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Due to the fact that osseointegration is contingent on bone metabolism, low vitamin D levels in the blood may have an unfavourable impact on bone development around dental implants. Only a few researches have looked into the probable link between vitamin D levels in the blood and early dental implant failure (EDIF), which happens within three months of placement well before the prosthetic abutment is engaged. The goal of this study was to see if there is a association between low vitamin D levels in the blood and EDIF. This prospective study was conducted among the total of 100 patients within the age group 18-55 years who fulfilled the inclusion & exclusion criteria of the study. These subjects were selected from the patients who visited the outpatient department of Himachal Dental College, Sundernagar. Clinical parameters were assessed at 3 month post-operatively and implant failures were assessed and correlated with the levels of serum vitamin D. In our study, 6, 71 and 23 subjects were 30 ng/ml vitamin D serum levels respectively. One (1) incidence of failure was reported in patients with high serum levels of vitamin D (>30 ng/mL) (4.3%). Failed implants were revealed maximum among subjects with vitamin D level The relation between serum Vitamin D levels and early dental implant failure is statistically insignificant. More clinical trials with a prospective design and appropriate statistical analysis are needed, to confirm whether or not a relation between low serum levels of vitamin D and an increased rate of early dental implant failure exists.

To evaluate the noninferiority of intraocular pressure (IOP)-lowering latanoprost without benzalkonium chloride (BAK) versus latanoprost with BAK (for treatment of open-angle glaucoma or ocular hypertension).Overall, 578 patients were randomized 1:1 to latanoprost without BAK or latanoprost with BAK once daily in the affected eye(s) for 12 weeks. The primary efficacy endpoint was IOP, measured on days 0, 7, 28, 56, and 84 (8 am, 10 am, and 4 pm). Noninferiority was established if the following criteria were met: 95% confidence interval (CI) of the mean difference between treatments included 0 mm Hg for all time points (N1), 95% CI upper limit less than 1.5 mm Hg (N2), and less than 1 mm Hg for≥7 of 12 time points (N3). Primary efficacy analysis was performed on the intent-to-treat population. Safety measurements included ocular and systemic adverse event (AE).The 95% CI included 0 mm Hg for 7/12 time points (N1), 95% CI upper limit was less than 1.5 mm Hg for 12/12 time points (N2), and less than 1.0 mm Hg for 4/7 time points (N3). AEs were mild and similarly distributed between groups.Latanoprost without BAK did not meet two of three criteria for noninferiority and showed a similar safety profile relative to latanoprost with BAK.

Bridgitte Shen Lee,1 Ranjan Malhotra,2 Kenneth Sall,3 Brittany Mitchell,4 James Peace5 1Vision Optique, Houston, TX, USA; 2Ophthalmology Associates, St. Louis, MO, USA; 3Sall Research Medical Center, Inc., Artesia, CA, USA; 4Medical Affairs North America, Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA; 5Peace Eyecare, Inglewood, CA, USACorrespondence: Bridgitte Shen Lee, Vision Optique, 5158 Buffalo Speedway, Houston, TX, 77005, USA, Tel +1 713-838-2020, Fax +1 713-838-2030, Email bshenlee@gmail.comPurpose: To evaluate the long-term safety of latanoprost benzalkonium chloride (BAK)-free vs currently marketed latanoprost 0.005% ophthalmic solution containing BAK (referred to as reference), to treat open-angle glaucoma (OAG) or ocular hypertension (OHT).Patients and Methods: This phase 3, multicenter, open-label, nonrandomized, single group assignment, safety study included patients who previously completed a phase 3 noninferiority study. Patients self-administered 1 drop of latanoprost BAK-free nightly for 36 weeks in the affected eye(s). Intraocular pressure (IOP), visual acuity (VA), and slit lamp biomicroscopy were assessed predose at baseline and Days 28, 56, 84, 112, 140, and 168; dilated ophthalmoscopy and visual field (VF) at baseline and Day 168. Adverse events (AEs) were recorded throughout the study.Results: A total of 161 patients who previously received latanoprost BAK-free (n = 80) or reference (n = 81) were enrolled. Latanoprost BAK-free maintained lowered IOP for both the study and nonstudy eye in all patients relative to baseline throughout the study. Clinically significant retinal or optic nerve changes were identified in 5 patients (1 mild-to-moderate change, prior latanoprost BAK-free; 4 mild changes, prior reference). No clinically important changes were identified for VA, slit lamp biomicroscopy, and VF measurements. Ocular AEs occurred in 66 (82.5%) vs 74 (91.4%) patients on prior latanoprost BAK-free and reference, respectively; the most frequent being eye pain (50.0% vs 64.2%) and ocular hyperemia (47.5% vs 54.3%). Most AEs were mild. There were 5 serious systemic AEs in 5 patients (n = 3, prior latanoprost BAK-free; n = 2, prior reference); all were considered unrelated or not likely related to treatment. One patient (prior reference) discontinued due to follicular conjunctivitis. There were no deaths or serious ocular AEs.Conclusion: Latanoprost BAK-free was well tolerated. These findings support the chronic use of latanoprost BAK-free to treat OAG or OHT.Clinical Trial Registration Number: NCT00945958.Keywords: adverse events, intraocular pressure, preservative, prostaglandin, safety, tolerability

