Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
January-February 2019
Volume 23 | Issue 1
Page Nos. 1-85

Online since Thursday, January 3, 2019

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EDITORIAL  

Surrogate endpoints… Uncommon for a common man! p. 1
Ashish Kumar
DOI:10.4103/jisp.jisp_671_18  
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PRESIDENT’S MESSAGE Top

Plagiarism – An artistic way of “MIMICKING” p. 3
Anil Melath
DOI:10.4103/jisp.jisp_682_18  
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SECRETARY’S MESSAGE Top

ISP memberships – Streamlining conversions in life membership p. 4
Abhay Kolte
DOI:10.4103/jisp.jisp_681_18  
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REVIEWS Top

Periodontically accelerated orthodontic tooth movement: A narrative review p. 5
Karan Sharma, Puneet Batra, Saurabh Sonar, Amit Srivastava, Sreevatsan Raghavan
DOI:10.4103/jisp.jisp_207_18  
Adult orthodontics has gained widespread acceptance recently with the introduction of more esthetic options for the patient. The major deterrent that remains is the prolonged treatment time associated with comprehensive orthodontic treatment. The objective of this paper is to present a review of techniques, which could be employed by the orthodontist in conjunction with a periodontist to enhance the rate of orthodontic tooth movement. The biological rationale and clinical manipulation have been discussed with a brief review of the current literature about these techniques. The interdisciplinary approach involving the orthodontist and the periodontist can benefit the patient by affording them with reduced treatment time.
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ORIGINAL RESEARCH Top

A comparative evaluation of the micronutrient profile in the serum of diabetes mellitus Type II patients and healthy individuals with periodontitis p. 12
Biju Thomas, Ballamajalu Rajendra Prasad, Nallilu Suchetha Kumari, Vishakh Radhakrishna, Amitha Ramesh
DOI:10.4103/jisp.jisp_398_18  
Background: Micronutrients play an important part in metabolism and maintenance of tissue function the maintenance of the integrity and vitality of the periodontal tissues depends on the availability of adequate nutrients, and it is possible that deficiencies can produce pathological alterations in the periodontal tissues. However, the association between nutritional factors and periodontal health is not fully understood. The essential micronutrients for maintaining health include zinc, copper, selenium, and iron. These micronutrients are required for a variety of biomolecules to maintain the normal structure, function, and proliferation of cells and also immune functions. Periodontal disease and diabetes mellitus (DM) are considered to have a bidirectional relationship, and periodontitis is recognized as the 6th major complication of DM. The number of studies on the role of micronutrients with regard to periodontal disease is limited. Aims: This study aims to evaluate the role of micronutrients-zinc, copper, selenium, and iron, in the serum of chronic periodontitis patients and chronic periodontitis with DM Type II patients, to see whether they can serve as potential markers for chronic periodontitis and also to assess whether periodontitis can have systemic effects. Materials and Methods: A volume of 5 ml of venous blood was collected from each of the study participants, from the antecubital vein. The blood was then centrifuged and stored at −20°C before being analyzed. Zinc, copper, and selenium were estimated by the atomic absorption spectrophotometry, bathophenanthroline method was used to estimate iron. Statistical Analysis: It was carried out using Student's t-test and analysis of variance. The honestly significant difference Tukey test and Pearson's correlation was also used. Results: The mean serum zinc levels were significantly higher in healthy controls as compared to Periodontitis and Periodontitis with DM type II. The mean serum copper levels were significantly higher in Periodontitis with diabetes as compared to controls and periodontitis. Serum selenium levels were significantly higher in controls as compared to periodontitis with diabetes. The mean serum iron levels were significantly higher in periodontitis with diabetes. The Zinc: Copper (Zn: Cu) ratio was found to be significant for the periodontitis with diabetes group. Conclusion: The results obtained from this study suggests that the serum levels of micronutrients Zn and Se were decreased and levels of Cu and Fe are increased in chronic periodontitis as compared to healthy control. There was a potentiated difference in the values in patients with DM Type II. The results show that the levels of these micronutrients can be used as effective biomarkers for chronic periodontitis and that periodontitis has systemic manifestations.
