Objective: The aim of this study was to review literature on the effects of herbal dentifrice compared to conventional dentifrice on plaque and gingival inflammation. Materials and Methods: MEDLINE, Cochrane Central Register of Controlled Trials, and major journals were explored for studies up to September 30, 2017. A comprehensive search was designed and the articles were independently screened for eligibility by two reviewers. Randomized controlled clinical trials, in which oral prophylaxis was undertaken before the intervention was introduced into the oral cavity using toothbrush were included. Where appropriate, a meta-analysis (MA) was performed and standardized mean differences (SMDs) were calculated. Results: Ten articles out of 1378 titles were found to meet the eligibility criteria. A MA showed that for plaque intervention the SMD was 2.14; 95% confidence interval (CI): 0.88–3.41, P = 0.0009; test for heterogeneity: P < 0.00001, I² = 96% in favor of conventional dentifrice; and for gingival inflammation, the SMD was 1.37; 95% CI: 0.49–2.26, P = 0.002; test for heterogeneity: P < 0.00001, I² = 94% which also was in favor of conventional dentifrice. Subgroup analysis for plaque intervention and gingival inflammation in case of long-term (more than 4 weeks and up to 6 months) and short-term effects (minimum of 4 weeks) of herbal dentifrice showed no difference when compared to conventional dentifrice. Conclusion: Currently, there is no high-quality evidence to support or abnegate the anti-plaque and anti-gingivitis effects of the herbal dentifrice.

Background: Hormonal changes in women affect bone mineral density, especially during and postmenopausal years, which leads to susceptibility to osteoporosis which interfere with implantation. Aims: This study aims to use cone-beam computed tomography (CBCT) viewer program to predict patients with osteoporosis which may decrease the success rate of implantation and to evaluate osteoporosis effect on the posterior mandible. Settings and Design: This cross-sectional study consists of 60 Iraqi females who were divided into three groups: Group 1 consisted of 20 nonosteoporotic females aged 20–30 years as a control group, Group 2 consisted of 20 nonosteoporotic females aged 50 years and above, and Group 3 consisted of 20 osteoporotic females aged 50 years and above. Materials and Methods: The posterior mandibular first molar area was examined for alveolar bone height and radiographic density (RD) using CBCT. Statistical Analysis Used: Statistical analysis was computer assisted using the Statistical Package for the Social Sciences (SPSS version 21). Interclass correlation coefficient was used for calibration. Normally distributed variables were assessed using one-way ANOVA, and Dunnett test with control and not normally distributed were assessed by Kruskal–Wallis test, and multiple Mann–Whitney U-test with Bonferroni adjustment. Results: RD showed a significant difference between Group 2 and Group 3 (P = 0.000, MD = 158.554). On the other hand, alveolar bone height showed a significant difference between Group 1 and Group 2 (P = 0.039). Conclusions: RD in the posterior mandible first molar area is significantly affected in osteoporotic patients and it can be used as a predictor for the presence of osteoporosis using CBCT.

Introduction: The periodontal tissue reaction to variations in occlusal forces has been described in the literature wherein clinical and histologic changes are discussed that produced due to stresses in the periodontal structures. Unfortunately, these stresses are not quantified. Aim: The aim of this study is to determine the stress produced on various periodontal tissues at different occlusal loads using finite element model (FEM) study. Materials and Methods: Four FEMs of maxillary incisor were designed consisting of the tooth, pulp, periodontal ligament (PDL), and alveolar bone at the various level of bone height (25%, 50%, and 75%). Different occlusal load (15 and 29 kg) at an angle of 50° to the long axis of the tooth was applied on the palatal surface at the level of middle third of the crown. All the models were assumed to be isotropic, linear, and elastic, and the analysis was performed on a Pentium IV processor computer using the ANSYS software. Results: At normofunction load, the stresses were maximum on the mesial side near the cervical region at point D for tooth (−10.93 Mpa) for PDL (−4.06 Mpa) for bone (−4.3 Mpa) with normal bone levels as the bone levels decreased the stresses increased and the stresses tend to concentrate at the apical region. At any given point, the stresses were increased by 90% at hyperfunctional load. Conclusion: Based on the findings of the present study, there is reasonably good attempt to express numerical data of stress to be given normal occlusal and hyperfunctional loads to simulate clinical occlusal situations which are known to be responsible for healthy and diseased periodontium.

