Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
May-June 2019
Volume 23 | Issue 3
Page Nos. 185-294

Online since Thursday, May 2, 2019

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EDITORIAL  

Generalized periodontitis; Stage IV, Grade C; currently stable. 1. Current smoker >12 cigarettes per day 2. Optimally controlled diabetes. p. 185
Ashish Kumar
DOI:10.4103/jisp.jisp_151_19  
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PRESIDENT’S MESSAGE Top

Healthy smile: The fuel for fitness p. 187
Anil Melath
DOI:10.4103/jisp.jisp_179_19  
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SECRETARY’S MESSAGE Top

Can we progress as a profession without the well being of the professionals? p. 188
Abhay Kolte
DOI:10.4103/jisp.jisp_178_19  
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REVIEW Top

Actual quantitative attachment gain secondary to use of autologous platelet concentrates in the treatment of intrabony defects: A meta-analysis p. 190
Om Kumar Nemichand Baghele, Vrushali Madhavrao Kathole, Amarpreet Kaur Jasbirsingh Tuteja, Trupti Gajendra Giri
DOI:10.4103/jisp.jisp_498_18  
Background: There are no authoritative meta-analyses and no clear quantitative assessments available estimating effects of open flap debridement (OFD) combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) over and above that of OFD. This study evaluated the actual quantitative mean gain for various clinical (clinical attachment level [CAL], probing pocket depth [PPD] and gingival marginal level [GML]) and radiographic (intrabony defect depth [IBD]) parameters of Platelet Concentrates- PCs (PRP/PRF) as sole grafting material along with OFD and OFD alone in the treatment of intrabony defects. Materials and Methods: A detailed electronic search was carried out in PUBMED/MEDLINE, COCHRANE, EBSCOHOST, and Google Scholar databases by unifying related search terms with additional hand searches in select specialty journals up to May 2017. The eligibility criteria included human randomized clinical trials, either of a parallel group or a split-mouth design with follow-up period of at least 6 months. Periodontal intrabony defects with radiographic IBD ≥3 mm with corresponding CAL ≥5 mm were included. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models. Results: Actual quantitative mean gains were calculated for OFD with PRF/PRP (CAL = 1.1 mm, IBD = 1.68 mm, PPD = 0.97 mm and GML = 0.48 mm) over and above that of OFD alone. Conclusion: Because of very high heterogeneity, the results may not be dependable. Apart from gains in radiographic bone fill, all other periodontal clinical parameters showed negligible gains. Using PRF technologies in periodontal intrabony defects may not be of great clinical significance over and above that of OFD alone, the effect sizes are also not large enough.
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Most effective method for the management of physiologic gingival hyperpigmentation: A systematic review and meta-analysis p. 203
Meisha Gul, Muhammad Hasan Hameed, Muhammad Rizwan Nazeer, Robia Ghafoor, Farhan Raza Khan
DOI:10.4103/jisp.jisp_555_18  
Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.
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ORIGINAL RESEARCH Top

To detect the minimum inhibitory concentration and time-kill curve of shiitake mushroom on periodontal pathogens: An in vitro study p. 216
Shikha Sharma, Shobha Prakash
DOI:10.4103/jisp.jisp_249_18  
Introduction: Shiitake (Lentinula edodes) is an Asian edible mushroom with the second-largest cultivation percentages among edible mushrooms in the world. Previous studies have shown its nutritional richness such as high quantities of proteins, minerals, and vitamins. Moreover, in vitro and animal studies have displayed the medical importance of shiitake extracts including antitumor, antiviral, antibiotic, and hypocholesterolemic actions and also shown to have antibacterial efficacy and has been used for the elimination of oral biofilms and as a substitute of current chemical-based treatments. This study aims to analyze the inhibitory and antibacterial efficacy of shiitake mushroom extracts on periodontal pathogens. Materials and Methods: Double extract, i.e., hot water and ethanol extract of shiitake were used for the assessments of minimum inhibitory concentrations on Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, and Prevotella intermedia using the tube-dilution method, and the time-kill curve was assessed for the above bacteria. Results: Shiitake has shown potent antibacterial effects at a concentration of 3.12 μg/ml and has shown no growth after 2 h of culture. Conclusion: Shiitake mushroom extract has shown the potential antimicrobial effect on the certain periodontal pathogens.
