Evaluation of papilla levels following three different techniques for the second stage of implants - A clinical and radiographic study.

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.

Comparative Evaluation of the Efficacy of Bioactive Ceramic Composite Granules Alone and in Combination with Platelet Rich Fibrin in the Treatment of Mandibular Class II Furcation Defects: A Clinical and Radiographic Study.

INTRODUCTION: Predictable closure of furcation defects with bone grafts, Guided Tissue Regeneration (GTR) and a combination of the two has remained an elusive goal so far. Hence, evaluation of biomimetic agents as candidate technologies for periodontal regeneration merit due consideration. In this study, Choukroun's Platelet Rich Fibrin (PRF), a second generation platelet concentrate, is combined with bone graft to examine if the addition enhances the therapeutic potential of bone graft in the management of Class II furcation defects. AIM: To evaluate and compare the clinical effectiveness of Bioactive Ceramic Composite Granules (BCCG) alone and in combination with PRF in the treatment of mandibular Class II furcation defects. MATERIALS AND METHODS: Twenty mandibular Class II furcation defects in 16 systemically healthy patients were randomly allocated to test and control groups. Test sites were treated with PRF and bone graft, while control sites were treated with BCCG alone. Soft tissue parameters (probing pocket depth and clinical attachment loss), hard tissue parameters (vertical and horizontal depth of furcation defects) and radiographic parameter (radiographic alveolar bone density) were measured at baseline and six months post surgery. Statistical analysis was performed using Wilcoxon signed rank test for intragroup comparison of parameters and Mann-Whitney U test for intergroup comparison. RESULTS: Statistically significant improvement was observed in the test group compared to the control group with respect to all the measured parameters. However, complete furcation closure was not observed at any of the treated sites. CONCLUSION: Adjunctive use of PRF with bone graft may be a more effective treatment modality in the management of mandibular Class II furcation defects when compared to bone graft alone.

A Clinical Evaluation of Biphasic Calcium Phosphate Alloplast with and without a Flowable Bioabsorbable Guided Tissue Regeneration Barrier in the Treatment of Mandibular Molar Class II Furcation Defects.

BACKGROUND: Guided tissue regeneration (GTR) therapy has shown good results in the management of mandibular molar class II furcation defects. Advances in biomaterial sciences have developed alloplastic bone replacement graft materials and bioabsorbable GTR barrier membranes with good biologic response and handling properties. The aim of this study was to compare the attachment gain and the bone fill obtained with an alloplast [biphasic calcium phosphate (BCP) 60% hydroxyapatite (HA) and 40% beta tricalcium phosphate (b-TCP)] with and without a bioabsorbable GTR barrier [flowable poly (DL-lactide) (PLA) dissolved in N-methyl-2-pyrrolidone (NMP)] in the treatment of mandibular molar class II furcation defects. MATERIALS AND METHODS: A total of 20 class II furcation defects were treated in 16 patients with chronic periodontitis in a comparative study. Ten defects were treated with Camceram(®) (BCP 60% HA and 40% - TCP) bone replacement graft material (group I) and 10 defects with a combination of Camceram® bone replacement graft material with Atrisorb® Freeflow™, bio-absorbable GTR barrier (flowable PLA dissolved in NMP) (group II). At baseline and at 6 months postsurgery, clinical parameters of vertical probing depth (PD) and horizontal probing depth (P-H), clinical attachment level (CAL), gingival recession (GR), and vertical depth of furcation defect (VDF) and horizontal depth of furcation defect (BP-H) were evaluated. RESULTS: Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) program. Intergroup comparisons made at 6 months postsurgery by unpaired Student's t-test showed mean reduction in PD in group I was 3.10 ± 0.73 mm and in group II was 3.20 ± 1.03 mm (p > 0.05). Mean reduction in P-H in group I was 1.60 ± 0.69 mm and in group II was 1.90 ± 0.73 mm (p > 0.05). Gain in CAL in group I was 2.80 ± 1.03 mm and in group II was 2.90 ± 0.94 mm (p > 0.05). Change in GR in group I was -0.30 ± 0.48 mm and in group II was -0.30 ± 0.48 (p > 0.05). Reduction in VDF in group I was 1.30 ± 0.67 mm and in group II was 1.80 ± 0.63 mm (p ≤ 0.01). Reduction in BP-H in group I was 1.30 ± 0.67 mm and in group II was 1.90 ± 0.73 mm (p ≤ 0.05). CONCLUSION: It was concluded that the combination technique of BCP alloplast with a flowable bioabsorbable GTR barrier led to better results in regard to defect bone fill as compared with when the BCP alloplast alone was used.

