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Background: This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM)., Methods: A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months., Results: Group-1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups., Conclusion: ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients., (© 2023 American Academy of Periodontology.)

Background: The interaction between the recipient area and the graft is one of the key factors in the success of periodontal plastic surgery. This randomized controlled, split-mouth, double-blinded clinical trial aimed to compare the clinical and aesthetic outcomes of epithelialized palatal graft (EPG) and gingival unit graft (GUG) in achieving root coverage in localized (Recession Type 1) RT1 recession defects., Methods: Twenty participants with forty bilateral recession defects randomly received EPG or GUG surgical treatment modalities for each of the recession defects. Clinical measurements recorded at baseline and after six months included recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and the average width of mesial and distal interdental papilla (aWIDP)., Results: There was a statistically significant greater mean root coverage (MRC) percentage at GUG sites (80.68 ± 16.12%) in comparison to EPG sites (71.05 ± 17.23%) ( p  = 0.01). The treatment satisfaction ( p  = 0.009) and aesthetic satisfaction ( p  < 0.001) experienced were significantly better for GUG as compared to EPG. The regression model ( R 2  = 0.56) significantly predicted MRC percentage in GUG sites with baseline RD ( β  = -12.49; p  = 0.02) and aWIDP ( β  = -9.31; p  = 0.02)., Conclusion: GUG showed a better MRC, aesthetics and increased KTW. Root coverage procedures often need to suffice the dual objective of coverage and aesthetics at the same time. GUG is a simple modification of the conventional EPG that can provide better clinical and aesthetic outcomes., (© 2024 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

Objectives: The aim of the present study is to evaluate and compare healing outcomes, probing pocket depth (PPD) reduction, clinical attachment, and alveolar bone level following Modified Widman Flap (MWF) with and without 4× prismatic loupe in infrabony pockets., Methods: Patients having at least one infrabony pocket with PPD ≥5 mm and angular bone loss ≥3 mm bilaterally were randomly assigned to a microsurgical (test) group with MWF using 4× magnifying loupes and conventional (control) group by MWF only. At baseline, 3 and 6 months plaque index, bleeding index, PPD, and relative clinical attachment level were taken. The healing outcome was evaluated with a healing index by Landry. Pain score was assessed with Visual Analog Scale (VAS). The percentage of defect depth (DD) reduction was assessed by cone beam computed tomography (CBCT) and periapical radiograph. Continuous data between groups were analyzed using an unpaired "t" test. Within-group comparison was done using repeated measures analysis of variance followed by multiple pairwise comparisons and paired "t" test., Results: There was a statistically significant ( P = 0.004) reduction in intrabony DD in each group evaluated through CBCT. The mean VAS score after 1 week of surgical procedure was 3.67 at the conventional site compared to 2.9 at the microsurgical site, which was statistically significant ( P = 0.004). Statistically significant ( P ≤ 0.05) healing scores were observed for microsurgery group (84.6% after 1 week) compared to control group (15.4% after 1 week)., Conclusion: Although blinding of patients and surgeons was difficult and healing indices used are subjective, it can be concluded that microsurgery under 4× magnifying loupe is as effective as conventional MWF in the treatment of infrabony pockets but clinical parameters are greatly enhanced by microsurgery with improved healing and less patient discomfort., Competing Interests: None., (Copyright: © International Journal of Health Sciences.)