Aim: To determine and analyse the most common chief complaints associated with chronic periodontitis in patients suffering from periodontal disease in Derabassi, Punjab, India. Materials and Methods: Dental records of 7680 patients were examined. Categorisation of all the subjects on the basis of periodontal diagnosis, age and gender was carried out. The various chief complaints reported at first visit were grouped into 3 major groups based on patient perception. A rank order was created based upon the frequency of chief complaints and number of chief complaints per subject and analysed. Results: Out of total (20750) 13 chief complaints recorded, only 5 were considered periodontitis symptoms and the remaining chief complaints were related to esthetics/ dental emergencies according to patient perception. Periodontitis symptom, as chief complaint was maximum for age group 41-50 years and female category, and the difference observed was statistically highly significant. Conclusion: Deposits, stains and bleeding gums were the first, second and the third most common chief complaints respectively in the study population and most of them were related to esthetics according to patient’s perception. This information should be utilised for enhancing awareness in general public for early diagnosis and effective periodontal treatment in early stages of periodontitis.

Aim: The purpose of the study was to assess the knowledge and awareness of dentists in Himachal Pradesh, India towards COVID-19 and how are they handling their fear and apprehension as well as modification in their clinical practice due to coronavirus pandemic. Methodology: Our study population consisted of dentists who work in Himachal Pradesh, regardless of their place of work, either in Private clinics, Colleges and Hospitals, or Health Centres. The main instrument to collect data was an online questionnaire using Google forms. Responses were sought from only those dental professionals who were having patient dealing and not from other students or any kind. Results: A total of 263 participants took part, submitting the questionnaire i.e. students (44.4%), College Faculty or Govt. Employee (26%) and Private practitioner (46%). The result clearly shows that dental practitioners across the state have high knowledge and awareness (96.9%) about COVID-19 even though they are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic effect on humanity. Our study clearly shows that student practitioners were more apprehensive as compared to faculty or private practitioners, who were more confident to treat patients who had COVID-19 like symptoms. Conclusion: Dentists in Himachal Pradesh are aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches. In reality, not much is known about Coronavirus and misinformation generally creates a panic like situation. So, as more authentic information is relayed to health care providers then this anxiety and fear will also lessen.

Neutrophils discovered by Elie Metchnikoff are granulocytes that play a critical role as a first-line defense in innate immunity. They freely circulate in the blood vessels. Upon receiving the chemotactic gradient signal, neutrophils become the first white blood cells that get activated in various inflammatory sites, defending the human body from the microbial attack. The process of neutrophil extracellular traps (NETs) formation, through the neutrophil action mechanism, is a specific type of cell death, known as NETosis, distinct from necrosis and apoptosis. Oxidative burst mechanisms kill the pathogens trapped in NETs by two procedures – production of reactive oxygen species and chromatin unfolding. The mechanism of NETs draws an analog with the pathogenesis of periodontitis due to dysregulated neutrophilic response to specific bacterial species found in subgingival plaque. NETs are a fibrous structure that consists of a backbone of chromatin with attached globular domains. There are granular proteins and peptides in these domains as well as some cytoplasmic components. The core histones-A potent antimicrobials (H2A, H2B, H3, and H4) that together account for around 70% of the protein mass are the key component of the system. In this NETs-novel coronavirus disease-19 (nCOVID-19) intriguing centric overview, we have a mechanism for NET production; the ability of NETs to entrap and kill pathogens, including the potential immunogenicity of NETs in disease. We have also speculated a few comments on the possible role of NETs in the nCOVID-19.

