Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
March-April 2016
Volume 20 | Issue 2
Page Nos. 123-224

Online since Monday, April 11, 2016

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Let's get into the “Cure Mode” p. 123
Ashish Sham Nichani
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Periodontology – The years ahead p. 124
Praveen Bhasker Kudva
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Impact p. 126
Balaji Manohar
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Polymerase chain reaction: A molecular diagnostic tool in periodontology p. 128
Rajendran Maheaswari, Jaishree Tukaram Kshirsagar, Nallasivam Lavanya
This review discusses the principles of polymerase chain reaction (PCR) and its application as a diagnostic tool in periodontology. The relevant MEDLINE and PubMed indexed journals were searched manually and electronically by typing PCR, applications of PCR, PCR in periodontics, polymorphism studies in periodontitis, and molecular techniques in periodontology. The searches were limited to articles in English language and the articles describing PCR process and its relation to periodontology were collected and used to prepare a concise review. PCR has now become a standard diagnostic and research tool in periodontology. Various studies reveal that its sensitivity and specificity allow it as a rapid, efficient method of detecting, identifying, and quantifying organism. Different immune and inflammatory markers can be identified at the mRNA expression level, and also the determination of genetic polymorphisms, thus providing the deeper insight into the mechanisms underlying the periodontal disease.
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Periodontal pocket as a potential reservoir of high risk human papilloma virus: A pilot study p. 136
Manjunath Mundoor Dayakar, Anna Shipilova, Dinesh Gupta
Aim: Human papilloma viruses (HPVs) are small DNA viruses that have been identified in periodontal pocket as well as gingival sulcus. High risk HPVs are also associated with a subset of head and neck carcinomas. HPV detection in periodontium has previously involved DNA detection. This study attempts to: (a) Detect the presence or absence of high risk HPV in marginal periodontiun by identifying E6/E7 messenger RNA (mRNA) in cells from samples obtained by periodontal pocket scraping. (b) Detect the percentage of HPV E6/E7 mRNA in cells of pocket scrapings, which is responsible for producing oncoproteins E6 and E7. Materials and Methods: Pocket scrapings from the periodontal pockets of eight subjects with generalized chronic periodontitis were taken the detection of presence or absence of E6, E7 mRNA was performed using in situ hybridization and flow cytometry. Results: HPV E6/E7 mRNA was detected in four of the eight samples. Conclusion: Presence of high risk human papillomaviruses in periodontal pockets patients of diagnosed with chronic periodontitis, not suffering from head and neck squamous cell carcinoma in the present day could link periodontitis to HPV related squamous cell carcinoma. Prevalence studies are needed detecting the presence of HPV in marginal periodontium as well as prospective studies of HPV positive periodontitis patients are required to explore this possible link.
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Occurrence of Aggregatibacter actinomycetemcomitans in Indian chronic periodontitis patients and periodontally healthy adults p. 141
Vinayak Mahableshwar Joshi, Kishore Gajanan Bhat, Manohar Suresh Kugaji, Preeti Shivaji Ingalgi
Background: Aggregatibacter actinomycetemcomitans (Aa), an important primary periodontal pathogen, is known for its strong virulence characteristics that cause periodontal disease. We investigated Aa occurrence in Indian individuals using culture and 16 s rDNA polymerase chain reaction (PCR). Materials and Methods: A cross-sectional study with 100 participants each in the healthy and chronic periodontitis (CP) groups was conducted. The subgingival plaque was collected and immediately plated on selective media for Aa. The remaining plaque samples were used for DNA extraction. PCR was performed using specific primers for Aa. Statistical Analysis Used: The detection of bacteria and the clinical parameters between the groups were compared using the Mann–Whitney U-test. For assessing the agreement between the results of anaerobic culture and PCR, Kappa analyses were performed. Results: Aa levels using culture and PCR was 51% and 69% in the CP group and 12% and 30% in the healthy group, respectively. The two groups showed significant differences (P < 0.00001). The detection accuracy of culture and PCR was assessed, and the coefficient of accuracy (k) was highly significant in the healthy (0.3103; P < 0.0001) and CP groups (0.1536; P < 0.0497). Conclusions: Aa was predominantly found in the CP group compared with the healthy group, which is consistent with previous findings. Our results showed that both techniques can be used for detecting Aa. An ideal technique for detecting subgingival microorganisms should be carefully selected depending on the scope of the intended future work.
