Indian Society of Periodontology Good Clinical Practice Recommendations for Peri-implant Care.

Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri-implant diseases and manage the existing peri-implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral health-care delivery across the country. The current clinical practice recommendations focused on peri-implant care to bridge the gap between academic theory and clinical practice by compiling evidence-based suggestions for preventing and treating peri-implant diseases. Twenty-eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri-implant health and maintenance, peri-implant mucositis, and peri-implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home-care recommendations regarding maintaining peri-implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence-based, integrated, and comprehensive peri-implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well-being of implant patients and ensure the long-term success of implant therapy.

ISP good clinical practice recommendations for gum care.

Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to "Gum Care for All", is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.

The effects of autologous platelet concentrate on the healing of intra-bony defects: a randomized clinical trial.

PURPOSE: The present study aimed to evaluate the clinical and radiographic effects of autologous platelet concentrate (APC) on the healing of intra-bony defects filled with ß-tricalcium phosphate (ß-TCP) and covered with collagen membranes. SUBJECTS AND METHODS: This study included 30 defects of 14 systemically healthy subjects. All of them had, at least, two deep intra-bony, inter-proximal periodontal defects. Minimum probing pocket depth (PPD) was 6 mm. Clinical and imaging examination was performed both at baseline and at 3, 6, and 9 months after surgery. RESULTS: Both the test and control group revealed a significant reduction in all variables when compared with the base line. Mean reduction of the PPD in two groups at each follow-up time point showed no significant difference. Means of the clinical attachment gain of the same groups were significantly different (p<0.05). Mean gingival recession at 3 month was not significant. However, the means of gingival recession coverage of two groups were significantly different at 6 and 9 months (p<0.05 for both). CONCLUSION: Sites treated with APC are more likely to demonstrate more clinical attachment gain and recession coverage at the end of 9 month compared to those without APC.

Modified lateral positioned flap with platelet-rich fibrin graft for treatment of denuded root surfaces: A clinical study.

BACKGROUND: Root coverage (RC) procedures such as lateral positioned flap (LPF) have been used since long time but with limited success and specific indications. AIM: This prospective clinical study was designed to evaluate clinically the effect of modified LPF (mLPF) with platelet-rich fibrin (PRF) graft for the treatment of denuded root surfaces. MATERIALS AND METHODS: Fifteen isolated Miller's Class I and II gingival recession of single-rooted teeth were selected for the study. Scaling and root planing was done, and oral hygiene instructions were given to the patients. Plaque index, gingival index, and recession parameters (probing depth, gingival recession height, clinical attachment level [CAL], and width of keratinized tissue [WKT]) were assessed at baseline. Following this, mLPF with PRF was done at the recession sites, and parameters were assessed at 3 and 6 months. STATISTICAL ANALYSIS: To analyze the posttreatment effect, paired t-test was performed at relevant degrees of freedom and 95% confidence level. RESULTS: The mean percentage of RC attained was 72.2% at 3 months and 73.5% at 6 months. The WKT shows a mean gain of 2.93 mm at 3 months and 3 mm at 6 months. CONCLUSION: mLPF with PRF produced statistically significant reduction in recession depth and gain in both CAL and WKT by the end of 6 months.

Effect of Smoking and Tobacco Chewing on Periodontal Disease and Non-Surgical Treatment Outcome: A Clinical and Biochemical Study.

OBJECTIVE: The purpose of this study was to compare effects of smoking and smokeless forms of tobacco consumption (tobacco chewing) on periodontal disease parameters and response of these subjects to non-surgical periodontal therapy. METHODS: One hundred sixty-eight patients with chronic periodontitis were screened for the study. Eighteen patients were excluded as they decided to quit the tobacco habit. One hundred fifty patients fulfilling the inclusion and exclusion criteria were grouped as: Group 1, 50 smokers; Group 2, 50 tobacco chewers; and Group 3, 50 non-smokers, non-tobacco chewers (controls). Scaling and root planing was performed at the initial visit as a part of initial therapy. The clinical parameters recorded at baseline, 1 month, 2 months and 3 months were plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and gingival crevicular fluid (GCF) measurement. RESULTS: With respect to the comparison between smokers and tobacco chewers, smokers had significantly more probing depth at baseline examination, while tobacco chewers had more gingival recession. Gingival inflammation, response to non-surgical treatment and oral hygiene maintenance were more suppressed in smokers as compared to tobacco chewers. CONCLUSION: Tobacco consumption in both forms affects the severity of periodontal disease. It affects the response of periodontal tissues to non-surgical treatment. In addition it leads to poorer oral hygiene and hampers maintenance of oral hygiene.

