Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
January-February 2020
Volume 24 | Issue 1
Page Nos. 1-92

Online since Thursday, January 2, 2020

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EDITORIAL  

Shouldn't “Periodontology” be the “branch of choice” for postgraduation? p. 1
Ashish Kumar
DOI:10.4103/jisp.jisp_606_19  
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PRESIDENT’S MESSAGE Top

Oral health scenario in India p. 3
Nymphea Pandit
DOI:10.4103/jisp.jisp_601_19  
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SECRETARY’S MESSAGE Top

Periodontology: Narrative versus optics p. 5
Harpreet Singh Grover
DOI:10.4103/jisp.jisp_599_19  
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REVIEWS Top

The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence p. 7
Rohini Govindasamy, Sugavanesh Periyasamy, Mohan Narayanan, Venkateshwarapuram Rengasamy Balaji, Manikandan Dhanasekaran, Balakrishnan Karthikeyan
DOI:10.4103/jisp.jisp_228_19  
Background and Objectives: The poor maternal oral health in the pregnancy has an impact on the fetus through the oral-systemic link. Various studies have proven the relationship between poor maternal oral health and the occurrence of adverse pregnancy outcomes. Hence, periodontal therapy becomes indispensable during pregnancy. Previous systematic reviews and meta-analysis conducted to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes have shown inconsistent results. Hence, we conducted the present review to assess the influence of periodontal therapy on the occurrence of adverse pregnancy outcomes including the studies published till date. Materials and Methods: We searched for the relevant studies using the databases PUBMED, MEDLINE, CINAHL, and EMBASE on the randomized controlled trials evaluating the influence of periodontal treatment on adverse pregnancy outcomes from 2000 to 2018. Nineteen studies were considered for the present review based on the predetermined criteria. The risk of bias tool by Cochrane was used to evaluate the risk of bias among the studies. Results: Among the studies included for the present review, the occurrence of preterm birth among the pregnant mothers who received periodontal therapy ranged from 0% to 53.5%, while in the control group, the range was 6.38%–72%. The rate of LBW among the mothers treated for periodontal disease ranged from 0% to 36%, and in the control group, it varied from 1.15% to 53.9%. Conclusion: With best possible evidence, it can be inferred that nonsurgical periodontal therapy is safe during pregnancy. Even though it does not completely avert the occurrence of adverse pregnancy outcomes, it can be recommended as a part of antenatal care.
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ORIGINAL RESEARCH Top

Effects of leukocyte–platelet-rich fibrin and advanced platelet-rich fibrin on the viability and migration of human gingival fibroblasts p. 15
Zeinab Rezaei Esfahrood, Mohammadreza Talebi Ardakani, Mehdi Shokri, Maryam Shokri
DOI:10.4103/jisp.jisp_218_19  
Background: Platelet products play a fundamental role in the process of healing. The new generation of platelet-rich fibrin (PRF), namely advanced PRF (A-PRF), has different biological and mechanical properties compared to those of leukocyte-PRF (L-PRF). This study aimed to compare the effects of L-PRF and A-PRF on the viability and migration of human gingival fibroblasts (HGFs). Materials and Methods: In this in vitro study, the effects of A-PRF and L-PRF on the viability and migration of HGFs after 24 and 48 h were evaluated using the methyl thiazolyl tetrazolium assay. The viability of the negative control culture medium was considered to be 100%. The mean optical density of the test groups was divided by that of the negative control group and reported as percentage. One-way ANOVA was applied to assess the effects of time and type of PRF on the viability and migration of HGFs. Pairwise comparisons were made using the Tukey's test. Results: At 24 h, cell viability in the L-PRF group was significantly higher than that in the A-PRF group (P < 0.05). However, no significant difference was noted between the two groups at 48 h. At 24 h, L-PRF caused significantly higher cell migration compared to the negative control group, whereas at 48 h, both A-PRF and L-PRF significantly increased cell migration compared to the control group. Conclusion: Within the limitations of this study, L-PRF and A-PRF had significant effects on the viability and migration of HGFs. Further studies on these platelet concentrates are warranted.
