Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
July-August 2020
Volume 24 | Issue 4
Page Nos. 297-391

Online since Wednesday, July 1, 2020

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Speculation (S) versus anticipation (A) versus reality (R) - Corona Virus-2 Highly accessed article p. 297
Ashish Kumar
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Transformation of dentistry in post COVID era Highly accessed article p. 299
Nymphea Pandit
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Adjusting to a new world - Are we ready? p. 300
Harpreet Singh Grover
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Reproducibility and validity of anterior implant esthetic indices: A review p. 301
Gunjan Srivastava, Swagatika Panda, Saurav Panda, Subrat Kumar Padhiary, Sitansu Sekhar Das, Massimo Del Fabbro
Background: The purpose of this review was to narrate about the reproducibility and validity of different indices evaluating esthetic aspects in anterior single implant-supported restorations. Materials and Methods: An electronic search of Medline, Scopus, Embase, Cochrane Central, and Web of Science databases was performed using the keywords “dental implants,” “anterior esthetics,” “esthetic score,” and “esthetic index.” Besides, a manual search of dental implant journals was carried out. Results: The electronic search revealed 932 titles. After further review, 14 articles fulfilled the eligibility criteria and were included in this review. Because of the heterogeneity of the study designs, interventions, and parameters used for assessment of esthetics, no meta-analysis could be performed. Conclusion: Many indices have been proposed for the evaluation of the esthetic aspects of single implant-supported reconstructions in the anterior maxilla. All of them have some advantages and drawbacks that this review pointed out. The evidence level of studies used for the validation of these indices is poor. It is necessary to achieve a consensus on the tools for assessment of the esthetic aspect and perform evidence-based studies to validate an appropriate index.
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Mapping the link between cardiac biomarkers and chronic periodontitis: A clinico-biochemical study p. 309
Ramanarayana Boyapati, Vijaya Vudathaneni, Swetha Bharathi Nadella, Radhika Ramachandran, Ravindranath Dhulipalla, Chaitanya Adurty
Background: Various risk factors are coupled with atherosclerotic complications, such as myocardial infarction and stroke. Periodontitis is considered one of them. Aims and Objectives: The objective of the study is to compare and correlate the occurrences of periodontitis with serum levels of cardiac-biomarkers in patients with coronary heart-disorders. Materials and Methods: Of 70 individuals diagnosed with coronary artery diseases, 32 patients with chronic periodontitis constituted the test group, 31 without chronic periodontitis constituted the control group. Cardiac-biomarkers analyzed were Troponin T, Troponin I, Myoglobin; low density lipoprotein (LDL), high-density lipoprotein, very LDL (VLDL), total cholesterol (TC), and highly sensitive C-reactive protein (Hs-CRP). Periodontal characteristics were drawn from the plaque index (PI) and gingival index, probing depth (PD), clinical attachment loss, and periodontal inflammatory surface area (PISA). Statistical Analysis: In order to separate any association between cardiac biomarkers and clinical parameters of periodontitis, detailed statistical analysis through independent t-test and Pearson test of correlation was done. Results: Statistically significant differences were seen not only in PI, PD, and PISA between both the groups (P < 0.05), but also between various cardiac parameters of test and control groups (P < 0.001). Positive relations were seen in the test group, between cardiac biomarkers such as TC, VLDL, Hs-CRP, and Troponin T with periodontal parameters such as PD and PISA. Conclusion: The study reveals, a strong association between periodontitis and diseases of cardiovascular nature, highlighting the need for awareness and timely medical interventions to prevent periodontitis from scaling up and interfering with the risk of cardiovascular problems.
