managed by surgical intervention.

Combined endodontic - Periodontal lesion: A clinical dilemma

Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.

Root coverage with bridge flap.

Gingival recession in anterior teeth is a common concern due to esthetic reasons or root sensitivity. Gingival recession, especially in multiple anterior teeth, is of huge concern due to esthetic reasons. Various mucogingival surgeries are available for root coverage. This case report presents a new bridge flap technique, which allows the dentist not only to cover the previously denuded root surfaces but also to increase the zone of attached gingiva at a single step. In this case, a coronally advanced flap along with vestibular deepening technique was used as root coverage procedure for the treatment of multiple recession-type defect. Here, vestibular deepening technique is used to increase the width of the attached gingiva. The predictability of this procedure results in an esthetically healthy periodontium, along with gain in keratinized tissue and good patients acceptance.

Oral squamous cell carcinomas in age distinct population: a comparison of p53 immunoexpression.

AIMS The study aimed to assess the diffused expression of p53 protein in patients with OSCC and its association with age at diagnosis (using 50 years as a cut point). STUDY DESIGN Ten normal oral mucosa and sixty OSCC lesions from age-distinct patient populations were immunohistochemically analyzed for the expression of p53 protein. RESULTS In OSCC cases, 31 out of total 60 cases (51.67%) showed positive expression for p53 protein and it was more common in older study group (56.67%) than in younger study group (46.67%) but the difference was not statistically significant. Moreover, there was also no significant difference in the p53 indices (percentage of p53 positive cells) between the two study groups (P = 0.827). CONCLUSION The alteration rates were found to be slightly higher in older patients although not statistically significant.

Esthetic root coverage of Miller's Class II recession with laterally positioned flap

Gingival recession is one of the common soft tissue problems faced by dentists and patients. Marginal gingival recession specially in the anterior teeth is of common concern due to functional and aesthetic problems. The exposed root surfaces cause deterioration in the esthetic appearance, dentin hypersensitivity, and inability to perform proper oral hygiene procedures. Various surgical techniques have been introduced to correct gingival recession defects. This article presents a case which was successfully managed by lateral pedicle technique for root coverage in single teeth in the lower anterior region. In this procedure the soft tissues adjacent to the recession area was positioned over the defect. This technique resulted in an esthetically healthy periodontium alongwith good patient′s acceptance. The outcome of this procedure resulted in a clinically significant amount of root coverage.

Gingival depigmentation: Clinical comparison between two techniques

Gingival melanin pigmentation occurs in all human races. Although clinical melanin pigmentation presents a major esthetic concern for many people, it does not pose a medical problem nor is it any disease entity. Esthetic gingival depigmentation procedures can be performed in these patients, with excellent results. This article presents a de-epithelization procedure using popular surgical techniques such as the scalpel and the other with bur abrasion. These techniques were successfully used to treat gingival hyperpigmentation. Although it was found that bur abrasion increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction.

Dentigerous cyst associated with an impacted maxillary mesiodens

A dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete permanent dentition the diagnosis is 95% dentigerous cysts, and only 5% are associated with supernumerary teeth. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. We report the case of a dentigerous cyst in association with an impacted mesioden in an 18-year-old male patient. Radiographically, the cyst appeared as an ovoid, well-demarcated unilocular radiolucency with a sclerotic border. The present case report describes the successful management of a dentigerous cyst by surgical enucleation. Careful evaluation of the history and the clinical and radiographic findings, help clinicians to diagnose the condition accurately, identify the etiological factors, and administer the appropriate treatment.

Calcium hydroxide: A boon in complete healing of horizontal apical one-third root fracture

Introduction: A variety of traumatic conditions can cause root fractures. The root fractures are more likely to occur in fully erupted permanent maxillary central incisors with a completely formed root followed by the maxillary lateral and the mandibular incisors. They involve the dental pulp, supporting tissues, and the mineralized structures of a tooth. Diagnosis of the horizontal root fractures is mainly reached by the information obtained in clinical and radiographic examinations. Case Report: This case report describes the management of the horizontal apical one-third root-fractured tooth without surgical removal of the apical fragment, by long-term calcium hydroxide dressing with good signs of healing of fracture at 3 months followed by conventional root canal treatment with the follow-up examination for 1 year after the completion of treatment. Discussion: Calcium hydroxide has showed a miracle in successful healing of apical one-third root fracture.