Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
September-October 2020
Volume 24 | Issue 5
Page Nos. 393-492

Online since Tuesday, September 1, 2020

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“Resident” experts without experience p. 393
Ashish Kumar
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Dental economics: Past, present, and the future p. 395
Nymphea Pandit
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The scourge of cartelization p. 397
Harpreet Singh Grover
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Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review p. 398
Gunalan Kalaivani, Venkateshwarapuram Rengaswami Balaji, Dhanasekaran Manikandan, Govindasamy Rohini
In the field of modern dentistry, ideal three-dimensional positioning of dental implant with optimal prosthetic fit offers successful long-term outcomes. To achieve such accurate implant placement, presurgical evaluation of hard and soft tissue matters the most. Their efforts can be attained using various application programs such as digital imaging, implant planning software, laboratory- or computer-assisted surgical guides, and dynamic navigation approach. To overcome different opinions and choices regarding guided surgery, this article explains an evidence-based literature review to assess its various outcomes and allowing informed choices before using various guided surgical techniques based on its expectation and reality outcomes. This highlights a clinician's choice to guide his successful implant surgery without causing distress in the midway of treatment. An online search was done on PubMed/Medline database to bring in accuracy to the expertise. This review includes reference of publications from 2000 to 2019, which is related to promising outcomes using computer-assisted static or dynamic navigation system for the placement of implant. Out of these, 809 were related to the computer-guided implant placement. Relevant papers were chosen in accordance with the inclusion and exclusion criteria. This review article contemplates to reflect the fact that computer-guided approach is considered to offer more predictable, safer, and faster implant placement with the predetermined final prosthetic outfit. Thus, digital planning and placing of dental implants in the correct position keep escalating to a higher achievement levels than a classical freehand approach. Nevertheless, this guided surgical approach also holds some errors and risks, which must be identified and rectified.
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Soluble CD163 as a biomarker of periodontal disease – A biochemical study using enzyme-linked immunosorbent assay p. 409
Karthikeyan S.S Sai Karthikeyan, RG Shiva Manjunath, Geetika Kumar, Bharti Chaudhary
Background: The aim of the study was to evaluate the levels of soluble CD163 (sCD163) in gingival crevicular fluid (GCF) and blood serum of individuals having periodontitis, gingivitis, and healthy periodontium. Further, the role of sCD163 as a biomarker of periodontal disease was also assessed. Materials and Methods: A minimum of 5-μl GCF and 10 ml of venous blood was collected using a micropipette and 10-ml syringe, respectively, from the study population which was divided into three groups as healthy (Group I, n = 10), gingivitis (Group II, n = 10), and periodontitis (Group III, n = 10). sCD163 samples were assessed using a commercially available sCD163 enzyme-linked immunosorbent assay kit. Clinical parameters such as oral hygiene index simplified, gingival index (GI), percentage of sites with bleeding on probing, probing depth, and clinical attachment loss were recorded. Results: The mean serum sCD13 levels were 743.45 ± 51.17 ng/ml, 563.25 ± 103.74 ng/ml, and 431.0 ± 31.08 ng/ml when compared to the mean GCF sCD163 levels which were 59.81 ± 7.61 ng/ml, 38.93 ± 12.42 ng/ml, and 30.49 ± 12.60 ng/ml for periodontitis, gingivitis, and healthy individuals, respectively. The sCD163 levels were higher in patients with periodontitis when compared to the periodontally healthy individuals. Conclusion: Within the limitations of the present study, it can be concluded that sCD163 levels can be used as a diagnostic marker of disease as its levels are remarkably increased in GCFs of patients having periodontitis.
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Quantitative analysis of gingival phenotype in different types of malocclusion in the anterior esthetic zone p. 414
Surekha Ramrao Rathod, Noopur Pradeep Gonde, Abhay Pandurang Kolte, Pranjali Vijaykumar Bawankar
Background: For any esthetic treatment planning, the shape and form of gingiva should be a prime factor of concern. The correct identification of gingival phenotype (GP) ensures a firm foundation for future health and prognosis of the treatment indicated. Hence, the aim of the present study was to evaluate the correlation between the GP in the anterior esthetic zone with different types of maloclussion and severity of crowding. Materials and Methods: A total of 110 periodontally healthy controls were equally divided into two groups depending on the type of malocclusion. They were further divided according to the levels of dental crowding as mild, moderate, and severe. GP was measured on the anterior esthetic teeth using transgingival probing, and width of the attached gingiva (WAG) was measured using histochemical staining method. Results: In severe crowding group, the GP in 12 and 22 region was found to be thick (P = 0.035) while, in 32 and 42 region was thin (P = 0.042). The WAG shows a significant difference between WAG with 23 in severe crowding group with P = 0.042, whereas there was no significant relationship found between the GP with Angle's classification. Conclusion: Within the limitations of the study, it can be concluded that the teeth in the maxillary and mandibular anterior esthetic region showed the thin phenotype. When the severity of crowding increases, the GP and WAG vary depending on the position of the tooth. There is no association between the Angle's classification and the mean GP of the maxillary and mandibular anterior region teeth.
