The human characteristics of curiosity, wonder, and ingenuity are as old as mankind. People around the world have been harnessing their curiosity into inquiry and the process of scientific methodology. Recent years have witnessed an unprecedented growth in research in the area of nanoscience. There is increasing optimism that nanotechnology applied to medicine and dentistry will bring significant advances in the diagnosis, treatment, and prevention of disease. Growing interest in the future medical applications of nanotechnology is leading to the emergence of a new field called nanomedicine. Nanomedicine needs to overcome the challenges for its application, to improve the understanding of pathophysiologic basis of disease, bring more sophisticated diagnostic opportunities, and yield more effective therapies and preventive properties. When doctors gain access to medical robots, they will be able to quickly cure most known diseases that hobble and kill people today, to rapidly repair most physical injuries our bodies can suffer, and to vastly extend the human health span. Molecular technology is destined to become the core technology underlying all of 21 ^st century medicine and dentistry. In this article, we have made an attempt to have an early glimpse on future impact of nanotechnology in medicine and dentistry.

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Treatment of gingival recession has become an important therapeutic issue due to increasing cosmetic demand. Multiple surgical procedures have been developed to obtain predictable esthetic root coverage. More specifically, after periodontal regenerative surgery, the aim is to achieve complete wound healing and regeneration of the periodontal unit. A recent innovation in dentistry is the preparation and use of platelet-rich plasma (PRP), a concentrated suspension of the growth factors, found in platelets. These growth factors are involved in wound healing and postulated as promoters of tissue regeneration. This paper reports the use of PRF membrane for root coverage on the labial surfaces of the mandibular anterior teeth. This was accomplished using laterally displaced flap technique with platelet rich fibrin (PRF) membrane at the recipient site.

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Background: Periodontitis is one of the major reasons for tooth loss in adults. India, with a population of over 1 billion, is bound to become a developed nation soon. This transition will require a population that is healthy, including in terms of periodontal health. Early studies done in India gave an indication that the population is highly susceptible to periodontitis. Aim: This paper reviews the prevalence of periodontitis in the Indian population. Settings and Design: Review of periodontitis prevalence studies on the Indian population. Materials and Methods: After identifying articles from PubMed and hand searching, the epidemiology of periodontitis is reviewed together with the case definition, study settings, type of population, age and other factors as all these are bound to affect the prevalence rates determined in various studies. Statistical Analysis: None. Results: This review identifies very limited number of studies that provide prevalence data and faces difficulty in comparing various studies due to nonstandardization of case definition and use of nonrepresentative samples. There is a high prevalence of periodontitis among the adults and the economically weak population. Conclusions: There is a very urgent need for standardized population-based studies with a robust design to identify the true prevalence of periodontitis, which in turn will help in planning oral health policies and creating the necessary infrastructure.

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Ultrasound offers great potential in development of a noninvasive periodontal assessment tool that would offer great yield real time information, regarding clinical features such as pocket depth, attachment level, tissue thickness, histological change, calculus, bone morphology, as well as evaluation of tooth structure for fracture cracks. In therapeutics, ultrasonic instrumentation is proven effective and efficient in treating periodontal disease. When used properly, ultrasound-based instrument is kind to the soft tissues, require less healing time, and are less tiring for the operator. Microultrasonic instruments have been developed with the aim of improving root-surface debridement. The dye/paper method of mapping ultrasound fields demonstrated cavitational activity in an ultrasonic cleaning bath. Piezosurgery resulted in more favorable osseous repair and remodeling in comparison with carbide and diamond burs. The effect of ultrasound is not limited to fracture healing, but that bone healing after osteotomy or osteodistraction could be stimulated as well.

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The main aim of this review is to update the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Exclusive data is available on the association between these two chronic diseases till date. Articles published on this relationship often provide the knowledge of definitions of diabetes mellitus and periodontal diseases, prevalence, extent, severity of periodontal disease, complications of diabetes along with the possible underlying mechanisms. The authors reviewed human epidemiological studies, cross-sectional observations and longitudinal cohort, case control that evaluated variables exclusively over the past 30 years and the predominant findings from the "certain" articles are summarized in this review. This review clarifies certain queries such as 1) Do periodontal diseases have an effect on the metabolic control of diabetes? 2) Does diabetes act as a risk factor of periodontitis? 3) What are the possible underlying mechanisms relating the connection between these two chronic diseases? 4) What is the effect of periodontal intervention on metabolic control of diabetes? After a thorough survey of literature, it was observed that diabetes acts as a risk factor in development of periodontitis as periodontitis is significantly aggravated in patients suffering from diabetes having long term hyperglycemia. Different mechanisms underlying the association between the accelerated periodontal disease and diabetes are emerging but still more work is required. Major efforts are required to elucidate the impact of periodontal diseases on diabetes. At the same time, patients are needed to be made aware of regular periodontal maintenance schedule and oral hygiene.