Context: The changes in the volume and dimensions of the alveolar bone after tooth extraction often lead to challenges in prosthetic rehabilitation of the same necessitating ridge preservation procedures (RPP)., Aim: The aim of this randomized clinical trial was to evaluate and compare the dimensional and histomorphometric changes of the sites preserved using the collagen membrane with and without demineralized bone matrix (DMBM)., Settings and Design: Interventional, parallel-design, double blinded, randomized controlled trail., Materials and Methods: A randomized controlled trial was designed with 45 participants having at least 2 teeth indicated for were enrolled in this study. The sites were randomly assigned to the control group (RPP using collagen membrane) and the test group (RPP using collagen membrane with DMBM). The clinical parameters assessed were alveolar bone width and alveolar bone height. Histomorphometric analysis was carried out on tissue trephined from the preserved sites to evaluate the percentage of bone and connective tissue (CT %) formed 8 months postRPP., Statistical Analysis Used: Shapiro - Wilk test and paired and unpaired t -test., Results: Horizontal resorption was significantly less in the test group (7.375 ± 1.64). Histomorphometry of these sites revealed a complete absence of residual graft particles, presence of trabecular bone, and a more mineralized matrix (63.256%) as compared to the control sites (46.833%)., Conclusions: The use of DMBM along with the collagen membrane for RPP yielded better results both clinically and histomorphometically., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Contemporary Clinical Dentistry.)

Introduction: Polycystic ovary syndrome (PCOS) is a female metabolic disorder that is characterized by ovulatory dysfunction, elevated serum androgen concentrations, and polycystic ovarian morphology (PCOM). However, diagnosis of PCOS in adolescents is challenging., Areas Covered: The mechanisms of PCOS pathophysiology are discussed that include: i) dysregulation of the levels of steroidal enzymes ii) abnormalities in the secretion of gonadotropin releasing hormone, luteinizing hormone, and follicle stimulating hormone , and iii) abnormalities in ovarian Thecal and Granulosa cell function. Current clinical diagnosis protocols for PCOS in women are covered. The challenges in diagnosis of PCOS particularly in adolescents are highlightedWe highlighted an important unmet need for an accurate serum test for the early diagnosis of adolescent girls with PCOS., Expert Opinion: Steroid metabolite profiling that captures hyperandrogenism has shown some early promise to serve as a biomarker for early diagnosis of PCOS in women, something that would be especially useful in adolescents.

Background: Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage., Aim: To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage., Methods: A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage., Results: RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively., Conclusion: The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller's class-I and class-II defects., Competing Interests: Conflict-of-interest statement: No conflict of interest., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival., Methods: Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months., Results: The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% ( P = 0.04)., Conclusion: GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Society of Periodontology.)

Aim: The study aimed to longitudinally evaluate the efficacy of gingival unit grafts (GUGs), a modification of free gingival grafts, in the management of Miller's class I and class II recession defects in mandibular anterior region, over a period of 18 months., Materials and Methods: 17 subjects with 21 recession defects in mandibular anterior region were treated using GUG. Clinical parameters of recession depth (RD), clinical attachment levels (CALs), and keratinized tissue width (KTW) were recorded at baseline, 1, 6, and 18 months. Patient-centered outcomes were measured using a visual analog scale (VAS) for pain and discomfort on 14th postoperative day and for treatment satisfaction at the end of 18 months., Results: There was a statistically significant improvement in RD, CAL, and KTW at 18 months when compared to baseline levels. A mean root coverage (MRC) percentage of 84.76 ± 11.79% was achieved at the end of 18 months. Patient-related outcomes for VAS for pain and discomfort as well as treatment satisfaction showed favorable results., Conclusion: GUG can be used as a predictable treatment modality for Miller's class I and class II recession defects in mandibular anterior region. The results obtained can be well maintained over 18-month period with optimal maintenance care., Clinical Significance: The advantage of involving marginal gingiva in GUG results in a well-contoured graft, which increases the ease of adaptation and suturing. The biological characteristic of intact marginal vasculature results in early integration of graft into the recipient area and greater success in graft survival over denuded root surface, causing better long-term RC outcomes.

The aim of the present study was to compare the effect of traditional orthodontics and Piezocision-assisted orthodontics on the periodontal status and rate of canine retraction. In a split-mouth study, 20 subjects undergoing orthodontic treatment were selected. Conventional orthodontics was performed on 20 canine sites (control side), and contralateral canines were subjected to Piezocision-assisted orthodontics (experimental side). The experimental side showed statistically significant increase in rate of canine retraction as well as an increase in alveolar bone level in mesial and buccal aspects.