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A novel soft tissue cone-beam computed tomography study in the evaluation of gingival thickness associated with subepithelial connective tissue graft versus acellular dermal matrix in the management of gingival recession: A clinical study p. 421
Nimisha Mithradas, Uma Sudhakar, Lalitha T Arunachalam, Snophia Suresh, Manoj Raja
Background: Dental esthetic awareness among patients led the clinicians to introduce newer materials and predictable techniques that satisfy the patients' esthetic demands. Aim: To evaluate and compare the efficacy of subepithelial connective tissue graft (SECTG) and acellular dermal matrix (ACDM) allograft in the treatment of Millers Class I or Class II recession with the determination of gingival thickness using an impertinent method, soft tissue cone-beam computed tomography (ST-CBCT). Materials and Methods: A split-mouth study with a total of ten patients with bilateral Millers class I or class II recession is randomly assigned by a coin toss method as Group I (SECTG) and Group II (ACDM) along with coronally advanced flap. Clinical parameters including recession height (RH), recession width (RW), probing depth, clinical attachment level (CAL), and height of keratinized tissue (HKT) were evaluated at baseline, 90th day, and 180th day for both groups. The thickness of keratinized tissue (TKT) was determined by most reliable, predictable and noninvasive method called ST-CBCT. Results: Statistically significant reduction in RH and RW, gain in CAL, and increase in HKT and TKT in both Group I and Group II were seen in 90th day and 180th day. However, when both Group I and Group II were compared between 0 and 180th day, the change in RH and RW, gain in CAL, and increase in HKT and TKT did not show any statistically significant change. Conclusion: The present study suggested that root coverage with both SECTG and ACDM is very predictable procedure and it is stable for 6 months. ST-CBCT is a newer dimension in periodontal imaging and will certainly aid clinicians in the execution of various treatment modalities with increased predictability.
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Role of Orthoboon (glucosamine sulfate + collagen + Vitamin C): A novel host-modulating agent in the management of chronic periodontitis p. 428
Gautami S Penmetsa, Anudeep Mopidevi, Venkata Ramaraju, Radhika Ramachandran, MV Ramesh
Background: Recent trends suggest using novel host-modulating agents as a treatment strategy for chronic periodontitis. Glucosamine sulfate (GS) was proven to have anti-inflammatory actions related to its ability to suppress neutrophil functions. Orthoboon, an anti-arthritic and anti-inflammatory drug, has shown to have a positive therapeutic effect due to its constituents made of a combination of GS, Vitamin C, and collagen. The aim of the study was to evaluate the host modulatory effects of Orthoboon on periodontal status and to estimate the C reactive protein (CRP) levels before and after nonsurgical periodontal therapy (NSPT). Materials and Methods: A total number of 40 patients with chronic periodontitis were randomly divided into two groups of 20 patients each. The test group patients (n = 20) received 500 mg Orthoboon three times daily for 45 days. Prior to the initiation of Orthoboon, all patients in both test group and control group were subjected to Phase I periodontal therapy. CRP levels were estimated immediately after phase I therapy and 45 days after therapy. Clinical parameters including plaque index, gingival index, and bleeding index were recorded before and after NSPT for the two groups. Results: The mean CRP levels were reduced significantly in the test group before and after administration of Orthoboon and also there were statistically significant differences in the mean CRP levels at the end of 45 days between the test group and the control group. Conclusion: Administration of Orthoboon, i.e., GS, with a combination of Vitamin C and collagen was proved to be of a significant benefit in the test group than in the control group.