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Interleukin-21 and its association with chronic periodontitis p. 21
Rani Vilas Lokhande, Jeevan Gangadhar Ambekar, Kishore Gajanan Bhat, Nilima Nandkumar Dongre
DOI:10.4103/jisp.jisp_410_18  
Context: Interleukin-21 (IL-21) is a pleiotropic cytokine, well documented to contribute to the development of Th17 cells which have been shown to play an important role in the pathogenesis of periodontitis. Periodontal disease is a chronic infection of tooth-supporting tissue. Aim: This study evaluates the saliva and serum levels of IL-21 in patients with chronic periodontitis and periodontally healthy individuals. Settings and Design: The present study was carried out in the Department of Microbiology in association with Department of Oral Medicine and Radiology, Maratha Mandal's N.G.H Institute of Dental Sciences and Research Centre, Belgavi, Karnataka. Materials and Methods: Fifty samples of each group were included in the present study. The levels of IL-21 were assessed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit and the results were expressed as pg/mL. Statistical Analysis Used: Statistical analysis was performed using SPSS 17.0 software. Data were expressed as mean ± standard deviation and interquartile ranges and comparison of controls and cases by Mann–Whitney test. Results: Serum and salivary levels of IL-21 were significantly higher in chronic periodontitis group than in controls (P < 0.001). Clinical periodontal parameters correlated positively with serum IL-21 levels. Conclusions: IL-21 is highly expressed in patients with chronic periodontitis and correlated well with clinical parameters of periodontal destruction. Therefore, IL-21 appears to play a role in tissue destruction and can be used as diagnostic biomarker in chronic periodontitis. Saliva can be considered to be a useful alternative to serum as a diagnostic sample.
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Antioxidant therapy (lycopene and green tea extract) in periodontal disease: A promising paradigm p. 25
Pragya Tripathi, Vikram Blaggana, Preeti Upadhyay, Manika Jindal, Shweta Gupta, Sadaf Nishat
DOI:10.4103/jisp.jisp_277_18  
Background: Increased oxidative stress has emerged as one of the prime factors in the pathogenesis of periodontitis. Hence, antioxidant therapy may become a promising tool in the treatment of periodontal disease. Uric acid (UA) being a major antioxidant in saliva can be used as a marker to assess the total antioxidant capacity. Aim: The aim of the study was to investigate the influence of orally administered antioxidants (lycopene and green tea extract) on periodontal health and salivary UA levels in gingivitis patients as an adjunct to scaling and root planing (SRP). Materials and Methods: Thirty systemically healthy participants having generalized gingivitis were randomly distributed into two groups. Control group participants received full mouth oral prophylaxis, while test group participants received oral lycopene and green tea extract (CLIK®) for 45 days along with complete oral prophylaxis. Plaque index (PI), sulcular bleeding index (SBI), and salivary UA levels were evaluated at baseline and 45 days after SRP. Data were analyzed with t-test, using SPSS software (PASW, Windows version 18.0). Results: Both treatment groups demonstrated statistically highly significant (P ≤ 0.001) reduction in plaque and SBI. After treatment, a highly significant increase (P ≤ 0.001) in the test group and significant (P ≤ 0.05) increase in the control group was observed for salivary UA levels. Posttreatment comparison between test and control group delineated statistically significant results in PI (P ≤ 0.001), SBI (P ≤ 0.001), and salivary UA levels (P ≤ 0.01). Conclusion: Lycopene with green tea extract may prove to be a promising adjunctive prophylactic and therapeutic modality in the treatment of gingivitis patients. However, further studies are needed to evaluate the additive effect of antioxidants with routine oral prophylaxis therapy.