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Comparative evaluation of two antibacterial-coated resorbable sutures versus noncoated resorbable sutures in periodontal flap surgery: A clinico-microbiological study p. 220
Prerna Ashok Karde, Kunal Sunder Sethi, Swapna Arunkumar Mahale, Alefiya Shabbir Mamajiwala, Aishwarya Madhukar Kale, Chaitanya Pradeep Joshi
DOI:10.4103/jisp.jisp_524_18  
Background: Sutures at the surgical site can act as a reservoir for microbes, leading to surgical site infection. This mainly occurs in braided sutures due to wicking action. The use of triclosan-coated suture (TCS) or chlorhexidine-coated suture (CCS) could be one of the possible alternatives to reduce the microbial load. Objectives: The study was designed to assess the antibacterial efficacy of resorbable TCS and CCS along with its effect on healing after periodontal flap surgery in comparison to noncoated sutures (NCSs). Materials and Methods: Thirty patients with chronic periodontitis indicated for periodontal flap surgery satisfying inclusion criteria were randomly assigned in the three groups: (1) NCS-polyglycolic acid sutures (control group), (2) TCS-polyglycolic acid sutures (experimental Group A), and (3) CCS-polyglycolic acid sutures (experimental Group B). All the patients were evaluated at day 0 (baseline), day 8, day 15, and day 30 for healing index (HI), postoperative pain (POP), and visible plaque index (VPI). Aerobic and anaerobic bacterial growth around each suture was evaluated after day 8. Two randomly chosen samples from each group were examined using confocal laser scanning microscopy (CLSM) for the presence of biofilm. Results: Although intergroup HI and POP were statistically insignificant (P > 0.05), intragroup evaluation showed statistically significant improvement. VPI was more in NCS compared to antibacterial sutures. There was significantly less concentration of anaerobic bacteria as compared to aerobic bacteria (P < 0.05). CLSM showed the presence of more viable bacteria on NCS as compared to antibacterial sutures. Conclusion: TCS or CCS sutures can be used in periodontal surgeries to reduce the bacterial load at the surgical sites.
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Comparative evaluation of the chlorhexidine and cinnamon extract as ultrasonic coolant for reduction of bacterial load in dental aerosols p. 226
Kunal Sunder Sethi, Alefiya Mamajiwala, Swapna Mahale, Chetan Purushottam Raut, Prerna Karde
DOI:10.4103/jisp.jisp_517_18  
Background: Ultrasonic instruments generate aerosols with significantly greater number of bacteria. Preprocedural mouthrinses or chemotherapeutic coolants are used for the reduction of bacterial load in dental aerosols. The use of chlorhexidine as an ultrasonic coolant has been well established. However, this application has not yet been investigated for cinnamon extract which is known to have antibacterial and anti-inflammatory properties in vivo. Aim: The aim of this study is to compare and evaluate the efficacy of chlorhexidine and cinnamon extract as an ultrasonic coolant in reduction of aerosol contamination and biofilm formation during ultrasonic scaling in comparison with the distilled water (DW). Materials and Methods: Sixty patients diagnosed with moderate-to-severe gingivitis were randomly divided into three groups of twenty patients each undergoing ultrasonic scaling. For Group I, chlorhexidine was used as an ultrasonic coolant; for Group II, cinnamon extract was used; and Group III was served as control where DW was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. Both the plates from each position were incubated aerobically for 48 h. The total number of colony-forming units were counted as mean ± standard deviation and statistically analyzed. In addition, biofilm sampling of dental unit waterlines (DUWLs) was also done to evaluate the effect of these antimicrobials. Apart from microbial examination, clinical parameters such as plaque index and gingival index were also evaluated at baseline and 1-month follow-up. Results: Chlorhexidine and cinnamon both were equally effective (P > 0.05) in reducing the bacterial count in aerosols and biofilm in DUWL as compared to DW when used as ultrasonic cooling agent. Conclusion: Both cinnamon and chlorhexidine used as an ultrasonic device coolant through DUWLs effectively helped in the reduction of bacterial count in dental aerosols.
