Au revoir Ashish Kumar Journal of Indian Society of Periodontology 2019 23(5):389-390

Dream it, believe it, and build it Anil Melath Journal of Indian Society of Periodontology 2019 23(5):391-392

Concluding note: Time to look back and move ahead Abhay Kolte Journal of Indian Society of Periodontology 2019 23(5):393-394

44-year journey of palatal connective tissue graft harvest: A narrative review Komal Puri, Ashish Kumar, Manish Khatri, Mansi Bansal, Mohd Rehan, Srinivasa Tenkasale Siddeshappa Journal of Indian Society of Periodontology 2019 23(5):395-408 Connective tissue graft (CTG) is considered the gold standard for soft-tissue correction and augmentation surgeries, but involves a secondary donor area and its associated complications. The techniques to harvest CTG have undergone a large number of modifications over a period of 44 years since the time it was introduced by Edel in 1974 to increase the width of keratinized gingiva. This review compiles all the techniques of graft harvest from the palate and their modifications which have been introduced in the last 44 years till date. This review is based on systematic reviews, comparative human studies, and case reports describing any new technique of graft harvest. Publications till April 2018 were selected and further reviewed. In addition, specific related journals and books were searched upon. In order to minimize the pain, bleeding, and morbidity associated with donor site, several researchers proposed harvesting of the connective tissue by means of different techniques, each precisely different from others in terms of design, incisions, and procedure of harvest. Although the latest techniques are minimally invasive with reduced incision lines, less compromised blood supply, accelerated healing, and no sloughing of the overlying flap, they are technique sensitive which requires higher expertise to execute.

Genotypic variations of Porphyromonas gingivalis in chronic periodontitis patients with and without diabetes: An in vitro study using arbitrarily primed-polymerase chain reaction and heteroduplex-polymerase chain reaction Siladitya Sen, Kukkamalla Meena Anand Journal of Indian Society of Periodontology 2019 23(5):409-415 Context: Diabetes has become an endemic throughout the world. Periodontitis is associated with diabetes, and it has been regarded as the sixth complication of diabetes. However, the role of diabetes on periodontopathic microbiota such as Porphyromonas gingivalis remains unclear. Aims: To compare the total number of different genotypes of P. gingivalis in chronic periodontitis patients with and without diabetes by using arbitrarily primed-polymerase chain reaction (AP-PCR) and heteroduplex-PCR. Settings and Design: This is a single-center comparative study. Materials and Methods: A total of 100 patients were included in this study. Patients were divided into two groups: Group A – patients having chronic periodontitis without diabetes (50) and Group B – patients having chronic periodontitis with diabetes (50). Subgingival plaque samples were collected from both groups of patients. Plaque samples were cultured for P. gingivalis. Positive culture samples and extracted DNA from samples by proteinase-K method were collected. Part of DNA samples were checked by AP-PCR using OPA-13 primer, and part of the DNA were checked using heteroduplex-PCR using P. gingivalis-specific Pg8 primer. Results were analyzed by polyacrylamide gel electrophoresis procedure. Statistical Analysis Used: Independent t-test and Chi-square test (SPSS 16) were used. Results: Thirty-four out of fifty samples of Group B patients were found positive for P. gingivalis, whereas 21 out of 50 samples in Group A were found positive for P. gingivalis. AP-PCR showed nine different genotypes in Group B and six different genotypes in Group A. Heteroduplex-PCR showed a total of seven different genotypes in Group B and five different genotypes in Group A. Conclusions: Results of this study show that, in diabetic condition, P. gingivalis shows increased variations in genotypes.