Aim and Objective: The aim of this study was to prospectively determine and establish the periodontal prognosis of diseased molars in diabetic patients using the Miller–McEntire Periodontal Prognostic Index (MMPPI) with an additional criterion for diabetes (changes in glycosylated hemoglobin levels), at 2-year postperiodontal therapy. Materials and Methods: A sample of 200 molars in 25 patients with diabetes mellitus (DM) and chronic periodontitis were evaluated. The prognostic parameters evaluated include age, probing depth (PD), mobility, furcation involvement, diabetes, and molar type. The total score calculated from all parameters was used considered prognosis score for each molar. All patients were evaluated at baseline and 2-year posttreatment. Results: The results of this study suggest that following prognostic factors, DM (hazard ratio [HR] =5.2), age (HR = 0.4), and molar type (HR = 0.6) were clinically significant at the end of the 2-year posttherapy from baseline. A total of 4 (2%) teeth were extracted from the 200 teeth with a mean of 0.02 for the tooth lost during 2-year posttreatment. Significant improvements (P < 0.05) in the frequency PD, furcation, and mobility scores were noted at 2 years. Conclusions: These findings demonstrate that score for DM as prognostic criterion is a valid addition to MMPPI. The factors such as DM, age, and molar type can impact the prognosis of molar survival. Studies with a larger sample size and longer follow-up are required to affirm the findings of this preliminary study.

Aim: The aim of the present study was to assess the clinical and radiographical parameters in horizontal bone defects in patients with chronic periodontitis. Materials and Methods: In this randomized, controlled clinical trial study, nine individuals with 94 sites having moderate to deep periodontitis were selected and distributed to Group A – open flap debridement (OFD), Group B – open flap debridement and intra marrow penetration (OFD + IMP) and Group C – Open flap debridement + Intramarrow penetration + platelet rich fibrin matrix (OFD + IMP + PRFM). Plaque index (PI) and gingival index (GI) were evaluated at baseline, 6 months, and 9 months after surgery. Probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and 9 months after surgery. Radiographic assessment was carried out to measure the periodontal defect depth and defect fill percentage (DF%) at baseline and 9 months after the surgery using radiovisiography. Results: The statistical evaluation obtained after 9 months showed no significant difference between PI and GI at 9 months interval. Intergroup comparison of PPD and CAL has shown significant difference in Group C as compared to Group A and B with P < 0.05. The defect depth was statistically significant at 9 months in all the groups, and DF percentage (DF%) has shown statistically significant results in Group C as compared to A and B with P = of 0.001. Conclusion: The addition of PRFM to horizontal type of periodontal defects has shown promising results over a 9-month follow-up period.

Introduction: During orthodontic treatment, patients are expected to undergo consistent periodic prophylaxis as a result of complexities in oral hygiene. The aim of this study was to investigate, analyze, and compare the effectiveness of two professional prophylaxis systems of rubber cup polishing (RCP) and air-powder polishing (APP) in patients undergoing orthodontic treatment based on different levels of plaque and pigment on teeth and the extent of attachment of brackets after prophylaxis. Materials and Methods: A total of 50 patients were selected for this clinical trial study. A couple of months after the orthodontic treatment, the patients were placed on professional prophylaxis in terms of the plaque index. Randomized cross-arch prophylaxis (right maxilla with left mandible), RCP (left maxilla with right mandible), and APP were carried out on the patients. The main indexes in the study (number of plaque removal and debonding), the work time duration per second, and convenience of patients using visual analog scale in each of the methods were evaluated as minor factors. Data were recorded in a special checklist. Results: The mean of the plaque index and the time spent on RCP were observed to be higher than APP. The average satisfaction rate of patients with RCP was higher than APP. The debonding of the bracket and the tooth was not observed in any of the methods. Conclusion: APP is more efficient than RCP for performing professional prophylaxis of orthodontic patients.

Background: Low-level laser therapy (LLLT) is based on the principle of biostimulation or biomodulation effect. LLLT after gingivectomy has resulted in better wound healing because of its action on collagen synthesis, angiogenesis, and growth factor release. Aim: The aim of this split-mouth controlled clinical trial was to assess the effect of LLLT, using diode laser (InGaAsP), on wound healing and patients' response after scalpel gingivectomy. Materials and Methods: Forty patients with gingival enlargement in the maxillary and mandibular anterior region (bilaterally symmetrical) were included in the study. After gingivectomy, a diode laser (InGaAsP) was randomly applied to one side of the surgical area on the 1^st, 3^rd, and 7^th day postoperatively. The surgical areas were disclosed by a solution (Alpha Plac^®) to visualize the areas where the epithelium was absent. Comparison of the surface areas on the LLLT-applied sites and controls was made clinically by visualizing the stained area by two examiners. Results: LLLT-applied sites had significantly lower stained areas signifying improved wound healing compared with the controls on the postoperative 7^th and 30^th day. Conclusion: Within the limitations of this study, the results indicated that LLLT might improve wound healing after gingivectomy.

