ISSN: 0972-124X |
Published by Medknow Publishers
VOL 17 NUMBER 2 (2013)
- Our instructions, your intentions and our combined expectations…Is there a perfect article??
Ashish Sham Nichani
Journal of Indian Society of Periodontology 2013 17(2):153-153
- Building on a solid foundation…
Journal of Indian Society of Periodontology 2013 17(2):154-154
- Putting the best foot forward
Journal of Indian Society of Periodontology 2013 17(2):155-155
- Gene therapy in periodontics
Anirban Chatterjee, Nidhi Singh, Mini Saluja
Journal of Indian Society of Periodontology 2013 17(2):156-161
GENES are made of DNA - the code of life. They are made up of two types of base pair from different number of hydrogen bonds AT, GC which can be turned into instruction. Everyone inherits genes from their parents and passes them on in turn to their children. Every person's genes are different, and the changes in sequence determine the inherited differences between each of us. Some changes, usually in a single gene, may cause serious diseases. Gene therapy is 'the use of genes as medicine'. It involves the transfer of a therapeutic or working gene copy into specific cells of an individual in order to repair a faulty gene copy. Thus it may be used to replace a faulty gene, or to introduce a new gene whose function is to cure or to favorably modify the clinical course of a condition. It has a promising era in the field of periodontics. Gene therapy has been used as a mode of tissue engineering in periodontics. The tissue engineering approach reconstructs the natural target tissue by combining four elements namely: Scaffold, signaling molecules, cells and blood supply and thus can help in the reconstruction of damaged periodontium including cementum, gingival, periodontal ligament and bone.
- Systemic anti-microbial agents used in periodontal therapy
Vishakha Patil, Rohini Mali, Amita Mali
Journal of Indian Society of Periodontology 2013 17(2):162-168
Periodontitis is an infectious disease with marked inflammatory response, leading to destruction of underlying tissues. The aim of periodontal therapy is to eradicate the pathogens associated with the disease and attain periodontal health. This is achieved by non-surgical and surgical therapy; however, mechanical debridement and topical application of antiseptics may not be helpful in all cases. In such cases, adjunctive systemic antibiotic therapy remains the treatment of choice. It can reach micro-organisms at the base of the deep periodontal pockets and furcation areas via serum, and also affect organisms residing within gingival epithelium and connective tissue. Before advising any anti-microbial agent, it is necessary to have knowledge of that agent. The aim of this review article is to provide basic details of each systemic anti-microbial agent used in periodontal therapy. The points discussed are its mode of action, susceptible periodontal pathogens, dosage, its use in treatment of periodontal disease, and mechanism of bacterial resistance to each anti-microbial agent. It might be of some help while prescribing these drugs.
- Is immunesenescence a contributing factor for periodontal diseases?
Maheaswari Rajendran, V Priyadharshini, Gaurav Arora
Journal of Indian Society of Periodontology 2013 17(2):169-174
Current concept in periodontal diseases (PDs) states that it is the host's response toward the periodontal pathogens which leads to tissue destruction and attachment loss. Hence the role of immune response in the progression and resolution of PD must be considered vital. Any alteration in the immune system disturbs the homeostasis of the periodontium. Decline in immune system is the hallmark of aging, leading to increased susceptibility of elderly individuals to bacterial infections. The periodontal apparatus which is being constantly exposed to plaque biofilm is more vulnerable to destruction in aged individuals. Ageing related alterations in immune system has been discussed elsewhere as a contributor to various chronic inflammatory diseases like atherosclerosis, preterm, and low birth weight, etc. This paper reviews on the possible role of aging in periodontal destruction through altered immunity. Aging has long been associated with altered systemic inflammation. It has been discussed whether (1) this systemic inflammation is a consequence of increased occurrence of chronic inflammatory diseases upon aging or (2) aging associated systemic inflammation leads to such diseases. The immune responses which are protective at the first stages of life might result detrimental in the elderly. Hence it might be very difficult to individuate genetic profiles that might allow to identify individuals with a major risk for one or more age related diseases. Taking this into consideration, the cause of PDs in elderly is addressed with a systemic approach in order to understand the complex interplay between the aging immunity and PDs.
- A new classification system for gingival and palatal recession
Ashish Kumar, Sujata Surendra Masamatti
Journal of Indian Society of Periodontology 2013 17(2):175-181
Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. To propose a new classification system that gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to present classifications. A separate classification system for palatal recessions (PR) is also proposed. This article outlines the limitations of present classification systems and also the inability to classify PR. A new comprehensive classification system is proposed to classify recession on the basis of the position of interdental papilla and buccal/lingual/palatal recessions.
- Drug-induced gingival overgrowth: The nemesis of gingiva unravelled
Vipin Bharti, Chhaya Bansal
Journal of Indian Society of Periodontology 2013 17(2):182-187
Drug-induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction (ADR) in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. It gradually becomes a source of pain and the condition often leads to disfiguration. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. It would seem pertinent to identify and explore possible risk factors and relating them with the treatment plan. This article throws light on respective drugs and their association with gingival overgrowth and approaches to treatment based on current knowledge and investigative observations.
- The effect of MTAD, an endodontic irrigant, on fibroblast attachment to periodontally affected root surfaces: A SEM analysis
Mostafa Ghandi, Behzad Houshmand, Mohammad H Nekoofar, Rachel K Tabor, Zahra Yadeghari, Paul M. H. Dummer
Journal of Indian Society of Periodontology 2013 17(2):188-192
Background: Root surface debridement (RSD) is necessary to create an environment suitable for reattachment of the periodontium. Root surface conditioning may aid the formation of a biocompatible surface suitable for cell reattachment. BioPure™ MTAD (mixture of Doxycycline, citric acid and a detergent) is an endodontic irrigant with antibacterial properties and the ability to remove smear layer. It was hypothesized that MTAD may be useful for root surface conditioning. The efficacy of MTAD as a conditioner was measured by examining fibroblast attachment to root surfaces. Materials and Methods: Thirty-two specimens of human teeth with advanced periodontal disease were used. The surfaces were root planed until smooth. Half of the specimens were treated with 0.9% saline and the other samples with Biopure MTAD. As a negative control group, five further samples were left unscaled with surface calculus. Human gingival fibroblast cells HGF1-PI1 were cultured and poured over the tooth specimens and incubated. After fixation, the samples were sputter-coated with gold and examined with a SEM. The morphology and number of attached, fixed viable cells were examined. The data was analysed using the Mann-Whitney-U statistical test. Results: There was no significant difference between the numbers of attached cells in the experimental group treated with MTAD and the control group treated with saline. Little or no attached cells were seen in the negative control group. Conclusion: RSD created an environment suitable for cell growth and attachment in a laboratory setting. The use of MTAD did not promote the attachment and growth of cells on the surface of human roots following RSD.
- Efficacy of a commercially available multi-herbal formulation in periodontal therapy
A Suchetha, Ashit G Bharwani
Journal of Indian Society of Periodontology 2013 17(2):193-197
Objective: This prospective clinical trial was designed to evaluate the clinical effects of a commercially available powder (Periocare ® Gum massage powder), containing various herbal medicaments, in the reduction of plaque and gingival inflammation in subjects diagnosed with gingivitis. Materials and Methods: Seventy-five subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into the following three groups: Group I - Scaling + Periocare ® Gum Massage powder, Group II - Periocare ® Gum Massage powder alone, and Group III - Scaling only. Clinical evaluation was done at baseline, 2 weeks, 4 weeks, and 6 weeks using gingival index, plaque index, and microbiological culturing of plaque samples. Results: Periocare ® Gum Massage (multi-herbal formulation) powder as an adjunct to mechanical therapy (scaling) showed significant clinical and microbiological improvement in the gingival index and plaque index scores as compared to other groups. Periocare ® Gum Massage powder as a monotherapy did not prove to be effective for plaque control. Conclusion: Periocare ® Gum Massage may be a useful herbal formulation for chemical plaque control and improvement in plaque scores and gingival status.
- Green tea extract as a local drug therapy on periodontitis patients with diabetes mellitus: A randomized case-control study
Jayaprakash S Gadagi, Vijay K Chava, Venkata Ramesh Reddy
Journal of Indian Society of Periodontology 2013 17(2):198-203
Background: The green tea extract is a naturally occurring product having beneficial effects that counteract with the pathobiological features of periodontitis and diabetes mellitus. Hence, the present study was aimed at incorporation of green tea extract into hydroxylpropyl methylcellulose and investigates its efficacy in chronic periodontitis patients associated with and without diabetes mellitus. Materials and Methods: For the in vitro study, formulation of green tea strips and placebo strips, and analysis of drug release pattern from the green tea strips at different time intervals were performed. For the in vivo study, 50 patients (20-65 years), including 25 systemically healthy patients with chronic periodontitis (group 1) and 25 diabetic patients with chronic periodontitis (group 2) were enrolled. In each patient, test and control sites were identified for the placement of green tea and placebo strips, respectively. Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) were examined at baseline, first, second, third, and fourth weeks. Microbiological analysis for Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans was performed at baseline and fourth week. Results: The in vitro study showed 10.67% green tea release at 30 min; thereafter, a slow release was noted till 120 min. In vivo study: Both groups showed significant reduction in GI scores at the test sites. Group 1 showed significant (P < 0.001) PPD reduction at different time intervals at the test sites. However, group 2 showed significant reduction from baseline (5.30 ± 0.70) to fourth week (3.5 ± 0.97). Statistically significant gain in CAL at the test sites was observed both in group 1 (1.33 mm) and group 2 (1.43 mm). The prevalence of P. gingivalis in group 1 test sites was significantly reduced from baseline (75%) to fourth week (25%). Conclusions: Local drug delivery using green tea extract could be used as an adjunct in the treatment of chronic periodontitis in diabetic and non-diabetic individuals.
- Evaluation of the efficacy of green tea catechins as an adjunct to scaling and root planing in the management of chronic periodontitis using PCR analysis: A clinical and microbiological study
Sanjeevini A Hattarki, SP Pushpa, Kishore Bhat
Journal of Indian Society of Periodontology 2013 17(2):204-209
Background: Increased knowledge of anaerobic bacteria in the development of periodontal diseases has led to new treatment strategies aiming primarily at suppression or elimination of specific periodontal pathogens. Over the last few decades, green tea has been subjected to many scientific and medical studies. Aim: The purpose of the present study was to assess the effect of green tea catechins on the red complex organisms using Polymerase Chain Reaction for microbiological analysis. Materials and Methods: A split mouth study was conducted, in which a total of 20 subjects were included. Green tea catechin as local drug delivery was placed at study sites. Clinical parameters namely probing pocket depth (PPD), gingival index (GI), plaque index (PI) were recorded. Sub-gingival plaque samples were collected, and red complex micro-organisms were studied using PCR. Clinical and microbiological parameters were recorded at baseline, 1 st , and 5 th week after treatment. Results: The results showed statistically significant difference in PPD, GI, and PI and significant reduction of red complex organisms from baseline to 1 st week and baseline to 5 th week in both study and control groups (P < 0.001). Intergroup comparison between study and control group was statistically insignificant for PPD, PI, and GI. A significantly greater reduction in Tannerella forsythus (Tf) at 1 st week and 5 th week and Porphyromonas gingivalis (Pg) at 1 st week was observed in study group when compared to control group. Conclusion: Green tea catechin can be used as an effective local drug delivery along with scaling and root planing in treatment of chronic periodontitis.
- Evaluation of the association between chronic periodontitis and acute coronary syndrome: A case control study
Amitha Ramesh, Biju Thomas, Amita Rao
Journal of Indian Society of Periodontology 2013 17(2):210-213
Background: The periodontal tissues mount an immune inflammatory response to bacteria and their products and the systemic challenge with these agents also induce a major vascular response. Although many studies have found a correlation between chronic periodontitis and cardiovascular diseases, the role of infection in acute coronary syndrome is disputed. The aim of this study is to investigate whether there is an association between chronic periodontitis and acute coronary syndrome. Materials and Methods: A total of 30 patients, ages ranging from 30 -80. 15 patients from A. B. Shetty Memorial Institute of Dental Sciences and 15 patients admitted to Coronary Care Unit of Justice K. S. Hegde Charitable Hospital Deralakatte Mangalore were included in the study. Variables age more than 40 and gender were also analyzed. Results: Of the 30 patients analyzed in this study, periodontitis was recognized in 11 patients of the acute coronary syndrome group and 10 patients in the healthy group. Fisher's exact test yielded a p value of 0.4539 with an odds ratio of 0.727(95% confidence interval 0.151 to 3.493). Conclusion: No significant association was found between periodontal disease and acute coronary syndrome. Periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects. Properly powered longitudinal case control and intervention trials are needed to identify how periodontitis and periodontal interventions may have an impact on cardiovascular diseases.
