Low-level laser therapy (LLLT) is being extensively studied in the field of periodontics as a noninvasive technique to achieve better results after nonsurgical and surgical therapy. However, there is a lack of definitive guidelines for the use of LLLT to promote gingival and periodontal wound healing. The primary objective of this systematic review was to critically analyze the studies evaluating the effect of low-level diode laser on human gingival fibroblasts in vitro and to develop wavelength-specific guidelines for photobiomodulation of human gingival fibroblasts. A thorough electronic and manual search was conducted for relevant articles published until December 2019. Nine studies were included in the review after the initial screening of 1334 articles. Our data analysis revealed that LLLT with diode laser stimulates human gingival fibroblasts as there was the increase in cell viability, proliferation, migration, and protein synthesis in irradiated cells. The diode lasers in the 600–700 nm spectrum were effective in the 10 mW to 30 mW power range. Lasers in the 700–800 nm range were effective in the 25–50 mW power range and diode lasers in the 800–900 nm range were effective at a power setting of 10 mW. It was possible to ascertain a suitable power setting for a particular wavelength spectrum, but no other parameters could be defined due to a lack of reporting of details. Hence, the authors have developed guidelines for comprehensive reporting of in–vitro studies to facilitate future research and overcome existing lacunae in knowledge.

Background and Objectives: Periodontitis caused by multifactorial polymicrobial infection results in a destructive inflammatory process and loss of tooth supporting tissues. Many putative bacterial virulence factors that cause host destruction are regulated by iron and haem. Therefore, this study investigated the free haem levels in the gingival crevicular fluid (GCF) at periodontitis sites in smokers and nonsmokers and their relationship to subgingival microbial composition. Materials and Methods: A cross-sectional study was carried out on 78 patients with a split-mouth design who were divided into Group I A – periodontally healthy sites and Group I B – periodontally diseased sites in nonsmokers with chronic periodontitis and Group II A – periodontally healthy sites and Group II B – periodontally diseased sites in smokers. Clinical parameters recorded included a plaque and gingival index, papillary bleeding index, pocket probing depth, and clinical attachment level. The collected GCF samples were subjected to Biovision™ Hemin Colorimetric Assay Kit and subgingival plaque samples to BANA™ test. Results: Increased GCF free haem concentration and positive BANA sites were seen at periodontitis sites compared to healthy sites, in both smokers and nonsmokers group. However, no difference was found in GCF free haem levels between smokers and nonsmokers, but it was statistically significant with respect to BANA-positive sites. Conclusion: Thus, this study concludes that the higher concentration of GCF free haem at diseased sites indicates that it could be used as a potential biomarker to determine active periodontal sites, also smoking and BANA results did not influence the biomarker levels.

The aim of this study was to evaluate and compare the mechanical resistance of platelet-rich fibrin (PRF) membrane when submitted to resistance traction on longitudinal axis. Blood collection of a healthy individual was collected with an amount of 300 mL and divided into 30 tubes containing 10 mL each one. The samples were divided into three groups, according to the g-force protocols: (1) F200 g: (2) F400 g; (3) F800 g. Membranes of each g-force group were divided into subgroups, according to waiting time after centrifugation: (T0) immediate use and (T30) use after 30 min. Considering these intervals of time, the concentrate was removed from tubes and inserted in a PRF metallic box to confection of the membrane. The PRF membranes were submitted to mechanical tension on a universal testing machine and obtained to a resistance force of each membrane. The centrifugation time showed no statistically significant difference for membrane resistance for any force applied (P > 0.05; Student's t-test). For T0 group results demonstrated no influence for membrane resistance (P = 0.357; Student's t-test), therefore T30 showed statistically significant difference (P = 0.040; Student's t-test) for membrane resistance for centrifugation forces applied, with highest value when applied greatest force. The findings suggest that the waiting time for centrifugation could be determined according to demand of application, and for immediate use of the membrane, the centrifugation did not influence the resistance, on the other hand, after 30 min, the application of higher force resulted in a membrane with considerable resistance.

