Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
May-June 2018
Volume 22 | Issue 3
Page Nos. 191-281

Online since Friday, June 8, 2018

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EDITORIAL  

Is “Impact” the “Factor” that matters…? (Part II) p. 191
Ashish Kumar
DOI:10.4103/jisp.jisp_355_18  
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PRESIDENT’S MESSAGE Top

Indian society of periodontology: Yours; mine; or ours? p. 193
Nitin Dani
DOI:10.4103/jisp.jisp_350_18  
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SECRETARY’S MESSAGE Top

Periodontal disease prevalence: Right time to address the challenges p. 194
Abhay Kolte
DOI:10.4103/jisp.jisp_360_18  
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REVIEW Top

Nanotechnology in dentistry: Unleashing the hidden gems p. 196
Swati Verma, Ramakrishna Chevvuri, Hunny Sharma
DOI:10.4103/jisp.jisp_35_18  
Nanotechnology in dentistry refers to new generation research carried out to develop newer technologies, restorative materials and drugs of Nano dimensions. The word “Nano” refers to Nanoscale particles. Although the science of nanotechnology in dentistry is recent and less developed, but still has vast potential to show advancement and improvement in the field of dentistry. As nanotechnology is making firm grip in other fields such as drug delivery system and reducing toxicity by the emergence of more biocompatible materials. Clinicians, researchers, and manufacturers are taking keen interest and participation in the advancement of this field. This paper is an attempt in unleashing the hidden gems of nanotechnology-focusing latest developments in field restorative and surgical dentistry to enhance the quality and biocompatibility of newer generation dental materials and technology. This paper will also focus on potential hurdles encountered in the development of newer materials by utilizing the science of nanotechnology and their potential safety issues concern.
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ORIGINAL RESEARCH Top

Serotypes of Aggregatibacter actinomycetemcomitans in relation to periodontal status and assessment of leukotoxin in periodontal disease: A clinico-microbiological study p. 201
Sudhakar Shuntikudege Suprith, Swati Setty, Kishore Bhat, Srinath Thakur
DOI:10.4103/jisp.jisp_36_18  
Context: Aggregatibacter actinomycetemcomitans (A.a) serotypes may add some important information of the pathogenetic background of periodontal infections. A.a leukotoxin is an important virulence factor in the pathogenesis of periodontal disease and its rate of progression. When compared to minimally leukotoxic strains, variants of A.a highly leukotoxic strains produce 10–20 times more leukotoxin. Aims: The aim of the present study was to detect serotypes a, b, c, d, and e of A.a its leukotoxin and find its correlation with periodontal status. Settings and Design: Microbiological analysis and cross-sectional study. Materials and Methods: A total of 80 subjects (40 chronic periodontitis and 40 aggressive periodontitis) in the age range of 14–55 years were selected. Subgingival plaque samples were collected and checked for the presence of A.a. Following isolation of the organism, detection of the serotypes and leukotoxin assessment was done. Statistical Analysis Used: The proportions of A.a were calculated using descriptive statistics in terms of percentage. Chi-square test was used to find association between serotype, leukotoxin, and periodontal disease in individual group. Results: Out of 80 plaque samples, 45% tested positive for A.a. serotype b was detected in 33.33%, whereas serotype e in 8.33% samples and serotype c in 2.77% samples. Serotypes a and d were not detected in any of the samples. A combination of serotypes was seen in 47.22% of the sites. Of these 76.47% showed a combination of 2 serotypes, while 23.52%showed a combination of 3 serotypes. 8.33% showed untypable serotype. All samples had low-toxic variants of A.a. Conclusions: Serotype b and serotype e were predominant in chronic periodontitis, and serotype b was predominant in aggressive periodontitis. An association could be present between serotype and periodontal disease.