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The antiplaque efficacy of lantibiotic Nisin extract mouthrinse p. 31
Dipika Mitra, Amitabh Yadav, Saurabh Prithyani, Ligi Elsa John, Silvia Rodrigues, Rohit Shah
DOI:10.4103/jisp.jisp_326_18  
Aim: This study aimed to determine the antiplaque efficacy of Nisin Z extract mouth rinse (Test) as compared to 0.2% chlorhexidine gluconate mouthrinse (Positive control) and distilled water (Placebo) and to assess minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of Nisin Z against Prevotella intermedia (Pi), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans (Aa) in vitro. Materials and Methods: Forty-five individuals were randomly divided into three groups (15 in each group). The baseline plaque scores were brought to 0 with scaling and polishing. They were asked not to use any kind of mechanical oral hygiene aid for 4 days and advised to use mouthwashes A, B, or C (Group A: Nisin Z; Group B: distilled water; Group C: chlorhexidine) for 4 days. Following the 4-day plaque re-growth model, Plaque Index was checked on days 1 and 5. Results: In intergroup comparison, a statistically significant difference was seen between Nisin and placebo groups and chlorhexidine and placebo groups, with Nisin and chlorhexidine showing superior antiplaque activity. There was also statistically significant difference between Nisin and chlorhexidine groups, with chlorhexidine showing superior antiplaque activity. In vitro Nisin showed effective inhibition against all three bacterial strains Pi, Pg, and Aa exhibited the highest sensitivity to Nisin with a MIC of 2.5 μg/ml and MBC of 15 μg/ml. Conclusion: Nisin Z mouthrinse was found to be a potent plaque inhibitor, though less effective than chlorhexidine mouthrinse. However, it can serve as a good natural alternative to the gold standard.
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Use of different concentrations of hyaluronic acid in interdental papillary deficiency treatment: A clinical study p. 35
Shivani Singh, Kharidi Laxman Vandana
DOI:10.4103/jisp.jisp_332_18  
Background: In the present era, demand of beauty and esthetics has increased rapidly. Interdental papilla construction, especially in the esthetic zone, is one of the most challenging tasks. Interdental papilla loss might occur due to several reasons as a consequence of periodontal surgery, trauma, and others. Aim and Objective: The present study was aimed to prepare economically feasible injectable form of hyaluronic acid (HA) gel in three different concentrations – 1%, 2%, and 5% HA to evaluate its efficacy in the enhancement of deficient interdental papilla (IDP). Materials and Methods: A total of 42 sites (mean age range was 29.6–30.6 years) was categorized into three groups; 1% HA group (16 sites), 2% HA group (14 sites), and 5% HA group (12 sites). Total 35 sites were followed up out of 42 in which 2% HA group included only 7 sites. Both maxillary (17 sites) and mandibular (18 sites) sites were included in this study. HA was injected at 2 mm apical to papillary tip at weekly interval for 3 weeks. The IDP augmentation was measured using UNC-15 probe and modified stent at 1, 3, and 6 months. The photographic analysis was done using Image J software. Results: On clinical measurement, 5% of HA showed highly significant enhancement (P = 0.001) of 19.2%, 20.6% 18.2% at 1, 3, and 6 months, respectively. On photographic analysis, 5% of HA showed 41%, 42.9%, and 39.8% at 1, 3, and 6 months, respectively. However, intergroup comparison showed nonsignificant improvement. Conclusion: This study results suggest that the use of 5% of HA is effective for interdental deficiency treatment with minimal rebound at the end of 6 months. The modified stent for IDP measurement used in this study for the first time in the literature is highly recommended. The photographic analysis using image J Analyzer serves a useful and dependable tool. Further, long-term clinical studies would throw more insight in this regard.
