Ayurveda is considered as the "science of life," because the ancient Indian system of health care focused views of man and his illness. India has an age-old heritage of traditional herbal medicine. Conventional drugs usually provide effective antibiotic therapy for bacterial infections, but there is an increasing problem of antibiotic resistance and a continuing need for new solutions. Hence, now herbal drugs are being preferred to synthetic antibiotics. 'Triphala' is a well-known powdered preparation in the Indian system of medicine (ISM). It consists of equal parts of the Emblica officinalis, Terminalia chebula, and Terminalia belerica. Currently, Triphala is being extensively researched for its various therapeutic effects including its anti-caries, antioxidant, anti-collagenase, and anti-microbial activities. The present review will focus on the comprehensive appraisal of Triphala and its several applications in dentistry.

Cranberry juice polyphenols have gained importance over the past decade due to their promising health benefits. The bioactive component, proanthocyanidins is mainly responsible for its protective effect. A lot has been said about its role in urinary tract infection and other systemic diseases, but little is known about its oral benefits. An extensive search was carried out in the PubMed database using the terms "cranberry polyphenols" and "periodontitis" together. The institute library was also thoroughly scrutinized for all relevant information. Thus, a paper was formulated, the aim of which was to review the role of high molecular weight cranberry fraction on oral tissues and periodontal diseases.

Objective: Chronic periodontitis (CP) is associated with increased levels of blood reactive oxygen species (ROS). So, treatment of CP may lead to decrease in blood ROS. However, not much literature is available comparing the effect of surgical and non-surgical periodontal treatment on blood ROS levels. Reactive oxygen metabolites (ROMs) are a useful measure of blood ROS. The aim of this study was to investigate the effect of periodontal treatment on plasma ROM levels in CP patients. Materials and Methods: Thirty CP patients and 15 controls were monitored. Plasma samples were collected at baseline and the clinical parameters were recorded. The CP patients were randomly divided into two groups: Scaling and root planing (Group II) and periodontal flap surgery (Group III). Both groups were re-evaluated 1 and 2 months after therapy. Clinical parameters were reviewed, plasma samples collected, and ROM levels were determined using a spectrophotometric technique. Results: At baseline, the ROM levels for Group II and Group III were 519.8 ± 62.4 and 513.4 ± 74.7 CARR U, respectively, which were higher than Group I value (282.9 ± 23.9, P < 0.001). Periodontal treatment in CP patients resulted in improvement of clinical parameters and a highly significant reduction in plasma ROM level (P < 0.001) after 2 months. Also, there was a more significant reduction in plasma ROM levels in Group III as compared to Group II (P < 0.05). Conclusions: In CP patients, surgical periodontal treatment was more effective in lowering the plasma ROM levels than when non-surgical periodontal treatment was performed alone and, therefore, may be more beneficial in reducing systemic oxidative stress.

Background: Periodontitis is an inflammatory disease characterized by connective tissue breakdown and alveolar bone resorption. Objective: The aim of this study was to make a quantitative evaluation of the gingival tissue components in biopsies from patients with different clinical states of periodontal disease and to determine the relationship between the presence of interleukin-8 and the tissue destruction. Materials and Methods: The study group consisted of 33 biopsies from adult subjects. A total of 25 periodontal patients were sub-classified on the basis of the clinical and radiographic criteria in mild, moderate and advanced periodontitis. Gingival samples were obtained from patients in the course of basic periodontal surgeries as a muco-periostic collate. Data were analyzed by the SPSS system. Results: Collagen fibres decreased as non-specific chronic states increased. A lymphocyte inflammatory infiltrate changed to a lymphoplasmocytary form. Reactivity to interleukin-8 was detected with the severity of the histopathologic diagnoses; however there was no association with the clinical diagnoses. Conclusions: Histopathology and histomorphometry of gingival tissue changed with the degree of inflammation. No evidence of interleukin-8 as a biomarker for clinical diagnoses of periodontitis was obtained.