- Chromogranin A: Novel biomarker between periodontal disease and psychosocial stress
Arunima Padmakumar Reshma, Rajeev Arunachalam, Jayakumar Kochu Pillai, Sarath Babu Kurra, Vini K Varkey, Mohanraj J Prince
Journal of Indian Society of Periodontology 2013 17(2):214-218
Context: The psychosocial stress has long been regarded as a significant pre-disposing factor for periodontal disease. The association between the periodontal disease and the neuroendocrine hormones has been observed. Chromogranin A (CgA) is supposed to link the activity of the neuroendocrine system to local and systemic immune functions and to be related to periodontitis. Aims: The aim of this study was to determine the CgA levels in saliva and plasma in periodontal health and disease and to assess their potential relationship to periodontitis. Settings and Designs: In this case-control study, the association between periodontal disease and stress marker has been assessed. Materials and Methods: Sixty subjects were chosen for this study: With case group comprising of 30 subjects with chronic periodontitis and control group comprising of 30 healthy subjects. Salivary and plasma CgA levels were determined by ELISA technique. Clinical parameters included were plaque index, papillary bleeding index and clinical attachment loss and probing depth. Correlation analysis was calculated by independent sample t-test. Results: Significantly higher CgA levels were found in saliva and plasma of patients with chronic periodontitis compared with healthy individuals (P < 0.05). No significant difference were observed between salivary and plasma CgA levels. Conclusions: The elevated level CgA in the plasma and saliva of subjects with stress induced chronic periodontitis has yielded insights into biological plausible association between the psychosocial stress and chronic periodontitis. Thus, our results suggest that CgA is a useful biomarker for evaluating at least in part the etiopathogenesis of periodontitis.
- A study to evaluate mobility of teeth during menstrual cycle using Periotest
Poonam Mishra, PP Marawar, Girish Byakod, Jyoti Mohitey, Sunil S Mishra
Journal of Indian Society of Periodontology 2013 17(2):219-224
Background and Objective: Over a century, an increased prevalence of gingival disease associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth supporting alveolar bone has rarely been investigated. So this study was undertaken to understand the effect on tooth mobility because of hormonal changes during the menstrual cycle. Materials and Methods: The mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with Periotest in 50 females at menstruation, ovulation, and premenstruation time points. Simplified oral hygiene index, plaque index, gingival index, and probing depth were also evaluated during the different phases of menstrual cycle for each subject participating in the study. Statistical Analysis: The results of the study were subjected to statistical analysis. Data analysis was done by applying Z test for comparing difference between two sample means. Result: The stages of menstrual cycle had no significant influence on the Periotest value. Despite no significant change in plaque levels, GI was significantly higher during ovulation and premenstruation time points. Conclusion: No change in tooth mobility was seen during the phases of the menstrual cycle. However, an exaggerated gingival response was seen during ovulation and premenstruation time when the entire menstrual cycle was observed.
- A need to educate postmenopausal women of their periodontal health
Leena Palomo, Rajeev Chitguppi, Maria Clarinda Buencamino, Dwetta Santos, Holly Thacker
Journal of Indian Society of Periodontology 2013 17(2):225-227
Background: Postmenopausal women have shown proactive willingness to take responsibility for their changing health care needs. The example of osteoporosis is a model that when educated of their bone health status, this cohort follows through with prevention and treatment regimens. Postmenopausal status is considered to be a risk factor for periodontitis. It is known that up to 50% of periodontal disease goes undiagnosed. The goal of periodontal therapy is to prevent tooth loss. Objective: Is there a need, then to educate and inform postmenopausal women of their periodontal status? Can dentists provide a greater service to this cohort by increasing education and information? Materials and Methods: The current study compares patient perception to actual clinical findings in 94 postmenopausal women. Patients are informed of their diagnosis, and educated about the disease, its risk factors and preventive and treatment modalities. Detailed interviews examine the patient intentions to follow up on preventive and treatment regimens suggested. Results: Although 97.8% of participants reported having "healthy gums", 36.2% had severe periodontitis in at least one site. Interviews reveal that patients associated disease with abscess, and would be likely to follow prevetive and treatment regimens when they were informed of their diagnosis and educated on the topic. Conclusion: The findings suggest a need to make education a priority when treatment postmenopausal women.
VOL 17 NUMBER 3 (2013)
- Whose manuscript is it anyway? The 'Write' position and number of authors….
Ashish Sham Nichani
Journal of Indian Society of Periodontology 2013 17(3):283-284
- An onward and upward transformation!
Journal of Indian Society of Periodontology 2013 17(3):285-285
- Growing from strength to strength
Journal of Indian Society of Periodontology 2013 17(3):286-286
- An innovative cosmetic technique called lip repositioning: A less invasive treatment possibility for dentists and surgeons
Alessandro Mangano, Alberto Mangano
Journal of Indian Society of Periodontology 2013 17(3):287-287
- Plasticity of T helper cell subsets: Implications in periodontal disease
Avaneendra Talwar, KV Arun, T. S. S. Kumar, Jasmine Clements
Journal of Indian Society of Periodontology 2013 17(3):288-291
T helper (Th) cells have an important role in host defence as well in the pathogenesis of periodontal disease. Th cells differentiate from naive cells into various subsets, each of which is associated with a set of inducing and effector cytokines. Previously, it was thought that this differentiation was an irreversible event. Recent evidence suggest that even differentiated Th cells, retain the flexibility to transform from one lineage to another, a phenomenon referred to as plasticity. This plasticity is thought to be brought about by epigenetic modifications that are regulated by external and internal signals in the micro-environment of these cells. The factors and mechanisms which affect the plasticity of these cells and their potential role in the etio-pathogenesis of periodontal disease has been described in this article.
- Molecular mechanisms involved in the bidirectional relationship between diabetes mellitus and periodontal disease
Harpreet Singh Grover, Shailly Luthra
Journal of Indian Society of Periodontology 2013 17(3):292-301
Both diabetes and periodontitis are chronic diseases. Diabetes has many adverse effects on the periodontium, and conversely periodontitis may have deleterious effects further aggravating the condition in diabetics. The potential common pathophysiologic pathways include those associated with inflammation, altered host responses, altered tissue homeostasis, and insulin resistance. This review examines the relationship that exists between periodontal diseases and diabetes mellitus with a focus on potential common pathophysiologic mechanisms.
- Vitamin D and periodontal health: Current concepts
Nithya Anand, SC Chandrasekaran, Narpat Singh Rajput
Journal of Indian Society of Periodontology 2013 17(3):302-308
Vitamin D is crucial for a wide variety of organ systems; nevertheless, its deficiency is highly prevalent, present in 30-50% of the general population. Evidence has demonstrated that vitamin D deficiency may place subjects at risk for not only low mineral bone density/osteoporosis and osteopenia, but also infectious and chronic inflammatory diseases. Through its effect on bone and mineral metabolism, innate immunity, and several vitamin D receptor gene polymorphisms, vitamin D has been reported to be associated with the periodontal disease.
- Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach
Anand K Patil, Adarsh S Shetty, Swati Setty, Srinath Thakur
Journal of Indian Society of Periodontology 2013 17(3):309-318
This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.
- Enzymatic evaluation of gingival crevicular fluid in cleft palate patients during orthodontic treatment: A clinico-biochemical study
Rithesh Kulal, Biju Thomas, MS Ravi, Suchetha Shetty
Journal of Indian Society of Periodontology 2013 17(3):319-323
Background: Therapeutic goal in patients with cleft lip and palate is esthetics and long-term health of the stomatognathic system. Patients with cleft lip and palate routinely require extensive and prolonged orthodontic treatment. The osseous structures are absent or poorly developed in the osseous clefts and may be traumatized in the course of orthodontic therapy; hence require constant monitoring during orthodontic treatment.The aim of the study was to evaluate the tissue response of cleft palate patients by quantitative analysis of enzyme activity during orthodontic treatment and assess any difference in the tissue response with that of noncleft patients undergoing orthodontic treatment. Materials and Methods: 20 patients requiring orthodontic treatment agedbetween 15 to 25 years were included to participate in the studyof which ten were cleft palate patients (group I) and ten noncleft patients (group II).The GCF samples were collected at incisor and molar sites during orthodontic treatment on days as per the study design in both the groups.The GCF enzymatic levels were estimated and compared. Results: Both groups showed significant increased enzyme activity at the incisor site compared to molar site corresponding to the phases of tooth movement. Conclusion: There was significant difference in enzyme activity between the incisor adjacent to the cleft site and molar site. There was no difference in the tissue response between cleft palate patients and noncleft patients during orthodontic treatment.
- Effect of surgical and non-surgical periodontal debridement on vascular thrombotic markers in hypertensives
Muhammad M Al Bush, Khattab K Razan, Al Dieri M Raed
Journal of Indian Society of Periodontology 2013 17(3):324-329
Background: Periodontal debridement has an impact on the vascular thrombotic markers in healthy individuals. This study aimed to investigate changes in several vascular thrombotic markers after surgical and non-surgical periodontal debridement in hypertensives with periodontitis. Materials and Methods: 40 hypertensives, 27 males and 13 females, 37-68 year old, mean 51.2 years, with moderate to severe periodontitis, were divided into two groups, (n = 20 for each); the first received comprehensive one session non-surgical periodontal debridement, (pockets 4-6 mm), while the second received comprehensive supragingival scaling with surgical debridement at one quadrant, (Pockets > 6 mm). Periodontal parameters included; plaque index (PI), gingival inflammation (GI), bleeding on probing (BOP), pocket probing depth (PPD). Vascular thrombotic tests included; platelets count (Plt), fibrinogen (Fib), Von Willebrand factor antigen activity (vWF:Ag), and D-dimers (DD). Results: PI, GI, BOP, PPD, decreased significantly (P = 0.001) after 6 weeks of periodontal debridement in both groups, while BOP and PPD remained higher in the surgical one (P < 0.05). Thrombotic vascular markers changes through the three-time intervals were significant in each group (P = 0.001), and time-group interception effect was significant for vWF:Ag (P = 0.005), while no significant differences between groups after treatment (P > 0.05). Conclusion: Periodontal debridement, surgical and non-surgical, improved the periodontal status in hypertensives. Periodontal treatment activated the coagulation system in hypertensives and recessed later while the treatment modality did not affect the degree of activation.
- Comparative evaluation of levels of C-reactive protein and PMN in periodontitis patients related to cardiovascular disease
G Anitha, M Nagaraj, A Jayashree
Journal of Indian Society of Periodontology 2013 17(3):330-332
Background: Numerous cross-sectional studies have suggested that chronic periodontitis is a risk factor for cardiovascular diseases. There is evidence that periodontitis and cardiovascular diseases are linked by inflammatory factors including C-reactive protein. The purpose of the study was to investigate the levels of CRP and PNM cells as a marker of inflammatory host response in the serum of chronic periodontitis patients and in patients with CVD. Materials and Methods: Study population included 75 patients; both male and female above 35 years were included for the study. The patients were divided into three groups of 25 each - Group I: Chronic periodontitis patients with CVD, Group II: Chronic periodontitis patients without CVD and Group III: Control subjects (without chronic periodontitis and CVD). Patients with chronic periodontitis had ≥8 teeth involved with probing depth (PD) ≥5 mm involved. The control group had PD ≤ 3 mm and no CVD. Venous blood was collected from the patients and C-reactive protein levels were analyzed by immunoturbidimetry. PMN was recorded by differential count method. Results: On comparison, OHI-S Index, GI, mean PD, CRP and PMN values showed significant difference from Group I to III. CRP level was highly significant in Group I when compared with Group II and Group III. PMN level was highly significant in Group I when compared with Group III PMN level which was not significant. Conclusion: This study indicated that periodontitis may add the inflammation burden of the individual and may result in increased levels of CVD based on serum CRP levels. Thus, controlled prospective trials with large sample size should be carried out to know the true nature of the relationship if indeed one exists.
