Background: Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss. Objective: The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries. Materials and Methods: It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made. Results: Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004). Conclusions: The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.

Background: Periodontitis is an inflammatory disease causing destruction of tissues surrounding the teeth. The primary etiological factor for periodontitis is plaque. An inference could be drawn that an overall reduction in microorganisms halts disease progression. It is desirable to have natural agents with minimal side effects to reduce the microbial load. Aim: The aim of the study is to assess the effect of hydrogen water on microbial count in plaque obtained from chronic periodontitis patients and to determine the antibacterial activity of hydrogen water at various time intervals. Materials and Methods: A total of twenty chronic periodontitis patients were included after obtaining approval from the institutional ethical committee. Written informed consent was obtained from all the twenty participants. Plaque samples were collected and exposed to hydrogen water at baseline, 1 min, 2 min 30 s, and 5 min. Samples were then cultured on blood agar and incubated in aerobic and anaerobic conditions. The colony forming units and total bacterial count were recorded after 24–48 h. Statistical Analysis: Intragroup pair-wise comparison was done using Wilcoxon sign-ranked test. Results: Hydrogen water showed antibacterial activity against aerobic and anaerobic organisms associated with chronic periodontitis. There was a statistically significant difference in the number of colony forming units from baseline to 1 and 2.5 min for the aerobic culture and also for baseline to 1, 2.5, and 5 min for the anaerobic culture. Conclusion: The data of the present study indicate that hydrogen water has an antibacterial effect on microorganisms associated with chronic periodontitis.

Background: The aim of our study is to assess the effectiveness of Curcumin and Tulsi in the control of periodontal parameters when delivered in the form of local drug delivery (LDD) agents. Methods: Curenext gel^® and Tulsi gel were used as the two LDD agent. A split mouth randomized clinical trial was carried out in 15 patients. Three sites in different quadrants were assigned treatment modality of scaling and root planing (SRP) alone, SRP with LDD of curcumin and SRP with LDD of Tulsi extract, respectively. Clinical parameters Probing Pocket Depth, Clinical Attachment Level, Plaque Index, Gingival Index, and modified Sulcus Bleeding Index were recorded and subgingival plaque sample collected for N-benzoyl-L-arginine-p-nitroanilide (BAPNA) assay on baseline followed by LDD with extracts in the assigned group. The parameters were recorded at baseline and on 30^th day postoperatively. Unpaired and Paired-'t' test were used for intergroup and intragroup comparison of recorded clinical and microbiological parameters. Results: All the treatment modalities showed statistically significant reduction in clinical and microbiological parameters on intragroup comparison. Intergroup comparison showed statistically significant reduction in Plaque Index in curcumin group and BAPNA assay in Tulsi group when compared to SRP. Conclusion: Both the herbs were effective in improving periodontal parameters and may develop as an alternative to currently used LDD agents in near future.

Background: Mesotherapy is a minimally invasive procedure which involves local intradermal therapy (LIT) with biologically active substances given in minor quantities to the area of pathology. Vitamin C is an important antioxidant agent which can modulate the attenuation of inflammatory process and enhance tissue repair. Aim: The aim of this study was to investigate the efficacy of local injections of Vitamin C for treating persisting inflammation of the gingiva. Materials and Methods: After phase I therapy was completed, five patients with persisting chronic inflammation of the gingiva were injected with the same dosages of Vitamin C into the gingival tissues. Patients were evaluated each week for resolution of gingival inflammation. Results: Clinical observation showed a significant improvement in inflammation of the injected sites during recall appointments. Conclusions: LIT with Vitamin C has a synergistic interaction along with scaling and root planing in the treatment of persistent gingival inflammation.

