Diabetes and Periodontitis – Role in Cognitive Impairment

>Introduction: The global burden of dementia, diabetes, and periodontitis is rapidly increasing and is becoming a serious area of concern. The incidence of diabetes and periodontitis usually increases in middle age, and because they share a bidirectional relationship, they are known to worsen if not controlled. Evidence suggests that the people who have diabetes are at a significant risk of developing dementia and in the last two decades, periodontitis has been increasingly linked with dementia. Currently, there is no definitive treatment of dementia.The Hypothesis: The patients who have uncontrolled diabetes with moderate-to-severe periodontal disease may be at a greater risk for developing neurodegeneration associated with dementia.Evaluation of the Hypothesis: The chronic effects of both periodontitis and diabetes may have an uncontrollable additive effect on the body of an aging individual. Immunosenescence may add to the complexity of such effects and in such a scenario, the complete resolution of the systemic inflammation or other interrelated process responsible for directly or indirectly triggering neurodegeneration may be compromised. We have proposed various interrelated mechanisms linking diabetes and periodontitis that may be amplified in an aging individual. These mechanisms may contribute to the neurodegeneration associated with dementia. Oral cavity is a major unbarred window into the systemic environment of an individual. Treatment and maintenance therapy for periodontitis on a routine basis may help reduce a significant amount of inflammatory load, especially in the diabetic population, who are at a greater risk for the future development of dementia

A clinical evaluation of bioactive glass particulate in the treatment of mandibular class II furcation defects

Bioactive glass particulate has been applied to dentistry in the treatment of bone defects, ridge preservation and periodontal bone defects including the furcation defects. The aim of this study was to compare the clinical attachment gain and vertical and horizontal bone fill obtained with open flap debridement (OFD) alone and OFD with bioactive glass particulate in the treatment of mandibular Class II furcation defects. Twenty mandibular class II furcation defects were selected in 16 systemically healthy patients out of which 10 defects were treated with OFD alone (Group I) and other 10 defects were treated with OFD and bioactive glass particulate (Group II). Each defect was randomly assigned to Group I and Group II. The soft tissue and hard tissue measurements including vertical probing depth, horizontal probing depth, clinical attachment level, gingival recession, vertical depth of the furcation defects, and horizontal depth of the furcation defects were recorded at baseline and six months post surgery. At 6 months evaluation, both treatment procedures resulted in significant improvement in soft tissue and hard tissue parameters when compared to the baseline. There was no significant difference between the two groups with respect to soft tissue changes (p>0.05) like probing depth reduction (3.30 mm versus 2.90 mm), clinical attachment level gain (2.90 mm Vs 2.80 mm) and gingival recession. Vertical defect fill were significantly greater in the bioactive glass sites (1.50 mm) compared to control sites (0.80 mm). There was highly significant reduction in horizontal probing depth of the defect (1.80 mm Vs 1.10 mm, p< 0.05) after 6 months post surgery. In conclusion, bioactive glass showed significant improvement in clinical parameters like vertical and horizontal defect fill in mandibular class II furcation defects when compared to OFD

Self-Induced Injury of The Periodontal Tissues : A Case Report

Self-induced injuries are inflicted based on habit, frequently associated with psychogenic background; related only in manner by which they are produced, bearing no particular anatomic, etiologic or microscopic similarities. The following case report attributes a suspicious periodontal lesion to self - induced injur

A clinical evaluation of bioactive glass particulate in the treatment of mandibular class II furcation defects

