The association between diabetes and periodontal disease has been well documented. Periodontitis is associated with alterations in immune responses in both diabetic and nondiabetic subjects. While diabetes is considered to be a risk factor for periodontal disease progression, few studies have demonstrated an association between the level of glycemic control and periodontal disease. Although poor glycemic control is significantly associated with poor periodontal health, few studies have been performed in Saudi Arabia to evaluate the immune responses in poor and better glycemic control and its effect on periodontal tissue. The aim of this study is to assess serum immunoglobulin levels (IgA, IgG, IgM) in type 2 diabetic (poor control and better control) and nondiabetic subjects with chronic periodontitis.

A total of 105 female patients were included in the study and they were divided into three groups, with 35 patients in each group. Group 1 was comprised of cases of diabetes exhibiting better control (HbA1c≤9%) and Group 2 was comprised of cases of diabetes exhibiting poorer control (HbA1c>9%). The third group was comprised of nondiabetic subjects with chronic periodontitis. In this study, clinical examination included plaque index, bleeding on probing, probing pocket depth, and attachment level (measured in all three groups). Serum immunoglobulin (IgA, IgG, IgM) levels were estimated and compared to the levels estimated for diabetic controls.

Mean plaque index, bleeding index, and probing pocket depth showed no significant differences among the three groups. However, mean clinical attachment loss was significantly higher for Group 2 as compared to Groups 1 and 3. IgA and IgG levels were found to be significantly higher in Group 2 (poorly controlled diabetes) as compared to Group 1 (better control) and Group 3 (control group).

There is a positive correlation between CAL and IgA and IgG, whereas there is a negative correlation between CAL and IgM.

The present study indicates that poor glycemic control may be associated with the increase in IgA and IgG serum antibodies. Elevated antibody levels may explain why poorly controlled diabetes exacerbates periodontal disease.

These findings demonstrate the importance of the immune system as well as good glycemic control, especially in patients diagnosed with periodontitis. The changes observed in immune response may be the cause or the effect of periodontal disease in diabetic patients. The increased incidence of periodontitis in diabetic patients suggests that the alteration in immune response may contribute to the pathogenesis of periodontitis in patients with poorly controlled diabetes.

Awartani F. Serum Immunoglobulin Levels in Type 2 Diabetes Patients with Chronic Periodontitis. J Contemp Dent Pract [Internet]. 2010 May; 11(3):001-008. Available from: http:// www.thejcdp.com/journal/view/volume11-issue3- awartani.

Diabetic patients have more severe periodontal destruction, but periodontal therapy can improve metabolic control. Recently, interest has focused on the use of subantimicrobial dose doxycycline (SDD) as a treatment paradigm. Therefore, this study was undertaken to evaluate clinical efficacy of SDD with scaling and root planning (SRP) in chronic periodontitis patients with diabetes.

Twenty chronic periodontitis patients with diabetes mellitus were randomly allocated to either a test and a control group. Clinical measurements were recorded at baseline and at six months for probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR). After SRP, patients in the test group were instructed to take SDD 20-mg capsules twice a day while patients in the control group took a placebo twice a day. Both groups were on this regimen for a six-month period.

A greater reduction in mean PPD was demonstrated in patients in the test group compared to the control group. The mean CAL increase observed in the test group was significantly greater (0.67 mm) than that in the control group.

It can be concluded that SRP, in conjunction with the SDD therapy described, is more effective then SRP alone in terms of CAL gain and PPD reduction in diabetic patients with severe periodontal disease.

Given the widespread prevalence of both chronic periodontitis and diabetes, the proposed treatment approach will prove to be of great value and contribute significantly to the overall health of the patients.

Deo V, Gupta S, Bhongade ML, Jaiswal R. Evaluation of Subantimicrobial Dose Doxycycline as an Adjunct to Scaling and Root Planing in Chronic Periodontitis Patients with Diabetes: A Randomized, Placebo-Controlled Clinical Trial. J Contemp Dent Pract [Internet]. 2010 May; 11(3):009-016. Available from: http://www.thejcdp.com/journal/view/volume11- issue3-deo.

