Clinical outcomes of flap versus flapless immediately loaded single dental implants in the mandibular posterior region: One-year follow-up results from a randomized controlled trial.

STATEMENT OF PROBLEM: Flapless implant placement with immediate functional loading has been reported in anterior locations. However, data on posterior locations are lacking. PURPOSE: The purpose of this randomized controlled trial was to determine and compare clinical outcomes of flap versus flapless surgically placed single posterior mandibular dental implants subjected to immediate functional loading. MATERIAL AND METHODS: Participants with missing mandibular first molar teeth were recruited and randomized into 2 groups (n=51): flapped and flapless. Dental implants were surgically placed and loaded immediately with interim restorations following implant protective occlusion. Outcome measures were implant failure, crestal bone loss, and periodontal parameters: modified plaque index, modified sulcus bleeding index, and pocket depths. Outcome data were recorded at baseline, 6-month, and 12-month follow-up visits. Cone beam computed tomography scans were used to calculate crestal bone loss, and periodontal outcomes were recorded by using a resin covered periodontal probe (α=.05). RESULTS: After 12 months, similar implant failure rates (P>.05) were found between the groups. Crestal bone loss in the flapped group was statistically higher than in the flapless group at 6 months (0.83 ±0.21 mm versus 0.75 ±0.23 mm) and at 12 months (1.04 ±0.27 mm versus 0.90 ±0.24 mm) from the baseline. The modified plaque index, modified sulcus bleeding index, and peri-implant probing depths (PDs) in both groups increased from the baseline to 6-month follow-ups (Baseline modified plaque index: 0.82 ±0.54 versus 0.79 ±0.21; Baseline modified sulcus bleeding index: 0.74 ±0.21 versus 0.70 ±0.43; Baseline PD: 1.25 ±0.37 mm versus 1.20 ±0.22 mm; 6 months modified plaque index: 1.54 ±0.70 versus 1.21 ±0.45; 6 months modified sulcus bleeding index: 1.93 ±0.54 versus 1.51 ±0.61; 6 months PD: 3.20 ±0.73 mm versus 2.80 ±0.43 mm). At 12-month follow-ups after repeated oral hygiene reinforcements, periodontal parameters had improved (decreased) significantly. CONCLUSIONS: Flapless implant insertion with immediate functional loading could be considered as an appropriate treatment option for providing functional restorations on the day of implant placement with minimal surgical intervention, reducing crestal bone loss, and periodontal complications.

Contextual barriers in effective interpersonal communication with patients: A qualitative analysis.

Purpose: Competence building in interpersonal communication (IPC) between undergraduate students and patients requires deep understanding of the factors influencing their interaction. These factors, contextual to our clinical setup were explored from multisource perspectives to understand the perceived barriers in IPC. Method: Qualitative hermeneutic phenomenological analysis was done for patient's semi-structured interviews (n = 16); interns (n = 15) and faculty (n = 14) unstructured focus group discussions. Three independent authors transcribed the data, derived codes and themes individually, and then collated and reflected on them to draw conclusions. Different collection methods, multisource perspectives, and multilevel analysis provided for triangulation and validation of the study results. Results: This study's multisource feedback identified seven inter-dependent barriers to interpersonal communication between students and patients. They were time constraints, lack of trust and respect, cultural diversity, loco-regional linguistic differences, lack of empathy, illiteracy, and financial constraints. Conclusions: The study concluded by identifying the unique set of barriers preventing interpersonal communication in our clinical microsystem. Addressing these contextual factors by preparing training modules and workshops would prepare undergraduate students for patient-centered care and partnership.

Effect of non-surgical periodontal therapy on salivary and gingival crevicular fluid concentration of visfatin in periodontal health and disease.