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Antimicrobial efficacy of Tulsi leaf (Ocimum sanctum) extract on periodontal pathogens: An in vitro study p. 145
Sajjanshetty Mallikarjun, Ashwini Rao, Gururaghavendran Rajesh, Ramya Shenoy, Mithun Pai
Background: Periodontitis is an infection of the periodontal complex with severe forms of disease associated with specific bacteria colonizing the subgingival area. Widespread use of drugs has resulted in the emergence of side effects, uncommon infections, and resistance. Plant medicine like Tulsi has been used in many clinical conditions, and it appears to be a suitable alternative to manage conditions affecting the oral cavity. Hence, the objective was to assess the in vitro antimicrobial activity of Tulsi leaves extract (Ocimum sanctum) on periodontal pathogens with doxycycline as standard, as doxycycline has been used as an adjunct to nonsurgical therapy in periodontitis patients. Materials and Methods: Ethanolic extract of Tulsi was prepared by cold extraction method. Extract was diluted with an inert solvent, dimethyl formamide, to obtain five different concentrations (0.5%, 1%, 2%, 5%, and 10%). Doxycycline was used as a positive control and dimethyl formamide, as a negative control. The extract and controls were subjected to the microbiological investigation against Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Agar well diffusion method was employed to determine the concentration at which Tulsi gave an inhibition zone, similar to doxycycline. Data were analyzed using one-way analysis of variance and Tukey post-hoc test was used for inter- and intra-group comparisons. Results: At 5% and 10% concentrations, Tulsi extracts demonstrated antimicrobial activity against A. actinomycetemcomitans, similar to doxycycline with similar inhibition zones (P > 0.05). P. gingivalis and P. intermedia, however, exhibited resistance to Tulsi extract that showed significantly smaller inhibition zones (P < 0.05). Conclusions: Tulsi demonstrated effective antimicrobial property against A. actinomycetemcomitans, suggesting its possible use as an effective and affordable “adjunct” along with the standard care in the management of periodontal conditions. However, further research assessing the toxicity, durability, and other assessments followed by clinical trials is necessary to explore the potential of Tulsi in combating oral conditions.
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Fibrin network pattern changes of platelet-rich fibrin in young versus old age group of individuals: A cell block cytology study p. 151
Shravanthi Raghav Yajamanya, Anirban Chatterjee, Chaitanya Nischay Babu, Deepika Karunanithi
Background: To evaluate variations in fibrin network patterns of the platelet-rich fibrin (PRF) in different age groups. Materials and Methods: Ninety-five patients were divided into three age groups: Group 1: (20–39 years); Group 2: (40–59 years); and Group 3: (60 years and above). PRF was prepared from blood samples of all patients and were subjected to cell block cytology method of histological analysis and slides were prepared to histologically assess the age-related changes in (i) fibrin network patterns in terms of density and (ii) entrapment of platelets and white blood cells (WBCs) within fibrin meshwork. Results: Two types of fibrin network pattern arrangements noticed: Dense and loose types in three age groups. However, there was a noticeable decrease in the dense type of fibrin network with progressing age and increase in the loose type of fibrin arrangement. Furthermore, variation in a number of platelets and WBCs entrapped within fibrin network in relation to age was noticed. Conclusion: From the current study it can be concluded that age can be considered as one of the influencing factors on quality of PRF in terms of fibrin network patterns and hence, platelet and WBCs entrapment within these fibrin networks.
