Periodontology

Generalized periodontitis; Stage IV, Grade C; currently stable. 1. Current smoker >12 cigarettes per day 2. Optimally controlled diabetes. Ashish Kumar Journal of Indian Society of Periodontology 2019 23(3):185-186

Healthy smile: The fuel for fitness Anil Melath Journal of Indian Society of Periodontology 2019 23(3):187-187

Can we progress as a profession without the well being of the professionals? Abhay Kolte Journal of Indian Society of Periodontology 2019 23(3):188-189

Actual quantitative attachment gain secondary to use of autologous platelet concentrates in the treatment of intrabony defects: A meta-analysis Om Kumar Nemichand Baghele, Vrushali Madhavrao Kathole, Amarpreet Kaur Jasbirsingh Tuteja, Trupti Gajendra Giri Journal of Indian Society of Periodontology 2019 23(3):190-202 Background: There are no authoritative meta-analyses and no clear quantitative assessments available estimating effects of open flap debridement (OFD) combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) over and above that of OFD. This study evaluated the actual quantitative mean gain for various clinical (clinical attachment level [CAL], probing pocket depth [PPD] and gingival marginal level [GML]) and radiographic (intrabony defect depth [IBD]) parameters of Platelet Concentrates- PCs (PRP/PRF) as sole grafting material along with OFD and OFD alone in the treatment of intrabony defects. Materials and Methods: A detailed electronic search was carried out in PUBMED/MEDLINE, COCHRANE, EBSCOHOST, and Google Scholar databases by unifying related search terms with additional hand searches in select specialty journals up to May 2017. The eligibility criteria included human randomized clinical trials, either of a parallel group or a split-mouth design with follow-up period of at least 6 months. Periodontal intrabony defects with radiographic IBD ≥3 mm with corresponding CAL ≥5 mm were included. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models. Results: Actual quantitative mean gains were calculated for OFD with PRF/PRP (CAL = 1.1 mm, IBD = 1.68 mm, PPD = 0.97 mm and GML = 0.48 mm) over and above that of OFD alone. Conclusion: Because of very high heterogeneity, the results may not be dependable. Apart from gains in radiographic bone fill, all other periodontal clinical parameters showed negligible gains. Using PRF technologies in periodontal intrabony defects may not be of great clinical significance over and above that of OFD alone, the effect sizes are also not large enough.

Most effective method for the management of physiologic gingival hyperpigmentation: A systematic review and meta-analysis Meisha Gul, Muhammad Hasan Hameed, Muhammad Rizwan Nazeer, Robia Ghafoor, Farhan Raza Khan Journal of Indian Society of Periodontology 2019 23(3):203-215 Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.

To detect the minimum inhibitory concentration and time-kill curve of shiitake mushroom on periodontal pathogens: An in vitro study Shikha Sharma, Shobha Prakash Journal of Indian Society of Periodontology 2019 23(3):216-219 Introduction: Shiitake (Lentinula edodes) is an Asian edible mushroom with the second-largest cultivation percentages among edible mushrooms in the world. Previous studies have shown its nutritional richness such as high quantities of proteins, minerals, and vitamins. Moreover, in vitro and animal studies have displayed the medical importance of shiitake extracts including antitumor, antiviral, antibiotic, and hypocholesterolemic actions and also shown to have antibacterial efficacy and has been used for the elimination of oral biofilms and as a substitute of current chemical-based treatments. This study aims to analyze the inhibitory and antibacterial efficacy of shiitake mushroom extracts on periodontal pathogens. Materials and Methods: Double extract, i.e., hot water and ethanol extract of shiitake were used for the assessments of minimum inhibitory concentrations on Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, and Prevotella intermedia using the tube-dilution method, and the time-kill curve was assessed for the above bacteria. Results: Shiitake has shown potent antibacterial effects at a concentration of 3.12 μg/ml and has shown no growth after 2 h of culture. Conclusion: Shiitake mushroom extract has shown the potential antimicrobial effect on the certain periodontal pathogens.

Comparative evaluation of two antibacterial-coated resorbable sutures versus noncoated resorbable sutures in periodontal flap surgery: A clinico-microbiological study Prerna Ashok Karde, Kunal Sunder Sethi, Swapna Arunkumar Mahale, Alefiya Shabbir Mamajiwala, Aishwarya Madhukar Kale, Chaitanya Pradeep Joshi Journal of Indian Society of Periodontology 2019 23(3):220-225 Background: Sutures at the surgical site can act as a reservoir for microbes, leading to surgical site infection. This mainly occurs in braided sutures due to wicking action. The use of triclosan-coated suture (TCS) or chlorhexidine-coated suture (CCS) could be one of the possible alternatives to reduce the microbial load. Objectives: The study was designed to assess the antibacterial efficacy of resorbable TCS and CCS along with its effect on healing after periodontal flap surgery in comparison to noncoated sutures (NCSs). Materials and Methods: Thirty patients with chronic periodontitis indicated for periodontal flap surgery satisfying inclusion criteria were randomly assigned in the three groups: (1) NCS-polyglycolic acid sutures (control group), (2) TCS-polyglycolic acid sutures (experimental Group A), and (3) CCS-polyglycolic acid sutures (experimental Group B). All the patients were evaluated at day 0 (baseline), day 8, day 15, and day 30 for healing index (HI), postoperative pain (POP), and visible plaque index (VPI). Aerobic and anaerobic bacterial growth around each suture was evaluated after day 8. Two randomly chosen samples from each group were examined using confocal laser scanning microscopy (CLSM) for the presence of biofilm. Results: Although intergroup HI and POP were statistically insignificant (P > 0.05), intragroup evaluation showed statistically significant improvement. VPI was more in NCS compared to antibacterial sutures. There was significantly less concentration of anaerobic bacteria as compared to aerobic bacteria (P < 0.05). CLSM showed the presence of more viable bacteria on NCS as compared to antibacterial sutures. Conclusion: TCS or CCS sutures can be used in periodontal surgeries to reduce the bacterial load at the surgical sites.