Comparative evaluation of cemental abrasion caused by soft and medium bristle hardness toothbrushes at three predetermined toothbrushing forces: An in vitro study.

BACKGROUND: Plaque control has been shown to have a pivotal role in maintaining optimal periodontal health. Toothbrushing as a mechanical plaque control tool is the most popular and effective option for self-performed oral health maintenance. However, the detrimental effects of bristle hardness and force exerted by toothbrushes on the tooth surface are the areas of concern. OBJECTIVE: The aim of this in vitro study was to evaluate the abrasive effect of two different manual toothbrushes exerting predetermined forces on cemental surfaces of the teeth. MATERIALS AND METHODS: Sixty extracted first molars were selected. Totally six experimental groups were formed based on the three predetermined forces 1.5, 3, and 4.5 Newton (N) and two types of manual toothbrushes, i.e., soft and medium bristle hardness. Buccal and lingual surfaces were independently brushed for 5000 cycles using specially designed toothbrushing machine. Throughout the experiment, type and quantity of toothpaste were kept constant. Post 5000 cycles of toothbrushing, change in surface roughness was measured using profilometer in microns and change in weight indicating loss of substance was measured in milligrams. RESULTS: Abrasion of cementum is force dependent. Data revealed that both soft and medium bristle hardness toothbrushes cause significant cemental abrasion at 3 and 4.5 N forces. CONCLUSIONS: Higher is the force, more is the cemental surface abrasion. Soft bristled toothbrush causes more cemental abrasion than medium bristled toothbrush at 3 and 4.5 N forces.

Comparative Alveolar Ridge Preservation Using Allogenous Tooth Graft versus Free-dried Bone Allograft: A Randomized, Controlled, Prospective, Clinical Pilot Study.

BACKGROUND: For the first time in India, allografts from human extracted teeth were prepared. A randomized, prospective, clinicoradiographical, histological study was conducted to evaluate their efficacy in comparison with freeze-dried bone allograft (FDBA) in alveolar ridge preservation. MATERIALS AND METHODS: Graft preparation: with written consent, teeth were collected from three donors (full mouth extraction cases). Once donors' serums were tested negative for HIV, HBV, HCV, and Venereal disease research laboratory (VDRL), mineralized whole tooth allograft (WTA) and dentin allograft (DA) were prepared using the standard protocol of Tissue Bank at Tata Memorial Hospital, Mumbai, India. STUDY DESIGN: In this randomized controlled trial, 15 patients undergoing extraction of at least four teeth were selected. In each patient after atraumatic extractions, one socket was grafted with WTA, second with DA, third with FDBA, and fourth was left ungrafted (control site). All the sites were covered with chorion membrane. To estimate three-dimensional alveolar crest changes, cone beam computed tomography scans were taken immediately after grafting and 4 months postoperatively. Bone biopsies using 3 mm trephine bur were obtained from four patients at the time of implant placement and evaluated histologically. RESULTS: Clinically uneventful healing was observed at all sites. Compared to other sites, WTA and DA consistently showed superior results demonstrating least reduction in alveolar crest height and width which was statistically significant (P < 0.05). Between WTA and DA sites, there was no statistically significant difference. Histological analysis also confirmed more new bone formation at WTA and DA sites. CONCLUSIONS: Rather than disposing extracted human teeth as a biomedical waste (common practice), they can be collected from suitable systemically healthy donors. With the help of tissue bank, they can be processed into an allograft, serving as an excellent alternative to conventional allografts.

Alveolar ridge preservation using autogenous tooth graft versus beta-tricalcium phosphate alloplast: A randomized, controlled, prospective, clinical pilot study.