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Air polishing with erythritol powder – In vitro effects on dentin loss p. 433
Jella C Kröger, Mikael Haribyan, Ibrahim Nergiz, Petra Schmage
Context: Low-abrasive polishing powders such as glycine (GLY) or erythritol (ERY) are used for subgingival air polishing. GLY was reported to possibly affect the dentin surface, while this is unclear for ERY. Aims: This in vitro study aimed to evaluate the substance loss from the dentin surface by air polishing with ERY at different settings for pressure (PR), distance (DI), and angulation of the spray jet to the surface (AJ). Materials and Methods: The in vitro testing was performed on smooth human root dentin surfaces. In 18 groups with 10 specimens each, ERY was applied with constant water supply for 5 s without moving the handpiece at the following settings: PR minimum (min), medium (med), and maximum (max); DI at 1, 3, and 5 mm; and 45° or 90° AJ. The substance loss was measured as defect depth (DD) using three-dimensional (3D)-laser profilometry. ANOVA with Bonferroni correction and α = 0.05 were used for statistical analysis. Results: The DD was statistically significantly higher at a DI of 1 mm compared to a DI of 5 mm for the respective groups of the same PR and AJ (P < 0.05). For DI 1 mm, max PR, and AJ 90°, the maximum loss of substance amounted DD of 117 ± 43 μm. The minimal loss of substance occurred at minimal PR, 45° AJ, and a DI of 5 mm (15 μm × 20 μm). DD related directly with the parameters PR and AJ and inversely with DI. The highest influence on DD was proven for DI. Conclusions: Slight loss of dentin might occur during air polishing with ERY depending on DI, PR and AJ. The setting influences the amount of dentin loss.
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A comparative evaluation of propolis and light-cured ormocer-based desensitizer in reducing dentin hypersensitivity p. 441
Snigdha Maity, Vidya Priyadharshini, Suman Basavaraju
Objectives: The purpose of the study was to evaluate and compare the clinical efficacy and the durability of propolis and Light-cured ormocer-based desensitizer (Admira Protect, Voco: Cuxhaven Germany) in the treatment of dentin hypersensitivity (DH). Materials and Methods: The study was conducted over a period of 2 months on 13 patients with 72 hypersensitive teeth, randomly allocated into three treatment groups: Group A: Treated with Propolis, Group B: Admira protect (Voco: Cuxhaven Germany), and Group C: Sterile water (Placebo control). Baseline sensitivity was recorded by the operator using tactile and evaporative stimuli. Visual analog scale (VAS) was used to record the degree of sensitivity perceived by the patients. All the groups received applications of allotted materials on day 1, 7, 14, and 21. After each applications VAS scoring was recorded. On day 30 and 60, only pain evaluation was done to determine the durability of each test materials. Statistical Analysis: One-way ANOVA, repeated measure ANOVA and post hoc test was done for multiple comparison. Results: All the groups showed significant results in reducing DH. Among Groups A and B, Group B showed immediate postoperative result at the end of the 1st week. Conclusion: Both the test materials were effective in reducing DH but Admira protect was found to be more efficient in reducing pain with longer duration of action (CTRI regd no: CTRI/2017/12/010755).
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Comparative evaluation of the effect of Ozone therapy and Photodynamic therapy in non-surgical management of Chronic periodontitis: A split mouth longitudinal study p. 447
Divyasree Kochilat Ameyaroy, Biniraj Kannanganatt Ramabhadran, Rishi Emmatty, Tony Pallipurathukaran Paul, Priya Jose
Background: A split-mouth longitudinal study was conducted to compare and evaluate the effect of ozonated water and photodynamic therapy (PDT) in nonsurgical management of chronic periodontitis, along with mechanical debridement procedure. Materials and Methods: Twenty-two patients diagnosed with chronic generalized periodontitis were subjected to the study. Following the assessment of gingival index, periodontal pocket depth, and clinical attachment loss, all patients underwent full-mouth scaling and root planing. Upper right and left quadrants of each patient were considered as sample sites in the study. Among these split-mouth sites, upper right quadrant of each patient was subjected to ozonated water irrigation with a 22-gauge needle and left upper quadrant was treated with PDT, which involved sulcus irrigation with indocyanine green dye (0.05 mg/ml) followed by low-level diode laser light application at 0.5 W and 810 nm (AMD Picasso) through a fiber-optic tip of 10 mm length, default angle of 60°, and fiber core diameter of 400 μm in noncontact continuous wave mode. Patients were recalled at the 2nd and 4th months regularly, and the therapy was repeated at the same sites in the same manner. Clinical parameters recorded before the study were assessed again at the end of the 2nd- and 6th-month period. Results: A statistically significant reduction (P < 0.05) was observed in gingival index scores within both the study groups at all intervals of the study. In Ozone therapy (OT) group, a statistically significant difference was noted for total periodontal pocket depth values between baseline and 2nd month (P = 0.000), baseline and 6th month (P = 0.000), and between 2nd month and 6th month (P = 0.029). In the PDT group, on contrary, a statistically significant difference was noticed in total periodontal pocket probing depth values between baseline and 2nd month (P = 0.000) and baseline to 6th month (P = 0.000), but a similar significant difference was not noticed between 2nd-month and 6th-month periods (P = 0.269). In group OT, a statistically significant difference was noted for total clinical attachment loss between baseline and 2nd month (P = 0.000), baseline and 6 months (P = 0.000), and 2nd month and 6th month (P = 0.019). In group PDT, a statistically significant difference in terms of its improvement was noted at intervals between baseline and 2 months (P = 0.000) and from baseline to 6 months (P = 0.000) but not between 2nd month and 6th month (P = 0.129). Conclusion: Results of the study showed that sub-gingival OT and PDT equally improved the clinical outcomes of treatment drastically following mechanical debridement at the end of first 2 months. Thereafter, it was shown to improve steadily throughout the study period, with slightly better results with OT compared with PDT.