OTX-101 (CEQUA™) is approved in the United States for treatment of keratoconjunctivitis sicca (KCS). This pooled analysis of 2 studies (phase 2b/3 and phase 3) evaluates the efficacy and safety of OTX-101 0.09% in the intent-to-treat (ITT) population and the subgroup of patients with a baseline Schirmer score less than 10 mm.In these randomized, multicenter, double-masked, vehicle-controlled studies, patients received 1 drop of either OTX-101 or vehicle in both eyes twice daily. A Schirmer's test was performed at baseline and day 84/early discontinuation. Symptom Assessment iN Dry Eye (SANDE) scores and adverse events were monitored at each visit.The pooled analysis included 523 and 525 patients randomized to OTX-101 0.09% and vehicle, respectively. In the ITT population, 16.6% of eyes receiving OTX-101 and 9.0% of eyes receiving vehicle showed a day 84 increase in Schirmer score ≥10 mm from baseline (P0.0001). In the subgroup with Schirmer score less than 10 mm at baseline, 18.7% and 10.2% of eyes receiving OTX-101 and vehicle, respectively, exhibited this outcome (P=0.0001). The mean (SD) percent change from baseline in global SANDE scores on day 84 in the ITT population was -29.0% (39.0%) and -30.4% (39.5%) for OTX-101 and vehicle groups, respectively. In the subgroup, the mean (SD) percent change was -27.3% (39.7%) and -31.4% (38.3%) for OTX-101 and vehicle groups, respectively. Adverse events were mostly mild to moderate.OTX-101 improved tear production compared with vehicle. Both OTX-101 and vehicle showed improved SANDE scores over baseline. OTX-101 was well tolerated in patients with KCS.

The oral cavity is a distinct space where the microbiota is continually changing from the mechanical effort of eating and the incursion of foreign microorganisms such as bacteria, fungi, and viruses. There is a balance between symbiotic bacteria and the innate immune system in healthy gingival tissues, which is mainly maintained by neutrophils. Neutrophils are the essential killers of the body and have been recognized for a long time. However, rather than accurate snipers, neutrophils are often seen as crude and unrefined legionnaires, whose successful missions are usually liable for significant collateral damage. The excess of microorganisms in the biofilm creates an inflammatory state that leads to the recruitment of more immune cells, in which mainly neutrophils can be detected. However, the microbial pathogens within the gingival crevice cannot be abolished or controlled by neutrophils. Sometimes, neutrophil accumulation, rather than protecting and favoring periodontal tissue, can lead to a chronic inflammatory disease that can destroy the tooth-supporting tissues or the periodontium. Thus, it is imperative to maintain homeostasis between neutrophil function and microbe challenge to ensure periodontal health. This critical review article aims to discuss and outline the morphology of neutrophil function in periodontal inflammation, including neutrophils' action on biofilm and neutrophil dysfunction to prevent various syndromes related to it and its myriad potential novel therapeutic measures.

Purpose To evaluate the safety and efficacy of OTX-101, a novel aqueous nanomicellar formulation of cyclosporine (0.09%), in the treatment of patients with dry eye disease (DED). Design A randomized, multicenter, vehicle-controlled, double-masked, phase 3 clinical trial. Participants Adults (18–90 years of age) with a history and clinical diagnosis of DED, a global symptom score of 40 or more (range, 0–100), and a lissamine green conjunctival staining score of 3 or more and 9 or less (range, 0–12) in at least 1 eye. Methods Eligible patients entered a run-in period of 14 to 20 days in which all patients administered vehicle twice daily. Patients who remained eligible at the baseline (day 0) visit were randomized in a 1:1 ratio to twice-daily treatment with OTX-101 0.09% or vehicle for 84 days. Main Outcome Measures Efficacy assessments included signs (unanesthetized Schirmer tear test, corneal and conjunctival staining) and symptoms (global symptom score) of DED. The primary end point was the proportion of eyes with a clinically meaningful improvement (increase of ≥10 mm) in Schirmer test score at day 84. Safety evaluations included adverse events (AEs), visual acuity, and intraocular pressure monitoring, slit-lamp, dilated ophthalmoscopy, and fundus examinations. Results A total of 744 patients were randomized and received study medication (371 to OTX-101 0.09% and 373 to vehicle). The primary end point was achieved; a significantly greater percentage of eyes in the OTX-101 0.09% treatment group achieved an increase of 10 mm or more in the Schirmer test score at day 84 (OTX-101 0.09%, 16.6%; vehicle, 9.2%; P Conclusions Clinically and statistically significant improvements in tear production and ocular surface integrity were observed in patients treated with OTX-101 0.09% for DED.