Evaluation of cortisol levels in gingival crevicular fluid and saliva in anxious and non-anxious patients with chronic periodontitis.

BACKGROUND: To evaluate gingival crevicular fluid (GCF) and salivary cortisol levels in anxious and non-anxious patients with chronic periodontitis. MATERIALS AND METHODS: A total of 45 patients with a mean age 43.4 ± 6.12 years were assigned to three groups: Healthy control group (Group 1), group with chronic periodontitis but no anxiety (Group 2) and group with chronic periodontitis and with anxiety (Group 3). State - Trait anxiety inventory and Hamilton Anxiety rating scale were used to assess the anxiety levels of all the subjects. Clinical measures such as plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded. GCF and unstimulated whole saliva samples were collected, and cortisol levels were determined using ELISA kit. RESULTS: PI, GI, PPD, and CAL were higher in Group 3. Hormone level was significantly higher in Group 3. A positive correlation was found among salivary and GCF cortisol and CAL in Group 3. CONCLUSION: Based on the obtained results individuals with high-levels of anxiety seem to be more prone to have periodontal disease. Salivary and GCF cortisol levels can be used as biomarker for evaluating part of the etiopathogenesis of chronic periodontitis.

Black triangle dilemma and its management in esthetic dentistry.

In recent years, clinician and dentist's esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in esthetically important zones. "White esthetics" is the natural dentition or the restoration of dental hard tissues with suitable materials. "Pink esthetics" refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. Reconstruction of the lost interdental papilla is one of the most challenging and least predictable problems. Restoration and maintenance of these tissues with adequate surgical and prosthetic techniques are a real challenge in modern esthetic dentistry. Treatment of marginal tissue recession, excessive gingival display, deficient ridges, ridge collapse, and esthetic defects around teeth and implants are some of the esthetic problems associated with the interdental papilla that have to be corrected in todays scenario which has been discussed in this review.

Clinical and radiographic evaluation of Nano-crystalline hydroxyapatite bone graft (Sybograf) in combination with bioresorbable collagen membrane (Periocol) in periodontal intrabony defects.

BACKGROUND: Nanosized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline Hydroxyapatite (NcHA) bind to bone and stimulate bone healing by stimulation of osteoblast activity. The present study aims to explore the clinical and radiographical outcome of NcHA bonegraft (Sybograf(®)) with collagen membrane (Periocol(®)), in comparison with open flap debridement (OFD), in the treatment of intrabony periodontal defects. MATERIALS AND METHODS: A parallel-group, randomized, controlled clinical trial was designed to conduct the study. Eighteen intrabony defects in 14 systemically healthy patients aged between 25 to 65 years were randomly assigned to test and control group. The plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site, NcHA bone graft and collagen membrane was placed, whereas at the control site, only OFD was done. Recall appointments were made at 7 days, 30 days, and then at 3 months and 6 months. RESULTS: The data were subjected to statistical analysis using the Mann-Whitney 'U' Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm (P=0.007) and CAL gain was 2.77±1.09 mm (P=0.007). In the test group, the mean PPD reduction of 4.33±0.5 mm (P=0.006) and mean gain in CAL was 3.77±0.66 mm (P=0.006) at 6 months. The mean increase in REC was 0.55±0.72 mm (P=0.025) in test, and 0.44±0.52 mm (P=0.046) in control group. The mean gain in radiographic defect fill was 2.07±0.67 mm (P=0.008) in test and 0.91±0.21 mm (P=0.007) in control group. CONCLUSION: The nanocrystalline hydroxyapatite bone graft in combination with collagen membrane demonstrated clinical advantages beyond that achieved by OFD alone.

Nano-crystalline hydroxyapatite bone graft combined with bioresorbable collagen membrane in the treatment of periodontal intrabony defects: A randomized controlled clinical trial.

