Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
July-August 2019
Volume 23 | Issue 4
Page Nos. 297-386

Online since Monday, July 1, 2019

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EDITORIAL  

Periodontal health: A welcome addition p. 297
Ashish Kumar
DOI:10.4103/jisp.jisp_261_19  
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PRESIDENT’S MESSAGE Top

Indian Society of Periodontology: The pillar of periodontics p. 299
Anil Melath
DOI:10.4103/jisp.jisp_295_19  
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SECRETARY’S MESSAGE Top

Are we addressing the core issues through bridge course? p. 301
Abhay Kolte
DOI:10.4103/jisp.jisp_277_19  
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REVIEW Top

Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: A systematic review and meta-analysis p. 303
Akanksha Jain, Jyoti Gupta, Dipika Bansal, Shaveta Sood, Shipra Gupta, Ashish Jain
DOI:10.4103/jisp.jisp_417_18  
Background: There is enough evidence, which suggests that nonsurgical periodontal therapy (NSPT) improved the glycemic control in patients of Type 2 diabetes mellitus (T2DM) with chronic periodontitis (CP). This meta-analysis is aimed to explore the effect of NSPT, exclusively scaling and root planing (SRP) as monotherapy on glycemic control and periodontal parameters in patients of T2DM with CP. Materials and Methods: Two databases, MEDLINE and EMBASE, were searched from June 2006 to June 2016. Initially, 464 potentially relevant studies were evaluated. Randomized controlled trials with duration of ≥3 months, based on the treatment group managed with SRP without any supportive use of local drug delivery or systemic antibiotics, while the control group received no periodontal therapy, were selected. This resulted in six appropriate articles with a total of 812 patients of T2DM with CP. Alteration in glycated hemoglobin (HbA1c) was the primary outcome measure, whereas the changes in clinical attachment level (CAL) and probing pocket depth (PPD) were the secondary outcome measures. Results: SRP treatment resulted in a decrease in HbA1c by 0.26% (P = 0.17) at 3–4 months compared to the control group. Further, on subgroup analysis, SRP therapy revealed a decrease in PPD and CAL at 3–4 months, though statistically insignificant. Conclusion: SRP treatment leads to modest improvement in glycemic status and periodontal parameters in T2DM patients with CP at 3–4 months.
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Effects of recombinant human bone morphogenetic protein-2 compared to other biomaterials in the treatment of intrabony defects in periodontitis patients: A systematic review p. 311
Raghavendra Shrishail Medikeri, Vinayak Venkoosa Meharwade, Kumar Ankit Sinha
DOI:10.4103/jisp.jisp_748_18  
Background: Bone morphogenetic proteins have a powerful osteoinductive capacity and have been used as a new adjunct to graft materials for bone regeneration. The objectives of this systematic review are to assess the amount of radiographic bone fill, clinical attachment level (CAL) gain, and reduction in pocket depth (PD) in patients with intrabony defects in periodontitis patients following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2). Materials and Methods: Electronic bibliographic databases search of Medline, Science Direct, and Google Scholar was made from January 1980 to December 2017. Studies using rhBMP-2 to treat periodontal intrabony defects of the maxillary or mandibular region with follow-up period of at least 6 months were searched. Two reviewers performed the systematic review using the PRISMA Statement for reporting and the Cochrane risk-of-bias tool was used for quality assessment. Results: It was found that rhBMP-2 showed statistically significant results with respect to radiographic defect resolution, CAL, and PD reduction at 9 months compared to open-flap debridement but showed statistically significant results only with respect to radiographic bone fill when compared with platelet-rich fibrin at 6 months. Conclusion: The rhBMP-2 may provide a promising alternative to traditional grafting procedures therapy that can enhance periodontal regeneration in patients having intrabony defects. Due to limited human studies, it can be concluded that no definitive evidence exists to ascertain the effectiveness of rhBMP-2 in the treatment of intrabony defects in periodontal diseases.
