Generalized aggressive periodontitis and its treatment options: case reports and review of the literature

Periodontal Status and Herpesiviridae, Bacteria, and Fungi in Gingivitis and Periodontitis of Systemically Compromised Pediatric Subjects: A Systematic Review

BACKGROUND

Gingivitis and periodontitis are microbially associated diseases, with some features characteristic of pediatric age and others linked to systemic diseases. While the role of periodontal pathogenic bacteria is well recognized, the contribution of fungi and viruses, particularly Herpesviridae, remains controversial. Studies in adults have highlighted the presence of Herpesviridae, but evidence in pediatric subjects, especially systemically compromised, is limited. This systematic review aimed to assess periodontal status (e.g., health, gingivitis, periodontitis, necrotizing gingivitis, and/or periodontitis) and the subgingival and/or salivary microbial (bacterial, viral, and fungal) profile in systemically compromised pediatric (≤18 years) subjects with gingivitis and/or periodontitis compared to clinical periodontal health.

METHODS

The review protocol was registered on PROSPERO (CRD42024597695) and followed the PRISMA statement. Data from eight studies were descriptively analyzed and qualitatively assessed through ROBINS-I and JBI tools.

RESULTS

CMV was frequently detected, particularly in necrotizing gingivitis (19.40%). EBV was found in necrotizing gingivitis (20.69%) and periodontitis (10.34%); HSV was mainly associated with gingivitis and necrotizing gingivitis. Bacteria species in periodontitis included Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium, and Campylobacter species. Candida albicans was detected in periodontitis, suggesting a fungal involvement in the disease's pathogenesis. Although the bacterial and fungal profile was not investigated, limited viral presence was noted in subjects with healthy periodontium, indicating a stable microbiome.

CONCLUSIONS

These findings underscore the dynamics of microbial interactions in the progression of periodontal disease in systemically compromised pediatric subjects.

Synergistic Antibacterial and Antibiofilm Effects of Clindamycin and Zinc Oxide Nanoparticles Against Pathogenic Oral Bacillus Species

Oral bacterial pathogens, including Bacillus species, form biofilms that enhance antibiotic resistance, promote bacterial adherence, and maintain structural integrity. The ability of bacteria to form biofilms is directly linked to several oral diseases, including gingivitis, dental caries, periodontitis, periapical periodontitis, and peri-implantitis. These biofilms act as a predisposing factor for such infections. Nanoparticles, known for their strong antibacterial properties, can target specific biofilm-forming microorganisms without disturbing the normal microflora of the oral cavity. This study focuses on the biofilm-forming ability and clindamycin (CM) resistance of Bacillus species found in the oral cavity. It aims to evaluate the antibacterial and antibiofilm properties of zinc oxide nanoparticles (ZnO-NPs) against oral Bacillus species and assess the effectiveness of combining CM with ZnO-NPs in reducing antibiotic resistance. The antibacterial susceptibility of Bacillus isolates was tested using ZnO-NPs and CM, demonstrating synergistic effects that reduced the minimum inhibitory concentrations by up to 8-fold. The fractional inhibitory concentration (FIC) index indicated a significant synergistic effect in most strains, with FIC values ranging from 0.375 to 0.5. It was found that the majority of Bacillus strains exhibited significant biofilm-forming capabilities, which were reduced when treated with the ZnO-NPs and CM combination. The study also evaluated the cytotoxicity of ZnO-NPs on cancer cells (CAL27) and normal fibroblasts (HFB4). CAL27 cells showed stronger cytotoxicity, with an IC50 of 52.15 µg/mL, compared to HFB4 cells, which had an IC50 of 36.3 µg/mL. Genetic analysis revealed the presence of biofilm-associated genes such as sipW and tasA, along with antibiotic resistance genes (ermC), which correlated with the observed biofilm phenotypes. Overall, this study demonstrates the potential of combining ZnO-NPs with CM to overcome antibiotic resistance and biofilm formation in the oral bacterial pathogens, Bacillus species. These findings suggest new approaches for developing more effective dental treatments targeting oral biofilm-associated infections and antibiotic resistance.

