Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
March-April 2021
Volume 25 | Issue 2
Page Nos. 91-180

Online since Monday, March 1, 2021

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EDITORIAL  

Plagiarism: Injurious to the academic health of the researcher and research! p. 91
Ashish Kumar
DOI:10.4103/jisp.jisp_22_21  
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PRESIDENT’S MESSAGE Top

Dynamic concepts of periodontal etiology p. 93
Nymphea Pandit
DOI:10.4103/jisp.jisp_33_21  
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SECRETARY’S MESSAGE Top

Research: Key to a greater learning p. 95
Harpreet Singh Grover
DOI:10.4103/jisp.jisp_48_21  
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REVIEW Top

Oral health of individuals with dementia and Alzheimer's disease: A review p. 96
Syed Ameer Hamza, Saba Asif, Syed Akhtar Hussain Bokhari
DOI:10.4103/jisp.jisp_287_20  
This paper explores the epidemiological evidence about oral health of individuals with neurodegenerative conditions of Alzheimer's disease (AD) and dementia. PubMed, Web of Science, and Scopus were searched to identify the relevant research papers published during January 2012 to June 2020. All cross-sectional, case–control, and cohort studies reporting oral and dental morbid conditions for status and association with AD and dementia were explored. The explored literature from 22 studies shows that oral health parameters of oral health and levels of oral inflammatory markers were deranged and exaggerated in patients suffering from AD and dementia. Many studies have observed poor oral hygiene as result of lack or irregularity in toothbrushing. Regarding decayed, missing, and filled teeth status in AD/dementia populations, no significant difference is reported. Periodontal diseases have been noted at raised levels in AD and dementia patients and shown progression with aggravation in neurological disorders. Both edentulousness and low chewing efficacies are associated with low cognition. Stomatitis and coated tongue and other oral pathologies are significantly higher in AD patients. AD patients have demonstrated higher bacterial load and inflammation levels than controls, and consequently, inflammatory biomarker levels are also raised. AD patients have reduced salivary secretions and with low buffering capacity. Evidence from the current literature update postulates that individuals suffering from AD and dementia have special oral health-care needs. Appropriate oral health management may thus significantly improve their oral health-related and general quality of life.
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ORIGINAL RESEARCH Top

Are there correlations between radiographic grade levels and modified grade levels of periodontitis? p. 102
Fatih Karaaslan, Ahu Dikilitaş, Esra Özge Aydın, Vesile Şen, Şerife Esra Kurt
DOI:10.4103/jisp.jisp_49_20  
Background: At the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, periodontitis was reclassified according to a multidimensional staging and grading system. Grading takes variabilities in the rate of disease progression into account, relying on recognized progression risk factors, and is based on the assessment of bone loss at the worst-affected tooth in the dentition as a function of age, which is then modified by factors such as smoking and diabetes mellitus. In this context, the aim of this study was to determine whether there are correlations between radiographically calculated grades and grades modified by the presence of smoking or diabetes. Materials and Methods: In this descriptive study, individuals diagnosed with periodontitis according to the 2017 classifications were examined. The grade of periodontitis was measured using periapical radiography. A modified-grade level was assigned to the patients according to their glycated hemoglobin levels (in diabetics) or their smoking status. Results: The study included 341 individuals. No statistically significant relationship was revealed by Chi-square testing (P > 0.05) or in the kappa agreement index between the modified grades and the radiographic grades. Conclusions: Although there was no correlation between radiographic grade and modified grade in smokers and diabetic individuals, increasing the grade score in these individuals in accordance with the 2017 classification provides clinicians the opportunity to develop a risk-based treatment plan, commensurate with the severity of periodontal disease and the level of risk.
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Analysis of collagen fibers in human gingival tissues using picrosirius red stain under polarized microscope p. 106
Anu Chandran, Rahul Bhandary, Nina Shenoy, Urvashi Ashwin Shetty
DOI:10.4103/jisp.jisp_152_20  
Background: Collagen fibers are the main element of gingival connective tissue and contribute a leading role in the preservation of structural integrity and tissue function. Hence, its degradation is regarded as the main marker of periodontal disease progression. Aim: The aim of this study is to analyze and compare collagen fibers, their birefringence pattern in healthy and in diseased gingival tissues stained using picrosirius red stain (PRS) and the polarizing microscope. Materials and Methods: A total of 90 participants screened were divided into the control group (healthy gingiva) and experimental group (moderate periodontitis and severe periodontitis) based on the clinical parameters. Gingival tissue sections were stained with PRS and observed under the polarized microscope to assess the type of collagen fibers in healthy and diseased gingival tissue. Statistical analysis was performed using the one-way ANOVA and Tukey multiple comparison test. Results: The healthy group revealed well-packed collagen in a parallel pattern with a strong birefringence, whereas in severe periodontitis group showed loosely packed collagen fibers in a haphazard pattern suggestive of severe destruction of the extracellular matrix. The moderate periodontitis group had a blended mixture of thick and thin fibers. Conclusions: Collagen fibers showed birefringence property when stained with PRS that helps in a better understanding of normal and pathological conditions.