Detection of Enterococcus faecalis in subgingival biofilms of healthy, gingivitis, and chronic periodontitis subjects Chethana Kunthur Chidambar, Shrinidhi Maji Shankar, Pooja Raghu, Soumya Badravalli Gururaj, Kala Shashi Bushan Journal of Indian Society of Periodontology 2019 23(5):416-418 Background: Enterococcus faecalis is a Gram-positive, facultative anaerobic coccus that can survive under harsh conditions. Studies have shown a positive relationship between biofilm formation and gelE gene expression in E. faecalis. The production of gelatinase (MMP 2) has been detected in 50% of E. faecalis isolates from endodontic and periodontal infections, which suggests its role in the pathogenesis of apical and marginal periodontitis. Although E. faecalis is not considered a periodontopathogen, this species has been more frequently detected in subgingival samples with periodontitis than from periodontally healthy subjects, suggesting that the local conditions in periodontitis may favor its colonization. Hence, the aim of the current study was to detect and compare the presence of E. faecalis in subgingival biofilms of healthy, gingivitis, and periodontitis subjects. Materials and Methods: A total of 100 subjects aged between 25 and 55 years, from the Outpatient Department of Periodontics were recruited for the study. All the subjects were screened for gingival and periodontal status using plaque index, gingival index, and clinical attachment loss. They were divided into three groups based on the clinical findings. Group A: 18 healthy individuals (gingival index with score zero) Group B: 34 gingivitis patients (gingival index with score >1) Group C: 48 chronic periodontitis patients (clinical attachment loss >5 mm in >30% of sites). Subgingival plaque samples of all the enrolled subjects were collected using a sterile curette, later poured into a transport medium (Viability Medium Goteborg Agar III) and sent for microbial culturing within 2 h for detection of E. faecalis. Results: E. faecalis was detected in 26.8% of all samples evaluated. There was a significantly higher frequency of E. faecalis in subgingival biofilms of periodontitis group (41.7%), compared to gingivitis (5.9%) and healthy group (0%). Conclusion: Enterococci may contribute to increased collagen and periodontal destruction and may further lead to disease progression in patients with chronic periodontitis.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic periodontitis before and after nonsurgical therapy Anirudh Balakrishna Acharya, Indrajith Padukone Shetty, Shrinidhi Jain, Ibbani Padakannaya, Swetha Acharya, Leena Shettar, Srinath Thakur Journal of Indian Society of Periodontology 2019 23(5):419-423 Background: Various biomarkers have been evaluated for understanding the systemic inflammatory response (SIR) to periodontitis. Hematological markers have been reported to be useful biomarkers in a variety of diseases, including periodontal diseases. The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in periodontitis and their possible role in the SIR are not extensively documented. Therefore, this study assessed NLR and PLR in chronic periodontitis (CP) patients before and after periodontal treatment, which to the best of knowledge has not been reported in the literature. Materials and Methods: Sixty participants were grouped as systemically and periodontally healthy (H) (n = 30) and with CP (n = 30). Plaque index, gingival index, probing pocket depth, clinical attachment loss, leukocyte counts, platelet (PLT) counts, NLR, and PLR were estimated at baseline and also after treatment in the CP group. NLR was calculated as total neutrophil count/absolute lymphocyte count, and PLR was calculated as total PLT count/absolute lymphocyte count. The data were statistically analyzed. Results: Periodontal parameters differed significantly between groups H and CP at baseline and posttreatment. A pair-wise comparison of NLR and PLR between CP patients at baseline and posttreatment was significant. Correlation analyses were not remarkable. Receiver operating characteristics analyses provided significant NLR and PLR predictive cutoff values to differentiate between CP patients at baseline and posttreatment. Conclusion: NLR and PLR may serve as potential biomarkers of the SIR to CP to bridge the association between periodontal and systemic conditions.

Higher interleukin-33 levels in aggressive periodontitis cases Sujatha Pai Ballambettu, AR Pradeep, Meera Purushottam, Somdatta Sen Journal of Indian Society of Periodontology 2019 23(5):424-429 Context: Interleukin-33 (IL-33) is a novel alarmin that warns immune cells of tissue destruction in injury or infection. Aims: This study is aimed at analyzing and correlating the concentration of IL-33 in the gingival crevicular fluid (GCF) and plasma of healthy subjects and chronic and aggressive periodontitis patients with intronic variant single nucleotide polymorphisms (SNPs), rs1157505 (C/G) and rs7044343 (C/T) in the IL-33 gene. Settings and Design: This is a cross-sectional, biochemical, genetic study. Materials and Methods: Ninety subjects were divided into Group H: subjects with healthy periodontium, Group CP: chronic periodontitis patients, and Group GAgP: generalized aggressive periodontitis patients, based on clinical parameters of periodontal inflammation. IL-33 concentration in GCF, as well as plasma, was quantified using enzyme-linked immunosorbent assay. The SNPs rs1157505 and rs7044343 were analyzed using polymerase chain reaction-restriction fragment length polymorphism. Results: A significant difference was found in IL-33 concentration in GCF and plasma between the three groups. GG genotype of IL-33 SNP rs1157505 was associated with the highest GCF and plasma IL-33 concentration and was significantly more in GAgP than healthy or CP groups. IL-33 SNP rs7044343 did not show any such association. All GAgP patients had the highest GCF and plasma concentration of IL-33. Conclusions: IL-33 may be a potential inflammatory marker of periodontitis. GG genotype of SNP rs1157505 may be associated with GAgP.