From Oral Health to Obstetric Outcomes: A Comprehensive Review of Periodontal Disease and Its Implications for Preeclampsia

Periodontal disease and preeclampsia (PE) are both significant health concerns with implications for maternal and fetal well-being. Emerging evidence suggests a potential association between these two conditions, prompting increased interest in understanding their relationship and clinical implications. This comprehensive review examines the current literature on periodontal disease and PE, focusing on epidemiological evidence, proposed mechanistic pathways, and clinical implications. Epidemiological studies consistently demonstrate an increased risk of PE among pregnant individuals with periodontal disease, independent of traditional risk factors. Proposed mechanisms linking periodontal disease to PE include systemic inflammation, endothelial dysfunction, and immune dysregulation. The implications for research include the need for well-designed prospective studies and randomized controlled trials to elucidate further the mechanisms underlying the association and evaluate the effectiveness of periodontal interventions in preventing PE. Clinicians should be aware of the potential link between periodontal disease and PE and consider screening pregnant individuals for periodontal disease as part of routine prenatal care. Interdisciplinary collaboration between obstetricians and periodontists may be beneficial in managing pregnant individuals with periodontal disease to mitigate the risk of PE. By addressing these research gaps, we can further understand the relationship between oral health and obstetric outcomes and develop evidence-based strategies to improve maternal and fetal health.

Systemic immune-inflammation index in patients with generalized stage III grade C periodontitis

OBJECTIVES

Systemic immune-inflammation index (SII) is a novel, inflammatory biomarker whose role in predicting several chronic systemic diseases has been recently identified. However, its association with generalized stage III grade C periodontitis in young adults remains unknown.

MATERIAL AND METHODS

The study is a multicentered, double-blind, hospital-based case-control clinical study. Periodontal examination comprised of recording plaque index, sites with bleeding on probing, pocket depth and clinical attachment loss for patients with generalized stage III grade C periodontitis and periodontally healthy group. Complete blood counts were obtained and used for calculating SII, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio. Collected data were then subjected to statistical analyses.

RESULTS

SII was significantly higher in patients with generalized stage III grade C periodontitis compared to periodontally healthy individuals (723.87 vs. 537.74 × 109 /L, p < 0.0001). SII is associated with severe periodontitis in young adults (odds ratio [OR]:11.86, 95% CI 9.61-20.76, p < 0.0001) after adjusting for factors found significant in univariate analysis. Receiver operative curve analysis demonstrated a fair predictive validity of SII in detecting generalized stage III grade C periodontitis in young adults (AUC: 0.766, 95%CI 0.731-0.799, p < 0.0001, sensitivity 81.27%, specificity 76.50% and diagnostic accuracy 78.89%). SII did not exhibit superior predictive validity when compared with NLR in the context of generalized stage III grade C periodontitis (AUC for SII: 0.766, 95%CI 0.731-0.799, AUC for NLR: 0.788, 95% CI 0.754-0.819; p = 0.28).

CONCLUSION

SII is associated with generalized stage III grade C periodontitis in young adults.

A Modern Approach to Treat Molar/Incisor Pattern Periodontitis-Review

Molar-incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the classification of periodontal and peri-implant diseases and conditions. Despite the modification in nomenclature, the treatment strategies for MIPP remain a critical area of investigation. The core principles of MIPP treatment involve controlling local and systemic risk factors, managing inflammation, and arresting disease progression. Traditional non-surgical periodontal therapy, including scaling and root planing, is commonly employed as an initial step together with the prescription of antibiotics. Surgical intervention may be necessary to address the severe attachment loss. Surgical techniques like resective and regenerative procedures can aid in achieving periodontal health and improving esthetic outcomes. This review article aims to provide an overview of the current understanding and advancements in the treatment modalities of MIPP. Through an extensive analysis of the existing literature, we discuss various modern therapeutic approaches that have been explored for managing this challenging periodontal condition.

P. G, Rahman W. Clinical and diagnostic significance of blood leukocyte ratios in young patients with stage III grade C periodontitis

OBJECTIVES

Blood leukocyte ratios have been recently proposed as simple, rapid, cheap and easily accessible biomarkers of systemic inflammation. However, little is known about the relationship of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with periodontitis, which might not only serve as the potential biomarkers of systemic inflammation but also aid in diagnosis/screening of severe periodontitis. Hence, the purpose of this study was to evaluate the differences in the serum levels of these leukocyte ratios in healthy subjects and patients with generalized stage III Grade C periodontitis, and their applicability in identifying patients with the risk of developing severe periodontitis.

