Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
November-December 2019
Volume 23 | Issue 6
Page Nos. 499-594

Online since Wednesday, November 27, 2019

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Swachh Muh, Swastha Deh….Swastha Bharat…. Swachh Bharat [Clean Mouth, Healthy Body….Healthy India… Clean India] p. 499
Ashish Kumar
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Why Periodontology as a speciality: Down the memory lane p. 501
Nymphea Pandit
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Periodontology as a cult form p. 503
Harpreet Singh Grover
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Role of three-dimensional printing in periodontal regeneration and repair: Literature review p. 504
Meisha Gul, Aysha Arif, Robia Ghafoor
Three-dimensional (3D) printing is the process of building 3D objects by additive manufacturing approach. It is being used in endodontics, periodontology, maxillofacial surgery, prosthodontics, orthodontics, and restorative dentistry, but our review article is focused on periodontal application. A detailed literature search was done on PubMed/Medline and Google Scholar using various key terms. A total of 45 articles were included in this study. Most of the studies were in vitro, preclinical, case reports, retrospective, and prospective studies. Few clinical trials have also been done. Periodontal applications included education models, scaffolds, socket preservation, and sinus and bone augmentation and guided implant placement. It showed better alveolar ridge preservation, better regenerative capabilities, greater reduction in pocket depth and bony fill, ease of implant placement in complex cases with greater precision and reduced time with improved outcome and an important tool for education and training using simulated models.
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Interleukin-6, tumor necrosis factor-α, C-reactive protein, and hematological parameters in experimental periodontal disease after β-adrenergic blockade p. 511
Wellington Francisco Rodrigues, Camila Botelho Miguel, Javier Emilio Lazo-Chica, Carlos Antônio Trindade da Silva, Carlos Ueira Vieira, Juliana Trindade Clemente-Napimoga, Carlo José Freire Oliveira, Marcelo Henrique Napimoga
Background: Changes in the levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) observed during periodontal disease were linked with vascular manifestations. Recent studies showed that the beta-blocker propranolol reduces the pathological parameters associated with certain molecules at sites of bone injury. Hence, in this study, we evaluated the activity of propranolol on hematological parameters and systemic concentrations of inflammatory proteins in a model of experimental periodontitis. Materials and Methods: Periodontal disease was induced in rats. After euthanasia, the number of inflammatory cells in each rat was quantified using histopathological assays. In addition, hematological parameters were quantitated using automated analysers, cytokine levels were determined using an enzyme-linked immunosorbent assay, and CRP levels were determined using a high-sensitivity immunoturbidimetric assay. Results: Low doses of propranolol suppressed the systemic production of CRP, TNF-α, and IL-6; however, the hematological parameters were not affected. Conclusions: β-adrenergic activation indirectly contributes to the pattern of systemic inflammatory molecules observed in periodontal disease. These molecules may initiate cardiovascular diseases as a consequence of periodontitis.
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An oral cavity profile in illicit- Drug abusers? p. 517
Muhammad Mahmoud Al Bush
Background: The aim of this study is to shed the light on the oral cavity profile assessing teeth and periodontal tissues in previously illicit drug abusers of cannabis and heroin with different drug addiction circumstances. Materials and Methods: Study population included 100 inmates, aged 21–64 years, incarcerated for previous addiction to cannabis or heroin. Personal information and drug circumstances of addiction were registered with dental and periodontal parameters including daily teeth brushing frequency, decayed missed filled teeth (DMFT), plaque index (PI), gingival index (GI), bleeding on probing (BOP), recession, and clinical attachment loss (CAL). Results: Half of the population were illiterate, and 70% were married. Heroin was the most previously abused drug and more than 70% of the participants had been addicted for more than 12 months. Low teeth brushing activity profile dominated with higher values for DMFT and BOP in the heroin group compared with the cannabis (after age adjustment) (DMFT = 22.6 ± 7.9, 18.5 ± 9.8, respectively, P = 0.03) (BOP = 60% ± 30%, 66.6% ± 32%, respectively). In addition, higher values of BOP were recorded in the heroin injecting group compared with both of heroin fumes inhalation and cannabis smoking (BOP = 76.41% ± 27.7%, 59.12% ± 33.6%, 60.05% ± 31.8% P = 0.04, respectively), whereas PI, GI, Reces, and CAL means were comparable among groups regardless of other addiction circumstances. Conclusion: Abused drug type and the way its chemical form being administered would negatively affect, directly or indirectly, the oral cavity concomitantly with the sustained state of self-negligence and less interest in implementing the oral hygiene measurements. Altogether, addiction circumstances synergize leading to a distinctive dental and oral profile which would impose a burden to adapt a more customized treatment approach.