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Evaluation and comparison of hydroxyapatite crystals with collagen fibrils bone graft alone and in combination with guided tissue regeneration membrane p. 234
Shalabh Mehrotra, Zoya Chowdhary, Tanushree Rastogi
DOI:10.4103/jisp.jisp_386_18  
Background: The combination of collagen in bone grafts is being used because of its properties that accentuate the degree of regeneration. Furcation involvement poses challenge to the prognosis of a tooth, the use of bone grafts and a combination of grafts and membranes have proved to be beneficial in the treatment of furcation defects. Thus, the aim of the present study was to clinically evaluate and compare the effectiveness of collagen fiber bone graft with and without a membrane in the treatment of mandibular Grade II furcation defects. Materials and Methods: A clinical split-mouth randomized control trial, which included ten patients having bilateral mandibular Grade II furcation defects, was randomly assigned to Group I, treated with bone graft of hydroxyapatite with collagen fibers, and Group II, treated with bone graft of hydroxyapatite with collagen fibers and guided tissue regeneration membrane of polyglycolide and polylactide copolymer, respectively. The clinical measurements were recorded at baseline and 6 months after surgery; and plaque and gingival index were recorded at baseline and at 3 and 6 months after surgery. The data obtained was statistically evaluated. Results: The overall results showed that the treatment procedures demonstrated statistically significant reduction in probing pocket depth, vertical defect fill, and horizontal depth of furcation, with a gain in clinical attachment level. On comparison of both the groups, Group II showed superior results with a statistically significant difference in all parameters except in gingival recession. Conclusion: The findings of the study demonstrated superior clinical results obtained with hydroxyapatite with collagen fibers, used in combination with polyglycolide and polylactide copolymer as compared to used alone in the treatment of Grade II furcation defects.
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Demineralized freeze-dried bone allograft with or without platelet-rich fibrin in the treatment of mandibular Degree II furcation defects: A clinical and cone beam computed tomography study p. 242
Aravinda Basireddy, Santha Kumari Prathypaty, Durga Bai Yendluri, Santi Priya Potharaju
DOI:10.4103/jisp.jisp_465_18  
Background: Currently, there is no gold-standard regenerative material for the treatment of furcation defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used owing to their ease of use and cost-effectiveness. Aims: The aim of this study is to evaluate the ability of platelet-rich fibrin (PRF) to augment the regenerative effects exerted by demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular degree II furcation defects. Materials and Methods: Twenty-eight defects in 14 patients with bilateral Degree II mandibular furcation defects were included in the study. The test group was treated with a combination of DFDBA and PRF, while in the control group DFDBA was used alone. Clinical parameters such as probing depth, relative vertical clinical attachment level, relative horizontal clinical attachment level (RHCAL), gingival margin level (GML), plaque index, and sulcus bleeding index were measured at baseline and 6 months. Radiographic parameters, such as vertical defect depth, horizontal defect depth and defect fill, were measured using cone beam computed tomography, taken at baseline and 6 months. Statistical Analysis Used: The intragroup and intergroup comparisons were done using the paired t-test. Results: The intergroup comparison of mean change in the parameters showed, statistically significant difference in RHCAL (<0.001) and GML (0.014), and no significant difference in other parameters. Conclusions: Within the limitations of the present study, PRF seems to favor soft-tissue healing but has no additional benefit in bone regeneration when used in combination with DFDBA.
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Comparison of effectiveness of low-dose aspirin versus omega-3 fatty acids as adjuvants to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis p. 249
Prathyusha Rampally, Rekha Rani Koduganti, Sastri Nadiminty Ganapathi, Veerendranath Reddy Panthula, Prasanna Jammula Surya
DOI:10.4103/jisp.jisp_528_18  
Context: Periodontitis and diabetes are universally prevalent diseases which are interlinked with each other. Inflammatory products released both by the microorganisms, and the host plays a pivotal role in causing both the diseases. Pentraxins are acute-phase proteins which are often found to be elevated in inflammatory states. Anti-inflammatory agents have a very important role to play in curbing infection of which, aspirin and omega-3 fatty acids (O3FAs) are being administered often nowadays. Nonsurgical periodontal therapy (NSPT) remains the gold standard of treatment, and other agents have been used as adjuvants only, to increase the efficacy of treatment. Aims: This study compares the effects of low-dose aspirin versus O3FAs when used as adjuvants to NSPT in patients with diabetes and chronic periodontitis. Settings and Design: A total of 42 patients (mean age of 30–65 years) from a diabetic center who were diagnosed with Type II diabetes and chronic periodontitis were included in the study. Materials and Methods: This study was done in the department of periodontics of a tertiary referral care hospital in Hyderabad, in collaboration with a reputed diabetic center. Statistical Analysis Used: Intragroup comparison was done using the paired t-test for continuous data and Wilcoxon signed-rank test for score data. Intergroup comparison was compiled using independent t-test. All P < 0.05 were considered statistically significant. Results: Intragroup comparison at baseline and 3 months after NSPT showed statistically significant results (P < 0.001) in all the three groups pertaining to the clinical (gingival index, probing pocket depth, and clinical attachment level) and biochemical (glycosylated hemoglobin and pentraxin) parameters. However, the intergroup comparison showed a significant improvement in Group II related to pentraxin levels only (P < 0.001). Conclusions: O3FAs proved to be better than low-dose aspirin and placebo after NSPT.
