Periodontal status of anterior teeth following clinical crown lengthening by minimally traumatic controlled surgical extrusion.

Introduction: Anterior tooth fracture is the most commonly presenting clinical condition during routine dental practise. Restoration of such tooth is challenging task due to fracture position and amount of remaining coronal tooth structure. Tooth fracture at or below the gingival level usually have a poor prognosis. Treatment options for such clinical conditions range from tooth extraction to prosthodontic rehabilitation with surgical crown lengthening and/or orthodontic extrusion. This clinical report describes a multidisciplinary approach for management of such cases by the orthodontic forced eruption and clinical crown lengthening followed by the final restoration with indirect resin customized post core and crown.

Fractures of multiple permanent anterior teeth can be a traumatic experience for children, with functional, esthetic and psychological aspects. The treatment of complicated crown-root fractures (CRFs) is more challenging when the biologic width is violated. This paper presents a case of 12-year boy with complicated CRF of teeth #12 and #21, and horizontal crown fracture of tooth #11. It was managed by endodontic treatment, mucoperiosteal surgery with osteotomy to visualize the fracture line for fragment reattachment, followed by fiber-post placement and restoration with polycarbonate crowns. Clinical and radiographic evaluation after 6 months was satisfactory with adequate functional and esthetic results.

The relationship between type 1 diabetes mellitus (T1DM) and periodontal disease may exhibit by the alteration of bone metabolism. However, evidence for this relationship is scarce and inconclusive. Thus, the aims of the present study were to investigate salivary receptor activator of nuclear factor kappa-β (RANK), receptor activator of nuclear factor kappa-β ligand (RANKL), osteoprotegerin (OPG) gene expression and the RANKL:OPG ratio in T1DM and non-T1DM. Secondary objective was to determine the relationships of RANK, RANKL and OPG gene expression to clinical parameters of T1DM and periodontal disease. Twenty patients with T1DM and twenty age-matched non-T1DM were recruited. Clinical periodontal parameters were measured. Total RNA was isolated from non-stimulated saliva, and the relative gene expressions of RANK, RANKL, OPG and RANKL:OPG ratio were determined by quantitative real-time polymerase chain reaction. The T1DM group had significantly higher mean periodontal parameters than the non-T1DM group, while the mean plaque scores of both groups were not significantly different. There was a trend of higher relative gene expression of RANK, RANKL, and the RANKL:OPG ratio and lower expression of OPG in T1DM group but no statistic significant different when compared to non-T1DM. In the T1DM group, RANKL:OPG correlated with the percentage of bleeding sites, whereas RANK, RANKL, and HbA1c levels correlated with pocket depth. Bone metabolisms demonstrating by decreased OPG gene expression and upregulated of RANK, RANKL, RANKL:OPG with higher pocket depth and bleeding in T1DM may play an important role in periodontal destruction in T1DM.

BackgroundPeriodontal disease is an inflammatory disease in which pathogenic infections trigger a series of inflammatory responses and redox regulation. The hypothesis of this study was that a host’s redox regulation, as modified by genetic polymorphisms, may affect periodontal disease activities (including the plaque index (PlI), bleeding on probing (BOP), and pocket depth (PD)) during periodontal therapy.MethodsIn total, 175 patients diagnosed with periodontitis were recruited from the Department of Periodontology, Taipei Medical University Hospital. Both saliva samples and clinical measurements (PlI, BOP, and PD) were taken at the baseline and at 1 month after completing treatment. Salivary manganese superoxide dismutase (MnSOD) and catalase, and corresponding genetic polymorphisms (MnSOD, T47C, rs4880 and Catalase, C-262 T, rs1001179) were determined. The extent of change (Δ) of MnSOD or catalase was calculated by subtracting the concentration after completing treatment from that at the baseline.ResultsSubjects who carried the Catalase CC genotype had significantly higher salivary MnSOD or catalase levels. The MnSOD genotype had a significant effect on the percentage of PDs of 4~9 mm (p = 0.02), and salivary ΔMnSOD had a significant effect on the PlI (p = 0.03). The Catalase genotype had a significant effect on the PlI (p = 0.01~0.04), but the effect was not found for the mean PlI or PD. There was a significant interaction between the MnSOD genotype and salivary ΔMnSOD on PDs of 4~9 mm. After adjusting for gender, years of schooling, smoking status, and alcohol consumption, subjects with ΔMnSOD of < 0 μg/ml or Δcatalase of < 0 μg/ml had significantly higher 5.58- or 5.17-fold responses to scaling and root planing treatment.ConclusionsThe MnSOD T47C genotype interferes with the phenotype of salivary antioxidant level, alters MnSOD levels, and influences the PD recovery. MnSOD and catalase gene polymorphism associated with phenotype expression and susceptibility in periodontal root planing treatment responses.