Background: Herbal products are widely substituting synthetic antimicrobials due to their minimal adverse effects and cost-effectiveness. Murraya koenigii (curry leaf) is an easily available green leafy vegetable, which is known for their antimicrobial, antioxidative, and cytotoxic activity. However, no published literature available evaluates their effectiveness in treating gingival inflammation. This study was aimed to evaluate the effectiveness of M. koenigii mouthwash in reduction of plaque and gingivitis in comparison with commercially available chlorhexidine (CHX) mouthwash. Materials and Methods: This single-center, parallel-arm, randomized controlled clinical trial was carried out among individuals reported to the institution. A total of 45 participants with mild-to-moderate gingivitis were selected and divided into three groups. Group A and B participants undergone scaling and were instructed to use M. koenigii and CHX mouthwashes, respectively. Group C participants have received only scaling. All the participants were recalled after 14 days of prescribed mouthwash use and clinical parameters were recorded. One-way analysis of variance test and Student's paired t-test were used for inter- and intra-group comparison of parameters, respectively. Results: On intragroup comparison of clinical parameters, all the three groups showed a statistically significant difference with P ≤ 0.05. On pairwise comparison, it showed a significant difference for Group B versus Group C and Group A versus Group C, while between Group A and Group B showed no significant difference. Conclusion: M. koenigii mouthwash is equally effective as CHX, in treating plaque-induced gingivitis.

Background: The aim of the study was to evaluate the anti-inflammatory effect of chorion as a barrier membrane in periodontal pocket therapy by assessing interleukin-11 (IL-11) level in gingival crevicular fluid (GCF). Materials and Methods: The study was a randomized, controlled, single-blind clinical trial with split-mouth design. In each patient, two sites in two quadrants were selected and randomly allocated in Group 1 (flap surgery) and Group 2 (flap surgery + chorion membrane placement). After Phase 1 therapy, clinical and biochemical parameters were recorded at baseline and at 4 weeks. Plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), and IL-11 in GCF were assessed. GCF was collected using microcapillary tubes. IL-11 was assayed in GCF with ELISA kit (Genxbio^®). Results: At baseline, the clinical and the biochemical parameters were similar in both the groups. Intragroup comparison revealed statistically significant decrease in all clinical and biochemical parameters in Group 1 (P < 0.001) and Group 2 (P < 0.001). Intergroup comparison showed statistically significant decrease in SBI (P = 0.004), PPD (P = 0.004), CAL (P = 0.013), and IL-11 (P = 0.006) in Group 2 compared to Group 1 at 4 weeks. However, PI did not show any statistically significant difference on intergroup comparison. Conclusion: Adjunctive use of chorion membrane in flap surgery provides an additive anti-inflammatory effect along with improvement in clinical outcomes enhancing the long-term prognosis.

Context: The role of synbiotic in the management of aggressive periodontitis (AP) is not well established. Aim: We designed this study to evaluate the efficacy and safety of synbiotic as an add-on therapy in the management of AP. Settings and Design: This was a randomized, double-blind, placebo-controlled study. Materials and Methods: Sixty patients with AP were randomized to two groups of 30 each. Study group received standard treatment, i.e., scaling and root planing along with doxycycline 100 mg twice daily for the 1^st day (loading dose) followed by 100 mg once daily for 1 week and synbiotic lozenge twice daily for 8 weeks, whereas control group received standard treatment for 1 week and placebo lozenge for 8 weeks. Clinical parameters were recorded at baseline, 4^th, 8^th, and 12^th weeks. Statistical Analysis Used: Pearson's Chi-square test and one-way analysis of variance were used to analyze distribution of sex and age, respectively. Differences within the groups were analyzed by Student's paired t-test. Pearson's Chi-square test was applied to measure gingival bleeding index. Results: On comparison at 12 weeks, there was a statistically significant reduction (P < 0.01) in probing depth, clinical attachment loss, oral hygiene index, and bleeding on probing in study group. No Adverse drug reactions were noted. Conclusion: Co-administration of synbiotic lozenge along with standard therapy is highly efficacious in improving periodontal health in patients with AP.

