Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
July-August 2022
Volume 26 | Issue 4
Page Nos. 303-419

Online since Saturday, July 2, 2022

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Results: Establishing credibility p. 303
Ashish Kumar
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Periodontics………The conquistador of dental practice p. 305
Manish Khatri
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Reconnect or disconnect – Truth is stranger than fiction p. 306
Harpreet Singh Grover
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ISP good clinical practice recommendations for the management of dentin hypersensitivity Highly accessed article p. 307
Vishakha Grover, Ashish Kumar, Ashish Jain, Anirban Chatterjee, Harpreet Singh Grover, Nymphea Pandit, Anurag Satpathy, Baiju Radhamoni Madhavan Pillai, Anil Melath, Deepa Dhruvakumar, Roshani Thakur, Nilesh V Joshi, Neeraj Deshpande, Himanshu Dadlani, A Archana Meenakshi, KP Ashok, K Vinathi Reddy, Meenu Taneja Bhasin, Sanjeev Kumar Salaria, Abhishek Verma, Rajesh Prabhakar Gaikwad, Hemant Darekar, Ramesh Amirisetty, Mangesh Phadnaik, Vaibhav Karemore, Ravindranath Dhulipalla, Dhawal Mody, Tushar Shri Rao, Swarna Chakarpani, V Ranganath
Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry “Dentin Hypersensitivity,” based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.
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Antimicrobial and cytotoxicity properties of Plumeria alba flower extract against oral and periodontal pathogens: A comparative in vitro study p. 334
Jaskirat Kaur, Amee Dilip Sanghavi, Aditi Chopra, Richard Lobo, Swagata Saha
Context: Plumeria alba, commonly known as frangipani or West Indian jasmine, is a traditional and ancient folklore medicine known for its antimicrobial, anti-inflammatory, and antioxidant properties. The extracts from P. alba obtained from the leaves, bark, and flowers, are commonly used to manage bacterial, fungal, and viral infections such as herpes, scabies, and fungal infections. The constituents of the P. alba plant have shown promising antihelmintic, antipyretic, and antirheumatic properties. Although studies have confirmed that extracts from Plumeria species are effective against microbial infections and cancer, its role in managing oral diseases, particularly the chronic inflammatory disease of the gums (gingivitis and periodontitis), has never been explored. Therefore, the current study aimed to explore the antimicrobial and cytotoxic properties of the P. alba flower extract against oral and periodontal pathogens compared to chlorhexidine and doxycycline. Settings and Design: This was an in vitro study. Materials and Methods: The ethanolic extract was prepared from the freshly plucked P. alba flowers. The antimicrobial properties of the extract were evaluated by testing the minimal inhibitory concentration, minimal bactericidal concentration, and well-diffusion assay against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Prevotella intermedia, Tannerella forsythia, Streptococcus mutans, Actinomyces viscosus, Streptococcus salivarius, and Candida albicans. The results were compared to chlorhexidine and doxycycline. The cytotoxicity was checked by the against human-derived gingival fibroblast and keratinocytes. Statistical Analysis Used: One-way ANOVA for the mean zones of inhibition against all the microorganisms was done. Results: P. alba extract inhibited the growth for all the tested oral and periodontal pathogens at 25 μg/ml. The well-diffusion assay of P. alba extract was comparable to chlorhexidine but was not statistically significant compared to doxycycline. Conclusion: P. alba can be used as a promising alternative to chlorhexidine for the management of oral and periodontal infections.
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Assessment of anterior loop of mandibular canal and its implication in implant therapy p. 342
Namrata Madan Khetal, Salman Tarique Ansari, Rajvir Malik, Ashish Babanrao Lanjekar, Sanjana Jayant Jirafe, Apeksha Sanjay Gajghate
Context: Precise identification of anatomic structures is imperative for presurgical planning for implant installation to ensure effectiveness of procedures, especially in the region of mental foramen, and to prevent iatrogenic complications. Aims: This study aimed to assess the presence of anterior loop of mandibular canal and its approximation to the alveolar crest using cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans of the patients scheduled for implant therapy in the region of mental foramen were retrospectively analyzed for the presence of anterior loop of mandibular canal. Findings were compared based upon gender and side of the mandible. Distance between the most prominent part of anterior loop of mandibular canal and the alveolar crest was measured. Results: Anterior loop of the mandibular canal was identified 66.8% of hemimandibles analyzed with the highest prevalence in the fourth decade of life. Males and females exhibited predilection toward the right and left side, respectively. The presence of anterior loop of mandibular canal is associated with reduced distance between the neurovascular bundle and alveolar crest jeopardizing the placement of standard length dental implant. Conclusion: The current study emphasizes an increased need for precise identification and preservation of anterior loop of mandibular canal in the third and fourth decades of life, especially in females.