ve glass particulate has been applied to dentistry in the treatment of bone defects, ridge preservation and periodontal bone defects including the furcation defects. The aim of this study was to compare the clinical attachment gain and vertical and horizontal bone fill obtained with open flap debridement (OFD) alone and OFD with bioactive glass particulate in the treatment of mandibular Class II furcation defects. Twenty mandibular class II furcation defects were selected in 16 systemically healthy patients out of which 10 defects were treated with OFD alone (Group I) and other 10 defects were treated with OFD and bioactive glass particulate (Group II). Each defect was randomly assigned to Group I and Group II. The soft tissue and hard tissue measurements including vertical probing depth, horizontal probing depth, clinical attachment level, gingival recession, vertical depth of the furcation defects, and horizontal depth of the furcation defects were recorded at baseline and six months post surgery. At 6 months evaluation, both treatment procedures resulted in significant improvement in soft tissue and hard tissue parameters when compared to the baseline. There was no significant difference between the two groups with respect to soft tissue changes (p>0.05) like probing depth reduction (3.30 mm versus 2.90 mm), clinical attachment level gain (2.90 mm Vs 2.80 mm) and gingival recession. Vertical defect fill were significantly greater in the bioactive glass sites (1.50 mm) compared to control sites (0.80 mm). There was highly significant reduction in horizontal probing depth of the defect (1.80 mm Vs 1.10 mm, p< 0.05) after 6 months post surgery. In conclusion, bioactive glass showed significant improvement in clinical parameters like vertical and horizontal defect fill in mandibular class II furcation defects when compared to OFD

Black triangle dilemma and its management in esthetic dentistry

In recent years, clinician and dentist′s esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in esthetically important zones. "White esthetics" is the natural dentition or the restoration of dental hard tissues with suitable materials. "Pink esthetics" refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. Reconstruction of the lost interdental papilla is one of the most challenging and least predictable problems. Restoration and maintenance of these tissues with adequate surgical and prosthetic techniques are a real challenge in modern esthetic dentistry. Treatment of marginal tissue recession, excessive gingival display, deficient ridges, ridge collapse, and esthetic defects around teeth and implants are some of the esthetic problems associated with the interdental papilla that have to be corrected in todays scenario which has been discussed in this review

Clinical and radiographic evaluation of Nano-crystalline hydroxyapatite bone graft (Sybograf®) in combination with bioresorbable collagen membrane (Periocol®) in periodontal intrabony defects

Background: Nanosized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline Hydroxyapatite (NcHA) bind to bone and stimulate bone healing by stimulation of osteoblast activity. The present study aims to explore the clinical and radiographical outcome of NcHA bonegraft (Sybograf® ) with collagen membrane (Periocol® ), in comparison with open flap debridement (OFD), in the treatment of intrabony periodontal defects. Materials and Methods: A parallel-group, randomized, controlled clinical trial was designed to conduct the study. Eighteen intrabony defects in 14 systemically healthy patients aged between 25 to 65 years were randomly assigned to test and control group. The plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site, NcHA bone graft and collagen membrane was placed, whereas at the control site, only OFD was done. Recall appointments were made at 7 days, 30 days, and then at 3 months and 6 months. Results: The data were subjected to statistical analysis using the Mann-Whitney ′U′ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm (P=0.007) and CAL gain was 2.77±1.09 mm (P=0.007). In the test group, the mean PPD reduction of 4.33±0.5 mm (P=0.006) and mean gain in CAL was 3.77±0.66 mm (P=0.006) at 6 months. The mean increase in REC was 0.55±0.72 mm (P=0.025) in test, and 0.44±0.52 mm (P=0.046) in control group. The mean gain in radiographic defect fill was 2.07±0.67 mm (P=0.008) in test and 0.91±0.21 mm (P=0.007) in control group. Conclusion: The nanocrystalline hydroxyapatite bone graft in combination with collagen membrane demonstrated clinical advantages beyond that achieved by OFD alone

Towards a common etiopathogenesis: Periodontal disease and endometriosis

Context: Periodontal disease and endometriosis are seen to share a common pathogenesis. There is only one report suggesting the possible association between the two conditions. Aims: To study the association between endometriosis and periodontal disease. Settings and Design: This was a case–control study. Subjects and Methods: Periodontal screening was carried out in 25 women with endometriosis and 25 women without endometriosis. Severity of periodontal disease was classified based on the extent of loss of attachment. Statistical Analysis Used: Student's t-test, Mann–Whitney U test, and Karl Pearson correlation coefficient tests were used for statistical analysis. Results: The proportion of women with severe periodontitis was seen to be higher among women with endometriosis (70%). Conclusions: The results of the present study indicate the existence of a relationship between endometriosis and periodontal disease. However, further studies among larger cohorts of endometriosis may provide evidence about the association