Background and objective: Visfatin, a pleotropic mediator mostly produced by visceral fat, is crucial in controlling the immunological and defensive systems. It serves the roles of a cytokine, an enzyme involved in energy metabolism, and a growth factor. The objective of the present study was to assess the impact of non-surgical periodontal therapy (scaling and root planing) on visfatin concentrations in saliva and gingival crevicular fluid in individuals with Periodontitis (stage-II grade-A). Materials and methods: 54 individuals were divided into Group A (Periodontally Healthy) and Group B1(Periodontitis baseline) based on periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and radiographic parameters. After NSPT (SRP), Group B1 patients were recalled after 4 weeks, constituting Group B2 (post NSPT group B1). At baseline and 4 weeks after non-surgical periodontal therapy (SRP), all clinical parameters, salivary and GCF samples were recorded. An ELISA kit was used to measure the levels of visfatin. Using the paired t-test, unpaired t-test, and Pearson's correlation coefficient, data were analysed using SPSS 15. Results: After non-surgical periodontal treatment (SRP), the mean salivary and gingival crevicular fluid concentration of visfatin considerably decreased to a level comparable to periodontal health. In all groups, GCF visfatin concentration was higher than salivary concentration of visfatin. In periodontitis patients, visfatin concentration in GCF was 1.5 times higher than in saliva. Conclusion: The results of this investigation suggest a direct correlation between salivary and gingival crevicular fluid visfatin concentration and periodontal tissue inflammation and disease activity.

COVID-19 outbreak journey of dental care workers: A systematic review.

The conditions of health-care professionals including dental fraternity have been extremely affected during the COVID-19 pandemic. Dental care workers have suspended all routine dental activities with the fear of transmission of the virus from aerosol-generating dental procedures. They have also stood with medical care professionals as frontline warriors because of the exponentially overburdened of the COVID-19-positive patients worldwide. With the available literature, the aim of this article is to address the trajectories of the life of oral health workers during the outbreak of COVID-19 as well as to analyze what measures shall be taken to improve their overall physical, mental, social, and economic health and precautions while working in dental environment.

Evaluation of association between potential stress markers and periodontal health in medical and dental students: A questionnaire-based study.

Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress on periodontium through questionnaire and serum cortisol level. Subjects and Methods: Two hundred medical and dental undergraduates were recruited for the study. Case group included 82 examination going and control group had 79 nonexam going students. Their stress level was evaluated using a standard questionnaire (perceived stress scale). Gingival index, periodontal disease index, bleeding on probing index, serum cortisol level, and serum alpha-amylase level were also measured. Statistical Analysis Used: Bivariate correlations and multiple regression tests were done. Results: A positive correlation was found among stress scores, salivary cortisol, alpha-amylase, and periodontal disease measures. Conclusion: Periodontitis can be related to immunologic changes related to psychological states.

Localized probiotic-guided pocket recolonization in the treatment of chronic periodontitis: a randomized controlled clinical trial.

PURPOSE: This randomized clinical placebo-controlled trial was conducted to evaluate the effectiveness of Lactobacillus reuteri as a probiotic in guided pocket recolonization (GPR) for the treatment of chronic periodontitis (CP) adjunctive to scaling and root planing (SRP). METHODS: Forty-eight CP patients were randomly assigned to 3 treatment groups: group 1 (SRP+placebo), group 2 (SRP+single application of probiotic), and group 3 (SRP+incremental application of probiotic). Clinical parameters were evaluated at baseline and at 8, 12, and 24 weeks, whereas biochemical parameters were measured at baseline and 12 weeks. RESULTS: At 24 weeks, the probing pocket depth and clinical attachment level improved in all 3 groups from baseline with no significant intergroup differences; however, a statistically significant difference was observed in localized plaque and gingival scores between groups 1 and 3 (P<0.05). At 12 weeks, matrix metalloproteinase-8 (MMP-8), nitric oxide (NO), and gingipains-R (Rgps) levels improved in all 3 groups, with statistically significant differences between groups 1 and 3 for MMP-8 and NO (P<0.05), but no difference for Rgps levels. CONCLUSIONS: Within its limitations, the results of this study show that incremental 3-time application of L. reuteri as a probiotic led to improvements in clinical and biochemical parameters. This protocol can be a useful adjunct to SRP in the non-surgical management of CP. TRIAL REGISTRATION: Clinical Trials Registry - India Identifier: CTRI/2017/03/008231.

Prevalence of herpesviruses in periodontal disease of the North Indian population: A pilot study.