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Periodontally accelerated osteogenic orthodontics combined with recombinant human bone morphogenetic protein-2: An outcome assessment p. 257
Rampalli Viswa Chandra, Madhukar Reddy Rachala, Koguru Madhavi, Prabhuraj Kambalyal, Aileni Amarender Reddy, Mir Hasan Ali
DOI:10.4103/jisp.jisp_612_18  
Context: Periodontally accelerated osteogenic orthodontics (PAOO) combines alveolar corticotomy, bone graft materials, and the application of orthodontic forces for rapid correction of malocclusions. Aims: The present study aims to primarily assess differences in orthodontic treatment duration, bone quality around corticotomy sites, postoperative healing, and subjective pain when corticotomy was done conventionally and with the placement of recombinant human bone morphogenetic protein-2 (rhBMP-2). Settings and Design: Thirty individuals participated in this study. Individuals were randomly assigned into each of the following experimental groups; C + BMP: Corticotomy with 0.5 μg/mL rhBMP-2 and C: Corticotomy only. Materials and Methods: Clinical parameters included recording the duration of the treatment period, visual analog scale scores and early wound healing index scores. The evaluation of bone density was performed at baseline, 3 months, and 6 months by using RVG. Statistical Analysis Used: Two-way analysis of variance and post hoc multiple comparison tests were used to compare data between test and control groups at different time points. Results: rhBMP-2 application was effective in reducing the overall treatment time and resulted in an increase in bone density around corticotomy sites at the end of the treatment period when compared to conventional corticotomy procedure. Placement of rhBMP-2 neither delayed wound healing nor affected participant pain scores. Conclusions: From this trial conducted over a period of 6 months, rhBMP-2 has the potential to function as a regenerative material in PAOO.
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Oral health awareness and practices in pregnant females: A hospital-based observational study p. 264
Mayank Hans, Veenu Madaan Hans, Namrata Kahlon, Piyush Kumar Rameshchandra Ramavat, Usha Gupta, Asim Das
DOI:10.4103/jisp.jisp_372_18  
Background: The aim of this study was to assess the oral health awareness, methods adopted to maintain hygiene, prevalent myths regarding oral health in pregnancy, and importance of oral health during pregnancy, to help formulate oral health program for pregnant females in partaking hospital. Materials and Methods: A total of 225 pregnant females participated in the study. After complete demographic assessment of participants, a questionnaire was provided to them. Questionnaire included simple multiple choice questions on how they maintained oral hygiene, their oral health status, visit to the dentist, and barriers in seeking treatment. This was followed by a questionnaire regarding common myths and understanding of the importance of oral health during pregnancy which had three choices: true, false, and do not know. The results were expressed in percentages, and one sample t-test for percentages was applied where ever required. Results: Majority of participants self-reported some form of oral health problems with bleeding gums as a chief complaint leading the survey. Around half of the participants had never visited a dentist, and an abundant number of pregnant females reported safety concerns for developing the child as a reason for not taking any treatment during pregnancy. A highly significant number of participants were unaware of the importance of oral health during pregnancy and believed in age-old myths. Conclusion: The oral health care still remains on the backseat in care provided to pregnant female. A complete overhaul of understanding through individual, family, and community counseling is required to spread awareness.
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Prevalence of periodontitis in patients with pulmonary disease: A cross-sectional survey in the industrial district of India p. 269
Tanushree Rastogi, Zoya Chowdhary, Munagala Karthik Krishna, Shalabh Mehrotra, Ranjana Mohan
DOI:10.4103/jisp.jisp_435_18  
Background: Evidence state that periodontitis may have a contributory role in the onset and progression of pulmonary diseases. However, very limited data are available till date, studying the coexistence of both the conditions. Aim and Objective: The aim and objective of this study are to determine the prevalence of periodontitis among patients affected with various pulmonary diseases in Moradabad District, Uttar Pradesh, India. Materials and Methods: A total of 700 patients suffering from pulmonary diseases including tuberculosis (TB), chronic obstructive pulmonary disease, or pneumonia within the age group of 12–70 years were selected for the study. A detailed case-history for both pulmonary and periodontal status was taken. Periodontal Disease Index and Periodontal Index for Risk of Infectiousness were recorded for all patients. The scores were calculated and subjected to statistical analysis. Results: Individuals with pulmonary diseases showed a statistically significant prevalence of periodontal disease with higher values of periodontal disease index (31%) and periodontal index for risk of infectiousness (55%) at P < 0.05. Patients suffering from TB within the age group of 51–60 (42%) showed the highest prevalence of periodontitis with a more number of males (43%) being affected as compared to females at P < 0.01. Conclusion: Most of the study population was diagnosed with periodontitis with a higher proportion categorized under high-risk category as per PIRI scores.
