T helper (Th) cells have an important role in host defence as well in the pathogenesis of periodontal disease. Th cells differentiate from naive cells into various subsets, each of which is associated with a set of inducing and effector cytokines. Previously, it was thought that this differentiation was an irreversible event. Recent evidence suggest that even differentiated Th cells, retain the flexibility to transform from one lineage to another, a phenomenon referred to as plasticity. This plasticity is thought to be brought about by epigenetic modifications that are regulated by external and internal signals in the micro-environment of these cells. The factors and mechanisms which affect the plasticity of these cells and their potential role in the etio-pathogenesis of periodontal disease has been described in this article.

Both diabetes and periodontitis are chronic diseases. Diabetes has many adverse effects on the periodontium, and conversely periodontitis may have deleterious effects further aggravating the condition in diabetics. The potential common pathophysiologic pathways include those associated with inflammation, altered host responses, altered tissue homeostasis, and insulin resistance. This review examines the relationship that exists between periodontal diseases and diabetes mellitus with a focus on potential common pathophysiologic mechanisms.

Vitamin D is crucial for a wide variety of organ systems; nevertheless, its deficiency is highly prevalent, present in 30-50% of the general population. Evidence has demonstrated that vitamin D deficiency may place subjects at risk for not only low mineral bone density/osteoporosis and osteopenia, but also infectious and chronic inflammatory diseases. Through its effect on bone and mineral metabolism, innate immunity, and several vitamin D receptor gene polymorphisms, vitamin D has been reported to be associated with the periodontal disease.

This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.

Background: Therapeutic goal in patients with cleft lip and palate is esthetics and long-term health of the stomatognathic system. Patients with cleft lip and palate routinely require extensive and prolonged orthodontic treatment. The osseous structures are absent or poorly developed in the osseous clefts and may be traumatized in the course of orthodontic therapy; hence require constant monitoring during orthodontic treatment.The aim of the study was to evaluate the tissue response of cleft palate patients by quantitative analysis of enzyme activity during orthodontic treatment and assess any difference in the tissue response with that of noncleft patients undergoing orthodontic treatment. Materials and Methods: 20 patients requiring orthodontic treatment agedbetween 15 to 25 years were included to participate in the studyof which ten were cleft palate patients (group I) and ten noncleft patients (group II).The GCF samples were collected at incisor and molar sites during orthodontic treatment on days as per the study design in both the groups.The GCF enzymatic levels were estimated and compared. Results: Both groups showed significant increased enzyme activity at the incisor site compared to molar site corresponding to the phases of tooth movement. Conclusion: There was significant difference in enzyme activity between the incisor adjacent to the cleft site and molar site. There was no difference in the tissue response between cleft palate patients and noncleft patients during orthodontic treatment.

Background: Periodontal debridement has an impact on the vascular thrombotic markers in healthy individuals. This study aimed to investigate changes in several vascular thrombotic markers after surgical and non-surgical periodontal debridement in hypertensives with periodontitis. Materials and Methods: 40 hypertensives, 27 males and 13 females, 37-68 year old, mean 51.2 years, with moderate to severe periodontitis, were divided into two groups, (n = 20 for each); the first received comprehensive one session non-surgical periodontal debridement, (pockets 4-6 mm), while the second received comprehensive supragingival scaling with surgical debridement at one quadrant, (Pockets > 6 mm). Periodontal parameters included; plaque index (PI), gingival inflammation (GI), bleeding on probing (BOP), pocket probing depth (PPD). Vascular thrombotic tests included; platelets count (Plt), fibrinogen (Fib), Von Willebrand factor antigen activity (vWF:Ag), and D-dimers (DD). Results: PI, GI, BOP, PPD, decreased significantly (P = 0.001) after 6 weeks of periodontal debridement in both groups, while BOP and PPD remained higher in the surgical one (P < 0.05). Thrombotic vascular markers changes through the three-time intervals were significant in each group (P = 0.001), and time-group interception effect was significant for vWF:Ag (P = 0.005), while no significant differences between groups after treatment (P > 0.05). Conclusion: Periodontal debridement, surgical and non-surgical, improved the periodontal status in hypertensives. Periodontal treatment activated the coagulation system in hypertensives and recessed later while the treatment modality did not affect the degree of activation.

