Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   2010| July-September  | Volume 14 | Issue 3  
    Online since January 20, 2011

 
 
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ORIGINAL ARTICLES
Horizontal alveolar bone loss: A periodontal orphan
A Jayakumar, S Rohini, A Naveen, A Haritha, Krishnanjeneya Reddy
July-September 2010, 14(3):181-185
DOI:10.4103/0972-124X.75914  
Background: Attempts to successfully regenerate lost alveolar bone have always been a clinician's dream. Angular defects, at least, have a fairer chance, but the same cannot be said about horizontal bone loss. The purpose of the present study was to evaluate the prevalence of horizontal alveolar bone loss and vertical bone defects in periodontal patients; and later, to correlate it with the treatment modalities available in the literature for horizontal and vertical bone defects. Materials and Methods: The study was conducted in two parts. Part I was the radiographic evaluation of 150 orthopantomographs (OPGs) (of patients diagnosed with chronic periodontitis and seeking periodontal care), which were digitized and read using the AutoCAD 2006 software. All the periodontitis-affected teeth were categorized as teeth with vertical defects (if the defect angle was ≤45° and defect depth was ≥3 mm) or as having horizontal bone loss. Part II of the study comprised search of the literature on treatment modalities for horizontal and vertical bone loss in four selected periodontal journals. Results: Out of the 150 OPGs studied, 54 (36%) OPGs showed one or more vertical defects. Totally, 3,371 teeth were studied, out of which horizontal bone loss was found in 3,107 (92.2%) teeth, and vertical defects were found only in 264 (7.8%) of the teeth, which was statistically significant (P<.001). Search of the selected journals revealed 477 papers have addressed the treatment modalities for vertical and horizontal types of bone loss specifically. Out of the 477 papers, 461 (96.3%) have addressed vertical bone loss, and 18 (3.7%) have addressed treatment options for horizontal bone loss. Two papers have addressed both types of bone loss and are included in both categories. Conclusion: Horizontal bone loss is more prevalent than vertical bone loss but has been sidelined by researchers as very few papers have been published on the subject of regenerative treatment modalities for this type of bone loss. This study should be an impetus for greater attention to an otherwise ubiquitous periodontal challenge.
  3 8,957 938
Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study
KS Shobha, Mahantesha , Hema Seshan, R Mani, K Kranti
July-September 2010, 14(3):160-167
DOI:10.4103/0972-124X.75910  
Background and Objectives: The purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown-lengthening in human subjects. Materials and Methods: A clinical trial study involving 15 patients was carried out for a period of 6 months. Sites were divided into 3 groups: treated (TT) sites, adjacent (AD) sites and nonadjacent (NAD) sites. Free gingival margin [FGM], attachment level, pocket depth, bone level, biological width [BW] were recorded at baseline, 1, 3 and 6 months. Direct bone level after flap reflection was recorded before and after osseous resection at baseline only. Level of osseous crest was lowered based on BW, and supracrestal tooth structure needed using a combination of rotary and hand instruments. Statistical Analysis: Student t test and ANOVA were used. Results: Overall, apical displacement of FGM at TT, AD and NAD sites was statistically significant compared to baseline. The apical displacement of FGM at TT site was more when compared to that at AD and NAD sites at 3 and 6 months. The BW at the TT site was smaller at 1, 3 and 6 months compared to that at baseline. However, at all sites, BW was reestablished to the baseline value at the end of 6 months. Interpretation and Conclusion: The BW at TT sites was reestablished to its original vertical dimension by 6 months. In addition, a consistent 2-mm gain of coronal tooth structure was observed at the 1, 3 and 6-month examinations.
  2 6,176 1,172
REVIEW ARTICLE
The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ?
