An aberrant frenum is postulated to create functional and aesthetic problems. Archer's 'classical frenectomy' is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward's frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.

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Osteoimmunology is an emerging field of research dedicated to the relationship between the immune processes and the bone metabolism of various inflammatory bone diseases. The regulatory mechanisms governing the osteoclast and osteoblast are critical for understanding the health and disease of the skeletal system. These interactions are either by cell to cell contact or by the secretion of immune regulatory mediators like cytokines and chemokines by immune cells that are governed by the RANKL (TRANCE)-RANK- OPG axis. TRANCE-RANK signaling has served as a cornerstone of osteoimmunology research. There is increased recognition of the importance of the inflammatory and immune responses in the pathogenesis of periodontal disease. Thus, this field has provided a framework for studying the mechanisms underlying periodontal destruction. As bone homeostasis is mainly regulated by both the immune and endocrine systems, there emerged osteoimmunoendocrinology where adipokines take the lead. This review focuses on the underlying concepts of osteoimmunology, its relation to Periodontics.

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Background: Recent interest and advances in the field of alternative medicine has promoted the use of various herbal and natural products for multiple uses in the field of medicine. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research. This clinical study focuses on Aloe vera and highlights its property when used as a medicament in the periodontal pocket. Materials and Methods: A total number of 15 subjects were evaluated for clinical parameters like plaque index, gingival index, probing pocket depth at baseline, followed by scaling and root planing (SRP). Test site comprised of SRP followed by intra-pocket placement of Aloe vera gel, which was compared with the control site in which only SRP was done, and clinical parameters were compared between the two sites at one month and three months from baseline. Results: Results exhibited encouraging findings in clinical parameters of the role of Aloe vera gel as a drug for local delivery. Conclusion: we conclude that subgingival administration of Aloe vera gel results in improvement of periodontal condition. Aloe vera gel can be used as a local drug delivery system in periodontal pockets.

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Ankyloglossia or tongue-tie is the result of a short, tight, lingual frenulum causing difficulty in speech articulation due to limitation in tongue movement. In this article, we have reported a 24-year-old male with tongue-tie who complained of difficulty in speech following which he underwent frenectomy procedure under local anesthesia without any complications. Finally, he was given speech therapy sessions.

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Background: A paucity of conclusive research exists on the optimal design and mode of action of toothbrushes, leading to the introduction of new generation of toothbrushes. Sonic and ionic toothbrushes belong to this new generation of toothbrushes. The aim of the present study was to clinically assess and compare the efficacy of the sonic and ionic toothbrushes. Materials and Methods: A single blind study, using a split-mouth method, was conducted for 45 days on a total of 22 (11 males and 11 females) student volunteers, with age of 17 to 21 years. Plaque, gingival, and bleeding indices were recorded after every 15 days. Results: Both the toothbrushes showed significant reduction in all three parameters. However, the sonic toothbrush proved to be more effective than the ionic toothbrush on the percentage basis, the difference in parameters was statistically nonsignificant. Conclusion: It may be concluded from the present study that though the sonic toothbrush was insignificantly superior to the ionic toothbrush, both the toothbrushes are clinically effective in removing plaque and improving the gingival conditions.

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Periodontal diseases result in damage and destruction of the supporting structures of the teeth, including the bone and periodontal ligament. In some cases, there is loss of gingival coverage of the teeth in esthetic regions, with gingival recession and loss of interdental papilla. The surgical treatment in such situations is costly, requires prolonged healing time, and the results are often unpredictable; this makes it an unpopular choice. The reconstruction of these areas with prosthesis like gingival veneer can be useful to correct the deformities remaining after the control of periodontal diseases, especially in the maxillary anterior region. Dental practitioners can provide comfortable and accurately fitting gingival veneers, that are very stable and esthetically restore the interdental papilla and gingival recession defects. This method is an innovative treatment option for dealing with esthetic challenges and long-term dental health.

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It is dentists' dream to achieve bone repair with predictability, but without donor site morbidity as well as reconstruction of injured or pathologically damaged complex dental structures, however, this will no longer be a dream as these are being made into a reality using stem cell science. Stem cell science is clearly an intriguing and promising area of science. Stem cells have been isolated from a variety of embryonic and adult tissues. Dental stem cells are multipotent mesenchymal stem cells (MSCs) brought new enthusiasm among the researchers because of their easy accessibility, high quality and they don't pose the same ethical concerns and controversy in comparison with embryonic stem cells. This review article provides brief insights about stem cell basics, the state of art in human dental stem cell research and its possible impact on future dentistry. Even though most of these modalities are still in infancy, it is evident that the 21 ^st century dentist is going to play a critical role in the field of medicine. The aim of this article is to bring awareness among the dentists about the huge potential associated with the use of stem cells in a clinical setting, as well as proper understanding of related problems.

