Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
July-August 2021
Volume 25 | Issue 4
Page Nos. 273-364

Online since Thursday, July 1, 2021

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EDITORIAL  

The Times: Tragic The Loss: Huge & Irreparable p. 273
Ashish Kumar
DOI:10.4103/jisp.jisp_317_21  
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PRESIDENT’S MESSAGE Top

Relevance of compiling the research findings in dentistry p. 275
Nymphea Pandit
DOI:10.4103/jisp.jisp_327_21  
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SECRETARY’S MESSAGE Top

E-Power to Empower p. 277
Harpreet Singh Grover
DOI:10.4103/jisp.jisp_316_21  
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REVIEW Top

Evidence revealing the role of T cell regulators (Tregs) in periodontal diseases: A review p. 278
Paavai Ilango, Dhanapriya Kumar, Arulpari Mahalingam, Abirami Thanigaimalai, Vineela Katam Reddy
DOI:10.4103/jisp.jisp_308_20  
Periodontitis is an inflammatory disease of the periodontium, which is a reflection of the overgrowth of oral commensals. This alteration in the oral microbiota initiates inflammation of the gingiva, which when left untreated, terminates with the resorption of the alveolar bone that may lead to a poor and hopeless prognosis. With upcoming trends in modulating the host's immunity, the role of regulatory T-cells has gained importance. These T-cells defend against inflammation and autoimmunity as they suppress both. However, in both the conditions, the regulatory cells are invariably reduced in number. Novel methods to enhance the function of Tregs have made their way in dentistry, as a promising approach to cure periodontitis. This article discusses various significant tests and trials of Tregs in the recent years.
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ORIGINAL RESEARCH Top

Evaluating the efficacy of desensitizing dentifrices on dentinal hypersensitivity management: A scanning electron microscopic analysis p. 283
Vasu Midha, Vishu Midha, Anuraj Singh Kochhar, Gulsheen Kaur Kochhar, Ritasha Bhasin, Himanshu Dadlani
DOI:10.4103/jisp.jisp_247_20  
Introduction: Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial treatment with a noninvasive prophylactic home care approach, followed by in-office treatment if desired result is not achieved. Aim: The purpose of this study was to evaluate the effectiveness of four different pastes containing 5% NovaMin (Sensodyne Repair and Protect®), Propolis (Phytoshield Propolis®), 5% potassium nitrate (Sensodyne®), and 8% arginine (Colgate Sensitive Pro Relief®) based toothpastes in the treatment of DH. Materials and Methods: One hundred dentin slices were cut from the crown section of molars. Etching with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 –5% NovaMin, Group 2 – Propolis, Group 3 – 5% potassium nitrate, and Group 4 – 8% arginine. Samples were brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration of tubules. Results: 5% NovaMin group showed more completely occluded dentinal tubules when compared to other groups. The differences among all the groups were statistically significant (P ≤ 0.05). Conclusion: In the present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties.
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Analysis of micromovements and peri-implant stresses and strains around ultra-short implants – A three-dimensional finite-element method study p. 288
Nida Sumra, Shrikar Desai, Rohit Kulshrestha, Khusbhu Mishra, Raahat Vikram Singh, Prachi Gaonkar
DOI:10.4103/jisp.jisp_350_20  
Background: Success of an implant depends on its placement in the bone and how well the stress and strain are distributed to the surrounding structures when occlusal force is applied to it. The size and shape of the implant plays an important role is the formation and distribution of stress and strains in the periodontium. Von Mises stresses and micromovements need to be evaluated while placing implants in D4 bone quality regions for a higher success rate. Aim: To evaluate the peri-implant Von Mises stresses, strains, and micromovements distribution in D4 bone quality around ultra-short implants of 5 mm length with varying diameters of 4 mm, 5 mm, and 6 mm. Materials and Methods: The finite element method was employed to make models replacing maxillary molars in D4 type bone that was missing. Implants that could be classified as ultrashort (5 mm) were used. These implants were of varying diameters of 4, 5, and 6 mm. In each model, the implant was subjected to a force of 100 N and analyzed. The force was applied in an oblique (45 degrees) and vertical direction (90°) to the long axis of the tooth. The models were made such that they simulated cortical and cancellous anisotropic properties of the bone. The models were then analyzed using the program ANSYS workbench version 12.1. Results: When all the three diameters were compared wide diameter, i.e., 6 mm threads had the least values of peri-implant von Mises stresses, strains, and micro-movements around them. When thread shapes were taken into consideration square micro thread created the most favorable stress parameters around them with minimum values of stress, strains, and micromovements. Conclusion: Ultrashort implants combined with a wide diameter and platform switched can be used in atrophic ridges or when there is a need for extensive surgery to prepare the implant site.