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Comparative evaluation of C-reactive protein and complete blood count in chronic periodontitis patients following Phase I therapy: A serological and hematological study p. 525
Shailly Luthra, Harpreet Singh Grover, Alka Singh, Adosh Lall, Sujata Surendra Masamatti
Background: Periodontitis is an example of persistent low-grade disease. The primary cause for the disease is anaerobic gram-negative bacteria thriving in a protective biofilm in subgingival periodontal pockets. The treatment of this infection is removal of these deposits by mechanical instrumentation (Phase I therapy). This can help achieve reduction of the bacterial load thus suppressing localized inflammation. Phase I therapy or mechanical debridement of the subgingival area causes a severe transient bacteremia along with some damage to the surrounding soft tissue, resulting in a systemic inflammatory response being elicited. The objective of the current study was to comparatively assess periodontal parameters, serum C-reactive protein (CRP) levels, and transitory alterations in hematological parameters; in 30-systemically healthy patients having chronic periodontitis, before and after Phase I therapy. Materials and Method: The individuals underwent an intensive session of mechanotherapy with ultrasonic scalers. Blood samples were taken before treatment and at 1, 7, and 30 days after treatment to assess the parameters. Results: There was a clear recuperation in periodontal parameters as well as marked improvement in the values of CRP and complete blood count (CBC) by 30 days after transient alterations occurring initially. Conclusion: Phase I (mechanotherapy) – the first step in treatment of periodontitis leads to transient bacteremia by systemic dispersal of bacteria harbored in dental plaque. This produces an acute-phase response resulting in variations in the levels of CRP and the CBC counts. After a month, both periodontal and hematological parameters show marked improvement, thus establishing periodontal health and decreasing the risk of inadvertent cardiovascular or thromboembolic episode.
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Comparative evaluation of efficacy of 0.2% sodium hypochlorite (Hi Wash) mouthwash with 0.2% chlorhexidine mouthwash on plaque-induced gingivitis: A clinical trial p. 534
Rohit Mishra, Kabbur Thippanna Chandrashekar, Vandana Dubey Tripathi, Anushree Hazari, Blessy Shin Sabu, Anurag Sahu
Background: Bleeding gums are one of the common complaints to visit a dentist. Mechanical removal of plaque alone is not sufficient for the reduction of gingival inflammation associated with plaque. Mouthwashes are supplemented to it as a homecare product. The objective of this study is to evaluate the efficacy of 0.2% sodium hypochlorite mouthwash on plaque and gingival inflammation and to assess the clinical parameters of gingivitis patients from baseline to 21 days with the use of 0.2% sodium hypochlorite and 0.2% chlorhexidine mouthwashes. Materials and Methods: This clinical trial study included 60 patients with gingival inflammation evaluated using clinical parameters such as bleeding on probing index, plaque index, and gingival index at baseline and 21 days. Group A patients were given Hi Wash mouthwash and Group B 0.2% chlorhexidine mouthwash with 30 patients in each group. Results: The scores for clinical parameters were significantly reduced after 21 days in Group A and Group B patients, and there was a reduction in plaque-associated gingival inflammation without scaling and root planning. Conclusions: 0.2% sodium hypochlorite mouthwash is as effective as 0.2% chlorhexidine for the treatment of gingivitis as it is an adjunct to mechanical plaque removal in terms of safety, less side effects, less staining and can be used as a routine mouthwash.
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Comparison of efficacy of probiotics versus tetracycline fibers as adjuvants to scaling and root planing Highly accessed article p. 539
Lavanya Boyeena, Rekha Rani Koduganti, Veerendranath Reddy Panthula, Surya Prasanna Jammula
Context: Both gingivitis and periodontitis are due to the detrimental effects of the microbe-laden biofilm. The mainstay of periodontal treatment is, therefore, the disruption of this biofilm by scaling and root planing (SRP). Other treatment protocols such as systemic antimicrobials have been administered as adjuvants after scaling and root planning. However, due to antimicrobial resistance, as well as a shift of the flora from a symbiotic to a dysbiotic one, this mode of treatment has its shortcomings. Thus, local drug delivery has gained prominence as a therapeutic tool. Aims: The aim of this study is to compare the efficacy of subgingivally delivered probiotics as a monotherapy, in combination with tetracycline fibers, and tetracycline fibers alone after SRP. Settings and Design: This study was a parallel arm, randomized clinical and microbiological study. Thirty patients with chronic periodontitis aged between 20 and 50 years were selected from the outpatient ward of a tertiary referral care hospital in Hyderabad and equally divided into three groups. Materials and Methods: This study was conducted from January 2017 to February 2017 and ethical clearance was obtained from the institutional ethical committee. Statistical Analysis Used: Mean values and standard deviations were calculated for Plaque Index, Sulcular Bleeding Index (SBI), probing depth (PD), and microbial colony-forming units, for all the three groups at different time intervals. Paired “t-test” was used for intragroup comparison and Student's “t-test” for intergroup comparison. Results were regarded as statistically significant when P < 0.05. Results: Intragroup comparison yielded significant improvement in all the variables (P < 0.0001). However, intergroup comparison showed statistically significant differences pertaining to the PD (P < 0.001) and SBI only (P < 0.001), between Group A and Group B and Group B and Group C respectively. Conclusions: Group A and Group C showed better results than Group B.
