Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
September-October 2021
Volume 25 | Issue 5
Page Nos. 367-456

Online since Wednesday, September 1, 2021

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EDITORIAL  

What raises your research profile? Conducting scientific studies or writing systematic reviews and meta-analysis: Decide yourself! p. 367
Ashish Kumar
DOI:10.4103/jisp.jisp_442_21  
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PRESIDENT’S MESSAGE Top

Technology is a boon when it connects people p. 369
Nymphea Pandit
DOI:10.4103/jisp.jisp_467_21  
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SECRETARY’S MESSAGE Top

Has our postgraduate research hit a wall? p. 371
Harpreet Singh Grover
DOI:10.4103/jisp.jisp_461_21  
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META-ANALYSIS Top

Effect of Aloe vera as a local drug delivery agent in the management of periodontal diseases: A systematic review and meta-analysis p. 372
Ashwini Narendra Jadhav, Surekha Ramrao Rathod, Abhay Pandurang Kolte, Pranjali Vijaykumar Bawankar
DOI:10.4103/jisp.jisp_40_21  
Background: Aim of the present meta-analysis was to evaluate the effect of Aloe vera in various forms such as gel, mouthwash, and dentifrice on gingival and plaque index (PI) in comparison to various allopathic products such as chlorhexidine, metformin, chlorine dioxide, fluoridated toothpaste, and alendronate. Materials and Methods: A comprehensive electronic search was conducted on PubMed/MEDLINE, GOOGLE SCHOLAR, and HAND SEARCH of reference list of archived articles published till January 2020. Randomized controlled trials were searched comparing the Aloe vera product with other products which used PI and gingival index (GI) to evaluate the outcomes. Finally, nine studies assessing PI and four studies evaluating GI were considered for the meta-analysis. After extracting the information, a risk of bias was estimated. The standardized mean differences (SMDs) and fixed and random effect models were obtained from the mean treatment differences. Results: The estimates of SMD of PI from fixed effects (SMD = 0.271, 95% confidence interval [CI] = 0.00134–0.407, P < 0.001) and random effects (SMD = 0.288, 95% CI = 0.048–0.529, P = 0.019) were found slightly different, the models showed consistent results yielding positive and significant treatment effects. For GI fixed effects (SMD = 0.27, 95% CI = −0.035–0.575, P = 0.0803, not significant) and random effects (SMD = 0.259, 95% CI = 0.049–0.469, P = 0.016, significant) were found slightly different and positive. However, one model showed significant and another model showed nonsignificant treatment effects. Conclusion: Results from our meta-analyses confirmed the beneficial effects of A. vera in improving the periodontal parameters and hence may be considered as a safe alternative drug delivery agent for the management of periodontal diseases in future.
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ORIGINAL RESEARCH Top

Minimal influence of chronic inflammation on the potency and differentiation characteristics of gingiva-derived mesenchymal stem cells-An in vitro study p. 379
Basavarajappa Mohana Kumar, Shama Rao, Avaneendra Talwar, Veena Shetty
DOI:10.4103/jisp.jisp_410_20  
Objective: Gingiva-derived mesenchymal stem cells (GMSCs) have been identified and characterized from healthy tissues. However, reports on the influence of chronic inflammation on their stemness characteristics are sparse. The present study evaluated the potency and differentiation ability of GMSCs from periodontally healthy GMSC (H-GMSC) and inflamed GMSC (I-GMSC) tissues. Materials and Methods: Established H-GMSCs and I-GMSCs were evaluated on their potency characteristics, such as morphology, viability, proliferation rate, population doubling time, colony-forming ability, expression of stemness markers, and mesenchymal differentiation potential. Results: H-GMSCs and I-GMSCs exhibited fibroblast-like morphology and showed >95% viability with high proliferation potential and shorter doubling time. H-GMSCs showed fewer and smaller colonies, whereas I-GMSCs exhibited multiple and larger colonies. The evaluation of stemness markers revealed that both H-GMSCs and I-GMSCs were weakly positive for stage-specific embryonic antigen-4, Stro1, and CD105 (Endoglin), strongly positive for CD73 and CD90, and negative for the hematopoietic cell markers, CD34 and CD45. H-GMSCs showed a slightly higher osteogenic potential when compared to I-GMSCs, while I-GMSCs had a higher adipogenic potential than H-GMSCs. Conclusion: The findings showed that the inflammatory environment might have a stimulatory effect on the growth kinetics and ability of colony formation in GMSCs. However, varied osteogenic and adipogenic differentiation was observed between H-GMSCs and I-GMSCs.