- Evaluation of serum ceruloplasmin in aggressive and chronic periodontitis patients
B Harshavardhana, SK Rath, Manish Mukherjee
Journal of Indian Society of Periodontology 2013 17(3):333-337
Background: Pro-inflammatory markers are seen to increase in inflammatory diseases like periodontitis. Detecting an increase in these markers is one of the diagnostic modality. One such marker, which can be detected, is the ceruloplasmin. Ceruloplasmin induces hypoxia and generates oxygen radicals at the site of aggressive periodontitis. It also causes a state of hypoferremia leading to increase in the natural resistance of the body. The aim of this study was to evaluate the serum levels of cerruloplasmin in both aggressive and chronic periodontitis patients. Materials and Methods: Blood samples were collected from aggressive periodontitis patients (n = 20), chronic periodontitis patients (n = 20) and periodontally healthy patients (n = 20). The serum was extracted from all the blood samples and ceruloplasmin levels were spectroscopically evaluated through a new kinetic method, which used a norfloxacin based reagent. Results: Serum ceruloplasmin levels were found to be significantly higher in aggressive periodontitis patients (P > 0.05) than in chronic periodontitis patients (P > 0.05) even though increase in the level of ceruloplasmin was found in chronic periodontitis. Periodontally healthy patients did not show increase in the levels of serum ceruloplasmin. The levels of serum ceruloplasmin also increased with the disease severity whose manifestations were increased bleeding on probing, increased pocket depth and increased attachment loss. Conclusion: Serum ceruloplasmin levels increased in both aggressive and chronic periodontitis patients, but more in aggressive periodontitis patients making it a potential marker for diagnosis of periodontitis.
- Periodontitis, diabetes mellitus, and the lopsided redox balance: A unifying axis
Gowri Pendyala, Biju Thomas, Saurabh Joshi
Journal of Indian Society of Periodontology 2013 17(3):338-344
Aim:The aim of present study was to evaluate and compare the total antioxidant capacity in the saliva of type 2 diabetes mellitus (DM) patients and healthy subjects, with and without periodontal disease. Materials and Methods: The study was designed as a case-control study, comprising of 120 male subjects, who were divided into four groups of 30 patients each. Group I: Thirty type 2 diabetic males with periodontal disease; Group II: Thirty type 2 diabetic males without periodontal disease; Group III: Thirty healthy males with periodontal disease; Group IV: Thirty healthy males without periodontal disease. After clinical measurement and sampling, the total antioxidant capacities in the saliva of type 2 diabetic and healthy men were determined, and the data were tested by non-parametric tests. The total antioxidant capacity of the clinical samples was determined spectrophotometrically. Results: The total antioxidant capacity in the saliva was the lowest in type 2 diabetic males with periodontal disease. The results were statistically significant. Conclusion: The findings of our study finally conclude that the salivary total antioxidant capacity is affected in type 2 diabetic males, in addition to the impact of periodontal disease, and hence, can be used as a useful marker of periodontitis in healthy and diabetic patients.
- Use of autologous platelet rich plasma to treat gingival recession in esthetic periodontal surgery
Archana R Naik, Alampalli V Ramesh, CD Dwarkanath, Madhukeshwara S Naik, AB Chinnappa
Journal of Indian Society of Periodontology 2013 17(3):345-353
Background: Multiple approaches have been used to replace lost, damaged or diseased gingival tissues. Coronally advanced flap (CAF) and the use of guided tissue regeneration are among the successfully used surgical techniques to treat gingival recession. Platelet rich plasma (PRP), containing autologous growth factors, has been shown to promote soft-tissue healing. Therefore, the purpose of this study was to evaluate the efficacy of PRP in combination with CAF in the treatment of gingival recession. Materials and Methods: A total of 15 systemically healthy patients with buccal Miller's class I and class II gingival recession in cuspids or premolars participated in the study. CAF procedure was performed and PRP with collagen sponge was placed over the defect. Clinical parameters such as recession depth, recession width, surface area, width of keratinized gingival (KG), clinical attachment level (CAL), probing depth, plaque index and gingival index were evaluated at 3, 6 and 9 months post-surgery. The percentage of root coverage was calculated. Results: The results of this study suggest that the CAF procedure provides a predictable and simple technique in the treatment of localized Class I and Class II gingival recession. The additional application of PRP does significantly increase the width of KG and gain in clinical attachment. Conclusion: CAF procedure is a predictable and simple technique in the treatment of gingival recession and the additional application of PRP does significantly increase the width of KG and gain in CAL. The long-term benefits following surgical treatment of such defects needs to be determined further.
- Evaluation of single-tooth replacement by an immediate implant covered with connective tissue graft as a biologic barrier
SG Jyothi, MG Triveni, DS Mehta, K Nandakumar
Journal of Indian Society of Periodontology 2013 17(3):354-360
Background and Objectives: The aim of the present study was to evaluate the survival rate of Screw-Vent ® immediate implants augmented with sub epithelial connective tissue graft for single-tooth replacement for 1 year. Materials and Methods: Ten patients (five men and five women), with the mean age of 25.3 years, were consecutively treated on the out-patient basis by the placement of Screw-Vent ® dental implants in to the fresh extraction sockets in association of augmentation with sub epithelial connective tissue graft harvested from the palate, supporting single crowns. The clinical and radiographic parameters were recorded to evaluate the peri-implant soft tissue health and marginal bone loss, respectively, for each patient at baseline and at every 3 months interval for 1 year. Results: The 1 year cumulative survival rate of Screw-Vent ® dental implants was 100% for all 10 patients. Statistical analysis demonstrated highly significant values indicating an improvement in peri-implant soft tissue parameters in terms of peri-implant aesthetic parameters, which estimated the keratinized mucosa width. Statistically, non-significant marginal bone loss or gain indicated stable condition in hard tissue parameters. Interpretation and Conclusion: Single-tooth replacement by Screw-Vent ® dental implants in to a fresh extraction socket, in association with guided bone regeneration using autologous connective tissue graft is a predictable treatment as demonstrated by the 100% implant survival rates and appreciable increase in the width of the keratinized mucosa at 1 year follow up.
- Evaluation of efficacy of autologous platelet-rich fibrin with demineralized-freeze dried bone allograft in the treatment of periodontal intrabony defects
Chhaya Bansal, Vipin Bharti
Journal of Indian Society of Periodontology 2013 17(3):361-366
Background: Platelet-rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. The purpose of the study was to clinically evaluate and compare the efficacy of autologous PRF combined with demineralized freeze-dried bone allograft (DFDBA) to DFDBA alone in the treatment of periodontal intrabony defects. Materials and Methods: In a split mouth study design, 10 patients having two almost identical intrabony defects with clinical probing depth of at least 6 mm were selected for the study. Selected sites were randomly divided into two groups. In Group I , mucoperiosteal flap elevation followed by the placement of DFDBA was done. In Group II, mucoperiosteal flap elevation followed by the placement of homogeneous mixture of PRF with DFDBA was done. Clinical and radiographic parameters were recorded at baseline and at 6 months post-operatively. Results: Both treatment groups showed a significant probing pocket depth reduction, clinical attachment gain, defect fill, and defect resolution 6 months after surgery compared to baseline. However, there was a significantly greater probing pocket depth reduction and clinical attachment gain when PRF was added to DFDBA. Conclusion: Within limits of the study it may be concluded that a combination of PRF with DFDBA demonstrated better results in probing pocket depth reduction and clinical attachment level gain as compared to DFDBA alone in the treatment of periodontal intrabony defects.
- Evaluation of bioactive glass and demineralized freeze dried bone allograft in the treatment of periodontal intraosseous defects: A comparative clinico-radiographic study
Kishore Kumar Katuri, P Jaya Kumar, Chakrapani Swarna, D Narasimha Swamy, Kurumathur V Arun
Journal of Indian Society of Periodontology 2013 17(3):367-372
Aim: The purpose of this study was to evaluate the efficacy of demineralized freeze dried bone allograft (DFDBA) and bioactive glass by clinically and radiographically in periodontal intrabony defects for a period of 12 months. Materials and Methods: Ten systemically healthy patients diagnosed with chronic periodontitis, with radiographic evidence of at least a pair of contralateral vertical osseous defects were included in this study. Defect on one-side is treated with DFDBA and the other side with bioactive glass. Clinical and radiographic measurements were made at baseline 6 month and 12 month after the surgery. Results: Compared to baseline, the 12 month results indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, probing depth, clinical attachment level (CAL) and radiographic parameters (bone fill); P < 0.001*). However, sites treated with DFDBA exhibited statistically significantly more changes compared to the bioactive glass in probing depth reduction (2.5 ± 0.1 mm vs. 1.8 ± 0.1 mm) CAL gain 2.4 ± 0.1 mm versus 1.7 ± 0.2 mm; ( P < 0.001*). At 12 months, sites treated with bioactive glass exhibited 56.99% bone fill and 64.76% bone fill for DFDBA sites, which is statistically significant ( P < 0.05*). Conclusion: After 12 months, there was a significant difference between the two materials with sites grafted with DFDBA showing better reduction in probing pocket depth, gain in CAL and a greater percentage of bone fill when compared to that of bioactive glass.
- Papillon-Lefevre syndrome: A case report of 2 affected siblings
Anupriya Sharma, Gurpreet Kaur, Ashish Sharma
Journal of Indian Society of Periodontology 2013 17(3):373-377
Papillon-Lefèvre syndrome (PLS) is a very rare syndrome of autosomal recessive inheritance characterized by palmar-plantar hyperkeratosis and early onset periodontitis, leading to premature loss of both primary and permanent dentitions. Various etiopathogenic factors are associated with the syndrome, but a recent report has suggested that the condition is linked to x mutations of the cathepsin C gene. The purpose of this report is to describe two cases of PLS in the same family who presented to the Department of Dentistry of Dr. R. P. Government Medical College at Tanda, Kangra (Himachal Pradesh) with a chief complaint of mobility and rapid loss of teeth. Hyperkeratosis of palms and soles was present. On intraoral examination, there was severe gingival inflammation, abscess formation, and deep periodontal pockets with mobility of teeth. Histopathological examination of the specimen taken from the thickened skin was reported to be consistent with PLS. The dental treatment comprised oral prophylaxis, scaling and root planning, antibiotic therapy, instructions on oral hygiene, restorations, extraction of hopelessly affected teeth, and prosthetic rehabilitation.
- Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease
Anita H Panchal, Vasumati G Patel, Neeta V Bhavsar, Hardik V Mehta
Journal of Indian Society of Periodontology 2013 17(3):378-382
This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.
- Paramolar concrescence and periodontitis
Sanjay Venugopal, BV Smitha, S Prithyani Saurabh
Journal of Indian Society of Periodontology 2013 17(3):383-386
Concrescence is a developmental anomaly of dental hard tissues. It is a condition showing union of adjacent teeth by cementum. The concrescence leads to a loss of gingival architecture leading to the development of funnels, which may cause plaque accumulation thus, resulting in periodontal tissue destruction. There is a slight predilection for the mandible especially in the premolar area followed by the molar and anterior regions. Awareness of these developmental disturbances with proper diagnosis and treatment is very essential because it can compromise the periodontal attachment and can lead to the tooth loss. This article highlights the presence of a concrescence between mandibular second molar and the supernumerary fused teeth with their clinical and radiographic findings, along with its management.