Prasad Dhadse, Deepti Gattani, Rohit Mishra
July-September 2010, 14(3):148-154
DOI:10.4103/0972-124X.75908  
Many epidemiological studies have investigated the relationship between periodontal disease (PD) and cardiovascular disease (CVD), but their results are heterogeneous. This review article is designed to update the potential association, that forms the basis of understanding for a (causal) role for PD to cardiovascular events; as reported by various observational (case-control, cohort, cross-sectional) studies, epidemiological and interventional studies, not considering the other number of systemic health outcomes like cerebrovascular disease, pregnancy complications, chronic obstructive pulmonary disease, diabetes mellitus complications, osteoporosis, etc. A brief overview has been included for atherosclerosis (ATH), its pathophysiology and the association of periodontal infections as a risk factor for causing ATH, which seems to be a rational one; as development of ATH involves a chronic low-grade inflammation and moreover, it has long been set up prior to development of ischemic heart disease and thus provides potential contributing mechanisms that ATH may contribute singly or in concert with other risk factors to develop ischemic heart disease. This article goes on to discuss the correlation of evidence that is gathered from many scientific studies showing either strong, modest, weak or even no links along with their critical analyses. Finally, this article summarizes the present status of the links that possibly exist between PD and its role as a risk factor in triggering cardiovascular events, in the fairly long journey for the last two decades.
  2 4,636 945
CASE REPORTS
Amelogenesis imperfecta: A challenge to restoring esthetics and function
V Ranganath, Ashish S Nichani, V Soumya
July-September 2010, 14(3):195-197
DOI:10.4103/0972-124X.75917  
Rehabilitation of complicated cases poses difficulty in clinical practice, both with respect to restoring function and with esthetics. One such clinical condition where the dentist has to give importance to proper planning of the treatment and execution of the plan is amelogenesis imperfecta (AI), a condition where both function and esthetics are accommodated. This article discusses both the functional and esthetic rehabilitation of a patient with AI. Both the esthetics and function were hampered in this patient due to the condition. As a result, the treatment was properly planned and executed. A number of treatment options are available for us today to treat such a case. There is no one technique to be followed as such. However, the aim was to properly diagnose the case and provide good function and esthetics to the patient.
  1 13,657 641
Haim-Munk syndrome
Priyanka Pahwa, Arundeep K Lamba, Farrukh Faraz, Shruti Tandon
July-September 2010, 14(3):201-203
DOI:10.4103/0972-124X.75919  
Haim-Munk syndrome is an extremely rare autosomal recessive disorder of keratinization characterized clinically by palmoplantar hyperkeratosis, severe early onset periodontitis, onychogryphosis, pes planus, arachnodactyly, and acro-osteolysis. Recently, germline mutations in the lysosomal protease cathepsin C gene have been identified as the underlying genetic defect in Haim-Munk syndrome and in the clinically related disorders, such as Papillon-Lefθvre syndrome and prepubertal periodontitis. The periodontal disease associated with these syndromes is particularly aggressive and unresponsive to traditional periodontal therapies. As a result, most patients become edentulous by 15 years of age. This case report describes a patient with the cardinal features of Haim-Munk syndrome.
  1 3,634 278
ORIGINAL ARTICLES
Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus
Vinita Boloor, Biju Thomas
July-September 2010, 14(3):168-172
DOI:10.4103/0972-124X.75911  
Background and Objectives : A healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft subjects, especially in those with cleft lip, alveolus and palate (CLAP), maintenance of oral hygiene is a difficult task for the patients because of the patent oro-nasal communication. Crowding of teeth in cleft patients is a common finding, especially in those with CLAP and those with cleft palate (CP). In the case of multiple tooth-malpositions , transverse deficiency, arch length deficiency and primary cross-bite; periodontal trauma increases and is detrimental to periodontal health . According to literature, a critical periodontal situation was found in patients with CLAP. Hence a study was conducted to analyze the periodontal status of patients with cleft lip (CL); those with cleft palate; and those with cleft lip, alveolus and palate. Materials and Methods: The present study consisted of 60 cleft subjects divided into 3 groups: those with cleft lip; those with cleft palate; and those with cleft lip, alveolus and palate. Subjects with permanent dentition were selected, and the clinical examination included determination of oral hygiene status using Oral Hygiene Index - Simplified (OHI-S) index and periodontal status using community periodontal index (CPI). Results: Statistically significant increase in the periodontal disease in the CLAP group as compared with the other 2 groups, and the oral hygiene was seen to be generally poor with the CLAP group. Interpretation and Conclusion: Individuals with clefts are more prone to periodontal disease due to the presence of cleft, which causes retention of food in the defect sites and inability to maintain good oral hygiene; but the severity of periodontal disease is more if the defect is large and involving the lip, alveolus and palate.
