A majority of periodontal procedures performed today are related with clinical crown extension for esthetic or functional needs related to varied etiologies. The concepts and understanding about any particular treatment keep evolving and further refinements happen with each passing year. The objective of the review is to put forth the various new innovative inputs and concepts regarding crown-lengthening procedures (CLPs) as envisioned by the author and provide a relevant review on various surgical procedures. To the extent possible, a retrospective evaluation of the available literature on CLPs and associated treatment modalities were undertaken. Personal evaluations based on a cumulative understanding of various clinical situations being presented for CLPs across many years were instrumental in writing this review. A new perspective on need-based area-specific CLPs is presented in the review which can be appropriated with any presenting clinical scenario. The review also proposes a new categorization of apically repositioned flaps in multiple types, which may expand our surgical options. A new treatment algorithm based on proposed residual attached gingiva is introduced. The review also deals with a modified proposal for the restorative considerations and a CLP format for record keeping. The scope of CLPs is really wide and refinements in the treatment modalities are need of the hour. The expansion of CLP concept and innovative inputs will definitely appeal to an astute clinician.

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Smoking is a major risk factor for increasing the prevalence and severity of periodontal destruction. Multiple cross-sectional and longitudinal studies have demonstrated that pocket depth, attachment loss, and alveolar bone loss are more prevalent and severe in patients who smoke as compared with nonsmokers. Smoking exerts a major effect on the protective elements of the immune response, resulting in an increase in the extent and severity of periodontal destruction. Several tobacco intervention approaches can be useful in helping the patient deal with the nicotine withdrawal symptoms and psychological factors associated with smoking cessation. In addition, pharmacotherapeutic treatments such as nicotine replacement therapy and sustained bupropion administration have proved effective.

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The autologous platelet concentrates (APC) comprise of platelet rich plasma (PRP) and platelet rich fibrin (PRF). These platelet concentrates provide a rich source of growth factors and have been used alone or in combination with bone grafts (BG) during open flap debridement (OFD) to treat various periodontal osseous defects. This literature review was performed to assess the effect of adjunctive use of autologous platelet concentrates (APC) in the surgical management of periodontal osseous defects. Literature search was performed through the databases of national library of medicine and EBSCO host using PubMed and Google scholar search engines and manual searches in which 36 randomized clinical trials (RCT) meeting inclusion criteria that evaluated the healing outcomes of Probing depth (PD) reduction, gain in clinical attachment level (CAL) , radiographic bone fill and defect fill in intervention of OFD+APC / OFD+BG +APC as compared to OFD/ OFD+BG in the treatment of periodontal osseous defects published between 2001 to 2019 were assessed. Upon assessment of literature the adjunctive use of APCs appears to have an additive effect to open flap debridement alone or along with bone grafts in surgical management of periodontal osseous defects.

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Chronic periodontitis is precipitated as periodontal pockets, gingival recession (GR), decreased keratinized gingiva, and vestibular depth (VD). In the mandibular anterior region, it is frequently seen as GR and decreased VD. The development of high frenal attachment due to loss of periodontal support further increases the rate of progression of the disease and compromises the condition of the incisors. As mandibular incisors have short roots, they usually tend to become mobile early during the progression of periodontal disease. In this case report, a single-step surgery was done, which included periodontal flap surgery with bone augmentation in relation to mandibular anterior teeth. Following this, the width of keratinized tissue was increased using Diode laser by deepening the vestibule. This combined procedure can cover the exposed roots and increase the width of keratinized gingiva.

