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Porphyromonas gingivalisis a periodontal pathogen, which is considered to be a keystone pathogen for periodontitis. A diverse conglomerate of P. gingivalisvirulence factors including lipopolysaccharide, fimbriae, capsular polysaccharide, haemagglutinin and cysteine proteases (Arg-gingipains and Lys-gingipain) are considered to be involved in the pathogenesis of periodontitis. Leupeptin is a cysteine protease inhibitor which is specific for Arg gingipains. The present review focuses on action of leupeptin on Arg gingipains. A search was carried out systematically from the start till September, 2016. The search was made in Medline database via PubMed. The keywords enlisted were “leupeptin”; “gingipains”; “periodontitis” using Boolean operator “and.” The result was selection of 58 articles which linked leupeptin to periodontitis and gingipains; pathogenesis of periodontitis, pathogenicity of gingipains and role of leupeptin. It was concluded that leupeptin inhibits and attenuates a number of destructive activities of Arg gingipains including inhibition of platelet aggregation; inhibit degradation of LL-37, which is an antimicrobial peptide; blocking inhibition of monocyte chemoattractant protein; restoring level of interleukin-2; inhibiting degradation of collagen type I and IV to name a few.

Background: The need-of-the-hour is a material that can support coronally advanced flap (CAF) procedures in treatment of gingival recession. Recent literature shows that various bone substitutes are being used for this procedure. This study clinically evaluates the outcomes of CAF with and without bioactive glass putty (NovaBone®) in terms of root coverage, gains in keratinized tissue height, and root coverage esthetic score in multiple gingival recession defects.Methods: Ten healthy patients (age range 18-45 years) with multiple bilateral (n = 40 test 20; control 20) and comparable Miller's Class I or Class II gingival recession defects were selected. The defects were randomly assigned by a computer-generated list to either test (CAF + bioactive glass putty) or control (CAF alone) groups. Clinical parameters included gingival recession (GR), probing pocket depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), root coverage esthetic score (RES) evaluated at baseline and at 6 months post-surgery CAF with or without bioactive glass putty.Results: Six months post-surgery all clinical parameters showed significant reductions. Gingival recession showed significant reduction both in test and control groups (2.0 ± 0.47 mm and 2.3 ± 0.48 mm, respectively; p < 0.05) with no intergroup difference. The exposed root was covered by 72% (test) and 79% (control). CAL gain was also significant in both groups (test: 2.7 ± 0.67 mm; control: 2.8 ± 0.78 mm; p < 0.05) with no intergroup difference. Keratinized tissue height gain was significant in both the groups (test group: 1.2 ± 0.42 mm; control group: 0.9 ± 0.57 mm) with no intergroup difference. Also, the RES was significant for both the test and control groups (7.2 ± 2.78 and 7.7 ± 1.41 respectively) with no intergroup differences.Conclusions: In isolated Class I/II GR defects, CAF associated with bioactive glass putty provided no significant difference in root coverage, CAL, KTH or RES compared to CAF alone. However, statistically significant gains were seen in all the parameters in both groups as compared to baseline. We refute the claims of the recent studies using a bone substitute for root coverage. Further long-term clinical trials are warranted to substantiate our results. [ABSTRACT FROM AUTHOR]