Efficacy of an herbal antioxidant as an adjunct to nonsurgical periodontal therapy on procalcitonin levels in smokers with chronic periodontitis M V N Sravya, Rekha Rani Koduganti, Veerendranath Reddy Panthula, Prasanna Jammula Surya, Himabindu Gireddy, Rajashree Dasari, Manasa Ambati Journal of Indian Society of Periodontology 2019 23(5):430-435 Context: Smokers are at a higher risk of contracting periodontitis. This association is established and reported in many studies. Periodontitis is a polymicrobial disease, wherein smoking is an environmental factor which aggravates the damage caused to the tissues. Procalcitonin (ProCT) is a well-known marker for inflammatory and other infectious diseases and has been assessed in this study. It has been observed that the release of reactive oxygen species (ROS) is exaggerated in smokers. Antioxidants are administered to combat the harmful effects caused by the ROS, and Oxitard™ is a powerful herbal antioxidant that can counteract the action of free radicals. Aims: As smokers are more prone to tissue injury due to excessive release of ROS, this study aimed to understand the benefits of systemic administration of Oxitard after scaling and root planing (SRP) on serum ProCT levels in smokers with chronic periodontitis (CP). Settings and Design: This was a randomized interventional study, wherein forty patients participated. Materials and Methods: Forty smokers with CP aged, between 35 and 60 years, were equally divided into Group A (SRP + Oxitard) and Group B (SRP only), selected from an outpatient ward of a referral care hospital in Hyderabad. A written informed consent was obtained from all the patients, and the study was approved by the institutional ethical committee (DN0026-15). Statistical Analysis Used: Data were analyzed by GraphPad Prism software version 6.01 (GraphPad software incorporation, California, USA). Comparison within the groups was made by paired t-test and between the groups by unpaired t-test. P < 0.05 was considered of statistical significance. Results: Intragroup assessment showed an improvement in all the variables from baseline to 3 months, which was statistically significant (P < 0.0001). A comparison between the groups, however, yielded better results in Group A (Oxitard + SRP) over Group B. Conclusions: Oxitard administered systemically for 3 months after SRP was beneficial in improving both clinical and biochemical parameters.

Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized controlled split-mouth trial Anushree Manohar Potey, Rajashri Abhay Kolte, Abhay Pandurang Kolte, Dhawal Mody, Girish Bodhare, Resham Pakhmode Journal of Indian Society of Periodontology 2019 23(5):436-441 Background: The objective of our study was to evaluate and compare the effectiveness of coronally advanced flap (CAF) with or without the use of platelet-rich fibrin (PRF) membrane in the treatment of multiple adjacent recession defects (MARD) clinically and by cone-beam computed tomography (CBCT). Materials and Methods: Twenty healthy patients having 75 MARD were allocated randomly to CAF with orthodontic button group (CAFB) or CAFB + PRF membrane group (CAFB + PRF). Clinical parameters such as gingival recession depth (GRD), probing depth (PD), and keratinized tissue width (KTW) were calculated at baseline, 3 months, and 6 months. The distance from the facial alveolar crest of bone to gingival margin bone and gingival thickness (GT) at three different points were assessed by CBCT at baseline and 6-month postsurgery. Esthetic outcome and postoperative discomfort were evaluated using root coverage esthetic score and visual analog scale, respectively. Results: Percent root coverage achieved in CAFB category was 93.17% ± 13.23% and that in CAFB + PRF group was 95.68% ± 10.13% at 6 months, with no notable difference. Similarly, no difference was found in either group in GRD reduction, PD, and CAL postoperatively. Use of PRF resulted in statistically highly significant (P < 0.001) increased GT at 6 months' time point as compared to participants treated with CAF without PRF, which indicates clinical and esthetic benefits achieved through the procedure. Conclusions: CAFB can be used successfully to treat MARD with predictable outcome. Additional benefit in terms of gain in KTW and GT can be achieved when PRF membrane is used as an adjunct.