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Objectives: To compare the depth and duration of anesthesia experienced by the patient between lignocaine and articaine anesthetic solutions and to evaluate pain perception and intraoperative anxiety by computer-controlled injection while administering these anesthetic solutions. Materials and Methods: The clinical trial was designed as a randomized, single-center, double-blinded, parallel arm, and comparative study. Examiner and study patients were blinded to treatment assignment during the study. Patients were divided into three groups based on treatment to be performed (Root Planing 30, Curettage 30, and Surgery 20) and were anesthetized with articaine in one quadrant and lignocaine in another quadrant by computer-controlled anesthetic device (WAND^®). The duration of anesthesia was self-reported by the patients and was calculated by paired t-test. The pain and anxiety scores were calculated on Wong Baker's Facial Pain/Anxiety Scale' by Chi-square test. Results: Articaine had longer duration of anesthesia than lignocaine in all the three groups (P < 0.000). Articaine showed significantly lesser pain scores than lignocaine in Root Planing Group (P < 0.000). There was no significant difference in anxiety scores between different groups. Conclusion: Articaine has longer duration of anesthesia. Articaine administration was less painful than lignocaine administration.

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The vitality of dentin–pulp complex is fundamental to the life of the tooth and is a priority for targeting clinical management strategies. One novel approach to restore tooth structure is based on biology: regenerative endodontic procedure by application of tissue engineering. Regenerative endodontics is an exciting new concept that seeks to apply the advances in tissue engineering to the regeneration of the pulp–dentin complex. The basic logic behind this approach is that patient-specific tissue-derived cell populations can be used to functionally replace integral tooth tissues. The development of such “test tube teeth” requires precise regulation of the regenerative events to achieve proper tooth size and shape, as well as the development of new technologies to facilitate these processes. This article provides a general review of literature and a case report on the concept of revascularisation and its application in endodontics, providing an insight into the new developmental approaches on the horizon.

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Introduction: Correlational studies between subjective and objective evaluations in the area of cleft lip and palate might provide evidence on the reliability and validity of subjective evaluations. This will, in turn, help in deciding to use subjective evaluations in remote areas. Such correlational studies are scanty in Indian languages. Aims: The present study aimed at correlating the perceptual rating of hypernasality with its instrumental measure in Kannada speaking children with repaired cleft lip and palate (RCLP) across different stimuli. The study also discusses various aspects that affect nasality (the type of speech stimuli and age of first palatal surgery) which helps in better understanding of RCLP cases and their characteristics. Settings and Design: This study was based on correlational research designs. Subjects and Methods: Twenty-three Kannada speaking children with RCLP served as participants. Speech samples (vowels, oral words, nasal words, oral sentences, nasal sentences, and oronasal sentences) of children with RCLP were recorded using a sound level meter and were perceptually evaluated using Henningsson's rating scale by three experienced speech-language pathologists. Furthermore, nasalance values were objectively obtained using a nasometer. Statistical Analysis: This study was statistically analyzed using the Shapiro–Wilk test of normality and Spearman's correlation. Results: The results revealed a high positive correlation (0.78) between the subjective and objective assessment. The different degrees of perceptually rated hypernasality were in a positive correlation with nasometry scores of vowels (0.766), words (0.785), and sentences (0.819). Conclusions: A good correlation was obtained between the subjective and objective measurement of nasality indicating the high utility of perceptual evaluation in remote areas.

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Background: In recent days, tissue eosinophils are considered to have more impetus role in the biological behavior of various tumors. Compared to routine hematoxylin and eosin stain, the special stains such as carbol chromotrope for eosinophils are considered to be more specific and definitive for its evaluation in routine histopathology. Aim: This study aims to evaluate and compare the infiltration of tissue eosinophils in different grades of oral squamous cell carcinoma (OSCC) using a special stain – carbol chromotrope and to investigate the prognostic role of tissue eosinophils in OSCC. Methodology: The study was carried out with the sample size of fifty histopathologically diagnosed cases of OSCC, of which twenty cases were well differentiated, twenty cases were moderately differentiated, and ten cases were poorly differentiated, and comparison of infiltration of tissue eosinophils in the different grades of OSCC was done using special stain. The tissue sections were stained with carbol chromotrope special stain. Results: In the present study, more number of tissue eosinophils were seen in well-differentiated OSCC cases than the moderately and poorly differentiated OSCC cases, and the analysis of variance test showed P < 0.001. Tukey B's post hoc range test showed that mean scores fell in three different subsets, and the least mean score was observed in the poorly differentiated group (2.20) and the highest mean score was observed in the well-differentiated group (34.75). Conclusion: The results proved that the presence of more number of tissue eosinophils in well-differentiated OSCC is associated with favorable prognosis and that quantitative assessment of tissue eosinophilia should become a part of the routine histopathological diagnosis for the different grades of OSCC.

