Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411124EnglishN2019December31HealthcareThe Expanding Scope of Periodontics – A Review Article
English0110Yash JainEnglish Rathna ValluriEnglish C SrikanthEnglish Kranti Kiran Reddy EallaEnglishPeriodontology is widely recognized as the dental speciality pertaining to the ailments of the tissues surrounding and supporting the tooth. In the past decade a significant amount of research in periodontology was directed towards applications of advanced fields of studies like genomics, proteomics, nano-technology, bio-photonics, etc. The aim of the present review article is to outline the scope of periodontology, by briefing current practices and emphasizing the more recent and advanced developments.
EnglishAdvances in Periodontology, Biophotonics, Genomics, Nanotechnology, Periodontal Vaccine, Probiotics, Proteomics, Tissue-engineeringINTRODUCTION:
Periodontics as a speciality is considered to have begun during the mid-nineteenth century when John W. Riggs (1811-1885), now popular for defining the term “Riggs disease”, started confining his practice to treating diseases of the periodontium(1). Over the centuries, periodontics has come to include under its umbrella, an enormity of scientific disciplines.
DISCUSSION:
In the present article, periodontology is briefed in terms of its conventional diagnostic aids and therapies, and the more recent and advanced developments are then discussed.
Diagnostic Aids:
Periodontics encompasses a plethora of conventional and advanced diagnostic tools including probes, radiographic techniques and microbial analyses.
Probes: These are physical devices used to measure the distance from the bottom of the pocket to a reference line (usually the cemento-enamel junction)(2). An overview of all the periodontal probes developed is shown in Table 1.
Radiographic diagnostic aids include:
Digital Subtraction Radiography (DSR):This has been used in the post treatment assessment in regenerative procedures(3). It is a great tool in conducing longitudinal assessments.
Computer-assisted densitometric image analysis system (CADIA): or advanced than DSR, CADIA has been shown to detect the changes in the density of the crestal even bone before the crestal height reduces(4). CADIA can also be employed to evaluate the results of regenerative procedures.
Tuned aperture computed tomography (TACT): It has been shown to be more accurate for quantifying osseous changes in healing bone defects and has proposed as an alternative for pre-surgical implant planning(5).
Cone-beam computed tomography (CBCT): Studies have been done validating the usefulness and accuracy of CBCT in visualizing periodontal structures and in regenerative procedures(6).
Micro CT: In a study by Park(7) et. al., it was demonstrated that Micro CT is reliable approach for quantitative assessment of the alveolar bone.
Optical coherence tomography (OCT): OCT renders early detection of subgingival calculus possible as dental calculus has been found to have strong scattering properties and can be differentiated from Enamel(8).
Magnetic resonance imaging (MRI): In a study, including 25 patients with dental implants, by Gunzinger(9) et. al., it was discussed that MAVRIC (multi-acquisition variable-resonance image combination) reduced the artifacts from dental implants (which is one of the major issues for the use of MRI in oral cavity).
Other imaging techniques:
Ultrasound Imaging: It has been shown that this imaging modality is highly accurate and repeatable for periodontal evaluation(10). Various systems employing ultrasound have been developed for the detection of subgingival calculus, i.e., Detectar®, Keylaser II®, and Dental Endoscope.
Photoacoustic Imaging technique: This imaging technique integrates visible and near infrared excitation with acoustic detection and its application has been demonstrated in measuring periodontal pocket depths(11).
Diagnosis through Microbial Analysis: It has been observed that microbial analysis of the significant organisms in periodontal diseases helped in the clinical decision making process for the adjunctive use of systemic antibiotics(12).
Some of the methods of microbial analysis include:
1. Microscopic assays
2. Culture assays
3. Immunologic assays
direct immunofluorescence
direct immunofluorescence
4. DNA probe assays
5. Enzyme-based assays
Periodontal Therapy:
The core of periodontal therapy includes various non-surgical and surgical modalities. Non-surgical therapy is mainly focused at eliminating plaque and plaque retentive features (calculus, overhanging restoration margins etc) through scaling, root planning and is always combined with oral hygiene instructions.
