Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.

Stumbling upon Palatogingival Groove: A Case Report

Palatogingival grooves (PGG) are developmental malformations infamous for precipitating endodontic-periodontal lesions. Pertaining to their discreet occurrence, variation in groove depth and funnel like shape, adherence of plaque and calculus is apparent thereby jeopardizing the periodontium and pulp. A case of palatogingival groove in maxillary left lateral incisor was diagnosed and managed with endodontic treatment followed by open flap debridement to seal the groove with biodentine and fill the defect with bone graft. On follow up, the periapical lesion and the periodontal pocket were successfully resolved.

A Review of Tissue Engineering for Periodontal Tissue Regeneration

Periodontal disease is one of the most common diagnoses in small animal veterinary medicine. This infectious disease of the periodontium is characterized by the inflammation and destruction of the supporting structures of teeth, including periodontal ligament, cementum, and alveolar bone. Traditional periodontal repair techniques make use of open flap debridement, application of graft materials, and membranes to prevent epithelial downgrowth and formation of a long junctional epithelium, which inhibits regeneration and true healing. These techniques have variable efficacy and are made more challenging in veterinary patients due to the cost of treatment for clients, need for anesthesia for surgery and reevaluation, and difficulty in performing necessary diligent home care to maintain oral health. Tissue engineering focuses on methods to regenerate the periodontal apparatus and not simply to repair the tissue, with the possibility of restoring normal physiological functions and health to a previously diseased site. This paper examines tissue engineering applications in periodontal disease by discussing experimental studies that focus on dogs and other animal species where it could potentially be applied in veterinary medicine. The main areas of focus of tissue engineering are discussed, including scaffolds, signaling molecules, stem cells, and gene therapy. To date, although outcomes can still be unpredictable, tissue engineering has been proven to successfully regenerate lost periodontal tissues and this new possibility for treating veterinary patients is discussed.

Subcutaneous Facial Emphysema Following Open-Flap Air-Powder Abrasive Debridement for Peri-Implantitis: A Case Report and an Overview

Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement.

Comparative Evaluation of Open Flap Debridement Therapy with Two Different Types of Platelet Concentrates, T-PRF and L-PRF as Adjuncts- A Systematic Review

Conventional Periodontal therapy such as scaling and root planing and open flap debridement aims to halt the inflammation process and promotes repair of disease-related defects. Current regenerative procedures offers a limited potential toward attaining a complete periodontal restoration and none is considered a gold standard in the treatment of intrabony defects. This study was done to compare the efficiency of Titanium-Platelet Rich Fibrin and Leukocyte-Platelet Rich Fibrin as adjuncts to Open Flap Debridement therapy to treat intra-bony periodontal defects. A search was conducted through PubMed and various other databases such as Cochrane, Google Scholar and EBSCO Host , under the key words, OFD , T-PRF,L-PRF, Clinical Outcomes, Comparison and Randomised Contolled Trials. Six relevant articles were selected for analysis. Compared to non-platelet concentrates, L-PRFproves to be the better adjunct to open flap debridement therapy. When compared to T-PRF, however, L-PRF has comparatively inferior properties of bone defect resolution and fill.We can conclude that T-PRF has better properties, greater bone defect fill and defect resolution as compared to L-PRF.

The effect of horizontal and vertical dimensions of the interproximal space on the existence of interdental papillae – A clinical study

The aim of the present study was to determine the existence of inter dental papilla according to the vertical dimension, horizontal dimension and the combined effects of the vertical and horizontal dimensions of the interproximal space on the existence of interdental papilla.182 interdental sites of 42 periodontitis patients undergoing open flap debridement were included in the study. The existence of interdental papilla was determined based on the Papilla Presence Index (PPI). The vertical dimension (VD) was measured from the alveolar crest to the contact point using UNC-15 probe. Horizontal dimension (HD) was measured from the mesial surface of the distal tooth and the distal surface of the mesial tooth at the level of the alveolar crest using castroviejocaliper. Statistical analysis was done by using independent ‘t’ test, Pearson’s Chi-square test and Trend Chi-square test. The existence of papilla was significantly higher in VD ≤ 5mm (91.5%) compared to VD > 5mm (9.8%) [p< 0.0001]. The existence of papilla was significantly higher in HD < 2mm (97%) compared to HD ≥ 2mm (1.2%) [p< 0.0001]. The contribution of both vertical dimension and horizontal dimension to the existence of papilla was about 61.6% and thus the existence of papilla may be influenced by various other factors (about 38.4%) which were not included in this study.The vertical and horizontal dimensions of the interproximal space gains significance in determining the existence of papilla and further research is needed to analyze the other factors influencing the papilla.