- Ipsilateral idiopathic gingival enlargement and it's management using conventional gingivectomy and diode laser: A recurrent case after 15 years
Potharaju Kamala Devi, Gudi Pavan Kumar, Yendluri Durga Bai, Annamdevula Durga Ammaji
Journal of Indian Society of Periodontology 2013 17(3):387-390
Idiopathic gingival fibromatosis is a relatively rare condition characterized by the proliferation of the gingival tissues resulting in masticatory, esthetics, phonetics and psychological disturbances. The severity of the overgrowth can range from a solitary isolated mass to a more generalized and diffused enlargement. The etiopathogenesis of this bizarre condition is poorly understood and has been attributed to various factors. It can present as a single disorder or may manifest as part of a syndrome. This case reports an ipsilateral diffused idiopathic gingival enlargement in a middle aged adult recurring after a gap of 15 years. External bevel gingivectomy on the buccal aspects of maxillary and mandibular gingiva and diode laser for excision of the enlarged tissue on the lingual/palatal aspect was carried out to eliminate the excessive tissue. Periodic recalls showed maintenance of good oral hygiene and 1 year follow-up revealed no recurrence.
- Multiple myeloma presenting as gingival hyperplasia
Sanjeev Jain, Harjit Kaur, Gaurav Kansal, Parul Gupta
Journal of Indian Society of Periodontology 2013 17(3):391-393
Multiple myeloma is a malignant neoplasm that is characterized by a monoclonal proliferation of plasma cells. Oral and maxillofacial manifestations as an initial sign or symptom of multiple myeloma are rare. A 58-year-old male patient presented with generalized gingival enlargement for last 6 months. Based on clinical presentation, a diagnosis of gingival hyperplasia was made. After Phase I therapy, excisional biopsy was taken in anterior mandibular region and excised tissue was sent for histopathological examination. The histopathology report revealed a lining of stratified squamous epithelium with foci of ulceration. The subepithelial zone showed infiltration by sheets of mainly binucleate and multinucleate plasma cells, few cells being less differentiated. Rounded cytoplasmic inclusion bodies were identified in many of these cells. After a series of clinical investigations, a case of "multiple myeloma" was diagnosed. Patient presenting with generalized gingival hyperplasia should be worked up for systemic disease like multiple myeloma.
- On the minimally invasive approach to the gingival recession
Sergei V Jargin
Journal of Indian Society of Periodontology 2013 17(3):394-396
Some aspects of pathogenesis and therapeutic approach to the gingival recession are discussed in this short communication with the example of a typical case from Russia, where excessive socket curettage after a tooth extraction resulted in a marked gingival recession. Subgingival plaque and calculus can be secondary to recession. An argument about plaque as a source of microorganisms might be plausible in case of inflammation, although various microorganisms are normal for the oral cavity. From the viewpoint of general pathology, being an atrophic condition, recession can progress due to repeated damage. On the author's opinion, calculus removal is not indicated at least for aged patients with marked gingival recession, having modest esthetic demands. Socket curettage after exodontia should be gentle. Surgical treatment of the gingival recession is beyond the scope of this communication.
- News and Events
Journal of Indian Society of Periodontology 2013 17(3):397-401
- Awards and Achievements
Journal of Indian Society of Periodontology 2013 17(3):402-402
VOL 17 NUMBER 4 (2013)
- Reporting science with ethics: Your work is your reputation!
Ashish Sham Nichani
Journal of Indian Society of Periodontology 2013 17(4):407-408
- Kochi beckons you..Let us refresh our knowledge & rejuvenate our friendship
Journal of Indian Society of Periodontology 2013 17(4):409-409
- The final lap…
Journal of Indian Society of Periodontology 2013 17(4):410-410
- Reactive oxygen species in periodontitis
Parveen Dahiya, Reet Kamal, Rajan Gupta, Rohit Bhardwaj, Karun Chaudhary, Simerpreet Kaur
Journal of Indian Society of Periodontology 2013 17(4):411-416
Recent epidemiological studies reveal that more than two-third of the world's population suffers from one of the chronic forms of periodontal disease. The primary etiological agent of this inflammatory disease is a polymicrobial complex, predominantly Gram negative anaerobic or facultative bacteria within the sub-gingival biofilm. These bacterial species initiate the production of various cytokines such as interleukin-8 and TNF-α, further causing an increase in number and activity of polymorphonucleocytes (PMN) along with these cytokines, PMNs also produce reactive oxygen species (ROS) superoxide via the respiratory burst mechanism as the part of the defence response to infection. ROS just like the interleukins have deleterious effects on tissue cells when produced in excess. To counter the harmful effects of ROS, human body has its own defence mechanisms to eliminate them as soon as they are formed. The aim of this review is to focus on the role of different free radicals, ROS, and antioxidants in the pathophysiology of periodontal tissue destruction.
- Ribonucleic acid interference induced gene knockdown
Sruthima N. V. S. Gottumukkala, CD Dwarakanath, Sabitha Sudarsan
Journal of Indian Society of Periodontology 2013 17(4):417-422
Despite major advances in periodontal regeneration over the past three decades, complete regeneration of the lost periodontium on a regular and predictable basis in humans has still remained elusive. The identification of stem cells in the periodontal ligament together with the growing concept of tissue engineering has opened new vistas in periodontal regenerative medicine. In this regard, ribonucleic acid interference (RNAi) opens a new gate way for a novel RNA based approach in periodontal management. This paper aims to summarize the current opinion on the mechanisms underlying RNAi, in vitro and in vivo existing applications in the dental research, which could lead to their future use in periodontal regeneration.
- Mechanized scaling with ultrasonics: Perils and proactive measures
Rashmi Paramashivaiah, M. L. V. Prabhuji
Journal of Indian Society of Periodontology 2013 17(4):423-428
Mechanized scaling for plaque removal is a routine procedure in the practice of periodontics. Though it appears innocuous by itself, there are retinues of hazards associated with it on various organ systems in the body. Some of these unwanted effects and measures to avoid or ameliorate the same are elaborated here. Exposure to ultrasonic scaling is inevitable before any other treatment procedure. Aerosol contamination, vibrational hazards, thermal effects on the dental pulp, altered vascular dynamics, disruption in electromagnetic device, diminished hearing and dental unit waterline contamination are some of the probable off-shoots a patient has to bear. Uses of barrier devices, proper attention to usage of equipment, protection for ear and water treatment are few of solutions for the same. Though documented evidence for the existence of all effects is lacking, it is never the less significant for the overall safety of the patient. A conscientious clinician should therefore inculcate the available steps to overcome the hazards of ultrasonic scaling.
- Kinetics of drug release from a biodegradable local drug delivery system and its effect on Porphyromonas gingivalis isolates: An in vitro study
Ranganathan Vijayalashmi, Sabitha Manhalore Ravindranath, Nadathur Doraiswamy Jayakumar, Padmalatha , Sheeja H Vargheese, Kikkeri Laxminarayana Kumaraswamy
Journal of Indian Society of Periodontology 2013 17(4):429-434
Background: Conventional anti-microbial therapy largely consisted of systemic administration of various drugs effective against periodontal pathogens, but fraught with several problems. Based on the concept of local drug delivery a bioresorbable device made of pure fibrillar collagen has been developed. The aim of this study was to study the release of Tetracycline from this collagen fiber (Type I collagen) impregnated with Tetracycline and its antibacterial activity against Porphyromonas gingivalis. Materials and Methods: Porphyromonas gingivalis was isolated from plaque samples of chronic periodontitis patients by using a CO 2 incubator. DNA isolation was done followed by polymerase chain reaction (PCR) amplification to confirm the presence of bacteria. The release pattern of Tetracycline was assessed for a period of 10 days in water (group I) and Serum inoculated with Porphyromonas gingivalis (group II). Results: A significant presence of Tetracycline on all days in Group I and group II and the zone of inhibition was also present in both groups with a steady decline from day 1 to day 10. Conclusion: Since the results were well within the therapeutic concentration of drug required to inhibit the growth of gram -ve bacteria (Porphyromonas gingivalis), this bioresorbable Tetracycline fiber has the potential for clinical application.
- Aloe vera: It's effect on gingivitis
Neha Ajmera, Anirban Chatterjee, Vikas Goyal
Journal of Indian Society of Periodontology 2013 17(4):435-438
Objective: Aloe vera is the oldest medicinal plant that has maintained its popularity over the course of time. It is widely known for its medicinal uses in wound healing, as an analgesic, and for its anti-inflammatory properties. Aim: The aim of this study is to evaluate the anti-inflammatory property of aloe vera mouthwash on plaque-induced gingivitis. Materials and Methods: Forty-five patients who were diagnosed with plaque-induced gingivitis were included in the study. They were divided into three groups with fifteen patients in each group. Group 1 was asked to rinse with 10 ml of aloe vera mouthwash twice daily for three months. Group 2 were treated with scaling only. Group 3 patients were asked to rinse with aloe vera mouthwash and scaling was done. The clinical changes were evaluated with Loe and Silness gingival index (1963) and Muhlemann and Son's Sulcus bleeding index (1971) at baseline, after one month and three months, respectively. Results: The data obtained was compared statistically. The paired 't' test was done for intragroup comparison and one-way analysis of variance with a post hoc Tukey test was used for intergroup comparison. The data was obtained at the baseline, end of first month, and end of the third month. The result suggested reduction in gingival inflammation in all the three groups, but it was more in the aloe vera mouthwash and scaling group. Hence, it was concluded that aloe vera had a significant anti-inflammatory property. Thus, it can be used as an adjunct to mechanical therapy for treating plaque-induced gingivitis.
- Efficacy of xanthan based chlorhexidine gel as an adjunct to scaling and root planing in treatment of the chronic periodontitis
Meetu Jain, Deepak Dave, Preet Jain, Balaji Manohar, Bipin Yadav, Neema Shetty
Journal of Indian Society of Periodontology 2013 17(4):439-443
Aim: The aim of this study was to evaluate the clinical effectiveness of locally delivered xanthan-based Chlosite® gel as an adjunctive therapy to scaling and root planing in treatment of chronic periodontitis. Materials and Methods: In a randomized controlled clinical study, 30 patients were selected. Pocket depth between 5 and 7 mm was selected and each patient had two sites on the same side of the mouth. A total of 30 control sites were scaled and root planed and 30 test sites were scaled and root planed and Chlosite® gel was added. The clinical parameters, probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP), gingival index were recorded at baseline, 6 weeks, 3 months and 6 months. Statistical Analysis: Paired/unpaired t-test was used, significance was placed at 5% level of significance, i.e., P < 0.05 was considered as a significant. Results: From baseline to a period of 6 months, significant difference was found between test and control group for PD, CAL, PI and BOP, P value being PD (P = 0.002), CAL index (P = 0.014), respectively. Conclusion: Subgingival injection of xanthan-based Chlosite® gel adjunct with scaling and root planing appeared to cause significant improvement compared with scaling and root planing alone in persons with chronic periodontitis.
- Effect of local application of tea tree (Melaleuca alternifolia) oil gel on long pentraxin level used as an adjunctive treatment of chronic periodontitis: A randomized controlled clinical study
Enas Ahmed Elgendy, Shereen Abdel-Moula Ali, Doaa Hussien Zineldeen
Journal of Indian Society of Periodontology 2013 17(4):444-448
Background: Conventional non-surgical periodontal therapy has been proven to be an effective treatment for patients with chronic periodontitis. Tea tree oil (TTO) can be used as adjunct to conventional periodontal therapy in patient with chronic periodontitis. The aim of this study was to evaluate the effectiveness of adjunctive treatment of TTO on the clinical parameters and the level of pentraxin-3 (PTX3) in chronic periodontitis. Materials and Methods: A total of 40 patients with moderate to severe chronic periodontitis were divided into two groups, Group I received scaling and root planing (SRP) only, Group II received SRP and TTO gel. Clinical parameters were recorded and gingival crevicular fluid (GCF) samples were collected from each subject for measuring PTX3 levels at baseline, 1, 3 and 6 months after treatment. Results: In all evaluation periods, there was statistically significant reduction in each of the studied clinical parameters and PTX3 level in Group II as compared with Group I. Conclusions: The local delivery of TTO gel in case of chronic periodontitis may have some beneficial effects to augment the results of the conventional periodontal therapy. Moreover, it places a focus on the value of monitoring GCF levels of PTX3 as a marker of periodontal tissue healing.