Supplemental digital content is available in the text., Background: Keratoconjunctivitis sicca affects 5% to 33% of the population and is often accompanied by symptoms such as burning and dryness. This pooled analysis evaluated total and central corneal fluorescein staining (CFS) in patients receiving OTX-101 0.09% or vehicle in phase 2b/3 and 3 studies and whether improvements in corneal staining correlated with improved visual acuity. Methods: In these randomized, vehicle-controlled studies, patients received 1 drop of OTX-101 or vehicle in both eyes twice daily. Corneal staining was performed at baseline and days 28, 56, and 84. CFS was evaluated in each zone (0-to-4 scale); total corneal staining (0-to-20 scale per eye) was averaged over both eyes. Pooled safety assessments included adverse event monitoring. Results: Mean baseline CFS total scores (SD) were 4.2 (2.5) and 4.3 (2.6) for the OTX-101 (n = 523) and vehicle (n = 525) groups, respectively. For total corneal staining, least squares mean changes from baseline (standard error) were −0.9 (0.08) versus −0.5 (0.08) for OTX-101 and vehicle, respectively (P = 0.0008), on day 28 and −1.4 (0.09) versus −0.9 (0.09) on day 84 (P = 0.0002). There was a significantly high correlation (P = 0.0117) between reduced central corneal staining and improved visual acuity on day 84. Treatment-related adverse events were mostly mild, with instillation site pain reported by 21.8% and 4.0% of patients receiving OTX-101 and vehicle, respectively. Conclusions: Treatment with OTX-101 led to greater improvements versus vehicle in corneal surface staining as early as 4 weeks, and further improvements were seen up to 12 weeks. OTX-101 was well tolerated in patients with keratoconjunctivitis sicca.

Perioceutics or use of the pharmacological agents specifically developed to manage periodontitis is an interesting and emerging aids in the development of periodontal disease along with the mechanical debridement. The purpose of host modulatory agent which is a imperative part of perioceutic, is to restore balance between, on the one hand, pro inflammatory mediators and destructive enzymes, and on the other hand, anti-inflammatory mediators and enzyme. Host modulatory therapy (HMT) is a treatment concept that aims to reduce tissue destruction and stabilize or even regenerate the periodontium by modifying or down regulating destructive aspects of the host response and up regulating protective or regenerative responses. This paper review the Host Modulatory Therapy which in future will be the effective tool dental practitioners when used as adjunct to mechanical therapy in treating periodontal diseases.

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Background: Local drug delivery is most commonly used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease. Varied success rates have been documented for various vehicles used for intrasite delivery of active therapeutic agents. Recently, varnishes acting as a reservoir of chlorhexidine have shown potential for the management of chronic periodontitis patients. The aim of the present investigation was a comparative evaluation of the clinical effectiveness of single and multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) along with SRP in patients with chronic periodontitis. Materials and Methods: The present study included 30 patients with chronic periodontitis divided into three groups based on the number of subgingival applications of chlorhexidine varnish single application (Group A), two applications at a week's interval (Group B), and three applications with 7-day interval in between two applications (Group C). Clinical parameters, namely plaque index (PI), sulcus bleeding index, probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month and 3 months in all three groups to compare the clinical efficacy. Results: A statistically significant reduction was observed in PI, sulcus bleeding index, PPD, and RAL at 1 and 3 months in all the three groups. Greater (though statistically nonsignificant) improvements were observed in Groups B and C. Conclusion: Within limitations of the study, it can be concluded that multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) have an added benefit over the single application in the treatment of chronic periodontitis.

Background: Along with conventional periodontal surgical therapy, local delivery of antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, clinical trial was to evaluate the adjunctive effects of subgingivally delivered 0.5% azithromycin (AZM) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis in smokers versus non smokers. Methods: 38 sites in patients of chronic periodontitis were randomized and categorized into two treatment groups: Group 1 consisted of 19 sites in patients who were smokers and Group 2 consisted of 19 sites in non smokers, who received Scaling and Root Planing (SRP) plus 0.5% azithromycin gel Local drug delivery. Clinical parameters were recorded at baseline, 1 and 2 months. They included probing depth (PD) and clinical attachment level (CAL) and percentage bone fill. Results: Azithromycin resulted in significant improvements in both the groups. Mean decrease in PD in non smokers by the end of 2 months was 3.903mm and in smokers was 3.917mm. Gain in CAL in non smokers by the end of 2 months was 3.879mm and in smokers it was 3.920mm. Mean bone fill at one month for smokers was 15.86% and was 26.58% at 2 months. In non-smokers the mean bone fill was 17.19% at 1 month and 24.03% at 2 months. Conclusions: When compared to the non smokers, the adjunctive use of 0.5% AZM resulted in similar improvement in clinical outcome in the treatment of chronic periodontitis among smokers. Local drug delivery of Azithromycin gel contributed to decrease in probing pocket depth, gain in clinical attachment level and in alveolar bone. The apparent bone regeneration also raises the intriguing possibility that Azithromycin encourages bone formation once tissue inflammation has subsided.

