Background: Periodontitis is a complex multifactorial inflammatory disease characterized by the initial gingival destruction and progressive destruction of the periodontal ligament and alveolar bone, altering homeostasis and potential tooth loss. Periodontitis is primarily caused by dysbiotic microbial biofilms and an exaggerated host immune response, with persistent inflammation and tissue breakdown and it is influenced by genetic, environmental, and behavioral risk factors. Gene polymorphisms are variations in DNA and those associated with inflammatory cytokines, immune response regulators, and matrix-degrading enzymes contribute to disease susceptibility and progression. Aim: To assess the functional impact of non-synonymous single nucleotide polymorphisms in specific genes linked to periodontitis using an In silico approach. Objectives: To assess the gene polymorphism of interleukin genes using various bio tools like Sift, Panther, PolyPhen, SNPS&Go, and FATHMM and to compare the likeliness of the results. Materials and Methods: In this study, an in-silico approach was employed to assess the functional impact of non-synonymous single nucleotide polymorphisms (nsSNPs) in specific genes linked to periodontitis. Bioinformatics tools, including Sift, Panther, PolyPhen, SNPS&Go, and FATHMM, were utilized to predict the pathogenicity and structural consequences of selected polymorphisms. Results: The common tolerated sites in accordance with the various biotools are IL1B (rs1143634 F105F), IL3(rs40401 -P27S), IL4 (rs149950065- A102V, rs 199929962 -M128T), IL4R (rs1801275 -Q576R) IL6 (rs 2228145- D358A), IL 23R (rs11209026- R126Q R142Q) IL37(rs3811047 -T42A). The deleterious sites varied according to different biotool. Conclusion: These tools provided insights into evolutionary conservation, protein stability, and functional alterations induced by genetic variations. The findings highlight key deleterious polymorphisms that may serve as potential genetic markers for periodontitis susceptibility. This computational approach offers a cost-effective and rapid screening method for prioritizing polymorphisms for further experimental validation in genetic association studies.
This case report demonstrates the subperiosteal minimally invasive apicectomy and regeneration (SMART) procedure, in contrast to the traditional flap technique, for the apicectomy procedure. A minimally invasive method of incisions was used, and a subperiosteal tunnel was created with mucoperiosteum elevation. After thorough debridement of granulation tissue, the apicectomy procedure was performed; a sticky bone graft was prepared and then placed into the surgical site. Postoperative healing was uneventful with better esthetics. This technique had the advantage of not using membranes and screws and better preservation of keratinized gingiva. This case underscores the significance of an accurate diagnosis, describes the SMART procedure for apicoectomy, and presents a treatment approach for addressing the potential to replace the traditional approach in the future.
Aim: To compare and evaluate the shear bond strength (SBS) of resin nanoceramic and lithium disilicate-based glass ceramic to dentin luted with 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) containing resin cement following two different surface pretreatments. Materials and Methods: Eighty all ceramic computer-aided design (CAD)/computer-aided manufacturing (CAM) milled blocks were made and divided into four groups (I, II, III, and IV) of twenty samples each. The groups were surface pretreated resin nanoceramic block (I), surface pretreated lithium disilicate-based glass ceramic (Group II), Groups III and IV are nontreated resin nanoceramic and lithium disilicate-based glass ceramic blocks. Groups I and II are further subdivided into two subgroups (a and b) exposing them to two different surface pretreatments, i.e., air abrasion and acid etching, respectively. Collected teeth samples were sectioned at coronal dentin surface using water cooled diamond saw and polished to produce uniform smooth surface. A thin layer of 10-MDP containing resin cement was applied on all samples and luted on the dentin surface. All the luted specimens were subjected to universal tester to determine SBS and failure types were evaluated with stereomicroscope. Results: Statistically significant difference was found in the SBS of all samples with different pretreatment methods ( P < 0.05). Group Ia showed highest SBS (16.10 ± 1.51) followed by Group IIb (14.25 ± 0.90), Group Ib (12.30 ± 1.17), Group IIa (11.20 ± 1.23), and least bond strength values for Group III (10.25 ± 1.25) and Group IV (10.10 ± 1.20). Conclusion: Resin nanoceramic block with air abrasion pretreatment has the highest SBS followed by lithium disilicate-based glass ceramic with acid etching pretreatment.