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Expression of matrix metalloproteinase-9 in gingival tissue biopsy in patients with slowly/moderately and rapidly progressing periodontitis: An observational study p. 386
Papita Ghosh, Thamil Selvan Muthuraj, Prasanta Bandyopadhyay, Snehasikta Swarnakar, Puja Sarkar, Abinaya Varatharajan
DOI:10.4103/jisp.jisp_811_20  
Background: Matrix metalloproteinases (MMPs) are a group of host-derived zinc-dependent enzymes which mediates the destruction of the extracellular matrix. In periodontitis, there is excess production of MMPs associated with periodontal tissue destruction. The aim of this study was to estimate the level MMP-9 in both active and latent form in gingival tissue (GT) samples collected from periodontitis patients with different rates of progression and compare it with healthy individuals. Materials and Methods: Sixty patients were selected and divided into three groups, 20 each: Group A (slowly/moderately progressing periodontitis), Group B (rapidly progressing periodontitis), and Group C (clinical periodontal health). Plaque index, gingival index, periodontal probing depth (PPD), and clinical attachment level were recorded. GT samples were collected from all 60 patients and MMP-9 expressions were measured using gelatin zymography and western blotting. Results: Levels of active MMP-9 (aMMP-9) and latent MMP-9 (lMMP-9) were significantly high in both Group A (GA) (aMMP-9: 2.05 arbitrary unit [AU]/lMMP-9: 2.54 AU) and Group B (GB) (aMMP-9: 1.32 AU/lMMP-9: 1.74 AU) when compared to that of Group C (GC) (aMMP-9: 0.93/lMMP-9: 1.08 AU). In GA, levels of aMMP-9 showed a significant correlation with PPD values. No other correlations were found. Conclusion: The levels of aMMP-9 and lMMP-9 were increased in both the types of periodontitis when compared with periodontally healthy individuals. A significant correlation was found between PPD and activities of aMMP-9 in slowly/moderately progressing periodontitis patients. However, further studies are required to confirm these findings.
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A pilot study on glycemia and insulin resistance in patients with severe periodontitis p. 393
Annie Kitty George, Vivek Narayan, Nisha Kurian, Annu Elizabeth Joseph, Sukumaran Anil
DOI:10.4103/jisp.jisp_419_20  
Context: The potential impact of severe periodontitis on glycemia in systemically healthy individuals is not clearly established. It was hypothesized that among individuals who were previously undiagnosed for diabetes mellitus, patients with severe periodontitis have impaired glycemia and insulin resistance. Aims: The aim of our study was to assess and compare glycemia in severe periodontitis patients and in individuals with clinically healthy periodontium. Materials and Methods: A cross-sectional analytical design was employed. From among individuals who were undiagnosed for diabetes mellitus, 37 patients with severe periodontitis and 37 individuals with healthy periodontium in the age group of 25–55 years were recruited for the study. The fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and insulin resistance by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were assessed and compared between the two groups. Results: The mean FBS, HOMA-IR, and HbA1c were significantly higher for patients with severe periodontitis than those individuals with healthy periodontium. After adjustments for age, gender, and body mass index, patients with severe periodontitis had a statistically significant association with impaired glucose metabolism (HbA1c ≥5.7) (adjusted odds ratio [OR] of 9.56; 95% confidence interval [CI]: 1.819–46.08; P < 0.01). Furthermore, patients with severe periodontitis had significantly greater odds to develop impaired fasting glucose (adjusted OR of 7.489, 95% CI: 1.408–39.839; P < 0.01). Conclusions: The mean FBS, HbA1c, and HOMA-IR were significantly higher in severe periodontitis patients than in the control group. A higher proportion of patients presented with prediabetes, incident diabetes, and insulin resistance in the severe periodontitis group.
