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The purpose of the present study was to process and assess the effect of hydrated amnion chorion membrane and dehydrated amnion chorion membrane on proliferation of periodontal ligament (PDL) fibroblast cells. The amnion chorion membrane (ACM) from placenta of 18 systemically healthy patients was obtained from the Department of Obstetrics and Gynaecology. They were processed as hydrated and dehydrated based on different processing methods. The Periodontal ligament cells were obtained from periodontal ligament of freshly extracted premolars of systemically healthy patients, due to orthodontic reasons. The PDL cells were further cultured in laboratory and were exposed to hydrated and dehydrated amnion chorion membrane. The MTT assay was performed to assess the proliferation of PDL fibroblast cells after 24 and 48 h. The hydrated and dehydrated amnion chorion membrane showed proliferation of PDL fibroblasts after 24 and 48 h. The proliferation of PDL fibroblasts in hydrated (p = 0.043) and dehydrated (p = 0.050) amnion chorion membrane was statistically significant at the end of 24 and 48 h respectively. On inter-group comparison dehydrated ACM showed significant proliferation of PDL fibroblasts after 24 (p=0.014) and 48 h (p=0.019). Within the limits of the present study, it can be concluded: both hydrated and dehydrated amnion chorion membrane showed proliferationof PDL fibroblast cells. However, dehydrated ACM showed significant proliferation of PDL fibroblasts.

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BACKGROUND: Effectuating adequate width of keratinized tissue (WKT) can lead to a healthy and stable implant/soft tissue interface which is important for the long term success of the implant. The use of free gingival grafts (FGG) for widening the WKT around dental implants increases the amount of attached gingival tissue and prevents clinical attachment loss. AIM: The aim of the study was to assess the ability of FGG to create a healthy implant/soft tissue interface. METHODS AND MATERIAL: A total of 10 edentulous sites in 10 patients with inadequate keratinized tissue indicated for replacement of missing teeth were treated. An implant was placed in edentulous sites and the keratinized tissue was augmented using FGG at the second stage of implant surgery. WKT was recorded at baseline, 3rd month and 6th month post-operatively. Plaque index (PI), gingival index (GI), probing depth (PD) and papillary index (PPI) and were recorded at 3 and 6 months post-operatively to evaluate the health of peri-implant tissues. Paired t-test was used for standard deviation and the level of significance was taken as 5% (P < 0.05). RESULTS: The WKT at 3 (3.2±1.61mm) and 6 months (3±1.56 mm) compared to the baseline was statistically significant (P = 0.034). The other parameters PI, GI, PD, PPI showed no clinical significance from 3 and 6 months (P > 0.05). CONCLUSIONS: Augmentation of FGG created a significant gain in the WKT which resulted in a healthy implant/soft tissue interface.

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BACKGROUND: Conventional nonsurgical periodontal therapy eliminates the pathogenic microbes, yet residual deposits promote the recurrence of the disease. As antimicrobials may pose undesirable effects, alternate therapies are probed. AIM: The aim of the study is to evaluate the efficacy of locally delivered benzyl isothiocyanate (BITC) as an adjunct to scaling and root planing to treat patients with chronic periodontitis. MATERIALS AND METHODS: The study included 30 patients diagnosed with chronic periodontitis. Test (scaling and root planing along with BITC intervention) and control (scaling and root planing) sites were randomly assigned to each patient. These sites were in the contralateral quadrants, having a probing depth of 4-6 mm. The plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), and microbial load (colony forming unit [CFU]) were assessed at baseline, 1-week, and 6-week time interval. Data were analyzed by ANOVA/Friedman test, Mann-Whitney U-test, pairwise paired t-test, and Wilcoxon test, with P ≤ 0.05 set as statistically significant. RESULTS: The scores of PI, GI, PPD, and CAL from baseline to 6-week follow-up within both the test and control sites were noted to be statistically significant (P < 0.0001). The CFU showed a significant reduction (P = 0.0229) within the test site at varying time intervals. The change in the mean PI score from baseline to 6-week time interval between the test and control site was noted to be statistically significant (P = 0.0039). CONCLUSION: The local application of BITC chips effectively reduced the PI, GI, PPD, and CFU, subsequently with the gain in CAL, and improved the tissue integrity and thereby oral hygiene.