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Correlation between interleukin-1β and matrix metalloproteinase-1 levels in crevicular fluid with a proposed periodontal disease index in children p. 209
Juan Manuel Guízar-Mendoza, Christian Andrea LÓpez-Ayuso, Laura Anguiano-Flores, Martha Eugenia Fajardo-Araujo, Norma Amador-Licona
DOI:10.4103/jisp.jisp_383_17  
Background: The crevicular fluid contains biomarkers that allow the identification of periodontal disease, anticipation of its risk, and prediction of its progression. Purpose: The purpose of this study is to correlate interleukin-1β (IL-1β) and matrix metalloproteinase-1 (MMP-1) levels in crevicular fluid with periodontal disease severity in schoolchildren. Methods: A cross-sectional study was conducted in 82 schoolchildren between 9 and 12 years. The biofilm percentage, attachment level, gingival recession, dental calculus, and bleeding on probing were measured in the teeth 16, 26, 36, 41, and 46. These five parameters obtained were considered to propose a disease score between 0 and 10 points. In crevicular fluid from the tooth with the highest score, IL-1β and MMP-1 levels were measured. Results: According to the proposed score, mild gingivitis was identified in 20 schoolchildren, moderate gingivitis in 30, and severe gingivitis in 32. Biofilm percentage, IL-1β, and MMP-1 levels increased as the severity of the disease increase. The mean and 95% confidence interval were 23.2 pg/μl (18.6–27.7), 37.3 pg/μl (27.8–46.9), and 44.6 pg/μl (34.4–58.8) (P = 0.01) for IL-1β and 2.69 mol/min (2.51–2.87), 4.43 mol/min (3.9–4.95), and 5.59 mol/min (4.81–6.38) (P < 0.001) for MMP-1 in each group, respectively. The proposed clinical score correlated with biofilm percentage (r = 0.63), IL-1β (r = 0.50), and MMP-1 (0.45) levels, P < 0.001 in all cases. Conclusions: The proposed clinical score for periodontal disease in children correlated with percentage of biofilm, IL-1β, and MMP-1 levels.
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Association between obstructive sleep apnea and comorbidities with periodontal disease in adults p. 215
Catalina Latorre, Francina Escobar, Juliana Velosa, Daniela Rubiano, Patricia Hidalgo-Martinez, Liliana Otero
DOI:10.4103/jisp.jisp_38_18  
Background: Several studies have reported an association between periodontal disease and obstructive sleep apnea (OSA). However, heterogeneity of results suggests that there is insufficient evidence to support this association. Aims: The objective of this study was to identify the association between periodontal disease and OSA in adults with different comorbidities. Settings and Design: One hundred and ninety-nine individuals (107 women and 92 men) underwent polysomnography with a mean age of 49.9 years were recruited. Materials and Methods: The presence of OSA, comorbidities, and periodontal disease was evaluated in each individual. Student's t-tests or Chi-square and ANOVA tests were used to determine the differences between groups. Results: The prevalence of periodontal disease was 62.3% and 34.1% for gingivitis. The results showed no statistically significant association between all groups of patients with OSA and non-OSA patients for gingivitis (P = 0.27) and for periodontitis (P = 0.312). However, statistically significant association was shown between periodontitis and mild OSA compared with the periodontitis and non-OSA referent (P = 0.041; odds ratio: 1.37 and 95% confidence interval 1.11–2.68). The analysis between OSA and comorbidities showed a statistically significant difference for patients with OSA and hypertension (P < 0.001) and for patients with OSA and hypertensive cardiomyopathy (P < 0.001) compared with healthy individuals. Periodontitis was more likely in men with severe OSA and with any of two comorbidities such as hypertension or hypertensive cardiomyopathy. Women with hypertension or hypertensive cardiomyopathy were more likely to have mild OSA, and these associations were statistically significant (P < 0.05). Conclusions: This study identified association between periodontitis and mild OSA and this association was more frequent in women with hypertension or hypertensive cardiomyopathy. Periodontitis was associated with severe OSA in men who showed any of two comorbidities such as hypertension or hypertensive cardiomyopathy.