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Hidden truth of circulating neutrophils (polymorphonuclear neutrophil) function in periodontally healthy smoker subjects p. 157
Chitra Agarwal, Tarun Kumar Baron, Dhoom Singh Mehta
Context: Tobacco smoking is considered to be a major risk factor associated with periodontal disease. Smoking exerts a major effect on the protective elements of the immune response, resulting in an increase in the extent and severity of periodontal destruction. Aims: The aim of the present study was to assess viability and phagocytic function of neutrophils in circulating blood of the smokers and nonsmokers who are periodontally healthy. Settings and Design: Two hundred subjects in the mean range of 20–30 years of age were included in the study population. It was a retrospective study carried out for 6 months. Materials and Methods: Two hundred subjects were divided into four groups: 50 nonsmokers, 50 light smokers (<5 cigarettes/day), 50 moderate smokers (5–15 cigarettes/day), and 50 heavy smokers (>15 cigarettes/day). Full mouth plaque index, sulcus bleeding index, and probing depths were measured. Percentage viability of circulating neutrophils and average number of phagocytosed Candida albicans were recorded. Statistical Analysis Used: Means and standard deviations were calculated from data obtained within the groups. Comparison between the smokers and nonsmokers was performed by Kruskal–Wallis ANOVA analysis. Comparison between smoker groups was performed using Mann–Whitney–Wilcoxon test. Results: Percentage viability of neutrophils was significantly less in heavy smokers (66.9 ± 4.0), moderate (76.6 ± 4.2), light smokers (83.1 ± 2.5) as compared to nonsmokers (92.3 ± 2.6) (P < 0.01). The ability of neutrophils to phagocytose, i.e., mean particle number was significantly less in light smokers (3.5 ± 0.5), moderate smokers (2.3 ± 0.5), and heavy smokers (1.4 ± 0.5) compared to nonsmokers (4.9 ± 0.7) (P < 0.01) with evidence of dose-response effect. Conclusions: Smoking significantly affects neutrophils viability and phagocytic function in periodontally healthy population.
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Clinical and postextraction evaluation of periodontal disease indicators p. 161
Rajashri Kolte, Abhay Kolte, Pooja Wattamwar
Background: Clinical attachment level is the most frequently used and acceptable parameter in monitoring periodontal status in diseased individual and denotes patterns of periodontal destruction. Awareness of root morphology and the condition of the periodontal tissues is essential for reliable periodontal pocket probing and for effective debridement of root surfaces. Clinically, it is challenging to observe exact nature of complex periodontal attachment loss. The aim of the present study was to evaluate patterns of periodontal destruction based on vertical and horizontal attachment loss. Materials and Methods: A total of 200 extracted teeth were obtained from chronic periodontitis patients. Prior to extraction, clinical measurements were recorded and after extraction, the teeth were stained with crystal violet. Root length, vertical and horizontal attachment loss were measured using digital caliper. Results: There was a significant difference between clinical attachment level and vertical attachment loss for both maxillary and mandibular teeth. Mean vertical attachment loss varied between 5.17 mm and 9.17 mm. Interproximal surfaces exhibited statistically significant vertical attachment loss in both maxillary and mandibular dentition. Results indicated that vertical attachment loss was more severe with teeth belonging to the anterior sextant whereas the horizontal attachment loss was more pronounced with posterior teeth. Conclusion: Both vertical and horizontal attachment loss were observed in all periodontally involved teeth. There was a difference in clinical measurements and actual periodontal status denoted by postextraction staining. These findings have an impact on determining the prognosis and appropriate treatment plan for patients.
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The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically p. 167
Kharidhi Laxman Vandana, Ira Gupta
Background: To evaluate the gingival margin position (GMP) before and after open flap debridement in different gingival thickness (GT). Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B), mesiobuccal (MB), and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin) and Group 2 (thick). Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months), MB site (16 months). The gingival recession was obvious at Mi-B sites (16 months). In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months) period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically.