Forty years ago Marshal R. Urist discovered a substance in bone matrix that had inductive properties for the development of bone and cartilage, until date, at least 20 bone morphogenetic proteins (BMPs) have been identified, some of which have been shown in vitro to stimulate the process of stem cell differentiation into osteoblasts in human and animal models. The purpose of this paper is to give a brief overview of BMPs and to review critically the clinical data currently available on the use of BMPs in various periodontal applications. The literature on BMPs was reviewed. A comprehensive search was designed. The articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal applications were included. The available literature was analyzed and compiled. The analysis indicates BMPs to be a promising, as well as an effective novel approach to reconstruct and engineer the periodontal apparatus. Here, we represent several articles, as well as recent texts that make up a special and an in-depth review on the subject. On the basis of the data provided in the studies that were reviewed BMPs provide revolutionary therapies in periodontal practice.

Epigenetics refers to changes in gene expression that are not mediated by alterations of the genetic code itself but are caused by biochemical modifications of the nucleotide bases that alter the three-dimensional structure of DNA. The epigenome, consisting of chromatin and its modifications, functions as an interface between the inherited genome and the dynamism imposed by the environment. Over the past decade, there has been mounting evidence suggestive of associations between epigenetic modifications and various human conditions such as aging, and most common human diseases viz. cancer, cardiovascular diseases, diabetes, rheumatoid arthritis, HIV, etc., and the clearest evidence as the central mechanism for common multifactorial diseases has been identified with the factors involved in the inflammatory response. This emerging knowledge can give a great contribution to the field of medicine as it can be potentially utilized to develop newer understandings about pathogenesis, diagnostics, and therapies for major chronic human diseases, e.g., chronic metabolic diseases, immune-inflammatory disorders (including periodontal disease), and cancers, etc. The current paper aims to provide the clinicians a comprehensive review, based on the available supportive evidence to update this interesting concept capable of providing a better comprehension of the underlying disease mechanisms, so as to develop and decipher the novel methodologies to diagnose and treat these diseases.

Background Successful management of periodontitis requires treatment strategy that integrates therapies addressing both pathogen and host aspects of disease etiology. To evaluate sub gingivally applied curcumin gel in treatment of chronic periodontitis based on clinical and biochemical parameters. Materials & methods A randomized, double blind, parallel-group trial was carried out on 30 patients suffering from chronic generalized periodontitis with probing pocket depth≥5mm on at least 4 sites who were then randomly allocated to two groups. Control group was treated with Scaling and Root Planing (SRP) alone while experimental group was treated with SRP followed by subgingival application of curcumin gel. Saliva collection was done and the clinical parameters were recorded at baseline and follow up periods. Saliva analysis for IL-1β was done by ELISA. The statistical differences for the intra-group and intergroup measurements were analyzed by using Mann Whitney test. Spearman's rank correlation coefficient was used to examine the relationship between Interleukin - 1β and clinical parameters. Results Study elucidated mild adjunctive benefit of curcumin gel in reduction of gingival inflammation for a limited period of time. Though improvement in other clinical parameters was also greater in subjects treated with curcumin gel, results were not statistically different from those treated with SRP alone. None of the subjects who received curcumin gel experienced any adverse effect. Conclusion Within limitations, it can be concluded that single application of curcumin (turmeric) gel has limited added benefit over scaling and root planing in treatment of chronic periodontitis.

New approaches to periodontal diagnosis, including advanced microbiologic, biochemical, and genetic tests, have been shown to provide the clinician with the information not available by traditional means. The purpose of a diagnostic test is to confirm, exclude, classify, or monitor disease to guide treatment. Their clinical value depends on whether the information they provide leads to improved patient outcomes. This can be assessed by randomized trials, which compare patient outcomes from the new diagnostic test versus the old test strategy. Being nonmandatory for marketing approval, such trials are not always feasible because of large sample sizes requirements. So, many diagnostic tests enter the practice without being critically analysed for any additional benefits. Effective diagnosis is just as essential as the selection of effective treatments for the success of periodontal therapy. So, the current paper aims to focus on the practical utility of this rapidly emerging plethora of periodontal diagnostic tools, emphasizing the critical issues surrounding the clinical application of microbiologic and biochemical investigations, employed for periodontal diagnosis.