Background: The use of biofuel like platelet-rich fibrin (PRF) may enhance the healing potential of the tissues in tobacco smokers and diabetic patients. Aim: To evaluate the modified advanced PRF (A-PRF) buffy coat quantitatively in uncontrolled type-2 diabetic patients and tobacco smokers with chronic periodontitis by determining the size outcome of the buffy coat, the platelet and leukocyte concentration, and also to find out the influence of gender on these parameters. Materials and Methods: In this cross-sectional study, 180 generalized chronic periodontitis patients (46–55 years) were enrolled, Group 1 (Control group): 60 systemically healthy subjects; Group 2 (Test group): 60 Heavy tobacco smokers; and Group 3 (Test group): 60 uncontrolled type 2 diabetic patients. 15 ml of blood was drawn from all subjects to assess the size outcome, platelet, and leukocyte concentration also to find out the influence of gender on the various parameters of the prepared modified (A-PRF) membrane. Results: Uncontrolled type-2 diabetic patients had maximum height (23.39 ± 1.69 mm) and width (7.26 ± 0.16 mm) of modified (A-PRF) clot when compared to healthy individuals and tobacco smokers. The total number of platelet (245.38 ± 40.72 1000/ul) and leukocyte count (6.11 ± 0.60 1000/ul) and their percentage of concentration were 95.21 ± 2.16% and 77.25% ±1.98%, respectively, and is significantly higher in uncontrolled type-2 diabetic patients (P ≤ 0.05). Females were associated with the larger sized modified (A-PRF) clot with more number of platelets and leukocytes count than males. Conclusions: Size outcome of modified (A-PRF) clot was found to be comparatively larger in uncontrolled type-2 diabetic patients particularly in females of all the groups when compared to males. Among the hematological parameters, the total count as well as the percentage of platelet and leukocyte in modified (A-PRF) membrane was found to be higher in uncontrolled type-2 diabetic patients. Female subjects exhibited higher platelet and leukocyte concentration than males.

Background: Drilling of the implant site results in transient rise in temperature of the surrounding bone disrupting the bone healing process and implant stability. Overproduction of heat due to various factors at osteotomy site needs to be controlled as it hampers the final outcome of the procedure. Purpose: The purpose of this study was to evaluate various factors related to implant drills responsible for heat generation and temperature rise during osteotomy. Materials and Methods: A total of 64 bone specimens with dimensions of 15 mm × 15 mm were obtained from goat mandibles and were equally divided into Groups A and B with operating room temperature maintained at 25°C and 30°C, respectively. Osteotomies were performed using drills with diameters (4.2 mm and 5.6 mm) at various drilling depths (10 mm and 13 mm) with external saline irrigation temperatures (4°C and 25°C). Temperature change was recorded by laser thermometer. Results: The surgical drill depths, diameters, and room temperatures made no differences in temperatures at implant drilling sites whereas the temperatures of the irrigants provide sufficient heat control during drilling. Conclusion: Cooled saline provides beneficial effects in controlling the temperatures of osteotomy sites as compared to saline used at room temperature during implant site preparation.

Background: Reactive oxygen metabolites (ROMs) produced in periodontitis could contribute to excessive tissue damage. Thus, treatment of chronic periodontitis may decrease the ROM levels. The aim of this study is to evaluate the ROM levels in plasma, saliva, and gingival crevicular fluid (GCF) in generalized chronic periodontitis (GCP) patients before and after nonsurgical periodontal treatment. Materials and Methods: Two groups were included in this study. Group I consisted of 30 healthy controls (C) and Group II consisted of 30 subjects with GCP. Plaque index (PI), papillary bleeding index, Probing Depth (PD), and clinical attachment level were recorded. GCF, saliva, and plasma samples were collected from both groups. ROM levels were assessed. A baseline comparison was made between the two groups. Nonsurgical periodontal treatment was carried out for Group II subjects. Two months posttreatment, the clinical parameters and ROM levels in GCF, saliva, and plasma were reassessed in Group II, and the data were compared with their baseline values. Statistical analysis was done using SPSS 20 software and results were derived. Results: Two months posttreatment, Group II exhibited significant reduction in ROM levels in plasma, saliva, and GCF with significant decrease in PI, bleeding on probing, probing depth, and attachment loss. Conclusion: Thus, significant oxidative stress may occur in chronic periodontitis and nonsurgical periodontal therapy may be regarded as an effective treatment modality to treat the diseased periodontium, thereby preventing possible systemic diseases in future.

