Models of pathogenesis help in integrating the data available from current scientific research, which aid in comprehensive understanding of the disease. This stereotypic representation of a disease in the form of a conceptual model helps in translation of new information into practical applications. The evolution in the knowledge of pathogenesis of periodontal disease can lead to a revolution in treatment modalities. The true purpose of pathogenesis models is to highlight the key aspects that need the main focus. Various models of periodontal disease pathogenesis have been proposed based on the prevailing concepts of the disease at that point of time. The aim of the present review is to outline the vital aspects of existing models of periodontal disease pathogenesis.

Context: Gracey curettes are the most frequently used manual instruments in periodontal treatments. Aim: This study aimed to evaluate morphology of working ends of standard and modified Gracey curettes no. 1–2. Materials and Methods: Using scanning electron microscopy, four batches of unused standard curettes from seven manufacturers and modified curettes from 6 manufacturers were investigated for blade length, blade width, blade thickness, toe morphology, surface roughness, and cutting-edge morphology. Results: Working ends of the standard Gracey curettes were longer than the modified ones, with mean lengths of 5.65 ± 0.68 and 4.42 ± 0.82 mm, respectively. However, both standard and modified Gracey curettes had comparable widths and thicknesses, with the mean width of 0.86 mm and the mean thickness of 0.71 mm. Most samples had acceptably symmetrical toes, except those from three manufacturers which had unacceptable toes with angulations. Moreover, only two manufacturers produced curettes with smooth blades on all their surfaces. In addition, sharp or functional wire edges were seen in cutting edges of curettes from three manufacturers. Conclusions: Working ends of standard and modified Gracey curettes could have different morphological features if they were from different manufacturers or different batches. It is suggested that dentists or dental hygienists make a purchase decision based on their knowledge on morphology of a good curette in relation to its intended use in dental practice, rather than their familiarity or the curette's price. Furthermore, the curette needs to be examined using a widely available magnifying device when possible.

Purpose: Computer-guided surgery has been increased in recent years. Nonetheless, few data are available on the validation of this technique for immediate implant placement. The purpose of this in vitro study was to evaluate the accuracy of computer-guided surgery in immediate implant placement. Materials and Methods: Cone-beam computed tomography scans (CBCTs) and virtual models were obtained of eight fresh pigs hemi-mandibles to perform the digital planning of implants placement. Fifteen implants were simulated, and surgical guides were designed to transfer the digital planning to the surgical procedure. Postsurgical CBCTs were performed to compare the position of the planned implants versus the real implant position. Paired t-test and the intra-class correlation coefficient (ICC) were used to assess the mean differences and correlations in each outcome variable evaluated twice by one experienced researcher. Furthermore, variations were compared with the results reported in the scientific literature using a one-sample t-test P < 0.05. Results: The measurements of the outcome variables (implants position at the neck and apex level and the angular deviation) showed significant reproducibility (mean difference-0.01 mm, 0.07 mm, and 0.30°, respectively, P > 0.05). The ICC values ranged from 0.888 to 0.949. Furthermore, the mean deviation was 1.43 mm at the implant neck, 2.19 mm at the apex, and 6.81° for the angular deviation. Similarly, significant differences (P < 0.05) were found at the neck and angular deviation when comparing the results with values reported in the literature. Conclusions: Although some variations were observed, they did not have a clinically significant impact. Therefore, computer-guided surgery could be satisfactorily used in immediate implants placement.

Background: Human dental plaque is a complex microbial community containing millions of species. Gingivitis is a dysregulated immune-inflammatory response induced by dysbiotic plaque biofilm that interrupts symbiosis. The emergence of next-generation sequencing with 16S rRNA gene has greatly contributed in understanding the complexity of microbiota. However, studies focusing on microbiome in gingivitis are limited. The whole bacterial community is important in causing periodontal disease than a small number of periodontal pathogens. In this study, we attempted to profile the subgingival microbiome from individuals with healthy gingiva and in patients with gingivitis using next-generation sequencing technology. Materials and Methods: Subgingival plaque samples from 15 healthy periodontium (Group I) and 15 gingivitis (Group II) were collected and 16s rRNA sequencing was done in Illumina Solexa Sequencer. Data analysis using 16s metagenomics tool from BaseSpace onsite operational taxonomic units was assigned to each sequence using HOMD database. Individual variation in the microbiome of the subgingival samples between the two groups was also evaluated. Results: The comparison of top 20 species between Group I and Group II revealed no significant species group between them. Synergistetes was absent in Group I samples but found in Group II. At the genus level, HACEK group species were found in both the groups, while Dialister and Aneroglobus were found abundantly in the Group II. Conclusion: The presence of unique genera and species seen in Group II samples could point toward a dysbiotic shift that could be taking place in the subgingival environment leading to gingivitis.