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Comparative evaluation of open flap debridement alone and in combination with anorganic bone matrix/cell-binding peptide in the treatment of human infrabony defects: A randomized clinical trial p. 42
Pratima Ram Niwas Mishra, Abhay Pandurang Kolte, Rajashri Abhay Kolte, Natasha Gev Pajnigara, Kanan Ketan Shah
DOI:10.4103/jisp.jisp_339_18  
Background: The synthetic anorganic bone matrix/cell-binding peptide (ABM/P-15) has displayed an increased fibroblast migration and attachment with bone graft material, thus enhancing periodontal regeneration. The objective of the present study was to evaluate and to correlate the efficacy of open flap debridement (OFD) with and without ABM/P-15 in the treatment of human infrabony periodontal defects. Materials and Methods: A total of 20 chronic periodontitis patients with equal number infrabony defects were randomly selected and assigned into two groups depending on the treatment received: Control group (treated with OFD) and Test group (treated with OFD + ABM/P-15). Clinical parameters recorded included plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), gingival recession, and radiographic defect depth (RDD) which were evaluated at baseline and 6 months postsurgically. Results: When compared to baseline, both the treatment groups demonstrated improvements in the clinical parameters at 6 months. Test group exhibited a mean PPD reduction of 4.15 ± 1.04 mm, CAL gain of 3.10 ± 1.42 mm, and reduction in RDD of 1.90 ± 0.72 mm postoperatively at 6 months. In contrast to Control group, the Test group showed greater reduction in PPD (P < 0.05) which was statistically significant, greater CAL gain and greater mean RDD reduction (P < 0.001) which was highly significant. Conclusion: In the surgical management of periodontal infrabony defects, Test group elicited in statistically significant PPD reduction, CAL gain, and better infrabony defect fill at 6 months' postoperatively.
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Frenectomy with conventional scalpel and Nd:YAG laser technique: A comparative evaluation p. 48
Rakesh Kumar Yadav, Umesh Pratap Verma, Isha Sajjanhar, Rini Tiwari
DOI:10.4103/jisp.jisp_352_18  
Background: Frenectomy is complete excision of the frenum attachment to the underlying bone. Conventional frenectomy with blade has been widely used; however, laser-assisted frenectomy is the most recent alternative. Aim: The present study aims to compare two methods of frenectomy for the pain experienced, intraoperative bleeding, healing outcome, and need for analgesics. Materials and Methods: Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser group. Visual Analog pain score, intraoperative bleeding, number of analgesics used, and healing outcome 3 months postoperatively were recorded. Results: Group B patients experienced less pain (P = 0.016), less bleeding (P = 0.016), and required fewer number of analgesics (P = 0.008). Healing outcome at 3 months showed no significant difference between the two groups (P = 0.095). Conclusion: Based on the results of this study, it can be concluded that Nd:YAG laser is an efficient and a more comfortable alternative to scalpel for frenectomy.
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Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study p. 53
Shreya Lingamaneni, Lohith Reddy Mandadi, Krishnajaneya Reddy Pathakota
DOI:10.4103/jisp.jisp_226_18  
Background: Lasers have become a part of modern dentistry since the past three decades. A wide-ranging assortment of lasers is being used in periodontology for both soft and hard tissue surgical procedures. Regardless of the frequent practice of using these well-known surgical lasers, there is another lesser familiar class of lasers called the low-level lasers. The main doctrine behind using low-level laser therapy (LLLT) is centered on the biostimulation, or the biomodulation effect, which relies on the dexterity of low-intensity laser energy when irradiated at a specific wavelength, is able to modify cellular activities (increase in cell metabolism and fibroblast and keratinocyte proliferation). Aim: The aim of the present study was to investigate the adjunctive use of LLLT on gingival healing after gingivectomy procedures. Materials and Methods: Ten systemically healthy patients requiring gingivectomy or gingivoplasty procedures bilaterally in either the maxillary or mandibular teeth were included in the study. After surgical intervention, a diode laser (810 nm) was randomly activated to one side of the operated area while other side did not receive any treatment and served as the control. The healing index given by Landry et al. was used to evaluate the soft tissue healing immediately postsurgery and at the 3rd day, 1 week, and 2 weeks postoperatively. After the follow-up period, results were analyzed using appropriate statistical tests. Results: There was no statistically significant difference observed in the surface epithelialization between both groups on the 3rd and 7th-postoperative days, but highly significant differences were observed on the 14th day. Conclusion: Within the confines of this pilot study, the outcomes have indicated that gingival wound healing may be improved using LLLT after gingivectomy and gingivoplasty operations.