The aim of this study was to assess and compare the quantitative and qualitative oral colonization of Candida species between a group of healthy tobacco smokers and a comparable group of nonsmokers, and to investigate a possible correlation between oral candidal colonization and the quantity or duration of the smoking habit.

Fifty smokers and 50 nonsmokers were included in the study. Candida species were isolated using the concentrated oral rinse (COR) technique and identified using the germ tube test and API 20 C AUX yeast identification system.

Overall candidal transmission was 84 percent. Candida species were isolated from 42 (84 percent) of the smokers and 37 (74 percent) of the nonsmokers (p>0.05). The mean CFU/ml were 333 (SD=358) and 268 (SD=332), respectively (p>0.05).

Tobacco smoking did not appear to increase oral colonization with Candida species in healthy subjects.

The effects of smoking on oral tissues and the mechanisms by which Candida proliferate intra-orally as a result of cigarette smoking warrant additional study.

Darwazeh AM, Al-Dwairi ZN, Al-Zwairi AA. The Relationship between Tobacco Smoking and Oral Colonization with Candida Species. J Contemp Dent Pract [Internet]. 2010 May; 11(3):017-024. Available from: http://www.thejcdp. com/journal/view/volume11-issue3-al_dwairi

The aim of this study was to evaluate the clinical performance of direct resin composite restorations (Tetric Ceram-TC) and indirect composite inlays (Targis-TG) after 12 months.

Seventy-six Class I and II restorations (44 direct and 32 indirect) were inserted in premolars and molars with carious lesions or deficient restorations in 30 healthy patients according to the manufacturer's instructions. Each restoration was evaluated at baseline and after 12 months according to the modified USPHS criteria for color match (CM), marginal discoloration (MD), secondary caries (SC), anatomic form (AF), surface texture (ST), marginal integrity (MI), and pulp sensitivity (PS). Data were analyzed by Fisher and McNemar Chisquare tests.

No secondary caries and no pulpal sensitivity were observed after 12 months. However, significant changes in marginal discoloration (MD) criteria could be detected between baseline and one-year results for both materials (p<0.05). For marginal integrity (MI) criteria, the differences between baseline and oneyear recall were statistically significant (p<0.05). For marginal integrity (MI) criteria, Tetric Ceram (TC) showed results statistically superior to Targis (TG) in both observation periods (p<0.05). No statistically significant changes in color match (CM), anatomic form (AF), or surface texture (ST) appeared during the observation periods (p>0.05).

Direct resin composite restorations performed better than indirect composite inlays for marginal integrity, but all restorations were judged to be clinically acceptable.

Tetric Ceram direct restorations and Targis indirect inlays in posterior teeth provide satisfactory clinical performance and the comparison between them showed little difference after one year.

Mendonça JS, Neto RG, Santiago SL, Lauris JRP, Navarro MFL, Carvalho RM. Direct Resin Composite Restorations versus Indirect Composite Inlays: One-Year Results. J Contemp Dent Pract [Internet]. 2010 May; 11(3):025-032. Available from: http://www.thejcdp.com/journal/ view/volume11-issue3-santiago.

This study assessed the influence of current oral contraceptive pills on periodontal health in young females.

Seventy women ranging in age from 17 to 35 years (mean 24 years) had a comprehensive periodontal examination. Their current and previous oral contraceptive pill use was assessed by a questionnaire. A periodontal assessment was performed that included recording the following: plaque index, gingival index, probing depth, and attachment level at six sites per tooth. The periodontal health of women taking birth control pills for at least two years was compared to that of women not taking an oral contraceptive. The control and test groups were matched for socioeconomic status, age, oral habits, occupation, and educational levels.