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Width of attached gingiva plays an important role in maintaining periodontal health, provides stabilization of the gingival margin against frictional forces and aids in dissipating physiological forces exerted by the muscular fibers of the alveolar mucosa on the gingival tissues. Inadequate width of attached gingiva leads to attachment loss, soft tissue recession, and impedes oral hygiene measures. Hence, procedures using autografts and allografts have been proposed to augment the attached gingiva. Allografts like chorionic membrane (CM) are known to enhance release of growth factors, promote neovascularization, healing and enhance biotype. To assess the efficacy of CM in increasing the width of attached gingiva, vestibular depth and gingival thickness. Fifteen patients with inadequate attached gingival width were included in the study. Patients were randomly allocated to each group: Control group, CM group and CM + platelet rich fibrin (PRF) group. Attached gingiva width, vestibular depth, and gingival thickness were measured at baseline and 4 weeks post procedure. The control, CM and CM + PRF groups showed an increase in all parameters from baseline to 4 weeks. The increase in the attached gingiva (p = 0.042) width, vestibular depth (p = 0.043) and gingival thickness (p = 0.034) were statistically significant at 4 weeks for CM group and CM + PRF group respectively. The CM + PRF group showed better results compared to other groups. CM and PRF can be effectively incorporated to increase the width of attached gingiva and depth of vestibule.

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The goal of periodontal therapy is to prevent periodontal disease progression and to regenerate lost periodontal tissues. Various bone grafts are used alone or in combination with other treatment modalities for periodontal therapy. In literature no reports are presented with block allografts in the treatment of intrabony defects in periodontitis. Hence the study aimed to evaluate and compare clinically and radiographically freeze dried bone and demineralized freeze dried bone block allografts with chorion membrane in intra-bony defects at 12 months post-surgery. Eighteen intra-bony defects (9 intra patient pairs) in 9 patients with chronic periodontitis were randomly assigned to group 1 (FDBA + Chorion membrane) and group 2 (DFDBA + Chorion membrane) for periodontal therapy. Clinical and radiographic (RVG) measurements were made at base line and 12 months. Data obtained was subjected to statistical analysis. At 12 months on intra-group comparison both the groups showed statistically significant improvement in the plaque and gingival indices with reduction in the mobility, probing pocket depth and gain in clinical attachment (p value < 0.001). Radiographs showed significant bone fill and increased bone density (p value < 0.001). On inter-group comparison no statistical difference were observed at 12 months in clinical parameters and bone fill among both the groups. However, group 1 (FDBA) showed increase in the bone density which was statistically significant (p value < 0.001). The use of the FDBA and DFDBA block allografts showed significant improvement in the periodontal prognosis of teeth with intra-bony defects. Within the limitation of the present study, both the groups showed similar results with significant increase in bone density in FDBA group.

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BACKGROUND: The aim of the study was to evaluate the anti-inflammatory effect of chorion as a barrier membrane in periodontal pocket therapy by assessing interleukin-11 (IL-11) level in gingival crevicular fluid (GCF). MATERIALS AND METHODS: The study was a randomized, controlled, single-blind clinical trial with split-mouth design. In each patient, two sites in two quadrants were selected and randomly allocated in Group 1 (flap surgery) and Group 2 (flap surgery + chorion membrane placement). After Phase 1 therapy, clinical and biochemical parameters were recorded at baseline and at 4 weeks. Plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), and IL-11 in GCF were assessed. GCF was collected using microcapillary tubes. IL-11 was assayed in GCF with ELISA kit (Genxbio®). RESULTS: At baseline, the clinical and the biochemical parameters were similar in both the groups. Intragroup comparison revealed statistically significant decrease in all clinical and biochemical parameters in Group 1 (P < 0.001) and Group 2 (P < 0.001). Intergroup comparison showed statistically significant decrease in SBI (P = 0.004), PPD (P = 0.004), CAL (P = 0.013), and IL-11 (P = 0.006) in Group 2 compared to Group 1 at 4 weeks. However, PI did not show any statistically significant difference on intergroup comparison. CONCLUSION: Adjunctive use of chorion membrane in flap surgery provides an additive anti-inflammatory effect along with improvement in clinical outcomes enhancing the long-term prognosis.