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Knowledge on smoking and periodontal disease: A cross-sectional survey among targeted respondents p. 275
Shanthi Muniandy
DOI:10.4103/jisp.jisp_479_18  
Background: The impact of smoking on oral health is directly related to the toxic tobacco fumes. The study aimed to investigate the awareness of the link between smoking and periodontal disease among the population seeking periodontal treatment. Materials and Methods: A self-administered questionnaire constructed in local Malay language consisting of 13 questions on sociodemographic details and 10 questions on the knowledge domain was distributed to eligible respondents while they were waiting for their consultation in the periodontal clinic waiting hall. There were 330 study participants aged 16 years old and above, who participated in this study from all 12 dental clinics in the state of Perlis, Malaysia. Data were entered into Statistical Package for the Social Sciences version 20.0 for analysis. Descriptive statistics were used to describe the sociodemographic data, whereas association between potential factor and the knowledge of awareness was found using the Pearson Chi-square test of independence or a Fisher's exact test, depending on the eligibility criteria. Results: Our study showed that 4.5% (n = 15) of the respondents were not aware that smoking did add risk for oral cancer, 14.5% (n = 48) were not aware that smoking could cause gum disease. Smoking status was significantly associated with the awareness of smoking effect on gum disease (P = 0.002). The proportion of the active smokers being aware that smoking could potentially cause gum disease was considerably less as compared to the nonsmokers (62.7% vs. 83.3%). Conclusions: Continuous dental health campaigns and awareness program are crucial to instil awareness and health-seeking behavior as well as to enforce public's knowledge.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Dental management of a patient with incidentally detected hemophilia: Report of a clinical case p. 281
Sreenivas Nagarakanti, Hasya Sappati, Sumanth Gunupati, Bhumanapalli Venkata Ramesh Reddy, Vijay Kumar Chava
DOI:10.4103/jisp.jisp_461_18  
Individuals with hemophilia are at risk for bleeding episodes, which range from mild mucosal/soft-tissue bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to a 23-year-old patient suffering from uncontrolled bleeding after an electrosurgical procedure (operculectomy) in relation to the mandibular right third molar, in which hemophilia was a true accidental finding. Various safety measures that need to be considered during the dental surgical management of hemophilic patients are discussed.
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Periodontal microsurgery for management of multiple marginal tissue recession using Zucchelli's modification of coronally advanced flap and pericardium membrane in an esthetic zone p. 284
Dinesh Yadav, Sangeeta Singh, Subrata Roy
DOI:10.4103/jisp.jisp_107_18  
Marginal tissue recession (MTR) by definition is an apical shift of gingival margin, which leads to exposure of root surface. Patients affected with MTR often complain of sensitivity to cold on exposed root surfaces apart from esthetic concerns. In this article, a case of multiple Miller's class I MTR who presented with sensitivity to cold in relation to maxillary anterior teeth region was treated using Zucchelli's coronally advanced flap with pericardium membrane under operating microscope. The application of principles of periodontal microsurgery and guided tissue regeneration results in significant root coverage with reduction/elimination of sensitivity. Long-term success of root coverage procedures depends on the removal of etiology and maintenance therapy.
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Esthetic lip repositioning: A cosmetic approach for correction of gummy smile – A case series p. 290
Asha Ramesh, Radha Vellayappan, Sheethalan Ravi, Kaarthikeyan Gurumoorthy
DOI:10.4103/jisp.jisp_548_18  
Gummy smile has been a prevalent esthetic disorder commonly affecting younger individuals due to various causes such as skeletal, dento-alveolar, or soft-tissue origin. It can be due to jaw deformities, altered passive eruption, or tooth malpositioning. Usually, the corrective measures incorporate orthognathic surgery and orthodontic treatment. Orthognathic surgery results in significant morbidity and hospitalization. Lip repositioning can be employed as an alternative cosmetic treatment modality for the correction of an excessive gingival display with minimal risk or side effects. Although there are many articles existing in the literature on this topic, a series of three cases is unique in demonstrating the esthetic smile enhancement in an orthodontic patient and also a combination of lip–repositioning technique and laser-assisted crown lengthening in vertical maxillary excess cases. This case series also showed the predictability of lip-repositioning technique with a follow-up of 2 years.
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