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Objective: Purpose: To evaluate the efficacy of water flossing to traditional flossing in lowering the bleeding on probing (BOP) index around dental implants. Methods and Materials: This single-center, examiner-masked research enrolled patients with implants and randomly allocated them to one of two groups. The research analyzed the effectiveness of manual toothbrushes when used with either string floss or a water flosser. Results: After 30 days, the main result was a decrease in BOP occurrence. At the outset, neither group had noticeably higher rates of bleeding than the other. While only six of 20 implants in the floss group demonstrated a decrease in BOP after 30 days, 18 of 20 implants in the water flosser group did. Conclusions: These results demonstrate that the use of water flossers was associated with much less bleeding than that of string floss. The researchers think that water flossing might be a useful addition to the maintenance of dental implants.

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Aim: Planning the surgical operation, choosing the type of implant, and the effectiveness of the implant all heavily rely on the quantity and quality of the accessible bone. This study's goal was to determine how promptly inserted dental implants affected postoperative changes in bone density and crestal bone level by Cone bean computed tomography (CBCT) gray-scale value during a follow-up of three to six months. Method: A prospective clinical-radiographic investigation was conducted. Twenty participants with a partly edentulous arch who were also systemically healthy were chosen from the OPD of the Department of Periodontics and Oral Implantology. Each patient's oral hygiene status was noted, and a preoperative CBCT was performed to assess bone density. The following clinical parameters were noted before surgical procedures: plaque index (PI) (Silness and Loe, 1964), gingival index (GI) (Loe and Sillness, 1964), probing pocket depth (PPD), and primary stability. Result: A weak connection between Hounsfield unit (HU) in three months and six months was found. Moreover, a slender positive connection between baseline primary stability and three months was found. PI was shown to have a statistically significant difference between the means at several follow-ups (P value of 0.0001). PI and probing depth were not statistically different between baseline and six months (P values = 0.0001) or between three months and six months (P values = 0.050), respectively. Conclusion: The main outcome of this study shows that insertion torque is directly proportional to bone density and crestal bone level.

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Background: Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Materials and Methods: Study included 45 subjects with age group of 20-60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Results: Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Conclusion: Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure.

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BACKGROUND: A patient's ability to maintain a healthy bone-implant interface seems to be a major predictor of implant longevity over the long term. The implant surface is protected from the oral environment, the bone, and the implant itself by the peri-implant tissues. Platelet-rich fibrin (PRF) has been shown to help in the regeneration of bone and other connective tissues. Since there has been inadequate information on the role of PRF in maintaining soft tissue integrity and crestal bone changes, the present study aimed to evaluate these challenges clinically and radiographically in human patients who had dental implants placed with PRF. MATERIALS AND METHODS: There were a total of 15 patients who were recalled for the analysis, and they were split into two groups. PRF was used to complete the implant procedure in the experimental group, but PRF was not used in the control group. Cone beam computed tomography (CBCT) was used to evaluate the amount of alveolar bone prior to dental implant placement and intra-oral periapical radiograph (IOPAR) for postoperative assessment. Gingival index, plaque index, probing depths, papilla bleeding index, and crestal bone changes were used to document clinical limits. IOPAR using a similar approach was used to evaluate the crestal bone level alterations. Patients were evaluated clinically and radiographically for changes in the peri-implant soft tissue and crestal bone during implant placement, six and nine months postoperatively. RESULTS: From baseline (p=0.02) to six months (p=0.04) and nine months (p=0.04), both groups showed changes in crestal bone loss and soft tissue although the changes in the test group were smaller. Soft tissue changes showed significant differences for probing depth and papilla index score at baseline and at the end of the six and nine months (p<0.05), whereas no significant difference was noted with bleeding index and plaque index score during the follow-up (p>0.05). CONCLUSION:  To conclude, the provided data demonstrated that the local injection of PRF during implant placement has the potential to favorably stimulate bone formation, and may be used as a therapeutic adjuvant in the clinical setting of implant placement.