Background: Gingivitis and periodontitis are initiated by inflammation caused by microorganisms. Pathogen-associated molecular patterns (PAMPs) from these microorganisms are recognized through various toll-like receptors (TLRs) and NOD-like receptors (NLRs). In this study, we have chosen five TLRs and two NLRs as representatives taking part in the recognition and inflammation process, along with a few of their signaling mediators including CD14, MYD88, and TRIF to compare their mRNA expression levels between healthy and diseased gingival tissues. This will provide deeper insight into the mechanisms underlying gingivitis and periodontitis. Understanding the mechanisms involved in the onset and progression of the periodontal diseases could greatly help in establishing effective ways for prevention and treatment of these diseases besides decreasing the risk factor for relevant systemic disorders. Materials and Methods: Gingival tissue samples for mRNA extraction and cDNA synthesis were taken from patients with gingivitis and periodontitis and from healthy control subjects. Messenger RNA expression of all genes was assessed using real-time polymerase chain reaction (PCR). Results: Among the genes studied in different groups, only MYD88 mRNA expression was significantly higher in the periodontitis group compared to that of the controls. The expression level of this molecule was also significantly higher in patients with severe periodontitis compared to other patients and also compared to healthy individuals. In different tissues, positive significant correlations were observed between the mRNA expression levels of some genes. Conclusions: Elevated mRNA levels of MYD88 in periodontitis might have a key role in the pathogenesis of this disease. Therefore, MYD88 may be a useful target for the therapy of this disease.

Background and Objectives: Various bacterial species from subgingival biofilm have demonstrated aetiological relevance in the initiation and progression of periodontitis. The aim of this study was to detect the presence of Tannerella forsythia (Tf) in subgingival plaque of periodontally healthy subjects and chronic periodontitis patients by using both culture and PCR technique and compare the two techniques. Materials and Methods: Pooled subgingival plaque samples were taken using sterile curettes from predetermined sites in 50 periodontally healthy subjects and from 50 periodontitis subjects. Samples were analyzed for the presence of T. forsythia using both techniques. Statistical analysis of the results was done using Chi-square test, sensitivity, and specificity tests. Results: Both techniques could detect T. forsythia in subgingival plaque samples from healthy and periodontitis subjects. Periodontally healthy individuals and individuals with chronic periodontitis using the culture technique showed the presence of T. forsythia in 14 and 34%, respectively. PCR technique showed the presence of T. forsythia in 20% healthy and 40% chronic periodontitis patients. T. forsythia detection in the periodontitis group was statistically significantly higher when compared to the healthy group by both culture and PCR technique (P = 0.019 and P = 0.029). PCR demonstrated high sensitivity and low specificity when compared to the culture technique. Conclusion: The results indicated that T. forsythia was more prevalent in periodontitis patients when compared with healthy subjects. The PCR was found to be more sensitive than culture technique for detection of T. forsythia from the subgingival plaque samples.

Background: Ki-67 which is a non-histone nuclear protein which is expressed in proliferating cells, during all the active phases of the cell cycle. Increased Ki-67 expression has been seen in several inflammatory and malignant conditions like diabetes, rheumatoid arthritis, atherosclerosis, pancreatitis and squamous cell carcinoma. Aim: The aim of the present study is to analyze the expression of Ki-67 in gingival tissues by immunohistochemistry in smokers and non-smokers with healthy gingiva and chronic periodontitis. Materials and Methods: Gingival biopsies (n = 32) were obtained from smokers who had clinically healthy gingiva (n = 8), smokers with periodontitis (n = 8), chronic periodontitis (n = 8) and healthy gingiva (n = 8). The expression of Ki-67 was evaluated immunohistochemically. Statistical analysis used: Mean and standard deviation were estimated for the gingival tissue extract sample for each study group. Mean values were compared between different study groups by, one way ANOVA, post hoc analysis. In this study P < 0.05 was considered as the level of significance. Results: The mean number of Ki-67 positive cells/field was higher in the smokers with periodontitis group. When the mean Ki-67 positive cells were compared between different groups, statistical significant difference was observed between healthy and both the periodontitis groups (P = 0.000) and between smokers group (P = 0.001). Conclusions: Ki-67 was maximally expressed in smoker with periodontitis followed by chronic periodontitis patients, healthy smokers and healthy control patients which shed light on the toxic effects of tobacco in dysregulating the cell cycle and cellular proliferation. The findings of this study also help us to understand the role of the cell cycle in resolution of periodontal inflammation which is a salient feature in the pathogenesis of chronic periodontitis.

