Periodontal pathogens and destructive host responses are involved in the initiation and progression of periodontitis. The emergence of host response modulation as a treatment concept has resulted from our improved understanding of the pathogenesis of periodontal disease. A variety of drugs have been evaluated as host modulation agents (HMA), including Non Steroidal Anti Inflammatory Drugs (NSAIDS), bisphosphonates, tetracyclines, enamel matrix proteins and bone morphogenetic proteins. Chemically modified tetracyclines (CMTs) are one such group of drugs which have been viewed as potential host modulating agents by their anticollagenolytic property. The CMTs are designed to be more potent inhibitors of pro inflammatory mediators and can increase the levels of anti inflammatory mediators.

Healthy teeth and gums make a person feel confident and fit. As people go about their daily routines and with different eating and drinking habits, the tooth enamel turns yellowish or gets stained. Polishing traditionally has been associated with the prophylaxis procedure in most dental practices, which patients know and expect. However, with overzealous use of polishing procedure, there is wearing of the superficial tooth structure. This would lead to more accumulation of local deposits. Also, it takes a long time for the formation of the fluoride-rich layer of the tooth again. Hence, now-a-days, polishing is not advised as a part of routine oral prophylaxis procedure but is done selectively based on the patients' need. The article here, gives an insight on the different aspects of the polishing process along with the different methods and agents used for the same.

Background and Objective: Smoking is an important environmental risk factor involved in the causation and progression of periodontal disease. Smoking can impair various components of the host immune response and immune system. The virulence factors of periodontal pathogens stimulate inflammatory cytokine expression by mononuclear cells. IL-1b is the key mediator involved in the pathogenesis and disease progression. Therefore, whole gingival biopsy samples are assessed for this increased expression of IL-1. Material and Methods: 29 male subjects' age and gender matched were divided into three groups based on the periodontal and smoking status (Group A:healthy, Group B: non-smokers suffering from chronic periodontitis, Group C: smokers suffering from chronic periodontitis). Periodontal parameters like plaque index, gingival index, probing pocket depth and clinical attachment level were recorded at baseline and post scaling. The mRNA expression of IL-1b was determined by real time polymerase chain reaction and correlated with the periodontal and smoking status. Results: The improvement in the periodontal parameters was statistically significant in the non- smokers (Group B) and there was a 2 fold increase in the mRNA expression in this group. The smokers (Group C) showed lesser improvement in the periodontal parameters and there was an 8 fold increase in the mRNA expression of IL-1b. Conclusion: Association of smoking status with periodontal destruction can thus be correlated with the increased mRNA expression of IL-1b in chronic periodontitis patients.

Aim: Chronic periodontal disease (CPD) and type 2 diabetes mellitus (T2DM) share common pathogenic pathways. This study aimed to estimate levels of serum interleukin (IL-10), an anti-inflammatory cytokine also associated with T2DM and evaluate its association with hyperglycemia. Materials and Methods: This investigation involved sixty participants divided into four groups comprising 15 participants each: Group 1 (healthy controls), Group 2 (CPD patients), Group 3 (T2DM patients with CPD) and Group 4 (T2DM patients). Plaque index, gingival index, probing pocket depths (PPD), clinical attachment loss, bleeding on probing, random blood sugar, glycosylated hemoglobin (HbA1c), and serum IL-10 was measured. Results: Interleukin-10 was detected in all four groups. Statistically significant (P < 0.05) differences were observed in most of the variables in all groups. IL-10 correlated significantly with PPD in Group 1 and with HbA1c in Group 4. IL-10 regressed with PPD in Group 1 and with HbA1c in Group 4. IL-10 levels were lower in Group 3 when compared with Group 4 and was lowest in Group 2. Conclusion: Low IL-10 levels associated with high HbA1c. Pathogenic mechanisms of CPD seem to regulate IL-10. Serum IL-10 levels may be one of the predictors of glycemia.