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Comparative evaluation of soft and hard tissue dimensions in the anterior maxilla using radiovisiography and cone beam computed tomography: A pilot study p. 174
Savita Mallikarjun, Harsha Mysore Babu, Sreedevi Das, Abhilash Neelakanti, Charu Dawra, Sachin Vaijnathrao Shinde
Aims: To assess and compare the thickness of gingiva in the anterior maxilla using radiovisiography (RVG) and cone beam computed tomography (CBCT) and its correlation with the thickness of underlying alveolar bone. Settings and Design: This cross-sectional study included 10 male subjects in the age group of 20–45 years. Materials and Methods: After analyzing the width of keratinized gingiva of the maxillary right central incisor, the radiographic assessment was done using a modified technique for RVG and CBCT, to measure the thickness of both the labial gingiva and labial plate of alveolar bone at 4 predetermined locations along the length of the root in each case. Statistical Analysis Used: Statistical analysis was performed using Student's t-test and Pearson's correlation test, with the help of statistical software (SPSS V13). Results: No statistically significant differences were obtained in the measurement made using RVG and CBCT. The results of the present study also failed to reveal any significant correlation between the width of gingiva and the alveolar bone in the maxillary anterior region. Conclusions: Within the limitations of this study, it can be concluded that both CBCT and RVG can be used as valuable tools in the assessment of the soft and hard tissue dimensions.
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Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals p. 180
Srinivasa Tenkasale Siddeshappa, Sonika Nagdeve, Ramreddy Krishnarao Yeltiwar, Humera Parvez, Sushmita Deonani, Vikas Diwan
Background and Objective: Chronic low-level bacteremia and a systemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The objective of this study is to evaluate the effect of nonsurgical periodontal therapy on various hematological parameters in patients with periodontitis. Materials and Methods: A total of 30 periodontitis patients were selected for the study. Clinical parameters such as plaque index, gingival index, and probing pocket depth were assessed. For each patient, venous blood sample were collected, and the estimation of total leukocyte count (TLC), differential leukocyte count, platelet count, and erythrocyte sedimentation rate (ESR) was carried out. All the clinical and hematological parameters were measured at baseline, 1 week and 2 weeks after nonsurgical periodontal therapy. Results: The study results showed that there was a statistically significant decrease in TLC, ESR, and platelet count at 1 week and 2 weeks following nonsurgical periodontal therapy. Conclusion: In this study, it has been concluded that there is a decrease in the hematological parameters after nonsurgical periodontal therapy, which may also reduce the risk of atherosclerosis formation in the blood vessel and possibly prevent cardiovascular diseases.
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Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study p. 184
Kirti Chawla, Arundeep Kaur Lamba, Shruti Tandon, Farrukh Faraz, Varun Gaba
Aim: The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT) on wound healing after depigmentation procedure. Materials and Methods: In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site) using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine) on the 3rd, 7th, and 15th day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. Results: At day 3, test site showed 1.26 ± 0.23 mm2 and control site showed 1.45 ± 0.21 mm2 stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm2 and 1.12 ± 0.25 mm2 stain uptake, whereas the control site showed 1.37 ± 25 mm2 and 1.29 ± 0.28 mm2 staining, respectively, which were not statistically significant. Conclusion: Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3rd day. On the 7th and 15th day, the difference in healing was not statistically significant.
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Comparative evaluation of management of gingival recession using subepithelial connective tissue graft and collagen membrane by periodontal microsurgical technique: A clinical study of 40 cases p. 189
Prasanth Thankkappan, Subrata Roy, Vivek Bapurao Mandlik
Background: New technologies, instruments, and surgical techniques are necessary to help the clinician ensure the best result and satisfy the patient's expectations, and surgical microscope has been thoroughly demonstrated as a useful tool. A clinical study was carried out to compare 2 different types of root coverage procedures using periodontal microsurgical procedure. Materials and Methods: Forty patients were selected and divided into Group A and Group B. Group A subjects were treated with subepithelial connective tissue graft (CTG) whereas Group B subjects were treated using a resorbable collagen membrane. The procedures were performed with the help of an operating microscope using 250 mm objective lens and ×6 magnification. Results: A comparison between baseline, 1, 3, and 12 months have been done between groups among all parameters. It has been noticed that the root coverage was better in Group A subjects at all time. At 12 months, Group A showed 81.42% coverage where in Group B it was 70.08%. Similarly, increase in the width of keratinized gingiva and attached gingiva were more in Group A. Conclusions: The present study showed that use of microsurgical instrument helped to deliver precise incision, better visual acuity, and improved illumination which facilitate to gain a better final outcome. Root coverage was better in the patients using CTG.
