Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
November-December 2014
Volume 18 | Issue 6
Page Nos. 681-811

Online since Friday, December 19, 2014

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EDITORIAL  

We are online early! p. 681
Ashish Sham Nichani
DOI:10.4103/0972-124X.147393  
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PRESIDENT’S MESSAGE Top

Periodontology - The road ahead p. 682
Biju Thomas
DOI:10.4103/0972-124X.147394  
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SECRETARY’S MESSAGE Top

ISP reloaded p. 683
Balaji Manohar
DOI:10.4103/0972-124X.147395  
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LETTER TO EDITOR Top

Palatal bandage Highly accessed article p. 684
Ashish Kumar, Geeti Gupta
DOI:10.4103/0972-124X.147396  
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Author's reply: Platelet-rich fibrin as an adjunct to palatal wound healing after harvesting a free gingival graft: A case series p. 684
Kulkarni Mihir Raghavendra, Thomas Betsy Sara, Varghese Jothi Mariam, Giliyar Subraya Bhat
DOI:10.4103/0972-124X.147397  
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REVIEW ARTICLES Top

Toll gates: An emerging therapeutic target p. 686
Rajendran Maheaswari, Kiruthika Sivasankar, Sathya Subbarayan
DOI:10.4103/0972-124X.147398  
Innate immune system forms the first line of defense against microbial infections, as it exerts an immediate response. Innate immunity works through Toll-like receptors (TLRs) which functions as primary sensors of pathogens. TLR activates multiple signaling cascades leading to the induction of genes responsible for the release of inflammatory cytokines and type I interferon. Thus, they induce antimicrobial responses and also have an instructive role in adaptive immunity. However, TLR-mediated inflammation is said to be responsible for many of the destructive host responses in inflammatory diseases like periodontitis. Hence, therapeutics targeting TLRs are being used to treat disease such as HIV, Hepatitis B, asthma etc. Recently, synthetic TLR agonists are tried as novel vaccine adjuvant in treating periodontal diseases. This paper reviews the scope of TLR-based therapeutics in treating periodontitis.
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Neutrophil extracellular traps: Their role in periodontal disease p. 693
Lakshmi Kanth Kolaparthy, Sahitya Sanivarapu, Chakrapani Swarna, Narasimha Swamy Devulapalli
DOI:10.4103/0972-124X.147399  
Neutrophils are the first line of innate immune defense against infectious diseases. Since their discovery, they have always been considered tissue-destructive cells responsible for inflammatory tissue damage occurring during infections. Extensive research in the field of neutrophil cell biology and their role skewing the immune response in various infections or inflammatory disorders revealed their importance in the regulation of immune response. Neutrophils also release neutrophil extracellular traps (NETs) for the containment of infection and inflammation along with other antimicrobial molecules. Activated neutrophils provide signals for the activation and maturation of macrophages as well as dendritic cells. Neutrophils are also involved in the regulation of T-cell immune response against various pathogens and tumor antigens. Thus, the present review is intended to highlight the emerging role of neutrophil extracellular trap production in the regulation of immune response and its role in periodontal disease.
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Effectiveness of autologous platelet-rich fibrin in the treatment of intra-bony defects: A systematic review and meta-analysis p. 698
Monali Shah, Neeraj Deshpande, Ashit Bharwani, Prasad Nadig, Vikas Doshi, Deepak Dave
DOI:10.4103/0972-124X.147400  
The aim of the present meta-analysis is to determine the clinical and radiographic outcomes of using platelet-rich fibrin (PRF) for the treatment of periodontal intra-bony defect (IBD) compared with open flap debridement (OFD). MEDLINE/PubMed, EBSCO and Cochrane database were used to identify studies in English language published from January 1, 2005 to January 31, 2013. An additional hand search of the relevant journals and of the bibliographies of the paper identified was also performed. Articles retrieved were screened using specific inclusion criteria by five independent reviewers: Studies investigating the effect of platelet concentrate in surgical procedure for the treatment of periodontal intra osseous defects compared with the control group in which platelet concentrate was not used were included. Five relevant articles were selected for the meta-analysis of which 3 articles were retrieved after electronic search and two articles were included after hand search. The number of patients in studies ranged from 15 to 62 (32-90 sites) with mean age ranging from 29.47 to 39.7. A total of 298 sites were treated using PRF either in combination with graft or as a monotherapy in comparison to traditional OFD procedure. The meta-analysis showed a standard mean difference of 0.95 mm; 95% confidence interval (CI): 0.20-1.71 in clinical attachment level (CAL) and 2.33 mm; 95% CI: 1.43-3.23 in IBD after treatment of IBD with PRF compared with OFD. The meta-analysis showed clinically significant improvements in periodontal parameters such as CAL, IBD, and reduction in probing depth when IBDs were treated with PRF alone when compared to OFD.