BACKGROUND: A randomized, prospective clinical, radiographical, and histological study was conducted to evaluate healing after alveolar ridge preservation technique using two different graft materials, namely, a novel autogenous graft material i. e., autogenous tooth graft (ATG) and beta-tricalcium phosphate (ß-TCP) alloplast. MATERIALS AND METHODS: Fifteen patients undergoing extraction of at least three teeth were selected. Atraumatic extractions were performed. Of the three extraction sockets, one was grafted with ATG, other with ß-TCP, and the third was left ungrafted. Cone-beam computed tomography scans were taken immediately after grafting and 4 months postoperatively to check the changes in alveolar crest height and width at all the sites. Three patients in whom implant placement was done after complete healing; bone samples were harvested using a 3 mm diameter trephine during osteotomy preparation from both the ridge preserved sites and studied histologically. RESULTS: There was a statistically significant difference when the changes in width and height of alveolar crest were compared within all the three groups (P < 0.05). Among three sites, ATG-grafted sites showed the most superior results with a minimal reduction in alveolar crest height and width. Histological analysis also showed the same trend with more new bone formation at ATG-grafted sites as compared to ß-TCP-grafted sites. CONCLUSION: Postextraction, ridge preservation leads to more predictable maintenance of alveolar ridge height and width. ATG as compared to ß-TCP provided superior results. Based on this, we conclude that ATG material can serve as a better alternative to conventional bone graft materials.

Paralleling technique for frenectomy and oral hygiene evaluation after frenectomy.

BACKGROUND: High frenum attachment is a very common problem in the population. Various conventional techniques are available which has certain disadvantages; in addition to that high frenum also hinders oral hygiene maintenance. This study aims to evaluate patient's response to two different frenectomy technique, and oral hygiene maintenance before and after frenectomy. MATERIALS AND METHODS: Twenty patients with high labial frenum were randomly selected from the outpatient department. Patients were divided into two groups according to the technique used. Each group contained ten patients. One group was treated by "conventional scalpel technique" and other group by "new paralleling technique". To evaluate patients response, visual analogue scale for pain and speech were taken at first postoperative day, 1-week and 1-month. In other part of the study the oral hygiene maintenance was evaluated by using plaque and gingival bleeding index at baseline before frenectomy, 1-week and 1-month after frenectomy. RESULTS: Results showed that new paralleling technique for frenectomy causes less postoperative discomfort and also there was significant improvement in the oral hygiene maintenance by the patient after frenectomy. CONCLUSION: High maxillary frenum causes hindrance in oral hygiene maintenance. Paralleling technique for frenectomy causes less discomfort to the patient during healing phase when compared with the conventional technique.

Is gamma-glutamyl transpeptidase a biomarker for oxidative stress in periodontitis?

CONTEXT: Periodontal disease and oxidative stress (OS) are part of a vicious cycle with each causing a deleterious effect on the other causing changes in the levels of antioxidants, and enzymes of antioxidant defense. Biomarkers and methods used for measuring OS are very expensive. AIMS: To see how gamma-glutamyltransferase (GGT) fares, as a biomarker for OS in periodontits along with other routinely used biomarkers. DESIGN: A cross-sectional study involving 300 people of which 150 were cases and 150 were controls. SETTING: Candidates enrolled were patients visiting the OPD of MGV's Dental College and Hospital, Nasik, India between January 2011 and December 2012. MATERIALS AND METHODS: Serum samples of patients with periodontitis, and controls were analyzed for malondialdehyde, superoxide dismutase (SOD), glutathione peroxidase (GPx), uric acid, and GGT. STATISTICAL ANALYSIS USED: Analysis was performed using Student's t test. P <0.05 were considered to be significant. RESULTS: Malondialdehyde values were found to be significantly higher cases, while SOD, GPx and uric acid levels were found to be lower than controls. GGT levels were significantly higher in cases as compared to controls. CONCLUSIONS: GGT may be used as a cheap, quick, easy and precise marker for measuring OS.

