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BACKGROUND: Root coverage procedures have gained much popularity in recent years, due to increasing esthetic demands of patients. Coronally advanced flap (CAF) is a predictable technique for treating gingival recessions. Platelet-rich fibrin (PRF), an autologous platelet concentrate, has properties to enhance soft-tissue wound healing. A current method in dentistry is the use of human chorion membrane, a placental derivative, having biologic properties that help in healing and regeneration. Thus, the aim of the study was evaluation and comparison of the efficacy of chorion membrane and PRF membrane in the treatment of Miller's Class I and Class II recession defects. MATERIALS AND METHODS: This was a randomized controlled clinical study. Totally 30 sites with Miller's Class I and Class II recession were taken and randomly allocated to chorion membrane (test) PRF membrane (control) group. The clinical parameters recorded were clinical attachment level (CAL), recession height (REC-HT), recession width (REC-WD), width of keratinized gingiva (WKG) and gingival tissue thickness (GTH). RESULTS: Significant differences were seen from baseline to 6 months in test group regarding gain in CAL (P < 0.001), reduction in REC-HT (P < 0.001), decrease in REC-WD (P = 0.02), increase in WKG (P < 0.001), and increase in GTH (P < 0.001). In the control group also, significant difference was noted at the end of 6 months i regarding gain in CAL (P < 0.001), reduction in REC-HT (P < 0.001), decrease in REC-WD (P = 0.029), increase in WKG (P < 0.001), and increase in GTH (P < 0.001). Intergroup analysis showed significant differences between test and control groups at the end of 6 months, with CAL, REC-HT, WKG, and GTH showing statistically significant differences with P = 0.002, 0.001, 0.001, and 0.026, respectively. No significant difference was seen regarding REC-WD (P = 0.39). CONCLUSIONS: Both are effective materials in root coverage, but chorion membrane showed better and more stable results at the end of 6 months as compared to PRF membrane in treating gingival recession.

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Transformation of research into clinical practice is the most challenging step in evidence based dental practice. Designing the most reliable research with applicable endpoint evaluation is very important as it can lead to successful research outcomes that can be accepted in clinical practice. In the periodontal research few accepted endpoints are used frequently as they are believed to be the gold standard in measuring the periodontal disease and the treatment outcomes. However, a wide range of endpoints used are surrogate endpoints and these endpoints have no direct correlation with the patient centered outcomes. Hence, a direct relationship of surrogate endpoints with true endpoints needs to be established. This review highlights the importance of true endpoints and challenges in implementing these in clinical research. Importance of patient's centered outcomes are also reviewed and duly discussed here. Need for conducting research which includes the true endpoints or the surrogate endpoints with clinical applicability and tangible outcomes, was also suggested in this review.

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INTRODUCTION: Importance of good smile cannot be underestimated in enhancement of beauty, self-confidence and personality of a person. Health and appearance of gingiva is an essential part of attractive smile. Gingival pigmentation gives rise to unesthetic smile line. In present world, with increasing awareness to esthetic, people have become highly concerned about black gums. Various treatment modalities like abrasion, scrapping, scalpel technique, cryosurgery, electrosurgery and laser are available for treatment of gingival pigmentation. The present study was conducted with an objective of comparing efficacy of gingival depigmentation by cryosurgery and scalpel technique. METHOD: A Randomized control split mouth study was conducted for 25 patients with gingival pigmentation. Gingival pigmentation Index (GPI) for pigmentation and Visual Analoug Scale (VAS) for pain was evaluated for both test (Cryosurgery) and control sites (Scalpel technique) at baseline, 1month, 3months and 6 months. RESULTS: GPI score was 3 and 2 for 21/25 and 4/25 control sites and was 22/25 and 3/25 test sites respectively at baseline. Both the groups showed significant reduction in GPI score i.e., 0 at 1 and 3 months interval after treatment. GPI score increased to 1 for 5/25 sites treated with scalpel technique and 2/25 sites treated with cryosurgery at 6 months interval (P =0.0691). This indicates recurrence rate for pigmentation is higher after scalpel treatment. VAS Score was 3 for 10/25 sites treated with scalpel and was 2 for 12/25 sites treated with cryosurgery (P <0.001). CONCLUSION: It can be concluded that cryosurgery can be effectively and efficiently used for depigmentation by keeping patients acceptance and comfort in mind and also the long term results and ease of use when compared to scalpel technique.