Periodontal disease, is the most prevalent inflammatory affliction characterized by the loss of supporting structures of the teeth. Although bacteria are identified as prime agents initiating the disease, but major part of tissue destruction is driven by the host immune response to infecting agent and is responsible for the clinical presentation of the disease. Porphyromonas gingivalis (P. gingivalis) has been identified as main microbial factor for causation and progression of periodontal disease. Three emerging concepts of periodontal disease viz wide prevalence, polymicrobial nature and their role in perpetuation of systemic diseases bear critical significance on the development of novel therapeutic approaches to eradicate or alleviate the disease burden. Therefore, development of preventive approaches such as periodontal vaccine appears as an exciting modality which can prove as a significant adjunct to current periodontal therapies. The new generation diagnostics including microbial genome sequencing and bioinformatics analysis are available now to detect and analyze the whole genomic and proteomic data regarding almost all human pathogens for exploring these as novel drug targets for vaccine development. The current review, aims to provide an update of wide-ranging virulence factors of P. gingivalis as potential antigenic targets for periodontal vaccine development.

Background: The gingival morphology of the maxillary anterior region plays an important role in determining the final esthetic outcome. Knowledge of the periodontal biotype is of fundamental importance because the anatomical characteristics of the periodontium, such as gingival thickness, gingival width and alveolar bone morphology, will determine periodontium behavior when submitted to physical, chemical, or bacterial injury or during periodontal or implant surgical procedures and orthodontic treatment. Materials and Methods: 50 subjects with healthy periodontal tissues with no loss of attachment and (b) presence of all anterior teeth in both upper and lower jaw were selected. On clinical examination gingival thickness was recorded based on the transparency of periodontal probe. Following parameters are recorded from dental cast, i.e., crown length, crown width, papillary length (PL) and papillary width. Results: There was highly significant correlation between gingival biotype and crown length and area of papilla with P value −0.002 and 0.013 respectively. Significant correlation was found between area of crown and PL with P value −0.013 and 0.016. The results of discriminant function analysis showed that average crown length was the best single determinant of biotype and area of papilla was the next best choice. Conclusion: Within the limits of the current investigation, the existence and correlation of different gingival biotypes and dentopapillary complex dimension has been confirmed. These findings can be utilized as objective guidelines for determining the biotype and response of gingiva to many dental operative procedures.

Background: The aim of this study was to ascertain the effects of vertical and horizontal distances between the maxillary central incisors on the presence of interproximal dental papilla and to assess the association between the embrasure morphology and central papilla recession. Materials and Methods: The central papilla was visually assessed in 50 subjects using the standardized periapical radiographs of maxillary central incisors. The following vertical distances were measured; distance from the contact point to papilla tip, CP to proximal cementoenamel (pCEJ) junction, bone crest to CP (BC-CP) and BC-PT. The horizontal distance measured was interdental width (IDW) at pCEJ level. The measurements were recorded using a digital electronic caliper. Results: Significant association between the embrasure morphology and central papilla recession was observed for all study groups. All the interdental variables were significantly related to the presence of interdental papillae, with BC-CP distance being the strongest determinant of central papilla presence. The percentage of interdental papilla presence was 100% when the BC-CP distance was ≤6 mm and IDW ranged between 0.5 and 1.5 mm. Central papilla recession was observed most frequently with wide-long and narrow-long embrasure morphology. Conclusion: In relation to maxillary central incisors, all the interdental variables have significant influences on the presence of interdental papillae, with distance from BC to CP being the strongest determinant of central papilla presence.

To assess and compare the oral health related quality of life in patients suffering from chronic periodontitis using the short questionnaire of oral health impact profile (OHIP-14) in rural and urban populations of Punjab state, India.One hundred patients suffering from chronic periodontitis were screened and divided into two groups, rural and urban (50 participants in each group). The clinical parameters plaque index (PI), gingival index (GI), pocket probing depth (PPD) and OHIP-14 were assessed in all patients.The mean PI (2.11 ± 0.635), GI (1.61 ± 0.45), PPD (3.12 ± 0.692) and OHIP-14 (11.49 ± 9.733) scores were significantly higher in the rural than in the urban population (1.69 ± 0.45, 1.56 ± 0.355, 3.30 ± 0.973, 5.88 ± 5.588, respectively) suffering from chronic periodontitis. The most affected domain in the rural population was functional limitation, whereas psychological disability was the most affected in the urban population. A statistically significant positive correlation was observed between the periodontal parameters and OHIP-14 (p0.001) in both groups.Within the limitations of the study, periodontal status and oral health related quality of life are significantly correlated with each other in both rural and urban populations.