Introduction: Periodontitis is a polymicrobial and multifactorial oral disease and is the sixth complication of diabetes mellitus. Early diagnosis is important, and the use of non invasive biomarkers are highly useful for this purpose. The level of Macrophage Activating Factor (MAF) and Procalcitonin (ProCT) corresponds to the intensity of the inflammatory response and the severity of infection; thereby indicating that an increase in concentration or persistence of high values is considered as a prognostic indicator for severity of infection with an adverse outcome. Aim: To assess the periodontal parameters and quantify the levels of MAF and ProCT in saliva samples of generalised chronic periodontitis subjects with and without type 2 diabetes mellitus and to correlate these levels with the periodontal parameters. Materials and Methods: The study was a single centre cross- sectional study carried out at the Department of Periodontology, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India, from November 2018 to November 2019. A total of 80 subjects with generalised severe chronic periodontitis were selected and divided into two groups. Group I comprised of 40 subjects who were diagnosed with generalised chronic periodontitis without type 2 diabetes mellitus, whereas group II comprised of 40 subjects with generalised chronic periodontitis who had already been diagnosed with type 2 diabetes mellitus. Periodontal parameters such as Plaque Index (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) were recorded. The collected samples were subjected to molecular analysis for evaluating ProCT and MAF using Enzyme-Linked Immunosorbent assay (ELISA). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 25.1 (Chicago, USA Inc). Student’s Independent t-test was used to compare the mean values for the variables in the control and test group. The Pearson’s correlation test was used to evaluate correlation between all the variables. The p-value &lt;0.05 was set as the level of significance. Results: On comparing the periodontal parameters between group I and group II, there was no significant difference between the groups p-value &gt;0.05. The mean salivary ProCT level in group I and group II was 268.76±152.78 ng/mL and 785.75±244.37 ng/mL, respectively. The mean salivary MAF level in group I and group II was 7.15±2.02 ng/mL and 26.56±9.12 ng/mL, respectively. On comparing MAF and ProCT value between group I and group II, there was a statistically significant increase in group II (p-value &lt;0.001) and a weak correlation value with the periodontal parameters was seen. Conclusion: There was a significant difference in levels of MAF and ProCT in saliva samples of generalised chronic periodontitis subjects with and without type 2 diabetes mellitus, however the periodontal variables in each group did not correlate with MAF and ProCT.

Anterior tooth fracture is the most common type of trauma occurring to the dental tissues. Teeth fracturing at or below the gingival level usually have a poor prognosis, with extraction of the tooth being the most probable outcome. Clinical crown lengthening followed by prosthetic rehabilitation is a promising approach toward such cases. The clinical report presented here explains in detail the various treatment modalities available for such cases with special emphasis on orthodontic extrusion/forced eruption.

