Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
January-February 2021
Volume 25 | Issue 1
Page Nos. 1-89

Online since Thursday, January 7, 2021

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Authorship: Credit those who deserve it Highly accessed article p. 1
Ashish Kumar
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Implantology from a periodontist's perspective p. 3
Nymphea Pandit
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Synergise or perish p. 5
Harpreet Singh Grover
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Radiosurgery in periodontics: Have we forgotten it? Highly accessed article p. 6
Duddukuri Hema, Jammula Surya Prasanna
Radiosurgery (RS) has evolved from electrosurgery and uses ultra-high-frequency radio waves at a frequency ranging from 3 to 4 MHz. It is used to address numerous soft-tissue concerns in dentistry and as well as medicine with excellent and predictable results. A review of the indexed literature disclosed that RS has been employed for various periodontal procedures such as gingivectomy, gingivoplasty, crown lengthening, minimally invasive closed osteotomy, frenectomies, operculectomies, depigmentation, gingival curettage, periodontal flap procedures, mucogingival surgeries, harvesting soft-tissue grafts, and also in implantology. Reduced lateral heat production with minimal tissue damage, faster healing, availability of specialized electrodes, increased perception, and cost-effectiveness are some of the notable advantages of RS. The evidence available implies that RS when used appropriately might be a better and economical alternative to a scalpel, electrosurgery, and laser. Inadequate knowledge on the use of this treatment modality due to short of research conducted in this area could be the reason behind it becoming obsolete. This review is an attempt to reminiscence the uses of this versatile tool in periodontal therapy and reinstate its use in present-day clinical practice.
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Effect of epigallocatechin-3-gallate on tumor necrosis factor-alpha production by human gingival fibroblasts stimulated with bacterial lipopolysaccharide: An in vitro study p. 11
Elahe Karami, Zeinab Rezaei Esfahrood, Reza Mansouri, Ahmad Haerian, Amir Abdian-Asl
Background: Evidence shows that epigallocatechin-3-gallate (EGCG) in green tea has anti-inflammatory effects. Aim: This study assessed the effect of EGCG on the production of tumor necrosis factor-alpha (TNF-α) as an inflammatory cytokine in periodontitis, which produced by human gingival fibroblasts (HGFs) stimulated with lipopolysaccharide (LPS) of Porphyromonas gingivalis. Materials and Methods: In this study, HGFs were cultured and subjected to LPS and EGCG. Cell viability of different concentrations of EGCG (10, 25, 50, 75, and 100 μM) and LPS (1, 10, 20, and 50 μg/mL) was assessed using methyl-thiazole-tetrazolium (MTT) assay. Then, the best concentrations of EGCG and P. gingivalis LPS were used simultaneously and separately to assess the production of TNF-α by HGFs using the enzyme-linked immunosorbent assay (ELISA). Assessments were done at 1, 3, and 5 days. Data were read using the ELISA reader and analyzed by the SPSS through two-way ANOVA. Results: LPS at 1, 10, and 20 and EGCG at 10.25 and 50 μM showed the least cytotoxicity in MTT assay. ELISA showed EGCG alone decreased the production of TNF-α in all days, except 10 μM on day 1. 1, 10, and 20 μg/mL LPS increased the output of TNF-α on days 1 and 3 while reducing it on day 5. The combination of EGCG and LPS showed a decrease of TNF-α in all days except on day 5 that revealed an increase in the production of TNF-α at 25 and 50 μM EGCG. Conclusion: In the combination use of EGCG and LPS, EGCG shows anti-inflammatory effects by decreasing the production of TNF-α by HGFs stimulated with P. gingivalis.