Context: Periodontitis is an inflammatory disease which is ubiquitous. When there is an onset of infection, the innate immunity gets activated followed by the adaptive immune system. Inflammasomes identify the pathogen-associated molecular patterns or danger-associated molecular patterns and initiate inflammation. Nod- like receptor family pyrin domain-containing protein 3 (NLRP 3) is a protein belonging to the intracellular innate immune sensors that act against bacteria. The inflammasome acts along with the toll-like receptor pathways to initiate an action against pathogens. NLRP3 (also known as PYPAF-1 or cryopyrin) acts via apoptosis-associated speck-like protein (ASC). Aims: The study aimed at finding out the relation between levels of NLRP3 in chronic periodontitis and healthy subjects via the enzyme-linked immunosorbent assay (ELISA). Settings and Design: This was a Cross-sectional study. Materials and Methods: Clinical examination and saliva sampling of the study population was done. Reagents were prepared and NLRP3 levels were estimated using ELISA analysis. Statistical Analysis: Intergroup comparison was initiated using the unpaired t-test and for within the group (intragroup), the two-way analysis of variance was used. The Pearson correlation coefficient helped to determine the strength of linear association. Results: Increased levels of NLRP3 were seen in subjects suffering from chronic periodontitis. NLRP3 was also seen to be positively correlated to probing pocket depth, clinical attachment loss, gingival index, and plaque index. Conclusions: A positive correlation exists between NLRP3 and chronic periodontitis, and hence, NLRP3 can be a potential biomarker.

Context: Tumor necrosis factor-alpha (TNF-α) has been shown to play a critical role in the pathogenesis of periodontitis and diabetes. Nonsurgical periodontal therapy was shown to reduce inflammation and improves glycemic status. Recently, adjunctive low level laser therapy (LLLT) has been shown to alter the inflammatory process. Aim: To evaluate and compare the alteration in TNF-α levels before and after treatment in patients with periodontitis with and without type 2 diabetes mellitus (T2DM). Settings and Design: Randomised clinico-biochemical study was carried out for 8 weeks from September 2019 to December 2020. Materials and Methods: Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with T2DM), based on probing depth ≥5 mm, clinical attachment level ≥2 mm, and history of T2DM. Later were subdivided into A1, A2, B1, B2, based on assigned treatments. Clinical periodontal parameters and salivary TNF-α levels were evaluated and compared at baseline to 8 weeks. Statistical Analysis: Multiple group comparisons were done using analysis of variance, intra group comparisons were made using t-tests. Results: Comparison of periodontal parameters and salivary TNF-α levels from baseline to 8 weeks showed statistically significant difference (P < 0.05) in all groups, indicating a positive effect of scaling and root planing (SRP) and adjunctive LLLT. Conclusion: Both SRP and SRP with adjunctive LLLT effectively altered TNF-α levels, correlating reduced periodontal inflammation.

Background: Marginal tissue recession is a frequent clinical scenario that creates substantial compromise in esthetic appearance of the patient. The current randomized, double-blind interventional trial aims to evaluate the effectiveness of the combination of “platelet rich fibrin (PRF)” membrane with bioresorbable guided tissue regeneration (GTR) membrane as compared to GTR membrane alone utilizing “double lateral sliding bridge flap (DLSBF) technique” for the management of simultaneous GR defects in human subjects. Materials and Methods: Twenty subjects were randomly allotted in two groups: Group 1 (test): 10 subjects treated with PRF + GTR membrane using DLSBF technique and Group 2 (control): 10 subjects treated with GTR membrane alone using DLSBF technique. Clinical measurements such as relative gingival marginal level, “relative clinical attachment level (R-CAL),” “probing pocket depth (PPD),” “gingival recession (GR),” and “width of keratinized gingiva (WKG) and gingival thickness (GT)” were evaluated at the initiation of the study and 6 months thereafter. Results: Two groups showed statistically significant differences with respect to probing depth reduction, CAL gain, and increase in WKG and GT. No significant result was observed with mean root coverage (RC) and complete RC for test (84.80% ± 19.53% and 54.99% ± 38.53%) and control group (75.69% ± 18.86% and 35.83% ± 39.29%), respectively. Conclusions: The combination of PRF membrane used along with GTR membrane provides no additional benefits over GTR membrane alone. However, the DLSBF technique convincingly shows simultaneous elimination of multiple problems associated with GR, shallow vestibule, hypersensitivity, and aberrant frenum pull in a single stage with meticulous performance.