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Single application of 0.8% hyaluronic acid as a coadjuvant of nonsurgical treatment in nonsmoking patients with periodontitis: A split-mouth, randomized, controlled pilot clinical trial p. 545
Joana Cristina Rico Farto Lobato, Mafalda Alexandra dos Santos Vilhena, Catarina Izidoro, Ricardo Castro Alves, Luís Proença
Background: Topical coadjuvants might be indicated to increase the results of nonsurgical periodontal treatment and overcome some of its limitations. The aim of this study was to evaluate the clinical benefits of a single topical application of 0.8% hyaluronic acid (HA) as a coadjuvant to scaling and root planing (SRP) in periodontal patients. Materials and Methods: Sixteen patients diagnosed with periodontitis were recruited to participate in this split-mouth randomized controlled trial. At baseline, oral hygiene instructions, prophylaxis, and SRP were performed in both sides; additionally, a subgingival application of HA at 0.8% was made in the test side. Several clinical parameters were assessed at baseline, 6, and 12 weeks later: full mouth plaque score, gingival score, bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL). Results: At the end of 12 weeks, there was a overall improvement in all periodontal parameters in both sides (P < 0.05). Test sides showed less BoP when compared to the control sides (9.4 ± 4.0 vs. 14.9 ± 8.9, P < 0.05). Other periodontal parameters such as PD and CAL showed a slight improvement in comparison with the control sides, but the difference was not statistically significant (P > 0.05). Conclusion: Results from this study indicate that a single subgingival application of 0.8% HA seems to reduce gingival inflammation and improve clinical parameters, particularly BoP. Further studies are needed to evaluate the effect of repeated application of HA and long-term results.
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Comparative evaluation of analgesic and anti-inflammatory efficacy of ibuprofen and traumeel after periodontal flap surgery: A randomized triple-blind clinical trial p. 549
Revu Das, Jeevanand Deshmukh, Kardkal Asif, Harsha Sindhura, Mandakal Venkatapur Devarathanamma, Lakshminarayana Jyothi
Background: Pain management after performing flap surgery is of paramount importance. Taking into consideration the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs), and the advantages of homeopathic medication, the analgesic and anti-inflammatory properties of ibuprofen (NSAID) and traumeel (homeopathic AID) following flap surgery were evaluated. Materials and Methods: A randomized, triple-blinded, split-mouth clinical trial, with a sample size of 20 (age range of 20–60 years) was planned. Subjects included patients diagnosed with moderate chronic generalized periodontitis. Two quadrants for each subject were operated on, with an interval of 3 weeks. Random assignment of the operated quadrants to the following medication protocols was carried out by a third person: Ibuprofen, 600 mg and traumeel, 600 mg (up to three tablets) every 8 h for first 24 h and SOS (Si Opus Sit/if needed) thereafter for a period of 1 week as pain medication, respectively. After 1 week, sutures were removed. Primary outcomes were mean postoperative pain (modified visual analog scale) and number of tablets consumed in 1 week. The secondary outcome was postoperative tissue response. Any adverse effects were recorded. Results: Number of tablets consumed and pain perception was lower in traumeel compared to ibuprofen Group (P < 0.001). A better tissue response was shown by the group treated with traumeel as compared to the ibuprofen receiving group (P < 0.05). Three patients reported adverse drug reactions after consumption of ibuprofen. Conclusion: The present study suggested that while managing pain following flap surgery, traumeel was superior as compared to ibuprofen, with minimal or no side effects.