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Indocyanine green-mediated photothermal therapy in treatment of chronic periodontitis: A clinico-microbiological study p. 221
Chetan Purushottam Raut, Kunal Sunder Sethi, Bhagyashree Rajendra Kohale, Alefiya Mamajiwala, Ayushya Warang
DOI:10.4103/jisp.jisp_128_18  
Background: Photodynamic therapy (PDT) has developed as an alternative treatment modality in periodontitis patients. Different photosensitizers used over the years have shown contradictory results. Thus, recently indocyanine green (ICG)-mediated photothermal therapy has emerged for the treatment of chronic periodontitis. Aim: The present study aimed at comparing and evaluating the effects of photothermal therapy using ICG in the treatment of chronic periodontitis with scaling and root planing (SRP). Materials and Methods: This was a randomized, controlled, clinical trial where fifty participants were equally divided into two groups, i.e., control group (SRP) and test group (SRP + photothermal therapy). Clinical parameters were evaluated at baseline and 6-month follow-up. These were plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Microbiological analysis of plaque sample was also done to check for anaerobic mixed flora. Results: Significant reduction was seen in PD, CAL, and BOP in the test group as compared to control group after 6 months (P < 0.05). However, intergroup comparison of PI showed nonsignificant results (P > 0.05). Anaerobic culture of plaque samples of test group also revealed a significant reduction of microorganisms in comparison with control group. Conclusion: ICG-mediated photothermal therapy can act as an alternative to antimicrobial PDT as an adjunct to SRP in the treatment of chronic periodontitis.
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Comparative evaluation of efficacy and soft tissue wound healing using diode laser (810 nm) versus conventional scalpel technique for second-stage implant surgery p. 228
Manvir Kaur, Yash Paul Dev Sharma, Preetinder Singh, Shivli Sharma, Ankur Wahi
DOI:10.4103/jisp.jisp_46_17  
Background: This study was aimed to compare the efficacy and soft tissue wound healing using diode lasers (810 nm) versus conventional scalpel approach as uncovering technique during the second-stage surgery in implants. This was a prospective, randomized study which was conducted on 20 subjects in which the implants were already placed using a two-stage technique. Implant sites were examined and the patients were randomly divided into two groups. Materials and Methods: Patients were randomly divided into two groups, i.e., Group A and Group B. In Group A, implants were uncovered as a part of Stage II surgery with conventional scalpel technique, and in Group B, implants were uncovered using 810 nm diode laser. Clinical parameters such as need and amount of local anesthesia, duration of surgery, intraoperative bleeding, pain index, wound healing index (HI), and time for impression taking were recorded at various intervals. Results: Statistical differences for clinical parameters were seen between Group A and Group B showing uncovery of implant with laser more effective, and for time of impression taking, difference was statistically significant showing that impressions were taken early in case of Group A because of better healing which was recorded with help of HI, but the difference in time of healing between Group A and Group B was not statistically significant. Conclusion: The use of a diode laser (810 nm) in the second-stage implant surgery can minimize surgical trauma, reduce the amount of anesthesia, improve visibility during surgery due to the absence of bleeding, and eliminate postoperative discomfort.