MATERIAL AND METHODS

The subjects were categorized into case and control group. Clinical parameters including Plaque index (PI), modified Gingival Index (mGI), Mean ratio of bleeding sites, Probing Pocket depth (PPD) and the clinical attachment loss (CAL) were assessed in both the groups. Venous blood samples were collected from subjects from both groups for the biochemical analysis and blood leukocyte ratios- NLR, PLR and LMR were calculated. The values were then subjected to statistical analysis.

RESULTS

The results showed significantly higher NLR and lower LMR values in patients with generalized stage III grade C periodontitis. Both the blood leukocyte ratios were moderately associated with increasing clinical parameters of periodontal disease. However, the values of PLR, although found to be higher in the periodontitis group, did not make a significant difference when compared with periodontally healthy subjects. The cut-off value of >2.15 for NLR and <7.16 for LMR fairly predicted the risk of severe periodontitis in young adults.

CONCLUSIONS

NLR and LMR can provide a new insight into the relationship between periodontitis and systemic diseases and can be of potential diagnostic value in identifying patients with severe periodontitis of younger age group.

Clinical Effects of Locally Delivered Lactobacillus reuteri as Adjunctive Therapy in Patients with Periodontitis: A Split-Mouth Study

Different methods and products have been investigated as measures of adjunctive therapy to scaling and root planing (SRP). Probiotic use has gained interest for this particular application, especially Lactobacillus spp. This split-mouth interventional prospective study aimed to evaluate the clinical effects of L. reuteri DSM 17938 with local application in periodontal pockets of severe periodontitis patients. The study was conducted on 40 subjects with stage 3–4 periodontitis who, based on a split-mouth model, followed SRP and SRP + L. reuteri solution in five weekly sessions. Probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were assessed at baseline and at three months after probiotic treatment completion. Both SRP and SRP + L. reuteri generated significant improvements of all three clinical parameters, but the changes were significantly better for SRP + L. reuteri treated sites. Therefore, we can conclude that adjunctive therapy with L. reuteri DSM 17938 could represent an interesting treatment option, particularly for severe periodontitis cases.

Green Synthesis of Copper Nano-Drug and Its Dental Application upon Periodontal Disease-Causing Microorganisms

Dental pathogens lead to chronic diseases like periodontitis, which causes loss of teeth. Here, we examined the plausible antibacterial efficacy of copper nanoparticles (CuNPs) synthesized using Cupressus macrocarpa extract (CME) against periodontitis-causing bacteria. The antimicrobial properties of CME-CuNPs were then assessed against oral microbes (M. luteus. B. subtilis, P. aerioginosa) that cause periodontal disease and were identified using morphological/ biochemical analysis, and 16S-rRNA techniques. The CME-CuNPs were characterized, and accordingly, the peak found at 577 nm using UV-Vis spectrometer showed the formation of stable CME-CuNPs. Also, the results revealed the formation of spherical and oblong monodispersed CME-CuNPs with sizes ranged from 11.3 to 22.4 nm. The FTIR analysis suggested that the CME contains reducing agents that consequently had a role in Cu reduction and CME-CuNP formation. Furthermore, the CME-CuNPs exhibited potent antimicrobial efficacy against different isolates which was superior to the reported values in literature. The antibacterial efficacy of CME-CuNPs on oral bacteria was compared to the synergistic solution of clindamycin with CME-CuNPs. The solution exhibited a superior capacity to prevent bacterial growth. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and fractional inhibitory concentration (FIC) of CME-CuNPs with clindamycin recorded against the selected periodontal disease-causing microorganisms were observed between the range of 2.6-3.6 μg/ml, 4-5 μg/ml and 0.312-0.5, respectively. Finally, the synergistic antimicrobial efficacy exhibited by CME-CuNPs with clindamycin against the tested strains could be useful for the future development of more effective treatments to control dental diseases.