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ORIGINAL ARTICLES Top

Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva p. 705
Geeti Gupta, Ashish Kumar, Manish Khatri, Komal Puri, Deept Jain, Mansi Bansal
DOI:10.4103/0972-124X.147404  
Introduction: Demand for cosmetic therapy of gingival melanin pigmentation is common. Re-pigmentation after gingival depigmentation is an important point. The aim of this study is to evaluate the effect of surgical scraping and electrosurgery on postoperative pain, healing and recurrence of pigmentation. Materials and Methods: Fifteen patients with esthetic concern related to black gums were selected and treated by surgical scraping with respect to right quadrant and electrosurgery with respect to left quadrant. Patients were recalled post-operatively to evaluate healing and recurrence of pigmentation. Each patient was asked to complete the Visual Analogue Scale (VAS) index cards 2 and 24 hours postoperatively. Results: In the initial post-operative period, VAS index cards showed that the discomfort and pain level associated with electrosurgery was significantly higher than conventional scalpel surgery (P < 0.05). Clinically delayed healing was observed in the electrosurgically treated site. Electrosurgery showed better results as compared to epithelial excision for recurrence of pigments. At the end of 15 months, 7 sites in the scalpel excision group showed recurrence, whereas only 4 site showed recurrence in the electrosurgically treated group. Conclusion: The methods used here produced desired results and above all, the patients were satisfied with the outcome. Increased pain level and clinically delayed healing was associated with electrosurgery as compared to scalpel surgery, whereas repigmentation occurred more frequently in scalpel-treated sites.
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The effect of various ultrasonic and hand instruments on the root surfaces of human single rooted teeth: A Planimetric and Profilometric study p. 710
Antush Mittal, Ashish Sham Nichani, Ranganath Venugopal, Vuppalapati Rajani
DOI:10.4103/0972-124X.147405  
Background: The purpose of this study was to compare the effectiveness of different ultrasonic scalers and a periodontal curette on the root surfaces for calculus removal and root surface roughness. Materials and Methods: 40 single rooted teeth with subgingival calculus destined for extraction were assigned to one of three experimental groups (n = 10, in each group) and one control group (untreated, n = 10). Experimental groups were: Group 1: Piezoelectric ultrasonic group; Group 2: Magnetostrictive ultrasonic group; Group 3: Hand instrumentation group (Curette). After instrumentation, the teeth were extracted and the presence of residual deposits and root surface roughness were analyzed using Planimetric analyzing tool (Tool that measures the area of a plane figure as a mechanically coupled pointer traversing the perimeter of figure) and Surface Profilometer (Instrument used for profiling of an object). Root surface characteristics were evaluated qualitatively using SEM. Standardization of force, angulations and adaptation of instrument couldn't be achieved in our study due to in vivo study design rather than in vitro design in previous studies where procedure was done on the extracted teeth samples. Results: The results of the study showed that residual deposits were similar in all experimental groups. With respect to roughness parameters, Rq (Root mean square roughness) and Rt (Total roughness) a significant difference was observed (P < 0.001) among hand instrumentation and ultrasonic devices. SEM analysis revealed a similar root surface pattern for the ultrasonic devices, but curette showed many instrument scratches, gouges, and removal of large amount of cementum. Conclusions: Curette produced the rougher root surfaces than two ultrasonic devices used in the study and caused more root surface removal. Piezoelectric devices produced minimum root surface roughness but caused more root substance removal and more cracks than Magnetostrictive ultrasonic devices.