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Types of bone destruction and its severity in chronic periodontitis patients with tobacco smoking habit using periapical radiographs and transgingival probing: A cross-sectional study p. 20
B J Janardhana Amaranath, Neelam Das, Ira Gupta, Rohit Gupta, Bijoy John, Munishwar Parvathi Devi
DOI:10.4103/jisp.jisp_212_19  
Background: Tobacco smoking is an independent risk factor for periodontal disease which increases periodontal pocketing, attachment loss, as well as bone loss leading to varied severity and bone destruction in the form of horizontal and vertical patterns. Aim: The aim of the present study is to determine and measure the types and severity of bone destruction in chronic periodontitis (CP) patients with tobacco smoking habit using intraoral periapical (IOPA) radiographs and transgingival probing. Materials and Methods: A total of 60 male participants with CP were included in the study. Group A comprised 30 heavy cigarette smokers and Group B comprised 30 nonsmokers. Clinical parameters such as plaque index (PI), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. Amount and pattern of bone loss were assessed using IOPA and transgingival probing. Results: The mean values of PI, PPD, and CAL were 2.50 ± 0.28 mm, 9.33 ± 1.42 mm, and 10.2 ± 1.62 mm, respectively, for cigarette smokers, which were found to be higher and statistically significant as compared to nonsmokers. Cigarette smokers showed more bone destruction than nonsmokers in respect to maxillary molars 4.42 ± 1.31 mm and incisors 3.90 ± 1.10 mm as compared to nonsmokers. Types of bone destruction were more of vertical patterns (93.3%) in cigarette smokers. Conclusions: Tobacco smoking was associated with severe attachment loss. Tobacco smoking not only affects soft tissues but also hard tissues such as bone. Palatal sides of maxillary molars showed significantly higher bone loss and also had more percentage of vertical patterns of bone loss compared to nonsmokers. IOPA and transgingival probing may be used as noninvasive methods for the determination of types and severity of bone destruction in CP patients with or without tobacco smoking habit.
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Assessment of buccal and lingual alveolar bone width in the posterior region at dentate and edentulous sites: A cone-beam computed tomography study p. 26
Abhay Pandurang Kolte, Rajashri Abhay Kolte, Resham Aparna Vivek Pakhmode
DOI:10.4103/jisp.jisp_122_19  
Background: Alveolar bone dimensions form an important prognostic factor in determining the success of implant treatment outcome. The present study evaluated the buccal and lingual bone width in posterior dentate and edentulous sites using cone-beam computed tomography (CBCT). Materials and Methods: The study included 100 patients, divided equally into two groups, Group A (males) and Group B (females) indicated for implant therapy. CBCT scans were evaluated for the assessment of the thickness of buccal and lingual bone width at four levels, i.e., crestal bone width (CBW), mid root bone width, middle of alveolar bone housing bone width , and most apical portion bone width (APBW). Bone width was measured at three levels in the edentulous region as CBW, bone width 5 mm from crest (CBW-1), and 10 mm from crest (CBW-2). Results: Gradual increase in bone width was observed from crestal bone at buccal and lingual level (CBW-B and CBW-L) from 1.10 ± 0.29 mm and 1.21 ± 0.34 mm to APBW at buccal and APBW lingual side from 2.82 ± 0.51 mm and 3.43 ± 0.42 mm, respectively. For both the groups, the differences in bone width at three levels were statistically significant, with CBW being significantly higher for Group A than Group B. Conclusion: At edentulous sites, CBW was lesser as compared to the apical levels. The bone width on buccal and lingual sides of dentate sites at the coronal level is minimal compared to the apical level, which has definite implications for implant therapeutics.
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Evaluating the efficacy of different magnification variables during root planing procedure under a surgical operating microscope in chronic periodontitis: A randomized clinical trial p. 32
Gautami S Penmetsa, Kausalya Devi Panda, Anand Kumar Raju Manthena, Radha Rani Korukonda, Praveen Gadde
DOI:10.4103/jisp.jisp_378_19  
Background: The journey in the field of periodontics has destined from macrodentistry to microdentistry. The success of periodontal therapy always depends on better visual access and debridement which are prerequisites for achieving a clean and smooth root surface in attaining new attachment. Magnification is something which provides good hand-eye coordination resulting in better treatment outcomes. The aim of our study is to assess the effectiveness of magnification variable under a surgical operating microscope while performing root planing procedure. Materials and Methods: A randomized clinical trial was conducted on 45 patients who were diagnosed with mild-to-moderate chronic periodontitis and were treated under the surgical operating microscope with three different magnification variables (0.4, 0.6, and 1). Plaque index, gingival index (GI), and probing pocket depths (PPDs) were assessed from baseline to 4 weeks, whereas healing index was assessed after 2 weeks of root planing procedure. Results: The results of our study under the three magnification variables (0.4, 0.6 and 1) have shown no significant reduction in plaque or GI after 4 weeks of therapy. However, a significant reduction PPDs was observed after 4 weeks and improved healing index was observed after 2 weeks under all the three magnification variables with the variable 0.6 demonstrating more effective results. Conclusion: Even though all the three magnification variables have shown better treatment outcome and ergonomics, 0.6 magnification variable, i.e., ×3.5 – ×5, has demonstrated a more significant effect while performing root planing procedure.
