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Patients these days are increasingly conscious of personal appearance, and much attention is being focused on the smile. Cosmetic dentistry is also in the race to become the most advanced and demanding dental subspecialty. Recently, aesthetic lip surgeries have been introduced, like lip repositioning, lip reduction and lip enhancement surgeries, to improve facial aesthetics. The authors present a case of a 28-year-old healthy male who reported to the Department of Periodontics with the chief complaint of poor aesthetics and large lips. His lower lip was double the size of the upper lip. Therefore, an aesthetic lip reduction surgery was planned. The lip reduction operation could successfully manage the large lower lip with no intra or postoperative complications. No recurrence was observed within a period of 12 months. Cheiloplasty balances the look of the top and lower lips, improving the appearance of the face as a whole.

Introduction: The idea of Full-Mouth Disinfection (FMD) was presented in the early 1990s, the traditional method of treating periodontal disease, quadrant by quadrant over several visits. The FMD method has been recommended with a number of changes over time. Triphala, Ayurvedic medicinal herbal formulations is also useful in dentistry as antiplaque, antimicrobial, antioxidant, analgesic, antipyretic and anti-inflammatory agent. As Chlorhexidine (CHX) is used from past years for full mouth disinfection, there is need to evaluate the efficacy of CHX as well as Triphala in diabetic mellitus patients. Need of the study: As CHX has been used for years to disinfect the entire mouth, a study comparing the effectiveness of CHX and Triphala in individuals with Diabetes Mellitus (DM) for full mouth disinfection will be done. Aim: To evaluate and compare the efficacy of triphala and CHX in the treatment of Stage-II and III periodontitis with one stage complete mouth disinfection in Type-IIDM patients. Materials and Methods: This experimental study will be done in Sharad Pawar dental College, department of Periodontics after obtaining the ethical clearance during September 2021 to September 2022. About 24 type 2 diabetic subjects with Stage-II and Stage-III periodontitis, will be randomly divided into test Group-And control group with 12 in each group. In Group-A, Full mouth disinfection will be done using CHX and in Group-B full mouth disinfection will be done using Triphala. After full mouth subgingival scaling and root planning, patient will brush the dorsum of the tongue for one minute with gel, the mouth will be rinsed two times with mouthwash for one minute, the pharynx will be cleaned with a spray, and all periodontal pockets will be irrigated (thrice within 10 minutes) with a gel. Clinical parameters will be evaluated at baseline and six months. The clinical parameters are Probing Pocket Depth (PPD), Plaque Index (PI), Clinical Attachment Level (CAL), Papillary Bleeding Index (PBI). Paired t-test will be used to compare data within group for before and after treatment and unpaired t-test will be used to compare between the groups.

The glycosaminoglycan Hyaluronic Acid (HA) is present in the connective tissue of vertebrates. In the extracellular matrix of soft periodontal tissues, it is the most prevalent glycosaminoglycan with a higher molecular weight. In medical fields such as orthopaedics, dermatology, and ophthalmology, the use of HA in the treatment of inflammatory processes is well established. The extracellular matrix of various tissues, including connective tissue, synovial fluid, and other tissues, contains HA, a naturally occurring linear polysaccharide. Its efficacy in the treatment of inflammatory conditions has been proven. It has anti-inflammatory and anti-bacterial effects in the treatment of gingivitis and periodontitis in dentistry. It could be used as an adjunct to mechanical therapy in the treatment of periodontitis because of its tissue healing properties. Use of HA for implant surface modification has also been extensively studied. HA has proven to be effective in peri-implantitis. The purpose of this review paper is to explain HA’s involvement in periodontal therapy.