Context: Current clinical periodontal diagnostic techniques emphasize the assessment of clinical and radiographic signs of periodontal diseases which can provide a measure of history of disease. Hence, new methodologies for early identification and determination of periodontal disease activity need to be explored which will eventually result in expedited treatment. Aim: To evaluate the correlation of alkaline phosphatase (ALP) activity in gingival crevicular fluid (GCF) to clinical parameters of periodontal inflammation in smokers with chronic periodontitis. Materials and Methods: Study population included 15 smoker male patients in the age group of 35–55 years suffering from moderate generalized chronic periodontitis with history of smoking present. Following parameters were evaluated at baseline, 1 month and 3 months after scaling and root planing: plaque index, bleeding index, probing pocket depth (PD), relative attachment level (RAL), and GCF ALP activity. Statistical Analysis Used: Independent variables for measurements over time were analyzed by using Wilcoxon signed rank test. Results: A statistically significant reduction in all the clinical parameters and GCF ALP activity was observed from baseline to 1 month and 3 months. A correlation was observed between change in GCF ALP activity and PD reduction as well as gain in RAL at 3 months. Conclusion: The present study emphasizes that total ALP activity could be used as a marker for periodontal disease activity in smokers. Estimation of changes in the levels of this enzyme has a potential to aid in the detection of progression of periodontal disease and monitoring the response to periodontal therapy.

Systemic antibiotics in conjunction with scaling and root planing (SRP), can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of clinical attachment loss (CAL) and pocket depth change, and reduced risk of additional CAL loss. However, antibiotics are not innocuous drugs. Their use should be justified on the basis of a clearly established need and should not be substituted for adequate local treatment. The aim of this review is to discuss the rationale, proper selection, dosage and duration for antibiotic therapy so as to optimize the usefulness of drug therapy.

The management of periodontal defects has been an ongoing challenge in clinical periodontics. In the recent past, attention has been focused more on regenerative and reconstructive therapies i.e. bone grafts, guided tissue regeneration, root conditioning, polypeptide growth factors, rather than on respective therapies. These therapeutic measures are shown to be limited in the predictability of healing and regenerative response in the modern clinical practice because oral environment presents several complicating factors that border regeneration. The 21st century appears to represent a time in history when there is a convergence between clinical dentistry and medicine, human genetics, developmental and molecular biology, biotechnology, bioengineering, and bioinformatics, resulting in the emergence of novel regenerative therapeutic approaches viz. tissue engineering, gene therapy and RNA interference. The focus of this review paper is to furnish and update the current knowledge of periodontal tissue engineering, gene therapy and RNA interference i.e. the future of periodontal regeneration.

In this report, we present a case of gingival enlargement related to pregnancy causing chewing, speaking, breathing and cosmetic problems. The patient was a 23-year old woman in the eighth month of her first pregnancy, with localized gingival enlargement affecting both buccal and lingual aspects of the area between right maxillary lateral incisor and canine. Hormonal changes occurring during pregnancy have long been known to be associated with generalized or localized gingival enlargements. Pregnancy does not cause the condition but altered tissue metabolism in pregnancy accentuates the response to the local irritants.

Tobacco use has been recognized to be a significant risk factor for the development and progression of periodontal disease. Its use is associated with increased pocket depths, loss of periodontal attachment, alveolar bone and a higher rate of tooth loss. Nicotine, a major component and most pharmacologically active agent in tobacco is likely to be a significant contributing factor for the exacerbation of periodontal diseases. Available literature suggests that nicotine affects gingival blood flow, cytokine production, neutrophil and other immune cell function; connective tissue turnover, which can be the possible mechanisms responsible for overall effects of tobacco on periodontal tissues. Inclusion of tobacco cessation as a part of periodontal therapy encourages dental professionals to become more active in tobacco cessation counseling. This will have far reaching positive effects on our patients′ oral and general health.