Aim: The aim of this study is to compare the effectiveness of irrigation activation techniques on postoperative pain (PP) in mandibular premolar teeth after single-visit endodontic treatment. Methodology: Eighty patients with symptomatic irreversible pulpitis were selected. Patients were randomly allocated into four groups based on the final irrigation methods – Group I (side-vented needle), Group II (sonic activation), Group III (ultrasonic activation), and Group IV (reciprocal activation). After final irrigation protocol, obturation was done with gutta-percha points and AH Plus root canal sealer in a cold lateral condensation technique in all the groups. Postendodontic restoration was done using nanohybrid composite resin (Filtek Z350 × t, 3M ESPE, St. Paul, Minnesota, USA). Evaluation of PP was done at specific time intervals (2, 6, 24, 48, 72 h, and 7 days) after the single-visit root canal treatment. Patients were also instructed to take analgesics (ibuprofen 200 mg) if their pain scale crosses score 2 postoperatively based on Wong–Baker Faces chart. Statistical Analysis: The results were statistically analyzed by Friedman test and Mann–Whitney U -test. Results: There was a statistical significant difference in the mean PP scores among all the groups at different time intervals ( P < 0.05). Group III resulted in significantly less PP and analgesic than all the other groups in the first 24 h. Conclusion: Ultrasonic activation (Group III) showed least PP and analgesics intake than all the other groups.
Introduction: Periodontitis and hypertension are chronic conditions linked through shared inflammatory pathways and endothelial dysfunction. Emerging evidence suggests that dietary nitrate, particularly beetroot, may offer systemic and periodontal benefits via nitric oxide bioavailability. However, its impact in individuals with concurrent periodontitis and borderline hypertension remains underexplored. Objectives: This study aimed to evaluate the effects of dietary nitrate supplementation using beetroot gummies on salivary biomarkers and blood pressure in patients with periodontitis and borderline hypertension. Methodology: A clinical intervention was conducted on 40 participants aged 35–60 years with Stage I/II periodontitis and borderline hypertension, randomized into a control group and a test group receiving beetroot gummies (500 mg, twice daily for 15 days). Salivary nitrate, pH, ammonia, and blood pressure were assessed at baseline, day 15, and day 30. Repeated measures of analysis of variance and independent t -tests were used for statistical analysis ( P < 0.05). Results: Intragroup analysis showed a significant reduction in systolic and diastolic blood pressure in the test group postintervention. No statistically significant intergroup differences were observed in salivary nitrate, pH, or ammonia levels. However, trends indicated enhanced salivary pH stability and ammonia elevation. Conclusion: A significant reduction in blood pressure in periodontitis patients with borderline hypertension was evident in patients on nitrate-rich beetroot gummies, despite minimal changes in salivary biomarkers supporting the potential benefits of dietary nitrate that serves as a cost-effective adjunct in managing systemic and oral inflammatory conditions. However, further research is warranted with larger cohorts and extended follow-ups.
Background: The study aimed at the postobturation pain and healing of chronic apical periodontitis by the use of AH plus and Endosequence BC. Materials and Methods : A total of 44 patients with chronic apical periodontitis were enrolled in this double-blinded randomized clinical trial, randomly divided into two groups: Group I (AH Plus sealer) and Group II (Endosequence BC sealer). After root canal treatment and obturation, healing was evaluated at 1 and 3 months using radiographs and OsiriX Lite software. Pain levels were recorded before treatment and 24 h postoperatively using a 10-point Modified Verbal Descriptor Scale. Statistical analysis using an independent t -test compared pain scores and healing progress between the two groups at each time point. Results: Pain reduction (%) and lesion size in both groups were analyzed using an independent t -test. The EndoSequence BC Sealer group showed significantly greater pain reduction at 24 h ( P < 0.05) but not at 48 h, 72 h, or 7 days ( P > 0.05). Lesion size showed no significant difference between groups at baseline, 1 month, and 3 months. However, Group II exhibited significant lesion size reduction from baseline to 1 month and 3 months ( P < 0.05). Conclusion: Within the limitations of the study, initial pain reduction was observed in the bioceramic sealer. However, single-sitting root canal therapy for chronic apical periodontitis was performed without any failures being noted.