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Background: The present study was designed to evaluate clinical and antimicrobial effects of a single episode of subgingival tetracycline or chlorhexidine (CHX) irrigation in the absence of scaling and root planing. Materials and Methods: Thirty patients diagnosed with chronic periodontitis were recruited for this study, each providing four non-adjacent untreated periodontal pockets with a probing depth equal to or exceeding 6 mm. The four deep periodontal pockets in each patient were assigned to be irrigated with 150 ml each of CHX digluconate 0.2% (group A), tetracycline HCl at concentrations of 10 and 50 mg/ml (groups B and C, respectively), or sterile saline (group D) in a single episode. Recordings of plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), and subgingival bacterial counts from paper point samples were made pre-irrigation (day 0), and at days 7, 28, 56, and 84, post-irrigation. Results: The mean PI and GI scores for all the four groups were reduced post-irrigation, the reduction being significantly higher in group C compared to the other groups. The reduction in the PD and CAL was more significant in group C from day 0 to day 7, whereas the other groups showed minimal changes during this period. The change in the bacterial count was altered towards one of the periodontal health, it being more significant and consistent in the group C. Conclusion: The results of this study suggest that subgingival irrigation with high concentrations of tetracycline may play a beneficial role in the management of chronic periodontitis patients.

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Odontogenic tumors mainly occur as intraosseous growths but sometimes may present in a peripheral location on the gingiva where they are referred to as peripheral odontogenic tumors (POTs) which are a rare entity, the most common of them being the peripheral odontogenic fibroma that is an otherwise uncommon, slowly growing, benign odontogenic neoplasm of the periodontal soft tissues. In fact, peripheral odontogenic fibroma is the only POT that is more frequent than its central counterpart. Although considered to be with a potential to recur after excision, the actual recurrence rate is not known due to paucity of literature. This paper presents a case report along with review of the available literature and reinforces the importance of patient follow-up in addition to radiographic and histological examination of seemingly innocuous gingival exophytic lesions.

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Langerhans cell histiocytosis (LCH) is a group of rare disorders histologically characterized by the proliferation of Langerhans cells. Multiple organs and systems may be involved by the disease. Typically, there is bone involvement and, less frequently, lesions may be found in the lungs, liver, lymph nodes, skin, and mucosa. Oral soft tissue lesions without bone involvement are rare. We present a case of oral lesions associated with LCH in a young woman.

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Background: The use of different bioactive materials as coating on dental implant to restore tooth function is a growing trend in modern Dentistry. In the present study, hydroxyapatite and the bioactive glass-coated implants were evaluated for their behavior in osseous tissue following implantation in 14 patients. Materials and Methods: Bioactive glass and hydroxyapatite formulated and prepared for coating on Ti-6Al-4V alloy. Hydroxyapatite coating was applied on the implant surface by air plasma spray technique and bioactive glass coating was applied by vitreous enameling technique. Their outcome was assessed after 6 months in vivo study in human. Results: Hydroxyapatite and bioactive glass coating materials were nontoxic and biocompatible. Uneventful healing was observed with both types of implants. Conclusion: The results showed bioactive glass is a good alternative coating material for dental implant.

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Background: The aim of the study was to evaluate the relationship between obesity and periodontitis. Materials and Methods: A total of 300 subjects aged 20 years and above suffering from generalized periodontitis were recruited from Department of Periodontics, Pacific Dental College and Hospital, Udaipur. Periodontal status of the subjects was recorded. Body mass index and waist circumference were used as measure to assess obesity. Other variables like age, gender, oral hygiene index were also recorded. Results: When evaluation was done for prevalence of periodontal disease according to BMI in obese and non-obese, the prevalence of periodontal disease was significantly (P=0.03) more in obese (88%) than in non-obese (74.4%) individuals. [OR=−20.4 and 95% confidence interval (CI) 1.3-1.3]. Conclusion: The prevalence of periodontal disease is higher among obese subjects. Obesity could be a potential risk factor for periodontal disease in all age groups.