AIM: To evaluate the clinical outcome of nanocrystalline hydroxyapatite (NcHA) bonegraft (Sybograf(®)) in combination with collagen membrane (PerioCol(®)) compared with open flap debridement (OFD) only in the treatment of intrabony periodontal defects. MATERIALS AND METHODS: Eighteen intrabony defects in 16 systemically healthy patients aged between 25-65 years, were randomly assigned to test and control groups. The Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site NcHA bone graft and collagen membrane was placed, whereas at the control site only, OFD was done. Recall appointments were made at 7(th) day, 1(st) month, 3(rd) month, and 6(th) month. RESULTS: The data were subjected to statistical analysis using the Mann-Whitney 'U' Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm and CAL gain was 2.78±1.09 mm. In the test group, the mean PPD reduction of 4.33±0.5 mm and mean gain in CAL was 3.78±0.66 mm at 6 months. The mean increase in gingival recession was 0.55±0.72 mm in test and 0.44±0.52 mm in control group. CONCLUSION: The NcHA bone graft in combination with collagen membrane demonstrated better clinical outcomes compared with OFD alone.

Periodontal disease as a risk factor in pre-term low birth weight--an assessment of gynecologists' knowledge: a pilot study.

BACKGROUND: Pre-term low birth weight (PLBW) is a condition having tremendous financial impact on health care systems as well as the affected families. Studies suggest that 18.2% of all PLBW cases may be attributable to periodontal disease. OBJECTIVES: To assess gynecologists' knowledge of periodontal disease as a risk factor in PLBW and their knowledge with regard to the oral manifestations of periodontal disease. MATERIALS AND METHODS: A questionnaire survey was conducted on gynecologists in the city of Mangalore. The respondents were divided into four groups--those practicing only in medical colleges, those having only a private practice, those practicing in both medical colleges and in private practice, and post-graduate students of gynecology in the medical colleges in the city. STATISTICAL ANALYSIS USED: The Chi-square test for proportions was used to test the differences between the groups. RESULTS: Out of a total of 142 gynecologists, 93 participated in the survey. Group II respondents were omitted from the statistical analysis as the response rate was only 18.8%. Periodontal disease was considered to be a risk factor in PLBW by 52 (59.8%) respondents while 13 (14.9%) stated that it was not a risk factor at all. Sixty-seven (77%) respondents stated that bleeding/enlargement of the gingivae was a sign of periodontal infection. CONCLUSIONS: Respondents' knowledge was high regarding the oral manifestations of periodontal disease but was low regarding periodontal disease as a risk factor in PLBW.

A clinical evaluation of bioactive glass particulate in the treatment of mandibular class II furcation defects

Bioactive glass particulate has been applied to dentistry in the treatmentof bone defects, ridge preservation and periodontal bone defectsincluding the furcation defects. The aim of this study was to comparethe clinical attachment gain and vertical and horizontal bone fillobtained with open flap debridement (OFD) alone and OFD withbioactive glass particulate in the treatment of mandibular Class IIfurcation defects. Twenty mandibular class II furcation defects wereselected in 16 systemically healthy patients out of which 10 defectswere treated with OFD alone (Group I) and other 10 defects weretreated with OFD and bioactive glass particulate (Group II). Eachdefect was randomly assigned to Group I and Group II. The softtissue and hard tissue measurements including vertical probing depth,horizontal probing depth, clinical attachment level, gingival recession,vertical depth of the furcation defects, and horizontal depth of thefurcation defects were recorded at baseline and six months post surgery.At 6 months evaluation, both treatment procedures resulted insignificant improvement in soft tissue and hard tissue parameterswhen compared to the baseline. There was no significant differencebetween the two groups with respect to soft tissue changes (p>0.05)like probing depth reduction (3.30 mm versus 2.90 mm), clinicalattachment level gain (2.90 mm Vs 2.80 mm) and gingival recession.Vertical defect fill were significantly greater in the bioactive glass sites(1.50 mm) compared to control sites (0.80 mm). There was highlysignificant reduction in horizontal probing depth of the defect (1.80mm Vs 1.10 mm, p< 0.05) after 6 months post surgery. In conclusion,bioactive glass showed significant improvement in clinical parameterslike vertical and horizontal defect fill in mandibular class II furcationdefects when compared to OFD.