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Topographic characterization and in vitro biofilm adhesion to titanium and polypropylene membranes used for alveolar preservation p. 316
Marcela Resende, Elizabeth Ferreira Martinez
Background: Nonresorbable membranes have been widely used in guided bone regeneration (GBR) procedures in posttooth extraction alveoli. In this context, one of the properties suggested by the GBR technique is that these barriers, when exposed to the oral environment, control or prevent the infiltration of connective and epithelial tissue cells, favoring the proliferation of bone cells inside the alveolus, without the growth of biofilm. Materials and Methods: This in vitro study evaluated the topographic characteristics and in vitro biofilm adhesion on membranes used for alveolar preservation, bone Heal and Titanium Seal. Fragments of these membranes (5 mm × 5 mm) were used for all experiments. The topographical morphology and chemical characterization of the membranes were analyzed by scanning electron microscope and dispersive energy X-ray spectroscopy, respectively. For the in vitro biofilm adhesion assay, samples were immersed in Candida albicans (American Type Culture Collection [ATCC] 10231) and Staphylococcus aureus(ATCC 25923) mixed biofilm for 7 and 14 days. Biofilm formation was measured by quantitative analysis with crystal violet aqueous solution, in a spectrophotometer, with a wavelength of 590 nm. Results: The ultrastructural images showed a rough surface for the titanium membrane, without homogeneity in the surface structure, while the polypropylene membrane presented a smoother surface without depressions. The chemical composition of the membranes by Ehlers–Danlos syndrome has identified the presence of copolymer and traces of zinc for the polypropylene membrane; in contrast, the titanium membrane revealed the unique presence of titanium. In addition, there was a decrease in biofilm formation on the surface of the titanium membrane compared to polypropylene (P < 0.05), at both evaluated times. Conclusions: It can be concluded that despite the greater heterogeneity of the titanium membrane surface, the results showed less biofilm formation on this membrane (P < 0.05), which may be indicated in cases of oral cavity exposure.
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Evaluation of deoxypyridinoline levels in gingival crevicular fluid and serum as alveolar bone loss biomarker in patients with periodontitis p. 322
Suhail Syed, Vinathi Reddy Kankara, Krishnanjeya Reddy Pathakota, Preethi Krishnan, Ashank Mishra
Background: Several components of gingival crevicular fluid (GCF) reflect the course and predictability of periodontal disease and provide a pointer toward disease status. Potential biomarkers deoxypyridinoline (DPD), a metallophosphoesterase would correctly determine the presence of osteoclast-mediated bone turnover activity and seems to hold great promise as a predictive marker to determine bone destruction and active phases in the disease progression. Aim: The aim of the current study is proposed to investigate the biologic plausibility for the levels of DPD as biomarker in chronic periodontitis patients. Materials and Methods: The present cross-sectional study comprised 15 periodontally healthy and 15 chronic periodontitis patients who were age and genders matched, recruited from the outpatient department of Periodontics. GCF and blood samples for DPD estimation were collected from all the patients and analyzed using enzyme-linked immunosorbent assay kit. The clinical parameters such as clinical attachment loss (CAL), probing pocket depth (PPD), modified gingival index, bleeding index , and plaque index were recorded. Results: GCF DPD levels were significantly higher in chronic periodontitis patients when compared to periodontally healthy group. There were no significant correlations found among GCF and serum DPD levels with increasing age, gender, disease severity, and increase in PPD and CAL in both the groups. Conclusion: Within the limitations of this study, increased GCF DPD levels in chronic periodontitis can gauge ongoing periodontal destruction.
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Long-term stability of retreated defective restorations in patients with vertical food impaction p. 329
Golpar Radafshar, Fahimeh Khaghani, Samar Rahimpoor, Arshia Shad
Background: Vertical food impaction (VFI) is a common complaint among patients receiving interproximal restorations. However, there is a gap in the literature regarding outcomes of treating defective restorations with VFI. This study sought to determine 10-year stability of retreated defective restorations in patients diagnosed with VFI. Materials and Methods: A total of 150 teeth (75 pair), in 38 patients comprised our study population. All the participants had been diagnosed with VFI due to faulty restorations and treated by means of redoing the restoration to build a stable contact in at least one restored tooth. The criteria for building an optimum dental contact were defined. Demographic characteristics, date and frequency of redoing the restoration, type and material of restoration, number of restored surfaces, occlusal intercuspal relationship, missing adjacent and/or opposing teeth, cemento enamel junction to alveolar crest distance, recurrence of VFI symptoms, recurrent caries, and periapical pathology as well as periodontal variables were recorded. Results: Kaplan–Meier estimator revealed that the mean ± standard deviation of 1, 3, 5, and 10-year stability of reconstructed contacts was 89/2% ± 3/6%, 79/2% ± 5%, 70/7% ± 0/06%, and 66/3% ± 7/1%, respectively. The overall cumulative stability rate was 74/4%. Further analysis predicted that over a 12-year period, restored contacts were stable for 8.86 ± 0.6 years. Cox regression model indicated that having cusp to marginal ridge occlusal relationship (95% confidence interval [CI] for hazard risk (HR) = 1/1–13/9, HR = 3/93), and being over 40 years of age (95% CI for HR = 0/88–17/66, HR = 3/95) were major determinants of contact stability. Conclusions: Long-term stability of retreated and restructured tooth contacts with a history of VFI was 66%–89% in this specific sample.