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A profilometric and scanning electron microscopic analysis of tooth surface abrasion caused by rotary/oscillatory, linear motion, sonic, and ultrasonic toothbrushes: An in vitro study p. 112
Tejinder Pal Singh, Ashutosh Nirola, Rubby Brar
DOI:10.4103/jisp.jisp_162_20  
Background: Adequate plaque control facilitates good gingival and periodontal health, prevents tooth decay, and preserves oral health. Toothbrushing is the primary method of removing plaque and can be classified into powered and manual toothbrushes. Aim: The primary objective was to compare the abrasiveness and surface roughness caused by four different power-driven toothbrushes with a different mode of action, on tooth surfaces in vitro. Materials and Methods: An in vitro experiment was conducted on eighty freshly extracted tooth specimens which were equally divided into four groups. Each group was brushed with the specifically assigned electric toothbrush to that group, but keeping parameters such as force applied during brushing, storage of tooth before and after brushing, and toothbrushing time same. A total of the 2-month study was done on each tooth specimen. Tooth surface roughness was recorded before and after the toothbrushing experiment to check the difference between surface roughness readings. Scanning electron microscopic (SEM) analysis was done afterward to analyse the surface topography of each group specimens. Statistical Analysis Used: Paired t-test used for intergroup analysis and intragroup analysis was done using Kruskal–Wallis test. Results: After comparing the baseline and final readings of each group, it has been found that the mean difference between values is highly significant in Group 1 (rotary/oscillatory). The mean rank of Group 1 was least in all four groups, which showed the highest tooth surface abrasion in that group. SEM analysis also revealed that Group 1 tooth specimens had deeper scratches/lines comparatively to other groups. Conclusion: Rotary/oscillatory toothbrush caused the highest tooth surface abrasion when compared with other electronic toothbrushes.
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Evaluation of papilla levels following three different techniques for the second stage of implants – A clinical and radiographic study p. 120
L N. V. Alekhya Kamakshi, Ashita S Uppoor, Dilip G Nayak, Swati Pralhad
DOI:10.4103/jisp.jisp_60_20  
Objective: Papilla formation after placement of an implant is influenced by the underlying bone and the periodontal biotype. The second-stage surgery to uncover the implants may have an effect on the regeneration of papilla and various techniques such as the scalpel, diode laser, and punch technique are used. In the present study, an attempt has been made to evaluate papillary fill levels following three different techniques of second-stage implant surgery. Materials and Methods: A total of 35 patients with 45 implants (39 single implants and 3 sites with two adjacent implants) were randomly divided into three groups with 15 implants each: second-stage implant surgery with midcrestal incision using scalpel (Group I), with I-shaped incision using scalpel (Group II), and using diode laser (Group III). The mean papillary fill and mean crestal bone loss for all three groups were compared at baseline, 3 months, and 6 months of prosthesis delivery. Results: Complete papilla fill at 6 months was seen in 60% and 73.3% of sites in Group II and Group III, respectively. Bone level contacting implant and adjacent teeth was less in both Groups II and III. Bone level from the contact point to the bone crest was least in Groups II and III. Conclusion: The use of diode laser during second-stage surgery showed maximum papillary fill and minimal crestal bone loss when compared with other two techniques. Irrespective of technique used for second-stage surgery, bone loss did occur after prosthesis delivery.