INTRODUCTION: Periodontitis is a multifactorial disease of diverse microbiome, predominantly bacterial. Bacterial infection alone may not explain complete pathophysiology and clinical variations in disease pattern. Concept of herpesviruses playing a significant role in periodontal pathogenesis has been explored globally. Studies show varied results and difference may be accounted to variations existing in studied populations. The present study explored the prevalence of herpesviruses in periodontal disease of the North Indian population. MATERIALS AND METHODS: In this case-control study, tissue samples were collected from the normal gingiva (control: n = 48) and deepest pocket (cases: n = 48) using a single curette stroke. Periodontal disease status was assessed through the gingival index, pocket depth, and clinical attachment level which were compared to viral marker positivity. RESULTS: Ninety samples from 48 healthy gingiva and 48 periodontitis patients were assessed between the age range of 17-60 years. The prevalence of cytomegalovirus was 2.083% (cases) and 2.083% (controls) and Epstein-Barr virus (EBV) was 18.75% (cases) and 0% (controls). Odd's ratio for EBV in patients with periodontitis is calculated (Haldane-Anscombe correction) to be 21.82%. Herpes simplex virus 1/2 and varicella-zoster virus were absent in both groups. CONCLUSIONS: Within the limitation of this study, EBV was found in cases of periodontitis patients. Its role in disease initiation and progression is not clear. Further studies are required to ascertain EBV as risk factor in periodontal disease.

Relationship between VITAMIN D and chronic periodontitis.

INTRODUCTION: Chronic periodontitis is a multifactorial disease primarily caused by plaque microorganisms, modified from the immune inflammatory response to chronic infection, which leads to the destruction of periodontal tissues in a susceptible host. It is very well known that vitamin D plays a vital role in bone homeostasis and immunity. There can be a biologic rationale to suspect that Vitamin D deficiency could negatively affect the periodontium. Present study was conducted to investigate any relationship between periodontitis and vitamin D. MATERIAL AND METHOD: The clinico-biochemical relationship study was carried out in 168 subjects with Chronic Periodontitis. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) are correlated with serum level of Vitamin D. RESULTS: Statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed.No relationship between 25(OH) D levels and PI was observed.This study also revealed overall low levels of serum Vitamin D in patients with chronic periodontitis but the levels of Vitamin D did not decrease with the increase in the severity of periodontitis. CONCLUSION: A statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed. No relationship between 25(OH) D levels and PI was observed.

Efficacy of Acacia arabica gum as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized controlled clinical trial.

AIM: The aim of the present study was to explore the adjunctive use of Acacia arabica gel in the treatment of chronic periodontitis. METHODS: Single centre, randomised, triple blind, controlled trial on mild to moderate chronic periodontitis patients; Group I (SRP + Acacia arabica, n = 40) and Group II (SRP + placebo, n = 40); were analysed for clinical improvements in periodontal pocket depth (PPD) and clinical attachment levels (CAL) at baseline, 15 and 90 days on application of gels. Gingival index and plaque index were assessed as secondary parameters. RESULTS: Statistically significant PPD reduction (p < .05) and CAL gain (p < .05) was observed with use of Acacia arabica gel. The reduction in sites with moderate PPD was observed more among Group I than Group II and the difference was statistically significant (p = .001). Secondary outcome variables; Plaque Index and Gingival Index showed better resolution with Acacia arabica gel. CONCLUSION: Acacia arabica leads to better clinical outcomes in patients with mild to moderate chronic periodontitis with effective antiplaque and anti-gingivitis action. It may be recommended adjunct to SRP for maintenance in patients with mild to moderate chronic periodontitis.

Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff.

Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Use of carbon dioxide laser in oral soft tissue procedures.

Lasers have been introduced in dentistry as an alternative to conventional knife surgery. The advantage to the operator includes a clean dry field that enhances visibility and reduces the procedure time. The patient benefits by minimal postoperative pain and swelling. The paper discusses use of carbon dioxide laser in five conditions commonly encountered in oral cavity.

Comparative evaluation of periosteum as a barrier membrane with and without an alloplastic bone graft in periodontal osseous defects: A 9 months follow-up study.