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Isolation and immunohistochemical characterization of periodontal ligament stem cells: A preliminary study p. 295
Bhavna Jha Kukreja, Kishore Gajanan Bhat, Pankaj Kukreja, Vijay Mahadev Kumber, Rajkumar Balakrishnan, Vivek Govila
DOI:10.4103/jisp.jisp_442_20  
Context: It is a known fact that periodontal tissue regeneration can be achieved by the use of periodontal ligament stem cells (PDLSCs). Current mainstay of periodontal treatment is focusing on stem cell tissue engineering as an effective therapy, making it important to isolate PDLSCs from periodontal tissues. Aims: The present research endeavor was undertaken to elucidate a technique for isolating PDLSCs for in vivo reconstructing the natural PDL tissue. Settings and Design: The study design involves In vitro prospective study. Materials and Methods: Premolar teeth were extracted from 12 patients who were under orthodontic treatment. PDL cells were scraped from their roots. Using 10 ml of Dulbecco's modified Eagle's medium with pH 7.2, the specimens of the periodontal tissue were transferred to laboratory where cell culture was done. Isolated stem cells were grown on 24-well microtiter plates-containing cover slips. They were incubated overnight at approximately 37°C in 95% air and 5% humidification. Anti-CD 45, CD73, CD90, CD105, and CD146 antibodies were used. After staining, cells were observed under phase-contrast microscopy and in inverted microscope. Results: The cells showed a marked growth and 90% confluence at day 6. Cells presented thin and long fibroblastic spindle morphology. Isolated PDLSCs showed colony-forming ability at the 14th day after seeding. Immunohistochemical staining of PDLSCs showed positive uptake for CD146, CD90, CD73, CD105, and negative uptake for CD45. Conclusions: The human PDLSCs can be clearly isolated and characterized by using CD90, CD73, CD146, and CD105 markers of stem cells.
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Estimation of neopterin as a biomarker in biofluids of pre and post-menopausal women after initial periodontal therapy: A biochemical assay p. 300
Jammula Surya Prasanna, Chinta Sumadhura
DOI:10.4103/jisp.jisp_516_19  
Context: Periodontitis (PDD) is a chronic inflammatory condition by nature which destroys the surrounding tooth structures. Menopause (pre and post) worsens the inflammatory state. Biofluids could serve as sources of biomarkers that could diagnose or indicate the intensity and extent of both conditions. Aims: This study aimed to guestimate the various biofluids of neopterin (NP) levels in premenopause (pre-m) and postmenopausal (post-m) women with PDD after initial periodontal therapy (IPT). Settings and Design: This was an interventional cross-sectional study. Materials and Methods: Based on menstrual history, within the age range of 40–60 years, 30 female patients having PDD participated, who were grouped into pre-m and post-m, each group comprised 15 subjects. A biochemical test of NP levels was done at the initial and three months following IPT. Statistics used: Group comparisons and percentage decrement using independent sample t-test and paired t-test for intragroup comparison were done with the version 21, IBM SPSS software. Results: Intragroup NP analysis at different time points showed significant improvement. Intergroup comparison, however, has shown significant improvement in the premenopausal group (Group I) only. Conclusions: Reduced levels of NP were found in pre-m and post-m groups 3 months after IPT, inferring that IPT is a paragon in periodontal therapy and NP might be a good diagnostic marker to detect PDD.