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Aims and Objectives : Anemia of chronic disease (ACD) is one of the most common forms of anemia. It is defined as anemia occurring in chronic infections, inflammatory conditions or neoplastic disorders which are not due to marrow deficiencies or other diseases, and occurring despite the presence of adequate iron stores and vitamins. Periodontitis is one of the most prevalent chronic inflammatory diseases in humans. This study aimed at finding out if periodontitis, like other inflammatory conditions, could lead to anemia. Materials and Methods : Thirty chronic generalized periodontitis male patients with hemoglobin levels below 15 mg/dl and serum ferritin values above 30 ng/ml were selected. The various blood parameters recorded at baseline were hemoglobin levels(Hb), erythrocyte count (RBC), erythrocyte sedimentation rate (ESR), mean corpuscular volume(MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). Periodontal parameters recorded at baseline included: plaque index, gingival index, probing pocket depth, clinical attachment level. Periodontal treatment including surgery if required was carried out in all the patients. Periodontal status of patients was monitored by repeating evaluation of periodontal indices at three months and at the end of one year. The hematological values were again measured at the end of one year. Results: The results showed that correction of periodontal inflammation resulted in a significant increase in hemoglobin levels and erythrocyte counts. The erythrocyte sedimentation rate showed a reduction indicating resolution of periodontal inflammation. There was a significant, but much lesser, improvement in MCV, MCH and MCHC values. Conclusion: The results of this study showed that treatment of periodontitis leads to an improvement in hematocrit and other related blood parameters in chronic generalized periodontitis patients with anemia. This provides evidence that periodontitis like other chronic diseases may also cause anemia.

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The recession of gingiva is increasingly becoming a more prominent condition in the oral health of many patients and should be treated at its earliest detection. The multi-factorial etiology, decision modality, and current trends followed in treatment of gingival recession are discussed in this presentation. The correction of class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results. In this case report, I present an alternative technique in treating gingival recession- the tunnel connective tissue graft.

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Probiotics utilize naturally occurring bacteria to confer a health benefit when administered in adequate amounts. A few conventional foods containing probiotics are yogurt, fermented and unfermented milk, soy beverages etc. Most often, they come from two groups of bacteria, Lactobacillus or Bifidobacterium. Probiotics have been extensively studied for their health promoting effects. Scientific understanding of probiotics and their potential for preventing and treating periodontal conditions is at its infancy, but moving ahead. Extensive research to create a probiotic product intended to maintain dental and periodontal health is needed.

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Aim : The study aimed to determine the incidence of gingival recession in the mandibular central incisor region among school children aged 10-15 years in Udaipur (India). Materials and Methods : A sample of 1800 males and female kids were examined in a mobile dental unit. World Health Organisation (WHO) rules and standards were followed. Result : Gingival recession, when compared, with respect to age, mean clinical crown length, anterior crowding and frenal involvement was significant (p less than 0.00) with respect to affected teeth.

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Time has seen the emergence of more efficient and effective devices like jet abrasives. However, the role of rubber cups with prophy angles cannot be overlooked as they are still being widely used and provide an economical alternative. Owing to several shortcomings associated with the air polishing device using sodium bicarbonate (NaHCO ₃ ), trends are shifting towards the usage of low abrasive powders. Recent demonstration of Glycine Powder Air Polishing (GPAP) in removing subgingival biofilm results in less gingival erosion than hand instrumentation or NaHCO ₃ air-polishing. Despite the emergence of latest advances in polishing, data suggesting selective polishing of teeth is compelling.

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Gene therapy is a field of Biomedicine. With the advent of gene therapy in dentistry, significant progress has been made in the control of periodontal diseases and reconstruction of dento-alveolar apparatus. Implementation in periodontics include: -As a mode of tissue engineering with three approaches: cell, protein-based and gene delivery approach. -Genetic approach to Biofilm Antibiotic Resistance. Future strategies of gene therapy in preventing periodontal diseases: -Enhances host defense mechanism against infection by transfecting host cells with an antimicrobial peptide protein-encoding gene. -Periodontal vaccination. Gene therapy is one of the recent entrants and its applications in the field of periodontics are reviewed in general here.