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AIM: Periodontitis is considered as infection in periodontal supporting structure leading to tooth mobility and ulcerated periodontal pockets. The present study was conducted to assess Sirtuin 3 (SIRT 3) and SIRT 4 level in patients with diabetes mellitus (DM) and periodontitis. MATERIALS AND METHODS: The present study was conducted on 60 subjects. Subjects were divided into four groups, groups I to IV. Each group comprised of 15 subjects. In all subjects, fasting blood glucose level was assessed. Plaque index (PI), bleeding on probing (BOP), gingival index (GI), and clinical attachment level (CAL) were measured. The SIRT 3 and SIRT 4 were estimated by Western blot analysis. RESULTS: In group I, mean age was 44.13 ± 1.35 years, in group II, it was 43.53 ± 1.45 years, in group III it was 43.93 ± 1.22 years, and in group IV, it was 44.47 ± 0.74 years. The mean BOP score was significantly higher in group IV (5.74 ± 0.30) compared with group I (1.92 ± 0.44), group II (2.25 ± 0.22), and group III (5.31 ± 0.54). A statistically significant (p < 0.001) difference was observed in mean PI score in group I (2.25 ± 0.23), group II (2.26 ± 0.13), group III (4.37 ± 0.60), and group IV (3.25 ± 0.16). Mean GI score was significantly higher in group IV (8.89 ± 0.89) as compared with group I (0.78 ± 0.23), group II (0.95 ± 0.18), and group III (8.69 ± 1.13). A statistically significant difference was seen in mean CAL in group III (5.66 ± 0.64) and group IV (6.37 ± 0.30). Mean fasting blood sugar (mg/dL) in group I was 80.40 ± 13.05, in group II, it was 160.40 ± 27.20, in group III, it was 77.00 ± 12.78, and in group IV, it was 264.20 ± 53.17. The nonsignificant mean expression of SIRT 3 was seen in group I (29.20 ± 3.14), group II (29.19 ± 2.18), group III (28.89 ± 2.77), and group IV (29.59 ± 5.82). In group I, the mean level of SIRT 4 was 28.93 ± 12.55, in group II, it was 28.82 ± 9.14, in group III, it was 28.88 ± 6.03, and in group IV, it was 29.05 ± 10.68. CONCLUSION: Association of DM and periodontitis is well known. The SIRT 3 and SIRT 4 are useful indicators of glycemic level in patients with DM. CLINICAL SIGNIFICANCE: The SIRT 3 and SIRT 4 in DM show variation in their level. Early assessment may be proved beneficial in patients who are not responding to other drugs.

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AIM: To eva luate the effect of subgingival placement of doxycy-cline in the form of a resorbable membrane on the clinical and microbiological parameters in the treatment of inflammatory periodontal disease. Material and methods; We evaluated the effects of a controlled release system containing doxycycline both in vivo and in vitro conditions. Drug systems were prepared for both, and a total of 19 patients were included in the study with age range from 35 to 50 years. Clinical parameters like gingival index, probing depth, attachment loss, and gingival shrinkage were evaluated along with microbiological evaluation as well for a period of 10 weeks. RESULTS: In vitro study showed that the doxycycline hydroxy-propyl methylcellulose films are capable of releasing the drug in a sustained way with respect to time. It was observed that the gingival index score, periodontal probing depth, and gingival shrinkage showed low levels at the doxycycline-treated sites as compared to the placebo group. The microbial culture results also showed a marked reduction in the total anaerobic count post-treatment and till the end of the 10 week study period in the doxycycline-treated group. Thus, overall results showed that 30% doxycycline methylcellulose strips have significant effects and benefits on clinical and microbial parameters in more than 5 mm deep periodontal pockets. CONCLUSION: We conclude that 30% doxycycline both in vivo and vitro study has proven to be an effective antibiotic of choice both clinically and microbiologically. CLINICAL SIGNIFICANCE: Doxycycline has proven to have great promise as an antibiotic of choice. Thus, there is a significant advantage in the clinical use of doxycycline formulation for both the therapist and the patient. It can help dental professionals as an additional means to maintain an improved clinical health in periodontal problems of their patients. With this new therapeutic modality, we can augment the ability to treat periodontitis more effectively.

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BACKGROUND: The purpose of this study was to evaluate and compare the effect of smoking on the periodontal status and salivary composition of whole saliva in subjects with clinically healthy periodontium and chronic periodontitis. MATERIALS AND METHODS: The study comprised of 400 subjects equally divided into four groups of non-smokers with clinically healthy periodontium, smokers with clinically healthy periodontium, non-smokers with chronic periodontitis and smokers with chronic periodontitis. Clinical measurements and non-stimulated whole saliva were obtained. Biochemical analysis of salivary total protein, calcium, magnesium and phosphorus was performed. RESULTS: The clinical parameters of probing depth and clinical attachment levels did not reveal any statistically significant differences between the smokers and non-smokers groups. The plaque index and gingival index were significantly higher in smokers with periodontitis (P<0.05) as compared with non-smokers with periodontitis. On biochemical analysis of whole saliva, total protein, calcium, magnesium and phosphorus were reduced in smokers with periodontitis to 0.43±0.50 gm/dL, 3.47±1.49 mg/dL, 0.80±3.87 mEq/L Neo and 18.45±8.77 mg% from 1.70±2.09 gm/dL, 13.89±10.34 mg/dL, 1.26±0.90 mEq/L Neo and 29.23±16.02 mg%, respectively, in non-smokers with healthy periodontium. CONCLUSION: The present study exhibited reduced concentrations of total proteins, calcium, magnesium and phosphorus in whole saliva in smokers with chronic periodontitis. It may thus be concluded that the analysis of salivary composition could be used as an auxiliary means of diagnosis.