Background: Innovating newer methods to diagnose a multifactorial disease such as periodontitis is always challenging for a clinician. Gingival crevicular fluid (GCF) which is closely associated with the periodontal tissue environment has been used a viable alternative to saliva for the diagnosis of periodontitis., Aim: The aim of the present study was to estimate and compare the interleukin-35 (IL-35) levels in GCF and serum among healthy, gingivitis, and chronic periodontitis (CP) individuals as well as to evaluate the effect of nonsurgical periodontal treatment (NSPT) on IL-35 level among patients with CP., Settings and Design: The study was conducted at the Department of Periodontics, Srirama Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India. It is a comparative study., Materials and Methods: A total of 60 participants were divided into healthy (Group I; n = 20), gingivitis (Group II; n = 20), and CP (Group IIIA; n = 20). GCF samples collected from each individual at baseline and 6 weeks after NSPT for Group III individuals (Group IIIB; n = 20) were quantified for IL-35 levels using enzyme-linked immunosorbent assay., Statistical Analysis: All analyses were performed using Shapiro-Wilk test, analysis of variance, Tukey's honestly significant difference post hoc test, and multiple regression analysis., Results: The mean IL-35 concentration in GCF was significantly high ( P < 0.05) for Group IIIA (70.26 ± 4.0 pg/ml), as compared to Group I (54.81 ± 22.3 pg/ml) and Group IIIB (55.72 ± 10.2 pg/ml)., Conclusion: In the present study, GCF and serum IL-35 concentration among CP individuals was highest among all the groups. Individuals receiving NSPT showed a significant reduction in IL-35 levels as compared to CP individuals., Competing Interests: There are no conflicts of interest.

Aim: Lycopene, a carotenoid and hesperidin, a flavonoid are naturally occurring in vegetables and fruits. Synergistic effect of a combination of carotenoid and flavonoid has been reported due to its antioxidant activity. Therefore, the present study was aimed to evaluate the protective effect of this combination on pylorus ligation induced ulcers in rats., Materials and Methods: Thirty Wistar albino rats were divided into five groups (n = 6). Rats were fasted for 24 h before pylorus ligation. After 24 h of fasting the rats were treated with hesperidin (100 mg/kg) and lycopene (2 mg/kg) and their combination 1h prior to surgery. After an hour under ether anesthesia pylorus ligation was performed, after 5 h the animals were sacrificed, stomach was dissected, and gastric contents were collected and measured. Total acidity and pH of gastric content was estimated. Ulcer index was calculated, and macroscopic examination of the stomach was carried out., Results: The sham operated rats showed a significant increase in pH, volume of gastric content and total acidity and ulcer index. The rats pretreated with lycopene and hesperidin showed significant improvement in the ulcer conditions. However, rats treated with a combination of lycopene and hesperidin showed more significant restoration of gastric function as compared to sham operated rats. Moreover, a significant difference was also noted in rats treated with a combination as compared to lycopene and hesperidin treatment alone., Conclusion: Thus experimentally the combination was seen to treat ulcers by anti-secretory, neutralizing, cytoprotective and mainly due to its antioxidant property.

Objective: To assess the reliability and accuracy of smartphones in diagnosing transmitted fundus images in comparison with a laptop., Materials and Methods: Fundus images captured with a Topcon NW 200 camera were transferred onto a conventional laptop and a smartphone and given to ophthalmologists for diagnosis. The smartphone and the laptop diagnosis were compared with the actual face to face diagnosis statistically to assess their diagnostic accuracy., Results: Fundus images of 228 eyes of 114 patients (mean age 47 years,73.6% males) were included in the study. 92.5% eyes were correctly diagnosed by both smartphones and laptop. Smartphone analysis revealed 98% sensitivity,57% specificity and kappa value of 0.62 in comparison to laptop, suggessting substantial interrater agreement., Conclusions: Smartphones are as effective as the laptop in diagnosing fundus pathologies and hold promise for teleophthalmology in future.