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Cosmetic treatments have become an integral part of periodontal treatment. One of the commonly used esthetic periodontal procedures is coverage of denuded root surface. While considering the elimination of these defects two criteria should be considered, the esthetic aspects and the functional aspects. This case report has describes a two stage surgical technique using double pedicle flap with connective tissue graft followed by coronally advanced flap for the treatment of a severe localized gingival recession measuring 15 mm. The recession measurement at the end of 12 months was 1 mm. It showed a predictable result at the end of one year. The advantages of this technique are excellent colour matching, dual blood supply to graft and very predictable results. The promising result suggest that this technique can be used in severe gingival recession cases with minimum amount of keratinized tissue.

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Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice.

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Nitric oxide (NO) is not only important in host defense and homeostasis but it is also regarded as harmful and has been implicated in the pathogenesis of a wide variety of inflammatory and autoimmune diseases. The presence of NO in periodontal disease may reflect the participation of an additional mediator of bone resorption responsible for disease progression. The aim of this study was to assess the level of NO in serum in chronic periodontitis, and correlate these levels with the severity of periodontal disease. Sixty subjects participated in the study and were divided into two groups. NO levels were assayed by measuring the accumulation of stable oxidative metabolite, nitrite with Griess reaction. Results showed subjects with periodontitis had significantly high nitrite in serum than healthy subjects. NO production is increased in periodontal disease, this will enable us to understand its role in disease progression and selective inhibition of NO may be of therapeutic utility in limiting the progression of periodontitis.

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Background: We face various problems while measuring the Clinical attachment level (CAL) from Cemento-enamel junction (CEJ). This study aims to record and compare the CEJ location measurements using a xed reference point (FRP) [Custom made stent] before and after ap elevation. Materials and Methods: A custom made stent and UNC-15 probe were used. Recording of CEJ location was made using a UNC-15 (Hu-Friedy) probe, before (close CEJ) and after (Open CEJ) the reflection of the flap from the lower edge of the stent in those subjects who were indicated for flap surgery, at baseline. Results: We used statistical analysis involving intra-group comparison done by Paired-'t' test. The close and the open CEJ measurements demonstrated a, statistically, non-significant difference. The equi-measurements of close and open CEJ numerical data were remarkably lower than the under and overestimation of measurements. Thus, despite certain disadvantages of stent, the FRP provides a simple solution for CAL measurement. Conclusion: The results of this study confirms the objective of the study and strongly suggests that CAL measurements done without FRP is subjected to great variation and the diagnostic and prognostic interpretation of CAL should be viewed seriously in periodontics.

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Periodontal destruction is initiated by bacteria that stimulate host responses leading to excess production of cytokines. Anticytokine therapy for periodontal diseases especially targets proinflammatory cytokines, that is, TNF-α, IL-1, and IL-6, because these are essential for the initiation of the inflammatory immune reaction and are produced for prolonged periods in periodontitis. This therapy aims to bind the cytokines with the receptors present on target cells such as the fibroblasts. The three basic treatment strategies are: (1) neutralization of cytokines, (2) blockage of cytokine receptors, and (3) activation of anti-inflammatory pathways, such as, immune-suppressive pathways. This new therapy can act as a host response modulator in the control of inflammatory diseases of gums and may provide the basis for new molecular therapeutic approaches to the treatment of periodontitis.

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Periodontal disease is a chronic adult condition. Bacteria implicated in the etiology of this disease causes destruction of connective tissue and bone. As a result of stimulation by bacterial antigen PMN produces free radicals via respiratory burst as a part of host response to infection. Patients with periodontal disease display increased PMN number and activity. This proliferation results in high degree of free radical release culminating in heightened oxidative damage to gingival tissues, periodontal ligament and alveolar bone. Damage mediated by free radicals can be mitigated by "ANTIOXIDANT DEFENSE SYSTEM ". Physiological alteration and pathological states produced by free radicals depend on disequilibrium between free radical production and antioxidant levels leading to oxidative stress. Hence this study has been designed to estimate the TOTAL ANTIOXIDANT CAPACITY in patients with PERIODONTITIS and healthy control subjects

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Background: The purpose of this case study was to evaluate the success and predictability of a rotated papillary pedicle graft in combination with the coronally advanced flap using surgical loupe (2.5X magnification) for the treatment of Miller's class I gingival recession. Materials and Methods: Fifteen systemically healthy patients with isolated gingival recession underwent the procedure. The probing depth, percentage root coverage, width of the keratinized gingiva and the gain in clinical attachment, papilla width, papilla height, area of the papilla at the donor site, were recorded at baseline, 3 months and 12 months. Results: All parameters except probing pocket depth, significantly improved from baseline to 12 months. The mean recession defect of 2.67 ± 0.03 mm present at baseline reduced to 0.13 ± 0.35 mm at the end of the 3 ^rd months and stabilized at 0.27 ± 0.59 mm at 12 months. The mean reduction in recession depth was 2.40 ± 0.03 mm at the end of the study. Complete recession coverage was obtained in 13 of the 15 (87%) of the cases treated with a mean percentage recession coverage at 12 months being 86 ± 35.19%. The gain in the width of the keratinized gingiva was 1.33 ± 0.13 mm at the end of the study. There was no postoperative morbidity from where the graft was harvested at the end of the study period. Conclusion: The use of magnification in mucogingival surgery resulted in achieving a high degree of success and predictability as well as an excellent esthetic outcome.