Although there was no difference in plaque index levels between the two groups, current oral contraceptive pill users had higher levels of gingival inflammation and bleeding on probing. However, no significant differences were found regarding mean probing depths and attachment loss between the two groups.

Women who were on oral contraceptive pills had more extensive gingivitis and gingival bleeding than their matched controls not taking them.

As birth control policies are advocated by most countries, and because oral contraceptives are the most widely used method for birth control, a need exists to assess the effects of oral contraceptives on the periodontal health of young women. Although additional studies are needed to better understand the mechanism of OC-induced gingivitis, female patients should be informed of the oral and periodontal side effects of OCs and the need for meticulous home care and compliance with periodontal maintenance.

The aim of the present study was to identify the trends in tooth loss among patients attending four general dental practices in the south Indian State of Kerala.

The reasons for extraction of permanent teeth among patients who had attended the four clinics during a one-month period were categorized as follows: (1) dental caries and their sequelae, (2) periodontal disease, (3) orthodontic, (4) impactions, (5) prosthodontic, and (6) other reasons.

A total of 997 permanent teeth were extracted, of which 445 (44.6 percent) teeth were extracted due to dental caries and their sequelae, 331 (33.2 percent) teeth due to periodontal disease, 111 (11.1 percent) teeth for orthodontic purposes, 25 (2.5 percent) teeth due to impactions, 25 (2.5 percent) teeth for prosthodontic purposes, and 60 (6 percent) teeth for other reasons.

The results of the present study suggest that dental caries and periodontal disease were the two major causes of tooth mortality in this particular patient population.

This is probably the first study to report on the trends in tooth loss in general practice in India. Similar studies should be conducted in other regions of the country to generate valuable data regarding the oral health patterns of the nation's population.

Anand PS, Kamath KP, Nair B. Trends in Extraction of Permanent Teeth in Private Dental Practices in Kerala State, India. J Contemp Dent Pract [Internet]. 2010 May; 11(3):041-048. Available from: http://www.thejcdp.com/journal/ view/volume11-issue3-anand.

This article describes the surgical management of a young, female patient with severe gingival enlargement of unknown etiology.

Gingival enlargement frequently occurs as gingival hyperplasia, representing a reaction to a known stimulus or agent and, histopathologically, implies an increase in both extracellular matrix and cell numbers. The enlargement may range from mild, in which gingival architecture is minimally affected, to severe, in which the gingiva becomes bulbous and covers the clinical crowns of teeth. A number of local and systemic factors, such as plaque, hormonal changes, drug ingestion, and heredity, can cause or influence gingival enlargement. Mild to moderate increase in gingival bulk is relatively common, but massive gingival enlargement with associated bone resorption is rare.

This case involved a 19-yearold female patient who presented with generalized severe gingival enlargement with aggressive periodontitis, a condition of some five to six months in duration.

Based on a thorough clinical and radiographic examination, laboratory tests, and oral hygiene instructions, an internal bevel gingivectomy was performed to remove excess gingival tissue and areas of bone loss were debrided properly. There was no recurrence eight months following the last surgery.

Although we were not able to identify the exact cause of the gingival enlargement, amelioration of the unusual very soft, friable, enlarged gingivae and the severe periodontal attachment loss was observed.

Before initiating any periodontal management of a case of severe gingival enlargement with aggressive periodontitis, it is recommended to perform a complete extraoral and intraoral examination with radiographs, take a family and medical history, and determine if any medications may be responsible for the gingival enlargement. Additional testing and analysis, as described in this case, may be necessary.

Vishnoi SL, Phadnaik MB. Unusual Gingival Enlargement with Aggressive Periodontitis: A Case Report. J Contemp Dent Pract [Internet]. 2010 May; 11(3):049-055. Available from: http://www.thejcdp.com/journal/ view/volume11-issue3-vishnoi.

The aim of the present paper is to report a case of benign cementoblastoma (BC) involving multiple maxillary teeth and discuss the importance of its diagnosis in clinical oral practice.