Background: Human leukocyte antigens (HLA) have been considered a candidate of genetic risk markers for aggressive periodontitis (AP). AP has also been associated with polymorphonuclear leukocyte (PMN) dysfunction. The role of monocyte subsets in AP has also not been completely explored. Therefore, the present study was undertaken to assess in, AP subjects, the possible association between defective PMN adhesion and β₂ -integrin expression; defective neutrophil migration and actin polymerization level; the expression of ABO blood group and HLA antigen; and the percentage of CD14+ CD16+ monocytes and CD45RA monocytes. All these parameters have been compared with the subjects of chronic periodontitis (CP) and healthy controls. Materials and Methods: A total of 45 subjects of the age group 20-50 years, free from any known systemic disease, were divided into three groups - Group I - periodontally healthy control (n = 15), Group II - CP (n = 15) and Group III - AP (n = 15). Peripheral blood samples were collected. ABO grouping and HLA typing were performed. β₂ -integrin expression, actin polymerization level and percentage of CD14+ CD16+ monocytes and CD45RA monocytes were estimated by fluorescence-activated cell sorter analysis. Results: Most of the subjects of AP belonged to the blood group "AB," and an increased frequency of HLA-A30, CW1 and DR1 (P < 0.1) and B44 and DQ2 (P < 0.05) were also observed in this group. In the AP group, both average values (β₂ -integrin and actin level) were significantly less than those of normal subjects (P < 0.001). The mean percentage of CD14+ CD16+ monocytes was found to be maximum in CP, followed by AP, and then in healthy subjects, while the mean percentage of CD45RA was maximum in AP, followed by CP, and then in healthy subjects. Conclusions: With the present state of knowledge from this study, a definite association of ABO blood groups and HLA phenotypes with periodontal diseases is yet to be established. Leukocytic functional defects were found in AP subjects. A statistically significant percentage of CD14+ CD16+ and CD45RA monocytes were found in AP subjects as compared with the normal control and CP groups.

Background: Local drug delivery agents can effectively deliver the antimicrobial drugs in bactericidal concentration, and have shown improved clinical outcomes when used as an adjunct to mechanical therapy. The aim of this study was to evaluate the efficacy of a xanthan-based chlorhexidine gel versus herbal extracts' gel as an adjunct to periodontal therapy in the treatment of chronic periodontitis. Materials and Methods: A total of 150 sites, age group of 30-50 years, periodontal pockets measuring 5-8 mm and diagnosed with chronic periodontitis were selected for the study. The selected sites were randomized in five groups: Scaling and root planing (SRP) alone (Group A), SRP + Chlosite gel (Group B), SRP + Herbal gel (Group C), Chlosite gel alone (Group D) and Herbal gel alone (Group E). Clinical parameters such as Plaque Index, Gingival Index, probing pocket depth and clinical attachment level were recorded at baseline and 1- and 3-month intervals. Results: After 3 months, there were statistically significant reductions in all the clinical parameters for Groups B and C compared with Group A. There was no significant reduction in all clinical parameters between Group D and E where no mechanical therapy was performed. Conclusion: The results indicate that the local application of herbal gel can be comparably used as chlorhexidine gel in the treatment of chronic periodontitis as an adjunct to mechanical periodontal therapy.

