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Periodontitis is a multi-factorial chronic inflammatory condition which affects the supporting tissues of the tooth. Periodontal disease and diabetes have bi-directional relationship. The host response against periodontal pathogens results in release of various inflammatory mediators which may have profound effects on systemic condition notably Type 2 Diabetes Mellitus. Netrin-1 are the laminin-like secreted neuronal guidance protein which acts as a guidance cue in the developing central nervous system.They function either chemo-attractive or chemo-repulsive through DCC and UNC-15 receptor respectively. MCP-1 has a significant role in the pathophysiology of several diseases as a critical modulator of monocyte chemotaxis and T-lymphocyte differentiation. This study was designed to evaluate the levels of Netrin-1 and MCP-1 in Gingival Crevicular Fluid (GCF) and serum in Stage III Grade B Periodontitis, T2DM and Obesity.
Learning Objectives:
1. To estimate the levels of Netrin-1 and MCP-1 in GCF and serum in periodontally healthy subjects, Stage III Grade B periodontitis subjects, with and without Type 2 Diabetes Mellitus and Obesity.
2. To find out association between Netrin-1 and MCP-1 levels in GCF and serum in periodontally healthy subjects, Stage III Grade B periodontitis subjects, with and without Type 2 Diabetes Mellitus and Obesity.
3. To compare and correlate between the levels of Netrin-1 and MCP-1 in GCF and serum in periodontally healthy subjects, Stage III Grade B periodontitis subjects, with and without Type 2 Diabetes Mellitus and Obesity.
4. To explore the possibility of using Netrin-1 and MCP-1 as a marker of inflammation in Stage III Grade B periodontitis and relating with clinical parameters.
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ABSTRACT
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Periodontal disease is an inflammatory condition of the periodontium characterized by attachment loss, and ultimately, tooth loss. Tooth loss is the initiating event of masticatory dysfunction, which may only be noticeable to the patient once a substantial amount has occurred. A significant concern that comes with this dysfunction is the difficulty in its diagnosis, and the limitations it poses on restoration and rehabilitation. The presence of masticatory dysfunction is the delineating factor between a diagnosis of Stage III and Stage IV Periodontitis. However, being the ambiguous concept that it is, it creates gray areas in both diagnosis and treatment, and subsequently, implementation in the clinical practice that present research continuously aims to decode. Recently, a guideline on the diagnosis and management of these cases has been published demonstrating current evidence which includes clinical investigations that may make it more applicable to the daily practice.
Learning Objectives:
• To give a brief revision on the current classification of periodontitis
• To discuss the criteria that are unique to the Stage IV classification
• To present the proposed framework on treatment sequence for management of Stage IV cases
• To emphasize the key concepts in setting treatment goals and management of Stage IV cases
• To introduce current evidence on the clinical application for the diagnosis of masticatory dysfunction
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There are several advantages of using an allogenic bone block for vertical bone regeneration. Firstly, very good stability can be obtained at the surgical site after fixation of the block. Secondly, there is no donor site morbidity which is a complication when harvesting autogenous block bones. Thirdly, there is no need for the fixation of the barrier membrane for stability which can be a technically demanding procedure. However, the number of studies on vertical bone augmentation using the allogenic bone block is low. In this presentation, clinical cases of vertical ridge augmentation using irradiated allogenic cortico-cancellous bone will be shown including radiographic and histological evidence.
Learning Objectives:
1. Clinical indications of vertical bone augmentation using the allogenic block bone.
2. How to achieve appropriate fixation of the block bone.
3. The appropriate combination of regenerative materials when using the block bone.
4. The amount of vertical bone gain that can be expected using the allogenic bone block
5. Histological appearance of the regenerated bone using the allogenic block bone.
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Objective: To compare key markers of bone remodelling in a sheep tooth extraction model for sockets left to heal naturally or grafted with the bovine-derived xenograft Bio-Oss® covered with a collagen Bio- Gide® membrane. Design: Right side premolar teeth were removed from thirty Romney- cross ewes. Standardised sockets in each sheep were randomly allocated treatments, a grafted test and an empty control. At 4-, 8- and 16-weeks sheep were euthanized, and tissue collected (N = 10/group). RANK, RANKL and OPG immunohistochemical analysis was performed (n = 3). RANK, RANKL, OPG, COL1A1, TIMP3, SP7 and MSX2 mRNA expression levels were determined using RT2 -qPCR assays (n = 3). Results: Histologically, more new woven bone was observed in the test group at all time points. Strong RANK and RANKL expression was found in both groups; at all time points with stronger RANK staining in the test group at 8 and 16 weeks. Strong OPG staining was localized to both osteoblasts and connective tissues. RANK receptor mRNA was expressed at a lower level in the test group (− 4.26-fold; p = 0.02) at 4 weeks and SP7 at 16 weeks (− 2.89-fold; p = 0.04). COL1A1 and TIMP3 mRNA expression increased significantly over time in the control group (p = 0.045, F = 5.4 and p = 0.003, F = 42.2 respectively). Conclusion: Socket healing over time was comparable. The sheep tooth extraction model was found to be suitable for the evaluation of changes in the alveolar bone at the molecular level.