Background: Numerous cross-sectional studies have suggested that chronic periodontitis is a risk factor for cardiovascular diseases. There is evidence that periodontitis and cardiovascular diseases are linked by inflammatory factors including C-reactive protein. The purpose of the study was to investigate the levels of CRP and PNM cells as a marker of inflammatory host response in the serum of chronic periodontitis patients and in patients with CVD. Materials and Methods: Study population included 75 patients; both male and female above 35 years were included for the study. The patients were divided into three groups of 25 each - Group I: Chronic periodontitis patients with CVD, Group II: Chronic periodontitis patients without CVD and Group III: Control subjects (without chronic periodontitis and CVD). Patients with chronic periodontitis had ≥8 teeth involved with probing depth (PD) ≥5 mm involved. The control group had PD ≤ 3 mm and no CVD. Venous blood was collected from the patients and C-reactive protein levels were analyzed by immunoturbidimetry. PMN was recorded by differential count method. Results: On comparison, OHI-S Index, GI, mean PD, CRP and PMN values showed significant difference from Group I to III. CRP level was highly significant in Group I when compared with Group II and Group III. PMN level was highly significant in Group I when compared with Group III PMN level which was not significant. Conclusion: This study indicated that periodontitis may add the inflammation burden of the individual and may result in increased levels of CVD based on serum CRP levels. Thus, controlled prospective trials with large sample size should be carried out to know the true nature of the relationship if indeed one exists.

Background: Pro-inflammatory markers are seen to increase in inflammatory diseases like periodontitis. Detecting an increase in these markers is one of the diagnostic modality. One such marker, which can be detected, is the ceruloplasmin. Ceruloplasmin induces hypoxia and generates oxygen radicals at the site of aggressive periodontitis. It also causes a state of hypoferremia leading to increase in the natural resistance of the body. The aim of this study was to evaluate the serum levels of cerruloplasmin in both aggressive and chronic periodontitis patients. Materials and Methods: Blood samples were collected from aggressive periodontitis patients (n = 20), chronic periodontitis patients (n = 20) and periodontally healthy patients (n = 20). The serum was extracted from all the blood samples and ceruloplasmin levels were spectroscopically evaluated through a new kinetic method, which used a norfloxacin based reagent. Results: Serum ceruloplasmin levels were found to be significantly higher in aggressive periodontitis patients (P > 0.05) than in chronic periodontitis patients (P > 0.05) even though increase in the level of ceruloplasmin was found in chronic periodontitis. Periodontally healthy patients did not show increase in the levels of serum ceruloplasmin. The levels of serum ceruloplasmin also increased with the disease severity whose manifestations were increased bleeding on probing, increased pocket depth and increased attachment loss. Conclusion: Serum ceruloplasmin levels increased in both aggressive and chronic periodontitis patients, but more in aggressive periodontitis patients making it a potential marker for diagnosis of periodontitis.

Aim:The aim of present study was to evaluate and compare the total antioxidant capacity in the saliva of type 2 diabetes mellitus (DM) patients and healthy subjects, with and without periodontal disease. Materials and Methods: The study was designed as a case-control study, comprising of 120 male subjects, who were divided into four groups of 30 patients each. Group I: Thirty type 2 diabetic males with periodontal disease; Group II: Thirty type 2 diabetic males without periodontal disease; Group III: Thirty healthy males with periodontal disease; Group IV: Thirty healthy males without periodontal disease. After clinical measurement and sampling, the total antioxidant capacities in the saliva of type 2 diabetic and healthy men were determined, and the data were tested by non-parametric tests. The total antioxidant capacity of the clinical samples was determined spectrophotometrically. Results: The total antioxidant capacity in the saliva was the lowest in type 2 diabetic males with periodontal disease. The results were statistically significant. Conclusion: The findings of our study finally conclude that the salivary total antioxidant capacity is affected in type 2 diabetic males, in addition to the impact of periodontal disease, and hence, can be used as a useful marker of periodontitis in healthy and diabetic patients.