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Assessment of oral health status and periodontal treatment needs among rural, semi-urban, urban, and metropolitan population of Gurgaon District, Haryana State p. 195
Harpreet Singh Grover, Amit Bhardwaj, Narender Yadav
Background: Role of various etiologic factors in periodontal disease has been investigated by means of epidemiologic surveys and clinical studies. The community periodontal index of treatment needs (CPITN) provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions. Materials and Methods: This study was conducted on 4000 individuals among rural, semi-urban, and metro population of Gurgaon District, Haryana State, to find out the oral health status and periodontal treatment needs (TNs) using CPITN index. Results: An inference was drawn from the results that among 4000 participants from all the four population groups' maximum, i.e., 63.80% of individuals needed TN2 whereas 18.20% of individuals needed TN3 and 18.10% of individuals needed TN1. Conclusion: It can be concluded with a word of hope and a word of warning. Hope lies in the fact that the measurement of periodontal diseases by epidemiological study of this condition is improving and receiving wide spread attention. The warning lies in the varied nature of the condition which goes to make up periodontal disease and perplexing ways in which these conditions blend. In addition to dental practitioner, periodontist and public health workers must devote more time and effort toward controlling periodontal disease than they seem to be devoting at present.
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A rare presentation of lipoma on mandibular mucogingival junction p. 199
Gaurav Sharma, Kanu Jain, Archna Nagpal, Chandrababu Sudha Baiju
Lipoma is the most common tumor of mesenchymal tissues of body, but its occurrence in oral cavity is infrequent. Buccal mucosa is the most common intraoral site of lipoma followed by tongue, floor of the mouth, and buccal vestibule. The involvement of mucogingival junction is rare. We present a unique case report of oral lipoma occurring on mandibular mucogingival junction with review of literature which has emphasis on differential diagnosis.
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Mucoepidermoid carcinoma of the palate: A rare case report p. 203
Samiksha Jaypal Jarde, Sushma Das, Savitha Arumugam Narayanswamy, Anirban Chatterjee, Chaitanya Babu
Mucoepidermoid carcinomas (MECs) of minor salivary gland origin are rare in children and adolescents and have been reported rarely. Literature regarding their clinical features and biologic behavior is scanty. The purpose of this case report is to discuss the clinical manifestation, diagnosis, and treatment plan of MEC of the palate. A 16-year-old male subject visited the Department of Periodontics, The Oxford Dental College and Hospital, Bangalore, India complaining of a painless swelling in the left posterior area of the hard palate since 6 months. Several clinical, radiographic, and histopathological investigations were carried out to rule out the lesion. Incisional biopsy of the lesion confirmed the diagnosis of lesion as MEC of the palate following which a wide surgical excision with adjacent free margins was carried out. This case report highlights the need for proper diagnosis and treatment plan in the cases of malignant tumors as it can lead to morbidity and mortality.
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Esthetic dentistry for multiple gingival recession cases: Coronally advanced flap with bracket application p. 207
Minkle Gulati, Ashish Saini, Vishal Anand, Vivek Govila
Treatment of gingival recession is essential to rectify the esthetic and functional deficiencies of the patient and to combat further periodontal destruction. However, treating multiple recession cases is quite challenging, and therefore requires constant modifications of the prevalent treatment strategies as per the severity of the condition. The objective of this case report was to evaluate the effectiveness of coronally advanced flap (CAF) technique without vertical incisions using CAF brackets (CAF+B) for treating a patient presenting with class II gingival recession defects in relation to maxillary anteriors. Complete root coverage was observed, and the results were consistent even after 6 months. The current case report demonstrates good outcomes of the CAF + B technique without the use of any additional soft tissue grafts or vertical incisions, therefore, endorsing the promising potential of the CAF + B technique in multiple gingival recession cases.