- Effect of hydrogen peroxide mouthwash as an adjunct to chlorhexidine on stains and plaque
Pravesh Jhingta, Ashu Bhardwaj, Deepak Sharma, Naresh Kumar, Vinay Kumar Bhardwaj, Sanjeev Vaid
Journal of Indian Society of Periodontology 2013 17(4):449-453
Aim: To investigate whether the use of an oxidizing mouth rinse as an adjunct to chlorhexidine is efficacious in reducing stains and plaque. Materials and Methods: This study had a single-blind, three-group (n = 35 each) parallel design, including a 21 days experimental period during which group I rinsed with chlorhexidine (CHX) 0.2% alone, group II used chlorhexidine (CHX) followed by hydrogen peroxide (H 2 O 2 ) 1.5%. Group III rinsed with the same mouthwashes in reverse order. Patients were randomly assigned to one of the three groups. The examination for plaque, and stains was done after 1, 2, and 3 weeks of rinsing. Results: Group II showed significantly less stain intensity in comparison with group I after 14 and 21 days (P values 0.025 and 0.005, respectively). The proportion of stained surfaces was less in the group II than in the group I and was significant at the end of 1 week. The plaque formation was significantly less in groups II and III than group I at 7, 14, and 21 days. Conclusion: The adjunctive use of hydrogen peroxide to chlorhexidine proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of stains.
- Association of salivary calcium, phosphate, pH and flow rate on oral health: A study on 90 subjects
Mohamed Fiyaz, Amitha Ramesh, Karthikeyan Ramalingam, Biju Thomas, Sucheta Shetty, Prashanth Prakash
Journal of Indian Society of Periodontology 2013 17(4):454-460
Background and Objectives: This study was designed to compare inorganic salivary calcium, phosphate, flow rate and pH of un-stimulated saliva and oral hygiene of healthy subjects, patients with periodontitis and dental caries and to correlate salivary calcium level with the number of intact teeth. Materials and Methods: The present study consisted of 90 patients aged between 18 and 55 years and were divided into three groups, periodontitis, dental caries and controls. Oral hygiene index-simplified, probing pocket depth, clinical attachment level and number of teeth present, teeth with active carious lesions were recorded. Salivary flow rate and pH was recorded and subjected to biochemical investigation. Estimation of inorganic calcium and phosphate was performed by colorimetric method. Results: Results showed statistically significant increase in salivary inorganic calcium and phosphate levels, poor oral hygiene status, pH and salivary flow rate in patients with periodontitis when compared with dental caries group and controls. Interpretation and Conclusion : Individuals who have increased salivary inorganic calcium, phosphate, pH, flow rate and maintain poor oral hygiene could be at a higher risk for developing periodontitis and may have less dental caries and more number of intact teeth.
- Salivary pH: A diagnostic biomarker
Sharmila Baliga, Sangeeta Muglikar, Rahul Kale
Journal of Indian Society of Periodontology 2013 17(4):461-465
Objectives: Saliva contains a variety of host defense factors. It influences calculus formation and periodontal disease. Different studies have been done to find exact correlation of salivary biomarkers with periodontal disease. With a multitude of biomarkers and complexities in their determination, the salivary pH may be tried to be used as a quick chairside test. The aim of this study was to analyze the pH of saliva and determine its relevance to the severity of periodontal disease. Study Design: The study population consisted of 300 patients. They were divided into three groups of 100 patients each: Group A had clinically healthy gingiva, Group B who had generalized chronic gingivitis and Group C who had generalized chronic periodontitis. The randomized unstimulated saliva from each patient was collected and pH was tested. Data was analyzed statistically using analysis of variance technique. Results: The salivary pH was more alkaline for patients with generalized chronic gingivitis as compared with the control group (P = 0.001) whereas patients with generalized chronic periodontitis had more acidic pH as compared with the control group (P = 0.001). Conclusion: These results indicate a significant change in the pH depending on the severity of the periodontal condition. The salivary pH shows significant changes and thus relevance to the severity of periodontal disease. Salivary pH may thus be used as a quick chairside diagnostic biomarker.
- Evaluation of the effect of one stage versus two stage full mouth disinfection on C-reactive protein and leucocyte count in patients with chronic periodontitis
Chandra Mohan Pabolu, Ramesh Babu Mutthineni, Srikanth Chintala, Naheeda , Navya Mutthineni
Journal of Indian Society of Periodontology 2013 17(4):466-471
Background: Conventional non-surgical periodontal therapy is carried out in quadrant basis with 1-2 week interval. This time lag may result in re-infection of instrumented pocket and may impair healing. Therefore, a new approach to full-mouth non-surgical therapy to be completed within two consecutive days with full-mouth disinfection has been suggested. In periodontitis, leukocyte counts and levels of C-reactive protein (CRP) are likely to be slightly elevated, indicating the presence of infection or inflammation. The aim of this study is to compare the efficacy of one stage and two stage non-surgical therapy on clinical parameters along with CRP levels and total white blood cell (TWBC) count. Materials and Methods: A total of 20 patients were selected and were divided into two groups. Group 1 received one stage full mouth dis-infection and Group 2 received two stages FMD. Plaque index, sulcus bleeding index, probing depth, clinical attachment loss, serum CRP and TWBC count were evaluated for both the groups at baseline and at 1 month post-treatment. Results: The results were analyzed using the Student t-test. Both treatment modalities lead to a significant improvement of the clinical and hematological parameters; however comparison between the two groups showed no significant difference after 1 month. Conclusion: The therapeutic intervention may have a systemic effect on blood count in periodontitis patients. Though one stage FMD had limited benefits over two stages FMD, the therapy can be accomplished in a shorter duration.
- Gingival crevicular blood: As a non-invasive screening tool for diabetes mellitus in dental clinics
Neema Shetty, Rajesh Shankarapillai, Lalit Kumar Mathur, Balaji Manohar, Aditi Mathur, Meetu Jain
Journal of Indian Society of Periodontology 2013 17(4):472-477
Background: A high number of patients with periodontitis may have undiagnosed diabetes. Self-monitoring devices provide a simple method for rapid monitoring of the glucose level in the blood by utilizing a blood sample from the finger, but this method requires a needle puncture to obtain blood. It is possible that gingival crevicular blood (GCB) from routine periodontal probing may be a source of blood for glucose measurements. Aim: To establish whether GCB can be used as a non-invasive diagnostic aid in screening for diabetes mellitus during routine periodontal examination. Materials and Methods: The study involved 50 diabetics and 50 non-diabetics, with an age range of 26-66 years. Both diabetic and non-diabetic patients had moderate to severe gingivitis with at least one tooth in the maxillary anterior region showing bleeding upon probing. The Gingival Index and Oral Hygiene Index-Simplified were recorded. Blood oozing from the gingival sulcus/pocket following periodontal pocket probing was collected using a capillary tube and transferred to the test stick of a glucose self-monitoring device (Accu-Chek, Roche Diagnostic, Germany) in patients with comparable gingival and oral hygiene status. This value was compared with the peripheral fingerstick blood glucose (PFBG) value, which was obtained by pricking the finger tip at the same visit. Statistical analysis was performed using Pearson's correlation coefficient. Result: There was no statistically significant difference between the gingival crevicular blood glucose (GCBG) values and the PFBG values in both the diabetic (P = 0.129, NS) and the non-diabetic (P = 0.503, NS) groups. Karl Pearson's product-moment correlation coefficient was calculated, which showed a positive correlation between the two measurements in the diabetic (r = 0.943) as well as the non-diabetic (r = 0.926) groups. Conclusion: The results suggest that GCB can be used as a non-invasive diagnostic aid in screening for diabetes mellitus during routine periodontal examination.
- A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation
Libby John Thomas, Pamela Emmadi, Ramakrishnan Thyagarajan, Ambalavanan Namasivayam
Journal of Indian Society of Periodontology 2013 17(4):478-483
Aims: The purpose of this study was to compare the clinical efficacy of subepithelial connective tissue graft and acellular dermal matrix graft associated with coronally repositioned flap in the treatment of Miller's class I and II gingival recession, 6 months postoperatively. Settings and Design: Ten patients with bilateral Miller's class I or class II gingival recession were randomly divided into two groups using a split-mouth study design. Materials and Methods: Group I (10 sites) was treated with subepithelial connective tissue graft along with coronally repositioned flap and Group II (10 sites) treated with acellular dermal matrix graft along with coronally repositioned flap. Clinical parameters like recession height and width, probing pocket depth, clinical attachment level, and width of keratinized gingiva were evaluated at baseline, 90 th day, and 180 th day for both groups. The percentage of root coverage was calculated based on the comparison of the recession height from 0 to 180 th day in both Groups I and II. Statistical Analysis Used: Intragroup parameters at different time points were measured using the Wilcoxon signed rank test and Mann-Whitney U test was employed to analyze the differences between test and control groups. Results: There was no statistically significant difference in recession height and width, gain in CAL, and increase in the width of keratinized gingiva between the two groups on the 180 th day. Both procedures showed clinically and statistically significant root coverage (Group I 96%, Group II 89.1%) on the 180 th day. Conclusions: The results indicate that coverage of denuded root with both subepithelial connective tissue autograft and acellular dermal matrix allograft are very predictable procedures, which were stable for 6 months postoperatively.
- A comparative evaluation of the effectiveness of guided tissue regeneration by using a collagen membrane with or without decalcified freeze-dried bone allograft in the treatment of infrabony defects: A clinical and radiographic study
Vishal Kiran Kher, Manohar L Bhongade, Tony D Shori, Abhay P Kolte, Swarup B Dharamthok, Tushar S Shrirao
Journal of Indian Society of Periodontology 2013 17(4):484-489
Background: The present, randomized, controlled clinical and radiographic study was undertaken to compare the effectiveness of guided tissue regeneration (GTR) by using a collagen membrane barrier with or without decalcified freeze-dried bone allograft (DFDBA) in the treatment of periodontal infrabony defects characterized by unfavorable architecture. Materials and Methods: Sixteen systemically healthy patients with 20 periodontal infrabony defects were selected for the study. Each patient had at least ≥ 5 mm clinical probing pocket depth (PPD) at the selected site and depth of intrabony component ≥ 3 mm as assessed by clinical and radiographic measurements. Baseline measurements included plaque index, papillary bleeding index, PPD, gingival recession, clinical attachment level and radiographic defect depth (DD). At the time of surgery, the defects were randomly assigned to either the test group (collagen membrane plus DFDBA) or the control group (collagen membrane only). Results: At the 6-month examination, PPPD reduction was significantly greater in the GTR + DFDBA group (4.06 ± 0.38 mm) compared with the GTR group (3.2 ± 0.74 mm). The mean gains of clinical attachment were 3.54 ± 0.36 mm in the test group and 2.50 ± 0.74 mm in the control group. Radiographic DD reduction was similarly greater in the GTR + DFDBA group (2.40 ± 0.51 mm) compared with the GTR group (1.60 ± 0.51 mm). Conclusions: The results of the present study indicate that the use of a GTR membrane with bone graft has significantly improved all clinical parameters tested as compared with the use of bioresorbable membrane alone in the treatment of infrabony defects characterized by unfavorable architecture.
- Comparative evaluation of decalcified freeze dried bone allograft with and without local doxycycline in non-contained human periodontal infrabony defects
Ashish Agarwal, Hirak S Bhattacharya, G Srikanth, Anjali Singh
Journal of Indian Society of Periodontology 2013 17(4):490-494
Background: Doxycycline has been advocated as useful adjuncts in periodontal therapy not only due to their antimicrobial actions, but also to their recently recognized anti-collagenolytic, anti-inflammatory, osteoclast inhibitory and fibroblast stimulating property. The purpose of the present cohort study was to evaluate the regenerative outcomes of bone graft with or without local doxycycline in non-contained infrabony periodontal defects. Materials and Methods: 16 one or two wall infrabony defects, in 11 patients suffering from moderate to severe chronic periodontitis, aged 35-60 years, were randomly divided for bone graft, alone (control) and with doxycycline (test) for the study. At baseline, after 3 months and after 6 months of post-operative period, pocket probing depth (PPD), clinical attachment level (CAL), radiological bone fill (RBF) and alveolar height reduction were recorded. Analysis of variance and Newman-Keuls post-hoc test were used or statistical analysis. A two-tailed probability (P) value P < 0.05 was considered to be statistically significant. Results: For the control group PPD reduction 2.00 ± 0.18 mm, CAL gain 1.38 ± 0.17 mm, RBF 0.63 ± 0.27 mm (18.0%) was observed while in the test group PPD reduction 2.00 ± 0.38 mm, CAL gain 1.25 ± 0.31 mm, RBF 0.75 ± 0.31 mm (20.7%) was evaluated. While alveolar height reduction for the control group and test group was 13% and 12.5% respectively. Conclusion: The study confirmed no added benefits of local doxycycline, as compared with bone graft alone, for regeneration of non-contained human periodontal infrabony defects.