Background: Multiple approaches have been used to replace lost, damaged or diseased gingival tissues. Coronally advanced flap (CAF) and the use of guided tissue regeneration are among the successfully used surgical techniques to treat gingival recession. Platelet rich plasma (PRP), containing autologous growth factors, has been shown to promote soft-tissue healing. Therefore, the purpose of this study was to evaluate the efficacy of PRP in combination with CAF in the treatment of gingival recession. Materials and Methods: A total of 15 systemically healthy patients with buccal Miller's class I and class II gingival recession in cuspids or premolars participated in the study. CAF procedure was performed and PRP with collagen sponge was placed over the defect. Clinical parameters such as recession depth, recession width, surface area, width of keratinized gingival (KG), clinical attachment level (CAL), probing depth, plaque index and gingival index were evaluated at 3, 6 and 9 months post-surgery. The percentage of root coverage was calculated. Results: The results of this study suggest that the CAF procedure provides a predictable and simple technique in the treatment of localized Class I and Class II gingival recession. The additional application of PRP does significantly increase the width of KG and gain in clinical attachment. Conclusion: CAF procedure is a predictable and simple technique in the treatment of gingival recession and the additional application of PRP does significantly increase the width of KG and gain in CAL. The long-term benefits following surgical treatment of such defects needs to be determined further.

Background and Objectives: The aim of the present study was to evaluate the survival rate of Screw-Vent ^® immediate implants augmented with sub epithelial connective tissue graft for single-tooth replacement for 1 year. Materials and Methods: Ten patients (five men and five women), with the mean age of 25.3 years, were consecutively treated on the out-patient basis by the placement of Screw-Vent ^® dental implants in to the fresh extraction sockets in association of augmentation with sub epithelial connective tissue graft harvested from the palate, supporting single crowns. The clinical and radiographic parameters were recorded to evaluate the peri-implant soft tissue health and marginal bone loss, respectively, for each patient at baseline and at every 3 months interval for 1 year. Results: The 1 year cumulative survival rate of Screw-Vent ^® dental implants was 100% for all 10 patients. Statistical analysis demonstrated highly significant values indicating an improvement in peri-implant soft tissue parameters in terms of peri-implant aesthetic parameters, which estimated the keratinized mucosa width. Statistically, non-significant marginal bone loss or gain indicated stable condition in hard tissue parameters. Interpretation and Conclusion: Single-tooth replacement by Screw-Vent ^® dental implants in to a fresh extraction socket, in association with guided bone regeneration using autologous connective tissue graft is a predictable treatment as demonstrated by the 100% implant survival rates and appreciable increase in the width of the keratinized mucosa at 1 year follow up.

Background: Platelet-rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. The purpose of the study was to clinically evaluate and compare the efficacy of autologous PRF combined with demineralized freeze-dried bone allograft (DFDBA) to DFDBA alone in the treatment of periodontal intrabony defects. Materials and Methods: In a split mouth study design, 10 patients having two almost identical intrabony defects with clinical probing depth of at least 6 mm were selected for the study. Selected sites were randomly divided into two groups. In Group I , mucoperiosteal flap elevation followed by the placement of DFDBA was done. In Group II, mucoperiosteal flap elevation followed by the placement of homogeneous mixture of PRF with DFDBA was done. Clinical and radiographic parameters were recorded at baseline and at 6 months post-operatively. Results: Both treatment groups showed a significant probing pocket depth reduction, clinical attachment gain, defect fill, and defect resolution 6 months after surgery compared to baseline. However, there was a significantly greater probing pocket depth reduction and clinical attachment gain when PRF was added to DFDBA. Conclusion: Within limits of the study it may be concluded that a combination of PRF with DFDBA demonstrated better results in probing pocket depth reduction and clinical attachment level gain as compared to DFDBA alone in the treatment of periodontal intrabony defects.

Aim: The purpose of this study was to evaluate the efficacy of demineralized freeze dried bone allograft (DFDBA) and bioactive glass by clinically and radiographically in periodontal intrabony defects for a period of 12 months. Materials and Methods: Ten systemically healthy patients diagnosed with chronic periodontitis, with radiographic evidence of at least a pair of contralateral vertical osseous defects were included in this study. Defect on one-side is treated with DFDBA and the other side with bioactive glass. Clinical and radiographic measurements were made at baseline 6 month and 12 month after the surgery. Results: Compared to baseline, the 12 month results indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, probing depth, clinical attachment level (CAL) and radiographic parameters (bone fill); P < 0.001*). However, sites treated with DFDBA exhibited statistically significantly more changes compared to the bioactive glass in probing depth reduction (2.5 ± 0.1 mm vs. 1.8 ± 0.1 mm) CAL gain 2.4 ± 0.1 mm versus 1.7 ± 0.2 mm; ( P < 0.001*). At 12 months, sites treated with bioactive glass exhibited 56.99% bone fill and 64.76% bone fill for DFDBA sites, which is statistically significant ( P < 0.05*). Conclusion: After 12 months, there was a significant difference between the two materials with sites grafted with DFDBA showing better reduction in probing pocket depth, gain in CAL and a greater percentage of bone fill when compared to that of bioactive glass.