Surgical therapy is indicated when there are deep obstinate periodontal pockets despite good plaque control. Other surgical procedures include those that correct a variety of natural and pathological aberrations in the periodontium (curettage, gingivoplasty, gingivectomy, muco-gingival surgeries, crown lengthening surgery, root resection procedures and periodontal reconstructive procedures). Different approaches in surgical periodontology (conventional scalpel and laser surgeries, cryosurgery, electro cauterization, piezosurgeries) provide a diverse treatment options for diverse conditions. These therapies constitute the core of periodontics (Table 2).
Scope of Periodontics:
The scope of periodontics extends substantially into the other specialities of dentistry.
Periodontics-Orthodontics:
The significance of the implications of orthodontic therapy in periodontics can not be over-stated as the medium for orthodontic tooth movement is the periodontal ligament, a central component of the periodontium. In a patient with compromised periodontal health, meticulous care must be provided to ensure the orthodontic therapy is carried out in inflammation-free periodontal tissues. Another interesting overlap between the principles of these two specialities is the ‘Periodontally Accelerated Osteogenic Orthodontics’ where orthodontic tooth movement is accelerated by way of integrating selective alveolar corticotomy and particulate bone-grafting with orthodontic-therapy(13). Temporary anchorage devices or mini-implants are often used for orthodontic anchorage.
Periodontics-Prosthodontics:
The success of the outcome of any prosthodontic treatment is based on the solid foundation of the periodontium and on restoration designs that are conducive to periodontal health.
Periodontics-Oral Surgery:
Many a surgical procedures constitute this interdisciplinary interface such as frenectomy, frenotomy, ridge augmentation procedures, etc. During orthognathic surgeries, there is convincing evidence that suggests, there is significant incidence of periodontal injury in the region of segmental osteotomy(14). It has been reported that orthognathic surgeries have a marked effect in the development of gingival recessions(15).
Periodontics-Restorative Dentistry:
When planning a restoration, consideration must be given to the margin placement, restoration contours and contacts, embrasure shape, and polish of the restoration, so that it is conducive to periodontal health.
Periodontics-Endodontics:
There is an intimate relationship between the periodontium and the endodontium through the apical foramen, lateral canals, accessory canals and dentinal tubules. Such a natural continuum in the anatomy predisposes to a pathological continuum as well.
Periodontics-Forensics:
The interplay in these departments is appreciated during age estimation using tooth cementum annulations (TCAs) and amino acid racemization (sample taken from gingiva, as it is the most accessible), Gingival epithelium assessment, and using implants (that endure the thermal insults due to the high melting point of titanium) and implant recognition software for identification(16).
Periodontology and Geriatrics:
Age-related changes are seen in every tissue of the periodontium in the elderly (thinning of the epithelium, reduced keratinization, flattening of rete pegs in gingiva; increase in the fibrous component in the connective tissue; increase in the width of cementum; resorption of bone). In this group of patients the treatment protocol must reflect the consideration of any other systemic and psychological diseases, resistance and regenerative potential, state of host immune response. In an article by Ira B. Lamster(17) it is discussed that there is a present-day demographic shift where the count of older adults (>65 years) surpasses the count of young individuals (Englishhttp://ijcrr.com/abstract.php?article_id=2645http://ijcrr.com/article_html.php?did=26451. Michael G Newman, Henry H Takei, Perry R Klokkevold, Fermin A Carranza. Carranza’s clinical periodontology.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411124EnglishN2019December31HealthcareComparative Efficacy of 3Dimensional (3D) Cell Culture Organoids Vs 2Dimensional (2D) Cell Cultures Vs Experimental Animal Models In Disease modeling, Drug development, And Drug Toxicity Testing
English1117Santenna ChenchulaEnglishSunil KumarEnglishShoban Babu VEnglishHistorically animal studies and 2D cell culture models have been strengthening biomedical and pharmaceutical research, with many limitations. Currently, new drug development for many diseases like cancer is an important necessity. An organoid is a miniaturized version of an organ produced in vitro that shows realistic micro-anatomy, is capable of self-renewal and self-organization and exhibits similar functionality as the tissue of origin. While their size is small (typically < 3 mm in diameter), organoids are stable model systems of organs and tissues that are amenable to long-term cultivation and manipulation. They are classified into those that are tissue-derived and those that are stem cell-derived. They help in both in vivo and in vitro investigation and represent one of the latest innovations in the research for a model to recapitulate the physiologic processes of whole organisms. They reduce experimental complexity, and are compliant to real-time imaging techniques, and more importantly, they enable the study of aspects of human development and disease, drug toxicity in a clear fashion that is not easily or correctly modelled in animals and 2D cell cultures. However 3D organoids have also had some limitations like vascularity, inflammatory system, etc. Despite these limitations, it is evident that organoids have great potential to revolutionize the way we approach disease modelling, drug discovery, and toxicology.