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A novel approach in the management of mandibular degree II furcation defects using bone grafts in conjunction with a biomimetic agent: A randomized controlled clinical trial p. 334
Koyyalamudi Prudhvi, Katragadda Raja Venkatesh Murthy
Aim: Of the periodontal defects requiring regeneration, degree II furcation defects pose a substantial challenge to clinicians. This study was designed to evaluate the relative effectiveness of bone autograft (BA) and autologous platelet-rich fibrin (PRF) as against decalcified freeze-dried bone allograft (DFDBA) along with autologous PRF in the management of degree II mandibular furcation defects.Materials and Methods: Fourteen patients (11 men and 3 women; mean age: 42.36 years), with bilateral degree II buccal furcation defects in the mandibular molars, were enrolled in the study. In each patient, randomly selected sites were divided into control site (site A) which received BA with PRF membrane and test site (site B) received DFDBA + PRF mixed with graft and also as a membrane using split-mouth design. Clinical parameters including plaque index, gingival index, gingival marginal levels, probing depth, and clinical attachment level were recorded at baseline and at 3 and 6 months' postsurgery. Horizontal and vertical furcation measurements were taken prior to the surgery through sounding and after degranulation. These measurements were repeated after 6 months. Results: The mean reduction in the horizontal defect depth was 1.86 ± 0.66 mm (70.75%) in site A and 1.71 ± 0.73 mm (74.25%) in site B. The mean improvement in the vertical defect fill was 1.64 ± 0.74 mm (55.8%) in site A and 1.43 ± 1.34 mm (64.86%) in site B was achieved. Conclusion: The use of combination therapy using either BA or DFDBA in conjunction with PRF appears to be effective in treating furcations.
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A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller's Class I recession coverage therapy p. 342
Thamil Selvan Muthuraj, Somen Bagchi, Prasanta Bandyopadhyay, Soma Mallick, Papita Ghosh, Murugan Jeyasree Renganath
Background: According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller's Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller's Class I GR. Materials and Methods: All the 15 patients participated in the study who had totally 30 bilateral Miller's Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. Results: The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. Conclusion: From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller's Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.
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Evaluation of the efficacy of subgingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries p. 348
Rajni Jain, Rashi Chaturvedi, Nymphea Pandit, Vishakha Grover, Deborah M Lyle, Ashish Jain
Background: In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations. Aims: The aim of this study was to evaluate of the efficacy of sub-gingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries. Settings and Design: Randomized comparative parallel group interventional clinical trial. Materials and Methods: Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06% chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12% CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks' postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows). Results: A statistically significant difference was seen with the use of 0.06% CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12% CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing. Conclusion: The adjunctive use of subgingival home irrigations using 0.06% CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.
