Assessment of periodontal health status in patients with Parkinson's disease-A systematic review and meta-analysis of cross-sectional studies

INTRODUCTION

Parkinson's disease (PKD) is neurodegenerative disorder marked by tremors, bradykinesia, muscle rigidity and reduction in precise hand movements which could lead to improper oral hygiene and Periodontal disease. Current systematic review aims to review existing literature and provide assessment of periodontal health in PKD patients through a meta-analysis METHODS: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42023451700. Databases were searched for studies having sufficient data on periodontal health in patients with PKD compared to healthy controls and reporting outcomes in terms of various periodontal parameters of probing depth (PD), plaque index (PI), clinical attachment level (CAL), presence of bleeding on probing and gingivitis. Quality assessment of included was evaluated using Newcastle Ottawa Scale (NOS).

RESULTS

Eleven studies fulfilled the eligibility criteria, of which ten studies were suitable for meta-analysis. Pooled estimate through the SMD showed that all periodontal parameters were altered and significantly deteriorated in PKD compared to controls but this group differences were statistically insignificant (p > 0.05). Publication bias through the funnel plot showed symmetric distribution with absence of systematic heterogeneity.

CONCLUSION

Parkinson's disease could be a possible factor in deterioration of periodontal health.

Maxillary Sinus Floor Augmentation With Allograft Alone Compared With Alternate Grafting Materials: A Systematic Review and Meta-Analysis

A meta-analysis of scientific literature was conducted to ascertain the superiority between allografts and other regenerative grafts for maxillary sinus floor augmentation (MSFA). Review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in PROSPERO-CRD42023392766. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from 2000 to December 2022 for studies reporting MSFA using allografts or other regenerative grafts. Quality assessment of included studies was evaluated using the Cochrane risk of bias (ROB)-2 tool for randomized controlled trials through its domains. Risk of bias summary graph and ROB summary applicability concern were plotted using RevMan software version 5.3. The standardized mean difference was used as a summary statistic measure with random effect model and P value <0.05 as statistically significant. Four studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which all 4 studies were suitable for meta-analysis. Pooled estimate through standardized mean difference signifies that new bone formation was more or less similar for both graft materials, whereas regenerative grafts showed more residual bone grafts (P>0.05). Publication bias through funnel plot showed symmetric distribution with the absence of systematic heterogeneity. Both allografts and other regenerative grafts are equally effective in the MSFA in terms of new bone formation, whereras regenerative grafts showed more residual bone grafts. Furthermore, randomized controlled trials are required to establish evidence in outcomes involving sinus floor augmentation and different graft materials.

Efficacy of One Stage Full Mouth Disinfection on the Oral Health-Related Quality of Life in Patients with Generalised Chronic Periodontitis

Introduction: Intraoral translocation of periodontal pathogens from untreated intraoral niches can lead to recolonisation and reinfection of recently treated periodontal pockets. Poor oral health hampers the patient’s Quality of Life (QoL) as it causes social isolation, inferiority and the development of psychiatric conditions. Full Mouth Disinfection (FMD) performed within 24 hours using chlorhexidine has reported significant improvements in clinical, microbiological and psychological parameters when compared to conventional periodontal treatment. Aim: To investigate the long-term effect of FMD on Oral HealthRelated Quality of Life (OHRQoL) in patients with generalised chronic periodontitis. Materials and Methods: This study was a prospective clinical study conducted in the Department of Periodontology, Dr DY Patil Dental College and Hospital, Pune, Maharashtra, India, from October 2019 to December 2021. Study consisted of 60 participants who were allotted into two groups; 30 periodontally healthy volunteers (control group) and 30 patients (test group) diagnosed with generalised chronic periodontitis. The test group was asked to fill out the Oral Health Impact Profile-14 (OHIP-14) questionnaire to assess the OHRQoL at baseline followed by FMD protocol. All the patients were kept at periodic recall, and the OHRQoL was assessed again taken after one months three months, and six months. The control group was asked to fill out the questionnaire at the baseline. Repeated measure analysis of variance with post-hoc bonferroni test was used to compare differences in variation present from baseline to one month, three months and six months. For intergroup comparison at different time intervals, an unpaired t-test was applied. Results: The age group of participants ranged from 25- 55 years with a mean age of 41.3 years. Test group had 18 males and 12 females and, 20 males and 10 females were in the control group. The mean OHIP-14 score at baseline was 3.58±3.29 in the control group and 42.35±4.32 in the test group at baseline, showing a mean difference of -38.76±0.93, which was statistically significant. After one month there was a significant improvement in the OHIP-14 scores of the test group (26.35±2.60), which was further reduced to -13.58±0.81 and -9.0±0.88 by the end of three and six months. Therefore, a notable improvement in the QoL and periodontal conditions of the patients following FMD was appreciated. Conclusion: Periodontitis negatively impacts the OHRQoL. FMD provides an improvement in the perceived QoL among periodontitis patients.