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Comparative study using autologous platelet-rich fibrin and titanium prepared platelet-rich fibrin in the treatment of infrabony defects: An in vitro and in vivo study p. 554
Dipika Kalyan Mitra, Priyanka Nandkumar Potdar, Saurabh Suresh Prithyani, Silvia Victor Rodrigues, Gaurav Prabhakar Shetty, Meenakshi Abhay Talati
Background: The platelet concentrates had been pioneered to be used in regenerative medicine since above a decade. Aims and Objectives: To compare the autologous platelet rich fibrin (PRF) and titanium prepared platelet rich fibrin (T-PRF) in the treatment of infrabony defects, clinically and radiographically and to compare the histologic difference between PRF and T-PRF by light microscopy and scanning electron microscopy (SEM). Materials and Methods: The present study is a split mouth randomised controlled trial study in which 20 sites were selected and randomly assigned equally into 10 sites each in group A [Test group=T-PRF] and group B [Control group=PRF]. Clinical parameters were evaluated at baseline,3 months and 9 months. Radiographic parameters were evaluated at baseline and 9 months. Histologic differences between light microscopy and SEM for both PRF and T-PRF was studied after sequential processing. Results: There was marked reduction in Probing Pocket depth and gain in Clinical Attachment Level in both the T-PRF and PRF groups from baseline to 9 months in intragroup comparisons. However, on intergroup comparisons, no statistical significance was seen. Radiographically, mean defect depths for both the groups showed statistically significant reduction from baseline values to 9 months on intragroup comparisons but not on intergroup comparisons. In-vitro evaluation, on both light and scanning electron microscopy, T-PRF showed denser fibril meshwork as compared to PRF. Conclusion: The clinical parameters and radiographic outcomes showed marked improvement at 9 months with both PRF and T-PRF in the treatment of infrabony defects from baseline values in intragroup comparison. However, statistically efficacy of T-PRF was not seen to be superior to that of PRF both clinically and radiographically. Histologic evaluation showed T-PRF had denser fibrils as compared to PRF in both light and scanning electron microscopy.
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Factors associated with dental visit and barriers to the utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: A cross-sectional study p. 562
Diplina Barman, Rajeev Ranjan, Anirban Kundu
Background: There is a lack of knowledge related to the utilization of dental services by tribal pregnant women who constitute over 35% of the Indian population. The aim of the present study was to identify barriers to the utilization of the dental services and also the factors that concern the tribal mothers' visit to the dental office. Materials and Methods: A total of 300 tribal mothers visiting a tertiary care unit participated in this cross-sectional, observational study. A pilot study with twenty participants was conducted before the commencement of the study. Data were collected using a modified questionnaire consisting of demographic data and questions relating to oral health knowledge, attitude, and practices, as well as barriers to the utilization of dental services and factors that concern dental visits during pregnancy. Data analysis was done using SPSS software package 21.0. Nonparametric statistical tests were done to analyze oral health knowledge and attitude of the participants. Various factors were identified using univariate and multivariate models using simple logistic regression analysis and multiple logistic regression analysis. Results: Among the two different tribes considered in the present study, the Saora tribe seemed to be more conscious toward oral health, and 29.7% of participants visited the dentist during pregnancy. The age and experience of the participants along with the educational level, employment status, and knowledge about oral health-related pregnancy outcomes influenced their dental visits. The most reported barrier included the lack of awareness and knowledge of the availability of the dental services. Accessibility and distance to the dental clinic were not found to be negative confounding factors among the participants for the utilization of the services. Conclusion: This study concludes that previous experience and consciousness of the mother to utilize the dental services played a vital role in the utilization of dental services among tribal pregnant women. However, the findings of the present study clearly indicate the need for further research to understand barriers to the utilization of dental services among underprivileged tribal groups of population.
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Analysis of curtailing prevalence estimates of periodontitis post the new classification scheme: A cross-sectional study p. 569
Rohit Mishra, Kabbur Thipanna Chandrashekar, Vandana Dubey Tripathi, Ashima Trivedi, Hemasha Daryani, Anushree Hazari
Aim: Among various dental ailments, periodontitis has always had a towering popularity. The inauguration of new classification scheme for periodontal diseases and conditions in 2017 World Workshop has a remarkable impact on the diagnosis of periodontal diseases worldwide. This study is based on comparison between the two classifications by American Academy of Periodontology for diagnosing periodontitis. Materials and Methods: This study focuses on the prevalence estimates of periodontitis by diagnosing the periodontal diseases using two different criteria simultaneously: the first criterion was based on the classification approved in 1999 World Workshop and the other criterion was based on the new classification scheme of periodontal diseases and conditions in 2017 World Workshop. Results: It was found that there was significant reduction in the prevalence estimates (P < 0.001) of periodontitis following the new classification scheme. Conclusion: The new classification scheme recognizes the clinical salience of periodontitis and is more likely to influence the treatment modality of long sufferings of the patients having periodontal problems across the globe. The new classification will also lay the base for future research in the field of dentistry. More future studies are required to assess the prevalence of periodontitis following new classification scheme on a larger scale.