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Evaluation and association of periodontal status with levels of Porphyromonas gingivalis in chronic periodontitis with and without Type 2 diabetes mellitus following nonsurgical periodontal therapy using quantitative polymerase chain reaction: An interventional study p. 399
Pranita Avinash Rode, Rajashri Abhay Kolte, Abhay Pandurang Kolte, Hemant Jyotiswarup Purohit, Renuka Kashi Swami
DOI:10.4103/jisp.jisp_522_20  
Background: The aim of the present study was to detect and correlate the levels of Porphyromonas gingivalis with clinical parameters after nonsurgical periodontal therapy (NSPT) in chronic periodontitis patients with or without Type 2 diabetes mellitus (T2DM), using quantitative polymerase chain reaction (Q-PCR) method. Materials and Methods: Sixty patients equally divided into three groups, i.e., periodontally healthy (Group I), chronic periodontitis (CP) (Group II), and CP with T2DM patients (Group III) were assessed through clinical parameters of probing pocket depth (PPD) and clinical attachment level (CAL) and were correlated for the presence of P. gingivalis in the respective groups. PPD, CAL, and saliva samples for microbiological evaluation were assessed at baseline, 1-, and 3-month post-NSPT. Results: Significant reduction of PPD was found 1.26 ± 0.22 versus 0.43 ± 0.33 mm in Group I, 4.62 ± 0.78 versus 2.58 ± 0.60 mm in Group II, and 6.28 ± 1.52 versus 4.01 ± 1.38 mm in Group III post-NSPT at 3 months. Similarly, a notable reduction of CAL was exhibited in both Group II (5.28 ± 0.80 vs. 3.12 ± 0.77 mm) and Group III (7.14 ± 1.59 vs. 4.51 ± 1.38 mm) patients after NSPT at 3 months. A greater reduction of P. gingivalis concentrations was observed in both Group II and Group III at 3-month post-NSPT. Conclusion: The substantial improvement of clinical parameters was found to be in correlation with the load of P. gingivalis, which was reduced more in Group II than in Group III, emphasizing the applicability and sensitivity of Q-PCR method for its assessment.
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Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease p. 405
Madhurya Nagaraj Kedlaya, Amitha Ramesh, Giridhar Belur Hosmane, Rahul Bhandary, Hakkim Rajula Sajna, Biju Thomas
DOI:10.4103/jisp.jisp_546_20  
Context: Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD. Settings and Design: A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study. Subjects and Methods: Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed. Results: The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD. Conclusions: The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.
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Functionally graded membrane: A novel approach in the treatment of gingival recession defects p. 411
Shivani Dhawan, Megha Takiar, Anish Manocha, Rajan Dhawan, Ranjan Malhotra, Jyoti Gupta
DOI:10.4103/jisp.jisp_583_20  
Background: Guided tissue regeneration has recently been advocated in re-constructing soft-tissue dimensions in recession defects. Advancement in nanotechnology has led to increased zest for approaches such as electrospinning of biologically active; nanofibrous functionally graded regenerative membranes for periodontal tissue engineering. A functionally graded membrane (FGM) had been tailored by incorporating chitosan and nano-hydroxyapatite over Amnion membrane and used in gingival recession defects. Study Design: It was single-blind, randomized controlled study. Split-mouth study was conducted in nine patients and 22 sites with recession defects were selected. Sites were divided into Group A (Amnion membrane with coronal advanced flap) and Group B (FGM with coronal advanced flap). Materials and Methods: Sites were assessed clinically by recording plaque index (PI), gingival index (GI), vertical recession defect depth (VRDD), relative clinical attachment level (CAL), and width of keratinized tissue at baseline, 3–6 months; and radiographically by recording linear bone growth by dentascan at baseline and 6 months. Result: Both groups showed statistically significant reduction in PI, GI and VRDD, and CAL and nonsignificant reduction in width of keratinized tissue at 3 and 6 months postoperatively. Group A showed statistically significant linear bone growth at 6 months. Group B also showed gain in linear bone growth at 6 months; however, result was statistically nonsignificant. Conclusion: FGM had shown favorable results by enhancing bone growth while preventing the gingival tissue downgrowth.
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Effect of piper extract mouthwash as postprocedural rinse on levels of Porphyromonas gingivalis in periodontitis patients p. 418
Gopalakrishnan Sundaram, Ramakrishnan Theagarajan, Gomathi Dhakshina Murthy, Gopalakrishnan Kanimozhi
DOI:10.4103/jisp.jisp_509_20  
Background: Dental biofilm plays a crucial role in periodontal disease development. Mouth rinse is used to enhance oral hygiene after scaling and root planning (SRP). The aim of the study was to evaluate the clinical and microbiological effectiveness of a piper extract mouthwash against Chlorhexidine (CHX) in periodontitis patients. Materials and Methods: Sixty patients with Stage II periodontitis participated in this study and were randomly divided into two groups (Group I – Stage II Grade A periodontitis patients were provided with prepared piper extract mouthwash and Group II – Stage II Grade A periodontitis patients were provided with 0.2% CHX). Plaque index, gingival index, sulcus bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 30 days after SRP. Subgingival plaque samples were taken for microbial examination (colony-forming unit), quantification of Porphyromonas gingivalis using the real-time polymerase chain reaction at baseline, and 30 days after SRP. Results: Intragroup comparison for the clinical parameters showed statistically significant reduction in both the groups (P < 0.0001). Intergroup comparison for clinical parameters, there was no statistical significance seen after 30 days. Intragroup comparison for microbial analysis showed significant reduction in both the groups after 30 days (P < 0.0001). On intergroup comparison for microbial analysis, both the groups showed reduction after 30 days without significance. Conclusion: Piper extract mouthwash (Group I) showed similar antimicrobial activity against P. gingivalis when compared to 0.2% CHX mouthwash (Group II) that could be used as a substitute to CHX.