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Effect of green tea, ginger plus green tea, and chlorhexidine mouthwash on plaque-induced gingivitis: A randomized clinical trial p. 307
Anshula Deshpande, Neeraj Deshpande, Rameshwari Raol, Kinjal Patel, Vidhi Jaiswal, Medha Wadhwa
DOI:10.4103/jisp.jisp_449_20  
Background: Dental plaque, a microbial biofilm, is the primary etiological factor leading to the initiation of gingivitis and dental caries. It is therefore important to prevent it by taking effective plaque control measures. This research aimed at comparing the anti-plaque and anti-gingivitis effects of green tea (GT), GT plus ginger (GT + G), and chlorhexidine mouthwash (CHX) in children. Materials and Methods: This was a randomized clinical trial, with a sample size of 60 children between the age group of 10–14 years with plaque and gingivitis. They were randomly allocated in three different groups, depending upon the mouthwash used: Group A (GT mouthwash), Group B (GT plus ginger mouthwash), and Group C (CHX mouthwash). Plaque index and gingival index were recorded at baseline, then at interval of 15 days and 30 days after using mouthwash. Results: The mean gingival score and plaque showed a significant reduction from the baseline among all the three groups when compared with subsequent recall visits (15 days after using mouth-rinse and 30 days after using mouthwash) with P < 0.05. Conclusion: It can be concluded that the results of all three groups are comparable and hence herbal mouthwash can be used effectively as an alternative to CHX and as an adjunct to mechanical plaque control.
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Extracellular matrix containing nanocomposite bone graft in periodontal regeneration – A randomized controlled clinical and radiographic evaluation p. 313
Abhinav Prakash Deshpande, Mala Dixit Baburaj, Lashika Vasant Tambe, Upendra Prasad
DOI:10.4103/jisp.jisp_440_20  
Background: The study aims to evaluate the effect of adding extracellular matrix (ECM) component – natural collagen to nanocrystalline hydroxyapatite (nHA) bone graft in the treatment of intrabony defect in chronic periodontitis patients. Materials and Methods: Forty chronic periodontitis patients having at least one intrabony defect were treated surgically by open flap debridement and the defect grafted (Group A: 20 sites grafted with nHA with natural collagen and Group B: 20 sites grafted with nHA). Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and radiographic defect depth (RDD) were evaluated. Results: The mean PPD reduced from 7.6 ± 0.88 at baseline to 4.45 ± 0.69 and 2.60 ± 0.6 at 3 and 6 months, respectively, in Group A. In Group B, the mean PPD reduced from 7.5 ± 0.89 at baseline to 4.95 ± 0.60 and 2.65 ± 0.59 at 3 and 6 months, respectively. The mean CAL reduced from 7.75 ± 0.85 at baseline to 5.05 ± 0.76 and 3.6 ± 0.68 at 3 and 6 months, respectively, in Group A. In Group B, the mean CAL reduced from 7.70 ± 0.86 at baseline to 5.8 ± 0.7 and 3.75 ± 0.64 at 3 and 6 months, respectively. The mean RDD reduced from 8.13 ± 0.78 and 8.12 ± 0.83 at baseline to 4.27 ± 0.66 and 3.94 ± 0.5 after 6 months in Groups A and B, respectively. After 3 months, a statistically significant reduction in mean PPD and CAL values was noted in Group A while the results were comparable after 6 months. Conclusion: The effectiveness of nHA composite during initial healing phase (3 months) can be attributed to the presence of ECM-collagen in bone graft matrix.
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Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli's technique p. 320
S Raja Rajeswari, MG Triveni, AB Tarun Kumar, PL Ravishankar, M Prem Blaisie Rajula, Lydia Almeida
DOI:10.4103/jisp.jisp_187_20  
Background: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. Aim: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. Materials and Methods: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. Statistical Analysis and Results: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. Conclusion: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.