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Clinical and microbiological effects of 1% Matricaria chamomilla mouth rinse on chronic periodontitis: A double-blind randomized placebo controlled trial p. 354
Ashish Agarwal, Bharti Chaudhary
Background: Several herbal mouth rinses are assessed in the literature as an adjunct to scaling and root planning (SRP) for the treatment of periodontal diseases. The objective of this study was to evaluate and compare the clinical and microbiological effects of Matricaria chamomilla (MTC) mouth rinse with chlorhexidine (CHX) and placebo mouth rinse for the management of chronic periodontitis. Materials and Methods: This double-blind, randomized, placebo controlled, clinical trial involved seventy five patients, suffering from chronic periodontitis, which were randomly divided into three groups: negative control (SRP + placebo), positive control (SRP + 0.12% CHX), and test group (SRP + 1% MTC mouth rinse). Mouth rinsing (adjunctive therapy) was continued for 1 month while clinical parameters (plaque index, gingival index, sulcus bleeding index, probing pocket depth [PPD], clinical attachment level, gingival recession [GR], stain index) and microbial colony forming units were evaluated at base line, 6 weeks, and 3 months. Results: All groups showed a significant change in parameters (except GR for placebo group) between base line and 3 months. MTC mouth rinse suggested added significant benefits over placebo group over the study period. However, it determined more but nonsignificant improvement in PPD (3.68 mm vs. 3.36 mm) and CAL (3.00 mm vs. 2.72 mm) as compared to CHX rinse at 3 months' period as compared to baseline. Conclusion: Advantages of using test group were comparable to CHX associated group; therefore, MTC mouth rinse can be used as an effective adjunct during nonsurgical periodontal therapy for chronic periodontitis.
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A comparative evaluation of manual and powered brushing on oral health and microbial status of mentally challenged individuals p. 362
Kharidi Laxman Vandana, Pramod Vinayak Tatuskar, Narayan Narendra Valavalkar
Background: Tooth brushing is a very simple and effective method for removing daily dental deposits and for preventing dental and periodontal diseases. In physically or mentally challenged person, there arises difficulty in oral hygiene maintenance so that oral hygiene methods may need to be simplified or modified to suit the individual situation. Methodology: Thirty individuals of age group 15–30 years with mild to moderate degree of mental retardation were selected. A randomized double-blind split-mouth design with Clinical Phase-i (aided brushing) and Clinical Phase-ii (unaided brushing) with a washout period of 3 days was conducted. The study duration was for 0–45 days. Two types of brushing that is manual and powered brushing were done. The recording of all clinical and microbial parameters were done on 0th day and 21st day while the clinical parameters were recorded up to 45th day. Results: On intragroup comparison, throughout the study phases, both manual and powered brushing significantly reduced the Quigley–Hein plaque index (48%), gingival bleeding index (GBI) (44%), and modified gingival index (52%). The Pearson correlation between GBI and periodontal pathogens like Prevotella internedia, Porphyromonas gingivalis, and Fusobacterium nucleatum showed statistically significant relation (P < 0.05) in powered brushing group. Conclusion: Powered toothbrush was more effective than manual toothbrush in reducing plaque levels and microbial count in the mentally challenged individuals. The Colgate 360 tooth brush is advisable to mentally challenged individuals.
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Effectiveness of fluoride varnish, diode laser, and their combination in treatment of dentin hypersensitivity: A randomized split-mouth clinical trial p. 369
Akanksha Jain, Jyoti Rao, Neha Pal, Alok Singh
Background: Dentin hypersensitivity is a common dental problem with no permanent cure and predictable prognosis. Aim: The aim of this study was to evaluate the effectiveness of fluoride varnish (sodium fluoride [NaF]), diode laser, and the combination of NaF and diode laser in the treatment of dentin hypersensitivity. Settings and Design: This was a randomized split-mouth clinical trial. Materials and Methods: Sixty patients aged 20–60 years suffering from dentin hypersensitivity to air-blast, cold, and tactile stimulation corresponding to 4 cm and above on the Visual Analog Scale (VAS) in three quadrants with at least two hypersensitive teeth per quadrant were selected. Hypersensitive teeth were allotted to Group 1 – 5% NaF varnish application alone, Group 2 – 810-nm gallium–aluminum–arsenide laser (GaAlAs) diode laser (0.5 W) irradiation alone, and Group 3 – NaF varnish application, followed by diode laser irradiation. VAS score was recorded at baseline, 1 week, 2 weeks, 1 month, 3 months, and 6 months. Results: A statistically significant reduction in dentin hypersensitivity was observed in all the three groups, from the baseline to the 1st-, 3rd-, and 6th-month follow-ups (P < 0.05). Group 2 and Group 3 demonstrated a significantly higher reduction (P < 0.05) in dentin hypersensitivity for all the stimuli as opposed to Group 1 at all follow-up intervals. However, no statistically significant difference (P > 0.05) was present between Group 2 and Group 3 at all follow-ups. Conclusion: Diode laser is significantly more effective than fluoride varnish alone in the treatment of dentin hypersensitivity over a period of 6 months.