Efficacy of irrigation with different antimicrobial agents on periodontal health in patients treated for chronic periodontitis: A randomized controlled clinical trial.

INTRODUCTION: Periodontitis is inflammation of supporting tooth structure. Most individuals get affected by this disease if oral hygiene is not maintained. There are various mechanical and chemical methods for oral hygiene maintenance. In recent past, interest has been diverted toward the herbal/traditional product in oral hygiene maintenance as they are free from untoward effect. AIM: To assess the efficacy of subgingival irrigation with herbal extract (HE) as compared with 0.2% chlorhexidine (CHX) on periodontal health in patients who have been treated for chronic periodontitis, and still have residual pocket of 3-5 mm. MATERIALS AND METHODS: This was a controlled, single-blind, randomized study for 3 months. Patients were allocated in two groups (n = 15 each): (1) 0.2% CHX (control group); (2) HE consisting of Punica granatum Linn. (pomegranate), Piper nigrum Linn. (black pepper), and detoxified copper sulfate (test group). Solutions were used for the irrigation using pulsated irrigating device, WaterPik. Clinical outcomes evaluated were plaque index (PI), sulcus bleeding index (SBI), probing depth at baseline, 15th, 30th, 60th, and 90th day. Microbiologic evaluation was done at baseline and 90th day. RESULTS: Significant reduction in PI was seen in the group of irrigation with HE. While comparing SBI, irrigation with CHX shows a better result. Other parameters such as probing pocket depth and microbiological counting were similar for both groups. CONCLUSION: Irrigation with HE is a simple, safe, and noninvasive technique with no serious adverse effects. It also reduces the percentage of microorganism in periodontal pocket.

A case of oral focal mucinosis of gingiva: Lesion in disguise.

Oral focal mucinosis (OFM) is a rare soft tissue lesion of unknown aetiology. Clinically, it is most commonly found on the gingiva and presents as a painless, sessile or pedunculated mass. Histologically, it is characterized by focal myxoid degeneration of underlying connective tissue. Fifty-three-year-old patient reported with a painless, firm and fibrous gingival overgrowth present from 7 to 8 months. Clinical examination and patient's history pointed towards "irritation fibroma". An excisional biopsy was performed. The histopathologic diagnosis was established as OFM, an uncommon and poorly characterized type of lesion. This case report stresses on the fact that prediagnosis of OFM is almost impossible. Thus though rare, OFM must be considered in the differential diagnosis of soft tissue overgrowths in oral cavity.

Idiopathic gingival fibromatosis.

Idiopathic gingival fibromatosis (IGF) is a rare hereditary condition characterized by slowly progressive, nonhemorrhagic, fibrous enlargement of maxillary and mandibular keratinized gingiva caused by increase in submucosal connective tissue elements, mostly associated with some syndrome. This case report describes a case of nonsyndromic generalized IGF in an 18-year-old male patient who presented with generalized gingival enlargement. The enlarged tissue was surgically removed by internal bevel gingivectomy and ledge and wedge procedure. The patient was regularly monitored clinically for improvement in his periodontal condition as well as for any recurrence of gingival overgrowth.

Dental health education through the brushing ROBOTUTOR: A new learning experience.

AIM: In the present study, a new electronic model ROBOTUTOR was designed to compare the efficacy of different modes of dental health education for demonstration of the Bass toothbrushing technique and also to evaluate its efficacy with different modes of dental health education in patient understanding. MATERIALS AND METHODS: Total 150 subjects were randomized into two groups, Group 1 (Questionnaire) and Group II (Investigators). Subjects with history of gingivitis and only mild periodontitis were included. Demonstration of Bass technique was given to each subject with the help of three different modes, i.e., ROBOTUTOR, clinician, and audio-video aids. RESULTS: The result was evaluated in terms of effectiveness, ease of understanding, attraction, and recollection. In the present study, the best mode of education is clinician demonstration and the least effective one is the audio-video mode. In contrast, the ROBOTUTOR model was found to be more attractive than the other two. CONCLUSION: Although demonstration by clinician is the best, it is time consuming and not feasible for community purpose. ROBOTUTOR would thus save clinician's chair side time and help in effective demonstration of the brushing technique.