Background: Chlorhexidine (CHX) is considered as a gold standard of antimicrobial rinses. Various herbal oral rinses are available in the market. However, little is known of its effectiveness. Aim: The aim of this study was to evaluate the clinical changes after the usage of herbal oral rinse and 0.12% CHX. Subjects and Methods: In a randomized clinical trial, 76 patients with dental plaque-induced gingivitis were assigned to Group I (Herbal Oral Rinse - Hiora^; ) and 76 patients with dental plaque-induced gingivitis to Group II (0.12% Chlorhexidine-Peridex^; ). Gingival index and Plaque index scores were recorded at baseline and 21 days after scaling. Results: Intragroup comparison in both groups showed that plaque index and gingival index scores were statistically significant after 21 days as compared to baseline. Intergroup comparison showed that plaque index scores and gingival index scores were statistically significant in Group II as compared to Group I. Conclusion: When herbal oral rinse was compared to 0.12% CHX, 0.12% CHX mouth rinse effectively reduced the clinical symptoms of plaque-induced gingivitis.

Background: The palatal masticatory mucosa is the main donor area of soft tissue and connective tissue grafts used for increasing the keratinized mucosa around teeth and implants, covering exposed roots and increasing localized alveolar ridge thickness. The aim of this study was to compare the thickness of the palatal masticatory mucosa as determined on a cone-beam computerized tomography scan versus thickness determined via bone-sounding. Materials and Methods: A total of 20 patients requiring palatal surgery participated. Thickness of the palatal tissue was measured at various points radiographically and clinically. The two techniques were compared to determine the agreement of the two measurement modalities. Results: Statistical analysis determined that there was no significant difference between the two methods. Moreover, the tissue thickness was shown to increase as the distance from the gingival margin increased, and the tissue over the premolars was thicker than the other teeth. Conclusion: Cone-beam computerized tomography can be used as a noninvasive method to accurately and consistently determine the soft tissue thickness of the palatal masticatory mucosa with minimal bias at different locations on the palate.

Background: Many paraclinical methods are available today for an accurate assessment of the periodontal status prior and during the periodontal treatment. The microbial-enzymatic N-benzoyl-DL-arginine-2-napthylamide (BANA) test is one of the modern alternatives to bacterial cultures. It detects the presence of three periodontal pathogens in the subgingival plaque (Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia). Aims and Objective: The aim and objective of this study was to detect the presence of BANA micro-organisms and also to determine the effect of scaling and root planning in adult periodontitis patients. Materials and Methods: A total number of 20 patients (80 sites) all having periodontitis were selected. Four test sites (permanent molar from each quadrant) were selected from each patient and assessed for plaque index, bleeding index and pocket depth before and after scaling and root planning. BANA test was used for the detection and prevalence of the "red complex" bacteria in plaque samples. Results: Showed that the BANA tests are statistically correlated with the severity of periodontal destruction. There was a significant correlation between the BANA test results and the quantity of bacterial plaque, the test being influenced by the composition of bacterial plaque. Conclusion: This study encourages the use of such chair-side tests for a proper diagnosis of periodontal disease and for a good evaluation of the treatment results.

Background: Residual calculus exists not only on teeth treated by scaling alone but also on teeth treated by flap surgery. Periodontal microsurgery enables more definite removal of calculus, atraumatic handling of tissues through optical magnification. The purpose of this study was to compare the clinical outcomes of microsurgery with conventional open flap debridement in patients with chronic periodontitis. Methods: Thirteen chronic periodontitis patients were randomly assigned for test (microsurgical) and control (conventional) open flap debridement in a split mouth design. At baseline, 3, 6 and 9 months the following clinical parameters were recorded: Probing pocket depth, relative attachment level, gingival recession, gingival bleeding index. Postoperative healing at 1-week by early healing index and pain scale for 7 days were assessed. Results: Paired t-test was used to compare means within the groups, and unpaired t-test was applied to compare the means of the two groups. At 3, 6 and 9 months postoperatively there was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups and there was no significant difference between both the groups. Gingival margin level and gingival recession increased in both the groups, but it was not statistically significant. Early healing Index score of 1 was found in 85% of test sites and 28% of control sites. The mean pain scale was 0 in test site and 1.07 ΁ 0.75 in control site. Conclusions: In open flap debridement procedure, a microsurgical approach can substantially improve the early healing index and induce less postoperative pain compared with applying a conventional macroscopic approach.