Background: The periodontal phenotype (PP) plays an important role in the function, esthetics, and maintenance of periodontal health and has a great influence in periodontal, restorative, and dental implant therapies. Aim: The aim of this study was to conduct a clinical evaluation of the PP and its morphometric variations through the cone-beam computed tomography (CBCT), from dentistry students with periodontal health. Materials and Methods: Sixty students were examined, and the clinical parameters of probing depth and width of keratinized tissue (WKT) in the upper anterior segment were accessed. The gingival thickness was evaluated as thick or thin, through the translucency of the periodontal probe through the marginal gingiva. By convenience sample, 13 students were selected to assess bone thickness and gingival thickness and biological width through the previous CBCT examination. Results: The most prevalent PP, according to the classification by De Rouck et al., was the thick scalloped (55%), and using the classification of Kao and Pasquinelli, the thick PP was most common (73,3%). The thick PP in both the classifications was more prevalent in both genders and the WKT was significantly higher in the thick-flat scalloped PP. The bone thickness was always greater than the gingival thickness in CBCT examinations both in the measures 1 mm and 3 mm above the bone crest. The average of the biological width measurement was 2.02 mm. Conclusions: The thick PP was most prevalent in the sample studied, and the gingival thickness was always thinner than the bone thickness in the measures evaluated.

Background: Periodontitis is a chronic inflammatory disease that is mainly initiated by plaque biofilm which may require treatment using periodontal flap surgery. Recently, diode lasers have become popular in the field of periodontology owing to advantages such as antibacterial effect, promoting angiogenesis, and providing hemostasis. However, scientific data on application of diode laser in periodontal flap surgery and its benefits are limited. Hence, the aim of the study was to investigate the adjunctive effect of removal of remnant pocket epithelium by 980 nm diode laser and biostimulation in modified Widman flap (MWF) surgery for the treatment of chronic periodontitis. Materials and Methods: A total of 20 patients with generalized chronic periodontitis with pocket probing depth (PPD) ≥5mm post Phase I therapy were selected for this split-mouth study. MWF surgery was performed in Group 1, and in Group 2, MWF surgery with adjunctive diode laser de-epithelization and biostimulation was done. Clinical parameters including PPD, clinical attachment level, plaque index, and gingival index were recorded at baseline and 3 months following treatment, and postprocedural pain (Visual Analog Scale [VAS] score) was assessed 1-week posttreatment. In addition, colony-forming units/milliliter (CFU/ml) of anaerobic bacteria at baseline and 3 months were microbiologically examined. Results: MWF surgery along with diode laser led to a significant improvement in Group 2 compared to Group 1 in clinical parameters such as PPD, relative clinical attachment level, VAS score as well as microbial parameter CFU/ml after 3 months. Conclusion: Diode laser as an adjunct to MWF in chronic periodontitis can provide enhanced clinical attachment gain with little postoperative discomfort.

Background: Hyaluronan is a naturally occurring polysaccharide in the extracellular matrix of the connective tissue. It imparts antibacterial and osteogenic properties to the nano hydroxyapatite bone graft (NHA). Aim: This study aims to evaluate the efficacy of hyaluronan-NHA (H-NHA) composite in the treatment of infrabony defects in chronic periodontitis patients. Materials and Methods: Eight systemically healthy chronic periodontitis patients with 32 graftable sites were included in the study. After flap reflection and debridement, the defect sites in the test quadrant were filled with H-NHA graft and those in the control quadrant were filled with NHA graft alone. Clinical parameters such as probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline and 3, 6, 9, and 12 months; bone probing depth (BPD) and radiographic parameters such as amount and percentage of defect depth reduction (DDR, PDDR) and change in alveolar crest level (ALR) were assessed at baseline and 6 and 12 months. Statistical Analysis Used: Descriptive statistics, one-way analysis of variance, and Student's t-test were used for statistical analysis. Results: At the end of 12 months, H-NHA group showed a greater reduction in PPD (5.06 ± 0.582 mm), BPD (4.22 ± 0.371 mm), and gain in CAL (4.00 ± 0.421 mm) as compared to the NHA group (3.21 ± 0.648 mm, 3.21 ± 0.047 mm, and 2.86 ± 0.127 mm, respectively). In addition, DDR, PDDR, and ALR were better in H-NHA group (1.92 ± 0.647 mm 48.22 ± 31.561 mm, and 1.22 ± 0.808 mm, respectively) as compared to the NHA group (1.14 ± 0.602 mm, 20.14 ± 25.349 mm, and 0.89 ± 0.626 mm, respectively). Statistically significant improvements in all the parameters were seen in the test sites when compared to control sites at 12 months. Conclusion: H-NHA composite graft can be considered a promising periodontal regenerative material.