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Comparative evaluation of oxygen saturation during periodontal surgery with or without oral conscious sedation in anxious patients p. 718
Hiranya Shivananda, Kepu Vijay Raghava, Sharath Karanth Sudhakar, Biju Thomas, Mundoor Manjunath Dayakar
DOI:10.4103/0972-124X.147406  
Context: Stress and anxiety during dental procedure can alter respiratory rate and thereby alter oxygen saturation in the blood, leading to emergencies like syncope. It can be prevented by preoperative intravenous sedation. However, it can lead to respiratory depression. Hence, this study was carried out to analyze the effect of oral conscious sedation on oxygen saturation during periodontal surgery in anxious patients. Aim: The aim was to compare the oxygen saturation levels during periodontal surgery with and without oral conscious sedation using diazepam in anxious patients. Settings and Design: Randomized clinical trial. Materials and Methods: The study population consisted of 20 generalized periodontitis patients, identified as anxious for dental treatment with dental anxiety scale. A randomized split-mouth design was used with one quadrant of surgery involving preoperative oral sedation (diazepam), and the second without it. Oxygen saturation was monitored by pulse oximetry. Data were recorded at 5 time periods during the surgery. Statistical Analysis Used: Mann-Whitney U-test. Results: No statistically significant difference between sedated and nonsedated patients in oxygen saturation with P = 0.683. Conclusions: Oral conscious sedation can be used for anxious patients during periodontal surgery for alleviation of anxiety and for better patient acceptance during surgical procedures without significant respiratory depression.
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Toll-like receptor 9 gene polymorphism in chronic and aggressive periodontitis patients p. 723
Nipun Ashok, Shivaraj Warad, Nagaraj Balasaheb Kalburgi, Shivaprasad Bilichodmath, Prabath Singh Valiyaparambil Prabhakaran, Bassel Tarakji
DOI:10.4103/0972-124X.147407  
Aim: Periodontitis is a multifactorial disease, with microbial dental plaque as the primary etiological factor. However, the manifestation and progression of periodontitis is influenced by a wide variety of other determinants and factors such as social and behavioral factors, systemic factors, microbial composition of dental plaque, genetic, and many other emerging risk factors. The aim of this study was to analyze genetic polymorphisms in the toll-like receptor 9 (TLR9) gene at - 1237C/T and its association with chronic and generalized aggressive periodontitis (GAgP) in an Indian population. Materials and Methods: This study was carried out on 90 subjects, which included 30 GAgP and 30 chronic periodontitis patients and 30 healthy controls. Within the limitations of our study, only 30 subjects were included in each group due to the low prevalence of GAgP patients. Blood samples were drawn from the subjects and analyzed for TLR9 genetic polymorphism at - 1237C/T by using polymerase chain reaction-restriction fragment length polymorphism method. Results: No significant difference was found in genotype and allele frequency of TLR9 genetic polymorphism (- 1237C/T) in generalized aggressive and chronic periodontitis patients and healthy controls. Conclusion: Toll-like receptor 9 genetic polymorphism at - 1237C/T may not be associated with GAgP and chronic periodontitis patients in Indian population.
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Assessment of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in Down's syndrome subjects and systemically healthy subjects: A comparative clinical trial p. 728
Nizar Ahmed, Harinath Parthasarathy, Mohamed Arshad, Dhayanand John Victor, Danny Mathew, Siva Sankari
DOI:10.4103/0972-124X.147408  
Objectives: To compare and quantify the presence of periodontal pathogens Aggregatibacter actinomycetemcomitans (Aac) and Porphyromonas gingivalis (Pg) in Down's syndrome (DS) and systemically healthy subjects with periodontitis and gingivitis. Materials and Methods: Fifty‑nine age‑matched subjects were categorized into four groups; Group I: DS subjects with gingivitis, Group II: DS subjects with periodontitis, Group III: Systemically healthy subjects with gingivitis and Group IV: Systemically healthy subjects with periodontitis. Plaque samples from all the four groups were collected and analyzed to evaluate the presence of Aac and Pg using real time polymerase chain reaction. The indices used were oral hygiene index simplified, community periodontal index for treatment needs and plaque index. Results: This study showed a statistically significant detection in the levels of both Aac (<0.001) and Pg (<0.001) in DS subjects with periodontitis when compared with the healthy controls with periodontitis; moreover, there was a statistically significant increase in Pg levels compared to Aac in DS gingivitis group. Conclusion: There was a statistically significant presence of Pg and Aac in both DS gingivitis and DS periodontitis over control groups with increased levels of Pg compared with Aac in DS gingivitis group.