Learning Objectives:
1. To determine the expression of RANK/RANKL/ OPG during healing in a grafted and ungrafted tooth extraction socket
2. To understand the expression of markers of healing in a grafted and ungrafted tooth extraction socket
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Dental implants having been applied to restore the lost dentition for more than fifty years, nevertheless, the time required from implant insertion to functional restoration still takes four to six months for osteointegration. Besides, once exposed to the oral environment, the poorly circulated bone surround implant is more prone to uncoupled bone loss and unresolved immune response induced by oral microbial challenge due to poorly vascularized peri-implant structure in comparison with periodontal structures generated from transplanted tooth. Thus, how to rapidly replace missing teeth with bio-inductive dental implants remains a crucial and unresolved issue. Recent study found the topological signals may induce epigenetic changes in the attached stromal cells, lead to remodeling of the chromatin and activate genes that favor osteogenic differentiation. Our findings further demonstrate that laser-modified titanium surface not only provides topological cues for osteogenesis on gingival stromal cells but also enhance exosome production to promote coupled angiogenesis.
Learning Objectives:
Laser-modified titanium surface provides topological cues for gingival stromal cells which promotes osteogenesis and coupled angiogenesis.
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We have developed a bovine bone xenograft (OMB) doped with antibacterial lipoic-capped silver-nanoparticles (AgNP), for alveolar ridge preservation after tooth extraction. In 4 sheep, mandibular premolar teeth were extracted; each also received two 8.5x4mm deep circular defects in the femoral epicondyle of both posterior legs. Sites were filled either OMB, OMB+AgNP, BioOss® xenograft or left unfilled, and covered with a resorbable collagen membrane. Two sheep each were euthanised after 8 and 12 weeks. Samples were analysed using non-demineralised resin-embedded histology. Results: OMB+/-AgNP demonstrated equivalent bone fill to each other and to BioOss®; all grafted sites showed more bone fill than un-grafted controls. Mandibular socket and femur sites were comparable. Results were not statistically compared in this pilot study. Conclusions. Both modified OMB BBXs showed equivalent results to commercially available BBX (BioOss®). The addition of AgNP did not impair bone healing. This pilot study supports progressing to larger-scale preclinical trials.
Learning Objectives:
– Grafting materials and Guided bone regeneration
– Novel antimicrobial approaches to oral infection
– Histomorphometric analysis in animal model
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Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome. HGF usually begins during the transition from primary to permanent teeth, other than disrupting the eruption of permanent teeth and functional derangement of the dentition, it can have a negative psychological effects to a young patient due to impaired aesthetic. As it does not resolve spontaneously, both periodontal and orthodontic aspects need to be considered which may involve multiple surgical intervention and orthodontic movement which prove to be challenging. This lecture will discuss the Periodontic-Orthodontic management of a clinical case of HGF covering the various surgical approach, timing of extraction and orthodontic movement.
Learning Objectives:
1. Understanding the clinical characteristics of Hereditary Gingival Fibromatosis (HGF)
2. Discuss management of HGF involving periodontic-orthodontic approach using a clinical case
3. Discuss briefly recurrence rate and psychological effects of condition
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Recently, the development of injectable scaffolds for tissue engineering has been growing interest. To develop a novel scaffold for periodontal hard and soft tissue regeneration, bone graft pastes consisting of nano-hydroxyapatite, chitosan, and gelatin (nHA/KG) and also a crosslinked collagen/gelatin (Col/Gel) hydrogel has been designed. In vitro studies on physical, chemical, and biological characteristics were analyzed. For nHA/KG paste, the viscosity characteristics resemble the gel phase. PO43-, CO32-, -OH, Amide I, and II functional groups were detected in nHA/KG paste. Increasing the collagen concentration in the hydrogel (Col-Gel) 1:2 showed the best degradability rate. 3D culture studies of MC3T3E-1 and MRC-5 on nHA/KG paste and HGFs on Col/Gel showed the percentage of cell viability >70%. Up-regulated expression of ALP, OCN, RUNX2, and COL1 were exhibited by nHA/KG pastes. Similar results were also found on COL1 expression by HGFs with Col-Gel. Both nHA/KG pastes and Col/Gel hydrogel are potentially injectable scaffolds for periodontal regenerative therapy.
Learning Objectives: To analyze the differences in the characteristics of nHA/KG bone graft paste and crosslinked collagen/gelatin hydrogel (Col-Gel) in periodontal tissue regeneration.