Background: The etiology of gingival recession is often multifactorial. Wide array of surgical techniques are available to manage gingival recession. The aim of the present study was to compare, minimally invasive approach (vestibular incision subperiosteal tunnel access [VISTA]), in combination with platelet-rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple recession defects in maxillary anterior region. Materials and Methods: A total of 32 sites from 10 systemically healthy controls were allocated randomly to VISTA with PRF (VISTA + PRF) and VISTA with CTG (VISTA + CTG). Plaque index, gingival index, Probing probing pocket depth (PPD), relative attachment level (RAL), recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and percentage of root coverage (%RC) were calculated at 6 months postoperatively. Results: Results showed significant improvement in mean PPD, RAL, RD, RW, and KTW. %RC in VISTA + PRF and VISTA + CTG was 83.25% ± 25.02% and 86.43% ± 22.79%, respectively, at 6 months. There were no significant differences in the parameters between the VISTA + PRF and VISTA + CTG groups. Conclusion: VISTA is a minimally invasive surgical approach, which can be combined with CTG or PRF in the management of Miller's Class I and Class II recession defects, with predictable outcomes. There were significant improvements in the clinical parameters from baseline to 6 months in both the groups. To match with the CTG, which is the gold standard procedure, PRF can be used as an alternative for treating multiple recession defects.

Background: The aim of this cross-sectional study was to assess the analgesic consumption and the frequency and intensity of pain after nonsurgical periodontal therapy, as well as to associate these factors with the extent and severity of periodontitis and with the degree of anxiety before the procedure. Materials and Methods: Fifty-one patients with chronic periodontitis were recruited. The degree of previous anxiety was assessed with the dental anxiety scale questionnaire. Periodontal data were obtained by means of clinical examination and circumferential probing performed by undergraduate students, supervised by a clinical lecturer. The teeth submitted to treatment in the session were registered. Analgesic consumption was recorded 7 days after periodontal intervention. To measure pain, a visual analog scale was used. The patient was instructed to record the pain intensity at 2, 4, 8, 24, and 48 h after subgingival scaling. Differences in pain intensity between periods after nonsurgical periodontal therapy were performed using Anova test. P < 0.05 was statistically significant. Results: There was no relevant difference between groups in all variables used in the study (P > 0.05). The use of analgesics was significantly more frequent among individuals who had reported higher levels of pain. The degree of anxiety before treatment was similar among groups (P > 0.05). Most individuals reported no pain or mild pain (P < 0.05). Conclusion: Nonsurgical periodontal therapy is associated with low pain or absent pain.

Background: A major dental concern in children with special health-care needs is poor oral hygiene, which results in increased incidences of dental caries, gingivitis, and periodontal disease. Aims: The study intended to determine if there was a difference in the oral health status of children with visual impairment and normal children and to evaluate the efficacy of the frequently used dental aids. Settings and Design: The study population included 90 children, 45 children with visual impairment (study group) with age- and sex-matched 45 normal children (control group). Both the groups were further divided into three intervention subgroups. Subgroup A: manual toothbrushes, Subgroup B: manual toothbrush with medicated mouthwashes, and Subgroup C: powered toothbrushes. Materials and Methods: For each subject, oral hygiene index simplified (OHIS), Turesky-Gilmore-Glickman modification of the Quigley-Hein Plaque Index (TQPHI), and decayed missing filled teeth (DMFT) indices were recorded at baseline, i.e., before any intervention. This was followed by oral prophylaxis by ultrasonic scaling. The three indices were recorded in 0 (baseline), 30 days (1 month), 90 days (3 months), and 180 days (6 months), respectively. Statistical Analysis Used: ANOVA test, Chi-square test, and student paired test were used for statistical analysis. Results: The mean TQHPI and OHIS values of mouthwashes at the end of 6 months were 1.01 and 1.60, respectively, which were lower than manual and power brushes. No statistically significant reduction in the DMFT scores with the use of any of the adjuncts was noted. Conclusions: Among the dental aids used in the study, mouthwash showed a significant reduction in plaque and oral hygiene scores as compared to powered toothbrushes and manual brushes alone.