Aim: A randomized controlled clinical trial was conducted to evaluate the effect of local drug delivery (LDD) of Acmella oleracea (Akarkara) and Acacia catechu (kattha) gels as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis patients. Materials and Methods: Thirty patients with ninety sites aged 25–65 years with generalized chronic periodontitis having pocket probing depth (PPD) of more than or equal to 5 mm on the basis of inclusion and exclusion criteria were selected. They were treated according to split-mouth design protocol. The placement of gel containing A. oleracea (1%) (Group 1) and A. catechu (1%) (Group 2) as LDD was placed at the two test sites, respectively, and only SRP was done in the control group (Group 3). Periodontal dressing was applied to all the three sites after procedure, and patients were given oral care guidelines. Evaluation of clinical parameters gingival index (GI), plaque index (PI), gingival bleeding index (GBI), PPD, clinical attachment level (CAL), and relative attachment level (RAL) was done at baseline, 1, 3, and 6 months, and microbiological parameter was assessed at baseline and 6 months. N-benzoyl-DL-arginine-2-napthylamide (BANA) test was used for the microbiological analysis. Results: Clinical parameters from baseline to 6 months at different time intervals demonstrated a significant reduction in mean GI, PI, GBI, and PPD and gain in CAL and RAL over a period of 6 months, and results were statistically significant in all the three treatment groups. However, on intergroup comparison, clinically significant difference was observed, but statistically, results were significant at few intervals. The microbiological analysis revealed a statistically nonsignificant reduction at the end of 6 months on intra- and intergroup comparison. Conclusion: The study concluded that the use of A. catechu gel and A. oleracea gel clinically showed improvement in clinical parameters when combined with SRP, attributing to better anti-inflammatory and healing properties.

Introduction: The etiological factors of periodontal diseases are the habitation of dysbiotic bacteria, absence of beneficial bacteria, and susceptibility of the host. Irresolute pattern in the periodontal diseases pathogenesis leads to the evolution of novel antimicrobial therapy. Objective: The objective of the study is to assess and compare the competency of locally delivered probiotic paste with chlorhexidine gel as a supplement to scaling and root planing (SRP) in chronic periodontitis patients. Materials and Methods: A split-mouth randomized controlled trial was designed on 10 systemically healthy participants having chronic periodontitis at three distinct quadrants with 5–6-mm pocket depth. The sites in each participant were randomly selected for Group A (negative control), Group B (positive control), and Group C (test). In Group A, only SRP, Group B – SRP + chlorhexidine local drug delivery (LDD), Group C – SRP + probiotic LDD were done, respectively. Gingival index (GI) and bleeding index (BI) were determined at baseline, 3^rd, 6^th, and 9^th weeks, whereas probing pocket depth (PPD), Russell's periodontal index, and clinical attachment level were checked at baseline and after 9 weeks. Results: It shows a significant reduction in GI, BI, PPD, and gain of CAL in probiotic LDD group. Conclusion: Nowadays, since microbes are rapidly developing resistance to antibiotics, the development of probiotics is a boon for the treatment of periodontal diseases. Diseases of the periodontium are not restricted to the oral cavity alone but also have strong systemic effects. Hence, probiotics give a natural and promising choice of therapy to establish both good oral and systemic health.

Background: The proportionate presence of natural teeth, gingival tissues along with the interdental papilla (IDP) is critical components of an esthetic smile. Hence, the present study examined the IDP height (PH), its position clinically and radiographically as papilla proportion (PP) and crestal PP (CPP). Materials and Methods: The study included 120 patients with healthy periodontium with an age group of 20–40 years, equally divided as males and females. The maxillary anterior interdental sites from canine to contralateral canine were examined for PH, PP, crestal PH (CPH), and CPP. Results: The mean values of PH, PP, CPH, and CPP were found to be greater on the mesial aspects of all the teeth as compared to the distal aspects. The females exhibited overall higher values than males for all the parameters. Majority of the teeth exhibited statistically significant differences for PP on mesial aspect when compared based on gender with mean values of 44.58% ±3.35% (males) and 47.17% ±3.23% (females) (P < 0.0001) for central incisor (CI). The CPP on mesial aspect for CI was 50.57% ±3.51% (males) and 54.21% ±3.76% (females) with P < 0.0001. A similar trend was followed in other teeth. Conclusion: The maxillary anterior teeth exhibit greater values on mesial aspects for parameters such as PH, PP, and CPP in both the gender thereby indicating an apical positioning of the IDP tip on distal aspect when compared to mesial. Furthermore, the values and differences were more pronounced in females than the males.