BACKGROUND: Regenerative procedures frequently include the use of barrier membranes and bone grafting materials to encourage the growth of key surrounding tissues. The present study aims to evaluate and compare the ability of periosteum in intrabony defect regeneration. MATERIALS AND METHODS: A total of ten intrabony defects were equally divided in two treatment groups. Group I consisted of Periosteum used as a barrier memebrane and Group II of periosteum as barrier membrane alongwith graft material. Nine months post operative evaluation of defect fill was done radiographically. RESULTS: Mean defect fill (CEJ-BBD) was found to be significantly lower in Group II as compared to Group I (P = 0.041). CONCLUSION: Within the limitations of this study, alloplastic graft material supplimentation results in better regeneration with Periosteum used as a barrier membrane.

Periodontio-integrated implants: A revolutionary concept.

Though the fields of regenerative dentistry and tissue engineering have undergone significant advancements, yet its application to the field of implant-dentistry is lacking; in the sense that presently the implants are being placed with the aim of attaining osseointegration without giving consideration to the regeneration of periodontium around the implant. The following article reveals the clinical benefits of such periodontio-integrated implants and reviews the relevant scientific proofs. A comprehensive research to provide scientific evidence supporting the feasibility of periodontio-integrated implants was carried out using various online resources such as PubMed, Wiley-Blackwell, Elsevier etc., to retrieve studies published between 1980 and 2012 using the following key words: "implant," "tissue engineering," "periodontium," "osseo-integration," "osseoperception," "regeneration" (and their synonyms) and it was found that in the past three decades, several successful experiments have been conducted to devise "implant supported by the periodontium"that can maintain form, function and potential proprioceptive responses similar to a natural tooth. Based on these staunch evidences, the possibility of the future clinical use of such implant can be strongly stated which would revolutionize the implant dentistry and will be favored by the patients as well. However, further studies are required to validate the same.

Role of space provision in regeneration of localized two-wall intrabony defects using periosteal pedicle graft as an autogenous guided tissue membrane.

BACKGROUND: Marginal pedicle periosteum (MPP) has been used as a rigid membrane in guided tissue regeneration (GTR) for osseous defects. The present study aims to study the effect of space provision by an alloplastic graft material in bone defect area (BDA) reduction of 2-wall defects. METHODS: Twenty interproximal intrabony 2-wall defects in healthy non-smoking patients with chronic periodontitis were randomly divided in control (group 1, periosteum alone) and experimental (group 2, periosteum with alloplastic graft material) groups. Measurements of probing depth (PD), clinical attachment level (CAL), and radiographic BDA were done at the baseline and 6-month postoperative evaluations. RESULTS: The 6-month postoperative assessment showed clinical and radiographic improvements with PD reduction, CAL gain, and changes in BDA in both groups, which was statistically significant compared with baseline (P <0.05). However, BDA reduction was statistically greater in group 2 (48.88% ± 18.61%) compared with group 1 (14.08% ± 12.97%) at the 6-month follow-up (P = 0.009). CONCLUSION: Within the limitations of this study, it can be concluded that space provision by an alloplastic graft material increases the regenerative potential of MPP as a GTR membrane and results in increased defect fill.

Periodontal plastic pioneering procedures revisited.

BACKGROUND: Various periodontal plastic procedures are available for treatment of localized gingival recessions. However, in the mirage of newer techniques and materials available, it is difficult for clinicians to decide on the treatment modality. Pioneering techniques provide a cost effective and effective means of maintaining esthetics in recession cases. MATERIALS AND METHODS: Twenty-two subjects with localized gingival recessions were divided in equal groups and treated with lateral pedicle graft (Group A) and Free mucosal graft (Group B). Clinical parameters of length and width of recession and apico coronal length of keratinized gingiva (ACKG) was measured at baseline, 30 and 90 days. Root coverage percentage was calculated. RESULTS: Both groups were effective in recession coverage and gain in ACKG. Root coverage gained in Group A was 65.0 ± 25.2% and for Group B was 61.6 ± 20.5%. CONCLUSION: Lateral pedicle graft and Free mucosal graft provide not only effective means of gaining in root coverage of localized gingival recession cases but also result in gain of ACKG. These techniques remain an important part of periodontal plastic surgery.