Immunohistochemical Evaluation of Periodontal Regeneration Using a Porous Collagen Scaffold

(1) Aim: To immunohistochemically evaluate the effect of a volume-stable collagen scaffold (VCMX) on periodontal regeneration. (2) Methods: In eight beagle dogs, acute two-wall intrabony defects were treated with open flap debridement either with VCMX (test) or without (control). After 12 weeks, eight defects out of four animals were processed for paraffin histology and immunohistochemistry. (3) Results: All defects (four test + four control) revealed periodontal regeneration with cementum and bone formation. VCMX remnants were integrated in bone, periodontal ligament (PDL), and cementum. No differences in immunohistochemical labeling patterns were observed between test and control sites. New bone and cementum were labeled for bone sialoprotein, while the regenerated PDL was labeled for periostin and collagen type 1. Cytokeratin-positive epithelial cell rests of Malassez were detected in 50% of the defects. The regenerated PDL demonstrated a larger blood vessel area at the test (14.48% ± 3.52%) than at control sites (8.04% ± 1.85%, p = 0.0007). The number of blood vessels was higher in the regenerated PDL (test + control) compared to the pristine one (p = 0.012). The cell proliferative index was not statistically significantly different in pristine and regenerated PDL. (4) Conclusions: The data suggest a positive effect of VCMX on angiogenesis and an equally high cell turnover in the regenerated and pristine PDL. This VCMX supported periodontal regeneration in intrabony defects.

Soft Tissue Healing and IL-6 Cytokine Levels in Microsurgical and Conventional Open Flap Debridement in Patients with Chronic Periodontitis - A Randomized Clinico-Biochemical Trial

BACKGROUND The present study was conducted to compare clinical outcomes and gingival crevicular fluid (GCF) interleukin (IL)-6 cytokine levels in microsurgical and conventional open flap debridement procedure. METHODS Thirty sites in chronic periodontitis patients were randomly assigned into Group I (microsurgical) and Group II (conventional) open flap debridement in a split-mouth design. Gingival bleeding index (GBI), probing pocket depth (PPD), relative attachment level (RAL) were recorded at baseline and 3 months. GCF IL-6 cytokine levels were assessed at baseline and on 3rd day postoperatively. Pain perception using visual analog score (VAS) and soft tissue healing using early healing index (EHI) were assessed after on 7th day post-surgery. RESULTS There was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups. Intergroup gingival bleeding index scores were statistically significant at the end of 3 months. The difference in visual analog scores between the two groups was found to be statistically insignificant whereas early healing index scores between the groups was found to be statistically significant. Group I showed lower levels of IL-6 on 3rd day postoperatively. It was also found that there was positive correlation of IL-6 levels with clinical parameters such as PPD and RAL. CONCLUSIONS Open flap debridement using microsurgical approach can substantially improve clinical parameters and wound healing compared with conventional macrosurgical approach. IL-6 levels were lower in microsurgical group indicating less invasive surgical approach. KEY WORDS Open Flap Debridement, Periodontal Microsurgery, Wound Healing, IL-6, Cytokine, GCF.

Efficacy of Calcium Phosphate Composite Bone Graft in Treatment of Periodontal Intrabony Defects: Clinico-radiographic Study

Introduction: Regeneration of periodontium is always difficult to achieve regardless of all advancement. In an attempt to refine, various materials have been tried and tested. The present study was carried out to evaluate regenerative potential of easy-graft CRYSTAL in intrabony defects, clinically, and radiographically. Methods: This randomised split-mouth study was conducted at Rungta College of Dental Sciences and Research from 2015 October to 2015 October. Intrabony pockets more than 5 mm and radiographic evidence of vertical bone loss were selected from 15 patients having two sites each. The chosen sites were randomly divided into test sites: open flap debridement (OFD) with easy-graft CRYSTAL and control sites (OFD). The clinical parameters evaluated were Plaque Index, Gingival Index, Probing Pocket Depth, Relative Attachment Level, and Gingival Recession at baseline, three months, and six months postoperatively. Radiographic parameters recorded were Defect Fill and Percentage of Defect Fill at baseline, three months, and six months. Data were analysed in SPSS v.20. Results: At six months, improved clinical and radiographic values were obtained compared to baseline. The plaque and gingival index showed statistically significant reduction. Both groups showed statistically significant reduction in mean probing pocket depth and gain in relative attachment level. Mean gingival recession score was increased in both the group but was not significant. There was significant increase in Defect Fill and Percentage of Defect fill in both groups with better bone fill in test group. Conclusion: Easy-graft CRYSTAL is a potential regenerative material for the treatment of periodontal intrabony defects.