- Clinical and radiographic evaluation of demineralized bone matrix (grafton) as a bone graft material in the treatment of human periodontal intraosseous defects
Mahantesha , KS Shobha, R Mani, Amritha Deshpande, Hema Seshan, K Kranti
Journal of Indian Society of Periodontology 2013 17(4):495-502
Purpose: The purpose of this clinical trial was to evaluate the efficacy of demineralized bone matrix (DBM) as a bone graft material in the treatment of human intrabony periodontal defects as compared with control defects treated by open flap debridement (OFD) alone. Materials and Methods: A controlled clinical trial was carried out for a period of 9 months in 11 patients (4 males and 7 females) with an age group of 25-50 years, contributing to a total of 30 defects. The selected defects were then randomly divided in to experimental sites (OFD + DBM) and control sites (OFD alone). Probing depth, clinical attachment levels and position of the gingival margin were recorded at baseline 3, 6 and 9 months post-operatively. Standardized radiographs (parallel technique) were also documented at these recall intervals. Results: On completion of 9 months, the mean percentage of probing depth reduction achieved in the experimental sites and control sites was 61.70%, 23.86% respectively. The mean percentage of clinical attachment level gain was 61.34% and 19.37% in the experimental and control sites respectively. In the experimental sites recession was observed to a lesser extent. Conclusion: The use of DBM was more effective than OFD in improving clinical parameters and radiographic bone fill as shown in the present study. However, there is a need for further long term studies.
- Massive pregnancy gingival enlargement: A rare case
Amitabh Srivastava, Krishna Kumar Gupta, Sunita Srivastava, Jaishree Garg
Journal of Indian Society of Periodontology 2013 17(4):503-506
Gingival enlargement related to pregnancy is sometimes seen in the oral cavity. Pregnancy is a physiological state that brings full of changes in a woman's life. The metabolism and immunology of the body are modified by progesterone and estrogen as well as other local factors, these sex hormones may modify the oral mucosa and may lead to various periodontal diseases. A case of female patient 23 yrs of age reported during 8 th month of pregnancy with a localised gingival enlargement affecting the buccal aspect of left maxillary central incisor upto canine. The hormonal changes occurring during pregnancy may be associated with generalized or localised gingival enlargement and the presence of local factors may accentuate the gingival response. Rarely the enlargement becomes maasive and protrude out extraorally.
- Peripheral ossifying fibroma
Khizer Mohiuddin, NS Priya, Shivamurthy Ravindra, Sarvani Murthy
Journal of Indian Society of Periodontology 2013 17(4):507-509
Peripheral ossifying fibroma (POF) is one of the inflammatory reactive hyperplasia of gingiva. It represents a separate clinical entity rather than a transitional form of pyogenic granuloma and shares unique clinical characteristics and diverse histopathological features. We present a case of POF in a 65-year-old male patient in the posterior maxillary gingiva, the clinical presentation of which differs from the usual presentation. Differential diagnosis and some interesting facts of POF are discussed.
- A silent tumor of the gingiva: An unusual case report and surgical management with 1 year follow-up
Babita Pawar, Avneesh Tejnani, Neha Kaur Sodhi, Gowri Pendyala
Journal of Indian Society of Periodontology 2013 17(4):510-513
Neurofibroma is a benign tumor of the peripheral nerve sheath characterized by the proliferation of Schwann's cells, perineural cells, and endoneurial fibroblasts. Here, we present a case of unique variation in the observed characteristics of a neurofibroma, with no relation to neurofibromatosis (NF) type-1 or von Recklinghausen disease of the skin. A swelling was observed in the right maxillary gingiva in relation with 14-16 regions of a 25-year-old female patient. The lesion was smooth, with sessile base, painless, non-ulcerated, and with normal color. An excisional biopsy of the lesion was performed, and histologically the diagnosis was confirmed. The patient remains uneventful after 1 year of clinical follow-up. Oral cavity involvement by a solitary neurofibroma in patients with no other signs of NF is uncommon and the gingival involvement is very rare.
- Pyogenic granuloma of the gingiva: A misnomer? - A case report and review of literature
Sheiba R Gomes, Quaid Johar Shakir, Prarthana V Thaker, Jamshed K Tavadia
Journal of Indian Society of Periodontology 2013 17(4):514-519
Pyogenic granuloma is a commonly occurring inflammatory hyperplasia of the skin and oral mucosa. It is not associated with pus as its name suggests and histologically it resembles an angiomatous lesion rather than a granulomatous lesion. It is known by a variety of names such as Crocker and Hartzell's disease, granuloma pyogenicum, granuloma pediculatum benignum, benign vascular tumor and during pregnancy as granuloma gravidarum. This tumor like growth is considered to be non-neoplastic in nature and it presents itself in the oral cavity in various clinical and histological forms. Due to its frequent occurrence in the oral cavity, especially the gingiva, this article presents a case report of a large pyogenic granuloma of the gingiva and its management, reviews the literature and discusses why the term "pyogenic granuloma" is a misnomer.
- Acute gingival bleeding as a complication of dengue hemorrhagic fever
Saif Khan, ND Gupta, Sandhya Maheshwari
Journal of Indian Society of Periodontology 2013 17(4):520-522
Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.
- Gingival squamous cell carcinoma masquerading as an aphthous ulcer
Prathypaty Santha Kumari, Gudi Pavan Kumar, Yendluri Durga Bai, Eragam Yella Reddy Balaji Naveen Reddy
Journal of Indian Society of Periodontology 2013 17(4):523-526
Gingival squamous cell carcinoma (GSCC) is an uncommon condition of the oral cavity. It is seldom associated with classic risk factors of oral cancer and shows a predilection for females. It's close clinical resemblances to various lesions of the oral cavity may make it go unnoticed. This may lead to diagnosis at advanced stages and coupled with the proximity to underlying alveolar bone may result in subsequent morbidity and mortality. A case of GSCC camouflaged as an aphthous ulcer in a middle aged woman is presented. The article highlights the importance of early diagnosis resulting in conservative treatment approaches.
- An unusual clinical presentation of plasma cell gingivitis related to "Acacia" containing herbal toothpaste
Anjali Makkar, Shikha Tewari, Kamal Kishor, Santprakash Kataria
Journal of Indian Society of Periodontology 2013 17(4):527-530
A 17-year-old female patient presented with unusual enlargement of the gingiva with generalized alveolar bone loss. In spite of periodontal therapy, including plaque control, scaling, root planning and surgical treatment, recurrence with the same degree of the gingival enlargement and further loss of attachment level occurred. Biopsy revealed dense infiltration of normal plasma cells separated by collagenous stroma. Discontinuation of herbal toothpaste resulted in remarkable remission of the gingival enlargement within 2 weeks. Enzyme-linked immunosorbent assay of toothpaste components disclosed " Acacia" as an etiologic antigenic agent and confirmed the diagnosis of plasma cell gingivitis (PCG). Usually, PCG is not associated with the loss of attachment. This case report appears to be the first publication to document an atypical presentation of PCG with generalized aggressive periodontitis related to the use of herbal toothpaste containing " Acacia" extract from the tree "Acacia Arabica."
- Spontaneous correction of pathologically migrated teeth with periodontal therapy alone
Himanshu Dadlani, Srinivas Sulugodu Ramachandra, Dhoom Singh Mehta
Journal of Indian Society of Periodontology 2013 17(4):531-534
Pathological tooth migration is a characteristic sign of an advanced form of chronic periodontitis. The etiology of pathological tooth migration is complex and multifactorial. Usually treatment of pathological migration includes a multidisciplinary approach. However, in some cases, spontaneous repositioning of the pathologically migrated teeth has been reported following periodontal therapy alone. In the present report, following periodontal surgery, there was a spontaneous repositioning of the migrated teeth and restoration of dento-facial esthetics. The treatment options in cases of pathological tooth migration, based on the severity, are also discussed.
- The perio-esthetic-restorative approach for anterior rehabilitation
Nitin Tomar, Tushika Bansal, Marisha Bhandari, Anamika Sharma
Journal of Indian Society of Periodontology 2013 17(4):535-538
Ensuring clinical success begins with a careful discussion of treatment planning, comprehensively covering all variables in simple to complex cases. Procedures including the crown lengthening surgery, furcation treatment and mucogingival therapy and tooth restoration are essential treatment regimens requiring multifaceted expertise. The interplay of periodontics and restorative dentistry is present at many fronts including the response of the gingival tissue to the restorative preparations. Dental restorations and periodontal health are inseparably interrelated. The adaptation of the margins, the contours of the restoration, the proximal relationships and the surface smoothness have a critical biological impact on the gingiva and the supporting periodontal tissues. The different surgical procedures used for crown lengthening are gingivectomy/gingivoplasty, apically positioned flap with or without osseous resection and orthodontic extrusion. The paper presents crown lengthening of severely mutilated teeth to increase the clinical crown height for adequate restoration.
- Use of collagen as a biomaterial: An update
Ruby Khan, Mohd Haroon Khan
Journal of Indian Society of Periodontology 2013 17(4):539-542
Biomaterial science is an expanding area, which encompasses a wide range of medical knowledge involving arthroplasty, cochlear implants, heart valves designing, lenses, dental fixation and tissue engineering. Within this context, in vitro cell culture on polymer scaffolds is one of the adopted strategies for tissue creation. It consists of a specific cell line that is seeded onto a particular substrate. This scaffold should provide excellent biocompatibility, controllable biodegradability, appropriate mechanical strength, flexibility as well as the ability to absorb body fluids for delivery of nutrients. Collagen certainly fulfils these demands; therefore, it is often chosen as a biomaterial. Moreover, this protein is abundant in the animal kingdom and plays a vital role in biological functions, such as tissue formation, cell attachment and proliferation.
- Microbial dysbiosis in periodontitis
Sameera G Nath, Ranjith Raveendran
Journal of Indian Society of Periodontology 2013 17(4):543-545
Periodontitis is a biofilm-associated inflammatory disease of the periodontium. This disease appears to have multiple etiologies with microbial factor contributing to initiation of the disease and immunological factor of the host propagating the disease. This review is on the concept of "microbial dysbiosis" and molecular nature of periodontitis, and the scope of traditional and emerging technologies for treating this disease.
- Implants in adolescents
Rohit A Shah, Dipika K Mitra, Silvia V Rodrigues, Pragalbha N Pathare, Rajesh S Podar, Harshad N Vijayakar
Journal of Indian Society of Periodontology 2013 17(4):546-548
Implants have gained tremendous popularity as a treatment modality for replacement of missing teeth in adults. There is extensive research present on the use of implants in adults, but there is a dearth of data available on the same in adolescents. The treatment planning and execution of implant placement in adolescents is still in its infancy. This review article is an attempt to bring together available literature.
- News and Events
Journal of Indian Society of Periodontology 2013 17(4):549-556
VOL 17 NUMBER 5 (2013)
- State of the Journal: My thoughts on the past and the future
Ashish Sham Nichani
Journal of Indian Society of Periodontology 2013 17(5):561-562
- A dream fulfilled!
Journal of Indian Society of Periodontology 2013 17(5):563-563
- Light at the end of the tunnel
Journal of Indian Society of Periodontology 2013 17(5):564-564
- Periodontal research: Basics and beyond - part I (defining the research problem, study design and levels of evidence)
Haritha Avula, Ruchi Pandey, Vijayalakshmi Bolla, Harika Rao, Jaya Kumar Avula
Journal of Indian Society of Periodontology 2013 17(5):565-570
Research in the field of periodontology has witnessed a tremendous upsurge in the last two decades unveiling newer innovations in techniques, methodologies, and material science. The recent focus in periodontal research is an evidence-based approach which offers a bridge from science to clinical practice. This three part review series intends to take a reader through a maze of periodontal research, unraveling and simplifying various issues in the design, conduct and interpretation of various study designs routinely used in the field of periodontal research. This understanding would facilitate a researcher with a focused and an enhanced vision toward formulating studies which can more efficiently translate sound scientific phenomena into clinically meaningful results.