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BACKGROUND AND OBJECTIVES: The pathogenesis of inflammatory periodontal diseases essentially involves degradation of extracellular matrix molecules, and collagen breakdown and matrix metalloproteinases (MMPs) are proteinases primarily involved in this process. It is known that doxycycline downregulates MMP activity. Curcumin has anti-inflammatory effect and also downregulates MMP activity. Thus, a study was conducted to evaluate the anti-inflammatory effect of curcumin by its inhibition of MMP-9 activity and compare the same with doxcycline, which has known anticollagenase activity. SUBJECTS AND METHODS: Gingival tissue samples were obtained from thirty patients diagnosed with chronic periodontitis. The tissue extracts were treated with Curcumin and doxycycline and inhibition of MMP-9 analyzed by gelatinzymography. Gels obtained were stained with Coomassie Brilliant Blue, and enzymatic activities detected as bands of gelatinlysis against blue background. Relative MMP-9 levels were measured by scanning the clear zones and analyzing the percentage inhibition. RESULTS: Results showed that MMP-9 activity was significantly decreased by both the drugs. Curcumin showed 61.01% reduction in the MMP-9 activity at 1500 µg/ml concentration and doxycycline showed 59.58% reduction in the MMP-9 activity at 300 µg/ml concentration. CONCLUSION: The current study showed that curcumin has inhibitory effect on polymorphonuclear leukocyte-type MMP-9 involved in matrix degradation in periodontitis. Since Curcumin has a potent anti-inflammatory effect, it may have therapeutic potential as a host modulation agent in periodontal diseases.

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A thick gingival biotype is a requisite for good periodontal health. It has important role in resisting trauma and subsequent gingival recession. The gingival thickness is a significant predictor of clinical outcome of periodontal surgeries. Various surgical procedures are used to increase the gingival thickness. The present study incorporated the innovative step of placement of chorion membrane to objectively evaluate the increase in thickness of gingival biotype during periodontal pocket therapy. The patients in age group between 25 and 45 years with chronic periodontitis, indicated for flap surgery were selected for the study. The sites with pocket depth of 6-8 mm in the mandibular anterior teeth were divided into test and control sites. Periodontal flap surgery was carried at both the sites and chorion membrane was placed at the test sites. The gingival thickness measurement was assessed using a markings marked on injection needle, these markings were read using digital vernier caliper, pre and post operatively. The baseline values of gingival thickness at test site (1.04 ± 0.19 at mid buccal region, 1.24 ± 0.20 at mid papillary) and control site (0.94 ± 0.11 at mid buccal region, 1.14 ± 0.11 at mid papillary region) showed no statistically significant difference. At test sites, 6 weeks post treatment (1.36 ± 0.16 at mid buccal region and 1.48 ± 0.17 at mid papillary region) as compared to control sites (1.06 ± 0.11 at mid buccal region, 1.24 ± 0.11 at mid papillary) showed statistically significant increase in gingival thickness (p ≤ 0.05*). The innovative step of placement of chorion membrane during periodontal pocket therapy facilitated increase in the gingival thickness in the areas with thin gingival biotype.

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BACKGROUND: The mainstay of periodontal therapy is mechanical removal of subgingival plaque. There is considerable interest in supplementing it with the use of antibiotics and antiseptics. Many drawbacks are associated with these adjunctive pharmacological regimens such as development of resistance to antibiotics and disruption of microflora of the gastrointestinal tract. Hence, alternate means of killing subgingival bacteria are clearly desirable. One such method is the use of laser. AIM: This study aimed to investigate antibacterial capabilities of gallium-arsenic (Ga-As) laser on photosensitized periodontopathic organisms. The three bacteria selected for the study were Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia. SETTINGS: The subjects for the study were selected from the patients visiting the Department of Periodontics, Karnataka Lingayat Education Society's Institute of Dental Sciences, Belgaum. DESIGN: In vitro study design. MATERIALS AND METHODS: Subgingival plaque samples collected from chronic periodontitis patients were cultured anaerobically for 72 h. Predetermined number of colonies of each bacterium was taken and was then divided into cases and control groups. Both groups were photosensitized using toluidine blue O (TBO) dye and the case groups were irradiated with Ga-As laser. Bacterial colonies were then serially diluted and were incubated for subculture. After incubation period, the number of viable bacterial count was performed. STATISTICAL ANALYSIS: Wilcoxon-signed rank test was carried out to determine significance of reduction on subsequent dilution within the bacterial group. Mann-Whitney U-test was performed to determine the significance of reduction between cases and control of particular bacterial group. RESULTS: The results revealed substantial reduction in the viable bacterial count. F. nucleatum was found to be most sensitive to killing by laser irradiation followed by P. intermedia and then P. gingivalis. Further, the TBO dye per se did not have any significant bactericidal effect. CONCLUSION: Photodynamic Therapy may prove to be a promising method for eradicating periodontopathic bacteria in near future.