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BACKGROUND: One of the most common aesthetic problem encountered in the field of periodontology is gingival recession, which is, perceived by the patients as increase in length of teeth. The treatment of buccal gingival recession is a common requirement due to aesthetic concern or root sensitivity. This study was planned to evaluate the efficacy of PRF membrane compared to that of CTG in Miller's class I gingival recessions. MATERIALS AND METHODS: 32 sites with Miller's Class I gingival recessions, out of which 16 sites received PRF (test) and 16 sites received CTG (control). Each patient had undergone an initial periodontal treatment, including oral hygiene instructions, plaque control, and scaling and root planing, followed by re-evaluation. All clinical recordings; recession height, recession width, clinical attachment level, height of keratinized tissue, thickness of keratinized tissue, healing index and pain perception, were performed immediately before surgery (baseline) and after 6 months interval following periodontal surgery. RESULTS: In the test group, significant improvement was seen in terms CAL, REC-HT, REC-WD, HKT and TKT from baseline to 6 months. In the control group, only significant improvement seen was in REC-HT and TKT from baseline to 6 months. Comparison of both Healing Index and VAS score was done and it showed no significant difference between test and the control group except VAS at 1 week. CONCLUSION: Though CTG is a gold standard procedure, PRF can be used as an alternative procedure by keeping patient's comfort and recognition in mind.

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AIMS: To investigate clinically and radiographically, the bone fill in extraction sockets using demineralized freeze-dried bone allograft alone and along with platelet-rich fibrin (PRF). MATERIALS AND METHODS: A randomized controlled clinical trial was carried out on 36 nonrestorable single-rooted teeth sites. Sites were randomized into demineralized freeze-dried bone allograft (DFDBA) combined with PRF - test and DFDBA - control groups using a coin toss method. After the placement of graft material, collagen membrane was used to cover it. The clinical parameters recorded were ridge width and ridge height. All the parameters were recorded at baseline and at 90 and 180 days. STATISTICAL ANALYSIS USED: Independent t-test and paired t-test. RESULTS: In both groups, there is significant reduction in loss of ridge width and ridge height from baseline to 90 days (P < 0.001), baseline to 180 days (P < 0.001), and 90-180 days (P < 0.001). However, when both the groups were compared the test group favored in the reduction of ridge width while there was no statistical difference in reduction of ridge height among at different intervals. CONCLUSIONS: Although DFDBA is considered as an ideal graft material, PRF can be used as an adjunctive with DFDBA for socket preservation.

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INTRODUCTION: Several bone graft materials have been used in the treatment of infrabony defects. Demineralized freeze-dried bone allograft (DFDBA) has been histologically proven to be the material of choice for regeneration. However, platelet-rich fibrin (PRF) has been said to have several properties that aid in healing and regeneration. Hence, this study focuses on the regenerative capacity of PRF when compared with DFDBA. MATERIALS AND METHODS: A total of 40 sites with intrabony defects were selected and were assigned to the test group (open flap debridement [OFD] and PRF, n = 20) and the control group (OFD + DFDBA, n = 20). At the test sites, two PRF plugs were placed in the intrabony defect after debridement of the site and flap was sutured in place. The parameters measured were probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML). These parameters were measured just before surgery (baseline) and at 6 months postsurgery. The changes in PD, RAL, and GML were analyzed at baseline and postsurgically after 6 months in each group with paired t-test and between the two groups with unpaired t-test. RESULTS: The mean reduction in PD after 6 months in the test PRF group is 3.67 ± 1.48 mm where in control DFDBA group is 3.70 ± 1.78 mm. Gain in RAL in the test PRF group is 2.97 ± 1.42 mm where in control DFDBA group, it is 2.97 ± 1.54 mm. Gingival margin migrated apically in the test PRF group by 0.43 ± 1.31 mm where in control DFDBA group by 0.72 ± 2.3 mm. It was seen that the differences in terms of PD (P = 0.96), RAL (P = 1.00) and GML (P = 0.62) were not significant. CONCLUSION: Platelet-rich fibrin has shown significant results after 6 months, which is comparable to DFDBA for periodontal regeneration in terms of clinical parameters. Hence, it can be used in the treatment of intrabony defects.

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Demineralized freeze-dried bone allograft (DFDBA) has been used extensively in periodontal therapy. Questions have been raised however, about the osteogenic potential of the variety of grafts available. In India the cost factor is another important consideration. The aim of this study therefore was to evaluate the clinical efficiency of the low priced, indigenously prepared DFDBA obtained from the Tata Memorial Hospital (TMH) Tissue Bank, in periodontal regeneration in infrabony periodontal defects, as compared to DFDBA obtained from the Pacific Coast Tissue Bank (DEMBONE). The latter was used as the control. 16 patients with bilaterally similar periodontal infrabony defects were selected, and randomly allotted to the test and control groups. At baseline, using standardized protocol, recession, probing depths (PD), and clinical attachment levels (CAL) were measured, following which periodontal surgery was carried out, with placement of the respective graft materials. Patients were recalled after 6 months for re-assessment. Statistically significant improvement was obtained for PD reduction and CAL gain for both groups (p < 0.05). However, no significant difference was observed between the test and control groups. It was therefore concluded that both the materials from different tissue banks are equally effective clinically, with the test material being additionally cost effective.