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Public awareness, knowledge, attitude and acceptance of dental implants as a treatment modality among patients visiting SDM College of Dental Sciences and Hospital, Dharwad p. 58
Emaan Ahmed Siddique, Pragathi Raghavendra Bhat, Sudhindra Sushilendra Kulkarni, Vijay Ashok Trasad, Srinath Lakshman Thakur
DOI:10.4103/jisp.jisp_281_18  
Background: The use of dental implants as a prosthetic treatment modality for partially edentulous or completely edentulous patients is increased more commonly ever since the concept of osseointegration has been accepted. Objective: The objective of this study is to assess the awareness, knowledge, attitude, and acceptance of dental implants as a treatment modality among patients visiting SDM Dental College, Dharwad. Materials and Methods: A cross-sectional survey was conducted among 500 patients visiting SDM College of Dental Sciences and Hospital (SDMCDSH), Dharwad, using a self-explanatory questionnaire. Results: A total of 500 individuals participated in the survey. The results of this survey indicate that 93.4% of the patients knew about dental implants, and for majority of them, the major source of information was through their dentist followed by relatives and friends and electronic media. About 60.4% patients disapproved the removable prosthesis as an option for the replacement of missing teeth. 77.2% patients expressed that they could not afford for the dental implant treatment. The major deterioration for this treatment was related to the cost in 80.4% patients, surgical procedure in 11.6% patients, and a long treatment time in 5.6% patients. While 60.4% patients felt that dental implants being expensive, is the treatment option only for the rich. Conclusion: The results of this survey showed that majority of the patients visiting SDMCDSH, Dharwad, were aware about dental implants as a treatment modality for the replacement of missing teeth. Although the attitude was positive and they did accept dental implants as a treatment option, the treatment cost mainly was the major reason to take a back step.
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Multifaceted assessment of dentine hypersensitivity, evaluation of demographic prevalence along with associated factors: A cross-sectional study p. 64
Zoya Chowdhary, Prabhati Gupta, Jagandeep Kaur, Yogesh Garg, Neeti Swarup
DOI:10.4103/jisp.jisp_425_18  
Background: Dentine hypersensitivity (DH) is a relatively common problem which may affect the adult population. The etiology remains multi-factorial with interactions between stimulus and pre-disposing factors causing its aggravation. Aim: To study the prevalence of DH and associated factors and also to find the association between various factors and DH. Materials and Methods: A cross-sectional study was carried out and a total of 5091 patients, both male and females, were evaluated through questionnaire. Out of the total only 1400 patients were included in the study and were further evaluated clinically. A complete demographic data was obtained and the DH was confirmed by the use of air -water jet of the dental chair and scratching the suspected tooth with a dental probe. The pain response of the subject was recorded using the visual analog scale (VAS) and verbal rating scale (VRS). The data obtained was statistically evaluated and Chi-square test was applied for comparison of different demographic factors with DH. Results: The overall prevalence of DH was 27.4%. Various demographic factors were found to affect DH such as age, gender, education, and diet. The most common stimulus was found to be cold (21.4%) and common predisposing factor was gingival recession and attrition (28.6%). Clinical examination yielded a statistically significant association between VAS and VRS scores for DH and demographic factors. Conclusion: The prevalence of DH in present study was 27.4% which is attributed to gingival recession as predisposing factor and cold stimuli as the precipitating factor.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Enamel renal gingival syndrome: A rare case report p. 69
Koel Debnath, Amita Couthino, Anirban Chatterjee, Sadhana Shenoy
DOI:10.4103/jisp.jisp_532_18  
Enamel renal syndrome is a unique syndrome associated with kidney agenesis associated with kidney agenesis, amelogenesis imperfecta, and gingival hyperplasia. The prevalence rate of this rare syndrome is <1/1,000,000. A 17-year-old male patient came to the department of periodontics, with a chief complaint of dislodged crown in the anterior teeth region. On clinical examination, the patient had teeth with mottled enamel and gingival enlargement. The orthopantomograph and gingival biopsy revealed pulpal calcification and gingival calcification, respectively. Furthermore, the renal ultrasonography revealed absence/agenesis of the left kidney. Thus, based on radiographical, histological, and ultrasound investigations, the patient was diagnosed with nephrocalcinosis syndrome. The patient was treated with periodontal therapy and prosthodontic full-mouth rehabilitation. This case report highlights the need of a periodontist to be acquainted about the signs and symptoms of the syndrome to benefit an individual in the right diagnosis and treatment plan.