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Putative periodontal pathogens in persisting periodontal pockets of endodontic origin p. 17
Dhayanand John Victor, Sangeetha Subramanian, P SG Prakash, Deepika Rachel Samuel Raj
Background: The microbial profile of endodontically treated teeth, presenting with a persisting deep periodontal pocket, secondary to a primary endodontic lesion, draining through the gingival crevice, has received very less attention. This observational study was done to evaluate if these sites with persisting pockets of endodontic origin persist because they have acquired bacteria which are considered as putative periodontal pathogens. Materials and Methods: Subgingival plaque samples were collected from fifty patients diagnosed with a primary endodontic and a secondary periodontal lesion that persisted even after completion of the root canal treatment. Clinical parameters such as probing pocket depth, clinical attachment level, plaque index, furcation, and tooth mobility were recorded. Real-time polymerase chain reaction was used to determine the possible association between six bacteria, which are frequently associated with periodontal and endodontic lesions. Results: The mean cycle threshold value for Treponema denticola (Td) was found to be 33.74, and for Enterococcus faecalis (Ef), it was 34.39. With regard to clinical attachment loss, Td (P < 0.04) and Parvimonas micra (P < 0.05) had a significant correlation. Conclusion: Ef (92%) and Td (86%) were found to be most prevalent. Porphyromonas gingivalis and Tannerella forsythia were in minimal to nonexistent levels.
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Minimally invasive therapy for reconstruction of lost interdental papilla by using injectable hyaluronic acid filler p. 22
Unnati Pitale, Pritish Chandra Pal, Gauri Thakare, Manish Verma, Shikha Dhakad, Rohit Pandey
Background and Aim: Reconstruction of interdental papillae (IDP) is among the most difficult periodontal therapy. Papillary recession is multifactorial, and several surgical, nonsurgical, and minimally invasive techniques have been suggested. The purpose of this study was to evaluate the clinical application of injectable hyaluronic acid (HA) gel for the reconstruction of IDP in Nordland and Tarnow's Class I and II papillary recession cases. Materials and Methods: In the present in vivo clinical trial, 7 patients (2 males, 5 females) with 25 defects were selected. A volume of 0.2 ml HA gel was injected at the respective areas and massaged for 2–3 min. Photographs were obtained, and the assessment of the data was performed clinically (CP-GM, interproximal width [IPW]) and by Image analysis software (black triangle height [BTH], black triangle width [BTW]). Comparison of mean values was performed using the analysis of variance, followed by Post hoc Bonferroni test. Value of P ≤ 0.05 was considered statistically significant. Results: Application of HA gel for the reconstruction of IDP was successful in 6 months. CP-GM, BTH, IPW, and BTW showed a statistically significant difference from baseline to 3 and 6 months interval (P = 0.01). Post hoc Bonferroni test for CP-GM, BTH, BTW, and IPW revealed a statistically significant difference from baseline to 3 months (P ≤ 0.05) and 6 months (P ≤ 0.05) and a nonsignificant difference at 3–6 months (P ≥ 0.05). Conclusion: Injectable HA gel is a promising minimally invasive therapy for enhancing papillary esthetics.
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Estimation and correlation of procalcitonin in saliva and serum of chronic periodontitis patients before and after nonsurgical periodontal therapy: An analytical comparative study p. 29
Ambili Renjith, Laljyothi Sujatha
Background: Procalcitonin (ProCT) is an emerging inflammatory biomarker in bacterial infections. Few studies have reported raising salivary ProCT in periodontitis patients. Hence, the study aims to analyze and correlate the changes in saliva and serum ProCT in periodontitis patients before and after nonsurgical periodontal therapy. Materials and Methods: We have included 15 chronic periodontitis patients of mean age 41.8 ± 6.82 years who satisfy the inclusion criteria in the study. After saliva and serum collection, clinical parameters such as plaque index, gingival index, gingival bleeding index, probing pocket depth, and clinical attachment were recorded, and scaling and root debridement were performed. Reevaluation was done at 1- and 3-month interval. ProCT was estimated using the enzyme-linked immunosorbent assay. Results: Salivary ProCT was significantly greater than its serum counterpart at baseline and 1 month after periodontal therapy (0.20 vs. 0.26, 0.13 vs. 0.14 ng/ml respectively). We noticed a significant reduction in salivary as well as serum ProCT (35% and 46%, respectively) 1 month after scaling and root debridement. A significant moderate positive correlation was found between paired observations of salivary and serum ProCT at baseline as well as after periodontal therapy (r = 0.61 and 0.7). A further reduction of salivary ProCT was noticed 3 months after nonsurgical therapy (0.11 ng/ml). Conclusions: Serum ProCT significantly decreases with periodontal treatment, indicating the impact of periodontal therapy on systemic inflammation. Since salivary ProCT is positively correlated with serum ProCT, we can consider it as an alternative biomarker to its serum counterpart.