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Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial p. 454
Yarabham Chakravarthy, Rampalli Viswa Chandra, Aileni Amarender Reddy, Gollapalle Prabhandh Reddy
Aims: The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession. Materials and Methods: Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery. Results: OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW. Conclusion: Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.
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Awareness and management of peri-implantitis and peri-mucositis among private dental Practitioners in Hyderabad - A cross-sectional study p. 461
Rinky Tripathi, Sanjay Vasudevan, Ajay Reddy Palle, Rajani Kumar Gedela, Anahita Punj, Varanasi Vaishnavi
Background: Implant therapy, in India, has flourished in recent years and is being practiced widely by many dental practitioners today. Along with the increasing number of implants being placed today, there has also been a constant rise in the number of complications associated with it. Objectives: The aim of this study is to evaluate the knowledge and awareness of implant placement and management of peri-implant diseases among dental professionals. Materials and Methods: A total of 568 dental practitioners were approached with a questionnaire for collecting data related to demographic details, experience, and knowledge about implant placement and management of its complications. Of these, only 262 were included as part of the statistical analysis. This data collected were compiled and analyzed using descriptive statistics. Results: Results showed that most dentists who participated in this study have adequate knowledge about etiological factors and its management. Those who acquired implant skills through sources that are not in accordance with accepted standards had unsatisfactory knowledge and practice behavior. Conclusion: The awareness and knowledge regarding the implant procedures and their complications such as peri-implant mucositis and peri-implantitis were higher in self-trained dentists and by dentists who are practicing for >10 years and calls for updating of knowledge.
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Oral health status and treatment needs of substance abusers in Western Uttar Pradesh p. 467
Yogesh Garg, Zoya Chowdhary, Kamal Garg, Apoorva Gupta, Minal Kshirsagar, Jaidupally Ramvillas Reddy
Background: Substance abuse has often associated with high caries, poor periodontal health, and altered functioning of the individual. The substance abuse may be natural or synthetic in origin, both causing deleterious effect on the oral and overall health of the individual. Aim: To assess the oral health status and treatment needs of substance abusers attending deaddiction centers in Western Uttar Pradesh. Materials and Methods: A cross-sectional study was conducted among 220 substance abusers from 6 randomly selected deaddiction centers. The subjects were divided into four groups: Group 1, alcohol (A); Group 2, nicotine (N); Group 3, alcohol + nicotine (AN); and Group 4, other drugs (O). A demographic record along with full-mouth examination was recorded based on the World Health Organization pro forma. Results: The overall results showed that out of the total participants, 144 had oral mucosal lesions. Alcohol group had significantly higher mean community periodontal index code 3 (pockets 4–5 mm) than the other groups (P < 0.05). The prevalence of decayed, missing, filled teeth (DMFT) was 83.33%, and the mean DMFT of the alcohol group was significantly higher than the other combinations group (P < 0.01). Conclusions: The oral health status of substance abusers was poor, with a large number of oral mucosal lesions. The dental caries status and periodontal status were the worst among the alcohol group.