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BACKGROUND AND OBJECTIVE: Periodontitis is a major public health problem in India with a prevalence of 60-80%. If untreated it acts as a risk factor for systemic diseases. Data on anaerobic periodontal microflora in the Indian population is very scarce. Hence, this study was undertaken to know the nature of oral microbiota in chronic periodontitis in this region of India and also the semiquantitative study in pre- and post-treatment group and to determine antibiotic susceptibility pattern for aerobic isolates. MATERIALS AND METHODS: The present study was conducted on 60 cases. Material was collected from the subgingival pockets in patients with chronic periodontitis attending the Periodontology, Outpatient Department. Clinical samples were transported to the laboratory in fluid thioglycollate medium. Initially Gram's stain and Fontana stains were done. Aerobic, anaerobic, and microaerophilic culture were put up. Antibiotic sensitivity test was done for aerobic isolates. RESULTS: Sixty samples yielded 121 isolates of which 78.34% were polymicrobial, 11.66% were monomicrobial and oral commensals were grown in 10% cases. Out of 121 isolates 91.74% were anaerobic, 7.43% were aerobic and 0.83% were microaerophilic. Fusobacterium species was the most common isolate among anaerobes. Using "paired t-test" "P" value was significant indicating significant reduction in colony count after phase-I periodontal therapy. CONCLUSION: This study has shown that anaerobic bacteria are important cause of chronic periodontitis, along with aerobes and microaerophilic organisms. Fusobacterium spp, Bacteroides fragilis, Porphyromonas spp and Prevotella intermedia are the most common anaerobic pathogens. Bacterial culture methods are still economical and gold standard.

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OBJECTIVE: Due to the rampant use of antibiotics bacteria are acquiring resistance to penicillin group of drugs, which results in prescription failure in clinical practice. Beta-lactamase producing organisms are not only more virulent they also cause surrounding bacteria to become resistant. Hence, this study was undertaken to know the prevalence of extended spectrum beta-lactamase (ESBL) producing anaerobic bacteria in chronic periodontitis. MATERIALS AND METHODS: The present study was conducted for a period of 1 year from January to December 2010 at a tertiary care teaching hospital. Clinical samples were collected from the sub gingival pockets from cases of chronic periodontitis and transported to the laboratory in fluid thioglycollate medium. Gram's staining was performed and anaerobic culture put up. All the anaerobic bacteria isolated were tested for beta-lactamase production by Nitrocefin disc method. RESULTS: A total of 60 samples yielded 121 isolates, out of which 26% were ESBL producers. Bacteroides fragilis was the most common organism followed by Fusobacterium species. CONCLUSION: ESBL producing anaerobic bacteria exits in chronic periodontitis cases and the present study identified 26% of the isolates to be ESBL producers. Antibiotic resistance testing is essential before starting the therapy and in emergency cases drugs should be chosen to cover ESBL producers.

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BACKGROUND: The relatively safe nature and cost-effectiveness of herbal extracts have led to a resurgent interest in their utility as therapeutic agents. Therefore, this prospective, double-blind, randomly controlled clinical trial was designed to compare the antiplaque and antigingivitis effects of newly formulated mouthrinse containing tea tree oil (TTO), clove, and basil with those of commercially available essential oil (EO) mouthrinse. MATERIALS AND METHODS: Forty patients were selected for a 21-day study period and randomly divided into two groups. The test group patients were given newly formulated herbal mouthrinse and the control group patients were given commercially available EO mouthrinse. The Plaque Index (PI), Gingival Index (GI), and Papillary Marginal Attachment (PMA) Index were recorded at baseline, 14 days, and 21 days. The microbial colony forming units (CFU) were assessed at baseline and 21 days. RESULTS: Test group patients using herbal mouthrinse showed significant improvement in GI (0.16), PI (0.57), and PMA (0.02) scores. These improvements were comparable to those achieved with commercially available EO mouthrinse. However, the aerobic and anaerobic CFU of microbiota were reduced with the herbal mouthrinse (P = 0.0000). CONCLUSION: The newly formulated herbal mouthrinse and commercially available mouthrinse were beneficial clinically as antiplaque and antigingivitis agents. Newly formulated mouthrinses showed significant reduction in microbial CFU at 21 days. So, our findings support the regular use of herbal mouthrinse as an antiplaque, antigingivitis, and antimicrobial rinse for better efficacy.