Background: A wide variety of drugs have the potential to affect immune and inflammatory responses of periodontium. A class of antidepressant drug, selective serotonin and norepinephrine reuptake inhibitors, has shown anti-inflammatory function. The aim of the present study is to explore the effect of desvenlafaxine on clinical periodontal parameters in patients with chronic periodontitis. Materials and Methods: The patients were divided into two groups as follows: test group (n = 63) comprised of participants on 50 mg once-daily dose of desvenlafaxine for ≥2 months and control group (n = 72) included participants who were yet to be prescribed medication for depression. Periodontal parameters of both the groups were analyzed and compared statistically. Results: Participants taking desvenlafaxine revealed lower values of periodontal parameters as compared to those in control group. The number of pockets with greater depth and clinical attachment loss was greater in control group. Conclusion: In our study, patients on desvenlafaxine were associated with less pocket depth and bleeding on probing.

Background: The prevalence of oral disease during pregnancy affects the health of the fetus and mother. The interdisciplinary protocol between general dentists (GDs), gynecologists, and general medical practitioners (GMPs) is proved to reduce the incidence of maternal and neonatal complications. Aim: The aim of the present survey is to assess the knowledge, awareness, and attitude of practicing gynecologists, GMPs, and GDs regarding the association of periodontitis and adverse pregnancy outcomes. Materials and Methods: This cross-sectional study was conducted among 150 health-care professionals in Madurai. A well-structured pretested questionnaire consisted of 12 questions which were used to assess the awareness of association regarding maintaining oral health during pregnancy among GMPs, GDs, and gynecologists. The knowledge, awareness, and practice scores were calculated for the correct answers to the questions. A software program (SPSS 12) was used for statistical analysis. Results: The mean age of participants was of 33.14 ± 1.5, 32.58 ± 2.80, and 37.7 ± 9.7, respectively. Majority of the participants agreed the importance of dental examination and maintaining oral health during pregnancy GMPs (96%), GDs (100%), and gynecologists (92%). About 92% of gynecologists and GMPs supported that providing dental treatment during pregnancy improved pregnancy outcomes. About 64%, 76%, and 68% of GMPs, GDs, and gynecologists, respectively, confirmed the association between periodontal disease and adverse pregnancy outcomes. Conclusion: In this study, knowledge and awareness of gynecologists and GMPs are appreciable; however, their attitude toward bringing the facts into clinical practice needs to be improved through integrated programs.

Healing of extraction socket leads to the dimensional changes which will affect the placement of the implant and its emergence profile. Atraumatic extraction, socket preservation technique, and immediate implant placement decrease the alveolar bone resorption by maintaining the postextraction socket. Hürzeler et al. introduced socket-shield technique by keeping a buccal fragment of the tooth to prevent the buccal cortical bone from resorption. This case report represents a 40-year-old male patient with grossly decayed maxillary left lateral incisor indicated for extraction replaced with an immediate implant. While examining cone-beam computed tomography, thin buccal cortical plate was noticed which may get fracture during extraction. Socket-shield technique was designed for implant placement to protect buccal bone and to get the proper esthetic form. Two millimeters buccal fragment of the tooth was kept attached and the implant was placed in contact with tooth fragment. Three-month follow-up shows proper healing, and healthy peri-implant tissue shows that socket-shield technique with immediate implant placement will be a good alternative to preserve buccal cortical plate and implant placement, especially in the esthetic area.

Bleeding from the palatal donor site is a worrisome complication of palatal soft tissue harvesting procedures and leads to considerable stress to both the patient and the surgeon. Several methods to control palatal hemorrhage have been suggested in literature, including a palatal suture, but a precise protocol has not been suggested. The present case report aims to suggest a protocol for the greater palatine compression suture (GPCS). Five patients who experienced profuse bleeding from the palatal free gingival graft donor site were treated with the GPCS. The palatal midline was used as a landmark and the location of the greater palatine foramen was estimated. The suture was placed anterior to the estimated location of the foramen and was passed deep into the palatal tissue with the aim of looping and compressing the vascular bundle. In all the patients, an immediate reduction and arrest of bleeding from the palatal wound was observed with blanching of the soft tissues around the suture. The proposed technique is a predictable method to control palatal hemorrhage and can be used if other less invasive techniques fail to stem the blood flow from an injured palatal vessel.

Periodontally accelerated osteogenic orthodontics (PAOO) is a clinical procedure that incorporates selective corticotomy, particulate grafting, and application of optimal orthodontic forces. It reduces treatment time, increases stability of teeth, and prevents relapse of orthodontic tooth movement (OTM). The present case report highlights the technique and principles of PAOO for rapid OTM.