An increasing number of people all around the world are turning to the nature by using the natural herbal products. Green tea with active chemical ingredients possesses diverse pharmacological properties. Aim: The aim of this study is to compare the antiplaque efficacy of green tea catechin mouthwash with chlorhexidine gluconate mouthwash. Materials and Methods: A single blinded cross-over study was conducted among 30 participants in the age group of 18-25 years. The mouthwash samples for the study were previously labeled assigning the letters: A (0.25% of green tea catechin mouthwash) and B (0.12% of chlorhexidine mouthwash). The study subjects were randomly divided into two groups of 15 each and the study was divided into two phases. In phase I, the mouthwash A was given to one group and other group was given mouthwash B. After a 15 day washout period, in phase II, both groups were given other mouthwash. At the end of each phase of 1 week, plaque score was recorded by using Turesky modification of the Quigley-Hein plaque index. Results: The plaque scores were compared and the difference between the green tea catechin and chlorhexidine mouthwash was determined by t-test. The difference between plaque scores were not statistically significant (P > 0.05). The results showed that both the groups that is green tea catechin mouthwash (0.25%) and chlorhexidine mouthwash (0.12%) have comparable results in plaque reduction. Conclusion: This study supports the effectiveness of green tea catechin mouthwash as an antiplaque agent. It should be explored as a cost-effective, long-term antiplaque rinse with prophylactic benefits.

Background: Bacteremia is associated with periodontal diseases whose extent is related to the severity of inflammation in periodontal tissues. The purpose of this study was to assess and compare the various blood parameters in healthy subjects and severe chronic periodontitis patients. Materials and Methods: 100 patients with severe chronic periodontitis (test group) and 100 periodontally healthy subjects (control group) in the age group 35-60 years participated in the study. Blood parameters were recorded with blood samples drawn from the antecubital fossa by venous puncture. Results: Periodontitis group showed lower erythrocyte count and mean corpuscular hemoglobin concentration (MCHC), and increased total leukocyte count (TLC) and neutrophil, lymphocyte, and eosinophil count, compared to the healthy control group. Conclusions: To conclude, periodontitis may tend toward anemia and there is marked leukocytosis due to increased number of circulating neutrophils and lymphocytes.

Aim: The purpose of the study was to evaluate the serum levels of zinc (Zn) and magnesium (Mg) in type 2 diabetes mellitus (DM) with periodontitis patients and to correlate them with the levels of serum cholesterol, high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), and triglycerides among the study subjects. Materials and Methods: A total of 600 subjects participated in the study, who were divided into four groups as control healthy individuals (group I), type 2 DM without periodontitis (group II), type 2 DM with periodontitis (group III), and periodontitis subjects without DM (group IV), matched for age, sex, and duration of diabetes. Serum concentrations of glucose, total cholesterol, triglycerides, HDL-c, Zn, and Mg were measured using enzymatic methods in an UV absorption spectrophotometer, and LDL-c was calculated using Friedwald's formula. Student's t-test, Pearson correlations, and analysis of variance (ANOVA) tests were used for statistical analysis. Results: The serum zinc level was found to be significantly increased in type 2 DM without periodontitis (group II) and periodontitis subjects without type 2 DM (group IV) (P < 0.0001), and the level was lowered in type 2 DM with periodontitis (group III) when compared to control. The serum Mg level was found to be significantly decreased (P < 0.0001) in group II, group III, and in group IV, when compared to control. We found a significant increased level of serum total cholesterol and LDL-c and decreased triglycerides and HDL-c in type 2 DM subjects with periodontitis (group III, P < 0.0001). Conclusion: Patients with DM and periodontitis had altered metabolism of Zn and Mg which were linked to increased values of serum cholesterol and LDL-c and decreased HDL-c, contributing to the progression and complications of type 2 DM with periodontitis.

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

Background: An increasing number of adult patients are seeking orthodontic treatment to improve their dental appearance. However, special attention must be given to the periodontal status of the adults as periodontal disease and its sequel, such as pathologic migration of anterior teeth, result in esthetic and functional problems. In such adult patients, an interdisciplinary approach often offers the best option for achieving a predictable outcome to solve complex clinical problems. Materials and Methods: A prospective study was carried out on 20 adult patients [mean age = 33.3 ± 4.52 (SD), 11 females and nine males] with periodontally compromised and malaligned dentition. Loe and Silness Gingival Index (GI), Ramfjord's Periodontal Disease Index (PDI) and Dental Aesthetic Index (DAI) were recorded at the start and after completion of treatment. Results: Comparison of GI, PDI and DAI before and after completion of treatment showed statistically significant differences, indicating the relevance of combined orthodontic-periodontic treatment in periodontally compromised dentition (P < 0.01). Conclusion: The outcome of the study showed that an interdisciplinary approach is a simple solution for complex clinical problems arising as a sequel to periodontitis, such as pathological tooth migration, restoring function, esthetics and periodontal health.