English3D organoids, 2D cell culture, Drug discovery, Organ toxicity, High-throughput screeningIntroduction:
Traditionally animal studies using rats and mice etc., and 2D cell culture models have been used over the past decades in the field of biomedical research. Both these models are extremely helpful in disease modelling prior to the advent of the three-dimensional (3D) cell culture organoid technology. Nude and severe combined immunodeficiency (SCID) mice are immunodeficient mice, which are most commonly used as conferee of human cells or tissues as they accept foreign tissues or cells relatively easily due to a lack of host immunity. Another variety of rodents are humanized mice; this variety of mice lacks an innate immune system because these varieties completely procreated with human immune cells by hematopoietic stem cell transplantation [1]. Such humanized mouse models are particularly useful to model disease pathology and to allow for the assessment of potential therapeutic candidates. They provide a systemic environment to study disease pathology due to the presence of an intact immune system and blood circulation, which are essentially impossible in 2D models. Many studies have been succeeded in providing new insight into disease pathogenesis using humanized rodents in modelling human diseases. However, there are many raising questions on the pertinence of using mouse models to study human diseases [2]. 2D cell cultures used to study different cell types, along with drug screening and testing. Usually, it contains the monolayer system which allows cell growth over a polyester or glass flat surface presenting a medium that feeds the growing cell population [3].Endless biological breakthroughs occurred through 2D cell culture research(quote few examples). However these 2D cell culture models have limitations due to their simplicity, lack of tissue-specific architecture, mechanical and biochemical cues, and cell-to-cell and cell-to-matrix interactions, so this model can’t accurately depict and simulate the rich environment and complex processes observed in vivo such as cell signalling, chemistry or geometry, which makes them relatively poor models to predict drug responses for certain diseases like cancer [4]. As a result, data gathered with 2D cell culture methods could be non-predictive or misleading. Use of murine animal models for disease modelling, drug testing, and therapeutic development is not only costly and time-consuming but may not mimic biological responses in humans due to species differences. Considering all these limitations of animal studies and 2D cell culture system are not effective in disease modelling and drug research. However 3D cell culture organoids serve to overcome the challenges faced by 2D culture and animal disease models. Nonetheless, such modelling of human diseases in 3D cell culture organoids may still need to be validated in vivo, ultimately using a humanized mouse model.
3Dimensional (3D) cell culture Organoids
An organoid is "a collection of organ-specific cell types that develops from stem cells or organ progenitors and self-organizes through cell sorting and spatially restricted lineage commitment in a manner similar to in vivo.An organoid is a miniaturized version of an organ produced in vitro that shows realistic micro-anatomy, is capable of self-renewal and self-organization and exhibits similar functionality as the tissue of origin. While their size is small (typically Englishhttp://ijcrr.com/abstract.php?article_id=2646http://ijcrr.com/article_html.php?did=2646
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