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Efficacy of free gingival graft in the augmentation of keratinized tissue around implants: A prospective clinical study p. 330
Abhishek Shah, Shaila Veerappa Kothiwale
DOI:10.4103/jisp.jisp_490_20  
Background: Effectuating adequate width of keratinized tissue (WKT) can lead to a healthy and stable implant/soft tissue interface which is important for the long term success of the implant. The use of free gingival grafts (FGG) for widening the WKT around dental implants increases the amount of attached gingival tissue and prevents clinical attachment loss.Aim: The aim of the study was to assess the ability of FGG to create a healthy implant/soft tissue interface. Methods and Material: A total of 10 edentulous sites in 10 patients with inadequate keratinized tissue indicated for replacement of missing teeth were treated. An implant was placed in edentulous sites and the keratinized tissue was augmented using FGG at the second stage of implant surgery. WKT was recorded at baseline, 3rd month and 6th month post-operatively. Plaque index (PI), gingival index (GI), probing depth (PD) and papillary index (PPI) and were recorded at 3 and 6 months post-operatively to evaluate the health of peri-implant tissues. Paired t-test was used for standard deviation and the level of significance was taken as 5% (P < 0.05). Results: The WKT at 3 (3.2±1.61mm) and 6 months (3±1.56 mm) compared to the baseline was statistically significant (P = 0.034). The other parameters PI, GI, PD, PPI showed no clinical significance from 3 and 6 months (P > 0.05). Conclusions: Augmentation of FGG created a significant gain in the WKT which resulted in a healthy implant/soft tissue interface.
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Comparison of clinical efficacy of diode laser and erbium, chromium: Yttrium, scandium, gallium, and garnet for implant stage 2 recovery procedure – A randomized control clinical study p. 335
Sahana Selvaganesh, Priya Lochana Gajendran, Thiyaneswaran Nesappan, Abhinav Rajendra Prabhu
DOI:10.4103/jisp.jisp_448_20  
Aim: The aim is to compare the clinical efficacy of diode laser and erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser for implant stage 2 recovery procedure. Materials and Methods: A total of 30 patients who had undergone dental implant placement were included in this study. The subjects were randomly allocated into three groups. Group 1 patients (n = 10) had implant recovery using diode laser, Group 2 (n = 10) implant recovery with Er, Cr:YSGG and conventional scalpel method (n = 10) was the third group. The pain assessment was recorded using visual analog scale (VAS scale), time taken for the procedure, intra-operative bleeding, time taken for healing were recorded for the three groups. Results: Data were tabulated and the results were analyzed using SPSS software version 26. Mann–Whitney U-test was used to compare the postoperative analgesic used, postoperative VAS score, the time taken for recovery and time taken for healing between the three study groups. Results were considered to be statistically significant when P < 0.05.Operation duration under Er, Cr:YSGG were much faster than the diode laser, however the results were not statistically significant (P = 0.051). The operation time under Er, Ch: YSGG and laser were faster than the conventional scalpel group (P = 0.000). The time taken for healing was faster in the Er, Cr:YSGG laser group than the diode laser and the scalpel group (P = 0.000). VAS scale at day 0 was higher in the conventional group than the two laser groups (P = 0.000). Conclusion: Considering the advantages of both these laser systems such as less anesthesia, less surgical trauma and faster healing, and post-operative comfort, lasers are an effective tool for implant stage two recovery techniques. However, since diode lasers are more cost effective when compared to Er, Cr:YSGG, diode lasers may meet the clinical needs when compared to hard-tissue lasers.
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Prevalence of gingival recession and its correlation with gingival phenotype in mandibular incisors region of orthodontically treated female patients: A cross-sectional study p. 341
Rawabi Hamdan Alsalhi, Syeda Tawkhira Tabasum
DOI:10.4103/jisp.jisp_526_20  
Background: Gingival recession is associated with dentin hypersensitivity, unesthetic appearance, and carious or noncarious cervical lesions. Orthodontic treatment, gingival thickness (GT), and keratinized tissue width (KTW) play roles in gingival recession etiology. The study is aimed to compare the prevalence of gingival recession in the mandibular incisor region of orthodontically-treated females with untreated controls, and to identify if there is any correlation among the GT, KTW, and gingival recession. Subjects and Methods: A total of 150 Saudi females were enrolled in this study. They were categorized into the treatment group (n = 75) and control group (n = 75). Background characteristics and clinical periodontal parameters including the plaque index, gingival index, GT, KTW, gingival recession length (GRL), and gingival recession width (GRW) were recorded and compared between groups, and any associations were identified. Results: Among the orthodontically-treated females, 31 (41.33%) had at least one mandibular incisor with gingival recession, in contrast to 18 (24%) of the controls. Pearson's correlation analysis indicated a significant positive correlation between the GT and KTW and between the GRL and GRW (P < 0.001). In addition, a significant negative correlation was observed between the KTW and GRL and between the KTW and GRW (P < 0.001). However, no significant correlation was found between the GT and GRL or between the GT and GRW. Conclusions: Our findings indicated that orthodontic treatment is a predisposing factor for the development or progression of gingival recession, particularly in females with a narrow KTW.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Oral manifestations of systemic leukemia-first sign of presentation p. 347
Annette Milton Bhambal, Himangi Shrivastava, Shantala Prashant Naik, Preeti Nair, Nisheeth Saawarn
DOI:10.4103/jisp.jisp_551_20  
Acute myeloid leukemia (AML) is an aggressive hematopoietic malignancy that left untreated or undiagnosed can lead to death within few days. Hence, early diagnosis and appropriate treatment become necessary. Oral manifestations in AML could be the presenting feature or could a part of systemic manifestations. Gingival lesions appear as generalized enlargement with hemorrhagic discoloration with or without spontaneous bleeding. Sometimes, gingival lesions itself could a presenting sign without any other systemic manifesto. We report a similar case which was undiagnosed earlier and the patient came with a complaint of only the gingival swelling.