Background: Repeated abutment replacements may insults the soft tissue (mucosal) barrier mechanically, that might initiate other toxic irritants and bacteria into the mucosal-implant barrier that may affect the strength of the tissues around implants. The development of the “definitive abutment,” might minimize the chances of peri-implant soft and hard tissue loss. Therefore, the study was designed to assess peri-implant tissue dimensions in dental implants with definitive abutment (Test group) and repeated abutment replacements (Control group). Materials and Methods: Twenty edentulous sites from systemically healthy participants were selected for the study. Parameters registered were bleeding on probing, Sulcus probing depth, peri-implant marginal bone loss (PMBL) and additionally, two parameters were measured both clinically and radiographically, which included distance of cement enamel junction to alveolar crest (CEJ-AC) and distance of CEJ to gingival margin (CEJ-GM). At the time of surgery, sites were allocated randomly to either test group or control group. All the measurements were recorded at baseline, 3 and 6 months. Results: The PMBL increased from baseline to 3 months in control (1.05 ± 0.28 mm) and test groups (0.65 ± 0.41 mm). When the clinical values of CEJ-AC and CEJ-GM were compared with their respective radiographic values, no substantial differences were noticed between both the groups. The soft-tissue margins in both the groups remained comparatively stable across all the time points. Conclusion: The findings of this study point toward the use of implants with definitive abutment are more beneficial in achieving better maintenance in terms of marginal peri-implant tissue health.

Background: Around the world, an increasing number of people are turning towards nature by using the natural herbal products not only because they are inexpensive but also for better cultural acceptability, better compatibility with the human body and minimal side effects. This study assessed the effectiveness of liquorice (root extract) mouth rinse against dental plaque and gingivitis and compared it with 0.2% chlorhexidine (CHX) gluconate mouth rinse. Materials and Methods: A double-blind, concurrent parallel randomized controlled clinical trial (CTRI/2016/09/007311) of four months duration was conducted. Forty-four volunteers who met the inclusion criteria were randomized into two groups through the computer-generated random sequence. Based on in vitro minimum inhibitory and minimum bactericidal concentration evaluations on periodontal pathogens, a concentration of 20% (w/v) of aqueous liquorice root extract mouth rinse was prepared. Both the groups were asked to rinse with their respective mouthwash twice daily for 15 days. Gingivitis was evaluated using gingival index (GI), and dental plaque was evaluated using the Turesky modification of the Quigely Hein Plaque Index (PI). The evaluation was carried out at day zero, 8^th and 23^rd (15 days after intervention). Intra- and intergroup comparisons of indices for both the arms were done using the paired sample t-test and unpaired t-test, respectively. Results: There was a statistically significant (P = 0.000) reduction in mean PI and GI scores for both the groups after a follow up of 15 days. The intergroup comparison of plaque and gingival index scores for both the mouth rinse groups came out to be statistically significant (P = 0.000). Conclusion: Both liquorice and CHX gluconate mouth rinse restricted plaque accumulation and gingival inflammation. Considering the established side effects of long-term use of chemical formulations, the herbal mouth rinse preparation can promise to be an effective self-care therapy.

Objectives: Virgin coconut oil (VCO) pulling has antimicrobial activity and has been promoted as beneficial to oral health; however, limited information exists on its clinical effectiveness. This study aimed to compare the microbiological effects of VCO with palm oil (PO) pulling when used as an adjunctive oral hygiene care. Materials and Methods: Thirty-six volunteers with gingival inflammation were randomly assigned to start with (1) VCO (test) and (2) PO (control) interventions in a crossover design. Oil pulling was performed for 28 days adjunctively to oral hygiene routine. After a 21-day wash-out period, the participants switched the oil type and restarted the protocol. Plaque samples were collected for microbial culture at baseline, after the first oil pulling period, after washout, and after the second oil pulling period. The total, aerobic, and anaerobic bacteria and Mutans streptococci (MS) counts were recorded. The mean differences between VCO and PO were compared by paired t-test. Results: The number of total, aerobic, or anaerobic bacteria after 28 days of oil pulling was not significantly different from baseline in both PO and VCO groups. However, PO pulling demonstrated a significant reduction from baseline of MS count (P = 0.010), while VCO pulling showed no significant reduction. There was no statistically significant difference in the mean changes of any microbiological parameters between the two treatments. Conclusions: VCO pulling did not show statistically significant superior benefit against plaque bacteria over PO pulling. Using PO pulling as an adjunctive oral hygiene care may reduce the number of MS, but this requires further investigations.