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Effects of ozonated olive oil and photobiomodulation using diode laser on gingival depigmented wound: A randomized clinical study p. 422
Thangmawizuali Tualzik, Rahul Chopra, Swyeta Jain Gupta, Nikhil Sharma, Medhavee Khare, Lakita Gulati
DOI:10.4103/jisp.jisp_655_20  
Objective: Photobiomodulation (PBM) using diode laser is regarded an effective modality for the repair of tissues and control of pain. Ozone, owing to its biocompatibility, healing, and antimicrobial properties, is used in dentistry as well. This study was carried to clinically compare and evaluate the healing of gingival depigmented wounds using ozonated oil and PBM. Materials and Methods: A laser depigmentation procedure was conducted on seven patients exhibiting bilateral upper and lower gingival melanin hyperpigmentation, followed by the application of ozonated oil (Group 1) and laser PBM (Group 2). The clinical parameters are taken namely Visual Analog Scale and Healing Index (HI), were evaluated on the 3rd, 7th, and 15th day. Results: Statistical analysis showed better HI in Group I as compared to Group II on the 3rd day, but it was comparable in both groups on the 7th and 15th day. Conclusion: The application of ozonated oil was found to be more efficacious in promoting the initial healing of wound in comparison to PBM. Both ozonated oil and PBM also showed the same capabilities in reduction of the postoperative pain.
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Periodontal health of the geriatric population in old-age homes of Delhi, India p. 427
Nisha Rani Yadav, Meena Jain, Ankur Sharma, Vishal Jain, Shilpi Singh, Arundeep Singh, Vamsi Krishna Reddy, Shourya Tandon
DOI:10.4103/jisp.jisp_193_20  
Background: Periodontal disease is one of the leading causes of tooth loss in the geriatric population. Assessment of periodontal disease in a population is an important step in planning effective prevention and control programs for periodontal disease. Therefore, a study was carried out in old-age homes of Delhi to assess the periodontal status of 65–74-year-old elderly and recommend interventions to improve their periodontal health. Materials and Methods: A cross-sectional study was conducted among 464 elderly from old-age homes of Delhi. Periodontal health status of the participants was determined using the WHO oral health assessment form. Community Periodontal Index (CPI) and loss of attachment (LOA) were recorded. Collected data were analyzed using SPSS version 23. Chi-square test was used to determine statistically significant difference among CPI scores and LOA according to age and gender. P ≤ 0.05 was considered statistically significant. Results: The result of the study showed that 25.4% of the elderly had healthy periodontium, 71.1% had a periodontal pocket of 6 mm or more, and 2.40% had a pocket depth of 4–5 mm. Around 36% had 6–8 mm LOA and 34.70% had 9–11 mm LOA. The difference between CPI scores among gender and age group was not significant (P = 0.20, P = 0.096). However, the difference among gender for LOA was found significant (P = 0.014). Conclusion: The results from this study show that periodontal health of elderly residing in old-age homes is very poor. The periodontal status of this population can be enhanced by special collaborative efforts from the government and various nongovernmental organizations toward preventive and curative periodontal health services.