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Matrix metalloproteinase-9-1562 C/T promoter gene polymorphism in chronic periodontitis: A cross-sectional observational study p. 348
Puja Sarkar, Thamil Selvan Muthuraj, Prasanta Bandyopadhyay, Papita Ghosh
Background: Matrix metalloproteinases (MMPs) are a major group of enzymes, released in inflamed periodontal tissues in large quantities, resulting in connective tissue matrix breakdown. One of the most predominant MMPs is MMP-9. Association between chronic periodontitis (CP) and MMP-9 gene polymorphism (GP) in some ethnic populations has been already established. The aim of the current study was to assess the association of single-nucleotide polymorphism in the promoter region of MMP-9 gene with CP in Kolkata population, if any. Materials and Methods: Forty eligible individuals were recruited for the study and grouped as A and B: Group A (twenty periodontally healthy individuals) and Group B (twenty CP patients). Venous blood samples collected from all the forty individuals were used to isolate the genomic DNA. GP for MMP-9 gene was detected using polymerase chain reaction and sequencing method. The data obtained were then analyzed statistically. Results: A significantly different genotypic and allelic variation was observed in the control and test groups, with C/T genotype and T allele present in only CP group. Conclusion: Within the limitations of this study, we can conclude that there was no significant association between patients with periodontitis and MMP-9-1562 C/T promoter GP.
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Clinical evaluation of periodontal status in subjects with multibracket appliances and the role of age and gender during initial months of fixed orthodontic treatment p. 353
Sapna Singla, Monika Kamboj, Priyanka Gupta, Gurvanit Lehl, Manjit Talwar
Background: During fixed orthodontic treatment, the presence of various fixed appliances like brackets in the oral cavity for a long period leads to various changes in the oral microflora, ultimately affecting the periodontal health of the teeth. Hence, the current study was performed to clinically assess the periodontal status of the subjects undergoing fixed orthodontic treatment and to evaluate the role of age and gender during the first 6 months of treatment. Materials and Methods: Forty-one subjects (26 females and 15 males) in the age range of 12–28 years scheduled for fixed orthodontic treatment were included in the study. Twenty-eight subjects were adolescents with a mean age of 13.96 years and 13 were adults with a mean age of 22.38 years. Plaque index (PI) and gingival index (GI) were recorded at the beginning and the end of 1, 2, 3, and 6 months of the treatment, and pocket probing depth (PPD) was evaluated at the start and after 6 months of fixed orthodontic treatment. Results: The study showed a statistically significant increase in the mean values of PI (1.10 ± 0.264) and GI (0.929 ± 0.220) over a period of 6 months when compared with the baseline mean values, i.e., 0.557 ± 0.224 and 0.423 ± 0.329, respectively (P < 0.001). The mean PPD values exhibited no significant change. Effect of orthodontic treatment on adolescents/adults and between genders did not statistically differ. Conclusions: Fixed orthodontic treatment with multibracket appliances significantly increases plaque accumulation leading to significant inflammatory changes in the gingival tissues without any significant changes in the clinical probing depths of the pockets regardless of age and gender.
