Vivek Govila

Host modulation therapy: An indispensable part of perioceutics.

Traditionally, only antimicrobials have been used as the chemotherapeutic modality for the treatment of periodontitis. Though bacteria are the primary etiologic factors of periodontal diseases, yet the extent and severity of tissue destruction seen in periodontitis is determined by the host immuno-inflammatory response to these bacteria. This increasing awareness and knowledge of the host-microbial interaction in periodontal pathogenesis has presented the opportunity for exploring new therapeutic strategies for periodontitis by means of targeting host response via host-modulating agents. This has lead to the emergence of the field of “Perioceutics” i.e. the use of parmacotherapeutic agents including antimicrobial therapy as well as host modulatory therapy for the management of periodontitis. These host-modulating agents used as an adjunct tip the balance between periodontal health and disease progression in the direction of a healing response. In this article the host-modulating role of various systemically and locally delivered perioceutic agents will be reviewed.

Low level laser therapy in the treatment of aphthous ulcer

Recurrent aphthous stomatitis (RAS) is one of the most common and painful ulcerative lesions of the oral cavity, but until now no cure has been recognized for it. Two patients diagnosed with minor RAS were treated in a single sitting with low level laser therapy using 940-nm diode laser. The lesions healed completely within 3-4 days and a follow-up for 1 showed no recurrence in these patients. According to the results of this study, low level laser therapy can decrease the healing time, pain intensity, size, and recurrence of the lesion in patients with minor RAS, and hence can be considered the most appropriate treatment modality for minor RAS, with greatest clinical effectiveness.

Periodontal disease and type I diabetes mellitus: Associations with glycemic control and complications

Objective: The aim of the study was to evaluate periodontal health status in patients diagnosed with type 1 diabetes mellitus (DM1) and to establish a correlation between metabolic control and periodontal health status. Materials and Methods: Periodontal health parameters namely plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded in 28 patients diagnosed with type 1 diabetes mellitus (DM1) and 20 healthy controls. Diabetes history was recorded based on the information provided by the physician and it included date of diagnosis, duration, age of diagnosis, latest values of glycosylated haemoglobin and existing diabetic complications. Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications. Results: The periodontal health in the diabetic group was compromised and they had greater bleeding index (P < 0.001), probing pocket depth (P < 0.001) and clinical attachment level (P = 0.001). Patients diagnosed for diabetes for shorter duration of time (4-7 years) showed bleeding index-disease severity correlation to be 1.760 ± 0.434. Conclusion: Periodontal disease was more evident in type 1 diabetes mellitus patients and periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.

Proteomics – The research frontier in periodontics

Periodontitis is an inflammatory condition resulting from the interplay between the infectious agents and host factors. Various protein molecules play a vital role in the initiation, progression and severity of periodontal diseases. The study of proteins as biomarkers in periodontal diseases has been highlighted during the last few years. In periodontitis multiple bacteria derived (e.g. collagen degrading enzymes, elastase like enzymes etc) and host derived mediators (eg. PGE2, TNF, IL1, IL6, MMPs etc) expressed in the saliva and gingival crevicular fluid, can be utilized as diagnostic markers for the disease. Another significant development regarding human genes and proteins has been the discovery of potential new drugs for the treatment of periodontal diseases. Therefore the information of the proteins involved in the pathogenesis of periodontal diseases can be utilized for its diagnosis, prevention and treatment.

Inhibitory effect of cranberry juice on the colonization of Streptococci species: An in vitro study

Background: Dental biofilm harboring oral bacteria is highly correlated with the progression of dental diseases. The existence of micro organisms as polyspecies in an oral biofilm and dental plaque has profound implications for the etiology of periodontal disease. The adhesion of streptococci to the tooth surface is the first step in the formation of dental plaque. Antiadhesive agents which can disrupt the biofilm formation can be an effective alternative to antibacterial therapy. Materials and Methods: A total of 10 patients both male and female between the age group of 20–40 years were included in the study. Plaque samples were taken and subjected to culturing on rabbits blood agar plate for the growth of streptococci colonies for 24–48 h. The streptococci colonies were identified and was further subjected to subculturing for 24–48 h with disc containing ethyl alcohol+cranberry extract (Group A) and water+cranberry extract (Group B). Both these groups A and B were further divided into subgroups I, II, III, IV, and V according to concentration 1:2, 1:4, 1:40, 1:100 and 1:600 respectively. Results: Zone of inhibition of Group A with subgroup I disc was 2 mm. while with subgroups II, III, IV, V disc was 4mm. Whereas the zone of inhibition seen of Group B was same (2mm) in subgroups I, II, III, IV discs however a significant zone of inhibition (10mm) was observed in subgroup V disc. Conclusion: Cranberry juice (active ingredient: Non dialyzable material) inhibits the adhesion and reverses the coaggregation of various oral micro organisms. The present study revealed that cranberry gel in highly concentrated (1:600) form has an inhibitory effect on the colonization of the streptococci species, and thus can be beneficial in the inhibition of dental plaque formation.