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Effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students p. 432
Diego Dantas Lopes dos Santos, João Felipe Besegato, Sâmmea Martins Vieira, Andrea Abi Rached Dantas, Aryvelto Miranda Silva, Alexandre Monteiro da Silva
DOI:10.4103/jisp.jisp_327_20  
Background: The effects of fixed orthodontic therapy on the occurrence of halitosis are not yet fully understood. This study aimed to evaluate the effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students. Materials and Methods: Sixty-two undergraduate dental students were included in this cross-sectional study. Two groups (n = 31 per group) were composed of participants with (study group) or without (control group) fixed orthodontic appliance. Halitosis self-assessment and clinical diagnosis were assessed using a visual analogic scale (VAS) and sulfur volatile compounds (SVCs) assessment, respectively. The subjective (VAS) and objective (SVC) malodor assessments were classified in absence, light, moderate, or severe malodor. Chi-square Pearson test and Spearman's correlation were applied for data analysis, with a significance level of 5%. Results: The use of fixed orthodontic appliances had no effect on self-assessment (P = 0.490) or clinical diagnosis (P = 0.610) of halitosis. Self-assessment was not significantly associated with the diagnosis of halitosis regardless the use of fixed orthodontic appliance (P ≥ 0.737). Male participants showed higher diagnosis of halitosis (P = 0.007). SVC measurements showed the absence of halitosis in 51.6% and 58.1% of participants with or without orthodontic appliances, respectively. Conclusion: The use of fixed orthodontic appliances affected the self-assessment of halitosis but no SVC measurements. It was not verified a correlation between subjective and objective methods to diagnose halitosis in dental students.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Ameloblastic fibro-odontoma or complex odontoma masquerading as gingival enlargement p. 438
Doddabasavaiah Basavapur Nandini, Praveen Bokka Reddy, Waikhom Robindro Singh, Koijam Sashikumar Singh
DOI:10.4103/jisp.jisp_778_20  
Ameloblastic fibro-odontoma is a rare tumor affecting the pediatric population and young adults. The World Health Organization (WHO) in 2005 defined it as “A neoplasm composed of proliferating odontogenic epithelium in a cellular ectomesenchymal tissue with varying degrees of inductive changes and dental hard tissue formation.” There exists a controversy on its histogenesis designating it as a hamartoma (developing complex odontoma [CO]) or a true neoplasm since both the lesions appear similar histologically. Recently, the WHO in 2017 has clubbed both these lesions as the same entity. Most cases are reported in males and in mandible, while cases in maxilla are scarce. This article describes a recurrence of a previously reported case of ameloblastic fibroma which showed maturation into AFO or CO in a girl aged 6 years in the posterior maxilla. This case is reported due to its rarity and a brief review with differential diagnosis is also discussed.
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Diagnosis of the misdiagnosed: Mucormycosis depicting periodontitis p. 443
Prasannasrinivas Deshpande, Karthikeya Patil, Mahima V Guledgud, N Mounika Prashanthi
DOI:10.4103/jisp.jisp_720_20  
Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.
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Mucogingival augmentation by connective tissue graft for the management of orthodontic-induced alveolar fenestration with soft-tissue deficiency: A multidisciplinary approach p. 448
Ahmed Mohamed Elfana
DOI:10.4103/jisp.jisp_439_20  
Developing alveolar bone defects is one of the reported complications of orthodontic teeth movement especially in the region of the incisors, which may pose a risk for teeth health and their long term prognosis. In this case report, a 15-year-old female patient with an ongoing orthodontic treatment presented with labially protruded apices of lower anterior teeth and thin overlying soft tissue which caused esthetic and functional concerns. A combined periodontal-orthodontic approach was carried out starting with soft-tissue augmentation using bilaminar technique with sub-epithelial connective tissue graft and single incision access flap, followed by orthodontic repositioning of teeth. The augmented site healed uneventfully, and thick soft-tissue coverage was evident which helped the camouflage of the defect area and allowed for the recommencement of orthodontic treatment. Hence, orthodontic-induced alveolar defects with mucogingival complications can be successfully managed through a multidisciplinary approach with stable results after 1 year.
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A dynamic surgical navigational approach for immediate implantation and transcrestal sinus augmentation p. 451
Sanjay Jain, Akshita Solanki
DOI:10.4103/jisp.jisp_581_20  
Real-time dynamic navigation shows various advantages over static guides in the placement of dental implants. The goal of this article is to highlight a safe and alternative approach for transcrestal sinus augmentation and immediate implantation by dynamic navigation. It elaborates and defines numerous advantages of the trace and place workflow over the fiducial technique in dynamic navigation. The usage of osseodensifying burs were shown to have higher bone-implant contact, stability, and insertion torque. Their application allows drill-tip calibration that can thus be used for dynamic navigation allowing a real-time surgical evaluation for the implant placement. This article describes a novel technique for transcrestal sinus augmentation during implant placement with osseodensifying burs using dynamic navigation.
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