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Knowledge and awareness of periodontal diseases among Jordanian University students: A cross-sectional study p. 574
Nada Alzammam, Alaa Almalki
Background: Oral health plays an important role to maintain the general health. Therefore, controlling periodontal diseases may have a profound health effect. The importance of oral health is still a neglected and ignored social issue because most of the people are unaware of the relationship between oral health and systemic diseases. The aim of this study was to assess the knowledge and awareness of periodontal diseases among Jordan University of science and technology students. Materials and Methods: A cross-sectional study was conducted by distributing self-administered structured questionnaires to 906 university students between the ages of 18–30 years after obtaining their verbal consents. Results: A total of 906 students completed the questionnaire. Majority of students reported that they brush their teeth regularly while only 5.1% of students admitted that they never clean their teeth. Roughly one-quarter of students could define dental plaque correctly. A high “percentage” of females and medical students were more aware concerning gum inflammation signs and symptoms than males and students from faculties of engineering and science. Students of medical specialties and females were more aware of the relationship between smoking, diabetes mellitus, and heart diseases on the one hand and periodontal diseases on the other hand compared to opposite comparative groups. A low proportion of students were aware that proper scaling was not harmful to the teeth. Conclusions: In general, our study demonstrated that university students had poor knowledge regarding the etiology of periodontal diseases as well as the role of conventional treatment in maintaining good oral health by preventing the inflammatory process.
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Palatal pyogenic granuloma: An unusual complication following mucogingival surgery for alveolar socket preservation p. 580
Rampalli Viswa Chandra, Nama Bhavana
We report a case of palatal pyogenic granuloma following mucogingival surgery for alveolar socket preservation. A 24-year-old systemically healthy female underwent a pediculated palatal pedicle graft procedure to achieve soft tissue augmentation over a grafted maxillary anterior extraction site. After 1 month, a 15 mm × 20 mm exophytic growth extending from the palatal donor site to distance of 3–4 mm from the extraction socket was observed. After obtaining the subject's consent, local anesthesia was administered and the growth was excised from the base. On histopathological examination, the findings suggestive of pyogenic granuloma were seen. Palatal pyogenic granuloma occurs rarely and the authors were unable to find the reports of pyogenic granuloma originating in the vicinity of a surgical wound after a pediculated connective tissue mucogingival procedure. Healing plays a vital role in mucogingival procedures, and thus, it is very important to know about the complications affecting this important cascade of events. Failing to consider potential sources of irritation or trauma at the surgical site may lead to considerable morbidity even in sites that may heal without any untoward complications.
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Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up p. 584
Ísis De Fátima Balderrama, Rafael Ferreira, Daniel Romeu Benchimol Rezende, Ana Lúcia Raphaelli Nahás Nogueira, Sebastião Luiz Aguiar Greghi, Mariana Schutzer Ragghianti Zangrando
The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.
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Comparative evaluation of the platelet-rich fibrin bandage versus gelatin sponge-assisted palatal wound healing of free gingival graft donor site: A case series Highly accessed article p. 589
Samyak Gautam Belkhede, Sanjeev Kumar Salaria, Rajni Aggarwal
Periodontal plastic surgery often involves palatal donor site, thereby creating an open wound that is prone to postoperative complications such as bleeding, pain, and slow healing process. To prevent the same, platelet-rich fibrin (PRF) and gelatin sponge (GS) were utilized equally at the donor site in six patients. Patients were monitored at the 1st, 2nd, 3rd, and 4th weeks after surgery for postoperative discomfort (D), consumption of analgesics during first postoperative week, alteration of sensitivity (AS), change in feeding habits (CFH), complete wound epithelialization (CWE), and healing index (Landry et al. 1998). Two patients in the GS group showed significantly early CWE, higher healing index score, and less D, AS, and CFH postoperatively in comparison to the PRF group. It was suggested that GS can also be considered as an effective, economical, and biocompatible dressing material of choice to enhance wound healing and to minimize postoperative complications associated with the donor site.
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“The Perio-Diabetes Symposium”: Consensus Report of the Indian Society of Periodontology and Research Society for the Study of Diabetes in India - A joint event on Periodontitis and Diabetes p. 593
Sangeeta Dhir, Rajkumar Lalwani, Jugal Kishore Sharma, Abhay Kolte, Sumidha Bansal, Amit Gupta
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