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Assessment of benzyl isothiocyanate as an adjunct to conventional periodontal therapy p. 34
Vidhi Kevadia, Shaila Kothiwale
Background: Conventional nonsurgical periodontal therapy eliminates the pathogenic microbes, yet residual deposits promote the recurrence of the disease. As antimicrobials may pose undesirable effects, alternate therapies are probed. Aim: The aim of the study is to evaluate the efficacy of locally delivered benzyl isothiocyanate (BITC) as an adjunct to scaling and root planing to treat patients with chronic periodontitis. Materials and Methods: The study included 30 patients diagnosed with chronic periodontitis. Test (scaling and root planing along with BITC intervention) and control (scaling and root planing) sites were randomly assigned to each patient. These sites were in the contralateral quadrants, having a probing depth of 4–6 mm. The plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), and microbial load (colony forming unit [CFU]) were assessed at baseline, 1-week, and 6-week time interval. Data were analyzed by ANOVA/Friedman test, Mann–Whitney U-test, pairwise paired t-test, and Wilcoxon test, with P ≤ 0.05 set as statistically significant. Results: The scores of PI, GI, PPD, and CAL from baseline to 6-week follow-up within both the test and control sites were noted to be statistically significant (P < 0.0001). The CFU showed a significant reduction (P = 0.0229) within the test site at varying time intervals. The change in the mean PI score from baseline to 6-week time interval between the test and control site was noted to be statistically significant (P = 0.0039). Conclusion: The local application of BITC chips effectively reduced the PI, GI, PPD, and CFU, subsequently with the gain in CAL, and improved the tissue integrity and thereby oral hygiene.
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A comparison of the efficacy of scaling and root planning with application of pomegranate chip, pomegranate gel, and scaling and root planing in sufferers with adult periodontitis – A prospective study p. 41
Prashant Tyagi, Vidya Dodwad, Bhavna Jha Kukreja, Pankaj Kukreja
Context: The use of herbal compounds is a comparatively safer alternative to synthetic compounds for periodontal therapy. Aim: This study aims to investigate effect of extracts from pomegranate in a chip and gel form on periodontitis following scaling and root planing in adult periodontitis patients. Settings and Design: An in vivo prospective study. Materials and Methods: Thirty patients of adult periodontitis with initial pocket depth ≥4 mm were enrolled into the research and divided randomly into three groups, (10 in every group). After baseline examination, scaling root planing of tooth was achieved. Then subgingival application of medicated chips in Group 1, gel in Group 2, and placebo in Group 3 was done. Plaque index, gingival index, probing pocket depth, and relative attachment ranges were recorded at baseline, 21 days and 45 days. Statistical Analysis Used: Analysis of variance test. Results: The study confirmed significant improvements of plaque index ratings in Group 1 at day 21. It showed significant improvements of gingival index scores, probing pocket depth, and clinical attachment at day 21 and 45. Gingival index rankings and probing pocket depth were extensively elevated altogether in three groups at day 21 and 45. Relative attachment degree was extensively raised in Group 1 and Group 2 at day 21 and day 45 and in Group 3 at day 45. The relative attachment degrees confirmed significance at day 21 between Group 1 and Group 2, and Group 1 and Group 3. Conclusion: Pomegranate extracts in chip and gel shape may offer additionally advantages to scaling and root planing for remedy of periodontal pockets.
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Association between nonalcoholic fatty liver disease and inflammatory periodontal disease: A case-control study p. 47
Ajay Duseja, Gurparkash Singh Chahal, Ashish Jain, Manu Mehta, Aditya Ranjan, Vishakha Grover
Background: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. Aim: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. Settings and Design: Tertiary health care center, cross-sectional case-control observational study. Materials and Methods: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. Statistical Data Analysis: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). Results: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. Conclusion: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.