The Assessment of Periodontal Parameters, Salivary Total Protein and Albumin Contents in Patients Taking Warfarin

We assessed the association of periodontal disease and number of missing teeth with subclinical atherosclerosis in an adult Korean population. Cross-sectional data from 5404 individuals aged ≥50 years were obtained from the 2008-2010 Dong-gu study. Periodontal examinations were conducted to determine the number of missing teeth, pocket depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). The percentages of sites with PD ≥ 4 mm (PD 4%), CAL ≥ 4 mm (CAL 4%), and BOP (BOP%) were recorded for each participant. B-mode ultrasound was performed to determine common carotid artery intima-media thickness (CCA IMT) and the presence of carotid plaques. Multivariate linear regression models were used to assess the associations between periodontal parameters and CCA IMT and carotid plaque. Number of missing teeth was associated with increased CCA IMT, and BOP% was associated with increased CCA IMT in females only. This association was robust in never smokers. The number of missing teeth was associated with CCA IMT, and BOP% was associated with CCA IMT in females only. These associations were robust in never smokers. Our results suggest that tooth loss due to oral disease may play a role in subclinical carotid atherosclerosis.

The purpose of this study was to examine the effects of placement of retraction cord subgingivally upon periodontal indices including plaque index (PI), gingival index (GI), pocket depth (PD), bleeding on probing (BOP), and attachment level (AL), as well as gingival crevicular fluid (GCF) and TNF-alpha levels. Ten teeth in 6 patients who were periodontally healthy were selected. These teeth had pocket depths of 3 mm or less, no evidence of significant loss of attachment, BOP, or plaque accumulation. The patients each received an oral prophylaxis. The following week, baseline measurements of periodontal indices and TNF-alpha were taken and the retraction cord was placed for 15 minutes. Following removal, the patients were dismissed. The periodontal indices measured included PI, GI, PD, BOP, and AL. In addition, the levels of TNF-alpha in GCF, were investigated. These measurements were made before gingival retraction as a baseline and on the 1st, 3rd, 7th, 14th, and 28th days post retraction. A repeated measures ANOVA showed that TNF-alpha levels in GCF were significantly increased at all five intervals after gingival retraction compared to the baseline. The mean TNF-alpha level peaked at Day 1 (0.90 +/- 0.62), then declined at Days 3 (0.53 +/- 0.16), 7 (0.43 +/- 0.08), 14 (0.47 +/- 0.10), and 28 (0.43 +/- 0.08) but was still elevated 54% above baseline at Day 28, p < 0.01. The GI was significantly elevated at Day 1 (0.9 +/- 0.49), p < 0.01; Day 3 (0.53 +/- 0.32); and Day 7 (0.33 +/- 0.33), p < 0.05. Unlike TNF-alpha, GI recovered to the baseline by day 14. Other periodontal parameters, PI, PD, BOP, and AL were not significantly altered by the gingival retraction procedure. This pilot study supports the previous research that gingival retraction causes an acute injury that heals clinically in 2 weeks as is indicated by the GI. It also provides the first evidence that gingival retraction results in an elevation of the proinflammatory cytokine, TNF-alpha, in GCF.

BackgroundOur aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment.MethodsIn a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated.ResultsThe number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0–11) and control (Me = 5, IQR = 1–22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p < 0,001).ConclusionDespite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP.Trial registrationEUDRA-CT: 2015–004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI, registered 17. 12. 2015.

Aim: The labial frenum is a mucosal fold that connects the upper lip to the alveolar ridge. Frenectomy involves the surgical removal of a mucosal fold. The traditional surgical technique utilizing a scalpel remains popular for performing a frenectomy. The study aims to examine the effectiveness of applying Hyaluronic Acid (HA) Gel after conventional frenectomy. Methods: This research comprised 48 young patients (25 girls and 23 boys) aged 8 to 14. Participants were randomly divided into two groups. Group 1: Conventional Scalpel Surgery and Sterile Saline (SS) (n=24) and Group 2: Conventional Scalpel Surgery+HA (Aftamed, Child Gel 24% HA) (n=24). After measuring the participants’ periodontal parameters, the frenectomy was performed. Postoperative pain levels were evaluated daily for one week utilizing a 10-point Visual Analog Scale. Before frenectomy, Plaque Index (PI), Gingival Index (GI), Pocket Depth (PD), Bleeding On Probing (BOP), Keratinized Gingival Width (KGW), Attached Gingival Thickness (AGT) values were measured and recorded. The periodontal parameters were assessed and analyzed after a 3-month follow-up period. Results: VAS (Visual Analogue Scale) was assessed. The application of Although 0.24% HA gel caused less pain from days 1-3.6, there was no significant difference in pain levels between the HA gel and control groups (p&gt;0.05). Pain levels were equal between groups on day 7. No significant changes in PI, GI, PD, BOP, KGW, or AGT values after three months of follow-up (p&gt;0.05). Conclusions: During the first week after a frenectomy performed with classic scalpel surgery, the application of 0.24% HA gel did not significantly reduce pain levels. It did not result in significant changes in other measured periodontal parameters after three months of follow-up.