Asunto(s)

Técnica de Desmineralización de Huesos/métodos , Trasplante Óseo/métodos , Regeneración Tisular Guiada Periodontal/métodos , Pérdida de la Inserción Periodontal/diagnóstico , Pérdida de la Inserción Periodontal/terapia , Esterilización/métodos , Adulto , Trasplante Óseo/instrumentación , Femenino , Liofilización/métodos , Humanos , Masculino , Persona de Mediana Edad , Preservación de Órganos/métodos , Dosis de Radiación , Método Simple Ciego , Resultado del Tratamiento

RESUMEN

The aim of the present meta-analysis is to determine the clinical and radiographic outcomes of using platelet-rich fibrin (PRF) for the treatment of periodontal intra-bony defect (IBD) compared with open flap debridement (OFD). MEDLINE/PubMed, EBSCO and Cochrane database were used to identify studies in English language published from January 1, 2005 to January 31, 2013. An additional hand search of the relevant journals and of the bibliographies of the paper identified was also performed. Articles retrieved were screened using specific inclusion criteria by five independent reviewers: Studies investigating the effect of platelet concentrate in surgical procedure for the treatment of periodontal intra osseous defects compared with the control group in which platelet concentrate was not used were included. Five relevant articles were selected for the meta-analysis of which 3 articles were retrieved after electronic search and two articles were included after hand search. The number of patients in studies ranged from 15 to 62 (32-90 sites) with mean age ranging from 29.47 to 39.7. A total of 298 sites were treated using PRF either in combination with graft or as a monotherapy in comparison to traditional OFD procedure. The meta-analysis showed a standard mean difference of 0.95 mm; 95% confidence interval (CI): 0.20-1.71 in clinical attachment level (CAL) and 2.33 mm; 95% CI: 1.43-3.23 in IBD after treatment of IBD with PRF compared with OFD. The meta-analysis showed clinically significant improvements in periodontal parameters such as CAL, IBD, and reduction in probing depth when IBDs were treated with PRF alone when compared to OFD.

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AIM: The aim of this study was to evaluate the clinical effectiveness of locally delivered xanthan-based Chlosite(®) gel as an adjunctive therapy to scaling and root planing in treatment of chronic periodontitis. MATERIALS AND METHODS: In a randomized controlled clinical study, 30 patients were selected. Pocket depth between 5 and 7 mm was selected and each patient had two sites on the same side of the mouth. A total of 30 control sites were scaled and root planed and 30 test sites were scaled and root planed and Chlosite(®) gel was added. The clinical parameters, probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP), gingival index were recorded at baseline, 6 weeks, 3 months and 6 months. STATISTICAL ANALYSIS: Paired/unpaired t-test was used, significance was placed at 5% level of significance, i.e., P < 0.05 was considered as a significant. RESULTS: From baseline to a period of 6 months, significant difference was found between test and control group for PD, CAL, PI and BOP, P value being PD (P = 0.002), CAL index (P = 0.014), respectively. CONCLUSION: Subgingival injection of xanthan-based Chlosite(®) gel adjunct with scaling and root planing appeared to cause significant improvement compared with scaling and root planing alone in persons with chronic periodontitis.

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BACKGROUND: Open Bone Measurement (OBM) and Bone Sounding (BS) are most reliable but invasive clinical methods for Alveolar Bone Level (ABL) assessment, causing discomfort to the patient. Routinely, IOPAs & OPGs are the commonest radiographic techniques used, which tend to underestimate bone loss and obscure buccal/lingual defects. Novel technique like dentascan (CBCT) eliminates this limitation by giving images in 3 planes - sagittal, coronal and axial. AIM: To compare & correlate non-invasive 3D radiographic technique of Dentascan with BS & OBM, and IOPA and OPG, in assessing the ABL. SETTINGS AND DESIGN: Cross-sectional diagnostic study. MATERIAL AND METHODS: Two hundred and five sites were subjected to clinical and radiographic diagnostic techniques. Relative distance between the alveolar bone crest and reference wire was measured. All the measurements were compared and tested against the OBM. STATISTICAL ANALYSIS: Student's t-test, ANOVA, Pearson correlation coefficient. RESULTS: There is statistically significant difference between dentascan and OBM, only BS showed agreement with OBM (p < 0.05). Dentascan weakly correlated with OBM & BS lingually.Rest all techniques showed statistically significant difference between them (p= 0.00). CONCLUSION: Within the limitations of this study, only BS seems to be comparable with OBM with no superior result of Dentascan over the conventional techniques, except for lingual measurements.