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Self-correction of pathologic tooth migration after nonsurgical periodontal treatment in a metabolic syndrome patient with severe periodontitis and drug-influenced gingival enlargement p. 350
Hsin-Che Lee, Chao-Nan Wu, Kuo Yuan
DOI:10.4103/jisp.jisp_417_20  
Drug-influenced gingival enlargement (DIGE) and reduced bone support caused by periodontitis are two of the etiologic factors for pathologic tooth migration (PTM). Comprehensive management, including surgical, orthodontic, and prosthodontic treatment, is usually required for recovery from severe DIGE and PTM. An 85-year-old Taiwanese male with a history of hypertension and uncontrolled diabetes mellitus (DM) visited our dental department for severe gingival enlargement and spontaneous bleeding. He was diagnosed as having advanced periodontitis and DIGE. Remarkable PTM occurred on the front sextants of his dentition. The patient's DM was gradually controlled, and his calcium channel blocker treatment was substituted with a new regimen for 7 months. One year after nonsurgical periodontal treatment and reinforcing the patient's oral care, both DIGE and PTM were spontaneously resolved without any surgical or orthodontic intervention. We advocate the value of early diagnosis, improving patient's oral hygiene, and meticulous nonsurgical treatment for both DIGE and PTM.
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Modified laser-assisted lip repositioning surgery to treat gummy smile p. 355
Sana Farista, Aditi Chaudhary, Balaji Manohar, Shanin Farista, Rufi Bhayani
DOI:10.4103/jisp.jisp_65_20  
Excessive gingival display (EGD), known as “gummy smile,” is a major esthetic hurdle in today's population. The condition occurs due to various etiologies such as skeletal, dentoalveolar, or soft-tissue origin. The treatment modalities range from orthognathic surgery to periodontal plastic procedures. Lip-repositioning surgery (LRS) is a better alternative for the conventional orthognathic surgery and laser-assisted LRS can be a reliable and a less invasive alternative to conventional (scalpel) LRS. The present case describes the successful treatment of a young female exhibiting an EGD caused by hypermobility of the upper lip and was treated with a modified laser-assisted LRS coupled with gingival recontouring. In a study published earlier, a mild recurrence was observed and hence, to overcome the recurrence, a modified technique, by excising a strip of mucosa with an additional 2 mm of tissue along with the muscular attachment rather than scraping, was attempted.
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Piezosurgical corticotomy for rapid orthodontic tooth movement – A case series p. 360
S Swarna Meenakshi, Sankari Malaiappan
DOI:10.4103/jisp.jisp_316_20  
Prolonged treatment duration is one of the main concerns of patients undergoing orthodontic treatment. In addition to the longer duration, there are several drawbacks such as increased predisposition to root resorption, caries, and gingival recession. Thus, clinicians are always on the lookout for better solutions or alternatives. This is where the technique of corticotomy came in. In the present study, two cases where a piezosurgical corticotomy was done for rapid tooth movement have been discussed. The entire treatment duration was about 7–8 months without any relapse or posttreatment complications.
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