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Comparative evaluation of salivary soluble CD44 levels in periodontal health and disease p. 734
Sumeet Kaur, Savitha Narayanswamy, Alampalli Viswanathamurthy Ramesh
DOI:10.4103/0972-124X.147409  
Context: Inflammation, immunoactivation, and malignant diseases are associated with increased plasma levels of soluble CD44 (sCD44). Serum sCD44 has been recognized as a diagnostic marker in smoking-induced diseases. Aim: (1) To assess the levels of salivary sCD44 in periodontal health and disease. (2) To compare the levels of salivary sCD44 in smokers and nonsmokers. (3) To assess if salivary sCD44 levels could be used as a diagnostic marker for periodontitis. Setting and Design: A total of 60 patients were divided into three groups viz. Group A - healthy, Group B - aggressive periodontitis and Group C - chronic periodontitis (Subdivided into C1 - chronic periodontitis smokers and C2 - chronic periodontitis nonsmokers). Materials and Methods: The plaque index, gingival index (GI), probing depth and clinical attachment level; along with the radiographs were recorded. The saliva sample collected at baseline was stored at −80°C. The sCD44 levels were analyzed using ELISA. Statistical Analysis Used: ANOVA test and Mann-Whitney's test was used to compare readings between all the groups and Pearson correlation was calculated for CD44 and all the clinical parameters in each group. Results: Highest mean sCD44 was recorded in Group C2 followed by Group C1. The GI was positively correlated with CD44 levels in chronic periodontitis group. Contrary to previous reports nonsmokers subjects had higher CD44 levels as compared to smoker. Conclusion: Soluble CD44 levels were positively correlated with periodontal disease. Thus, salivary sCD44 could be considered as a one of the biomarker for periodontitis that is, aggressive and chronic periodontitis.
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Comparative evaluation of C-reactive protein in peripheral blood of patients with healthy gingiva, gingivitis and chronic periodontitis: A clinical and particle-enhanced turbidimetric immuno-analysis p. 739
Tushika Bansal, Deepa Dhruvakumar, Anita Pandey
DOI:10.4103/0972-124X.147410  
Background: C-reactive protein (CRP), an acute-phase protein monitored as a marker of inflammatory status, has been identified as a major risk factor for various systemic diseases. It is a reliable marker to infectious burdens and/or inflammation. The aim of this study was to compare and evaluate the systemic levels of CRP in the serum sample of the patients with healthy gingiva, gingivitis, and chronic periodontitis. Materials and Methods: A total of 60 systemically healthy patients were selected and divided into three groups: Patients with healthy gingiva (Group A), patients with generalized gingivitis (Group B) and patients with chronic periodontitis (Group C). Peripheral blood was collected and high-sensitive (hs)-CRP levels were estimated in the serum samples by using the particle-enhanced turbidimetric immuno-assay technique using a commercially available kit. Results: The mean hs-CRP level in Group A recorded was 0.437 ± 0.216, Group B was 0.771 ± 0.384 and Group C was 2.285 ± 0.381. A significantly elevated hs-CRP level was found in Group C as compared with Group B and A (P < 0.05). However, a moderate, but statistically significant increase in the hs-CRP levels was observed in Group B as compared with Group A (P < 0.05). The percentage of patients with elevated levels of hs-CRP >2 mg/l was significantly higher in Group C. Conclusion: The patients with chronic periodontitis demonstrated a mean hs-CRP levels higher than the patients with gingivitis and with healthy gingiva. Furthermore, with the increasing inflammation, the hs-CRP levels increased proportionately.