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ORIGINAL RESEARCH Top

Estimation of phagocytic activity of polymorphonuclear leukocytes in chronic and aggressive periodontitis patients with nitroblue tetrazolium test p. 316
Jagadish Reddy Gooty, Andem Shashirekha, Vikram Reddy Guntakala, Rajababu Palaparthi
DOI:10.4103/jisp.jisp_399_18  
Context: The phagocytic activity of polymorphonuclear leukocytes (PMN) is influenced by the type of disease entity, i.e., chronic generalized periodontitis, generalized aggressive periodontitis, and chronic generalized gingivitis. Aims: The purpose of this experimental study was to evaluate the phagocytic activity of PMN in patients with chronic generalized periodontitis, generalized aggressive periodontitis, and chronic generalized gingivitis. Materials and Methods: A total of 60 patients, 20 patients with chronic generalized periodontitis, 20 patients with generalized aggressive periodontitis, and 20 patients with chronic generalized gingivitis were selected for this study. Blood samples were collected from the patients. Peripheral smears were prepared from the samples, and the slides were stained using nitroblue tetrazolium test, and the phagocytic activity of the neutrophils was compared using the test results. Statistical Analysis Used: Intragroup comparison using Mann–Whitney U-test and intergroup comparison using Kruskal–Wallis one-way ANOVA test were done. Results: The results of the present study suggest that PMN phagocytic defect was present in most of the patients affected by generalized aggressive periodontitis; however, the phagocytic defect cannot be attributed to age, sex, or clinical parameters such as the plaque index or gingival index and probing pocket depths. Conclusions: The phagocytic activity of neutrophils in generalized aggressive periodontitis was low compared to chronic generalized periodontitis and chronic generalized gingivitis.
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Comparative evaluation of growth factors from platelet concentrates: An in vitro study p. 322
Anirban Chatterjee, Koel Debnath
DOI:10.4103/jisp.jisp_678_18  
Aim: The aim of the study was to compare and evaluate the various growth factors released for a period of 23 days from platelet rich fibrin (PRF) and platelet rich fibrin matrix (PRFM). Materials and Methods: A total of 15 systemically healthy controls were recruited and 10 ml of blood sample was withdrawn from the individual. Following the standard centrifugation protocol, PRF and PRFM were prepared. The platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor (TGF), and insulin growth factor (IGF) were evaluated for 23 days. Results: The PDGF released from PRFM was statistically significant from PRF till the 15th day of release. The VEGF too had an increased release up till the 15th day from PRFM group as compared to PRF, but no statistically significant difference could be obtained. EGF from the 15th day to 23rd day had a greater release from PRFM group as compared to PRF group. FGF from 7th day to 23rd day had statistically significant difference in the PRFM group as compared to PRF group. TGF and IGF had statistically significant difference in PRFM group as compared to PRF group from 11th day to 23rd day and 1st to 17th day, respectively. Conclusion: The initial and robust release of GFs was seen in PRFM group at earlier days, whereas a steady and constant release of six GFs could be appreciated from PRF group upto 23rd day. Therefore, for a rapid and early healing and regeneration, both the platelet concentrates can be utilized in periodontal therapy.
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Assessment of membrane-organizing extension spike protein as a biomarker for periodontal disease by comparing its level in gingival crevicular fluid in individuals with and without chronic severe periodontitis – A pilot study p. 329
Anjali Sreedharan, Mohammed Shereef, Jayachandran Perayil, Angel Fenol, Rajesh Vyloppillil, Biju Balakrishnan
DOI:10.4103/jisp.jisp_694_18  
Background: Membrane-organizing extension spike protein (Moesin) is a cytoskeletal protein expressed in the gingival crevicular fluid (GCF) which may play a role in the immune response in periodontal disease. The objective of this study was to evaluate whether Moesin can be used as a biomarker for periodontal disease. Materials and Methods: Thirty patients satisfying the required inclusion criteria were selected from those reporting to the out patient (OP) of the department of periodontics and divided into two groups: Group A – systemically healthy controls with no periodontitis and Group B – systemically healthy controls with chronic severe periodontitis. Periodontal parameters were recorded. GCF was collected, and Moesin levels in the two groups were assessed using enzyme-linked immunosorbent assay. Scaling and root planing (SRP) was done in Group B patients who were reviewed, and samples were collected again after 4 weeks and analyzed. Results: At baseline, the mean GCF Moesin level in Group A was 666.95 ± 471.872 pg/ml, while in Group B, it was found to be 27435.35 ± 14179.77 pg/ml, which showed a high statistically significant difference on comparison. The mean GCF Moesin level in patients with chronic severe periodontitis was 27435.35 ± 14179.77 pg/ml at baseline, and on review 1 month after SRP, it was found to have undergone a statistically significant reduction to 27161.23 ± 14161.57 pg/ml (P = 0.001). Conclusion: Within the limits of this study, it can be concluded that Moesin can serve as a potential biomarker for periodontal disease.