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Advanced alveolar bone resorption in the maxillary anterior teeth is a common finding that limits the placement of implants for prosthetic rehabilitation. Autologous bone graft from the mandibular symphysis is one of the oldest techniques in horizontal ridge augmentation techniques for placement of implants in advanced resorption of the alveolar ridge in the maxillary anterior region. This case report revisits the technique carried out using piezoelectric osteotome for harvesting block graft from the mandible to augment the resorbed ridge horizontally to place implant in a young and healthy patient.

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Background: The endangered Toto tribe of North Bengal is unique in their traditional oral hygiene practices. Aims & objective: To evaluate the prevalence of chronic periodontitis in the unique genetically homogenous population and also to assess their oral hygiene status. Materials and Methods: The study was conducted on the population with help of two stage approach involving both preformed set of questionaries' and also the intra-oral examination in accordance with standard guidelines. Results and Observations: The data were subjected to statistical analysis and significant association was found between loss of attachment, oral habits, OHI-S scores. CPI scores could be positively associated with OHI-S scores. Discussion and Conclusion: It was observed that despite of having predominantly fair OHI-S scores, high prevalence of deleterious oral habits and other local factors, prevalence of periodontal disease was low among the population.

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Background: Dentinal hypersensitivity is a sharp pricking pain occurring on exposure of the dentinal surface to the external stimuli such as hot, cold, air, tactile, and chemical. This study was conducted to compare the effectiveness of two herbal desensitizing pastes in the relief of dentinal hypersensitivity at different time intervals. Materials and Methods: Forty subjects (with two teeth per patient) were considered for this study and randomly divided into two groups: Group 1: Hiora K, herbal desensitizing toothpaste and Group 2: Dant Kanti medicated desensitizing toothpaste. Using tactile stimulus and air stimulus, the sensitivity scores were recorded on visual analog scale immediately, then at 2 weeks, and then at the end of 4 weeks and compared. Results: There was no significant difference in the distribution of tactile sensitivity score and air blast sensitivity score at baseline, immediately after application, after 2 weeks, and after 4 weeks between Groups 1 and 2. Statistical Analysis: Chi-square test was used for statistical analysis. Conclusion: Desensitizing pastes can be used as a safe, economical, and effective option in the management of dentinal hypersensitivity.

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Background: Assessment of tobacco-induced preoccupation and compulsive drive may help us to better diagnose addictive behavior, enhance cessation treatment, and predict smokers at the greatest risk of relapse. Objective: This study attempted to make a comparative assessment of the Obsessive Compulsive Smoking Scale (OCSS), which measures compulsive smoking with the Modified Fagerstrom Test for Nicotine Dependence (FTND) Scale. Methodology: The cross-sectional study included 250 private bus drivers of Namakkal district, Tamil Nadu, who were current smokers. OCSS and Modified FTND Scale were used to collect the data on nicotine dependence. Ordinal regression analysis was used to compare OCSS and FTND scales with smoking dependence predictor variables. Results: About 79% of the drivers exhibited high OCSS scores. The OCSS scores were significantly associated with variables such as duration of smoking, the number of cigarettes/bidis consumed, time of consumption of first cigarette, age when first smoked, age of daily smoking, and the number of quit attempts. Ordinal regression analysis revealed a higher statistically significant proportional odds ratio associated with the OCSS scale compared to the FTND scale (P < 0.05). Conclusion: The results suggest that the OCSS scale offers a better measure of nicotine dependence than the Modified FTND scale. Further studies are needed to conclude that the OCSS scale has better advantages over the FTND scale in clinical settings and thus be used as an effective tool in cessation programs.

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