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Efficacy of hyaluronic acid (hyaluronan) in root coverage procedures as an adjunct to coronally advanced flap in Millers Class I recession: A clinical study p. 746
Radhika Kumar, Moogala Srinivas, Jagdish Pai, Girish Suragimath, Krishna Prasad, Tejaswin Polepalle, Radhika Kumar, Moogala Srinivas, Jagdish Pai, Girish Suragimath, Krishna Prasad, Tejaswin Polepalle
DOI:10.4103/0972-124X.147411  
Background: The purpose of this study was to assess the efficacy of hyaluronic acid (HA) in root coverage procedures as an adjunct to coronally advanced flap (CAF) procedure. Materials and Methods: This was a randomized clinical trial with split mouth design, where 10 patients with 20 sites of Millers Class I recession were treated and followed-up for a period of 6 months. CAF procedure was performed, HA was applied onto the experimental sites before suturing the flap. Recession depth (RD) was measured regularly at baseline 1, 3, 6, 12, and 24 weeks postoperatively. Probing pocket depth (PPD) and clinical attachment level (CAL) were also measured along with RD at baseline and 12 and 24 weeks. Results: There was a significant change in RD, PPD, CAL, and percentage of root coverage in both groups when compared to the baseline values. There was no statistically significant difference between experimental and control group in terms of RD (P = 0.917), PPD (P = 0.917) and CAL (P = 0.761). RD was 3.2 mm ± 0.78 mm in experimental site and control sites 2.9 mm ± 0.73 mm reduced to 1.1 mm ± 0.99 mm in experimental sites and 1.0 mm ± 0.66 mm in control sites. Though, there is no statistically significant difference root coverage in the experimental group appeared to be clinically more stable compared with the control group after 24 weeks. Conclusions: This study suggests that use of HA may improve the clinical outcome of root coverage with CAF procedure.
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Evaluation of postsurgical clinical outcomes with/without removal of pocket epithelium: A split mouth randomized trial p. 751
Shantipriya Reddy, Nirjhar Bhowmik, Malur Prasad, Sanjay Kaul, Vinayak Rao, Savita Singh, Shantipriya Reddy, Nirjhar Bhowmik, Malur Prasad, Sanjay Kaul, Vinayak Rao, Savita Singh
DOI:10.4103/0972-124X.147413  
Background: Periodontitis is bacteria-related chronic inflammatory condition characterized by pocket formation, loss of clinical attachment, gingival recession, mobility, and eventual loss of teeth. The purpose of this study was to clinically evaluate the need for elimination of the pocket epithelium during mucoperiosteal flap surgery aimed at reattachment or re-adaptation. Materials and Methods: A split mouth design was done to compare modified Widman flap (MWF) with removal of the pocket epithelium and crevicular mucoperiosteal flap (CMF) without removing the pocket epithelium. The following measurements were taken after 1 month of completion of nonsurgical phase gingival index (Loe and Silness), plaque index (Silness and Loe), mobility, furcation involvement, level of attachment, pocket depth, gingival recession, gingival contour index, and dentinal hypersensitivity (ice stick test). In addition to these measurements, which were taken immediately prior to the surgery (baseline), 1- and 3-month and 6 months postsurgical measurements were also recorded. Results: The results of this study showed a greater reduction of mean probing depth in the test group (MWF). The control group (CMF) showed greater mean gingival recession compared to the test group throughout the study period. The test group showed more gain in the clinical attachment levels compared with the control group. The difference between the two groups was statistically significant (P < 0.001). Conclusions: The results of this study demonstrate that MWF surgery was more effective in reducing mean probing depth, showed greater gain in clinical attachment, and demonstrated less gingival recession.