Background: Neuropeptides have been identified as pivotal regulators of periodontal inflammation. The primary objective of this study is to investigate the salivary and serum levels of substance P (SP), vasoactive intestinal peptide (VIP), and cortisol, aiming to elucidate their relationship with periodontal health and disease. In addition, it aims to explore the potential associations between these biomarkers, stress factors, and clinical periodontal parameters. Materials and Methods: A total of 90 individuals were recruited as a part of this study and categorized into Group I: healthy periodontium, Group II: nonsmokers with periodontitis, and Group III: smokers with periodontitis. The clinical parameters evaluated were gingival index, plaque index, probing pocket depth, and clinical attachment loss. Perceived Stress Scale (PSS) was evaluated by validated questionnaires. Serum and salivary expression of SP, VIP, and cortisol levels were estimated all the groups. Neuropeptides were estimated with enzyme-linked immunosorbent assay procedure, and the cortisol was estimated using electrochemiluminescent method. Results: Salivary SP and salivary and serum VIP levels were comparatively high in the generalized periodontitis with smokers (Group III) than in the generalized periodontitis (Group II) and healthy periodontium (Group I) groups, and the difference was statistically significant ( P = 0.001). Salivary cortisol levels and PSS scores were comparatively high in the generalized periodontitis with smokers (Group III) than in the generalized periodontitis (Group II) and healthy periodontium (Group I) groups, and the difference was statistically significant. Conclusion: Neuropeptides SP and VIP are modulated in periodontal disease. Smoking and stress may influence neurogenic inflammation in periodontitis by enhancing the local peptidergic innervation within the periodontium.
Alveolar bone defects caused by trauma, periodontal diseases, and congenital malformations pose clinical challenges that require effective therapeutic solutions. Biological scaffolds play a key role in tissue engineering by providing structural support for cell adhesion, proliferation, and differentiation. Among various natural polymers, alginate has garnered significant attention as a promising material due to its superior biocompatibility and gelation properties. In the systematic review, a comprehensive search of PubMed, Cochrane, and Google Scholar was conducted, resulting in the identification of 81 studies. After rigorous evaluation of titles, abstracts, and full texts, 7 articles were selected for inclusion. Exclusions were made based on title relevance, abstract evaluation, full text analysis, and publication dates prior to 2010. Data extraction focused on scaffold design, cell types, growth factors, and regenerative outcomes such as cell proliferation, mineralization, and alkaline phosphatase activity. The outcomes from studies involving alginate-based scaffolds for alveolar bone regeneration demonstrated enhanced bone production, increased bone density, and accelerated healing. However, concerns remain regarding the mechanical properties of alginate and its ability to integrate with resident tissue, support angiogenesis, and maintain long-term stability. Alginate shows great potential as a biological scaffold for alveolar bone regeneration; additional studies are required to optimize its design and resolve existing limitations. Future advancements in biomaterials and regenerative medicine are expected to strengthen the role of alginate in clinical applications for bone tissue engineering.