Papillon-Lefèvre syndrome (PLS) is a very rare syndrome of autosomal recessive inheritance characterized by palmar-plantar hyperkeratosis and early onset periodontitis, leading to premature loss of both primary and permanent dentitions. Various etiopathogenic factors are associated with the syndrome, but a recent report has suggested that the condition is linked to x mutations of the cathepsin C gene. The purpose of this report is to describe two cases of PLS in the same family who presented to the Department of Dentistry of Dr. R. P. Government Medical College at Tanda, Kangra (Himachal Pradesh) with a chief complaint of mobility and rapid loss of teeth. Hyperkeratosis of palms and soles was present. On intraoral examination, there was severe gingival inflammation, abscess formation, and deep periodontal pockets with mobility of teeth. Histopathological examination of the specimen taken from the thickened skin was reported to be consistent with PLS. The dental treatment comprised oral prophylaxis, scaling and root planning, antibiotic therapy, instructions on oral hygiene, restorations, extraction of hopelessly affected teeth, and prosthetic rehabilitation.

This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

Concrescence is a developmental anomaly of dental hard tissues. It is a condition showing union of adjacent teeth by cementum. The concrescence leads to a loss of gingival architecture leading to the development of funnels, which may cause plaque accumulation thus, resulting in periodontal tissue destruction. There is a slight predilection for the mandible especially in the premolar area followed by the molar and anterior regions. Awareness of these developmental disturbances with proper diagnosis and treatment is very essential because it can compromise the periodontal attachment and can lead to the tooth loss. This article highlights the presence of a concrescence between mandibular second molar and the supernumerary fused teeth with their clinical and radiographic findings, along with its management.

Idiopathic gingival fibromatosis is a relatively rare condition characterized by the proliferation of the gingival tissues resulting in masticatory, esthetics, phonetics and psychological disturbances. The severity of the overgrowth can range from a solitary isolated mass to a more generalized and diffused enlargement. The etiopathogenesis of this bizarre condition is poorly understood and has been attributed to various factors. It can present as a single disorder or may manifest as part of a syndrome. This case reports an ipsilateral diffused idiopathic gingival enlargement in a middle aged adult recurring after a gap of 15 years. External bevel gingivectomy on the buccal aspects of maxillary and mandibular gingiva and diode laser for excision of the enlarged tissue on the lingual/palatal aspect was carried out to eliminate the excessive tissue. Periodic recalls showed maintenance of good oral hygiene and 1 year follow-up revealed no recurrence.

Multiple myeloma is a malignant neoplasm that is characterized by a monoclonal proliferation of plasma cells. Oral and maxillofacial manifestations as an initial sign or symptom of multiple myeloma are rare. A 58-year-old male patient presented with generalized gingival enlargement for last 6 months. Based on clinical presentation, a diagnosis of gingival hyperplasia was made. After Phase I therapy, excisional biopsy was taken in anterior mandibular region and excised tissue was sent for histopathological examination. The histopathology report revealed a lining of stratified squamous epithelium with foci of ulceration. The subepithelial zone showed infiltration by sheets of mainly binucleate and multinucleate plasma cells, few cells being less differentiated. Rounded cytoplasmic inclusion bodies were identified in many of these cells. After a series of clinical investigations, a case of "multiple myeloma" was diagnosed. Patient presenting with generalized gingival hyperplasia should be worked up for systemic disease like multiple myeloma.

Some aspects of pathogenesis and therapeutic approach to the gingival recession are discussed in this short communication with the example of a typical case from Russia, where excessive socket curettage after a tooth extraction resulted in a marked gingival recession. Subgingival plaque and calculus can be secondary to recession. An argument about plaque as a source of microorganisms might be plausible in case of inflammation, although various microorganisms are normal for the oral cavity. From the viewpoint of general pathology, being an atrophic condition, recession can progress due to repeated damage. On the author's opinion, calculus removal is not indicated at least for aged patients with marked gingival recession, having modest esthetic demands. Socket curettage after exodontia should be gentle. Surgical treatment of the gingival recession is beyond the scope of this communication.