The aim of this study was to investigate the clinical and radiologic efficacy of autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects associated with localized aggressive periodontitis (LAP). A total of 30 sites, 2 sites per individual in 15 LAP patients, were treated with modified flap operation (MFO; Kirkland flap) alone or combined with autologous PRF. The study variables included plaque index, sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level at baseline and 12 months postoperatively. The radiographic bone fill (RBF) on standardized radiographs was assessed after a year using image analysis software. The improvements in PD, CAL, and RBF in test sites compared to control sites were statistically significant (P < .05). Mean CAL gain and bone fill in the test sites were 4.0 ± 0.63 mm and 3.09 mm, respectively. Almost 80% of the PRF-treated sites showed ≥ 50% bone fill with minimal marginal tissue recession. Use of PRF significantly enhances the clinical and radiographic outcomes of open flap debridement in the treatment of periodontal intraosseous defects in patients affected by LAP.
The aim of this study was to measure the level of Oncostatin M (OSM) a gp130 cytokine in the gingival crevicular fluid (GCF) and serum of chronic periodontitis patients and to find any correlation between them before and after periodontal therapy (scaling and root planing, SRP). 60 subjects (age 25–50 years) were enrolled into three groups (n=20 per group), group I (healthy), group II (gingivitis) and group III (chronic periodontitis). Group III subjects were followed for 6–8 weeks after the initial periodontal therapy (SRP) as the group IV (after periodontal therapy). Clinical parameters were assessed as gingival index (GI), probing depth (PD), clinical attachment level (CAL), and radiographic evidence of bone loss. GCF and serum levels of OSM were measured by using Enzyme Linked Immunosorbent Assay (ELISA). It was found that mean OSM levels had been elevated in both the GCF and serum of chronic periodontitis subjects (726.65 ± 283.56 and 65.59 ± 12.37 pg·mL−1, respectively) and these levels were decreased proportionally after the periodontal therapy (95.50 ± 38.85 and 39.98 ± 16.69 pg·mL−1 respectively). However, OSM was detected in GCF of healthy subjects (66.15 ± 28.10 pg·mL−1) and gingivitis‐suffering subjects (128.33 ± 22.96 pg·mL−1) and was found as below the detectable limit (≈0.0 pg·mL−1) in the serum of same subjects. Significant correlation has been found between clinical parameters and GCF‐serum levels of OSM. Increased OSM level both in the GCF and serum, and the decreased levels after initial periodontal therapy (SRP) may suggest a use as an inflammatory bio‐marker in the periodontal disease.
Thorat MK, Pradeep AR, Pallavi B. Clinical effect of autologous platelet-rich fibrin in the treatment of intra-bony defects: a controlled clinical trial. J Clin Periodontol 2011; 38: 925–932. doi: 10.1111/j.1600-051X.2011.01760.x. Abstract Aim: Platelet-rich fibrin (PRF) may be considered as a second-generation platelet concentrate widely used to accelerate soft and hard tissue healing because of presence of many growth factors. The present study aimed to investigate the clinical and radiological effectiveness of autologous PRF in the treatment of intra-bony defects of chronic periodontitis patients. Material and Methods: Thirty-two intra-bony defects (one site/patient) were treated either with autologous PRF or a conventional open flap debridement alone. Clinical parameters such as plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL) and gingival marginal level (GML) were recorded at baseline and 9 months post-operatively. In both the groups, by using the image analysis software intra-bony defect fill was calculated on standardized radiographs (from the baseline and 9 months). Results: For all clinical and radiographic parameters test group was performed better than control group, and the difference was found to be statistically significant. Furthermore, images analysis revealed significantly greater bone fill in the test group compared with control (46.92%versus 28.66 %). Mean PD reduction (4.56±0.37>3.56±0.27) and CAL gain (3.69±0.44>2.13±0.43) in test group was found to be more compared with that of control group. In the test group, PD of >4 mm has highest percentage of PD reduction (68.9%) and CAL gain (61.6%). On frequency distribution analysis, there was no more difference for PD reduction in both the groups but CAL gain was much more in the test group than the control group. Conclusions: Within the limit of the present study, there was greater reduction in PD, more CAL gain and greater intra-bony defect fill at sites treated with PRF than the open flap debridement alone.
Objectives: Esthetics and smile-enhancing treatments have become an integral part of the dentistry; people always consult with periodontist for obtaining acceptable gingival esthetics. In smile designing esthetics, the color of gingiva has a major role. Although there is no any gold standard technique for managing melanin hyperpigmentation, esthetic concerns have lead increasing awareness about different depigmentation procedures. The aim of this study is to identify gingival melanin pigmentation patterns and to investigate its relationship based on clinical analysis with skin color, gender and gingival phenotype for various treatment modalities. Methods: In total, 200 subjects without any systemic disease (100 males and 100 females with mean age 26.5 years) screened by a single person and categorized them by skin color as fair, wheatish, brown, and dark to identify the different distribution patterns of gingival melanin pigmentation anatomically. Along with this severity of melanin pigmentation and gingival phenotypes were assessed. By using a Chi-square test correlations of variables were checked. Results: A positive statistical correlation was noticed between severity of gingival pigmentation and skin color. Dark-skinned subjects had heavy gingival pigmentation. The majority of population had pigmentation in attached gingiva and interdental papillae.Conclusion: Within the limits of the present study, the majority of population showed a positive correlation with their skin color and the severity of melanin pigmentation.