Several disorders related to growth and development affect children during their early stages of life. One rare disorder that affects about 15% of children is constitutional growth delay (CGD). Its results in the affected individuals appear unusually short and young for their age. The individuals are otherwise normal and appear as their normal counterparts as age increases. Inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue tumor that commonly affects the lungs, liver, and gastrointestinal tract. The occurrence of this tumor outside the aforementioned areas is very rare. It resembles a neoplastic tumor clinically and histologically. It is also referred to as inflammatory pseudotumor. Here, we report the case of an individual with CGD who also had an IMT involving the mandibular left canine region.

Capillary hemangiomas and pyogenic granuloma (PG) are well-recognized benign entities of the oral cavity which are vascular in origin. PG is said to have a predilection for gingival area, whereas capillary hemangioma involves the lips, cheek, and tongue. They may mimic more serious conditions such as malignancies making the clinical diagnosis quite challenging. There have been cases reported where PG was found on extra-gingival sites such as the palate, lips, and tongue. We present the two cases of lobular capillary hemangioma (LCH) on extragingival sites, namely the palate and buccal mucosa, which manifested as a different lesion clinically and histopathological examination was indicative of LCH. The cases reported here show that relatively common pathologies can present on rare or atypical regions inside the oral cavity, and hence, it is imperative for the clinician to consider such lesions while formulating a diagnosis.

Inflammatory fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, irritational fibroma (IF), peripheral giant cell granuloma, etc., are the different types of reactive gingival lesions that may occur in response to mild chronic irritation associated with subgingival factors, root remnant, iatrogenic factors, and trauma. Gingival IF is one of the most common reactive lesions and is usually sessile in nature, and its size is usually not more than 1.5 cm. Complete surgical excision along with the elimination of precipitating/aggravating factors is the treatment of choice generally adopted by a general dentist without giving due consideration to its size, location, and postoperative sequel. The present rare case describes the simple, easy to perform, and effective periodontal plastic treatment for the management of expected residual soft tissue defect, following surgical excision of large recurrent IF in the posterior maxillary teeth at 9 months postoperatively, in addition to its conceivable etiology and diagnosis.

Tooth loss can have not just a physical handicap but also a psychological bearing on an individual. Avulsion or complete displacement of the tooth from the socket can result due to various factors ranging from road traffic accidents to domestic abuse. Replantation of such avulsed teeth has been a topic of debate owing to the duration of extra oral time, storage medium and long term success. In this case report we discuss the successful replantation of an avulsed permanent tooth with an increased extra oral dry time using Injectable form of Platelet rich fibrin (i- PRF).

Context: Nowadays, complementary therapies are necessary for a major removal of microbial subgingival biofilm in the conventional treatment of periodontitis. Research has suggested the use of photodynamic therapy (PDT) as a promising therapy to manage oral cavity infections. This project proposes a new combination of photosensitizer chloroaluminum phthalocyanine and nanoemulsion as a strategy for improving bioactivity. The main purpose of this in vitro study was to evaluate the antimicrobial activity of nanoemulsion ClAlPc (ClAlPc-NE) on relevant periodontal bacteria before and after PDT. Materials and Methods: The phototoxic and antibacterial effect of ClAlPc-NE was evaluated against epithelial cells derived from an African green monkey kidney using the colorimetric method with salt tetrazolium 3-(4.5-dimethylthiazolyl-2)-2.5-Diphenyltetrazolium bromide (Merck) and periodontopathogen bacteria (Porphyromonas gingivalis (ATCC 33277), Aggregatibacter actinomycetemcomitans (ATCC 33384), and Prevotella intermedia (ATCC 25611) using the plate microdilution method according to Tavares et al., 2018, respectively. The light source used for the PDT was a LED laser (400–700 nm); the cells were irradiated for 2 min using 4.83 joules/cm². Results: Antibacterial effect of NE-PcAlCl against P. intermedia with minimum inhibitory concentration (MIC) 0.63 μM after TFD was determined. In the case of P. gingivalis and A. actinomycetemcomitans, no biological activity was found after PDT (MIC > 20 μM) under-evaluated experimental conditions. On the other hand, the ClAlPc-free and ClAlPc-NE cells were phototoxic on epithelial cells. Conclusion: The results helped to identify the potential use of ClAlPc-NE to inhibit the periodontal bacterial and additional studies are being developed.