Using ginger supplement in adjunct with non-surgical periodontal therapy improves metabolic and periodontal parameters in patients with type 2 diabetes mellitus and chronic periodontitis: A double-blind, placebo-controlled trial

To determine whether azithromycin (AZI) as an adjunct to scaling and root planing (SRP), when compared to placebo, decreases the number of sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 12 months post-treatment in stage III/IV periodontitis patients. In a double-blind randomized parallel-arm placebo-controlled trial, 40 stage III/IV periodontitis patients received steps 1 and 2 of periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20; AZI 500 mg/day, 3 days) or placebo (n = 20). Additional instrumentation of residual diseased sites (DS)-sites with PD ≥ 5 mm and BOP-was performed at the 3-, 6- and 9-month follow-ups. The primary outcome variable was the number of DS at the 12-month re-evaluation. Using a multivariate multilevel logistic regression model, the effects of gender, age, antibiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. The number of DS after 12 months was similar in the test (median (Me) = 4, interquartile range (IQR) = 0-6) and control (Me = 3, IQR = 1-6.5) groups. Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroup differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio (OR) for the healing of DS on molars (OR = 0.29; p < 0.001) and in smokers (OR = 0.36; p = 0.048). Stage III/IV periodontitis patients showed significant but comparable improvements in periodontal parameters and the number of residual DS at the 12-month revaluation regardless of treatment type. This may have been the result of the additional instrumentation received by patients at residual DS in both treatment groups. Treatment with AZI + SRP provided no additional benefits after 12 months in terms of periodontal parameters or the number of persisting sites with PD ≥ 5 mm + BOP as compared to SRP plus placebo. EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.

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Cigarette smoking is a risk factor for several diseases, and recent evidence strongly suggests an adverse effect on periodontal health. Nevertheless, the nature of the relationship between smoking and periodontal disease is not clear. Smoking causes defects in neutrophil function, impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Aims. This study aimed to assess periodontal health of smoker and nonsmoker under graduated dental students and to determine the possible factor of smoking and its effect on periodontal health. . In this study, 118 dental student participants (males only) between 18—25 years from 450 male under graduated dental student fit to the criteria of our research, were divided in two groups,61 smoker student and 57 non-smoker students. Demographic data, smoking status, and clinical periodontal parameter including plaque index (PI), pocket depth (PD), tooth mobility and bleeding on probing (BOP) indices were determined for each participant. . Smokers had a slightly higher PI (0.803±0.483) than that of nonsmokers (0.609±0.397, p=0.018). BOP and pocket depth tend to be greater in smokers (BOP=0.14±0.10 and PD=0.97±1.90 mm) than nonsmoker (BOP=0.13±0.09 and PD=0.72±1.57 mm). The greater percentage of students had started smoking due to friends’ influence (72%). There is a positive correlation between PD and PI for smokers (p=0.046). Also there is a positive correlation between BOP and PD for non-smokers with statistically significant difference (p=0.01). Moreover, there is a positive correlation between BOP and PD and PI for smokers (p=0.026) and there is a positive correlation between PI and BOP and PD for non-smokers with high statistically significant difference (p=0.0001). . The students having friends who are smoker are the most important factors associated with smoking, furthermore the percentage of bleeding is low since the fact that smoking effect the bleed vessel and cause vasoconstriction, finally Longitudinal trials need to be performed in order to obtain more conclusive result regarding the effect of smoking in periodontal disease.