Comparative evaluation of the chlorhexidine and cinnamon extract as ultrasonic coolant for reduction of bacterial load in dental aerosols Kunal Sunder Sethi, Alefiya Mamajiwala, Swapna Mahale, Chetan Purushottam Raut, Prerna Karde Journal of Indian Society of Periodontology 2019 23(3):226-233 Background: Ultrasonic instruments generate aerosols with significantly greater number of bacteria. Preprocedural mouthrinses or chemotherapeutic coolants are used for the reduction of bacterial load in dental aerosols. The use of chlorhexidine as an ultrasonic coolant has been well established. However, this application has not yet been investigated for cinnamon extract which is known to have antibacterial and anti-inflammatory properties in vivo. Aim: The aim of this study is to compare and evaluate the efficacy of chlorhexidine and cinnamon extract as an ultrasonic coolant in reduction of aerosol contamination and biofilm formation during ultrasonic scaling in comparison with the distilled water (DW). Materials and Methods: Sixty patients diagnosed with moderate-to-severe gingivitis were randomly divided into three groups of twenty patients each undergoing ultrasonic scaling. For Group I, chlorhexidine was used as an ultrasonic coolant; for Group II, cinnamon extract was used; and Group III was served as control where DW was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. Both the plates from each position were incubated aerobically for 48 h. The total number of colony-forming units were counted as mean ± standard deviation and statistically analyzed. In addition, biofilm sampling of dental unit waterlines (DUWLs) was also done to evaluate the effect of these antimicrobials. Apart from microbial examination, clinical parameters such as plaque index and gingival index were also evaluated at baseline and 1-month follow-up. Results: Chlorhexidine and cinnamon both were equally effective (P > 0.05) in reducing the bacterial count in aerosols and biofilm in DUWL as compared to DW when used as ultrasonic cooling agent. Conclusion: Both cinnamon and chlorhexidine used as an ultrasonic device coolant through DUWLs effectively helped in the reduction of bacterial count in dental aerosols.

Evaluation and comparison of hydroxyapatite crystals with collagen fibrils bone graft alone and in combination with guided tissue regeneration membrane Shalabh Mehrotra, Zoya Chowdhary, Tanushree Rastogi Journal of Indian Society of Periodontology 2019 23(3):234-241 Background: The combination of collagen in bone grafts is being used because of its properties that accentuate the degree of regeneration. Furcation involvement poses challenge to the prognosis of a tooth, the use of bone grafts and a combination of grafts and membranes have proved to be beneficial in the treatment of furcation defects. Thus, the aim of the present study was to clinically evaluate and compare the effectiveness of collagen fiber bone graft with and without a membrane in the treatment of mandibular Grade II furcation defects. Materials and Methods: A clinical split-mouth randomized control trial, which included ten patients having bilateral mandibular Grade II furcation defects, was randomly assigned to Group I, treated with bone graft of hydroxyapatite with collagen fibers, and Group II, treated with bone graft of hydroxyapatite with collagen fibers and guided tissue regeneration membrane of polyglycolide and polylactide copolymer, respectively. The clinical measurements were recorded at baseline and 6 months after surgery; and plaque and gingival index were recorded at baseline and at 3 and 6 months after surgery. The data obtained was statistically evaluated. Results: The overall results showed that the treatment procedures demonstrated statistically significant reduction in probing pocket depth, vertical defect fill, and horizontal depth of furcation, with a gain in clinical attachment level. On comparison of both the groups, Group II showed superior results with a statistically significant difference in all parameters except in gingival recession. Conclusion: The findings of the study demonstrated superior clinical results obtained with hydroxyapatite with collagen fibers, used in combination with polyglycolide and polylactide copolymer as compared to used alone in the treatment of Grade II furcation defects.

Demineralized freeze-dried bone allograft with or without platelet-rich fibrin in the treatment of mandibular Degree II furcation defects: A clinical and cone beam computed tomography study Aravinda Basireddy, Santha Kumari Prathypaty, Durga Bai Yendluri, Santi Priya Potharaju Journal of Indian Society of Periodontology 2019 23(3):242-248 Background: Currently, there is no gold-standard regenerative material for the treatment of furcation defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used owing to their ease of use and cost-effectiveness. Aims: The aim of this study is to evaluate the ability of platelet-rich fibrin (PRF) to augment the regenerative effects exerted by demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular degree II furcation defects. Materials and Methods: Twenty-eight defects in 14 patients with bilateral Degree II mandibular furcation defects were included in the study. The test group was treated with a combination of DFDBA and PRF, while in the control group DFDBA was used alone. Clinical parameters such as probing depth, relative vertical clinical attachment level, relative horizontal clinical attachment level (RHCAL), gingival margin level (GML), plaque index, and sulcus bleeding index were measured at baseline and 6 months. Radiographic parameters, such as vertical defect depth, horizontal defect depth and defect fill, were measured using cone beam computed tomography, taken at baseline and 6 months. Statistical Analysis Used: The intragroup and intergroup comparisons were done using the paired t-test. Results: The intergroup comparison of mean change in the parameters showed, statistically significant difference in RHCAL (<0.001) and GML (0.014), and no significant difference in other parameters. Conclusions: Within the limitations of the present study, PRF seems to favor soft-tissue healing but has no additional benefit in bone regeneration when used in combination with DFDBA.