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Clinicoradiographic evaluation of advanced-platelet rich fibrin block (A PRF + i PRF + nanohydroxyapatite) compared to nanohydroxyapatite alone in the management of periodontal intrabony defects p. 359
Jayasheela Mallappa, Deepa Vasanth, Triveni Mavinakote Gowda, Rucha Shah, Gunjiganuru Vemanaradhya Gayathri, Dhoom Singh Mehta
Background: Several bone grafting formulations have been given clinically acceptable outcomes in treating intrabony defects. Platelet rich fibrin (PRF), an autologous platelet concentrate holds potential to be used for regenerative treatment. The purpose of this study was to evaluate clinical and radiographic outcomes in periodontal intrabony defects treated with advanced-PRF block (A PRF + i PRF + nanohydroxyapatite [nHA]) compared to nHA alone. Methods: Twenty-eight sites in chronic periodontitis patients having probing pocket depth (PPD) ≥6 mm and 3 walled intrabony defects (depth of ≥3 mm) were selected, randomly allotted into two groups: Group A was treated with A-PRF block and Group B with nHA (Sybograf™). Clinical parameters including plaque index (PI), gingival index (GI), PPD, relative attachment level (RAL) and radiographically linear and volumetric defect fill were assessed using cone beam computed tomography at baseline and 6 months postoperatively. Results: Intragroup comparison using paired t-test and intergroup comparison using unpaired t-test was done. Group A demonstrated significantly higher reduction in PPD and gain in RAL when compared to Group B (P ≤ 0.05) at the end of 6 months. Similarly gain in bone volume was greater in Group A (0.1 ± 0.05) as compared to Group B (0.04 ± 0.02) (P ≤ 0.05). Conclusion: Advanced-PRF block showed significant clinical and radiographic improvement as compared to nHA alone which depicts that, it may be an ideal graft to be used for the treatment of periodontal intrabony defects.
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Detection of Porphyromonas gingivalis in umbilical cord blood of new-born and in subgingival plaque of pregnant participants with periodontal disease and its association with pregnancy outcomes: An observational study p. 365
JN Savitha, B Bhavya, Umesh Yadalam, Safiya Fatima Khan
Background: Preterm low birth weight (PLBW) is one of the causes of infant mortality and morbidity. Most of the studies have indicated the periodontal-systemic interlink. The association of periodontal pathogen on pregnancy outcome still stands inconclusive. The aim of the study was to detect the prevalence of Porphyromonas gingivalis in umbilical cord blood of new-born infant and correlate the same pathogen in subgingival plaque of pregnant women and to determine the adverse pregnancy outcomes and also to determine the correlation between periodontitis and the association of P. gingivalis in preterm birth/low birth. Materials and Methods: The present study included 130 pregnant participants in their full-term and preterm delivery with periodontitis. Periodontal disease was diagnosed clinically using gingival index, pocket depth, plaque index, and clinical attachment level. Umbilical cord blood samples and plaque samples collected using Gracey curette were subjected to culture for the detection of P. gingivalis. The results were subjected to the statistical analysis using the SPSS software. Results: The comparison of P. gingivalis in umbilical cord blood and plaque between preterm and full-term group was found to be significantly increased in preterm group. A statistically significant difference was also seen for the clinical parameters between the two groups, with increased values seen in case of preterm labor. Odd's ratio on the comparison of prevalence of periodontitis among full term and preterm group was statistically significant in preterm birth as compared with full-term birth. Conclusion: The study results showed statistically significant association of P. gingivalis with PLBW. Periodontal disease significantly affects the adverse pregnancy outcome.
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Successful management of gingival recession with interdental attachment loss using gingival unit grafts p. 373
Neelima Katti, Devapratim Mohanty, Poonam Agrawal, Subash Chandra Raj, Shib Shankar Pradhan, Debjani Baral
Background: Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival. Methods: Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months. Results: The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% (P = 0.04). Conclusion: GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months.