In Vivo Evaluation of Two‐Piece Implants Placed Following One‐Stage and Two‐Stage Surgical Protocol in Posterior Mandibular Region. Assessment of Alterations in Crestal Bone Level

BACKGROUND Endosseous implants can be placed following either two-stage technique requiring second-stage surgery or one-stage technique, which does not involve a second surgical intervention. PURPOSE The present study was undertaken to evaluate and compare the changes in crestal bone level when two-piece implants were placed in posterior mandibular region following one-stage and two-stage surgical protocol. MATERIALS AND METHODS A parallel group randomized prospective study was designed in which 20 two-piece implants were placed in the posterior mandibular region of 16 partially edentulous healthy patients following either one-stage (Group I) or a two-stage surgical protocol (Group II). Alterations in crestal bone level were assessed with the help of DentaScan at baseline, that is, at the time of implant placement, third month and sixth month. RESULTS Nonsignificant differences were seen in both groups in terms of changes in crestal bone level at the final evaluation. CONCLUSIONS Hence, it could be concluded that two-piece implants can be placed following one-stage surgical protocol as predictably as when two-stage surgical technique is followed.Background Endosseous implants can be placed following either two-stage technique requiring second-stage surgery or one-stage technique, which does not involve a second surgical intervention. Purpose The present study was undertaken to evaluate and compare the changes in crestal bone level when two-piece implants were placed in posterior mandibular region following one-stage and two-stage surgical protocol. Materials and Methods A parallel group randomized prospective study was designed in which 20 two-piece implants were placed in the posterior mandibular region of 16 partially edentulous healthy patients following either one-stage (Group I) or a two-stage surgical protocol (Group II). Alterations in crestal bone level were assessed with the help of DentaScan at baseline, that is, at the time of implant placement, third month and sixth month. Results Nonsignificant differences were seen in both groups in terms of changes in crestal bone level at the final evaluation. Conclusions Hence, it could be concluded that two-piece implants can be placed following one-stage surgical protocol as predictably as when two-stage surgical technique is followed.

An in vitro scanning electron microscopic study comparing MTAD (intracanal irrigant) and various root biomodifiers on periodontally involved human teeth

Background: Smear layer removal and collagen fiber exposure may improve regeneration outcome, which can be accomplished by use of root biomodifiers. These enhance the degree of connective tissue attachment to denuded roots. The objective of this in vitro scanning electron microscopic study was to comparatively evaluate mixture of tetracycline (TTC) and acid and detergent (MTAD) and other root biomodifiers for smear layer removal on periodontally involved human teeth. Materials and Methods: Forty human teeth were collected and stored in saline. After scaling and root planning, two samples were obtained from each tooth. A total of 80 dentin blocks were randomly divided into four groups: MTAD, TTC hydrochloride (TTC HCl), citric acid (CA), and normal saline. The agents were applied for 3 min by active burnishing. Immediately following treatment, the specimens were rinsed, dehydrated, fixed and prepared for scanning electron microscope and was examined at Χ3500 magnification. Previously trained blind examiners evaluated photomicrographs using Sampaios index (2005). Statistical analysis was performed. Results: MTAD is most efficacious in removing smear layer and showed statistically significant dentinal tubules opening, followed by TTC HCl and CA. Conclusion: MTAD and conventional root biomodifiers used in the study alters the dentin surface by smear layer removal and exposure of dentinal tubules. Hence, MTAD as a root biomodifier may have a significant role in periodontal regeneration .

Implant Maintenance: A Clinical Update

Introduction. The differences in the supporting structure of the implant make them more susceptible to inflammation and bone loss when plaque accumulates as compared to the teeth. Therefore, a comprehensive maintenance protocol should be followed to ensure the longevity of the implant. Material and Method. A research to provide scientific evidence supporting the feasibility of various implant care methods was carried out using various online resources to retrieve relevant studies published since 1985. Results. The electronic search yielded 708 titles, out of which a total of 42 articles were considered appropriate and finally included for the preparation of this review article. Discussion. A typical maintenance visit for patients with dental implants should last 1 hour and should be scheduled every 3 months to evaluate any changes in their oral and general history. It is essential to have a proper instrument selection to prevent damage to the implant surface and trauma to the peri-implant tissues. Conclusion. As the number of patients opting for dental implants is increasing, it becomes increasingly essential to know the differences between natural teeth and implant care and accept the challenges of maintaining these restorations.

Chlorhexidine–thymol varnish as an adjunct to scaling and root planing: A clinical observation

AIM To evaluate the efficacy of chlorhexidine-thymol varnish (Cervitec Plus(®)) as an adjunct to scaling and root planing in the improvement of periodontal parameters. MATERIAL AND METHODS A split mouth randomized clinical trial was conducted in 25 subjects with chronic periodontitis receiving scaling and root planing alone and as an adjunct to chlorhexidine-thymol varnish (Cervitec Plus(®)) and chlorhexidine-thymol varnish (Cervitec Plus(®)) alone. Clinical examinations were performed at baseline, 1 month and 3 months. RESULTS Short term advantages were observed in the clinical parameters in subjects receiving scaling and root planing and an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)) who showed the greatest improvement in the periodontal parameters at 3 months. CONCLUSION Subjects with chronic periodontitis significantly benefit from scaling and root planing when used with an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)).

Revolutionizing radiographic diagnostic accuracy in periodontics

Effective diagnostic accuracy has in some way been the missing link between periodontal diagnosis and treatment. Most of the clinicians rely on the conventional two-dimensional (2D) radiographs. But being a 2D image, it has its own limitations. 2D images at times can give an incomplete picture about the severity or type of disease and can further affect the treatment plan. Cone beam computed tomography (CBCT) has a better potential for detecting periodontal bone defects with accuracy. The purpose here is to describe how CBCT imaging is beneficial in accurate diagnosis and will lead to a precise treatment plan.