Introduction: Microbial adhesion on dental implant abutment can compromise the soft-tissue seal and result in periimplant infection. The aim of the present study is to compare the adherence of Streptococcus mutans , Streptococcus sanguinis , and Escherichia coli on the surface of direct metal laser sintering (DMLS) titanium, zirconia, and polyether ether ketone (PEEK) dental implant abutment materials. Settings: The study was conducted in the Department of Prosthodontics and Crown and Bridge, Government Dental College, Thiruvananthapuram. Design: The study design was in-vitro observational study. Materials and Methods: Disks of 2 mm thickness and 8 mm diameter of each material were placed in trypticase soy broth inoculated with E. coli and brain heart infusion broth inoculated with S. mutans and S. sanguinis , and incubated at 37°C for 72 h under agitation mode. The microorganisms adhered to the samples were extracted and plated for viable count. Surface roughness was evaluated using a profilometer, and average surface average roughness was estimated for each of the materials. The contact angle of each disk was computed. Statistical Analysis Used: One-way analysis of variance test ( F -test) and Scheffe multiple comparisons ( post hoc test) were carried out to compare quantitative parameters. Results: There was a statistically significant increase in the mean bacterial adherence of S. mutans in Zirconia (13.1 ± 4.8) as compared to PEEK (5.5 ± 0.5) ( P < 0.05). S. sanguinis in DMLS Titanium (11.4 ± 0.9) and E. coli in PEEK. Titanium exhibited the highest surface roughness and contact angle. Conclusions: Bacterial adhesion on DMLS titanium, zirconia, and PEEK presented varied results depending on the organisms tested. S. sanguinis adhered more to DMLS titanium and S. mutans showed more affinity toward zirconia, and E. coli adhered more to PEEK. Although DMLS titanium showed the highest surface roughness and contact angle, no significant correlation between surface characteristics and bacterial adhesion could be drawn.
Artificial intelligence (AI) has emerged as a transformative tool in health care, including periodontics, where its applications promise to revolutionize diagnosis, treatment planning, and disease management. This systematic review explores the integration of AI in periodontology, focusing on its ability to enhance diagnostic accuracy, predict disease progression, and optimize personalized treatment plans. By leveraging machine learning and deep learning (DL) algorithms, AI aids in the interpretation of complex datasets such as radiographs, clinical measurements, and patient histories. Key findings reveal that AI-driven tools significantly outperform traditional diagnostic methods in terms of speed and precision, while also facilitating real-time patient monitoring. Despite these advancements, challenges such as data standardization, ethical considerations, and the need for clinical validation remain major limitations. The review concludes that while AI has the potential to improve outcomes and efficiency in periodontics, its full integration requires addressing existing gaps in research and application.
Adolescents’ oral health is a vital yet often overlooked aspect of overall well-being. This paper explores the multifaceted dimensions of oral health in this demographic group, delving into the challenges they face, the impacts on their lives, and potential solutions to improve oral health outcomes. Through a comprehensive review of the literature, this paper aims to shed light on the importance of oral health promotion and preventive measures in adolescence, emphasizing the need for holistic approaches that consider social, cultural, and economic factors influencing oral health behaviors. Understanding the complexities surrounding oral health in adolescents can help policymakers, healthcare professionals, and educators to work together in implementing effective interventions and initiatives to foster better oral health outcomes in this critical stage of life. By implementing evidence-based strategies such as school-based programs, community outreach initiatives, digital health interventions, policy changes, and collaborative care models, stakeholders can promote positive oral health behaviors and improve access to preventive services. Investing in adolescent oral health today is essential for ensuring healthier futures and reducing oral health disparities in communities.
Uncommon case scenarios often present diagnostic challenges even to the medical fraternity at the primary and at times in the secondary healthcare facilities. Dental fraternity members may face circumstances where the patient seeks relief, moving up for multiple consultations for the same condition when their health does not improve from the initial state of disease presentation. One such patient presented with Herpes zoster oticus along with super-added bacterial infection, previously treated with the nonsteroidal anti-inflammatory drug (Aceclofenac) in a dental clinic for dental pain. Subsequently, the patient developed right-sided facial swelling and sought care in another multispecialty hospital, after 5 days of previous therapy from the dental clinic, where it was diagnosed to be a possible adverse drug reaction resultant from the usage of aceclofenac for dental pain. Later, she developed vesicles over her face and ear and visited our institute for another opinion. We herewith present a case of Ramsay Hunt syndrome with cranial polyneuropathy involving both the geniculate and the trigeminal ganglion associated with chronic suppurative otitis media, which prompted an early diagnosis and a better patient prognosis.