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Effect of aloe vera as a preprocedural rinse in reducing aerosol contamination during ultrasonic scaling p. 37
Benna Paul, Radhamoni Madhavan Pillai Baiju, Nafeesa Beevi Raseena, Periera Shibu Godfrey, Puthenpurayil Ibrahimkutty Shanimole
DOI:10.4103/jisp.jisp_188_19  
Background: The use of preprocedural mouth rinse is one of the recommended ways to reduce aerosol contamination during ultrasonic scaling. Different agents have been tried as preprocedural mouth rinse. Chlorhexidine and povidone-iodine significantly reduce the viable microbial content of aerosol when used as a preprocedural rinse. Studies have shown that aloe vera (AV) mouthwash is equally effective as chlorhexidine in reducing plaque and gingivitis. There is no published literature on the role of AV as a preprocedural mouth rinse. Hence, this study compared the effect of 94.5% AV to 0.2% chlorhexidine gluconate (CHX) and 1% povidone-iodine (PVP-I) as preprocedural mouth rinses in reducing the aerosol contamination by ultrasonic scaling. Materials and Methods: Sixty subjects were divided into three groups based on the preprocedural rinse use (0.2% CHX, 1% PVP-I, and 94.5% AV). Ultrasonic scaling was done for 20 min in the same closed operatory for all the subjects after keeping blood agar plates open at two standardized locations. Colony forming units (CFUs) on blood agar plates were counted, and predominant bacteria were identified after incubation at 37°C for 48 h. Results: There was statistically significant difference in the CFU counts between CHX group and PVP-I group and between AV group and PVP-I group. There was no difference between CHX group and AV group at both the locations. Conclusion: 94.5% AV as a preprocedural rinse is better than 1% PVP-I and comparable to 0.2% CHX in reducing CFU count.
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Evaluation of ozone as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized clinico-microbial study p. 42
Chandrappa Vasthavi, Harsha Mysore Babu, Vivekananda Marenahalli Rangaraju, Shivaprasad Dasappa, Leka Jagadish, Ravindra Shivamurthy
DOI:10.4103/jisp.jisp_162_19  
Background and Objectives: Mechanical plaque control is an essential part of periodontal therapy. In the present study, the efficacy of ozone water irrigation as an adjunct to scaling and root planing was evaluated in the treatment of generalized chronic periodontitis. Materials and Methods: Twenty-four patients with chronic periodontitis selected for the study were randomly divided into Group A and Group B, receiving ozone water irrigation and distilled water irrigation, respectively, after scaling and root planing. Subgingival plaque was collected from the selected investigational teeth and was analyzed using BANA-Zyme™ Processor to evaluate the “red complex” periodontal pathogens. The clinical and microbiological parameters were recorded at baseline, 14 days, 21 days, and 2 months. Results: The mean probing pocket depth scores for Group A and Group B at the baseline were 6.833 ± 1.193 and 7.833 ± 1.276; on day 14th, they were 6.616 ± 1.403 and 7.083 ± 1.378; on day 21st, they were 5.166 ± 0.937 and 6.083 ± 1.443;and on the 2nd month, they were 4.500 ± 0.797 and 5.166 ± 1.029, respectively. At the 2nd month, in Group A, 9 samples showed BANA negative and 3 samples showed BANA positive, and in Group B, 12 samples showed BANA negative and 0 sample showed BANA positive. The microbiological analysis showed a reduction in periodontal pathogens in both the groups. Conclusion: Significant improvement in both clinical and microbiological parameters suggests that subgingival ozonated water irrigation could be an efficient adjunct to scaling and root planing in the treatment of chronic periodontitis.