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Association of location and diameter of alveolar antral artery to crest of alveolar bone in dentate and partially edentulous patients – A cone-beam computed tomography study p. 55
Rajashri Abhay Kolte, Abhay Pandurang Kolte, Priyanka Sunil Rahate, Pranjali Vijaykumar Bawankar
Background: One of the most challenging anatomical conditions to manage during sinus augmentation using lateral window approach is the alveolar antral artery (AAA) when it is unusually wide in diameter and passes through the area of the osteotomy with a complete intraosseous course. The purpose of this study was to investigate the association of location and diameter of AAA to the crest of alveolar bone in dentate and partially edentulous patients using cone-beam computed tomography (CBCT). Materials and Methods: Totally 100 CBCT scans of patients (50 dentate and 50 edentulous) were selected and analyzed. The location and diameter of AAA in the lateral wall of the maxillary sinus were evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar (P1), second premolar (P2), and first molar (M1). Results: The diameter of AAA in dentate patients was higher in M1 region (1.32 ± 0.34 mm) than P1 (0.91 ± 0.20 mm) and P2 (1.07 ± 0.24 mm) regions as compared to edentulous patients. It was found that the location of AAA for P1 in the dentate group (22.35 ± 4.17 mm) was significantly higher than that of the edentulous group (20.37 ± 2.48 mm). A negative relationship has been found between age and the distance between the AAA canal and crest of the alveolar ridge in both dentate (P = 0.001) and edentulous (P = 0.003). Conclusion: A significantly negative relationship existed between age, diameter, and location of AAA in both the dentate and edentulous groups.
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Gingival squamous cell carcinoma masquerading as necrotizing ulcerative periodontitis p. 61
Saif Khan, Kafil Akhtar, Abdul Ahad, Jaiti Uppal
Necrotizing ulcerative periodontitis (NUP) is a painful and debilitating condition seen mostly in an immunocompromised state. Although squamous cell carcinoma (SCC) on gingiva is not uncommon, its presentation as a benign necrotizing lesion on gingiva is rare. Such presentations may lead to delayed diagnosis and poor prognosis. This report describes a case of a 34-year-old male presenting clinically with NUP around mandibular posterior teeth. Clinical features were misleading, but the histological findings established the diagnosis of well-differentiated SCC. Immunohistochemistry also showed features of epithelial–mesenchymal transition with decreased expression of E-cadherin and increased vimentin expression showing local invasion and metastasis. The patient was referred to the oncology department for evaluation of possible metastasis and further management of carcinoma.
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Idiopathic gingival fibromatosis in association with aggressive periodontitis and candidal infection: A unique case report with 7-year follow-up p. 65
Anuradha Bhatsange, Anuja Moharir, Vibhuti Mistry, Sharanbasappa Japatti
Idiopathic gingival fibromatosis, also called idiopathic gingival overgrowth (IGO), is a rare benign condition that occurs either in isolation or as a part of a syndrome. The overgrowth, if excess, impedes oral functions such as mastication and speech and causes cosmetic disfigurement. Diagnosis and treatment becomes challenging if the overgrowth is massive and accompanies other associated pathologies. This case reports concurrent occurrence of three pathologies, i.e., IGO, aggressive periodontitis, and candidal infection in a 20-year-old healthy male patient. The surgical procedure performed involved internal bevel gingivectomy combined with open-flap surgery. Seven-year follow-up revealed no recurrence of overgrowth and stable periodontal condition.
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Use of alternative communication with pictures for outpatient periodontal treatment in fragile X syndrome patients p. 70
Rafael Ferreira, Adriana Gledys Zink, Paulo Sérgio da Silva Santos
The purpose of this article is to discuss the clinical management and behavior during periodontal treatment in two patients with fragile X syndrome (FXS) using alternative communication with pictures (ACP). Both patients had a history of previous dental care only possible under general anesthesia. The ACP was used to anticipate the activities to be carried out, promoting ambiance, improving the professional–patient communication, and decreasing the stress of the patient. It was possible to carry out outpatient care without oral sedation and containment/physical restraint in both patients, being surpassed the communicative and behavioral difficulties. These case reports allow us to re-think dental care under general anesthesia or other invasive methods for patients with FXS. Therefore, the ACP is an important mediator tool that can facilitate the insertion and the management of patients with FXS, allowing the dental care outpatient clinic to promote oral health and quality of life for these patients, improving adherence to periodontal treatment and the periodontal maintenance for oral hygiene.
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Therapeutic effects of diode laser on vascular epulis in esthetic area p. 75
Tie-Lou Chen, Xiao-Man Wang, Xin-Hai Zhang, Jun Chen, Jin Liu
Vascular epulis is a rare clinical disease. In our study, a case of vascular epulis in the cosmetic area was treated by diode laser, without recurrence and obvious inflammation in the surgical site 5 years after surgery. This case report indicates that the excision of vascular epulis in the cosmetic area of the anterior teeth by diode laser could be an alternatively safe and complementary approach in lieu of conventional surgery.