This paper is the first-ever report, to our knowledge, of a case of generalized primary gingival pseudoepitheliomatous hyperplasia(PEH) with significant periodontal findings in a 23-year-old Indian female patient. It explains the need to differentiate PEH from squamous cell carcinoma in diagnosis and treatment planning. The present article also reviews current immunohistologic staining methods used to differentiate PEH from squamous cell carcinoma.A two-stage surgical approach was used to eliminate the lesion by gingivectomy and gingivoplasty under local anesthesia. Histopathologic examination of excised tissue was done to differentiate it from squamous cell carcinoma.After 1-year follow-up, there was uneventful gingival healing and no recurrence of the lesion.Differentiation of PEH from squamous cell carcinoma of the gingiva is important for diagnosis and treatment. It is also important to consider PEH as a rare condition of gingival overgrowth.
Objective: Periodontitis is considered to be a risk factor for systemic diseases such as atherosclerosis, diabetes, etc., and cytokines play a key role. The present study was carried out to measure the level of serum oncostatin M (OSM) in patients with chronic periodontitis, and to evaluate the effect of non-surgical periodontal therapy on the serum OSM concentration.
The present study aimed to assess the clinical and radiographic effect of a bone graft material (β-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet-rich fibrin in intrabony defects of periodontitis patients.This 6-month randomized controlled clinical trial was carried out in 42 intrabony periodontal defects (average age 40 years). Intrabony defects ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase 1 periodontal therapy were treated either with open flap debridement with bone graft (β-tricalcium phosphate + hydroxyapatite; control group) or open flap debridement with bone graft plus platelet-rich fibrin membrane (test group). Individual customized acrylic stents with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative clinical attachment level (RCAL), gingival marginal level (GML), vertical bone defect fill (VHD), and area of intrabony defects (AOD) on intraoral periapical radiographs. Clinical attachment level (CAL) gain was considered as primary outcome and PPD reduction and radiographic bone fill as secondary outcomes.The preoperative Plaque Index, RCAL, GML, PPD, VHD, and AOD in the control group were 1.06 ± 0.08, 11.57 ± 2.29 mm, 5.24 ± 1.89 mm, 6.29 ± 1.52 mm, 14.36 ± 2.65 mm, and 7.79 ± 4.39 mm2, respectively. After 6 months these were 1.08 ± 0.14, 9.34 ± 2.54 mm, 5.81 ± 2.20 mm, 3.52 ± 0.93 mm, 12.64 ± 2.34 mm, and 5.34 ± 3.2 mm2, respectively. The preoperative PI, RCAL, GML, PPD, VHD, and AOD in the experimental group were 1.14 ± 0.05, 12.19 ± 2.86 mm, 4.38 ± 1.63 mm, 7.81 ± 2.6 mm, 13.46 ± 3.42 mm, and 10.31 ± 8.71 mm2, respectively. After 6 months these were 1.09 ± 0.12, 8.62 ± 2.62 mm, 4.90 ± 1.79 mm, 3.71 ± 1.68 mm, 10.10 ± 2.07 mm, and 4.38 ± 2.67 mm2, respectively. After 6 months of evaluation both the groups showed a significant reduction in PPD (P < .001) and a significant gain in CAL (P < .001), as well as significant improvement in radiographic VHD fill and AOD changes. Again, the test group showed significant changes (P < .001) over the control group considering the same outcomes.With the study limitations in mind, it can be concluded that for the treatment of intrabony defects with the bone graft material (β-tricalcium phosphate + hydroxyapatite; Biograft, IFGL Bio Ceramics) or the same bone graft with platelet-rich fibrin membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters, the latter having highly significant benefits. However, the bone graft material requires improvement.
Background: Interleukin (IL)‐18 is a proinflammatory cytokine of the IL‐1 superfamily and is unique, with the capacity to induce T‐helper (Th)1 or Th2 differentiation depending on the immunologic context. Monocyte chemoattractant protein (MCP)‐1 is a CC chemokine responsible for chemotaxis of monocytes. A previous study showed the induction of MCP‐1 by IL‐18 in mice macrophages. The present study was carried out to examine the gingival crevicular fluid (GCF) levels of IL‐18 and MCP‐1 in periodontal health and disease and to evaluate any correlation between IL‐18 and MCP‐1 GCF levels. Methods: Sixty subjects (30 males and 30 females; age range: 26 to 49 years) participated in the study. The subjects were initially divided into three groups, consisting of 20 subjects in each group, based on the gingival index, probing depth (PD), clinical attachment loss (AL), and radiologic parameters (bone loss): healthy (group 1), gingivitis (group 2), and periodontitis (group 3), whereas patients in group 3 after treatment constituted group 4. GCF samples were collected from all of the groups to estimate the levels of IL‐18 and MCP‐1 using enzyme‐linked immunosorbent assay. Results: The mean IL‐18 and MCP‐1 concentrations in GCF were highest in group 3 (330.61 pg/μl and 73.3 pg/μl, respectively). The results suggest that IL‐18 and MCP‐1 levels increased in GCF from periodontal health to disease and decreased after periodontal therapy. Levels of IL‐18 and MCP‐1 positively correlated with PD and clinical AL in group 3. In addition, IL‐18 and MCP‐1 levels significantly correlated with each other in groups 2, 3, and 4. Conclusions: GCF IL‐18 and MCP‐1 concentrations increased in periodontal disease compared to health and correlated positively with the severity of disease. Further, based on the positive correlation of IL‐18 and MCP‐1 found in this study, it can be proposed that IL‐18 may promote an inflammatory response by the induction of MCP‐1 production and the subsequent recruitment and activation of circulating leukocytes at the inflammatory site.
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