Background and Objectives: Aim of this randomly controlled clinical study was to evaluate the role of antibiotics to prevent postoperative complications after routine periodontal surgery and also to determine whether their administration improved the surgical outcome. Materials and Methods: Forty-five systemically healthy patients with moderate to severe chronic periodontitis requiring flap surgery were enrolled in the study. They were randomly allocated to Amoxicillin, Doxycycline, and control groups. Surgical procedures were carried out with complete asepsis as per the protocol. Postoperative assessment of patient variables like swelling, pain, temperature, infection, ulceration, necrosis, and trismus was performed at intervals of 24 h, 48 h, 1 week, and 3 months. Changes in clinical parameters such as gingival index, plaque index, probing pocket depth, and clinical attachment level were also recorded. Results: There was no incidence of postoperative infection in any of the patients. Patient variables were comparable in all the three groups. Though there was significant improvement in the periodontal parameters in all the groups, no statistically significant result was observed for any group over the others. Conclusion: Results of this study showed that when periodontal surgical procedures were performed following strict asepsis, the incidence of clinical infection was not significant among all the three groups, and also that antibiotic administration did not influence the outcome of surgery. Therefore, prophylactic antibiotics for patients who are otherwise healthy administered following routine periodontal surgery to prevent postoperative infection are unnecessary and have no demonstrable additional benefits.

Background: The aim of this study is to compare, clinically and radiographically, the effectiveness of nanocrystalline hydroxyapatite (NHA) and synthetic resorbable hydroxyapatite (HA) in the treatment of intrabony defects. Materials and Methods: Ten subjects with bilateral defects, with probing depth (PD) 6-9 mm and radiographic evidence of an intraosseous component ≥4 mm participated in the present study. Subjects were allocated randomly to treatment with NHA (test group) or HA (control group). At baseline, 3 and 6 months after surgery, the following clinical parameters were recorded: Plaque index, gingival index, PD, relative attachment level (RAL), and radiographic reduction in intrabony defect. Results: At 6 months following therapy, the test group showed a reduction in mean PD from 6.4 ± 0.843 to 3.3 ± 0.8232 mm and a change in mean RAL from 12.9 ± 1.197 to 10.1 ± 0.7378 mm, whereas in the control group the mean PD decreased from 7.65 ± 1.8566 to 3.9 ± 1.1005 mm, and mean RAL decreased from 13.9 ± 0.9944 to 10.7 ± 0.6749 mm. On comparison of the mean difference in probing depth between the two groups after the unpaired t-test was applied at baseline, 3 months and 6 months, scores were found to be statistically non-significant (P > 0.01). Conclusion: The results of the present study indicate that both NHA and conventional HA led to the improvement of clinical and radiographic parameters over the course of the study. However, the test group did not show any significant improvement over the control group.

Background and Objectives : Assessing only the clinical and radiographic parameters for evaluation of dental implants may not be enough as they often reflect extensive inflammatory changes in the periodontal tissues. As peri-implant crevicular fluid (PICF) can give us a more prompt and objective measure of the disease activity, the purpose of this case series is to assess the peri-implant health status of single tooth dental implants not only clinically and radiographically but also biochemically. Materials and Methods: Thirteen patients were subjected to dental implants at single edentulous sites using a conventional surgical approach. At baseline, 6 months, and 12 months after implant placement, the clinical and radiographic parameters were recorded. Additionally, IL-1β in PICF was estimated using the ELISA kit at 6 ^th and 12 ^th month. Results: The clinical and radiographic parameters differed significantly around the implants at different time intervals with IL-1β levels showing highly significant differences between 6 months (31.79 ± 12.26 pg/μl) and 12 months (113.09 ± 51.11 pg/μl). However, Spearman's correlation coefficient showed no correlation with the clinical and radiographic parameters. Interpretation and Conclusion: Assessment of the various parameters confirmed that all the implants had a healthy peri-implant status. Although the levels of IL-1β in PICF were elevated at the 12 ^th month, they were well within the healthy range as observed by previous studies. This indicates that IL-1β, a biochemical marker, can be used as an adjunct to clinical and radiographic parameters in the assessment of EARLY inflammatory changes around implants.