Background: Ideal graft material for regenerative procedures is autogenous bone graft but the major disadvantage with this graft is the need for a secondary surgical site to procure donor material and the frequent lack of intraoral donor site to obtain sufficient quantities of autogenous bone for multiple or deep osseous defects. Hence, to overcome these disadvantages, bone allografts were developed as an alternative source of graft material. Materials and Methods: In 10 patients with chronic periodontitis, 20 bilateral infrabony defects were treated with freeze dried bone allograft (FDBA-Group A) and decalcified freeze dried bone allograft (DFDBA-Group B). Clinical and radiographic parameters were assessed preoperatively and at 3 months and 6 months postoperatively. Data thus obtained was subjected to statistical analysis. Results: Significant improvement in the reduction in probing depth and relative attachment level (RAL) from the baseline to 3 months to baseline to 6 months in group A and group B, which was statistically significant but no statistically significant reduction was seen between 3 months and 6 months. On inter-group comparison, no significant differences were observed at all-time points. In adjunct to the probing depth and RAL, the radiographic area of the defect showed a similar trend in intra-group comparison and no significant difference was seen on inter-group comparison at all-time points. Conclusions: Within the limitations of the current study, it can be concluded that DFDBA did not show any improvement in the clinical and radiographic parameters in the treatment of the intrabony defects as compared to FDBA.

Aim: The aim was to evaluate the bonefill in periodontal osseous defects with the help of guided tissue regeneration, bioresorbable membrane (PerioCol) + bone graft (Grabio Glascera) in combination and with bonegraft (Grabio Glascera) alone. Materials and Methods: The study involved total 30 sites in systemically healthy 19 patients. The parameters for evaluation includes plaque index sulcus bleeding index with one or more periodontal osseous defects having (i) probing depth (PD) of ≥ 5 mm (ii) clinical attachment loss (CAL) of ≥ 5 mm and (iii) ≥3 mm of radiographic periodontal osseous defect (iv) bonefill (v) crestal bone loss (vi) defect resolution. The study involved the three wall and two wall defects which should be either located interproximally or involving the furcation area. The statistical analysis was done using Statistical Package for Social Sciences, the Wilcoxon signed rank statistic W + for Mann-Whitney U-test. Results: The net gain in PD and CAL after 6 months for Group I ([PerioCol] + [Grabio Glascera]) and Group II (Grabio Glascera) was 3.94 ± 1.81 mm, 3.57 ± 2.21 mm and 3.94 ± 1.81, 3.57 ± 2.21 mm, respectively. The results of the study for Group I and Group II with regards to mean net bonefill, was 3.25 ± 2.32 (58%) mm and 5.14 ± 3.84 (40.26 ± 19.14%) mm, crestal bone loss − 0.25 ± 0.68 mm and − 0.79 ± 1.19 mm. Defect resolution 3.50 ± 2.34 mm and 5.93 ± 4.01 mm, respectively. Conclusion: On comparing both the groups together after 6 months of therapy, the results were equally effective for combination of graft and membrane versus bone graft alone since no statistical significant difference was seen between above parameters for both the groups. Thus, both the treatment modalities are comparable and equally effective.

Introduction: The prevalence of obesity has increased substantially over the past decades. Age, genetic factors, activity level, body weight, eating habits, medications, and hereditary factors are some of the causes of obesity. It is a risk factor for several chronic health conditions, as well as being associated with increased mortality. Obesity has also been associated with oral diseases, particularly with periodontal disease. Objective: The objective was to assess the periodontal status of obese and nonobese young individuals in colleges of Bangalore city. Materials and Methods: A cross-sectional study was undertaken to assess the periodontal status of 16-34-year-old obese individuals in colleges of Bangalore City. The students and staff of preuniversity and Degree Colleges of Bangalore City aged below 35 years were considered in the study. Data regarding demographic factors, oral hygiene habits, and dental visits were collected through a questionnaire. Periodontal status was examined using community periodontal index (CPI). Subjects were examined for weight and height as well as periodontal status. Results: It was observed that pocket 4-5 mm (CPI Code 3) is significantly higher among obese when compared to nonobese with P < 0.001 and loss of attachment 4-5 mm (Loss of Attachment Code 1) is significantly higher in obese when compared to nonobese with P < 0.001. Conclusion: The results described earlier and related research indicate that obesity may have potential for periodontal disease among young and/or those lacking oral health care.