Envisaging Antifungal Potential of Histatin 5: A Physiological Salivary Peptide

Fungi are reported to cause a range of superficial to invasive human infections. These often result in high morbidity and at times mortality. Conventional antifungal agents though effective invariably exhibit drug interactions, treatment-related toxicity, and fail to elicit significant effect, thus indicating a need to look for suitable alternatives. Fungi thrive in humid, nutrient-enriched areas. Such an environment is well-supported by the oral cavity. Despite this, there is a relatively low incidence of severe oral and periodontal fungal infections, attributed to the presence of antimicrobial peptides hosted by saliva, viz. histatin 5 (Hstn 5). It displays fungicidal activity against a variety of fungi including Candida albicans, Candida glabrata, Candida krusei, Cryptococcus neoformans, and unicellular yeast-like Saccharomyces cerevisiae. Candida albicans alone accounts for about 70% of all global fungal infections including periodontal disease. This review intends to discuss the scope of Hstn 5 as a novel recourse for the control of fungal infections.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

Assessment of Levels of Plasma Oxidative Stress in Patient Having Aggressive Periodontitis before and after Full Mouth Disinfection

Aim:

The primary purpose of the study was to evaluate the levels of oxidative stress in plasma in patients with aggressive periodontitis (AgP) before and after full-mouth disinfection.

Materials and Methods:

Twenty-five healthy controls and 25 participants with aggressive periodontal were assessed for plaque index, probing pocket depth, papillary bleeding index, and clinical attachment level. Periodontal bone support was assessed by taking full mouth periapical radiographs. Full-mouth disinfection of the patient was done within 24 h of clinical assessment of AgP. These parameters were assessed at the baseline and after 8 weeks of initial periodontal therapy. Plasma samples were taken and evaluated for various oxidative stress markers.

Results:

Strong positive correlation was observed among periodontal parameters and levels of enzymatic/nonenzymatic biomarkers for oxidative stress (thiobarbituric acid-reactive substances [TBARS], glutathione peroxidase [GPX], and catalase [CAT]) (P < 0.05), before and after periodontal management. The patients with AgP had high levels of TBARS, GPX, and CAT levels in the plasma matched to the healthy individuals (P < 0.05).

Conclusion:

Enzymatic and nonenzymatic oxidative stress may have a role in the pathogenesis AP. Initial periodontal treatment can lead to the reduction of these stresses.

Studying Effects of Calcium Oxide Nanoparticles on Dentinogenesis in Male Wistar Rats

This study aimed to evaluate potential impacts of calcium oxide nanoparticles (CaO-NPs) at different dosages on predentin thickness, number of blood vessels, periodontal ligament thickness, and blood glucose level of Wistar rats. Twelve rats were randomly gathered into four groups, untreated (control) and CaO-NP-treated groups at three concentrations (25, 50, and 100 mg/kg of the body weight) over a period of 60 days. Histological investigation was performed on twenty-four lower incisor teeth extracted from all the tested groups under a light microscope, and an automatic Fujifilm was used to measure the blood glucose level. The results showed that regular nanoparticle treatment significantly increased predentin and periodontal ligament thicknesses, a gradual decrease in vascularization in the pulp tissue, and an increase in the blood glucose level as the dosages of nanoparticles administered to the rats increased. Administration of the CaO-NPs at low dosage (25 mg/kg) could be beneficial for the growth and integrity of teeth and dentinal tissues in rats.

Comparing the efficiency of Er,Cr:YSGG laser and diode laser for the treatment of generalized aggressive periodontitis

BACKGROUND

This study aims to determine the effects of Er,Cr:YSGG and diode laser treatments on IL-1β, IL-8, and TNF-α levels in patients with generalized aggressive periodontitis.

METHODS

Twenty-six generalized aggressive periodontitis patients were enrolled in the study. We performed three treatment models: "scaling and root planning (SRP-only)," "SRP + Er,Cr:YSGG laser," and "SRP + diode laser." Each experimental quadrant was randomly allocated to the control group or the test group. The IL-1β, IL-8, and TNF-α levels were analyzed with an enzyme-linked immune-sorbent assay.

RESULTS

When the baseline and post-treatment IL-1β, IL-8, and TNF-α levels were compared, the most significant difference was observed in the SRP + Er,Cr:YSGG group and the least difference was observed in the SRP-only group.