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Evaluation of the cone-beam computed tomography accuracy in measuring soft tissue thickness in different areas of the jaws p. 334
Ehsan Moudi, Sina Haghanifar, Maryam Johari, Hemmat Gholinia, Mohammad Kazemi Ghanbarabadi
DOI:10.4103/jisp.jisp_675_18  
Purpose: Due to the extensive use of cone-beam computed tomography (CBCT) in dentistry, especially in measuring thicknesses of hard and soft tissues, and the fact that CBCT has low contrast resolution, the aim of this study was to evaluate the accuracy of CBCT in measuring soft tissue thickness. Materials and Methods: In this cross-sectional study, pink baseplate wax as a soft tissue simulation was overlaid in different areas of the jaws on the dry human skull, and the probe was used to determine the thicknesses of 1, 2, 3, and 5 mm. These thicknesses were then measured accurately with a digital caliper by one person four times at interval of a week. The skull was scanned using two CBCT scanners, and the different thicknesses of wax were measured by two observers four times with a week interval. The CBCT measurements were compared with digital caliper measurements as a reference. Results: Statistical analysis showed no significant difference between CBCT and digital caliper measurements for thickness <2 mm (P > 0.05). Conclusions: Statistically, the difference between digital caliper and CBCT measurements was <0.1 mm, but this difference is not clinically important. The accuracy of CBCT in measuring soft tissue thickness was 0.1 mm.
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Effects of amine fluoride and probiotic mouthwash on levels of Porphyromonas gingivalis in orthodontic patients: A randomized controlled trial p. 339
Neeraj Goyal, Pavithra Untagodu Shamanna, Sanju Thomas Varughese, Reji Abraham, Bobby Antony, Rishi Emmatty, Parson Paul
DOI:10.4103/jisp.jisp_551_18  
Introduction: Porphyromonas gingivalis is one among the major etiological agent in periodontal diseases and has been proved to cause gingival inflammation under orthodontic appliances. Aim: To assess the effect of amine fluoride and probiotic mouthwashes on levels of P. gingivalis during orthodontic treatment, using real time-polymerase chain reaction (RT-PCR). Materials and Methods: A randomised controlled trial was performed including 45 patients. There were three groups: Group A (control group), Group B (patients using Amflor mouthwash) and Group C (patients using probiotic mouthwash). During the treatment, all the 3 groups were advised to brush twice a day using Colgate tooth paste and Group B patients were advised to swish 15 ml fluoridated mouthwash (Amflor) and Group C advised to swish probiotic for 60 s before swallowing, once in the morning and once before sleep. After gently removing supragingival plaque, subgingival plaque samples were collected by inserting a sterile dental curette into the bottom of the gingival crevice around 31, 32, 41, and 42 at two different intervals: T1 at start and T2 after 6 months of fixed orthodontic treatment. Sub-gingival plaque samples collected were transferred to laboratory within 48 h for RT-PCR analysis in Tris-buffer solution, to maintain the integrity of bacterial DNA. Results: The levels of P. gingivalis were significantly decreased with probiotic mouth wash. Conclusions: Probiotic mouth wash can be used as an adjunctive measure along with regular brushing to improve periodontal status during fixed orthodontic treatment.
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Clinical and histological comparison of platelet-rich fibrin versus non-eugenol periodontal dressing in the treatment of gingival hyperpigmentation p. 345
Ritu Dahiya, Anshu Blaggana, Vinod Panwar, Shubham Kumar, Abhinav Kathuria, Srijna Malik
DOI:10.4103/jisp.jisp_688_18  
Background: The platelet-rich fibrin (PRF) has proven an immense role in angiogenesis and epithelization in a wound healing process. The present study aims to ascertain PRF's beneficial role in wound healing after depigmentation surgery. Materials and Methods: A total of 12 systemically healthy controls included were divided into two groups after scalpel depigmentation procedure. PRF was prepared according to Choukroun's standard protocol. Using split-mouth design after depigmentation, one group received PRF membrane, and in second group non-eugenol periodontal dressing was placed. The participants were evaluated for visual analog scale (VAS), healing index (HI) on 3rd and 5th day. Epithelization test using toluidine blue and histological examination employing punch biopsy was done on the 5th day. Results: On statistical scale, VAS, HI, epithelization test, and histological findings were statistically significant in the two study groups. PRF group proved better epithelization test and inflammatory cell infiltration was less in PRF group which confirmed superior wound healing in the group. Conclusion: PRF membrane postdepigmentation provided satisfactory patient comfort and enhanced the wound healing cascade.