Essentials of periodontal medicine in preventive medicine.

Influence of systemic disorders on periodontal diseases is well established. However, of growing interest is the effect of periodontal diseases on numerous systemic diseases or conditions like cardiovascular disease, cerebrovascular disease, diabetes, pre-term low birth weight babies, preeclampsia, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer's disease, gastrointestinal disease, prostatitis, renal diseases, which has also been scientifically validated. This side of the oral-systemic link has been termed Periodontal Medicine and is potentially of great public health significance, as periodontal disease is largely preventable and in many instances readily treatable, hence, providing many new opportunities for preventing and improving prognosis of several systemic pathologic conditions. This review article highlights the importance of prevention and treatment of periodontal diseases as an essential part of preventive medicine to circumvent its deleterious effects on general health.

Aesthetic enhancement with periodontal plastic procedure in a class 3 alveolar ridge defect.

Localised alveolar ridge defect refers to volumetric deficit of the limited extent of bone and soft tissue within the alveolar process. Such type of ridge defects can be corrected by surgical ridge augmentation that can be accomplished by the addition of either soft or hard tissues. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. The ideal ridge width and height allows placement of a natural appearing pontic which provides maintenance of a plaque-free environment. This article describes a procedure of surgical ridge augmentation of a localised alveolar ridge defect in the maxilla, followed by fixed partial denture, enhancing the aesthetics, function and health.

Treatment of multiple adjacent gingival recessions in a single surgical approach with expanded subepithelial connective tissue graft - An innovative approach.

BACKGROUND: Gingival recession on anterior teeth compromises facial esthetics and is associated with dentinal hypersensitivity. Multiple teeth recession requires multiple surgeries for adequate coverage. METHODS: Six anterior mandibular teeth were treated with single Subepithelial Connective Tissue Graft (SCTG) expanded with the use of alternate vertical incisions. A brief review of SCTG is included. RESULTS: 90 days evaluation revealed adequate recession coverage. Patient was satisfied with the esthetic results. CONCLUSION: The present technique may be an innovative approach for single surgical harvesting and placement of SCTG over long expanse multiple adjacent gingival recessions. This technique prevents multiple surgical traumas to the patient and enhances esthetics.

Odontogenic myxoma presenting as localized inflammatory gingival enlargement: A diagnostic dilemma.

Odontogenic myxoma (OM) is a rare and locally invasive benign neoplasm found exclusively in the maxillofacial region. The radiographic and clinical features are variable, and the diagnosis is therefore not easy. A case of OM of the maxilla is described in a 19-year-old female, previously diagnosed as inflammatory gingival enlargement. Clinical, histological, radiographic, and computed tomographic (CT) scan assessments were done, which were confirmatory for OM. Surgical excision of the lesion was done. The patient was put on periodic recall, as the recurrence rate of the lesion was high. The biological spectrum of OM was highly variable and diagnosis at an early stage was very difficult. Gingival enlargement presentation might not always be an inflammatory reaction. All possible differential diagnosis should be explored and various diagnostic tools utilized, to screen the enlargement.

Free gingival autograft for augmentation of keratinized tissue in apical to gingival recession - A case report.

BACKGROUND: The treatment of the mucogingival problem is one of the main objectives of the periodontal therapy. The insufficient or absent attached gingiva increases the risk of development of gingival recessions. METHOD: One patient with Miller class II gingival recession and small vestibule depth in the frontal mandibular region was selected for treatment. Autogenous free gingival grafts harvested from the palatal mucosa were used to gain the attached gingiva. RESULT: The initial healing completed in 2 weeks without complication. The augmentation of the attached gingival tissue using the free gingival graft technique led to gain of attached gingiva in the treated regions. CONCLUSION: The limitations of the apical mucosal flap displacement for preparation of recipient site in situations with inadequate vestibule depth and small alveolar bone height require a graft with small width. The result from the presented case report with application of the free gingival graft indicates that it could be applied when augmentation of the attached gingiva tissue.