Aims: Since the incidence of gingival overgrowth induced by amlodipine remains poorly defined, this study was carried out with an aim to determine the incidence. Materials and Methods: Dental patients who received amlodipine (N = 115), for more than 3 months were studied to determine the drug-induced gingival overgrowth. Clinical diagnosis of drug-induced overgrowth was verified by disappearance or decreased severity of gingival overgrowth after withdrawal of the causative drug. Results: The prevalence rate of amlodipine-induced gingival hyperplasia among experimental patients was 3.4%, while it was not observed among the control subjects. Oral examination revealed gingival overgrowth as a lobular or nodular enlargement on interdental papilla located in the anterior interproximal regions. Conclusions: In this study, there was a significant relationship between gingival inflammation resulting from dental plaque and drug dosage, and hyperplasia.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme defect in humans. G6PD deficiency is widely distributed in tropical and subtropical parts of the world and a conservative estimate is that at least 500 million people have a G6PD deficient gene. In several of these areas, the frequency of a G6PD deficiency gene may be as high as 20% or more. The vast majority of people with G6PD deficiency remain clinically asymptomatic throughout their lifetime. However, all of them have an increased risk of developing neonatal jaundice and a risk of developing acute hemolytic anemia when challenged by a number of oxidative agents. The most important treatment measure is prevention: Avoidance of the drugs and foods that cause hemolysis.

Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion with highly aggressive clinical behavior, higher incidence in young adults, and a strong tendency to recur. Two categories, trabecular JOF (TrJOF) and psammomatoid JOF (PsJOF), based on histologic criteria and a distinct predilection for specific age groups have been identified. Juvenile trabecular ossifying fibroma of peripheral variety is an uncommon clinical entity with aggressive local behavior and high recurrence rate. This article reports a case of aggressive JTOF in the anterior mandibular region in a 13-year-old boy with history of recurrence. Complete surgical resection of the growth was done along with involved periodontal ligament and periosteum to minimize the possibility of recurrence. The case was followed up for more than 3 months without recurrence.

Pyogenic granuloma (PyG) is a common cause of swelling in the oral cavity during pregnancy and also as an exaggerated response to any minor trauma. The condition is frequently associated with periodontal pain and discomfort, in some cases interfering with mastication and creating esthetic problems. Six patients reported to the Department of Periodontics with gingival overgrowth in the lower anteriors. After recording the details of the patients' oral hygiene status, all the patients were provided initial therapy with scaling and were prescribed analgesics for the reduction of pain and discomfort. After 1 week, surgical excision of the overgrowth was performed and sent for histopathological analysis. The histopathological report is suggestive of PyG.

Central odontogenic fibroma (COF), which has been categorized under the subheading of odontogenic tumors of ectomesenchyme, is such an uncommon neoplasm that much of its nature is left uncharted. COF is a rare tumor that accounts for 0.1% of all odontogenic tumors. Clinically, the lesion grows slowly and leads to cortical expansion. Radiologically, the lesion may be unilocular or multilocular. In some cases, it may be associated with root resorption or displacement. Histopathologically, the lesion is characterized by mature collagen fibers and numerous fibroblasts. A case of COF of the mandible in a male patient aged 49 years is described in this report. The patient showed no symptoms, no history of swelling discomfort or pain, and was unaware of the presence of the lesion. Orthopantomogram (OPG) showed generalized bone loss along with a unilocular radiolucent area, with a clear sclerotic lining and angular bone loss. Surgical enucleation of the lesion along with placement of osseo-graft, which is a bioresorbable demineralized bone matrix (DMBM), and platelet-rich fibrin was carried out in the defect site. Following surgery, patient was recalled for revaluation of the lesion; the surgical site showed good healing and an increase in bone height was seen.