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Regenerative potential of autologous platelet-rich fibrin with and without amnion membrane in the treatment of Grade-II furcation defects: A clinicoradiographic study p. 235
Jaspreet Kaur, Shalu Chandna Bathla
DOI:10.4103/jisp.jisp_119_18  
Context: Platelet-rich fibrin (PRF), platelet concentrate composed of cytokines and structural glycoproteins trapped within polymerized fibrin meshwork, has the potential to accelerate healing of periodontal tissues. Amnion membrane has also attracted a lot of attention in periodontal regeneration due to the presence of variety of growth factors. Aims: The aim of the study is to evaluate and compare the regenerative potential of autologous PRF with and without amnion membrane in the treatment of Grade II furcation defects. Settings and Design: This was a double-masked randomized, split-mouth design study. Materials and Methods: Fifteen patients with thirty mandibular degree II furcation defects were randomly allotted into Group I (PRF and amnion membrane) and Group II (PRF). Clinical parameters such as plaque index and gingival index-at defect site along with probing pocket depth, and relative attachment level and furcation defect depth were recorded at baseline, 3 months, and 6 months postoperatively. Assessment of radiographic parameters was done at baseline and 6 months postoperatively aided by computer-assisted tomography (Dentascan). Statistical Analysis Used: For intragroup variations, Wilcoxon signed-rank test, and for comparison between the two groups/intergroup variations, Independent t-test and Mann–Whitney test was performed. Results: All clinical and radiographic parameters showed statistically significant improvement at the sites treated with PRF and amnion membrane compared to those with PRF alone. Conclusions: Within the limitation of this study, there was greater pocket reduction, attachment level gain, and bone fill at sites treated with PRF and amnion membrane as compared to PRF alone.
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Comparative evaluation of hemodynamic, vasoconstrictive, and SpO2variability during different stages of periodontal surgery performed using 0.5% ropivacaine or 2% lignocaine HCl (1:80,000 adrenaline) local anesthesia: A randomized, double-blind, split-mouth pilot study p. 243
Ashank Mishra, Zohra Lalani, Butchibabu Kalakonda, Preeti Krishnan, Ruchi Pandey, Krishnajaneya Reddy
DOI:10.4103/jisp.jisp_18_18  
Aim: The aim of this study is to compare anesthetic, hemodynamic, vasoconstrictive, and SpO2variability of 0.5% ropivacaine to the “gold standard” lignocaine (2%) with epinephrine (1:80,000) during periodontal surgery. Materials and Methods: A total of 20 systemically healthy controls meeting the inclusion criteria were selected from the Outpatient Department of Sri Sai College of Dental Surgery. Preoperatively, all participants were infiltrated with 0.5 ml of 0.5% ropivacaine intradermally as test solution to record any allergic reaction. Open flap debridement was performed using local anesthesia containing 2% lignocaine hydrochloride with 1:80,000 epinephrine or 0.5% ropivacaine. Recordings were made of the time of onset, duration of action, the intensity, and depth of anesthesia and various hemodynamic changes throughout the surgical procedure. In addition, blood loss volume and postoperative pain were also assessed. Results: Ropivacaine showed statistically longer duration of action (mean±SD =5.3±0.71 hrs) than lignocaine with epinephrine (mean=2.14±0.98 hrs). Blood loss during flap surgery was comparatively less when performed under ropivacaine. No statistical differences were observed in systolic BP, diastolic BP, SpO2 and heart rate during different stages of periodontal surgery between either of the local anesthetic agents Conclusion: Ropivacaine demonstrates comparable efficacy as lignocaine with added advantage of longer duration of action and superior postoperative pain control. No adverse events from this newer anesthetic were noted, and hence, it can be used safely as a viable local anesthetic for periodontal surgical procedures.
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Soft-tissue esthetic outcome of single implants: Immediate placement in fresh extraction sockets versus conventional placement in healed sockets p. 249
Nima Naddaf Pour, Baharak Ghaedi, Mona Sohrabi
DOI:10.4103/jisp.jisp_21_18  
Background: Immediate implant placement has advantages such as requiring fewer surgical procedures and decreased treatment time; however, unpredictable soft- and hard-tissue outcome is a problem. This study aimed to compare the soft-tissue esthetic outcome of single implants placed in fresh extraction sockets versus those placed in healed sockets. Materials and Methods: This cross-sectional, retrospective study was performed on 42 patients who received single implants. Twenty-two patients with a mean age of 40.14 years received immediate implants while 18 patients with a mean age of 43.40 years were subjected to conventional (delayed) implant placement. The mean follow-up time was 14.42 ± 8.37 months and 18.25 ± 7.10 months in the immediate and conventional groups, respectively. Outcome assessments included clinical and radiographic examinations. The esthetic outcome was objectively rated using the pink esthetic score (PES). Results: All implants fulfilled the success criteria. The mean PES was 8.54 ± 1.26 and 8.10 ± 1.65 in the immediate and conventional groups, respectively. This difference was not statistically significant (P = 0.329). The two PES parameters, namely, the facial mucosa curvature and facial mucosa level had the highest percentage of complete score. Conclusions: Immediate and conventional single implant treatments yielded comparable esthetic outcomes.