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Evaluation of surgical scalpel versus semiconductor diode laser techniques in the management of gingival melanin hyperpigmentation: A split-mouth randomized clinical comparative study p. 47
Ganachari Bharath Chandra, Malleshappa Bhairammanavar Vinay Kumar, Narayan Narendra Walavalkar, Kharidhi Laxman Vandana, Pabbati Krishna Vardhan
DOI:10.4103/jisp.jisp_186_19  
Background: “Black gums” due to melanin pigmentation of the gingiva is one reason for the demand of cosmetic therapy. Clinicians are often faced with challenge to achieve gingival esthetics in such cases because of its recurrence. Although many procedures were described in literature for gingival depigmentation, only few are mentioning about the intensity of repigmentation. Hence, this study was designed to compare two different techniques for treatment of gingival melanin pigmentation. Materials and Methods: Twenty patients who were not esthetically pleased with the color of gingiva were selected. A randomized, split-mouth, depigmentation procedure was performed using surgical scalpel and diode laser techniques. Clinical parameters such as plaque and gingival index, bleeding, pain perception, wound healing, recurrence, and intensity of repigmentation were evaluated. Paired t-test and Chi-square test were used for analysis of data. Results: No bleeding was reported in patients treated with diode laser. Moderate pain was reported by patients treated with surgical scalpel, whereas none was reported in diode laser group. No statistically significant difference was observed for both treatment techniques in terms of wound healing, reappearance of gingival pigmentation, and intensity of the same at the end of 6 and 9 months postsurgically. Conclusion: Similar outcomes were observed for both the techniques. Few patients who resulted in no recurrence at 9 months were followed even up to 3 years. Hence, further studies should be done to know the underlying mechanisms. Keeping in mind of armamentarium and cost, surgical scalpel technique remained as the “gold standard” procedure for treatment of gingival melanin pigmentation.
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Comparison of effect of curcumin gel and noneugenol periodontal dressing in tissue response, early wound healing, and pain assessment following periodontal flap surgery in chronic periodontitis patients p. 54
M Venkata Sai Meghana, Jeevanand Deshmukh, MV Devarathanamma, K Asif, L Jyothi, H Sindhura
DOI:10.4103/jisp.jisp_105_19  
Background: The study was designed taking into consideration the drawbacks of periodontal dressing and healing properties of curcumin. The aim was to assess and compare the effect of Curcumin gel (Curenext) and noneugenol periodontal dressing (Coe pak) on tissue response, wound healing in the early stages, and pain post periodontal flap surgery in patients diagnosed with chronic periodontitis. Materials and Methods: Twenty patients requiring periodontal flap surgery were allotted to two groups at random, one receiving periodontal dressing and the other receiving curcumin for this cross over split-mouth study. Flap surgeries were performed on 2 quadrants with 3 weeks' interval. After suture removal, postoperative sites were assessed for tissue response (tissue color [TC] and tissue edema [TE]) and early wound healing as primary outcomes of the study. The secondary outcome was pain assessment and the number of analgesics taken by the individuals. Results: The two groups showed no significant differences with respect to tissue response, early wound healing, and pain perception. Curcumin group consumed lesser number of analgesics as compared to the one with periodontal dressing. Conclusion: It was confirmed that periodontal dressing and curcumin are effective in reducing the TE, normalizing the TC, enhancing the wound healing and reducing the pain perception. Curcumin can thus be used as an alternative to periodontal dressing.
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Clinical and radiographic evaluation of platelet-rich fibrin as an adjunct to bone grafting demineralized freeze-dried bone allograft in intrabony defects p. 60
Abhinav Atchuta, Jagadish Reddy Gooty, Vikram Reddy Guntakandla, Sunil Kumar Palakuru, Satyanarayana Durvasula, Rajababu Palaparthy
DOI:10.4103/jisp.jisp_99_19  
Background: Several bone graft materials are popularized in the treatment of intrabony defects. Demineralized freeze-dried bone allograft (DFDBA) is widely used in the treatment of intrabony defects. Platelet-rich fibrin (PRF) is autologous blood preparation which helps in wound healing and regeneration. Hence, this study focuses on evaluation of PRF, DFDBA, and their combination in the regeneration of intrabony defects. Materials and Methods: A total of 39 sites with intrabony defects were randomly assigned into three groups: (Group I - Open flap debridement, Group II - DFDBA alone, and Group III- DFDBA + PRF). Parameters such as probing pocket depth (PPD), relative attachment level (RAL), and radiographic bone fill were measured at baseline, 3 months, and 6 months. Intragroup comparison at various study intervals was made using one-way ANOVA test. Intergroup comparison was made using Tukey's multiple post hoc test. Results: Reduction in the PPD and greater difference in RAL was observed over the study period in all the three groups with greater reduction in DFDBA + PRF group. Reduction in the radiographic defect depths was observed over the study period in all the three groups with the greatest reduction of 38.99% in the DFDBA + PRF group. However, no statistically significant difference was reported by DFDBA versus DFDBA + PRF group. Conclusion: Combination of DFDBA and PRF improved the clinical and radiographic parameters compared to PRF and DFDBA alone. PRF was combined with DFDBA to produce a synergistic effect for treating intrabony defects in chronic periodontitis patients.
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Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical hospital in Pune: A comparative study p. 67
Nikhil Bomble, Sahana Hegde Shetiya, Deepti Rajendra Agarwal
DOI:10.4103/jisp.jisp_2_19  
Background: The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them. Materials and Methods: This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35–75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner. Results: Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD. Conclusion: Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.