Gingival enlargement, one of the manifestations of gingival and periodontal disease, is also known as gingival overgrowth. Idiopathic gingival enlargement is a rare gingival overgrowth, which is of an undetermined cause. This unknown etiology has now been linked to specific genes and idiopathic gingival enlargement is at times referred to as hereditary gingival enlargement. This condition is a benign, slow growing proliferation of gingival tissues. Aggressive periodontitis is the rapid form of periodontal disease which is characterized by extensive periodontal tissue destruction, increased host-susceptibility toward periodontal disease progress and a genetic predilection toward disease occurrence. We present a rare case of idiopathic gingival fibromatosis associated with generalized aggressive periodontitis in a young female. The patient presented with classic clinical and radiographic presentation associated with gingival enlargement and aggressive periodontitis. The diagnosis was then confirmed by histopathological and neutrophil functions tests.

Systemic antibiotic treatment has emerged as a powerful adjunct to conventional mechanical debridement for therapeutic management of the periodontal diseases. The conceptual basis for treating periodontal diseases as infections is particularly attractive in part because of substantial data indicating that these diseases may be associated with specific putative pathogens. Further, discrete groups of patients respond well to systemic antibiotics and exhibit improvement of clinical parameters, including attachment level and inflammation. This bacterial-host interaction, which is ever-so-present in periodontitis, directs us toward utilizing antimicrobial agents along with the routine mechanical debridement. This case report presents a case of a female patient with recurrence of the chronic generalized periodontitis with gingival enlargement, which is treated thrice by referral dentist. A through clinical examination was carried out pre-operatively and treatment was planned with systemic minocycline in conjunction with the conventional non-surgical approach. There was a significant reduction of pocket depth, gain in attachment with dramatic improvement clinically.

Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of surgical lip repositioning technique for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. The procedure restricts the muscle pull of the elevator lip muscles by shortening the vestibule, thus reducing the gingival display when smiling. Healing was uneventful and follow-up examinations of 10 months revealed reduced gingival display. For patients desiring a less invasive alternative to orthognathic surgery, lip repositioning is a viable alternative.

Peripheral ossifying fibroma (POF) is a non-neoplastic enlargement seen more often in females, in the interdental papilla and the anterior part of the maxilla, accounts for about 9% of all gingival growths. Of unknown etiology, unpredictable clinical course and pronicity for recurrence, POF is a clinician's cause for concern. Surgical excision is the treatment of choice, but with a reported recurrence rate of 7-45%, the management is often frustrating. With increasing acceptance of lasers in the repertoire of clinician's armory, laser excision of such lesions has become a possible, feasible, and patient-preferred approach. The purpose of this article is to report successful management and 1 year follow-up of two cases of POF using neodymium-doped yttrium aluminum garnet (Nd: YAG) laser. The absence of operative bleeding, relative ease of the procedure and patient acceptance lends the laser excision as an alternate therapeutic modality for excision of gingival enlargements of suspicious and vexatious nature.

Esthetic zone restoration is a challenging aspect in implant dentistry because of two critical factors such as level of bone support and soft tissue dimensions. Preservation of healthy peri-implant tissues is of primary importance for ensuring better esthetics over an extended period. The aim of the present case-series was to evaluate a new staged approach of implant placement in immediate extraction sockets for preservation of peri-implant soft and hard tissues. Four subjects scheduled for extraction of teeth in the esthetic zone with neither a periapical nor periodontal infection and with thick tissue biotype were included. For all the subjects sand blasted, large grit, acid etched platform switched implant with a diameter 2 mm less than the diameter of extraction socket and a conical abutment-implant connection (Morse taper) were placed 2 mm below the crest of the socket, with almost 2 mm gap between the labial plate and the implant with shoulder placed palatally/lingually. The implants were loaded after 2 months healing period and followed for a period of 1-2 years. In all the four patients there was preservation of both hard and soft tissues around the implant with a good esthetic outcome in all the follow up visits. Integrating immediate placement with stable implant-abutment connection, platform switching concept and careful case selection, we can achieve a very good esthetic outcome.