CONCLUSIONS

The use of Er,Cr:YSGG laser as an addition to the conventional mechanical periodontal treatment was found to be more successful than the diode laser + SRP use in aggressive periodontitis treatment.

Association of IL-10 -1082A>G, -819C>T, and -592C>A polymorphisms with susceptibility to chronic and aggressive periodontitis: a systematic review and meta-analysis

OBJECTIVES

Several epidemiological studies have evaluated association of interleukin 10 (IL-10) polymorphisms with risk of periodontitis. However, the results remain conflicting and inconclusive. Here, we carried out a comprehensive systematic review and meta-analysis to evaluate the association of IL-10 -1082A>G, -819C>T, and -592C>A polymorphisms with risk of chronic (CP) and aggressive (CP) periodontitis.

METHODS

Electronic databases including PubMed, Science Direct, SciELO, and CNKI were systematically searched to identify all relevant studies published up to 01 June 2020.

RESULTS

A total of 60 case-control studies with 5313 cases and 6528 controls met our inclusion criteria. Overall, the pooled data showed that the IL-10 -592C>A polymorphism was statistically associated with increased risk of periodontitis in the overall population, while no significant association was identified for IL-10 -1082A>G and IL-10 -819C>T polymorphisms. The subgroup analysis by ethnicity revealed that the IL-10 -1082A>G polymorphism was significantly associated with periodontitis risk in Caucasians, IL-10 -819C>T polymorphism in mixed population, and IL-10 -592C>A polymorphism in both Asians and mixed populations. When further analyzed by periodontitis type, only the IL-10 -592C>A polymorphism was associated with CP risk, but not AgP; and the IL-10 -1082A>G and -819C>T polymorphisms have not positive association neither in the CP and AgP.

CONCLUSIONS

The current meta-analysis showed that the IL-10 -592C>A polymorphism was statistically associated with periodontitis risk in the overall population. Moreover, the IL-10 -1082A>G, IL-10 -819C>T, and IL-10 -592C>A polymorphisms were associated with periodontitis risk by ethnicity. Therefore, the IL-10 polymorphisms are of high clinical relevance by ethnicity and would be a useful marker to identify patients who are at higher risk for periodontitis.

A comparative study of synbiotic as an add-on therapy to standard treatment in patients with aggressive periodontitis

Context:

The role of synbiotic in the management of aggressive periodontitis (AP) is not well established.

Aim:

We designed this study to evaluate the efficacy and safety of synbiotic as an add-on therapy in the management of AP.

Settings and Design:

This was a randomized, double-blind, placebo-controlled study.

Materials and Methods:

Sixty patients with AP were randomized to two groups of 30 each. Study group received standard treatment, i.e., scaling and root planing along with doxycycline 100 mg twice daily for the 1^st day (loading dose) followed by 100 mg once daily for 1 week and synbiotic lozenge twice daily for 8 weeks, whereas control group received standard treatment for 1 week and placebo lozenge for 8 weeks. Clinical parameters were recorded at baseline, 4^th, 8^th, and 12^th weeks.

Statistical Analysis Used:

Pearson's Chi-square test and one-way analysis of variance were used to analyze distribution of sex and age, respectively. Differences within the groups were analyzed by Student's paired t-test. Pearson's Chi-square test was applied to measure gingival bleeding index.

Results:

On comparison at 12 weeks, there was a statistically significant reduction (P < 0.01) in probing depth, clinical attachment loss, oral hygiene index, and bleeding on probing in study group. No Adverse drug reactions were noted.

Conclusion:

Co-administration of synbiotic lozenge along with standard therapy is highly efficacious in improving periodontal health in patients with AP.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Treatment of Localized Aggressive Periodontitis With Guided Tissue Regeneration Technique and Enamel Matrix Derivative

INTRODUCTION

Aggressive periodontitis (AgP) is a form of periodontitis characterized by rapid attachment loss in otherwise healthy individuals. Although different treatment options have been explored for management of the disease, control of disease progression and subsequent regeneration of the attachment apparatus are considered the ideal treatment objectives. Limited evidence is available with respect to the efficacy of different regenerative materials in the treatment of AgP.