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An interdisciplinary approach for the management of noncarious lesions p. 211
Sahana Purushotham, Nandini Manjunath, Melba Lisa DíSouza, Roshan Shetty
Miller's class III gingival recession is a common entity observed in individuals, posing a difficult situation for the clinicians to treat. Large fenestration defects with cervical abrasion compromise the esthetics resulting in poor prognosis. Obtaining predictable and esthetic root coverage has become an integral part of periodontal therapy. The present case report describes a situation where class III gingival recession with cervical abrasion was seen in the lower central incisors. The patient was successfully treated with a combination of restorations (Filtek Z350® composite resin) to fill the defect, followed by fenestration procedure to increase the vestibular depth and subsequently with grafting procedure (soft tissue autograft with bovine-derived xenograft collagen [Bio-oss]). Though the results were not tangible esthetically, it was functionally successful as evidenced during the follow-up period.
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Pedicled buccal fat pad graft for root coverage in severe gingival recession defect p. 216
Saurav Panda, Massimo Del Fabbro, Anurag Satpathy, Abhaya Chandra Das
Gingival recession (GR) is a condition resulting in root exposure which leads to root sensitivity, pain, root caries, plaque retention, poor esthetics, and tooth loss. Sites exhibiting Miller Class III and IV GR are not suitable for treatment with surgical root coverage techniques, and their prognosis are very poor with current techniques. In this case report, pedicled buccal fat pad (PBFP) was employed as subepithelial graft technique for root coverage of maxillary tooth with Class III GR defect along with furcation involvement and the absence of keratinized gingiva. PBFP as the subepithelial graft is likely to increase the predictability and outcome of root coverage procedures in the treatment of cases with poor prognosis, owing to its pedicled vascularity. PBFP may be considered as a reliable modality for root coverage of such severe maxillary posterior GR defects, as reported, that could not be repaired by other conventional procedures.
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Periosteal pedicle graft for the treatment of gingival recession defects current status and future prospects: What the evidence suggests? p. 220
Ajay Mahajan, Kanwarjit Singh Asi
Background: Gingival Recession defects are one of the most common defects for which patients seek periodontal treatment. Many treatment options are available for the management of gingival recession .Most of the treatments offered aim to treat the cause, cover the denuded root surface and produce a long term aesthetic result. The use of periosteal pedicle graft (PPG) is a recent innovation for the treatment of gingival recession defects and has gained much attention in a short span of time. Although studies have been done utilizing PPG successfully for the treatment of gingival recession defects (GRD) but it is still not clear, whether PPG technique should be included in the established list of techniques used to treat GRD? An effort has been made to arrive at a decision on the current utility of PPG in the treatment of GRD based on the scientific evidence available in literature. Materials and Methods: A review of current literature was done to critically evaluate the evidence related to the Periosteal pedicle graft technique. Results and Conclusion: Periosteal Pedicle Graft has come up as a viable treatment option for the treatment of GRD although it's still too early to predict the long-term results associated with PPG.
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Primary culprit for tooth loss!! p. 222
Sailavanya Nuvvula, Vijay Kumar Chava, Sivakumar Nuvvula
Aim: In order to facilitate planning for dental health services and to progress strategies to continue the reduction in tooth loss, it is important to identify the factors that result in such loss. therefore the aim of the study is to investigate the major cause for tooth extraction. Objective: to examine whether the major reason for tooth extraction is dental caries or periodontal disease. Materials and Methods: The study is carried out among the dental practitioners in our district. A questionnaire containing 10 items was distributed to the dental practitioners, which included age, gender, no of teeth indicated for extraction, the reason for extraction, and the periodontal parameters that are involved with the extracted tooth and were requested to complete the form on every extraction they were to undertake. the study form was collected at the end of the study period and data was subjected to statistical analysis. Results: A total of 502 patients were enrolled during the study period, and a total of 1055 teeth were extracted for several reasons. we found that 51.14%extractions are due to dental caries in case of 20-30years age groups, which is more when compared to tooth loss due to periodontal diseases in this age group. whereas in case of >40years of age group periodontal diseases account for 54.11%, and dental caries accounts for only 29.11%. Showing more teeth were lost due to periodontal disease. Conclusion: therefore we concluded that, caries is the dominant reason for extraction in patients with 20–30 years of age while periodontal disease accounts for the majority of tooth extraction in patients older than 40 years.
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