  1 4,276 308
Evaluation of periodontal risk assessment model among adults aged 30-60 years attending KLE Dental College, Belgaum: A hospital-based study
Shruthi Eshwar, Anil V Ankola, Ashok Kumar, Mamata Hebbal
July-September 2010, 14(3):173-177
DOI:10.4103/0972-124X.75912  
Aim : The aim of the present study was to evaluate the periodontal risk of individuals using the modified periodontal risk assessment model. Materials and Methods: Adult subjects aged 30-60 years attending the out patient department of Institute of Dental Sciences, Belgaum in a week's period were screened and 30 among those who met the criteria were included in the study. Complete history and examination of the oral cavity was done using mouth mirror and community periodontal index probes. Periodontal status was recorded using community periodontal index. Systemic conditions like hypertension and diabetes was assessed by suitable investigations. All the risk factors were plotted on a model using Microsoft excel and periodontal risk was assessed based on the findings and categorized as low, moderate and high risk. Results: Among 30 patients 13 were in low risk group, 10 in moderate risk group, and 7 in high risk group identified by proposed model given by Vishwa Chandra whereas 20 patients were in low risk group, 5 in moderate risk group and 5 in high risk group when identified Lang and Tonetti model (2003). Conclusion: In conclusion the use of risk assessment tool would result in reduction of complex therapies and would prevent the future effects of periodontal disease such as bone and tooth loss.
  1 3,566 387
Chlorhexidine varnishes effectively inhibit Porphyromonas gingivalis and Streptococcus mutans - An in vivo study
Ashwin Mathew George, Suresh Kumar Kalangi, Mithuna Vasudevan, NR Krishnaswamy
July-September 2010, 14(3):178-180
DOI:10.4103/0972-124X.75913  
Background: Chlorhexidine varnish (Cervitec- Ivoclar Vivadent- Liechtenstein) is a sustained-release delivery system that can provide protection against white spots and gingivitis, which are common iatrogenic side effects of orthodontic treatment. Chlorhexidine in varnish form does not depend on patient compliance, does not stain teeth or alter taste sensation like the mouth rinse. Materials and Methods : A split-mouth technique was followed in the treatment of 30 patients selected by stringent selection criteria, evaluating a single application of the test varnish on two randomly allotted quadrants along with a placebo on the other two quadrants. Streptococcus mutans counts responsible for white spots and P. gingivalis count [using PCR test] responsible for gingivitis were done at the start of the study, and then 1 and 3 months later. Results: The chlorhexidine varnish reduced the Streptococci mutans count at the end of 1 month, and this reduction was statistically significant. At the end of 3 months, there was no difference in the S. mutans counts between the two groups. There was a statistically significant reduction in the P. gingivalis count at the end of both 1 and 3 months in comparison to the placebo group. Conclusion: Chlorhexidine varnishes are capable of reducing S. mutans and P. gingivalis and gingivitis, thus improving the overall oral health of the patient. The side effects of chlorhexidine mouth rinses are not seen with this varnish. An application schedule of at least once a month is recommended as the effectiveness is reduced comparatively at the end of 3 months.