BC is a rare, benign odontogenic neoplasm of ectomesenchymal origin. This neoplasm has characteristic radiologic and microscopic features, and it is intimately associated with the roots of teeth.

The intra-oral examination in a 21-year-old white man revealed a palatine growth in the premolar-molar region. Dental panoramic and periapical radiographies showed a mixed radiodense/radiolucent lesion closely associated with the roots of three maxillary teeth. A biopsy was undertaken and confirmed the clinical hypothesis.

In most cases, initial BC is asymptomatic and early diagnosis can be performed by routine radiographic examination. BC was considered as an indolent lesion for several years. Nevertheless, recent studies have demonstrated that some BCs may exhibit aggressive biological behavior and can affect several teeth.

Because a benign cementoblastoma represents an odontogenic lesion, general practicing professionals must be able to identify the main features of this tumor. This case corroborates some papers that have demonstrated a possible aggressive behavior of BC. Therefore, a brief update concerning the clinical and radiographic features of this unique tumor is also provided.

Amorim RFB, Silveira EJD, França MN, Guimarães MCM, Lima Júnior N, Carvalho DR. A Case of Extensive Maxillary Benign Cementoblastoma. J Contemp Dent Pract [Internet]. 2010 May; 11(3):056-062. Available from: http://www.thejcdp.com/journal/view/ volume11-issue3-amorim

The aims of this report are to present three cases of autotransplantation along with a review of the indications, selection criteria for patient donor and recipient sites, and the major steps in the surgical procedure.

Autogenous tooth transplantation, or autotransplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. It can be a good treatment option in many cases if the dentist knows the implications, indications, and contraindications.

Three cases with different treatment indications and plans are presented. All showed autotransplantation of teeth as part of orthodontic treatment. It emphasized the benefits of this treatment modality such as new bone formation and lower costs. One case, a rare example of multiple congenitally missing teeth treated by autotransplantation, also was presented.

As shown in these case reports, there are instances where the autotransplantation of teeth is appropriate and may possibly simplify future planned orthodontic or prosthodontic treatment.

Tooth autotransplantation is an easy and good treatment option, applicable in a lot of cases, substituting different types of prostheses, including dental implants.

Abu Tair JA, Rahhal A. Tooth Autotransplantation in Orthodontic Patients. J Contemp Dent Pract [Internet]. 2010 May; 11(3):063-070. Available from: http://www.thejcdp. com/journal/view/volume11-issue3-abu_tair.

The purpose of the case report was to describe the treatment of a 4½-year-old boy with amelogenesis imperfect (AI) in the primary dentition.

AI is a hereditary condition that affects the development of enamel, causing quantity, structural, and compositional anomalies involving all dentitions. Consequently, the effects can extend to both the primary and secondary dentitions.

A 4½-year-old boy was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of amelogenesis imperfecta. The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms of both maxillary and mandibular primary incisors and canines.

Improvements in the patient's psychological behavior and the elimination of tooth sensitiveness were observed, and the reestablishment of a normal occlusion resulted in improved eating habits. The child was monitored in the Pediatric Dentistry Clinic at four-month intervals until the mixed dentition stage.

The oral rehabilitation of young children with AI is necessary to reestablish the stomatognathic system function, so important for a child's systemic health. An adequate medical history and a careful clinical examination were essential for a correct diagnosis. Treatment was rendered that was appropriate for the child's age and clinical/psychological characteristics.

Cost-effective restorative techniques involving stainless steel and composite-resin crowns are shown for the restoration of a young patient with amelogensis imperfecta.

Souza-e-Silva CM, Parisotto TM, Steiner-Oliveira C, Gavião MBD, Nobre-dos- Santos M. Oral Rehabilitation of Primary Dentition Affected by Amelogenesis Imperfecta: A Case Report. J Contemp Dent Pract [Internet]. 2010 May; 11(3):071-077. Available from: http://www. thejcdp.com/journal/view/volume11-issue3-nobre_ dos_santos.