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Bidirectionally positioned flap technique for molar class II furcation defect- 1 year follow up p. 73
Shikha Sharma, Ashita Uppoor, Dilip Gopinath Naik, Sayantan Karmakar
DOI:10.4103/jisp.jisp_322_18  
In the treatment of Class II furcation defects, guided tissue regeneration (GTR) in combination with bone grafts has provided better treatment outcomes in comparison to GTR alone. A 48-year-old male patient reported with a chief complaint of pain and bleeding in the right lower back teeth area from 3 months. On clinical and radiographic evaluation, a Class II buccal furcation defect was detected in tooth #46. A bidirectionally positioned flap (BPF) technique in combination with bone graft was done to treat the defect following nonsurgical therapy. The healing was satisfactory postoperatively. The patient was recalled for supportive periodontal therapy at 3, 6, and 12 months. Clinical and radiographic outcomes after 12 months revealed possible new attachment and stable periodontal status. It is concluded that inner periosteal flap in BPF technique may serve as an alternative technique to GTR barrier membranes in case of Class II furcation defects.
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A modified free gingival graft technique for gaining vertical and horizontal soft tissue augmentation p. 77
Marcelo Hissao Imano, Emanuelle Juliana Cunha, Carmen Lúcia Mueller Storrer, Tatiana Miranda Deliberador
DOI:10.4103/jisp.jisp_156_18  
The aim of this case report was to describe a modified free gingival graft technique for gaining vertical and horizontal soft-tissue growth in the posterior region of the mandible before installation of dental implants. Patient A.A., a 38-year-old female, received a modified free gingival graft in the posterior region of the mandible. After 90 days, an increase, both horizontally and vertically, of the gingival tissue was observed, and the patient was satisfied with the result. The dental implant was installed, and a 3-mm of the vertical gain of keratinized gingiva was observed. Further research is needed to evaluate the effectiveness of this technique before prosthetic dental implantation.
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SHORT COMMUNICATION Top

Stent as an accessory tool in periodontal measurements: An insight p. 81
Shivani Singh, Kharidi Laxman Vandana
DOI:10.4103/jisp.jisp_331_18  
A better reflection of periodontal destruction can be obtained by the measurement of the clinical attachment level (CAL), i.e., the distance from the probe tip to the level of the cementoenamel junction (CEJ). However, there were several problems in CEJ identification. Due to the time consumption and inherent problems in CEJ identification, CAL measurements without using a stent in surveys or other clinical trials are highly questionable. The use of stent is recommended during clinical trials which will minimize the errors in terms of over and underestimation of CALs. Hence, the stent used for vertical probing (vertical/occlusal stent), horizontal probing (furcation stent), and interdental papilla (IDP) stent for IDP-deficiency measurement is discussed to comprehend its clinical applications.
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REVIEWERS, 2018 Top

Reviewers, 2018 p. 85
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