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Histological and histomorphometric evaluation of efficacy of a polypropylene barrier in guided bone regeneration and modified guided bone regeneration in critical defects in rodent cranial vaults p. 351
Ernane Lacerda De Oliveira, Paulo Sergio Perri De Carvalho, Thiago Bezerra Da Silva
DOI:10.4103/jisp.jisp_111_18  
Background: The last few years have detailed a number of surgical materials and techniques to stimulate guided bone regeneration (GBR). Polypropylene has been used as a mechanical barrier, intentionally designed to be exposed to the oral environment, isolating the regeneration area, and allowing the blood clot to remain protected in a confined space while pluripotent mesenchymal cells regenerate the alveolar bone tissue. Aim: Due to the lack of studies on polypropylene barriers (PB) (Bone Heal– Bone heal ind. e Com. LTDA – São Paulo, Brazil), this study aimed to evaluate the histological repair process of critical defects (7 mm) made in the rodent cranial vaults comparing its efficacy in GBR and modified GBR. Materials and Methods: A total of 30 rats were divided into three groups. The control group consisted of 10 rats, wounds covered with just a blood clot. The second group consisted of an exposed/uncoated PB at the edges of the wound, and it was removed after 3 days. The third group used submerged PB with coaptation of the wound edges, and it was not removed. Five animals of each group were euthanized at 30 and 90 days postoperative and submitted to microscopic analysis and histomorphometric evaluation. Results: Modified GBR (membrane exposed to the oral medium) provided earlier tissue organization at 30 days; however, the third group presented better bone neoformation at 90 days. Conclusion: Modified GBR provided earlier tissue organization compared with the control group, as well as promoting improved bone neoformation, while regeneration with the submerged membrane presented better bone neoformation in the long term.
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Prevalence and predictors of early periodontal disease among adolescents p. 356
Radhamoni Madhavan Pillai Baiju, Elbe Peter, Bindu Radhakrishnan Nayar, Jolly Mary Varughese, Nettiyat Ommen Varghese
DOI:10.4103/jisp.jisp_512_18  
Background: Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala. Materials and Methods: A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15–18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets. Results: The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene. Conclusion: The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.
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Impact of periodontal knowledge and attitude on the status of the periodontium: A profile on West Godavari district, Andhra Pradesh, India p. 362
Gautami Subhadra Penmetsa, Gadde Praveen, Ramaraju Alluri Venkata
DOI:10.4103/jisp.jisp_506_18  
Background: Although regular patient education regarding the periodontal health/disease is advocated as a means of improving oral health, impregnable associations of periodontal knowledge and attitude with periodontal status have not been demonstrated. Materials and Methods: In a cross-sectional study conducted, 2400 participants were surveyed using a specially designed pretested pro forma to evaluate the knowledge and attitude concerning periodontal health and disease. The oral exanimation included recording of oral hygiene index, gingival index (GI), community periodontal index (CPI), and loss of attachment. Ethical clearance was obtained from the institutional review board. The data were analyzed using IBM SPSS version 21.0. Results: The mean age of the study population was 41.6 ± 9.5 years. The greater portion of individuals had high knowledge score (55.9%) and negative attitude (68.4%) toward periodontal health/disease. The mean oral hygiene index scores and GI scores were higher among individuals with high knowledge score and with negative attitude, and the differences were statistically significant among the groups. There was no difference in the mean plaque scores among individuals with different knowledge scores, but a higher score for individuals with negative attitude (1.24 ± 0.87) was evident. The proportion of individuals with healthy periodontium (score 0 for CPI and loss of attachment) had low knowledge score (54.3%); however, a positive attitude was elicited in 51.9% of the population. Conclusion: High knowledge score and negative attitude were related to periodontal status in West Godavari. Therefore, it can be emphasized that the presence of a positive attitude plays a key role in achieving better periodontal status.