Context: Hydrophilic dental implants were found to accelerate osseointegration thus reducing healing time in dental implants. Aims: The aim of the present study was to evaluate the marginal bone loss, healing of soft tissue, and primary and secondary implant stability of hydrophobic and hydrophilic implants in subjects with a history of periodontitis. Materials and Methods: Consenting patients who needs replacement of two or more teeth in mandible with adequate bone volume to accommodate dental implants were randomized to receive dental implants. Dental implants with a standardized diameter were placed on both quadrants of the mandibular arch. In one of these quadrants, an implant with hydrophilic properties was used, while the other quadrant received a conventional implant. Implant stability was measured using resonance frequency analysis immediately after implant placement and after 2 week, 1 month, and 3 months of implant placement. Marginal bone level was analyzed using intraoral periapical radiograph (IOPA) with grid after 3 months of implant placement. Soft-tissue healing was measured using Landry Turnbull and Howley Healing Index. Statistical Analysis Used: Independent Student’s t -test was used to compare the mean bone density and primary and secondary stability values between two groups during different time intervals and Mann–Whitney test was used to compare the mean soft-tissue healing scores between two groups at different time intervals. Results: Implant stability of hydrophilic implant was found to be higher when compared to conventional implants after 3 months of implant placement and the difference is statistically significant at P = 0.007. Mean marginal bone loss was significantly lesser in hydrophilic implants ( P = 0.013). Conclusions: The implant stability of hydrophilic implants was found to be statistically significant in periodontitis patients, and this outcome can be attributed to the notably reduced marginal bone loss observed in hydrophilic implants when compared to conventional dental implants.
Background: Resin composites require optimal mechanical strength for long-lasting restorations. Although preheating improves flowability, adaptation, and degree of conversion, repeated preheating cycles during clinical use may induce thermal stresses that alter material properties. Hence, it is important to evaluate the effect of repeated preheating under simulated oral stresses on the microhardness of nanohybrid composites. Aim: This study aims to assess and compare the microhardness of a nanohybrid composite cured at room temperature and after 1, 15, and 30 repeated preheating cycles at 70°C in Class I restorations, followed by chewing simulation and thermocycling. Materials and Methods: This in vitro study involved Class I cavity preparations on the occlusal surfaces of 60 extracted human premolars. Samples were allocated into four groups ( n = 15): Group 1 – composite placed without preheating; Group 2 – composite placed after 1 preheating cycle; Group 3 – composite placed after 15 preheating cycles; and Group 4 – composite placed after 30 preheating cycles. Following etching and bonding, the composite was preheated according to group allocation, placed in the cavities, and light-cured. Specimens were subjected to cyclic loading for 120,000 chewing cycles and 5000 thermocycles. Microhardness was evaluated using the Vickers microhardness test, and data were analyzed using the Kruskal–Wallis and Mann–Whitney U -tests ( P < 0.05). Results: The results showed no significant difference among the groups; however, a noticeable reduction in microhardness was observed after 30 cycles of repeated preheating. Conclusion: Under simulated oral conditions with chewing simulation and thermocycling, repeated preheating for 30 cycles did not significantly affect the microhardness of the nanohybrid composite, suggesting its durability.
Aim: The aim of this study was to assess the time-dependent antimicrobial efficacy of three endodontic irrigants 1% chlorhexidine (CHX), 1% alexidine (ALX), and 5% sodium hypochlorite (NaOCl) against Enterococcus faecalis , a common pathogen in persistent root canal infections. Materials and Methods: The microdilution method was used to calculate the minimum inhibitory concentration (MIC) for the experimental irrigants against E. faecalis . For the time-kill assay (TKA), concentrations were set at double the MIC to ensure effective antimicrobial activity. Standardized inoculum of E. faecalis was exposed to the experimental irrigants (1% CHX, 1% ALX, and 5% NaOCl) and control (bacterial suspensions without any irrigant served as the control) group, and bacterial viability was assessed at 30, 60, 90, and 180 s using serial dilutions to measure log reductions in colony forming unit (CFU) counts. Results: The results of the TKA showed the lowest mean CFU for ALX (2.1 ± 3.28), followed by CHX (7.09 ± 0.030), NaOCl (7.13 ± 0.02), and the control (7.21 ± 0.135). The difference was statistically significant ( P < 0.0001). Conclusion: Hence, the authors conclude that ALX showed the highest antimicrobial activity and could serve as a valuable alternative to conventional irrigants, particularly in cases where rapid and effective bacterial eradication is crucial for successful treatment outcomes.