Gingival crevicular fluid levels of Interleukin-22 (IL-22) and human β Defensin-2 (hBD-2) in periodontal health and disease : A correlative study

Background

Interleukin 22(IL-22), a recently identified, Th-22 associated cytokine has a key role in the production of human β defensin-2(hBD-2) and hence an indirect role in innate, nonspecific immunity. Hence this study was conducted as preliminary research to quantify and correlate the levels of IL-22 and hBD-2 in periodontal disease.

Materials and methods

Gingival crevicular fluid from subjects with chronic periodontitis (n = 27), gingivitis (n = 25) and healthy controls (n = 27) were obtained for the study. The periodontal status of each subject was assessed by criteria based on plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss. The levels of IL-22 and hBD-2 were measured in GCF samples with an enzyme-linked immunosorbent assay.

Result

Periodontal parameters were described and reported as mean values. The distribution and comparison of clinical parameters and gingival crevicular fluid IL-22, hBD-2 levels in healthy controls, gingivitis and chronic periodontitis groups were assessed using one way ANOVA test. Post Hoc Bonferroni test was used for intergroup comparisons. Association among the IL-22 , hBD-2 and clinical parameters in all three groups were examined using Pearson's correlation test.The IL-22 level was significantly greater in chronic periodontitis group than healthy controls (P < 0.001) and gingivitis group (P < 0.001). The hBD-2 level was significantly higher in the chronic periodontitis group compared to gingivitis (P = 0.003) and healthy controls (P < 0.001). The results also showed a statistically significant correlation (P = 0.002) between IL-22 and hBD-2 concentration in chronic periodontitis group.

Conclusion

These results indicate the role of IL- 22 and hBD-2 in the innate immune response during periodontitis.

Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review

Background

Currently, the leading theme in mucogingival surgery is the correction of gingival recession defects. Free gingival graft (FGG) has been successfully in use in this category of reconstructive therapeutic modality.

Objectives

The aim of this systematic review was to evaluate the literature with respect to efficacy of FGG in the management of Miller Class I and II localized gingival recessions.

Data Sources

Search strategies were performed via electronic database which included Pubmed-Medline, Google scholar and manual search using University library resources. Two reviewers assessed the eligibility of the studies.

Study Eligibility Criteria

Controlled clinical trials, randomized clinical trials and longitudinal studies evaluating recession areas treated by FGG with minimum of 6 months follow up were included. In-vitro and animal studies, studies mainly done on Miller Class III and IV gingival recession defect, studies on multiple gingival recessions and case series and case reports were excluded from the search.

Results

The electronic and manual search identified a total of 557 articles. A final screen consisted of 39 articles out of which 17 articles were selected for full-text assessment. Finally, 7 articles were selected for detailed evaluation for this systematic review. FGG has shown significant results in all the studies except for one study.

Conclusion

FGG produces substantial results, however, highly depends on the case selection and operator's skill and experience. FGG gives an impression of being the best alternative option in zones where gingival recession presents with inadequate width of attached gingiva and depth of vestibular fornix.

Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.

Oral telangiectatic granuloma with an intrabony defect

Oral telangiectatic granuloma is a benign hyperplastic lesion occurring in response to trauma or chronic irritation in the oral cavity. The characteristic histological appearance comprises of typical granulation tissue with a proliferation of small thin-walled blood vessels in the loose connective tissue. We describe a case of a 36-year-old female who had a swelling in the left maxillary region which was associated with the intrabony defect. An internal bevel gingivectomy was performed, and the histopathological report was suggestive of telangiectatic granuloma. The intrabony defect was managed with the placement of platelet rich fibrin plug in the defect. A follow-up at 6 months showed no recurrence and no loss in the width of keratinized tissue. The aim of this case is to highlight the rare association of intrabony defect with telangiectatic granuloma and the need for histopathological diagnosis in such lesions.

Comparative Evaluation of Coronally Advanced Flap with and without Bioactive Glass Putty in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial

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.

Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects

BACKGROUND

Platelet-rich concentrates are the most widely used regenerative biomaterials. Stimulation and acceleration of soft and hard tissue healing are due to local and continuous delivery of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. This article aims to evaluate the clinical efficacy of open flap debridement (OFD) with or without platelet-rich fibrin (PRF) in the treatment of intrabony defects.