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Treatment of lingual gingival recession on mandibular lateral incisor using minimally invasive full-thickness tunneling technique and subepithelial palatal connective tissue graft p. 78
Eiti Agrawal, Rahul Chopra, Nikhil Sharma
Gingival recession on the lingual aspect of teeth may cause dentinal hypersensitivity problems in patients. Treatment of such recessions is not a regular procedure owing to its anatomical restraints, difficulty in isolation as well as lack of esthetic importance. The present case describes the use of connective tissue graft (CTG) in the treatment of isolated lingual recession on mandibular lateral incisor using minimally invasive tunneling technique. Six-month posttreatment follow-up showed a root coverage of 3.5 mm with enhanced width of keratinized tissue. This report encourages the application of CTG along with tunneling technique in the treatment of lingual recession to achieve root coverage as well as alleviate patient's dentinal hypersensitivity issues.
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Proposal of a minimally invasive approach diagnosing desquamative gingivitis-associated diseases p. 83
Marco Túllio Brazão-Silva, Lioney Nobre Cabral, Tiago Novaes Pinheiro
Background: We aimed to present a minimally invasive clinical approach to collect a suitable sample for the laboratory diagnosis of desquamative gingivitis. Materials and Methods: The proposed technique involves Nikolsky's test for the collection of tissue samples. It consists of the histopathological analysis of the bullous membrane formed in cases with positive Nikolsky's sign (NS). Three patients without a previous diagnosis of the disease agreed to undergo this protocol before a biopsy. Results: The diagnoses of the three cases reported here were mucous pemphigoid (MP), pemphigus vulgaris (PV), and lichen planus (LP). The tissue samples collected using this technique were sufficient to microscopically observe partial-thickness epithelium (diagnosing PV) or full-thickness epithelium (diagnosing MP). The diagnosis of LP was only possible by conventional biopsy. Conclusion: We observed, for different cases, some advantages of the proposed technique: minimally invasive, potentially superior to exfoliative cytology, easily performed, and with low costs.
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Chlorhexidine: An effective anticovid mouth rinse p. 86
Ashish Jain, Vishakha Grover, Charandeep Singh, Anshul Sharma, Deepjyoti Kumar Das, Prashant Singh, Krishan Gopal Thakur, Rajesh P Ringe
Context: Dentists across the globe are witnessing a completely unforeseen and uncertain professional situation during these times of COVID-19 pandemic. There is conflicting evidence regarding the effectiveness of routinely used mouthwashes and especially Chlorhexidine, to reduce the viral load in oral cavity and the aerosols during oral procedures. Aims: Comparative evaluation of the effectiveness of the current 'gold standard' chlorhexidine and povidone iodine as a control agent, through an in-vitro analysis. Settings and Design: In-vitro laboratory analysis. Methods and Material: All the experiments for analysis of antiviral efficacy of chlorhexidine digluconate (2%)and povidone iodine(1%), against SARS-CoV-2 virus were performed in the BSL3 facility at the Council of Scientific and Industrial Research-Institute of Microbial Technology, using the VeroE6 cell lines. The analysis of the virus inactivation was based on quantification of viral RNA (Cycle threshold (Ct) profile) present in the culture supernatant using Real-Time Quantitative Reverse Transcription PCR (qRT-PCR). Statistical Analysis Used: Descriptive analysis (Statistical package for social sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). Results: Chlorhexidine digluconate in 0.2% concentration inactivated more than 99.9% of SARS CoV 2 virus, in minimal contact time of 30 seconds, which was considered better efficacy than povidone-iodine utilized for 30 and 60 seconds. Subtle differences were observed in the activity of both the compounds in terms of percent inactivation of virus, though a greater relative change in Ct values was observed for chlorhexidine. Conclusions: Within the limitations of the present study, it can be concluded that Chlorhexidine digluconate in 0.2% concentration inactivated SARS CoV 2 in minimal contact time i.e 30 secs, however both compounds tested i.e Chlorhexidine and povidone-iodine were found to have antiviral activity against SARS CoV2 virus.
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Reviewers, 2020 p. 89

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