Periodontal vaccine: A dream or reality.

Recent advances in cellular and molecular biology have led to the development of new strategies for vaccines against many types of infectious diseases. It has long been recognized that individuals who recovered from a disease developed subsequent resistance to the same. In the late 18th century, Edward Jenner developed and established the principle of vaccination using the cross protection conferred by cowpox virus, which is non-pathogenic in humans. With the rapid growth of microbial genome sequencing and bioinformatics analysis tools we have the potential to examine all the genes and proteins from any human pathogen. This technique has the capability to provide us with new targets for anti-microbial drugs and vaccines. However, to realize this potential new bioinformatics and experimental approaches to select these targets from the myriad of available candidates are required. Vaccination is a process that induces specific immune resistance to a bacterial or viral infection.

Gene therapy and its implications in Periodontics.

Gene therapy is a field of Biomedicine. With the advent of gene therapy in dentistry, significant progress has been made in the control of periodontal diseases and reconstruction of dento-alveolar apparatus.Implementation in periodontics include:-As a mode of tissue engineering with three approaches: cell, protein-based and gene delivery approach.-Genetic approach to Biofilm Antibiotic Resistance.Future strategies of gene therapy in preventing periodontal diseases:-Enhances host defense mechanism against infection by transfecting host cells with an antimicrobial peptide protein-encoding gene.-Periodontal vaccination.Gene therapy is one of the recent entrants and its applications in the field of periodontics are reviewed in general here.

Effect of moisture on flexural strength of fiber-reinforcedcomposites used as splinting materials / Efeito da umidade na resistência flexural de resinas compostas reforçadas por fibras usadas como material de esplintagem

Objectives: Different fiber types are available for reinforcing composite restorations. Little information exists regarding flexural strength of various fiber used to reinforce direct composites. This in vitro study examined the flexural strength of polyethylene and glass fibers when used to reinforce composite and influence of moisture exposure on the same materials. Materials and methods: The two types of fiber were used to reinforce blocks of composite (RX Flow, Dental Life Sciences) prepared to test flexural properties and compared with the unreinforced controls. Mean flexural strengths values were determined in a 3-point bend test at a crosshead speed of 8 mm/min by use of a universal testing machine. Results: Significant increases in mean flexural strength were found for all fiber-reinforced groups in comparison to the unreinforced controls at both before and after moisture exposure. The polyethylene fiber gave the greatest reinforcing effect. After 1 month of storage in an artificial saliva substitute, a significant decline occurred in the mean flexural strength of all the groups tested. Conclusion: Within the limitations of this study, the choice of fiber type was shown to have a significant increase on the flexural properties of the fiber-reinforced composite. Polyethylene fibers increased the flexural strength of the composite the most.

Objetivo: Diferentes tipos de fibras estão disponíveis para reforçar restaurações em resinas compostas. Há pouca informação sobre a resistência flexural de fibras usadas para reforçar compósitos diretos. Este estudo in vitro avaliou a resistência à flexão de fibras de polietileno e de vidro, quando usadas para reforçar resina composta e a influência da exposição à umidade sobre os mesmos materiais. Materiais e métodos: Os dois tipos de fibras foram usados para reforçar blocos de resina composta (RX Flow, Dental Life Sciences), preparados para testar as propriedades mecânicas e comparados com os controles não reforçados. Os valores médiosde flexão foram determinados em um ensaio de flexão de três pontos a uma velocidade de 8 mm/min em uma máquina de ensaio universal. Resultados: Um aumento significativo na resistência à flexão média foi encontrado para todos os grupos reforçados com fibras, em comparação com os controles não reforçadas, tanto antes quanto depois da exposição à umidade. A fibra de polietileno forneceu o maior efeito de reforço. Após 1 mês de armazenamento em saliva artificial, houve uma diminuição significativa na força média de flexão de todos os grupos testados. Conclusão: Dentro das limitações do presente estudo, o tipo de fibra demonstrou exercer um aumento significativo sobre as propriedades de flexão do compósito reforçado com fibras. Fibras de polietileno aumentaram mais a resistência à flexão do compósito.