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Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients' periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment.

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Obesity is characterized by the abnormal or excessive deposition of fat in the adipose tissue. Its consequences go far beyond adverse metabolic effects on health, causing an increase in oxidative stress, which leads not only to endothelial dysfunction but also to negative effects in relation to periodontitis, because of the increase in proinflammatory cytokines. Thus obesity appears to participate in the multifactorial phenomenon of causality of periodontitis through the increased production of reactive oxygen species. The possible causal relationship between obesity and periodontitis and potential underlying biological mechanisms remain to be established; however, the adipose tissue actively secretes a variety of cytokines and hormones that are involved in inflammatory processes, pointing toward similar pathways involved in the pathophysiology of obesity, periodontitis and related inflammatory diseases. So the aim of this article is to get an overview of the association between obesity and periodontitis and to review adipose-tissue - derived hormones and cytokines that are involved in inflammatory processes and their relationship to periodontitis.

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Rehabilitation of complicated cases poses difficulty in clinical practice, both with respect to restoring function and with esthetics. One such clinical condition where the dentist has to give importance to proper planning of the treatment and execution of the plan is amelogenesis imperfecta (AI), a condition where both function and esthetics are accommodated. This article discusses both the functional and esthetic rehabilitation of a patient with AI. Both the esthetics and function were hampered in this patient due to the condition. As a result, the treatment was properly planned and executed. A number of treatment options are available for us today to treat such a case. There is no one technique to be followed as such. However, the aim was to properly diagnose the case and provide good function and esthetics to the patient.

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Background: In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. Materials and Methods: A method of de-epithelialization of the pigmented gingiva using Kirkland's gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964. Results: The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant. Conclusion: As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.

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In the field of periodontology and implantology, assessment of the condition of teeth and surrounding alveolar bone depends largely on two-dimensional imaging modalities such as conventional and digital radiography. Though these modalities are very useful and have less radiation exposure, they still cannot determine a three-dimensional (3D) architecture of osseous defects. Hence, an imaging modality which would give an undistorted 3D vision of a tooth and surrounding structures is essential to improve the diagnostic potential. Cone-beam computed tomography (CBCT) provides 3D images that facilitate the transition of dental imaging from initial diagnosis to image guidance throughout the treatment phase. This technology offers increased precision, lower doses, and lower costs when compared with medical fan-beam CT. This review discusses all the finer details of CBCT which not only reveals 3D architecture of the periodontium but also helps to reconstruct it.

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In the changing era of perio surgeries one innovative remedy has ended the inconvenience of suturing and has allowed the clinician to meet growing expectations and demands of today's dental patient, and the remedy is fibrin glue. When periodontal plastic surgical procedures done or implants placed in esthetic zone, fibrin sealants may be variable alternative to closing flaps with sutures and with histologic benefits and has potential uses in field of medicine. Fibrin sealant is an excellent beginner in the era of sutureless periodontal flap surgery, and this article is a humble effort to prove it.

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Aim: The aim of the study was to assess the relationship between bone mineral density and periodontitis in premenopausal and postmenopausal women. Materials and Methods: Twenty women between the age group of 45-55 years were selected for this study. Ten premenopausal women with healthy periodontium constituted the control group and 10 postmenopausal women with ≥2mm of clinical attachment loss in >30% of sites constituted the study group. All patients were assessed for plaque index, probing depth and clinical attachment loss. Radiographs (six IOPA and two posterior bitewing) were taken and assessed for interproximal alveolar bone loss. The patients were scanned to assess the bone mineral density of lumbar spine (L2) and femur using dual energy X-ray absorptiometry (DEXA). Results: The bone mineral densities of lumbar spine (L2) and femur were significantly lower in the study group than the control group. Osteopenia of the lumbar spine and femur was observed in 60% whereas osteoporosis of lumbar spine was observed in 30% of cases in study group. Conclusion: Increased proportion of osteopenia and osteoporosis cases of lumbar spine and femur in postmenopausal women with periodontitis suggests that there is association between bone mineral density and periodontitis.

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