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Efficacy and safety evaluation of alcohol-containing and alcohol-free mouth rinses: A clinicocytological study p. 128
Vandana Gupta, Vandana Aditya Pant, Suraj Pandey, Aditya Bhusan Pant
DOI:10.4103/jisp.jisp_196_20  
Context: Whether the alcohol-based mouth rinses are as good as nonalcoholic mouth rinses as far as oral mucosal safety is concerned? Aims: The aim of the study was to investigate the oral mucosal safety of widely used alcohol- and nonalcohol-based mouth rinses at their recommended doses. Settings and Design: The clinical and cytological investigations were carried out by enrolling 120 systemically healthy volunteers fulfilling the inclusion criteria. The volunteers were subjected to a repeated mouth rinse for 60 days to either alcohol-based or alcohol-free mouth rinses at their recommended dosages. A comparative analysis for any clinical adverse response on the oral mucosa and efficacy, i.e., reduction of plaque and gingival index was done at the terminal of the exposure. The studies were also carried out to investigate the cytotoxicity and genotoxicity potential of alcohol-based and alcohol-free mouth rinses in the exposed mucosal cells. Subjects and Methods: The data have been presented in comparative account between alcohol-based and alcohol-free mouth rinses in the volunteers at day 0 and day 60. The cytotoxicity and genotoxicity potential of prescribed doses of alcohol- and alcohol-free mouth rinses have also been evaluated using tetrazolium bromide salt 3-(4, 5-dimethylthiazol-2-yl)-2,-diphenyl tetrazolium bromide, neutral red uptake, and trypan blue dye, micronucleus and chromosomal aberrations. Results: The study findings reveal no statistically as well as biologically significant adverse responses of both alcohol-based and alcohol-free mouth rinses at clinical and cytological level. Conclusions: Under cytological observation, repeated dose exposure up to 60 days of the mouth rinses (alcohol-based and alcohol-free) used in the study was found to be effective and safe at their prescribed dosages.
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Analysis of root coverage esthetic score in patients treated for gingival recession: An interexaminer reliability p. 133
Inti Srividya, Gautami Subhadra Penmetsa, Bukkapatam Venkata Subbareddy, Karuturi Lahari
DOI:10.4103/jisp.jisp_626_19  
Background: Awareness about pink esthetics among dentists in general needs to be assessed as root coverage procedures are the mainstay of treatment for gingival recession. Concordance among the dentists in figuring out the esthetic outcomes after root coverage procedures is inconsistent. Hence, this study aims to evaluate inter- and intra-examiner reliability of root coverage esthetic scores (RES) between periodontists and nonperiodontists. Materials and Methods: The study was conducted using twenty baseline and 6-month posttreatment photographs of Miller's Class I and Class II gingival recessions. The participants that constituted ten periodontists and ten nonperiodontists were assembled in the seminar hall to receive training on protocol and procedures for RES by the investigator. All the participants were shown twenty projections of side-by-side baseline and 6-month outcomes of root coverage procedures. Each projection was shown for 30 s during which the participants were made to use RES system to evaluate the surgical outcomes. Results: Periodontists showed the highest reliability in the scores of marginal tissue contour with an overall intraexaminer reliability to be perfect among periodontists. Intraexaminer reliability among nonperiodontists was fair, and gingival margin was the parameter with the highest reliability among them. Interexaminer reliability between periodontists and nonperiodontists showed slight reliability concerning gingival margin, and fair reliability was found for marginal tissue contour, soft-tissue texture, mucogingival junction, and gingival color. Conclusion: Satisfying the esthetic component of gingiva is the duty of every dentist in general and not only the periodontists. Significant variability was found in esthetic scores between the groups, which can probably be attributed to the lack of sufficient knowledge regarding pink esthetics among the nonperiodontists, which needs to be improved.
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Evaluation of platelet-rich fibrin and tricalcium phosphate bone graft in bone fill of intrabony defects using cone-beam computed tomography: A randomized clinical trial p. 138
Mudambi Prakash Pavani, Konda Reddy Krishna Mohana Reddy, Bavigadda Harish Reddy, Sunil Kumar Biraggari, C Hema Chandra Babu, Vinay Chavan
DOI:10.4103/jisp.jisp_621_19  
Background: Platelet-rich fibrin (PRF) is the second-generation platelet concentrate first described by Choukron et al. It incorporates leukocytes, platelets, and growth factors within dense fibrin matrix, can be used in periodontal regeneration alone or in combination with bone grafts. Aim: This study assesses bone fill in intrabony defects, following the use of β tricalcium phosphate (TCP) bone graft with and without PRF. Materials and Methods: Thirty sites with intrabony defects in periodontitis patients were selected, randomly allotted into three groups: Group A open flap debridement (OFD), Group B OFD with β TCP with PRF, and Group C β TCP. Clinical parameters such as plaque index, gingival index, sulcus bleeding index, and PPD recorded at baseline and 6 months. Radiographic parameters include cementoenamel junction (CEJ) to base of defect, CEJ to alveolar crest, depth of defect, and bone fill assessed using the cone-beam computed tomography (CBCT). The comparison between the test group and control group in terms of clinical and radiographical parameters was assessed using the independent sample t-test. Results: Significant reduction in probing depth measurements, defect fill observed in both β TCP with PRF and β TCP alone groups compared to OFD. However, intergroup comparison assessed using the independent sample t-test found to be statistically nonsignificant (P < 0.05 is considered significant). Conclusion: All three treatment strategies resulted in significant reduction in probing depth and bone fill at 6 months. Bone fill achieved in β TCP with PRF was more compared to β TCP alone and OFD at 6 months follow-up. CBCT can be accurately used to assess the morphology of intrabony defect and also in evaluating bone fill.