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PURPOSE: To investigate the association between maternal periodontal disease and its effect on haemoglobin levels and low birth weight infants. MATERIALS AND METHODS: This observational study included 770 mothers. Data regarding the periodontal status, pregnancy outcome variables, haemoglobin levels (Hb%) and other factors that may contribute to adverse pregnancy outcomes were collected. The data were analysed using the chi-square test and univariate logistic regression analysis. RESULTS: Factors such as literacy (P = 0.002), adverse oral habits (P < 0.001), dental health negligence (P < 0.001), obstetric history (P = 0.001) and Hb% (P < 0.001) showed a significant association with periodontal disease. The study showed only seven mothers had not received antenatal care (ANC), which reflected the awareness of ANC during pregnancy. The reduced haemoglobin levels had an association with the severity of periodontal disease. The univariate logistic regression analysis indicated that mothers with a probing pocket depth (PPD) > 6 mm (OR = 2.21, 95% CI [1.07-4.55], P = 0.032) had a higher risk of giving birth to low birth weight infants. CONCLUSION: Periodontitis significantly influenced low birth weight. The increase in the severity of periodontal disease was associated with an increased rate of pre-term infants. The severity of periodontitis influenced the maternal haemoglobin levels, i.e. more severe peridontitis was associated with lower haemoglobin levels. Severe anaemia and periodontal infection may have an adverse effect on pregnancy and fetal development.

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Periodontal regenerative therapy is aimed at reconstruction and to restore the architecture and function of lost or injured tissues. Melcher (J Periodontol 47(5):256-260, 1976) introduced the concept of guided tissue regeneration (GTR) for osseous reconstructive surgery. The aim of the present innovative clinical and radiographic study was to evaluate the effect of chorionic membrane (CM) in GTR in periodontal pocket therapy. Ten patients with moderate to severe periodontitis were selected in the single blind randomized controlled clinical trial. Patients were treated with periodontal pocket therapy along with CM in study sites and the control sites were treated with periodontal pocket therapy alone. The clinical parameters were recorded at baseline and 12 months. The radiographic parameters were recorded at baseline, 6 and 12 months. Clinical parameters included gingival index (GI), plaque index (PI), pocket probing depth (PPD) and relative attachment level (RAL). Digital images were analysed for bone gain (BG) and density. Data were evaluated using t test. Statistical significant differences were found in both sites at 12 months for GI, PI, PPD and RAL. Highly significant reduction was seen in GI 0.40 ± 0.08 (p = 0.0001), PI (0.41 ± 0.18), PPD 2.50 ± 0.53 mm (p = 0.0431) and increased BG 0.86 ± 0.18 (p < 0.0001) were observed in study sites. This shows that CM when used with pocket therapy can have influence on clinical parameters. Radiographic findings from this study demonstrated significant BG and density in sites treated with CM as compared to control sites.

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BACKGROUND: Neutrophils constitute the main phagocytic cell system in mammalian host defense against an infecting agent. Abnormalities in leukocyte number and function are associated with increased susceptibility to periodontal diseases. The purpose of this study is to evaluate the in vitro phagocytic properties of crevicular and peripheral blood neutrophils in healthy and periodontitis subjects. PATIENTS AND METHODS: A total of 30 subjects, that is, 10 patients in each of the following three groups: healthy controls, chronic periodontitis (CP), and localized aggressive periodontitis (LAP), were included in the study. The neutrophils were isolated from the peripheral blood and gingival crevice and tested for phagocytosis of Candida albicans. The percentage of leukocytes with ingested C. albicans was determined by light microscopy. RESULTS: A significant reduction in the phagocytic activity of crevicular fluid polymorphonuclear neutrophils (CF-PMN) of LAP subjects (mean: 54.3±7)(P<0.001) was observed, compared to healthy controls (mean: 74.2±9) and chronic periodontitis subjects (mean: 69±9)(P=0.352). The mean percentage of peripheral blood polymorphonuclear neutrophils (PMNs) with phagocytosis of opsonized C. albicans in LAP patients was significantly reduced (mean: 74.9±5)(P<0.0068) compared to the phagocytic activity of neutrophils from controls (mean:82.1±3) and chronic periodontitis subjects (mean: 82.0±5)(P=0.970). There was no significant reduction in the phagocytic activity of CF PMNs (mean: 69±9) (P=0.35) and peripheral blood PMNs (mean: 82.5)(P=0.97) in the chronic periodontitis group when compared to the control group. CONCLUSION: The phagocytic activity of both crevicular and peripheral neutrophils in subjects with periodontitis is altered, increasing the susceptibility to periodontitis. Thus individual susceptibility may be an additional and important modifying factor in the pathogenesis of periodontal disease.