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A new era of Nano!!! Comparative evaluation of ganglioside polymeric nanoparticle coated satranidazole gel and 1% metronidazole gel for the treatment of periodontitis p. 378
Shivam Kesarwani, Sarita Parihar, Sanjay Singh, Anju Gautam, Aishwarya Pandey, Md Meraj Anjum
Background: The present study was intended to comparatively assess the efficacy of ganglioside polymeric nanoparticle-coated 0.25% satranidazole-loaded nanoparticles in gel form with that of the commercially available 1% metronidazole gel as a local drug delivery (LDD) agent for the treatment of periodontal pockets. Materials and Methods: A split-mouth randomized clinical trial was carried out in 46 chronic periodontitis patients with probing pocket depth (PPD) ≥4 mm or clinical attachment loss greater than 3 mm on both quadrants of the same arch. Full-mouth scaling and root planing (SRP) was performed for all the patients followed by application of 0.25% satranidazole-loaded nanoparticles in gel form on one site (Group 1) and commercially available 1% metronidazole gel on another site (Group 2). Clinical parameters (gingival index, plaque index, PPD, clinical attachment level gain, and bleeding on probing) and microbiological analysis of the subgingival plaque samples were performed and assessed at baseline, after SRP, 21st day, and 90th day post treatment. Unpaired “t”-test and ANOVA tests were used for intergroup and intragroup comparison of recorded parameters. Results: The results showed that the satranidazole-loaded nanoparticle group as an adjunct to SRP in chronic periodontitis showed a statistically significant improvement in all the clinical parameters and a fewer relapse of microbial flora in comparison with the metronidazole group as an LDD agent. Conclusion: The present study depicted that both the LDD agents showed an effective improvement of clinical as well as microbiological parameters, but the satranidazole group consistently produced better results than the metronidazole group and hence has a promising future as an LDD agent in treating periodontal pockets.
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Comparative evaluation of nutmeg mouthwash and 0.2% chlorhexidine gluconate mouthwash on halitosis and plaque control: A randomized clinical trial p. 384
Monika Vasantrao Padol, Prashanth Vishwakarma, Arun Suresh Dodamani, Anup Wamanrao Gore, Karina Shyamlal Chachlani, Shradha Pramod Kharkar
Background: Myristica fragrans, commonly known as nutmeg, has been shown to have many medicinal properties including reduction of plaque and oral halitosis. In the present study, a mouthwash was prepared from nutmeg oil to compare its effectiveness with 0.2% chlorhexidine (CHX) gluconate mouthwash on halitosis and plaque control. Materials and Methods: A total of 60 participants having plaque and plaque-induced oral halitosis were enrolled and randomly divided into two groups as Group A (30) and Group B (30). Nutmeg and 0.2% CHX gluconate mouthwash were administered in Group A and Group B, respectively, for 21 days twice daily. Plaque index and organoleptic score were recorded at baseline, 14th day, and 21st day. The data were collected, tabulated in Microsoft Excel Sheet, and subjected to statistical analysis using appropriate statistical tests. Results: The percentage of change in plaque score between baseline and 14th day was 12.3% and 9.44% (P = 0.741), between baseline and 21st day 39.2% and 39.4% (P = 0.889), and between 14th and 21st day 27.7% and 29.9% (P = 0.805) for Group A and Group B, respectively, while the percentage of change in halitosis score between baseline and 14th day was 24.7% and 16.3% (P = 0.201), between baseline and 21st day 54.5% and 56.3% (P = 0.487), and between 14th and 21st day 34.9% and 40.0% (P = 0.393) for Group A and Group B, respectively. Conclusion: Nutmeg mouthwash is organic, economical, and equally effective as compared to 0.2% CHX gluconate mouthwash (Clinical Trials Registry-India/2020/10/028540).
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Self-esteem and oral health-related quality of life of women with periodontal disease – A cross-sectional study p. 390
Rohina Shamim, Rashmita Nayak, Anurag Satpathy, Rinkee Mohanty, Naina Pattnaik
Aim: The aim of this study is to assess the effect of periodontal disease on self-esteem and oral health-related quality of life (OHRQoL) in women. Materials and Methods: A cross-sectional study was conducted among 522 women (mean age − 38.92 ± 14.3 years). Oral hygiene status, plaque level, gingival inflammation, probing depth, and periodontal status were assessed. The self-esteem was assessed using a Rosenberg Self-esteem Scale, and the OHRQoL was measured using a 14-item oral health impact profile (OHIP-14) questionnaire. Results: Younger, employed women with higher income had significantly better OHRQoL and self-esteem. Women with healthy periodontium had better OHRQoL. Probing depth and community periodontal index scores were found to have a significant positive correlation with most of the sub-scale items and total OHIP-14 score in women with low self-esteem. Women with good OHRQoL and normal self-esteem were seen to be maintaining significantly better oral hygiene. No such statistically significant difference was observed in women with low self-esteem. Multiple regression analysis for the prediction of OHIP-14 score indicated that the best model included probing depth as the only statistically significant predictor (P = 0.002). Conclusion: Periodontal disease has a significant negative impact on self-esteem and OHRQoL in women.