Context: Gingival recession (GR) is a common finding seen in the periodontics clinic. It has a significant functional and esthetic impact on the patient's dentition and quality of life. Aims: The current study aimed to develop the descriptive mathematical models for different domains of GR based on the data obtained from the North Indian population. Settings and Design: Cross-sectional observational study. Materials and Methods: Consecutive 130 participants were enrolled between June and August 2019. Complete case history and thorough oral examination were carried out including assessment of periodontal variables, for example, pocket depth (PD), gingival marginal level, clinical attachment level (CAL), simplified oral hygiene index, and gingival index. Prediction models for different domains of GR, namely Miller's class, severity, extent, and distribution of recession were made, and further, the best-fitted model on the basis of “coefficient of determination (R²)” was analyzed. Statistical Analysis Used: Multiple linear regression. Results: Nine factors, i.e., mean CAL, mean PD, tooth mobility, abrasion, width of attached gingiva, number of teeth present, age, type of brush, and socioeconomic status showed a significant association with different domains of the GR. In addition, a high degree of overlap was observed among factors associated with different domains of the GR. Conclusion: Diverse clinical (mean CAL, mean PD, tooth mobility, and abrasion), biological (width of attached gingiva, number of teeth present, and age), and environmental factors (type of brush and socioeconomic status) were found to have a significant association with the occurrence of GR in the North Indian population. Owing to the multifactorial etiology of GR, the identification of susceptible patients based on the presence of risk factors is an essential step in developing action plans for the prevention of the disease.

Gingival enlargement may be a result of multifactorial etiology which includes local factors such as calculus, food lodgement, overhanging restorations, and overextended dentures as well as systemic conditions such as hormonal disturbances and blood dyscrasias. Acquired immune deficiency is a manifestation of immune disorder caused by a retrovirus Human Immunodeficiency Virus (HIV). The association of Acquired Immunodeficiency Syndrome or HIV with oral and periodontal lesions is highly significant. Seropositive patients usually present with periodontal diseases and atypical periodontal lesions. These clinical findings may prove to be a link for probing patients' systemic health. This case report describes one such case of a patient, unaware of HIV infection with localized gingival overgrowth, wherein detailed probing and investigation led to the diagnosis of underlying systemic condition as acquired immunodeficiency. Subsequently, antiretroviral therapy was started, and nonsurgical periodontal therapy was performed to resolve the gingival overgrowth.

The purpose of this case series report was to describe the subepithelial connective tissue pedicled palatal flap technique, its indications, and its efficacy in closure of alveolar ridge reconstruction. The present case series consisted of all 11 consecutive subjects who underwent a ridge augmentation with biomaterials or with bone grafts. Furthermore, in other cases were placed immediate or delayed implants. All cases were closed with a subepithelial connective tissue pedicled palatal flap reconstruction in our private dental clinic between 2014 and 2020. The main advantages of this flap are that the donor site remains primarily covered, the soft tissue volume at the recipient site is increased, and there is good integration of the graft because the blood supply of the flap comes directly from the base of the pedicle. All cases exhibited an increase in soft tissue height and width after 6 months and primary closure was successful. This case series suggests that the subepithelial connective tissue pedicled palatal flap may be useful for moderate vertical and horizontal augmentation in the recipient site.

The present case report describes the novel combination of connective tissue graft (CTG) wall technique with xenograft for periodontal regeneration of extensive intrabony defects in the esthetic area. A 24-year-old female patient presented with gingival recession with mesial and distal deep bony defects at the upper lateral incisor and probing depths (PDs) of 7 and 5 mm, respectively. The surgical technique involved split-thickness buccal flap elevation, grafting the bone defects with xenograft bone substitute, securing the CTG over the surgical site followed by flap advancement. Uneventful healing was evident with reduction in PDs (5 and 4 mm), recession depths, and improvement in clinical attachment levels after 1 year. Radiographically, bone fill in the intrabony component was evident. It can be concluded that the presented approach combines the benefits of bone substitute's space maintaining and osteoconduction properties with the advantages of CTG wall to support the regeneration site and the overlying flap for improved clinical and radiographic outcomes in deep intrabony defects.

Biopsy is one of the histological diagnostic techniques used to assess cells and tissues to determine the presence and extent of a simple nonneoplastic growth to complicated malignancies. In the oral cavity, there are many techniques available to harvest the tissue, it depends on anatomical location and morphology of the lesion. In which many causes artifacts in the specimen due to poor technique and handling, which can lead to diagnostic pitfalls and misery. Laser is one of the advanced surgical tools used to harvest oral tissue with minimal anesthesia and less discomfort. This was a split-mouth case report conducted on smaller lesion (plasma cell gingivitis) to assess laser and scalpel surgical techniques to determine thermal damage of laser biopsy.