- Periodontal research: Basics and beyond - Part II (ethical issues, sampling, outcome measures and bias)
Journal of Indian Society of Periodontology 2013 17(5):571-576
A good research beginning refers to formulating a well-defined research question, developing a hypothesis and choosing an appropriate study design. The first part of the review series has discussed these issues in depth and this paper intends to throw light on other issues pertaining to the implementation of research. These include the various ethical norms and standards in human experimentation, the eligibility criteria for the participants, sampling methods and sample size calculation, various outcome measures that need to be defined and the biases that can be introduced in research.
- Periodontal Research: Basics and beyond - Part III (data presentation, statistical testing, interpretation and writing of a report)
Journal of Indian Society of Periodontology 2013 17(5):577-582
Statistical analysis is the backbone of research and however befuddling it is to a clinician, it is crucial for a researcher to understand the various assumptions underlying the statistical methods. This paper aims at simplifying the various statistical methods that are routinely used in periodontal research. Data presentation, the relevance of clinical as against statistical significance and writing of a report are also discussed.
- Bone morphogenetic proteins: The anomalous molecules
Aena Pundir Jain, Siddharth Pundir, Anamika Sharma
Journal of Indian Society of Periodontology 2013 17(5):583-586
Bone is unique of all the tissues in the vertebrate organism. When injured, it heals by formation of new bone. Bone morphogenetic proteins (BMPs) are powerful inductors of the osteogenic activity during the embryologic bone formation phase and in cases of bone healing. They have proliferative effects on different cellular types, showing chemotactic properties and are able to induce mesenchymal cells differentiation into osteoblastic and chondroblastic line cells. Both primary cells and cell lines have been shown to respond to BMPs. Further the ability of embryonic cells to respond to BMPs by differentiating into cartilage and bone cells suggests that they are involved in the development of embryonic skeletal system. In addition, these proteins can also promote the angiogenesis, regulate the activity of some growth factors, and affect the production of these growth factors, which is helpful for the osteogenesis. BMPs have been considered as the most potent growth factors that can promote the bone regeneration. Thus, the aim of this review is to emphasize on the unique nature of the BMP molecules regarding their structure, classification, signaling mechanism, etc., as BMPs are the only molecules which show such deviation from the normal order, type. This will further help in understanding the role of BMPs and their potential advances which are necessary to facilitate the process of regeneration in periodontics.
- Drug addiction and periodontal diseases
Gurpreet Kaur Saini, ND Gupta, KC Prabhat
Journal of Indian Society of Periodontology 2013 17(5):587-591
The prevalence of drug addiction is increasing globally. Drug abuse damages many parts of the body such as oral cavity, lungs, liver, brain, heart etc., Addicts suffer from physical, psychological, emotional and behavioral problems. Their nutrition is also compromised. There is certainly an impact of all these factors on the health of periodontium. Dentists should be aware of the effects of drugs while treating the drug addicts. This article correlates the studies done on the impact of abused drugs such as alcohol, tobacco, opiates, cannabis, amphetamines etc., on general and periodontal health.
- Evaluation of thickness of cementum of periodontally diseased teeth of non-diabetic and type 2 diabetic patients: A scanning electron microscopy study
Radhika Gupta, Sushama R Galgali, Radhika M Bavle, Vidya Chandavarkar
Journal of Indian Society of Periodontology 2013 17(5):592-596
Background: It is suggested that diabetes plays an important role in tooth loss. The periodontal structure and alveolar bone architecture in diabetics have revealed alterations. However, changes in cementum of diabetics with periodontal disease have not been evaluated adequately. Thus, the aim of the study is to evaluate and compare the thickness of cementum in diseased and healthy areas of roots of teeth with chronic periodontitis from non-diabetic (group I) and type 2 diabetic patients (group II). Materials and Methods: Thirty incisors indicated for extraction as a result of chronic periodontitis from group I and group II were selected. Measurements of Probing Depth (PD) and Clinical Attachment Loss (CAL) were taken prior to extractions. Area of the root surface above the CAL (notch) was designated as diseased, while the area below the CAL (notch) was designated as healthy. The extracted tooth samples were sectioned longitudinally and were evaluated by scanning electron microscopy (SEM). Descriptive statistical analysis was performed. Results of continuous measurements were presented as Mean SD. Results: The results showed that in both groups the thickness of cementum in diseased areas was lower in comparison to the thickness in healthy areas. The mean thickness of cementum in both healthy and diseased areas was higher in group II compared to group I, though the differences in both were not statistically significant. Conclusion: Within the limits of the present study, group II showed greater mean thickness of cementum in both healthy and diseased areas compared to group I, though the differences were not statistically significant.
- Periodontal disease and type I diabetes mellitus: Associations with glycemic control and complications
Ajita Meenawat, Karan Punn, Vivek Srivastava, Anand S Meenawat, RS Dolas, Vivek Govila
Journal of Indian Society of Periodontology 2013 17(5):597-600
Objective: The aim of the study was to evaluate periodontal health status in patients diagnosed with type 1 diabetes mellitus (DM1) and to establish a correlation between metabolic control and periodontal health status. Materials and Methods: Periodontal health parameters namely plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded in 28 patients diagnosed with type 1 diabetes mellitus (DM1) and 20 healthy controls. Diabetes history was recorded based on the information provided by the physician and it included date of diagnosis, duration, age of diagnosis, latest values of glycosylated haemoglobin and existing diabetic complications. Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications. Results: The periodontal health in the diabetic group was compromised and they had greater bleeding index (P < 0.001), probing pocket depth (P < 0.001) and clinical attachment level (P = 0.001). Patients diagnosed for diabetes for shorter duration of time (4-7 years) showed bleeding index-disease severity correlation to be 1.760 0.434. Conclusion: Periodontal disease was more evident in type 1 diabetes mellitus patients and periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.
- Prevalence of enamel projections and its co-relation with furcation involvement in maxillary and mandibular molars: A study on dry skull
Prashant Bhusari, Ayushi Sugandhi, Sphoorthi Anup Belludi, Shoyab Khan
Journal of Indian Society of Periodontology 2013 17(5):601-604
Background: The objectives of this study were to investigate the incidence of cervical enamel projection (CEP) in molars of Indian dry human skulls and to evaluate its relationship with furcation involvement (FI). Materials and Methods: The material consisted of 944 upper and lower first, second and third permanent molars from 89 Indian dry human skulls. CEPs were investigated from the buccal aspect of the tooth and classified according to a system describeddescribed by Masters and Hoskins. FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest millimeter. Any measurement ≥2 mm was considered to have positive FI. Results: The results showed that CEPs was found more frequently in the mandibular than in the maxillary molars (2:1). The highest incidence of CEP was found in the mandibular second molar (14.7%) followed by the maxillary second molar (14.6%). The mandibular third molar showed the lowest incidence (5.5%). The association between CEP and FI (87.5%) was statistically significant. This favors the view of the possible role played by such anomalies in the progression of periodontal diseases. CEP in male skulls (77.4%) was significantly more prevalent than in female skulls (20.4%). No significant difference was found between the right and left side of maxillary and mandibular teeth with CEP and FI. Conclusion: The findings suggested the role of CEPs as a local contributing factor in localized chronic periodontitis and FI in molars. Detailed examination as well as early diagnosis of periodontal disease at the region of furcation is clinically very important.
- Effect of controlled-release PeriochipTM on clinical and microbiological parameters in patients of chronic periodontitis
Komal Puri, Vidya Dodwad, Kishore Bhat, Nikhil Puri
Journal of Indian Society of Periodontology 2013 17(5):605-611
Background: The aim of the present study was to evaluate and compare the clinical and microbiological effectiveness of Periochip TM as an adjunct to scaling and root planing (SRP) with SRP alone in patients with chronic periodontitis. Materials and Methods: This randomized, split mouth, 3-month clinical and microbiological trial included 30 sites in 15 patients aged 30-50 years diagnosed with chronic periodontitis. In each patient, two bilateral pockets probing 5-7 mm were randomly assigned to test and control groups. The test group received SRP plus Periochip TM , whereas the control group received SRP alone. Clinical indices and anaerobic culture analysis was done at baseline, 1 month, and 3 months interval. Total bacterial count and analysis of four major periodontopathogenic bacteria Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Aggregatibacter actinomycetemcomitans (Aa), and Fusobacterium nucleatum (Fn) was done. Results: Significant improvement was obtained in all clinical variables in the test group as compared to the control group over the study period. Total colony counts were significantly reduced in the test group as compared to control over the period of time. At baseline Aa was recovered from 4 test group sites and 5 control group sites, Pg from 15 test group and 14 control group sites, Pi from 5 test group and 2 control group sites, Fn from 7 test and 7 control group sites. At 3 months, Aa was recovered from 1 test group and 4 control group sites, Pg from 4 test group and 8 control group sites, Pi from 1 test group and 1 control group site, Fn from 3 test and 4 control group sites. Conclusion: Periochip TM placement as an adjunct to SRP, showed promising results, when compared to SRP alone. Healthy microflora can be maintained for a longer period of time and delay in the repopulation by periodontopathic microorganisms was observed.
- Evaluation of hemodynamic and SpO2 variability during different stages of periodontal surgery
Babak Amoian, Mozafar Rabíee, Maral Aghvami, Shabnam Milani
Journal of Indian Society of Periodontology 2013 17(5):612-616
Background: Changes in pulse rate and blood pressure are common consequences during oral surgeries. Hypoxia during surgical process is another side effect. The objective of the present study was evaluation of blood hemoglobin oxygenation and hemodynamic changes during periodontal surgery. Materials and Methods: This clinical trial study was conducted upon 50 subjects aging 30-55 years who referred to the clinic of dental faculty of Babol University and needed periodontal surgery with modified widman flaps in the anterior section of the maxilla. Pulse rate, blood pressure, and pulse oximetric evaluations were recorded in five stages during surgery. Results: The average of systolic and diastolic blood pressure had been in their maximum amount in the second stage of evaluation and minimum amounts were in the first one; while pulse rate changes were greatest in the second stage and lowest in the fifth stage. Analyzing the data revealed no significant difference in SpO 2 measurements in none of the stages evaluated. Conclusions: Blood pressure and heart rate increased significantly after the injection of anesthetic drug and in further phases they were decreased after the elimination of stimulating effect of adrenaline. SpO 2 changes were not significantly prominent.
- A clinical evaluation of a bioresorbable membrane and porous hydroxyapatite in the treatment of human molar class II furcations
K Gita Malathi, J Narendra Dev, K Suresh Kumar, Chitta Srikanth, PV Ravi Chandra, Arpita Paul
Journal of Indian Society of Periodontology 2013 17(5):617-623
Background: The ultimate goal of periodontal therapy is predictable regeneration of a functional attachment apparatus destroyed as a result of periodontitis. Reconstructive procedures have been used with varying success during the past decades to accomplish this goal. Aim: To evaluate whether the use of porous hydroxyapatite alone or a bioresorbable membrane alone would enhance the clinical results in the treatment of class II furcation defects in human lower molars. Materials and Methods: Fifteen patients with chronic periodontitis, aged between 39 and 49 years, with a pair of similar bilateral class II furcation defects (classification of Hamp et al.) in mandibular first molars were selected. A split-mouth design was incorporated and the selected 30 furcation defects were assigned to one of the two treatment groups, i.e., Group I treated with a bioresorbable membrane from bovine-derived collagen guided tissue regeneration membrane and Group II treated using porous hydroxyapatite bone graft material on the contralateral sides. Evaluation of clinical parameters, probing depths and attachment levels, and radiographs was done preoperatively and 6 months postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depths and gain in clinical attachment levels and linear bone fill. Comparison between Group I and Group II showed insignificant difference. Conclusion: Within the limits of this study, both the treatment modalities are beneficial for the treatment of human mandibular class II furcation defects.