Introduction: The goals of periodontal therapy include preventing illness, slowing or stopping disease development, replacing lost periodontal tissues, and preserving the therapeutic outcomes. The apical repositioning of the gingival edge during traditional periodontal surgery exposes the root surface to the oral cavity and reduces pocket depth. It may lead to attachment loss, Gingival Recession (GR). It is also commonly recognised that periodontal surgery causes pain and suffering. Laser assisted periodontal therapy has been the subject of study in an effort to address these drawbacks. Aim: To compare the efficacy of diode laser as an adjunct to Open Flap Debridement (OFD) with that of OFD alone in the management of chronic periodontitis patients. Materials and Methods: This randomised clinical trial with split mouth study design will be conducted in Periodontics Department at Sharad Pawar Dental College, Wardha, Maharashtra, India, for a duration of six months. Thirteen patients (26 quadrants) with generalised chronic periodontitis patients will be selected. The Probing Pocket Depth (PPD) ≥5 mm after phase I therapy will be included in this split mouth study. Diode laser (920 nm) will be used as an adjunct to OFD (test) as compared with conventional flap surgery (control). Clinical parameters like Plaque Index (PI), Papillary Bleeding Index (PBI), PPD, Relative Attachment Level (RAL) and Relative Gingival Marginal Level (RGML) and GR will be recorded at baseline and six months post-therapy. Visual Analogue Scale (VAS) will be used to determine patient discomfort intraoperatively and after one week. A questionnaire for patient-based outcomes will be administered after period of six months postsurgery and response will be recorded. Student’s paired t-test will be used for comparing the treatment groups at baseline and six months.

A 22-year-old female patient reported to the Department of Periodontics with a chief complaint of swollen gums in the lower front jaw region since six months, not associated with pain. Patient was apparently alright six months back, then she noticed a small growth in the mandibular anterior region of jaw. Patient gave a history of trauma six months back, at the same region due to fall on stairs. The condition was causing difficulty in mastication and poor aesthetics. The growth was sluggish at first, then progressed slowly until it reached its current size of 15×10 mm intraorally, with no extraoral swelling. In regard to tooth numbers 31, 32, 33 and the growth was pink in colour, firm, clearly defined, mobile, pedunculated, non pulsating, and smooth surfaced [Table/Fig-1,2]. The swelling was not associated with tenderness. Generalised bleeding on probing was present. Based on history and clinical features the growth was provisionally diagnosed as generalised chronic gingivitis with gingival fibroma. Differential diagnosis were gingival epulis, Pyogenic Granuloma (PG), peripheral ossifying fibroma, traumatic fibroma, peripheral giant cell granuloma, haemangioma and metastatic cancer. The patient was informed about the growth and the treatment options were explained such as such as excision of overgrowth using scalpel, cautery and lasers. Prior to treatment, informed consent was obtained from the patient. The results of blood tests such as haemoglobin (12.8 gm%), bleeding time (1 minute and 30 seconds) and clotting time (2 minutes) were all within acceptable and physiological limits. Under local anaesthesia (Lignox 2% with Adrenaline- 1:80000), the overgrowth was slightly elevated with the help of floss to determine the base or attachment of the overgrowth on gingiva [Table/Fig-3]. The growth was entirely excised from its base using a soft tissue 920 mm diode laser (BIOLASE) in pulse mode with protective armamentarium. During surgery, the fiber’s tip came into contact with the borders of the lesion [Table/Fig-4,5]. Proper scalloping of the gingival margins was done [Table/Fig-6]. There was no suturing done. Periodontal pack was applied [Table/Fig-7]. Brufen 400 mg was prescribed from the day of operation three times a day for three days as a postoperative medicine. The patient was given instructions that included, caring for the surgery site, eating soft diet for one day and maintaining good dental hygiene including brushing at non surgical site twice daily and use of chlorhexidine mouthwash twice daily [Table/Fig-8]. Following the surgery, the patient experienced no pain or discomfort. There was no sign of the lesion at recall visit. The tissue was sent for histological examination after the complete surgical removal of the lesion. Haematoxyllin and Eosin (H&E) stained tissue section showed lesional connective tissue stroma. It comprised of densely packed parallely arranged collagen fibres. At places, these collagen fibers are haphazardly arranged. The fibroblasts showed spindle shaped elongated nuclei. Severe chronic inflammatory cell infiltration was seen, suggestive of fibroma [Table/Fig-9]. Fibroma is the most frequent benign development in the mouth cavity [1]. Traumatic fibroma is a frequent, benign and slow growing, soft tissue tumour [2]. This mass is normally asymptomatic and increases in size over time [3]. These lesions can be caused by irritants such as plaque, calculus, overhanging edges, and restorations. Fibroma can develop as a result of an injury or local inflammation caused by fibrous hyperplasia [4]. A histologic examination of the lesion, can help rule out other benign and malignant fibroma-like tumours. Irritation fibromas, according to Arya S et al., and, Barker DS and Lucas RB, expressed two patterns of collagen arrangements, namely (a) radiating pattern and (b) circular pattern, depending on the site and level of irritation experienced by the lesion [2,3]. As a result, the authors concluded that static areas with greater stress, such as the palate, produced radiating patterns, but flexible areas (such as the buccal mucosa) with less trauma caused circular patterns [3]. According to Gupta D et al., true fibromas did not show this pattern [4]. Surgical excision is commonly used to treat fibroma, and recurrence is unlikely unless the source of irritation/trauma is entirely eradicated. Women account for 66% of all bothersome fibromas. It is unusual in the first 10 years of life. It is possible that the lesion is sessile or has a pedunculated base and it normally grows slowly over several months to reach its maximum size. The highest size is rarely more than 1.5 cm [5]. The lesion in the present case, however, was significantly greater in comparison. In the absence of malignant change, it is usually self-limiting. On the other hand, long term surveillance is essential to detect transformation and recurrence of such lesions [5]. The laser employed in the present case was extremely effective, safe, and straight-forward to operate, resulting in a predictable outcome with little difficulties.