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Background and Objectives: Prevention of the periodontal disease progression is the primary goal of periodontal therapy. When conventional therapy is found inadequate to attain periodontal health in chronic periodontitis, local antimicrobial agents have been used as an adjunct with scaling and root planning (SRP) which has reproduced encouraging results. Hence, this study was undertaken to evaluate the new sustained released local drug Chlosite clinically and microbiologically in smokers and non-smokers. Materials and Methods: The patients were grouped into experimental group A treated with SRP plus Chlosite (SRP + CHL), experimental group B treated with Chlosite alone (CHL), and control group C treated only with SRP alone. A total number of 141 sites from six patients (67 sites from three non-smoker patients and 74 sites from three smoker patients) participated in this study. The clinical parameters, Plaque index (PI), Gingival index (GI), Bleeding index (BI), and Relative attachment level (RAL), were recorded and subgingival plaque samples were collected and subjected to microbiological analysis. Results: On comparison of smokers and non-smokers, in SRP group, non-smokers showed a higher reduction in BI and GI and smokers showed a higher reduction in PI. There was no significant gain in RAL of both smokers and non-smokers. In SRP + CHL group, non-smokers showed a higher reduction in relation to BI and GI and smokers showed a higher reduction in relation to PI. There was no significant gain in RAL of both smokers and non-smokers. In CHL group, both smokers and non-smokers showed a nonsignificant reduction in BI, GI, and RAL, but smokers showed a significant reduction in PI as compared with non-smokers. All the groups showed reduction in the microbial count of Fusobacterium nucleatum, Porphyromonas gingivalis, and Tannerella forsythia which were found to be statistically not significant when it was compared between non-smokers and smokers. Interpretation and Conclusion: In this study, all treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PI, GI, BI, and RAL. Combination of SRP and Chlosite resulted in added benefits compared with the two treatment groups.

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Background: Even though numerous biomaterials have been devised and employed for periodontal regeneration, it should be well understood that the root surface receptiveness to clot formation and maintenance during initial periodontal wound healing, decides the nature of the connective tissue attachment. So this study was carried out with the prime objective of assessing the initial wound healing events occurring in vivo after the application of citric acid on to the root surfaces during periodontal regenerative therapy. Materials and Methods: Thirty-two human teeth were used for this in vitro study. Two dentin blocks each measuring 4 × 2 × 1 mm were made from each tooth. These dentin blocks were planed and treated differently with Phosphate Buffered Saline (PBS), citric acid, PBS and fresh human blood, citric acid and fresh human blood and were segregated into eight groups. Finally all the dentin blocks were processed and subjected to a scanning electron microscope study. Results: In PBS-treated samples, the dentin surface was irregular corresponding to smear layer and the dentinal tubule openings were obscured. Whereas, in those treated with citric acid revealed a smooth dentin surface devoid of smear layer and the dentinal tubular openings were clear. Further samples that were treated with PBS plus blood showed little or no fibrin network formation whereas with those citric acid plus blood showed a fine thick fibrin network formation adhered to dentinal surface. Conclusion: The results of this present in vitro study suggests that use of citric acid as a root conditioning agent has a beneficial effect on initial wound healing events, which are critical for periodontal regenerative therapies.

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Background: The objective of this double-blind clinical trial was to evaluate the effects of the nonsteroidal anti-inflammatory drug (NSAID), ketoprofen, on patients with chronic periodontitis. Materials and Methods: Two similar local drug delivery preparations of a poloxamen gel containing 1.5% ketoprofen and a placebo were indigenously prepared for this purpose. Ten subjects aged 33-55 years with moderate to severe chronic periodontitis were recruited and were monitored for a period of 90 days. Three sites in each patient (total 30 sites) with a probing pocket depth of 5-8 mm were selected and divided randomly into three groups: 1) group A: scaling and rootplaning (SRP) + drug A; 2) group B: SRP + drug B; and 3) group C: SRP. Clinical parameters and blood smear (from intracrevicular blood) were assessed to determine the differential count and Arneth index. All parameters were assessed at baseline, 30 days and 90 days, respectively. Results: Highly significant values were achieved for plaque index (P=0.00), and significant values were obtained for gingival index (P=0.044). Reduction in bleeding on probing was found to be highly significant. Probing depth and clinical attachment level showed no inter group variation. Conclusion: The results of this double-blind trial indicate that the combined effect of locally delivered ketoprofen with SRP was more effective in controlling periodontal disease than SRP alone.

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Background: The preservation or reduction of alveolar ridge resorption following tooth extraction is important in patients especially for those intended for implants at a later stage. One way to achieve this is by using membranes, graft materials, and biodegradable space fillers to prevent alveolar bone resorption and promote regeneration. A major attraction for using biodegradable and biocompatible polymers as space fillers for ridge preservation is their safety profile in comparison to xenograft materials like lyophilized bone and collagen. Materials and Methods: Biocompatible polylactide space fillers were fabricated by fusing porous polylactide particles. The sponges were loaded with drugs by placing them in the respective solutions. Pseudomonas aeruginosa was isolated from a chronic periodontitis patient and in vitro anti-microbial evaluation was done with the drug loaded sponges. Results: Chlorhexidine loaded space filler showed significant anti microbial effect against multiple drug resistant Pseudomonas aeruginosa isolated from a patient with chronic periodontitis. Conclusion: The results of this study indicate that biodegradable drug releasing polylactide space fillers has the potential to be used for ridge preservation following tooth extraction. Release of drugs in the socket may prove useful in preventing development of alveolar osteitis post extraction which can interfere with normal healing of the socket. Synthetic biodegradable polymers also exhibit a controlled degradation rate to achieve complete resorption within the intended time.