MATERIALS AND METHODS

Twenty subjects with forty intrabony defects were treated with either autologous PRF with open-flap debridement (test, n = 20) or open-flap debridement alone (control, n = 20). Soft tissue parameters included: Plaque index, sulcus bleeding index, probing depth, relative attachment level and gingival marginal level (GML). The hard tissue parameters included-distances from: Cement enamel junction to the base of the defect (CEJ-BOD): Alveolar crest to the base of the defect (AC-BOD): And CEJ to AC. The parameters were recorded at baseline and at 9 months postoperatively calculated using standardized radiographs by image-analysis software.

RESULTS

Statistically significant (0.005*) intragroup improvements were seen with all the hard and soft parameters in both test and control groups, except for GML. Statistically significant improvements were seen with the mean defect fill (CEJ-BOD and AC-BOD) (P = 0.003*) when intergroup comparisons were made.

CONCLUSIONS

Adjunctive use of PRF with OFD significantly improves defect fill when compared to OFD alone. PRF has consistently been showing regenerative potential; it is simple, easy and inexpensive biomaterial compared with bone grafts.

Zucchelli's technique or tunnel technique with subepithelial connective tissue graft for treatment of multiple gingival recessions

BACKGROUND

Gingival recession is both unpleasant and unesthetic. Meeting the esthetic and functional demands of patients with multiple gingival recessions remains a major therapeutic challenge. We compared the clinical effectiveness of Zucchelli's technique and tunnel technique with subepithelial connective tissue graft (SECTG) for multiple gingival recessions.

METHODS

Twenty systemically and periodontally healthy subjects having 75 recession defects (Miller's class I or II, 39 test and 36 control sites) were included. After initial nonsurgical therapy, test sites were treated with Zucchelli's technique and control sites with tunnel technique with SECTG. Plaque index, bleeding index, pocket depth, recession depth, clinical attachment level, and keratinized gingiva height were evaluated at baseline, 3 and 6 months post-surgery.

RESULTS

The mean root coverage was 89.33% +/- 14.47% and 80.00% +/- 15.39% in the test and control groups respectively, with no significant difference between groups. Statistically significant root coverage was obtained for 82.50% +/- 23.72% and 71.40% +/- 20.93% of defects in the test and control groups, respectively.

CONCLUSION

Zucchelli's technique is effective for the treatment of multiple adjacent recessions in terms of both root coverage and keratinized tissue gain, irrespective of the number of defects. Moreover, this technique does not require an additional surgical site as required in the gold standard SECTG.

Effect of non-surgical periodontal therapy on superoxide dismutase levels in gingival tissues of chronic periodontitis patients: a clinical and spectophotometric analysis

BACKGROUND: Superoxide dismutase (SOD), an antioxidant acting against superoxide (oxygen radical, O₂^.-), it is released in inflammatory pathways and causes connective tissue breakdown. Increased SOD activity in inflamed gingiva may indicate increased O₂^.- radical generation by neutrophils and other inflammatory cells at the diseased site. The aim of the study was to evaluate the effects of non-surgical periodontal therapy (NSPT) on SOD levels in gingival tissues of chronic periodontitis patients.

METHODS: Forty subjects: 20 periodontally healthy (Control) and 20 chronic periodontitis (Test); age range 24–55 years were recruited. Gingival tissue samples were collected by excising the inner lining of the periodontal pocket at baseline (prior to non-surgical periodontal therapy) and 2 months post therapy. In controls, tissue samples were obtained immediately after tooth extraction scheduled for orthodontic reasons. Clinical parameters included probing depth, clinical attachment level, gingival index, bleeding index, plaque index. SOD activities were assessed spectrophotometrically at baseline and 2 months post NSPT, results were analysed statistically.

RESULTS: At baseline, patients with chronic periodontitis had higher mean SOD activity (2.73 ± 1.36) than the control subjects (1.12 ± 1.13) with p = 0.00003 (p < 0.05). At 2 months post NSPT median SOD level (1.00) had come close to median SOD value of control group (0.85); p = 0.99 (p > 0.05). The resolution of inflammation with successful NSPT resulted in decreased SOD levels as in control group. Clinical parameters in patients with chronic periodontitis showed a significant improvement 2 months post NSPT (p < 0.05).

CONCLUSION: Non-surgical periodontal therapy significantly improves the clinical parameters and restores previously increased SOD levels to normal in chronic periodontitis patients.