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P4 Medicine is based on a proactive approach for clinical patient care incorporating the four “pillars” of prediction, prevention, personalization and participation for patient management. This lecture explores how the concepts of P4 medicine can be incorporated into the management of periodontal diseases. The proposed model of P4 Periodontics is highly aligned with the 2018 Classification of Periodontal Diseases and represents a logical extension of this classification into treatment paradigms. Each stage of periodontitis can be related to a holistic approach to clinical management. The role of “big data” in future P4 Periodontics is discussed and the concepts of a treat-to- target focus for treatment outcomes is proposed as part of personalized periodontics. Personalized periodontal therapies will refocus our thinking from risk management to regenerative solutions to manage the effects of disease and aging.
Learning Objectives:
1. Understand the 4 pillars of P4 Medicine
2. Recognize how P4 Medicine concepts align with the 2018 Classification of Periodontal Diseases
3. Appreciate how P4 medicine concepts can be incorporated into periodontal disease management.
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| Periodontal treatments involving cause-related therapy, resective and regenerative periodontal surgeries have been well documented over the last 30 years. In the era of esthetics, clinicians are seeking for optimal results by avoiding invasive treatments. Recent developments in regenerative techniques and adoption of microsurgery in periodontal and peri-implant tissue reconstruction minimize the tissue trauma/loss, and this led to an increase in the expectations of the patients. However, the clinical excellence does not only depend on the clinical skills or practice settings. Treatment outcome is influenced by combination of many factors. For clinical success, treatment steps and protocols should be embraced by patient and clinician. In this lecture, the requirements for periodontal/peri-implant tissue reconstruction and health will be discussed in greater details. |
ABSTRACT
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Periodontal surgeries aim to restore and maintain the health and aesthetics of the periodontium. Among the critical aspects of successful periodontal surgery is the preservation of the interdental papilla. The contour of the interdental tissues, as well as the color and texture of the keratinized tissues, are essential elements of anterior esthetics. Preservation techniques, such as careful flap design, minimally invasive approaches, and meticulous handling of soft tissues are essential to minimize trauma and maintain blood supply to the papilla. This presentation aims to highlight the significance of papilla preservation in periodontal surgery, the techniques, and their impact on the overall success of the procedure. Furthermore, the impact of patient-specific factors and anatomical considerations on papilla preservation outcomes is also addressed. By prioritizing papilla preservation and employing evidence-based techniques, periodontists can enhance treatment outcomes and patient satisfaction in periodontal surgery.
Learning Objectives:
1. To understand papilla preservation flap surgical technique
2. to learn how to maintain papilla form
3. To learn how to preserve soft tissue in esthetic areas
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The clinical judgment of whether to retain periodontally compromised molar through comprehensive periodontal therapy or to extract and replace them with dental implants involves a multifaceted decision-making process that extends beyond the scientifically reported efficacy of the two treatment modalities. This decision has to factor in multi-level elements, including but not exhaustive of the subject, dentition, and site-associated risk factors; periodontal, restorative, endodontic, and occlusal considerations; the strategic value of tooth in dentition; patient’s economics and predilection; and the clinician’s skill and level of training. This presentation will evaluate the existing modern approaches, efficacy, and cost efficiency related to treatment and maintenance of periodontally compromised molars. Furthermore, we will delve into the biological ramifications stemming from the ultimate loss of these molars and examine the strategies and implications associated with rehabilitating these residual ridges with dental implants. The significance of considering both patient and site-level factors when planning tooth extraction and formulating implant rehabilitation protocols will be highlighted.
Learning Objectives:
– Appraise the current evidence in the contemporary strategies, predictability, and cost effectiveness in the retention of periodontally compromised molars in the life course of periodontal patients.
– Predict alveolar healing patterns and sinus pneumatization following loss of periodontally compromised molars and comprehend the challenges associated with implant rehabilitation.
– Discuss the efficacy of alveolar ridge preservation in periodontally compromised molar extraction sites.
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Recently, lasers are increasingly being used in periodontal therapy because of various advantageous therapeutic effects such as ablation, hemostasis, bactericidal effect as well as biostimulation. To date, a number of clinical studies for periodontal pocket treatment using lasers have been published; however, a consensus has not yet been reached regarding its effects. This presentation introduces a novel procedure, using Er:YAG laser combined with conventional mechanical treatment (Er:YAG laser-assisted comprehensive periodontal pocket therapy: Er-LCPT). Er-LCPT is a minimally invasive flapless surgery and enables safe, effective, and comprehensive debridement of periodontal pockets. In the treatment of residual pockets, the effectiveness and safety of this procedure have been confirmed by case series, and also significantly improved outcomes of clinical parameters following Er-LCPT have been detected by RCT study when compared to SRP alone. Furthermore, Er-LCPT may also be used as a flapless regenerative surgery during initial therapy.
Learning Objectives:
– To enumerate the advantageous characteristics of Er:YAG laser in periodontal therapy
– To explain the current clinical status of Er:YAG laser in pocket treatment
– To understand the concept, procedure and effects of Er-LCPT technique
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