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Oral health status and treatment needs among primary school going children in Nagrota Bagwan block of Kangra, Himachal Pradesh p. 762
Anupriya Sharma, Pradeep Bansal, Ashoo Grover, Suresh Sharma, Ashish Sharma, Anupriya Sharma, Pradeep Bansal, Ashoo Grover, Suresh Sharma, Ashish Sharma
DOI:10.4103/0972-124X.147421  
Background: Oral diseases such as gingival diseases and dental caries affect about 80% of the school students worldwide. The study was taken up with the aim to evaluate the oral health status and treatment need in the School going children of Nagrota Bagwan Block of Kangra District, Himachal Pradesh. Materials and Methods: A total number of 3069 school children in the age group of 5-12 years studying in 96 government primary schools of study area were surveyed to find out the Oral Hygiene Index simplified (OHI-S) scores, community periodontal index (CPI) scores, dental caries and treatment need using dentition status and treatment need index (WHO diagnostic criteria, 1997). Results: The mean OHI-S was 2.7 ± 2.81and 2.8 ± 2.99 in 5-8 and 9-12 years age group, respectively. The gingival bleeding was observed in 76.8% and 75.9%, calculus in 10.2% and 18.3% in 5-8 and 9-12 years age group, respectively. The overall caries prevalence of subjects was 58.4% with high caries prevalence in females as compared to males and in 9-12 years age group as compared to 5-8 years age group. The mean dmft/DMFT was 2.05 ± 4.13 and 2.56 ± 4.20 in 5-8 years and 9-12 years age group, respectively. Treatment need observed was 62.3% and 75.3% in 5-8 and 9-12 years age group, respectively. Conclusion: The study demonstrated that school children in Nagrota Bagwan, Kangra district suffer from high prevalence of dental caries and have high treatment need as well as poor oral hygiene and gingival health status.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Mandibular Tori: A source of autogenous bone graft p. 767
Muthukumar Santhanakrishnan, Suresh Rangarao, Muthukumar Santhanakrishnan, Suresh Rangarao
DOI:10.4103/0972-124X.147423  
Restoration of lost alveolar bone support remains as one of the main objectives of periodontal surgery. Amongst the various types of bone grafts available for grafting procedures, autogenous bone grafts are considered to be the gold standard in alveolar defect reconstruction. Although there are various sources for autogenous grafts including the mandibular symphysis and ramus, they are almost invariably not contiguous with the area to be augmented. An alternative mandibular donor site that is continuous with the recipient area and would eliminate the need for an extra surgical site is the tori/exostoses. Bone grafting was planned for this patient as there were angular bone loss present between 35-36 and 36-37. As the volume of bone required was less and bilateral tori were present on the lingual side above the mylohyoid line, the tori was removed and used as a source of autogenous bone graft, which were unnecessary bony extensions present on the mandible and continuous with the recipient area. Post-operative radiographs taken at 6 and 12 month intervals showed good bone fill and also areas of previous pockets, which did not probe after treatment indicates the success of the treatment. The use of mandibular tori as a source of autogenous bone graft should be considered whenever a patient requires bone grafting procedure to be done and presents with a tori.
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Gingival enlargement in partial hemifacial hyperplasia p. 772
Rasika Ravindra Jagtap, Gaurav Shekhar Deshpande, Rasika Ravindra Jagtap, Gaurav Shekhar Deshpande
DOI:10.4103/0972-124X.147426  
Hemifacial hypertrophy is a rare developmental disorder, characterized by unilateral enlargement of facial tissues. The hemifacial hyperplasia is classified as true hemifacial hypertrophy and partial hemifacial hypertrophy. It is unilateral enlargement of viscerocranial condition in which not all structures are enlarged. We present a rare case of gingival enlargement in partial hemifacial hyperplasia highlighting the clinical and radiological findings with the corrective treatment offered for gingival enlargement.
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The pouch and tunnel technique for management of multiple gingival recession defects p. 776
Sneha Dani, Aditi Dhage, Gayatri Gundannavar, Sneha Dani, Aditi Dhage, Gayatri Gundannavar
DOI:10.4103/0972-124X.147431  
The desire for improved esthetics has increased tremendously over the years. Periodontal plastic surgery deals with regenerative procedures designed to restore form, function and enhance esthetics. The aim of this study was to evaluate the effectiveness of subepithelial connective tissue graft using pouch and tunnel technique as root coverage procedure. Three patients corresponding to a total of 8 sites participated in the study. Maxillary teeth with miller's class I gingival recession were included in the study. All the sites were treated using subepithelial connective tissue graft using pouch and tunneling technique. Patients were followed up for a period of 6 months and 1 year. All the treated teeth showed 100% root coverage at the end of 6 months and 1 year. Gingival recession is a common occurrence and its prevalence increases with age. It can lead to clinical problems, diminished cosmetic appeal and hence esthetic concern. There are various techniques for root coverage. Subepithelial connective tissue graft has shown the best predictability (95%) of root coverage in Millers class I & II cases. This technique preserves the intermediate papilla, accelerates the initial wound healing & also applies less traction. Due to minimal trauma at the recipient site, this procedure may be advantageous in treatment of recession as compared to other treatment modalities.