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Awareness and knowledge regarding maternal periodontal status and associated pregnancy outcomes among the gynecologists of Hubli-Dharwad p. 375
Shiphalika Sinha, Pragathi Raghavendra Bhat, Vivek Vijaykumar Govekar, Vijay Ashok Trasad, Anirudh Balakrishna Acharya
Introduction: Periodontitis is an inflammatory disease of gingiva and its supporting structures and is known to cause systemic infection which has adverse effect on pregnancy outcomes, such as preterm birth, preeclampsia, or miscarriage, which have been linked to maternal periodontitis. Aim: Thus, this study aimed to evaluate the knowledge and awareness regarding the association of periodontitis and adverse pregnancy outcomes among the gynecologists practicing in Hubli-Dharwad city. Materials and Methods: The study involved a survey for 50 practicing gynecologists in Hubli-Dharwad city, a pretested close-ended questionnaire was distributed comprising 10 questions on oral health for expectant mothers, and thus, their knowledge and awareness levels were assessed. Results: The results showed that majority of gynecologists agreed importance of maintaining good general health during pregnancy and supported that providing dental treatment during pregnancy improved the pregnancy outcomes. Conclusion: However, practical implementation and referring patients to dentists were less. The gynecologists were aware of the facts but failed to execute at the clinical level. Thus, this bilateral interdisciplinary protocol can thus reduce the incidence of maternal and neonatal complications.
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Idiopathic gingival fibromatosis with massive gingival overgrowth: A rare case report p. 379
Swati Sharma, Ajoy Kumar Shahi, Virendra Kumar Prajapati, Bishnupati Singh
Idiopathic gingival overgrowth can present itself as a part of syndrome or as an isolated entity. This is a case report of a massive gingival enlargement in a 12-year-old female child with nonsyndromic gingival fibromatosis, which was treated by multidisciplinary approach involving surgical and prosthetic rehabilitation and at the same time instilling psychological benefit.
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Accidental intraoperative ingestion of a paralleling pin during implant placement p. 383
PN Ramaraj, HK Ajeya Ranganathan, VM Nithin, G Vijaya Lakshmi
Foreign body ingestion although unusual may be possible during dental treatment when placing any implants, prosthetic crowns, restoration, endodontic treatment, or orthodontic treatment. When the ingestion occurs, it is always crucial to locate the foreign body within the patient's body by taking bi-planar radiographs. Any features of airway distress or obstruction should be ruled out and if it is located in the gastrointestinal (GI) tract, the nature and size of the material will decide the protocol of retrieval of the ingested object. However, there is always a risk of intestinal perforations or obstructions secondary to the ingestion. Here is a case report wherein there was an accidental ingestion of the paralleling pin during the first stage of the implant placement with indications of various GI investigations and recommendations to avoid instrument ingestion.
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Treatment of Grade III furcation involvement in upper molars: Case Series with 2–16-year follow-up p. 387
Camila Lopes Ferreira, Juliana de Fátima Pedroso, Victória Clara da Silva Lima, Tatiane Caroline de Souza Ramos, Antonio Braulino Melo Filho, Maria Aparecida Neves Jardini
Frequently, the clinicians are addressed to decide between the preservation of Grade III furcation molar and the implant replacement, due to the increased access among the population to this therapy over the years and high success rate of the osseointegrated implants. This case series presents clinical and radiographic data collected from 10 patients who underwent 13 root amputations for the treatment of degree Grade III furcation in maxillary molars with follow-up until 16 years. The results showed improvements in probing depth, bleeding on probing, and radiographic aspects. The follow-up time indicates that root amputation is an effective long-term treatment solution, especially when the patient's local, systemic, or financial conditions make it difficult or impossible to implant placement.
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