Background The gender and sex of an individual is known to have a significant bearing on the immune system, responsible for protection against infections and disease. Contemporary evidence suggests there exists a sexual dimorphism in the hetero immune as well as autoimmune responses in human beings and females show stronger and more vigorous immune responses to antigenic stimulations, e.g infectious diseases and vaccination. The evidence supportive to gender based heterogeneity in immune responses specifically in context of periodontal disease, is mounting in contemporary literature. Method A thorough and methodical search for related scientific publications have been accomplished by using different key words and terms like sex or gender based immune differences in periodontal disease, both by manual methods and on various electronic databases. Primary research articles, narrative and systematic reviews of good quality, relevant to the subject were included. Results The aggregate effects of the factors related to gender such as the steroid hormones as well as gene based differences in both sexes as supported by published literature are in line with the observed variation in susceptibility for chronic periodontitis in both genders , with males showing more risk for disease than women. Conclusion Gender as a risk factor for periodontal disease needs to identified, its underlying mechanisms to contribute needs to be revealed, so that novel strategies for risk assessment, disease identification and individualized therapeutic approaches can be developed for optimized patient care.

Epigenetics means gene expression alterations which occur due to the biochemical changes of the nucleotides modifying structure of DNA rather than the changes in the genetic code itself as in case of mutations. The epigenome, consisting of chromatin and its modifications, acts as a link between the inherited genome and the changes imposed by the environment. Over the past decade, there has been mounting evidence suggestive of associations between epigenetic modifications and various human conditions such as aging, and most common human diseases viz. cancer, cardiovascular diseases, diabetes, rheumatoid arthritis, HIV etc and the clearest evidence as the central mechanism for common multifactorial diseases, has been identified with the factors involved in the inflammatory response. Periodontal disease, basically an immune-inflammatory affliction, being a multifactorial complex disease, owing to its high prevalence, chronicity and wide ranging systemic effects, essentially calls for a better comprehension of the underlying disease mechanisms, so as to develop and decipher the novel methodologies to combat this disease. The current paper aims to visualize periodontal disease from an epigenetic perspective, featuring the contemporary evidence supported literature and tends to explore the possibilities to find some explanations for perio-systemic health links, individualized and improvised diagnostic tools for earlier detection and ways to halt the disease and help regeneration and reconstruction of the lost periodontal attachment apparatus with the biology based approaches.

Background: Presence of furcation involvement indicates advanced periodontitis, and a potentially less-favorable prognosis, for the affected tooth and its diagnosis has always been an enigma. The present study was carried out to measure and correlate the interdental and interradicular bone loss in patients suffering from periodontitis using radiovisuography (RVG) for the purpose of early furcation diagnosis. Materials and Methods: A total of 50 patients suffering from chronic generalized periodontitis and with furcation involvement in mandibular molars were selected. Under standardized conditions, RVGs were taken and the morphologic measurements defining the furcation areas were recorded and analyzed. Result: Interradicular bone loss of about 0.8 mm or more, was observed in the study subjects only when the bone loss at the interdental area was minimal of 3.7 mm. The correlation between the interradicular and the interdental bone loss was statistically highly significant (T-test, P < 0.001). A stronger correlation was observed in subjects above 40 years of age as compared with the younger subjects. There was not much difference in the degree of correlation between the interradicular and the interdental bone loss when compared in the context of gender. Conclusion: The very first millimeter of interradicular bone loss was seen when the interdental bone loss was around 4 mm. Therefore, to detect the earliest lesions of furcations, the interdental bone loss can be kept as an approximate guide for the comprehensive diagnosis and management of such sites/patients. The current investigation paves the path for future longitudinal studies with larger samples to ascertain these findings.

Periodontal diseases are comprised of a group of inflammatory conditions that result in the destruction of the supporting structures of the dentition. Emphasis has traditionally been placed on the deleterious actions of lipid mediators, such as prostanoids and leukotrienes, in propagating the inflammatory response and enhancing tissue destruction. Recently, the emerging understanding of the molecular basis of inflammation has elucidated that return of tissue homeostasis, triggered as part of a normal inflammatory response i.e. resolution of inflammation is an active, agonist-mediated, well-orchestrated phenomenon. The naturally-occurring pro-resolution lipid mediators, lipoxins, resolvins, protectins, maresins etc. have been identified as a novel genus of potent and stereoselective players that counter-regulate excessive acute inflammation and stimulate molecular and cellular events that define resolution. In this Review, we provide an update and overview of newly identified mediators that play pivotal roles in resolution and focus on the emerging appreciation of the endogenous pathways and mediators that control timely resolution which can be exploited as novel drug targets to extend the pharamaceutical armamentarium to combat chronic inflammation, thus controlling periodontal inflammation and the associated systemic inflammatory effects on the body, in general.