Background: Childhood obesity is a serious medical condition that affects children and adolescents. Being overweight and obese are important risk factors for various adult diseases including diabetes, cardiovascular, and cerebrovascular disease, hypertension, and periodontal diseases. This study aimed to compare the periodontal findings in obese children with those exhibiting normal body mass. Materials and Methods: In the present retrospective cohort study, 108 children, 12 years of age, were randomly assigned to the two groups with equal gender distribution, selected from the schools in Yazd, Iran: obese (body mass index [BMI] ≥25) and nonobese (BMI <25). After obtaining informed consent forms from their parents, each participant's demographic data and BMI were recorded, and periodontal indices were determined including plaque index (PI), bleeding on probing (BOP), pocket depth (PD), and clinical attachment loss (CAL). Then, a questionnaire on dietary and oral hygiene habits was completed by the participants. The data were collected and analyzed with a Chi-square test and t-test. Results: The results showed statistically significantly higher mean PI, BOP, and PD in obese participants than nonobese participants (P < 0.05), with no statistically significant difference in CAL between the two groups (P > 0.05). Conclusions: The periodontal indices of PI, BOP, and PD in obese children were significantly higher than in children with a normal weight. However, there was no statistically significant difference in CAL between the two groups.

Introduction: Illness perception is the cognitive representation of an illness, which determines how a person responds to it. The Revised Illness Perception Questionnaire (IPQ-R) assesses seven components of illness representation in various chronic diseases, but queries prevail about its factor structure. The study assesses the components of illness representation in patients with chronic periodontitis. Materials and Methods: A total of 625 voluntary, consecutive dental patients with a clinical diagnosis of periodontitis were recruited into the study. The Hindi version of IPQ-R was used, consisting of three parts-identity scale, structured scale, and perceived causes of the patient's ailment. Results: Of the 625 participants, 44.0% reported cyclical disease pattern, 30.4% said their disease was a mystery. Only 1.6% predicted it to remain throughout their life. A total of 44.0% of participants reported the disease to impact their day-to-day life severely. A significant difference was observed between males and females across seven components of IPQ-R. While 21.6% of participants attributed stress to be a major cause for their diseased state, 20.8% reported workload to be a major cause, but 42.4% attributed poor medical care in the past to be a major cause for their state. Conclusions: A sensible approach to treating a disease is to measure the patient's illness perception and target specific interventions accordingly. It would be cost-effective and break misconceptions about diseases in patients, ultimately providing them with better overall health and satisfaction.

It is often documented that chronic irritation could be an etiology of oral cancer; yet out of negligence little heed is paid to any sort of discomfort until it grows to a sizable mass where it is difficult to go unnoticed. Intraorally, the source of irritation could vary from a jagged tooth edge to a chronic cheek bite. Furthermore, the removable prosthesis and orthodontic appliances can lead to alteration of the oral mucosal tissue. This case report represents one such sequelae of an ill-fitting dental prosthesis. Surprisingly and unfortunately, the broken denture was still in use by the patient until the damage caused by it could no further be ignored, it is then that the patient sought medical help. A histopathological diagnosis of reparative giant cell granuloma was made, and the patient was treated by successful excision of the same.

This clinical case describes the longitudinal outcome of a radisected upper molar root. The palatal root acted as an abutment and was finalized with a double-premolar-shaped metal-resin crown with two rests on the adjacent teeth. Fifteen years later, the root and its crown were still in place, with no pathologic pocket probing depth and lack of inflammation; the tooth was still in function with no signs of periodontal breakdown. This therapeutic option seemed to have been biologically respectful and maintains the possibility to provide future implant therapy.

Complete tooth wear dentition is multifactorial and has challenges with diagnosis and etiology. Their rehabilitation often requires orthognathic surgery, orthodontics, periodontal surgery, and prosthodontic guidelines for occlusion with harmonious facial and dental esthetics. A patient needs a multidisciplinary approach with systematic analysis to formulate evidence-based approach to improve function and esthetics. Contemporary periodontal therapy also encompasses esthetic treatment where needs are frequently associated with changes in tooth size, shape, proportion, and balance that can adversely affect smile appearance. The article provides an evidence-based guideline for reconstruction of a worn dentition. The completed work includes crown lengthening, provisionalization, socket shield technique, oral implants, and gain in lost vertical dimension with occlusion correction and minimally invasive prosthetic restorations.

Excessive gingival display can be an esthetic concern for the patient. Conventional lip repositioning provides a conservative surgical option with less patient morbidity. The unified technique is a modification of conventional lip repositioning technique using the orthodontic brackets as anchorage to provide better soft-tissue closure with the lesser chances of relapse. This technique has been modified to be less invasive with better results. In this case report, patients undergoing orthodontic treatment with short upper lip were recommended for the surgical lip repositioning to reduce excess gingival display. Cases were treated with conventional lip repositioning technique and with unified lip repositioning technique, and after evaluation, comparison was done postoperatively. The unified lip repositioning technique showed better results with a significant decrease of gingival appearance and more patient compliance. Thus, in patients with short upper lip, unified lip repositioning technique can be a viable conservative treatment option.