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Evaluation of Morinda citrifolia (noni) fruit extract as a bone regenerative material in the treatment of periodontal intrabony osseous defects: Clinical and cone-beam computed tomography assessment p. 144
Blessy Shin Sabu, Kabbur Thippanna Chandrashekar, Rohit Mishra, Vandana Dubey Tripathi, Honey Khatri, Ankita Deo
DOI:10.4103/jisp.jisp_58_20  
Background: Nature and its products can be utilized for regeneration in periodontal destruction and damage to supporting tissues. We come across the use of various graft materials to reestablish the lost bone and for the long-term survival of teeth. The objective of this study was to evaluate the bone fill efficacy of Morinda citrifolia fruit extract in the periodontal bone defect. Materials and Methods: This randomized study included twenty patients indicated for periodontal regenerative therapy and were equally divided and assigned into the experimental and control group. Open flap debridement alone was performed in the control group, while placement of extract along with open flap debridement was done in the experimental group. Clinical parameters assessed were gingival index, probing pocket depth, and relative attachment level, and the amount of bone fill was assessed using cone-beam computed tomography (CBCT) at baseline and at 6-month interval. Results: From the values of clinical parameters, there was a mean reduction in probing pocket and gain in attachment level and a 27.7% increase in bone fill in experimental group as compared to the control group from CBCT analysis. Conclusions: The use of M. citrifolia fruit extract in the intraosseous defect was found to be efficacious in terms of relative attachment level and the amount of bone fill, and it had shown some anti-inflammatory affect.
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Association of sense of coherence with oral health behaviors and gingival bleeding among adolescents p. 150
Ruchi Nagpal, Anil Gupta, Charu Mohan Marya, Imran Mushtaq, Shourya Tandon
DOI:10.4103/jisp.jisp_165_20  
Context: Adolescents experience many types of gingival and periodontal diseases, including gingivitis, localized or generalized aggressive periodontitis, and periodontal complications of various systemic diseases. The occurrence of periodontal diseases is not only related to biotic factors but may also be affected by nonbiotic factors such as oral health behaviors and practices. Various factors that influence an individual's health-related behaviors include a psychosocial construct named sense of coherence (SOC). Aim: The aim of this study is to investigate the association of SOC with oral health behaviors and gingival bleeding. Settings and Design: This was a cross-sectional, analytical study that was done in the school setting. Materials and Methods: A random sample of 850 adolescents was selected from nine schools of the Faridabad block of Faridabad district (Haryana) through the multistage cluster sampling technique. Methods of data collection included a combination of questionnaire administration and clinical examination. The questionnaire comprised sociodemographic variables, questions related to oral health behaviors, and Antonovsky's SOC scale. The questionnaire was interviewer administered. Statistical Analysis: Unadjusted and adjusted rate ratios of gingival units having bleeding on probing were estimated by Poisson regression multilevel analysis in Statistical Package for the Social Sciences (SPSS) software for Microsoft Office. Results: Adolescents whose mothers had studied <8 years (relative risk [RR] 1.26; 95% confidence interval [CI] 1.04–1.38), who were males (RR 1.198; 95% CI 1.01–1.29), low SOC (RR 15.93; 95% CI 13.06–19.35), and toothbrushing frequency of less than once a day (RR 1.43; 95% CI 1.21–1.67) and children with plaque index >1 (RR 2.765; 95% CI 2.12–3.25) presented with the higher number of gingival units having bleeding. Conclusion: SOC is associated with gingival bleeding through oral health behaviors.