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BACKGROUND: The systemic use of non-steroidal anti-inflammatory drugs are associated with various side-effects like hepatotoxicity, blood dyscrasias, nephrotoxicity and gastric irritability. Among these, gastric irritability is the most common and the most important one, which should be taken care of. Therefore, it may be preferable to use a local formulation such as a mouthwash to treat the inflammatory conditions of the oral cavity. AIM: To determine the efficacy and acceptability of 0.074% diclofenac mouthwash in relieving pain and inflammation of post-periodontal surgery patients. MATERIALS AND METHODS: The study was designed as a double-blind, placebo-controlled clinical trial. Twenty chronic periodontitis patients who were scheduled for full-mouth periodontal flap surgery were randomized to receive either diclofenac mouthwash or placebo to rinse with 15 ml of solution daily for a period of 7 days. Modified gingival index (Lobene 1986) was used to verify gingival inflammation and visual analog scale was used to assess pain. After the baseline measurements for all the parameters were recorded, spontaneous pain and burning were evaluated daily while redness and edema were recorded on the 3 rd and 7 th day from the day of treatment. RESULTS: Data obtained were analyzed statistically using paired " t" test for intragroup comparison and unpaired " t"-test for intergroup comparison. Spontaneous pain was significantly reduced by diclofenac mouthwash. Other parameters, i.e. gingival inflammation and swelling, had not shown significant reduction in scores in either group, although the reduction was higher in the test group. CONCLUSION: The new 0.074% diclofenac mouthwash is an effective and tolerable medicinal product for post-surgical symptomatic relief.

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The purpose of the present study was to clinically and radiographically evaluate and compare the efficacy of demineralized freeze dried bone allograft (DFDBA) and bovine derived xenogenic bone graft (BDX) [Bio-Oss] with amniotic membrane (AM) as guided tissue regeneration (GTR) in the treatment of human periodontal Grade II buccal furcation defects. Ten patients suffering from chronic periodontitis, displaying bilateral Grade II buccal furcation defect, were randomly treated using DFDBA with AM (Experimental site A) or using bovine derived xenograft (BDX) with AM (Experimental site B). The clinical and radiographic parameters were recorded at baseline, 6 and 9 months. Healing was uneventful in all patients except one site which was treated with BDX + AM. At 9 months after therapy, soft tissue measurements for the DFDBA + AM group showed pocket depth (PD) reduction of 4.7 mm +/- 0.58, and relative attachment level gain of 4.8 mm + 0.32, while the BDX + AM group showed a PD reduction of 4.4 mm +/- 0.27, and AL gain of 5.1 mm +/- 0.09. Osseous measurements showed bone fill of 2.1 mm +/- 0.36 for the DFDBA + AM group and 2.43 mm +/- 0.38 for the BDX + AM group. Percentage gain in bone was 76.3% for the DFDBA + AM group and 79.6% for the BDX + AM group. Statistical analysis revealed there was no statistical difference between the two materials in all measurements. Within the limits of the present study, it can be concluded that: (1) at 9 months after surgery both therapies resulted in significant PD reductions and CAL gains and (2) significant improvement was seen in bone fill and percentage gain with both the material, however, there was no significant difference between both.

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Papillon- Lefèvre Syndrome (PLS) is a rare autosomal recessive trait, which is transmitted with an estimated frequency of one to four per million individuals. It is characterized by palmar plantar keratosis and severe early-onset periodontitis affecting both deciduous and permanent dentition. In this report, we present clinical, microbiological and leukocyte function test findings of a thirty-five year-old patient with symptoms typical of Papillon-Lefèvre Syndrome except for premature loss of deciduous and permanent dentition. The patient exhibited palmar plantar keratosis and an isolated, moderately deep periodontal pocket in the third quadrant. No anaerobic bacteria were isolated from the plaque culture. The neutrophil function test revealed defective chemotaxis and phagocytosis while intracellular killing and respiratory burst were normal.

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