Background: The aim of the present study was to compare various risk indicators of chronic periodontitis (CP) and aggressive periodontitis (AP) among patients of Davangere population. Methods: Totally, 89 CP and 90 AP patients were selected from outpatient Department of Periodontics, College of Dental Sciences, Davangere. Various clinical parameters proven to be risk indicators were determined for each patient such as age, gender, occupation, oral hygiene habits, personal habits, income, level of education, place of residence, frequency of dental visits, various oral hygiene indices, gingival status, wasting diseases, malocclusion, laboratory investigations, and the results were subjected to statistical analysis. Results: This study demonstrated that AP is manifested early in life in susceptible individuals. Proven risk indicators for AP and CP in the present study population included young age, place of residence, income and education levels, frequency of dental visits. Patients with AP had better oral hygiene habits and oral hygiene index results than patients with CP. Paan chewing and smoking could be considered as risk factors, both in CP and AP cases. The similar association of plaque scores but higher bleeding tendency in AP patients supported the fact of higher susceptibility of AP patients to periodontal breakdown. Malocclusion being present in the majority of cases could also be put forth as a risk factor for AP and CP. Conclusion: This study identifies the different risk indicators for CP and AP and demonstrates the need for constructing nationwide oral health promotion programs to improve the level of oral health awareness and standards in Indian population.

Introduction: Acquired Immuno Deficiency Syndrome (AIDS) is a condition in which the body becomes susceptible to a host of opportunistic infections. This syndrome is a culmination of infection with a lenti virus called Human Immunodeficiency Virus (HIV) particularly HIV 1. A cross section of the population including adults and children are affected by HIV infection with estimate of 36.1 million affected by the end of 2014.HIV infection affects the T lymphocytes especially cluster of differentiation 4 (CD4) count reducing it drastically jeopardizing the acquired immunity. The advent of Anti Retroviral Therapy (ART) has proved as a ray of hope, at least reducing the misery and suffering although not permanently. This study attempts to understand the prevalence of periodontal disease and other oral lesions, further examining their relationship with CD4 counts in the HIV seropositive patients on ART. Materials and Methods: A total of 72 HIV positive patients on ART reporting at ART centre at Raichur District hospital were screened in the study for periodontal status, oral manifestations. The latest CD4 count values were obtained from the hospital records. Results: The study showed a 36.11% of prevalence of periodontal disease; however no statistically significant association was seen with its relation to CD4 counts. Other oral manifestations were seen in 46% of patients with a high prevalence of Oral Candidiasis lesions and a positive association with CD 4 counts was seen. Conclusion: Under the limitations of this study no significant association was seen between CD4 counts and prevalence of periodontal disease however candiasis showed a stronger association. As HIV infection gradually becomes a chronic disease the features and course of chronic periodontal disease and other oral manifestations in HIV infected patients require more careful and extensive investigation.

Autogenous bone grafts have been considered the gold standard for bone grafting procedures. This case report describes the management of a two wall defect by utilizing the autogenous bone graft obtained during removal of ledges as a part of osteoplasty procedure. The bone was removed with a sickle scaler, and sufficient amounts of bone graft material were obtained to fill a two wall defect distal to left mandibular first molar.

Background: Periodontal plastic surgical procedures aimed at coverage of exposed root surface. Owing to the second surgical donor site and difficulty in procuring a sufficient graft for the treatment of root coverage procedures, various alternative additive membranes have been used. A recent resorbable amniotic membrane, not only maintains the structural and anatomical configuration of regenerated tissues, but also enhances gingival wound healing, provides a rich source of stem cells. Therefore, amniotic membrane is choice of material these days in augmenting the better results in various periodontal procedures. Aim: The aim of this observational case series was to evaluate the effectiveness, predictability and the use of a novel material, amniotic membrane in the treatment of shallow-to-moderate isolated recession defects. Materials and Methods: A total of three cases, showing Miller's Class I or Class II gingival recession, participated in this study. Recession depth, recession width, keratinized gingiva (KG) tissue width, clinical attachment level (CAL) were recorded at baseline, 3 and 6 months postoperatively. Results: Six months following root coverage procedures, the mean root coverage was found to be 70.2 ± 6.8%. CAL significantly decreased from 6.4 ± 0.54 mm preoperatively to 3.5 ± 0.9 mm postoperatively at 6 months while KG showed significant improvement from 3.2 ± 0.28 mm preoperatively to 5.9 ± 0.74 mm postoperatively at 6 months. Conclusion: Autogenous graft tissue procurement significantly increases patient morbidity while also lengthening the duration of surgery in placing the graft, while self-adherent nature of amniotic membrane significantly reduces surgical time and made the procedure easier to perform, making it membrane of choice.