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Gender-wise comparison of oral health-related quality of life and its relationship with periodontal status among the Indian elderly p. 72
Charu Mohan Marya, Harpreet Singh Grover, Shourya Tandon, Pratibha Taneja, Anil Gupta, Vandana Marya
DOI:10.4103/jisp.jisp_156_19  
Aim: The aim of this study is to assess if there are any gender differences in oral health-related quality of life (OHRQoL) and periodontal status among the elderly population of Haryana. Materials and Methods: A cross-sectional study was conducted among 1200 geriatric population of Faridabad district of Haryana. Subjects were selected by a combination of systematic, cluster, and multistage sampling techniques. Primary, secondary, and tertiary sampling units were chosen as wards, areas, and households, respectively. Self-Administered Questionnaire: Geriatric oral health assessment index was used to assess the OHRQoL among males and females. Periodontal status was assessed using the World Health Organization oral health survey pro forma with some modifications. Results: Results were analyzed using the Statistical Package for the Social Sciences 21 software. Gender-wise association of periodontal status with OHRQoL revealed a significant association with mobile teeth (P < 0.05). No relation was seen between OHRQoL, gingival bleeding, periodontal pocket, and loss of attachment (P > 0.05). Conclusion: No significant differences were observed in periodontal status among males and females, but OHRQoL was found to be better among males than females. Indian policymakers can use the conclusion derived from this study for planning and implementing public oral health strategies for the geriatric population.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Gingival fibromatosis with congenital hypertrichosis p. 80
Sameer Saxena, Gouri Bhatia, Karthik Munagala Krishna, Shalabh Mehrotra
DOI:10.4103/jisp.jisp_26_19  
Idiopathic gingival fibromatosis is a slowly progressive proliferative fibrous lesion of the gingival tissue, leading to functional, esthetic, and psychological difficulties. This entity is mainly associated with hypertrichosis and epilepsy either as an isolated disorder or as part of a syndrome. We present a case report of a female with severe generalized gingival fibromatosis and hypertrichosis which was treated by conventional gingivectomies under local anesthesia. Postoperative healing was uneventful with a marked improvement in patient's appearance and oral hygiene.
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Management of a malposed dental implant in the esthetic zone p. 83
Patathil Abdul Razak, Prasad Aravind, Priyatha Purushotham, Remya Ravi, Ravi Kunnaiah, Shanoj Ramacham Parambath
DOI:10.4103/jisp.jisp_733_18  
With the increased research in the field of dental implantology, there has been an extensive rise in the application of dental implants in various clinical situations. Complications arise with the frequent increase in the placement of dental implants; one of the common difficulties faced is placement of a malposed dental implant. Rehabilitation of prosthetically unfavorable implant is a serious challenge to a restorative dentist, a laboratory technician, and the patient. This is of great concern especially when it is in the maxillary smile zone. Prosthetic modifications, surgical corrections, or combination of both may be required in such situations. This case report describes a severely malposed dental implant in the maxillary left lateral incisor region in which an esthetically satisfactory result may not be feasible with prosthetic corrections alone. Hence, a surgical approach termed partial segmental osteotomy was initiated to reestablish the osseointegrated implant segment to a more favorable position before prosthetic phase.
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Periodontal esthetic surgery to improve a natural smile: Report case with 2-year follow-up Highly accessed article p. 87
Peterson Oliveira Boeira, Alexandre De Rossi, Leonardo Stephan Caporossi, Giana da Silveira Lima
DOI:10.4103/jisp.jisp_477_18  
The objective in this case report is to present a correction of excessive gingival exposure performed through periodontal esthetic surgery, using clinical crown lengthening and lip repositioning. The patient reported discomfort when smiling due to excessive gingival exposure, and clinical and photographic examinations of the patient showed vertical maxillary growth as the main diagnosis. In the digital smile design, the possibility of crown lengthening observed for teeth – upper left and right central incisors and upper left lateral incisor. A lip-repositioning procedure was also planned. An incision was performed at the mucogingival junction, and a parallel incision was realized at the top of the alveolar mucosa. Afterward, the incised gingival band was removed through vertical incisions in the planned border area. The muscular area was preserved. A simple suture was made, with the approach of the gingival margins around the surgical area. The crown-lengthening procedure was performed with the flapless technique. After 2-year follow-up, the periodontal esthetic surgery, comprising crown lengthening and lip repositioning, was noninvasive and can thus serve as an interesting alternative treatment for excessive exposure of the gingival smile, as it results in a harmonious and natural smile.
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REVIEWERS, 2019 Top

Reviewers, 2019 p. 92
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