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Adenomatoid odontogenic tumor mimicking a lateral periodontal cyst – A rare case report in the mandible p. 473
Balaji Manohar, Neha Verma, Neha Mannan, S Bhuvaneshwari
Adenomatoid odontogenic tumor (AOT) is benign tumor of the oral cavity characterized by its slow growth accounting to 3%–7% of the odontogenic tumors. AOTs mostly occur in the maxillary anterior region and most often than not associated with impacted anterior teeth. It affects the younger age group, especially below 20 years and is commonly seen in females. It occurs as two main variants – (a) central/intraosseous which is more common and (b) peripheral which is rare. The location of the lesion, its association with the impacted tooth, is the basis for the classification of AOT. The intraosseous type may be related to unerupted tooth (follicular variant) or may not be related to unerupted tooth (extra-follicular variant). Radiologically, AOT presents predominantly as a unilocular cystic lesion enclosing the unerupted tooth. The lesion presents rarely with a cystic component. Radiopacities on the intraoral periapical radiograph are seen as discrete foci having a flocculent pattern within radiolucency even with the presence of minimal calcified deposits. AOT being benign in nature is enucleated with least chances of recurrence. Here, we present a rare case of extra-follicular variant of adenomatoid odontogenic tumor in a 19-year-old female patient.
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Management and simultaneous implant placement of maxillary sinus membrane perforation: A report of two cases p. 477
Mangesh Phadnaik, Ripunjay Kumar Tripathi, Meghna Nigam, Ankit Solanki, Vaibhav Karemore
Rehabilitation of the long-standing edentulous posterior maxilla with dental implant poses a unique challenge. This is due to mainly two reasons – pneumatization of the maxillary sinus and atrophy of the alveolar bone. The challenge is intensified when the native bone is around 2–3 mm. This requires vertical bone augmentation in the form of direct sinus lift/lateral wall sinus lift procedure. The most common complication associated with this procedure is the sinus membrane perforation resulting in unfavorable stabilization of the graft and associated bone regeneration. Simultaneous implant placement becomes all the more difficult in such situations. As a result, of which implant placement has to be deferred resulting in extended treatment duration and multiple surgical appointments. The present case report represents two such sinus membrane perforation repair cases associated with lateral wall osteotomy approach for sinus augmentation with simultaneous implant placement in the posterior maxilla.
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Periodontal approach in the management of alveolar cleft p. 481
Vinathi Reddy Kankara, Sahithi Annavarapu, Krishnanjeya Reddy Pathakota, Preethi Krishnan
The alveolar cleft is a bone-related developmental defect in the alveolar process of the maxillae, which is termed as cleft alveolus. The deformity occurs in 75% of the cleft palate and lip patients. Reconstructive surgery can provide both functional and esthetic benefits to such individuals. Conflicting opinions exist on the management of alveolar cleft, and these affect the treatment planning. We present the case of a 19-year-old female patient with a complaint of mobile teeth in the left frontal region of the upper jaw. On clinical examination, unilateral cleft alveolus was observed between the left lateral incisor and the canine region. A multidisciplinary approach was adopted, orthodontic treatment was started, and periodontal regenerative surgery was planned. This report also discusses the substitution of autogenous bone grafts with other materials such as allogenic grafts (demineralized freeze-dried bone allograft), platelet-rich plasma, platelet-rich fibrin membranes, and amnion membranes, which could serve as a new line of treatment for the condition.
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Modified coronally advanced flap design in management of isolated gingival recession: Saddle flap technique p. 486
Selvaraj Raja Rajeswari, Triveni M Gowda, AB Tarun Kumar, Potluri Leela Ravishankar, Kapa Bhargavi Preeti, Divya Dhingra
Saddle flap technique, a modified coronally advanced flap approach for isolated gingival recession management was introduced and assessed in terms of clinical efficacy and patient satisfaction. A total of 10 systemically healthy subjects with isolated gingival recession defect (Miller Class I and II) were enrolled in the study. The primary endpoint measure was patient satisfaction in terms of esthetics and percentage root coverage. The secondary outcome measures comprised clinical attachment level change, gingival thickness variation, width of keratinized tissue alteration, and postoperative healing. At 1 year postoperative, 80% of the treated sites achieved 100% root coverage. Based on clinical results, saddle flap technique could be considered as one of the possible treatment options for isolated gingival recession with good esthetic and patient satisfaction.
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Erratum: Biomarkers in biological fluids in adults with periodontitis and/or obesity: A meta-analysis p. 491

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