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Plasma cell gingivitis: A perplexing and rare clinical entity p. 397
Muneesh Joshi, T Prasanth, Manab Kosala, SK Bhandari
Plasma cell gingivitis (PCG) is a diagnostic dilemma for clinicians. It is also referred to as atypical gingivostomatitis, idiopathic gingivostomatitis, allergic gingivostomatitis, and plasma cell gingivostomatitis which are characterized by bright fiery red gingiva with spontaneous bleeding on slight provocation. It is often confused with inflammatory gingival enlargement, erythematosus lichen planus, and other lesions. One such rare and benign entity is discussed in this article and managed after thorough clinical, radiological, histopathology, immunohistochemistry analysis.
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Hemangiopericytoma of the gingiva – An exemplary differential of a masquerading tumor p. 401
ManoVijay Balagangadharan, Mathew Jacob, Sekar Bala, Arulmani Periasamy
Periodontal diseases are unique as a small number lesions appearing as inflammatory in reality are neoplastic in nature, and it is imperative that an accurate diagnosis be rendered to provide the appropriate treatment and management. One of the most common clinical presentations of gingival lesions is pedunculated soft-tissue swellings. We report the case of a 63-year-old female who presented with a painless swelling on the interdental papilla of 23 and 24 with a history of recurrences. The lesion was excised by wide surgical excision. This article presents a unique case of a vascular tumor that had clinically mimicked a reactive lesion and with detailed history, thorough clinical examination had provided clues to a vascular entity namely hemangiopericytoma which was confirmed by histological diagnosis. Oral lesions, particularly occurring in gingiva, most often appear clinically benign or innocuous thus necessitating the need for careful examination with investigations to render a diagnosis.
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Natural teeth and implant-retained prosthesis in treated periodontitis subjects p. 404
Farhan Durrani, Samidha Pandey, Rakhshinda Nahid, Aishwarya Pandey, Preeti Singh
History of periodontal disease is a risk factor for the development of peri-implantitis. Implant treatment in susceptible patients should be followed by adequate periodontal treatment and stringent supportive programs. The assessment of the patient needs to be carefully evaluated before the procedure for implants. The risk associated with the sites to be treated requires evaluation with regular visits. The completion of treatment will still require committed follow-up visits with checks for pockets, bone loss, and plaque scores around implant-retained prosthesis as well as complete dentition. In our report, we describe in detail the reconstruction of lost dentition with implants in treated periodontitis subjects. The patients are still being followed with regular recall programs.
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A novel injectable platelet-rich fibrin reinforced papilla reconstruction technique p. 412
Komal Puri, Manish Khatri, Mansi Bansal, Ashish Kumar, Mohd Rehan, Aneesha Gupta
Formation of black triangles due to the loss of interdental papilla is one of the utmost perplexing esthetic problems of the periodontium. Many surgical and nonsurgical treatment options have been researched upon to obtain complete papillary fill, but minimally invasive procedures have always been the choice of treatment both for the operator as well as the patient. This article describes the use of injectable platelet-rich fibrin (i-PRF) as a novel nonsurgical technique for the reconstruction of deficient interdental papilla. This is probably the first article that describes the use of i-PRF for the nonsurgical treatment of black triangles. Six sites with the presence of deficient interdental papilla in four patients were selected for this case series. After completion and reevaluation of scaling and root planing, autologous i-PRF was injected at the base of the interdental papilla using the insulin syringe. Photographs obtained before the treatment and at 1, 3, and 6 months after the intervention were assessed by Image J software along with clinical measurements. The use of novel nonsurgical injectable PRF technique allows clinician to successfully treat deficient interdental papilla.
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ISP scientific events p. 418

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