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Background: Various mouth rinses have been used in the treatment of halitosis, but most of the evidence for the efficacy of mouth rinses is anecdotal. In the present study, 0.2% chlorhexidine rinse and an essential oil mouth rinse are compared for their efficacy in reducing the breath mercaptan levels. Materials and Methods: Fifteen patients with the chief complaint of oral malodor were randomly divided into 3 groups and were provided with the respective mouth rinses. Pre rinsing measurements were performed on the Day 1 and no other periodontal treatment was instituted. Post rinsing estimation of mercaptan levels was performed after 7 days. Results: When comparing chlorhexidine with the essential oil mouth rinse, the reduction in VSCs was highly significant in the chlorhexidine group (P<0.01). However, the reduction in the organoleptic scores was not significant among the two groups. Organoleptic scores showed very highly significant correlations with the VSC concentrations measured by the spectrophotometric method. Conclusion: The spectrophotometric technique employed in this study appears to be a promising new method for evaluation of oral malodor. Chlorhexidine still appears to be the agent of choice as a short term regimen in cases of oral malodor.

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It is essential for a dental surgeon or a periodontist to detect blood glucose level for patients whose signs and symptoms are suggestive of diabetes. Seventy patients in the age group of 40 to 80 years of either sex were selected for the study. The study population included patients with type 1 or type 2 diabetes mellitus. Venous blood was used as a control group, whereas gingival blood and finger-prick blood constituted the study groups I and II, respectively. The percentage deviations of gingival blood glucose level measurements and finger-prick blood glucose level measurements from the standard venous blood glucose level measurements were recorded, which showed that 72.86% of gingival and 68.57% of finger-prick blood glucose level measurements were found to be within ΁15% of the standard venous blood glucose level measurements. All values exhibited significant correlations among each other, but correlations between glucose values obtained using venous and gingival blood samples were higher than the correlations between glucose values obtained using venous and finger-prick blood samples.

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Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function, radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement of the gingiva of 6 months' duration and lower lip swelling of 7 months' duration. She was a known case of carcinoma of nasopharynx and had received radiotherapy and chemotherapy. Based on the history, the clinical appearance of the gingiva, and the other oral changes we considered both post-radiotherapy gingival enlargement and secondary metastasis to gingiva as possibilities. An incisional biopsy was performed (internal bevel gingivectomy). The histopathological report did not reveal any metastatic changes. Thus, we diagnosed post-radiotherapy gingival enlargement. For the multiple carious teeth, extraction and root canal treatment was carried out as necessary. The patient was referred to the department of Oral and Maxillofacial Surgery for management of swelling of the lips, which was diagnosed as lymphedema of the lip. Gingival enlargement is rare post radiotherapy. Such nonplaque-associated gingival enlargement in a patient who has undergone radiotherapy should be subjected to biopsy and histopathological examination to distinguish between secondary metastasis and post-radiation changes.

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Background and Objectives: Conventional diagnostic indicators cannot distinguish between disease activity and inactivity but can detect the past tissue destruction. A proper and true periodontal diagnosis is essential in order to have a rational treatment and preventive strategy and to identify sites at risk. The present longitudinal study was designed with an aim to examine the relationship between gingival crevicular fluid (GCF) levels of aspartate aminotransferase (AST) and periodontal disease progression and to analyze the level of AST in GCF before and after the initial therapy in chronic periodontitis patients and determine the relationship between AST and conventional measures of periodontal status. Materials and Methods: A total of 20 patients with chronic periodontitis were randomly selected. Two diseased sites and one healthy site were selected in each patient. The periodontal status and GCF-AST levels were recorded at baseline and 3 months post-initial therapy and statistically analyzed. Results: There was a statistically significant difference in AST levels between diseased periodontal sites and healthy sites (P<0.05), and between baseline and post-initial therapy (P<0.05). Improvements in clinical status were noted following periodontal therapy and there was a corresponding decrease in AST levels. Interpretation and Conclusion: In conclusion, it is suggested that AST levels may be a useful adjunct in the clinical assessment of periodontal disease sites since AST level decreases when periodontal status improves.

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