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Indications for palatal sinus lift: Case series p. 254
Amin Rahpeyma, Saeedeh Khajehahmadi
DOI:10.4103/jisp.jisp_357_17  
Background: Open sinus lift is indicated in posterior maxilla when subantral bone is insufficient for insertion of dental implants. Lateral approach is the most used technique. Sometimes, this surgery is difficult due to thick buccal bone or other anatomic variations of maxillary sinus. Aim: The aim of this study was to determine cases that palatal approach open sinus lift is indicated. Settings and Design: This study was a retrospective study. Materials and Methods: Archive files of Dental Implant Department of Mashhad Dental School were searched for palatal sinus lift. The reason for patients was noticed. Pre- and post-operative radiographs were evaluated. Results: Ten patients with palatal approach sinus lift were included. Seven patients had previous insufficient sinus lift, one patient had acute palatonasal recess, and two other patients had thick buccal bone. Conclusion: Palatal approach is maxillary open sinus lift is a useful auxiliary in patients with heavy buccal vestibule scar, thick buccal bone, deep palatonasal recess, and for reentry augmentation.
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Prevalence of variations in morphology and attachment of maxillary labial frenum in various skeletal patterns - A cross-sectional study p. 257
Elayadath Rajagopalan Rajani, Palakunnu Padmaprabha Biswas, Rishi Emmatty
DOI:10.4103/jisp.jisp_294_17  
Background: Maxillary labial frenum is a dynamic structure with a diverse morphology. Although an abnormal labial frenum is associated with syndromic and nonsyndromic conditions, it is often been neglected during the routine intraoral examination. The significance of various types of frenum (normal to abnormal), based on the attachment site and morphology in different skeletal patterns, has not been studied yet. Materials and Methods: A cross-sectional study was conducted in a clinical setting on 150 participants (50 each in Class I, Class II, and Class III skeletal pattern) within the age group of 13–30 years. Frenum was examined by direct visual method and intraoral photographs were taken for all the participants. Results: Chi-square and Fisher's exact tests were used. No gender-wise differences were found among the various frenum typologies. Mucosal type was the most prevalent in Class I and II and gingival type in Class III. Simple frenum was the common type in all the three groups. However, abnormal frenum categories based on its location and morphology were more in class III and found to be statistically significant. Papillary and papillary penetrating types are significantly associated with skeletal class III pattern and midline diastema (P < 0.05). Conclusion: The prevalence of papillary and papillary penetrating types of frenum are significantly more in Class III skeletal pattern. A labial frenum that is attached close to the gingival margin could be an etiological factor in midline diastema, mucogingival problems, and affect the growth of the alveolar process. Hence, an early diagnosis of abnormal frenum prevents the emergence of periodontal as well as orthodontic problems.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Grinspan syndrome with periodontitis: Coincidence or correlation? p. 263
Lata Goyal, Narinder Dev Gupta, Namita Gupta
DOI:10.4103/jisp.jisp_142_18  
Grinspan syndrome is a syndromic complex which comprises a triad of hypertension, diabetes, and oral lichen planus. It remains an enigmatic condition that whether it is separate entity or drug-induced lichenoid reaction emerging due to medications used to treat hypertension and diabetes. Diabetes is related to long-term hyperglycinemia leading to accelerated destruction of both nonmineralized connective tissue and bone leading to periodontitis. Moreover, there is also a possible link between cardiovascular disease and periodontitis. Here, we are presenting a case with the symptomatic triad fulfilling the diagnostic criteria of Grinspan syndrome. A 50-year-old female with type 2 diabetes mellitus and vascular hypertension came with the chief complaint of bleeding gums and severe burning sensation of the oral cavity. In addition, she was having generalized alveolar bone loss and clinical attachment loss. To the best of our knowledge, this coexistence has not been reported earlier. This needs further evaluation so that the preventive measures can be taken at early stage.