CASE PRESENTATION

The present case report describes periodontal regeneration techniques and 6-month outcomes in bilateral intrabony non-contained defects around mandibular first molars in a 21-year-old patient diagnosed with localized AgP (LAgP). Periodontal lesions were treated with regenerative therapy with enamel matrix derivative (EMD) and allograft on the right side and allograft with bioabsorbable collagen membrane without EMD on the left side. Treatment yielded favorable clinical outcomes in terms of probing depth reduction, clinical attachment level gain, minimal gingival inflammation, and radiographic bone fill. Radiographic bone fill was observed after 6 months, suggesting possible periodontal regeneration.

CONCLUSION

Both regeneration techniques used in this clinical report (guided tissue regeneration involving allograft and bioabsorbable membrane versus EMD combined with allograft without a barrier membrane) resulted in favorable outcomes in the treatment of deep (≥7 mm) non-contained intrabony defects in LAgP.

Orthodontic Management in Aggressive Periodontitis

Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis.

Dimorphic anemia and mental depression as a result of systemic manifestations of generalized aggressive periodontitis: A pioneer case report

Generalized aggressive periodontitis (GAP) is a rare form of periodontitis resulting in early loss of teeth. Most of the clinical evidence available in literature focuses on the diagnosis and management aspects of GAP. Systemic manifestations of GAP have been reported infrequently. To the best of our knowledge, the present case report is the first-ever evidence providing a possible mechanism and link between GAP, dimorphic anemia, and mental depression suggesting that dimorphic anemia and mental depression are probable systemic manifestations of GAP. A young female reported with her father to the hospital with a complaint of pain in her oral cavity and lack of desire to eat. On thorough examination, GAP with dimorphic anemia and mental depression were diagnosed. Periodontal treatment along with nutritional supplements was prescribed. An improvement was noticed in the patient's condition after a follow-up period of 6 months. Systemic manifestations of GAP should include the diagnoses of dimorphic anemia and mental depression and should be treated accordingly.

Characterization and Cytotoxicity Analysis of a Ciprofloxacin Loaded Chitosan/Bioglass Scaffold on Cultured Human Periodontal Ligament Stem Cells: a Preliminary Report

AIM:

The aim of this study was to analyze the cytotoxicity of ciprofloxacin (CIP) loaded on chitosan bioactive glass scaffold on human periodontal ligament stem cells (PLSCs) in vitro.

MATERIALS AND METHODS:

PLSCs obtained from human third molars, cultures treated with medium containing 15 x 15 mm chitosan/bioactive glass scaffolds without/with different concentration 0, 5, 10, and 20 % of CIP. A total of 15 x 10^3 cells were plated in 6 well plates. The attached cells of each group were harvested from the plates after 1, 4 and 8 days of culture to detect the viability of cells. The cell number was determined using a hemocytometer and the trypan blue dye-exclusion assay. Data was analyzed using normality using Shapiro-Wilk test. Comparisons between groups were made using One-way ANOVA complemented by Tukey’s test.

RESULTS:

When comparing the proliferation rate of cells in the four groups, no statistically significant difference was found (P = 0.633). With regards to cell viability, no statistical difference was found between the 0, 5, and 10 % CIP concentrations, while the 20 % CIP concentration demonstrated the least viability with a high statistically significant difference (P = 0.003).

CONCLUSION:

Twenty percentages CIP demonstrated the least proliferation rate and viability.

Assessment of Systemic Inflammatory Markers in Patients with Aggressive Periodontitis

BACKGROUND

"Aggressive periodontitis (AgP) is a destructive disease characterized by the following: The involvement of multiple teeth with a distinctive pattern of periodontal tissue loss; a high rate of disease progression; an early age of onset; and the absence of systemic diseases.'' Chronic low-level bacteremia and systemic inflammatory response have been suggested as a pathogenic link between periodontal disease and systemic disease. The present study was aimed to assess the levels of systemic inflammatory markers in patients with AgP.