Inadequate width of attached gingiva can lead to difficulty in maintaining oral hygiene, can cause recession and if the patient is undergoing orthodontic treatment the bands and brackets might get engrossed in the buccal mucosa. Therefore, increasing the width of attached gingiva is necessary. Here, authors presents a case of 19-year-old female patient who was referred from the Department of Orthodontics for impinging of bands into gingiva which was identified to be because of in adequate width of attached gingiva. Horizontal incision was given at mucogingival junction from tooth 34 to 44 region. Full-thickness flap was raised till the required vestibular depth recipient site is required. Free Gingival Graft (FGG) of size 15×10 mm in size was harvested from left palatal mucosa from distal to 24 to mesial to 26 region. Harvested FGG was sutured from 32 to 42 region in the recipient site. Platelet Rich Fibrin (PRF) membrane was prepared using patients own blood and this membrane was sutured at 33 and 43 region at the recipient site. An aluminium foil was kept at the donor site and above the membrane at the recipient site on which periodontal pack was given. After 21 days of healing, the width of attached gingiva increased from 2 mm at baseline to 8 mm. According to Visual Analog Scale (VAS), mild pain was felt by the patient and no difference in the colour was seen at both recipient and donor site at 21 days after surgery. Use of FGG and PRF helps to achieve improved results for increase width of attached gingiva.

The perioscope, which was only recently introduced, has greatly improved the removal of subgingval calculus during periodontal therapy. A fibre-optic periodontal endoscope was created to aid in the imaging of subgingival tissues and to improve periodontal disease diagnosis and treatment. Scaling and root planing have the goal of completely removing plaque and calculus from root surfaces. While this is unachievable, the agreed end-point during periodontal instrumentation is a smooth, glassy root surface. This has frequently led in over instrumentation and excessive cementum removal. Cement removal has been judged unnecessary in most cases. The removal of plaque, calculus, and endotoxin adhered to the root surface is critical. The easiest way to clean root surfaces is to use powered instruments sparingly. Due to a lack of visibility, excessive cementum removal occurs during hand instrumentation. The ability to visibly debride roots using endoscopic technology can improve success rates in a more conservative and minimally invasive manner. The perioscopy device was created to visualise the subgingival region for diagnosis, but it has since been altered to help with periodontitis therapy. The perioscope is a small camera that is encased in a sleeve and inserted under the gingival sulcus or pocket for subgingivally visualisation and instrumentation. This technique gives the greatest conservative approach to non surgical and surgical periodontal care because it enables superb magnified visualisation of the root surface and ensures the total or near complete elimination of the bacterial infection. The aim of this brief review was to provide knowledge about periodontal endoscopy, its implementation in day today practice.

Tracheobronchial carcinoids are relatively uncommon neoplasms with malignant (though indolent) potential and variable behavior. Clinical presentation is usually similar to any obstructive tracheobronchial lesions or rarely with presentation of carcinoid syndrome. Management varies from Pneumonectomy to use of lung sparing bronchoscoplastic techniques. We report the case of a 32-year-old male patient diagnosed with carcinoid of left main bronchus. Patient was successfully treated with trans-bronchoscopic diode laser. At 24 months of follow up patient remains asymptomatic and recurrence-free.