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Recombinant human bone morphogenetic protein type 2 in the reconstruction of atrophic maxilla: Case report with long-term follow-up p. 781
Andre Luiz Zetola, Thalyta Verbicaro, Sahara Littieri, Rafaela Larson, Allan Fernando Giovanini, Tatiana Miranda Deliberador, Andre Luiz Zetola, Thalyta Verbicaro, Sahara Littieri, Rafaela Larson, Allan Fernando Giovanini, Tatiana Miranda Deliberador
DOI:10.4103/0972-124X.147437  
Autologous bone is reported by scientific literature as the gold standard for the replacement of the bone loss in maxillary atrophic area. Notwithstanding, this grafting type shows several disadvantages as: The procedure morbidity, limited size of the graft and longer recovering time. Recombinant human bone morphogenetic protein type 2 (rhBMP-2) has been used as bone substitute for the reconstruction of large bone defects. The aim of this case was to report a clinical case exhibiting the reconstruction of the atrophic maxilla through using rhBMP-2 as grafting material associated with absorbable collagen sponge (ACS). At 8 months of following-up, osseointegrated implants were placed. After 2 years and 5 months of following-up, it could be observed an appropriate aesthetical and functional rehabilitation.
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Management of a pathologically migrated upper anterior tooth using platelet-rich fibrin and a modified crown preparation technique p. 786
George Sam, Vasundara Yayathi Shivashankar, George Sam, Vasundara Yayathi Shivashankar
DOI:10.4103/0972-124X.147439  
In adult periodontal patients, pathologic tooth migration can create serious functional and aesthetic problems. In such situations, a combined orthodontic and periodontal treatment is often indicated. However, the lengthy treatment time and the demanding nature of orthodontic therapy for such periodontally compromised teeth is often a challenge. In this case report, an approach combining platelet-rich fibrin for the treatment of osseous defect and a modified crown preparation technique to reposition the crown was done on a pathologically migrated right lateral incisor.
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Clinical and radiographic evaluation of recombinant human platelet derived growth factor with beta tricalcium phosphate in the treatment of a periodontal intrabony defect p. 789
Sneha Maroo, Katragadda Raja Venkatesh Murthy, Sneha Maroo, Katragadda Raja Venkatesh Murthy
DOI:10.4103/0972-124X.147441  
The need to increase the predictability of successful periodontal regeneration has led to the use of cell-stimulating proteins in combination with osteoconductive scaffolds and cells based on the principles of tissue engineering. The present case report describes the treatment of an intrabony defect with recombinant human platelet derived growth factor (rhPDGF) + β-tricalcium phosphate (β-TCP). A 25-year-old patient presented with a probing pocket depth of 9 mm mesial to the left maxillary molar. The radiograph revealed an intrabony defect with a depth of 4.23 mm. The defect was treated by open flap debridement and grafting with rhPDGF + β-TCP. On 9 months follow-up, the pocket depth reduced to 3 mm and the defect was completely filled as observed in radiographs and surgical re-entry. A gain in alveolar crest height was also observed.
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Unilateral gingival lymphangioma: A first case report p. 794
Avideh Maboudi, Maryam Seyedmajidi, Avideh Maboudi, Maryam Seyedmajidi
DOI:10.4103/0972-124X.147442  
Lymphangiomas are classified as vascular malformations. A 17-year-old male patient was referred with asymptomatic gingival enlargement with a vesicular feature on the buccal aspect of the central and lateral teeth of the right mandible; the lesion showed easy bleeding. After local anesthesia, subgingival, and sulcular incisions was performed on the buccal and lingual gingiva of the right central and lateral incisors of the mandible. Microscopic evaluation showed lymphangioma. A 3-year follow-up showed promising results.
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AUTHOR INDEX, 2014 Top

Author Index, 2014 p. 797
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TITLE INDEX, 2014 Top

Title Index, 2014 p. 805
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NEWS AND EVENTS Top

PARICHAY 2014 - A Report p. 809
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Professional Enrichment Programme - A Report p. 811
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