Aim: This study attempts to identify oral healthcare providers’ perceptions toward transgender patients, their perceived barriers in accessing oral health services, and to check if they were open to inclusive oral healthcare practices. This study also aimed to study the experiences of transgender patients in oral healthcare settings including their oral healthcare seeking behaviors and beliefs. Materials and Methods: A questionnaire study was conducted among 50 oral health practitioners and 96 transgenders in and around Puducherry (U.T.). The questionnaire explored participant demographics, their beliefs, and their experiences like barriers and transgender-inclusive practices in oral healthcare settings. Results: The results exposed the agreement of 26% of oral health practitioners’ unwelcoming attitudes toward transgender patients in their clinics. Furthermore, 43% of the transgenders revealed that they faced discrimination from certain oral health practitioners and the other patients in the clinic during their visits. Almost 72% of participants stated that they lack financial coverage for their treatments. Conclusion: A sense of responsibility among oral health practitioners and the common people to impart a sense of comfort and safety to transgenders is warranted. The government must enforce strict laws against discrimination and promote education, vocational training, employment, psychosocial counseling, free gender-affirmative surgeries, and subsidies for other healthcare concerns of the transgenders. The dental bodies must promote awareness of oral health issues of transgenders and conduct preventive and treatment programs for them regularly.
Radicular cysts are the most common cystic lesions in the jaws and are usually associated with a necrotic tooth. This case report presents a large radicular cyst involving the right maxillary central and lateral incisors. A 46-year-old male patient reported to our department with a chief complaint of swelling, discoloration, and pus discharge on application of external digital pressure in the upper front tooth region for 2 weeks. Advanced radiography like cone beam computed tomography (CBCT), apicoectomy, and histopathological investigation like biopsy, along with bone graft and collagen membrane, contributed to successful endosurgical management of this case. The treatment of choice for this case was enucleation under local anesthesia. No recurrence was noted during the follow-up period. At 12-month follow-up, CBCT showed complete reformation of the labial cortical plate and significant bone healing. Thus, the use of guided tissue regeneration should be considered as an adjunct in the management of large periapical lesions in medically compromised patients.
Background: In modern society, the pursuit of a beautiful smile significantly influences personal and social interactions. Patients increasingly seek treatment to enhance smile esthetics, where gingival appearance plays a vital role in the overall esthetic outcome, especially in fixed prosthodontic restorations. Proper treatment planning and maintenance of optimal gingival health are essential for achieving desirable results. Aim: This study aimed to assess the self-awareness and satisfaction of young adults regarding their gingival esthetics. Materials and Methods: A cross-sectional study was conducted among 195 young adults aged 18–28 years. Participants completed a self-administered smile esthetics self-perception questionnaire, consisting of 11 questions related to their gingival esthetics. Responses were calculated as Yes, No, Didn’t notice, or Maybe. Frequencies and percentages were calculated, and comparisons were performed using the Chi-square test, with significance set at P < 0.05. Results: Over half of the participants expressed awareness and satisfaction for Q1 (65.6%), Q2 (59.5%), Q3 (67.2%), and Q8 (60%). Q2 (Do you think people around you have a better smile?) had the highest percentage of “Maybe” responses (20%), indicating uncertainty. Gender differences were significant for Q2, Q3, Q8, and Q9. Other questions showed no significant differences ( P > 0.05). Conclusion: The findings emphasized the need for integrating both functional and esthetic considerations in dental practice to better meet patient expectations regarding gingival esthetics.
Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has revolutionized the prosthodontic field by offering unprecedented precision and efficiency in the fabrication of dental restorations. Among the different materials used in CAD/CAM dentistry, ceramics have emerged as a chief choice because of their good esthetics, biocompatibility, and enhanced mechanical properties. This review explores the basic principles of CAD/CAM technology and their role in the digital workflow of prosthodontic restorations. It also explains the characteristic features of ceramics which are suitable for CAD/CAM fabrication.