METHODS

A sample of 50 systemically healthy patients comprised two groups, based on full mouth periodontal examination: Group I healthy individuals, includes 25 periodontally healthy subjects with fully functioning dentition. Group II includes 25 patients diagnosed clinically as AgP. Laboratory blood investigation included white blood cell (WBC) count, neutrophil count, lymphocyte count, and platelet count. Serum protein parameters included total protein (TP), albumin (ALB), and globulin (GLB). Periodontal clinical parameters including plaque index, gingival index, probing pocket depth, and clinical attachment level were recorded.

RESULTS

Data analysis shows an increase in WBC, neutrophil, lymphocyte, and platelet count and a decrease in TP, ALB, and GLB in AgP patients when compared to healthy individuals.

CONCLUSION

Results of the present study shows an increase in blood parameters and decrease in serum protein parameters in AgP. Hence, AgP could be considered as one of the risk factors associated with the cardiovascular diseases as assessed by changes in the level of systemic inflammatory markers observed.

Aggressive periodontitis in a Nigerian teaching hospital

AIM

These case series were aimed at highlighting late presentations of aggressive periodontitis (AP) in a teaching hospital as well as proffering possible reasons for such presentations which would serve as part of the solution to prevent such presentations in the future.

BACKGROUND

Aggressive periodontitis is a severe form of destructive periodontitis traditionally believed to present around puberty. However, many cases seen in a teaching hospital presented much later for yet-to-be explained reasons.

CASE DESCRIPTION

Seven patients referred to the specialist periodontal clinic of a Nigerian teaching hospital presented with clinical features consistent with AP. Most of the patients were over twenty and some over thirty years of age.

CONCLUSION

Aggressive periodontitis patients seen in our center were often outside the traditional age brackets. The range of treatment options available to the patients were under-utilized due to serious financial constraints.

CLINICAL SIGNIFICANCE

Aggressive periodontitis comes with serious psychological challenges and severe morbidity. Prompt diagnosis and effective management hold the key to success It is important to investigate why many of the cases seen in our center presented that late. Could be due to ignorance and poverty or could be due to failure of dentists recognize these cases and consequent misdiagnosis? Further studies are needed to answer these questions.

Esthetic treatment of a periodontal patient with prefabricated composite veneers and fiber-reinforced composite: clinical considerations and technique

The advances in periodontal therapy and the clinical success of adhesive dentistry have changed the way dentists treat periodontal patients. As more teeth are saved, the demand for functional and esthetic restoration of periodontally involved teeth grows. Once, these teeth were restored with full-coverage splinted restorations, whereas today, adhesive techniques provide less invasive and less complicated treatment options. This paper presents a novel adhesive combination of fiber-reinforced composite and prefabricated composite veneers to restore function and esthetics in a periodontal patient with severe bone and attachment loss. After successful completion of the periodontal treatment, fiber-reinforced composite has been bonded to the buccal surface of the maxillary anterior teeth in order to control teeth mobility. At the same appointment, prefabricated composite veneers have been bonded to the splinted teeth in order to restore esthetics. The final result shows full integration of contemporary adhesive techniques for single-appointment, minimally invasive treatment of a periodontal patient.

CLINICAL SIGNIFICANCE

This paper describes the use of fiber-reinforced composite and prefabricated composite veneers for the treatment of severe periodontal patients with a minimally invasive, single-appointment technique.

Treatment of aggressive periodontitis

Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis.

Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: Case report

Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Here we report the case of a 25-year-old female who presented with generalized gingival recession. Black triangles were present between the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused by recent periodontal surgery. She also had slightly malposed maxillary anterior teeth. The patient elected to replace gingival tissue with pink composite resin and to alter the midline with composite resin veneers. The first treatment phase involved placement of pink gingival composite to restore the appearance of interdental papilla to her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) and lower (34, 33, 32, 31, 41, 42, 43, and 44) teeth. Phase two was to place direct composite resin bonded veneers on her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) teeth to alter the midline and achieve desired colour. The third treatment phase was to level the lower incisal edge shape by enameloplasty (31, 32, 41, and 42) to produce a more youthful and attractive smile. This case report and brief review attempt to describe the clinical obstacles and the current treatment options along with a suggested protocol. Use of contemporary materials such as gingival coloured composite to restore lost gingival tissue and improve aesthetics can be a simple and cost-effective way to manage patients affected by generalized aggressive periodontitis (AgP).