A 32-year-old patient with complete denudation of buccal root of tooth no. 14 was referred from the Department of Oral Surgery for opinion, as he was not willing for extraction. Patient's persistent urge to save the tooth, put forth a challenge, which motivated us to tweak the established techniques. The unusual presentation of the case and unexpected par-operative condition of the surgical site required out-of-box measures to deal with the situation. Though, the tooth no. 14 was having Grade-I mobility, it was endodontically treated, buccal root was resected, osseous graft was applied over the deficient ridge area and lateral pedicle flap was displaced over the short root-trunk area to cover the surgical site. To our astonishment, the tooth survived, mobility was reduced and complete coverage with soft-tissue was observed. Uneventful healing with stable gingival margin was observed at 3-month interval, which remained stationary at 1-year follow-up.

Gingival recession is defined as the displacement of gingival margin apical to cementoenamel junction. Aberrant frenum attachment can contribute to the progression of recession by generating tension on the marginal tissues. Treating such defects is a two stage procedure-frenectomy and recession coverage procedure. New techniques are developed to increase the predictability, reduce patient discomfort and number of surgical sites. Also, these techniques try to satisfy patients esthetic demands, which include the final colour and tissue blend of the covered area. In this case report, we present a method for coronally repositioning gingiva for root coverage over the maxillary central incisors while simultaneously performing a frenectomy, thus being clinically advantageous compared to two-stage technique.

The periosteum is highly cellular connective tissue with rich vascularity and regenerative potential, which make it suitable autogenous graft. The periosteum eversion technique utilized periosteum for coverage of denuded root surface. The purpose of this case report was to evaluate the periosteum eversion technique that involves a single surgical site, in terms of root coverage, gingival height, and probing depth. A patient with Miller class I gingival recession of 3.0 mm, gingival height of 2.0 mm and probing depth of 2.0 mm was treated by the periosteum eversion technique. Root conditioning was done with 24% ethylenediaminetetra-acetic acid. In this technique, marginal periosteum was used as a pedicle graft. At the end of 6 months, 100% root surface was covered successfully with 5.0 mm of gingival height and 1.0 mm of probing depth. The periosteum eversion technique can be used for the treatment of gingival recession defect successfully.

The osteotome technique is more predictable with simultaneous implant placement when there is <5-7 mm of preexisting alveolar bone height beneath sinus. Proper combination of platelet rich fibrin, mineralized freeze-dried human bone allograft, and autogenous bone has been recommended for this situation. The purpose of this article was to describe the proper method and materials which can grow >10 mm bone with osteotome technique and grafting materials where the edentulous posterior maxilla radio-graphically showed less bone between the alveolar crest and sinus floor.

Peripheral giant cell granuloma (PGCG) is an infrequent exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia. Lesions vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulcerations of the margin are occasionally seen. The lesions are painless, vary in size, and may cover several teeth. It normally presents as a purplish-red nodule consisting of multinucleated giant cells in the background of mononuclear stromal cells and extravasated red blood cells. This case report describes the unusual appearance of a PGCG extending from left maxillary interdental gingiva to palatal area in 32-year-old female patient.

Acute pericoronitis usually presents with severe localized pain, swelling and sometimes trismus. However, chronic pericoronitis and periodontal abscess produce a dull pain, moderate swelling and are occasionally seen migrating into distant sites producing fistulae intra-orally and/or extra-orally. This may quite often cause diagnostic dilemmas necessitating thorough medical and dental history, careful clinical examination and sometimes special investigations to confirm the etiology and or origin of infection. Here, we present three such cases and their management.

Several anti-inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open-flap debridement surgery. In this study, 60 patients who were undergoing open flap debridment surgery were randomly assigned to receive a single dose preoperative medication 1 hour prior to surgery. The patients were divided into three groups. In Group 1, 20 patients were given placebo drug orally. In Group 2, 20 patients were given 8 mg Dexamethasone orally and in Group 3, 20 patients were given 120 mg Etoricoxib orally. Patients were instructed to complete a pain diary hourly for the first 8 hours after each surgery and three times a day on the following 3 days. The four point verbal rating scale (VRS 4) and Numerical rate scale were used to assess discomfort. Post-operative Assessment of Pain and Discomfort showed that persistent discomfort and pain were found to be more in the placebo group compared to dexamethasone and etoricoxib group. The adoption of a preemptive medication protocol using either etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open-flap debridement surgeries.