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Shield the socket: Procedure, case report and classification Highly accessed article p. 266
Payal Rajender Kumar, Udatta Kher
DOI:10.4103/jisp.jisp_78_18  
The extraction of a tooth leads to a cascade of events which results in resorption of the alveolar bone around the socket. The buccal bone loss that occurs postextraction leads to vertical and horizontal bone loss. It requires complex hard and soft-tissue reconstruction to achieve esthetically pleasing results in such cases. In the socket-shield technique (SST) the root is bisected, and the buccal two-third of the root is preserved in the socket so that the periodontium along with the bundle bone and the buccal bone remains intact. A classification of SST technique is proposed depending on the position of the shield in the socket. This classification is required so as to help in understanding the preparation design and the role of shield and in maximizing the usage of the shield to achieve best possible esthetics in immediate implant placement sites.
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Coronally advanced flap in conjunction with platelet-rich fibrin-assisted immediate management of residual gingival defect following surgical excision of recurrent pyogenic granuloma in the maxillary esthetic segment p. 273
Sanjeev Kumar Salaria, Satwant Kaur, Isha Sharma, Karthikeyan Ramalingam
DOI:10.4103/jisp.jisp_94_18  
Exophytic gingival lesions are more frequently encountered intraorally, out of which few are reactive in nature. Pyogenic granuloma (PG) is one of the commonly occurring reactive benign mucocutaneous lesions; exact etiopathogenesis remains unclear. Although surgical excision is the treatment of choice, sometimes it may induce residual soft defect formation which further creates an esthetic problem, root sensitivity, etc., The present case report not only describes the diagnosis and treatment of PG but also the immediate successful management of residual gingival defect in the esthetic area (which was originated as a sequel of the excisional biopsy of recurrent PG) by utilizing platelet-rich fibrin in conjunction with coronally advanced flap in single-stage surgery. Clinical healing was uneventful and satisfactory at 2 weeks, and excellent coverage of residual mucogingival defect with gingival esthetic and normal sulcus depth was observed at 3 and 6 months postoperatively without any sign of a complication.
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Ascertaining the regenerative potential of the “gold standard” grafts: Achieving 100% root coverage in Miller's Class III recession with periosteal pedicle graft and autogenous bone p. 277
Shailly Luthra, Harpreet Singh Grover, Anil Yadav, Sujata Masamatti
DOI:10.4103/jisp.jisp_333_17  
Recession of the gingiva is defined as the stripping of a portion of the dental root surface as a result of gingival margin shifting apically. Various techniques have been advocated for root coverage. The practice of utilizing periosteal pedicle graft for covering gingival recession defects is a contemporary development. Utilizing bone grafts for hard tissue regeneration has also been implemented. This case report assesses the effectiveness of the surgical approach utilizing autogenous bone and periosteum for recession coverage. A participant with Miller's Class III gingival recession in #23 and #24 was treated using this technique. The loss of periodontal attachment was recorded to be 8 mm and 5 mm on the mid-buccal surface of the upper left canine and first premolar, respectively. Clinical parameters were recorded at 1, 3, 6, 9, and 12 months postoperatively. Complete root coverage was achieved when evaluated from baseline till 12 months, with clinical attachment level and keratinized tissue gain. The results of esthetics in terms of color match and tissue contours were satisfactory to the patient as well as to the clinicians.
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