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Prevalence of different forms of periodontitis in patients visiting Government Dental College and Hospital, Hyderabad, since last decade: A retrospective study p. 367
Santha Kumari Prathypaty, Manasa Akula, Arundhati Darapla, Manasa Dhulipala, Chiranjeevi Vedula
DOI:10.4103/jisp.jisp_698_18  
Context: Periodontitis is a highly prevalent oral disease affecting a wide range of people across all age groups and genders. It is the major cause of loss of teeth among all other oral diseases affecting the people. Aims: The current study aimed to evaluate the prevalence of different forms of periodontitis in patients visiting Government Dental College and Hospital, Hyderabad, over a period of 10 years. Settings and Design: Retrospective study. Materials and Methods: This retrospective analysis was put into execution to evaluate the prevalence of periodontal diseases in 74,414 patients referred to the Department of Periodontics in Government Dental College and Hospital, Hyderabad, from January 2007 to December 2016. Statistical Analysis Used: Descriptive analysis, Chi-square test. Results: Out of the 74,414 patients who were screened, 38,898 were male and 35,516 were female. A total of 67,236 patients (90.35%) had chronic periodontitis and 7178 (9.64%) had aggressive periodontitis. The most commonly found type was chronic localized periodontitis. Conclusion: The results of this study have helped to ascertain the various forms of periodontitis in the population of Hyderabad. This can serve as a basis for future studies with the idea of finding ways to ameliorate oral health in this population.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Aggressive periodontitis with a history of orthodontic treatment p. 371
Vivek Vijay Gupta, Srinivas Sulugodu Ramachandra
DOI:10.4103/jisp.jisp_654_18  
This report presents a 29-year-old aggressive periodontitis patient from Morocco with a history of orthodontic treatment. Despite all the first molars showing advanced bone loss, the maxillary anterior teeth did not show any periodontal destruction. The scientific literature rarely reports cases of aggressive periodontitis without involving maxillary anterior teeth. The treatment provided includes extraction of hopeless tooth, removal of overhanging restoration, scaling, root debridement, and regenerative periodontal therapy. The discussion highlights the dilemma during diagnosis of the case as either “iatrogenic periodontitis due to orthodontic treatment” or “localized aggressive periodontitis.” The age group of 15–35 years is the common age group for patients' seeking orthodontic treatment and the occurrence of aggressive periodontitis. Sound knowledge of periodontitis and identification of early signs of aggressive periodontitis through meticulous periodontal examination may help in earlier identification and minimalistic treatment. Education regarding periodontitis, especially aggressive periodontitis, is essential among orthodontists and general dentists. This case report aims to discuss the dilemma involved during diagnosis of localized aggressive periodontitis.
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Case report on low dose of Cilnidipine: A fourth-generation calcium channel blocker-induced gingival overgrowth p. 377
Sameera Gopinath, Vadakkedath Venugopal Harishkumar, Vediyera Chandroth Santhosh, Sreekanth Puthalath
DOI:10.4103/jisp.jisp_557_18  
Drug-induced gingival overgrowth is a frequently observed adverse effect of antihypertensive drug calcium channel blockers (CCBs). Gingival enlargements are more common with the dihydropyridine class of CCBs. The fourth-generation dihydropyridine CCB Cilnidipine was introduced in 1995 and is used as an antihypertensive agent for patients in the Indian subcontinent. This is the first report in literature to document an isolated case of generalized gingival overgrowth induced by the long-term use of low dose of cilnidipine in an elderly female patient who is under antihypertensive therapy. Gingival overgrowth is an adverse drug reaction of new-generation CCB Cilnidipine when administered even as low-dose antihypertensive therapy agent. Physicians and dentists should identify such late changes in susceptible individuals.
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Use of alveolar distraction osteogenesis for anterior maxillary defect reconstruction p. 381
Cláudio Marcantonio, Lélis Gustavo Nícoli, Suzane Cristina Pigossi, Raphael Ferreira de Souza Bezerra Araújo, Eloisa Marcantonio Boeck, Elcio Marcantonio Junior
DOI:10.4103/jisp.jisp_549_18  
Alveolar osteogenic distraction (AOD) is a biological process through which new bone formation occurs between bone segments that are gradually separated by incremental traction. This case report described the oral rehabilitation with dental implants of a patient with a vertical bone defect in the maxillary anterior region using the AOD technique. The patient presented with absence of the teeth 22, 21, 11, and 12 associated with a vertical bone defect. The AOD was performed using a supported osteodistractor device surgically installed with subsequent daily activations. After 21 days, the ideal positioning of bone fragment was confirmed and activation was ceased. Five months after the initial surgery, two dental implants were installed in the region of teeth 12 and 22. An FP3 metal–ceramic prosthesis was installed offering satisfactory esthetic results. In conclusion, the use of AOD to increase the alveolar ridge was effective and ensured rehabilitation with dental implants.
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