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Assessment of knowledge, awareness, and attitude among patients with cardiovascular disease about its association with chronic periodontitis p. 156
Pranjali Vijaykumar Bawankar, Abhay Pandurang Kolte, Rajashri Abhay Kolte
DOI:10.4103/jisp.jisp_101_20  
Background: A strong bilateral relationship between cardiovascular disease (CVD) and chronic periodontitis has been established for decades. However, a knowledge gap regarding this association still persists among patients. The main objective of the present study was to assess the knowledge, awareness, and attitude among patients with CVD about its association with chronic periodontitis (CP). Materials and Methods: This observational cross-sectional survey consisted of 500 patients with CVD. Along with information on demographic characteristics, data were collected on knowledge, awareness, and attitude of the interrelationships between periodontal disease and CVD, using a 5-point Likert scale, with 4 and 5 representing “agree” and “strongly agree,” respectively. Results: A significant number of the study population had no knowledge regarding the bilateral association CVD and CP. Other questions revealed limited awareness and ignorant attitude of the patients. Conclusion: Within the limitations of the study, it can be concluded that there is a lack of awareness and an ignorant attitude about the bidirectional relationship between CVD and periodontitis among the CVD patients. Special efforts should be taken by dental as well as medical professionals to increase the awareness in this regard and thereby deliver quality health-care services at earlier stages.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Sclerotherapy – A novel modality in the management of oral pyogenic granuloma p. 162
Abhishek Govind Soni
DOI:10.4103/jisp.jisp_189_20  
Pyogenic granuloma is a commonly occurring inflammatory hyperplasia involving the oral cavity. Surgical resection of the lesion is the mainstay treatment of pyogenic granuloma. However, intraoperative bleeding, postoperative infection, and recurrence chances are more with the surgical technique. Therefore, sclerotherapy has evolved as an effective alternative approach, which is simple, noninvasive, with minimal discomfort to the patient and having little recurrences and few complications. This case report is an attempt to highlight the usefulness of sclerotherapy procedure in the management of orogingival pyogenic granuloma, particularly involving the anterior esthetic zone of the oral cavity.
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Adult multifocal Langerhan's cell histiocytosis involving periodontal tissues p. 166
Vijay Kumar Chava, Vellampalli Udhaya Bhanu
DOI:10.4103/jisp.jisp_22_20  
Langerhans cell histiocytosis (LCH) is a rare inflammatory neoplasia characterized by uncontrolled stimulation and abnormal proliferation of Langerhans cells (LCs). It can present as unifocal or multifocal with local and systemic manifestations which involves various internal organs and mucosal tissues. The clinical course varies among individuals, ranges from spontaneous resolution to life-threatening conditions with multisystem involvement. Prognosis relies on the involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, mainly on organ dysfunction, and response to initial therapy. The diagnosis is based on histological study of tissues samples and shows tissue infiltration with LCs and the tumor cells immunopositive for s100/CD1a/Langerin/CD68 focal). In the oral cavity, LCH affects the alveolar or cortical bone and causes ulcerated lesions involving various mucosal and periodontal tissues. This article reports a case of adult multifocal LCH involving periodontal tissues with 1½ year posttreatment follow-up showing regression of the lesion.
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A regenerative approach using xenograft and PRF membrane in the management of muscosal fenestration in posterior maxilla – A rare case report p. 171
Swapnil Sanjay Karwa, Lalitha Basappa Shiggaon, Alka Sanjay Waghmare, Mayur Ashok Dhavan
DOI:10.4103/jisp.jisp_224_19  
Mucosal fenestration is a rare entity wherein apex of the tooth is exposed in the oral cavity due to breakdown of the overlying bone and mucosa. This leads to accumulation of plaque and if left untreated can hamper the further prognosis of the tooth. Although there are few evidences regarding mucosal fenestrations in posterior region of maxilla, treatment of the same have been challenging for the clinicians. This case report describes the management of mucosal fenestrations in the posterior maxilla by regenerative periodontal flap surgical approach using xenograft (Osseograft) and platelet-rich fibrin membrane.
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Terminal dentition to functional esthetic full-mouth implant reconstruction: Evidence-based approach p. 176
Farhan Durrani, Himani Painuly, Akanksha Shukla, Rakhshinda Nahid, Samidha Pandey
DOI:10.4103/jisp.jisp_479_19  
Implant-supported fixed dental prosthesis is a well-accepted treatment option for edentulism. Loss of teeth due to extensive caries or severe periodontitis presents a challenge to the clinicians. Young age disability with either of these problems can further make full-mouth rehabilitation on implants a complex procedure. The outcome of implant surgery with periapical infections and periodontal inflammation is unpredictable and often delays the placement of dental implants. Here, we describe a case of full-mouth reconstruction with implant-supported prosthesis in a young individual who lost all her teeth due to extensive caries. The journey from terminal dentition to functional esthetic rehabilitation was uneventful.
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