- Clinical and radiographical evaluation of a bioresorbable collagen membrane of fish origin in the treatment of periodontal intrabony defects: A preliminary study
BB Santosh Kumar, DR Aruna, Vinayak S Gowda, Sushama R Galagali, R Prashanthy, H Navaneetha
Journal of Indian Society of Periodontology 2013 17(5):624-630
Background: Recently, there has been interest in non-mammalian collagen sources such as fish collagen in periodontal regeneration. In the present study, collagen barrier membrane of fish origin was assessed in the treatment of periodontal intrabony defects. Materials and Methods: Ten systemically healthy chronic periodontitis patients having a paired osseous defect in the mandibular posterior teeth were selected and randomly assigned to receive a collagen membrane (test) or open flap debridement (control) in a split mouth design. Clinical parameters such as Plaque index, Gingival bleeding index, Probing pocket depth, Relative attachment level, and Recession were recorded at baseline, 3, 6, and at 9 months, while radiographic evaluation was done to assess alveolar crestal bone level and percentage of defect fill at 6 and 9 months using autoCAD 2007 software. Student's t test (two-tailed, dependent) was used to find the significance of study parameters on continuous scale. Significance was set at 5% level of significance. Wilcoxon signed rank test was used to find the significance of percentage change of defect fill. Results: The comparison between the two groups did not show any statistically significant differences in the parameters assessed (P > 0.05) but, within each group, clinical parameters showed statistically significant differences from baseline to 9 months (P < 0.05). Conclusion: Within the limits of the study, it can be inferred that no significant differences were found either by using collagen membrane of fish origin or open flap debridement in the treatment of periodontal intrabony defects.
- A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects
Rajan Padma, Ande Shilpa, Pavaluri Aravind Kumar, Meganderao Nagasri, Chetan Kumar, Annaji Sreedhar
Journal of Indian Society of Periodontology 2013 17(5):631-636
Background: There are various techniques developed to treat the exposed roots, a recent innovation in dentistry is the use of second generation platelet concentrate which is an autologous platelet-rich fibrin gel (PRF) with growth factors and cicatricial properties for root coverage procedures. Therefore, the present research was undertaken to study the additional benefits of PRF when used along with coronally advanced flap (CAF). Materials and Methods: Total of 15 systemically healthy subjects presenting bilateral isolated Miller's class I and II recession were enrolled into the study. Each patient was randomly treated with a combination of CAF along with a platelet-rich fibrin (PRF) membrane on the test site and CAF alone on the control site. Recession depth, clinical attachment level (CAL), and width of keratinized gingiva (WKG) were compared with baseline at 1, 3, and 6 months between test and control sites. Results: Mean percentage root coverage in the test group after 1, 3, and 6 months was 34.58, 70.73, and 100, respectively. Differences between the control and test groups were statistically significant. This study also showed a statistically significant increase in WKG in the test group (2.94 ± 0.77 at baseline to 5.38 ± 1.67 at 6 months). Conclusion: CAF is a predictable treatment for isolated Miller's class I and II recession defects. The addition of PRF membrane with CAF provides superior root coverage with additional benefits of gain in CAL and WKG at 6 months postoperatively.
- 2D FEA of evaluation of micromovements and stresses at bone-implant interface in immediately loaded tapered implants in the posterior maxilla
Shrikar R Desai, Rika Singh, I Karthikeyan
Journal of Indian Society of Periodontology 2013 17(5):637-643
Aim: The aim of the study is to evaluate the influence implant length on stress distribution at bone implant interface in single immediately loaded implants when placed in D4 bone quality. Materials and Methods: A 2-dimensional finite element models were developed to simulate two types of implant designs, standard 3.75 mm-diameter tapered body implants of 6 and 10 mm lengths. The implants were placed in D4 bone quality with a cortical bone thickness of 0.5 mm. The implant design incorporated microthreads at the crestal part and the rest of the implant body incorporated Acme threads. The Acme thread form has a 29° thread angle with a thread height half of the pitch; the apex and valley are flat. A 100 N of force was applied vertically and in the oblique direction (at an angle of 45°) to the long axis of the implants. The respective material properties were assigned. Micro-movements and stresses at the bone implant interface were evaluated. Results: The results of total deformation (micro-movement) and Von mises stress were found to be lower for tapered long implant (10 mm) than short implant (6 mm) while using both vertical as well as oblique loading. Conclusion: Short implants can be successfully placed in poor bone quality under immediate loading protocol. The novel approach of the combination of microthreads at the crestal portion and acme threads for body portion of implant fixture gave promising results.
- Sinus lift tissue engineering using autologous pulp micro-grafts: A case report of bone density evaluation
Giorgio Brunelli, Alessandro Motroni, Antonio Graziano, Riccardo D'Aquino, Ilaria Zollino, Francesco Carinci
Journal of Indian Society of Periodontology 2013 17(5):644-647
Background: Although autografts are the standard procedure for bone grafting, the use of bone regeneration by means of dental pulp stem cell is an alternative that opens a new era in this field. Rigenera Protocol is a new technique able to provide the surgeon autologous pulp micro-grafts. Materials and Methods: At the Department of Oral Surgery, Don Orione Hospital, Bergamo, Italy, one patient underwent to sinus lift elevation with pulp stem micro-grafts gentle poured onto collagen sponge. A CT scan control was performed after 4 month and DICOM data were processed with medical imaging software which gives the possibility to use a virtual probe to extract the bone density. Pearson's Chi-square test was used to investigate difference in bone density (BD) between native and newly formed bone. Results: BD in newly formed bone is about the double of native bone. Conclusion: This report demonstrated that micro-grafts derived from dental pulp poured onto collagen sponge are a useful method for bone regeneration in atrophic maxilla.
- Multicentric peripheral ossifying fibroma: A case report and review of the literature
Fayiza Yaqoob Khan, Suhail Majid Jan, Mubashir Mushtaq
Journal of Indian Society of Periodontology 2013 17(5):648-652
A peripheral cement-ossifying fibroma is a benign fibro-osseous lesion of a reactive rather than a neoplastic nature, whose pathogenesis is uncertain. It predominantly affects adolescents and young adults, with the peak prevalence between 10 and 19 years, especially affecting females (two to four times more). Such lesions are commonly found on the maxillary bone. We hereby present and discuss a unique case of multicentric Peripheral Ossifying Fibroma (POF) affecting both the maxillary and the mandibular gingiva in an 11-year-old boy, with a disease duration of two months. This case is probably one of the first few cases discovered, which demonstrates that there may be a multicentric variant of the Peripheral Ossifying Fibroma. The purpose of this article is to present a case of POF and to briefly review the current literature on this condition.
- Peripheral odontogenic myxoma of maxillary gingiva: A rare clinical entity
Vijay Kumar Jain, Soundarya Narayana Reddy
Journal of Indian Society of Periodontology 2013 17(5):653-656
Odontogenic myxoma comprises 3-6% of all odontogenic tumors. Odontogenic myxomas are relatively rare benign mesenchymal tumors found exclusively in the tooth-bearing areas of the jaw and are usually located centrally in the mandible. Soft-tissue localization is rarely seen and is classified as peripheral myxoma. Peripheral myxoma is slow growing and less aggressive, as compared to the central myxoma. It has a low recurrence rate. Till date, only few cases of maxillary gingival myxomas are reported in the literature. Here, we present an unusual case of primary peripheral odontogenic myxoma occurring in the gingiva of anterior maxilla in a 41-year-old female patient.
- An unusual clinical presentation of gingival melanoacanthoma
S. P. K. Kennedy Babu, S Agila, P Sivaranjani, Vineet Kashyap
Journal of Indian Society of Periodontology 2013 17(5):657-660
Gingival melanoacanthoma is a rare, benign pigmented lesion characterized clinically by sudden onset and rapid growth of a macular brown black lesion and histologically by acanthosis of superficial epithelium and proliferation of dendritic melanocytes. This article reports a previously undescribed case of pigmented unilateral diffuse gingival enlargement, which on histopathological examination proved to be melanoacanthoma. Intraoral examination revealed pigmented unilateral diffuse gingival enlargement in relation to second and third quadrants buccally, palatally/lingually. Based on these clinical findings, gingivectomy was performed and the excised tissue was sent for biopsy. Microscopic examination revealed acanthotic and parakeratotic surface epithelium with dendritic melanocytes distributed in basal and suprabasal layers of the epithelium. 1 year follow-up recall revealed no recurrence of lesion at the surgical sites. Our patient exhibits an unusual clinical presentation of melanoacanthoma of gingiva. Pigmented gingival overgrowth of recent origin and without any etiologic factors warrants histopathologic examination.
- Six year follow-up of a root coverage procedure on a lower molar tooth with lateral pedicle flap
AM Noorudeen, Anie Mary Paul, Mohammed Shereef
Journal of Indian Society of Periodontology 2013 17(5):661-664
Loss of periodontal attachment and subsequent recession is one of the most common deformities that affects the periodontium. Gingival recession is a muco-gingival defect, which is commonly treated for esthetic and physiologic reasons. Adequate thickness of attached gingiva and root coverage is essential in restored teeth for proper masticatory function as well as for oral hygiene maintenance. Various root coverage procedures Nill have been proposed to correct recession defects, including coronally advanced flap and lateral pedicle flap (LPF). A case report is presented dealing with the treatment of a gingival recession on a mandibular molar tooth using LPF with a 6-year follow-up.
- Intentional replantation of periodontally compromised hopeless tooth
G Nagappa, Shivanand Aspalli, Archana Devanoorkar, Sudhir Shetty, Prachi Parab
Journal of Indian Society of Periodontology 2013 17(5):665-669
Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation.
- Management of chronic luxated central incisor with hopeless prognosis
Gauresh Kumar Patel, Sheela Kumar Gujjari, BM Annapoorna, SC Veerendra Kumar
Journal of Indian Society of Periodontology 2013 17(5):670-675
Traumatic injuries are the most studied yet most challenging for a dentist. Extrusive luxation injuries are usually managed by repositioning tooth in the original position and pulp sensibility is evaluated at regular periodic intervals. However, when injuries are chronic, tooth is necrotic with compromised periodontal support, treatment is a challenge. Intentional replantation utilizing growth factors in fibrin rich network of platelet rich fibrin can be a treatment modality in such patients where other restorative modalities to establish function-esthetics rehabilitation is not possible.
- Modified single incision technique to harvest subepithelial connective tissue graft
Ashish Kumar, Vishal Sood, Sujata Surendra Masamatti, MG Triveni, DS Mehta, Manish Khatri, Vipin Agarwal
Journal of Indian Society of Periodontology 2013 17(5):676-680
Dental therapy in general and periodontal therapy in particular is directed increasingly at the esthetic outcome for patients. Gingival recession is one of the most common esthetic concerns associated with periodontal tissues. Although various treatment modalities have been developed, subepithelial connective tissue grafting remains the most successful and predictable technique for treatment of gingival recession. Harvesting a connective tissue graft from the palate is many times not only traumatic, but also very painful for the patient. Use of single incision to harvest the subepithelial connective tissue graft is one of the least traumatic, but relatively difficult technique to accomplish. This article presents a modified single incision technique, which is not only less traumatic and painful, but comparatively simple to employ and master. Two new instruments have been introduced to make harvesting of the connective tissue graft easier.
- Platform switching: A panacea for bone loss??
Manthan H Desai, Veena A Patil
Journal of Indian Society of Periodontology 2013 17(5):681-683
The goal of modern implant therapy entails more than just the successful osseointegration of the implant. A successful result must also include an esthetic and functional restoration surrounded by stable peri-implant tissue levels that are in harmony with the existing dentition. In an attempt to improve long-term bone maintenance around implants, a new implant-to abutment connection referred to as "platform switching" has been proposed. It refers to the use of an abutment of smaller diameter connected to an implant neck of larger diameter. Platform switching is a simple and effective way to control circumferential bone loss around dental implants. This short communication aims to present an overview of concept of platform switching in dental implantology.
- News and events
Journal of Indian Society of Periodontology 2013 17(5):684-692