  1 3,150 392
CASE REPORTS
Peripheral cemento-ossifying fibroma of maxilla
Anirban Chatterjee, Neha Ajmera, Amit Singh
July-September 2010, 14(3):186-189
DOI:10.4103/0972-124X.75915  
Peripheral cemento-ossifying fibroma is a reactive gingival overgrowth occurring frequently in anterior maxilla. It is a slow-growing benign tumor which may lead to pathologic migration and other periodontal problems, so it should be excised as soon as possible. The recurrence rate of peripheral cemento-ossifying fibroma is reported to be 8% to 20%, so a close postoperative follow-up is required. Herein, we are reporting a similar case of peripheral cemento-ossifying fibroma in the maxillary anterior region.
  - 4,677 402
Inter-disciplinary management of a patient with severely attrited teeth
Shyam Padmanabhan, Venkateswara Allu Reddy
July-September 2010, 14(3):190-194
DOI:10.4103/0972-124X.75916  
With increased awareness about dental esthetics, multidisciplinary periodontal therapy has begun to gain momentum. Management of severely attrited teeth is a challenging situation and is dealt with a multidisciplinary approach. In cases of severe tooth wear, the crown height is drastically reduced, in some cases up to the gingival level. This might require a contribution from the disciplines of endodontics, periodontics, orthodontics and prosthodontics for predictable results. Herein we describe the management of one such case.
  - 9,617 759
Idiopathic linear leukoplakia of gingiva: A rare case report
N Sapna, KL Vandana
July-September 2010, 14(3):198-200
DOI:10.4103/0972-124X.75918  
White lesions of the oral cavity are not uncommon though majority of them are benign. This case report documents a rare case of idiopathic linear leukoplakia of gingiva with no apparent etiology. Initial examination revealed a non-scrapable linear white lesion on the marginal and papillary gingiva of upper right teeth region. Incisional biopsy was taken for pathologic evaluation. Patient was treated with routine oral hygiene procedures and excision of the lesions. The histopathological results demonstrated hyperparakeratinized/orthokeratinized hyperplastic oral epithelium with orthokeratin-filled clefts and with no dysplasia. Clinical results demonstrated no recurrence after electrosurgical intervention. This paper reports a rare case of idiopathic linear leukoplakia of gingiva which was non-dysplastic in nature. Electrosurgical treatment proved to be successful compared to surgical technique as there was no recurrence even after two years of follow-up.
  - 5,642 410
EDITORIAL
The hidden base of the research pyramid
D Arunachalam
July-September 2010, 14(3):147-147
DOI:10.4103/0972-124X.75907  
  - 1,185 130
ORIGINAL ARTICLES
A comparison of ordinal regression models in an analysis of factors associated with periodontal disease
Shivalingappa B Javali, Parameshwar V Pandit
July-September 2010, 14(3):155-159
DOI:10.4103/0972-124X.75909  
Aim: The study aimed to determine the factors associated with periodontal disease (different levels of severity) by using different regression models for ordinal data. Design: A cross-sectional design was employed using clinical examination and 'questionnaire with interview' method. Materials and Methods: The study was conducted during June 2008 to October 2008 in Dharwad, Karnataka, India. It involved a systematic random sample of 1760 individuals aged 18-40 years. The periodontal disease examination was conducted by using Community Periodontal Index for Treatment Needs (CPITN). Statistical Analysis Used: Regression models for ordinal data with different built-in link functions were used in determination of factors associated with periodontal disease. Results: The study findings indicated that, the ordinal regression models with four built-in link functions (logit, probit, Clog-log and nlog-log) displayed similar results with negligible differences in significant factors associated with periodontal disease. The factors such as religion, caste, sources of drinking water, Timings for sweet consumption, Timings for cleaning or brushing the teeth and materials used for brushing teeth were significantly associated with periodontal disease in all ordinal models. Conclusions: The ordinal regression model with Clog-log is a better fit in determination of significant factors associated with periodontal disease as compared to models with logit, probit and nlog-log built-in link functions. The factors such as caste and time for sweet consumption are negatively associated with periodontal disease. But religion, sources of drinking water, Timings for cleaning or brushing the teeth and materials used for brushing teeth are significantly and positively associated with periodontal disease.
  - 3,299 269
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