A Comparison in Patient Comfort Using Conventional Syringe and Needleless Jet Anesthesia Technique in Periodontal Surgery-A Split-Mouth Randomized Clinical Trial.

Background and Objectives: Periodontal surgery requires local anesthetic coverage to alleviate patient discomfort. Needles and injections can engender feelings of fear and anxiety in individuals. This study aimed to assess the level of comfort and anxiety in patients during the administration of local anesthesia using needleless jet anesthesia (JA) when compared to a conventional syringe (CS) in periodontal surgery. Method and Materials: 60 sites were designated for injection in a split-mouth design in 30 subjects who required periodontal surgery. Local anesthesia was administered in two appointments scheduled one week apart using either a JA system or a CS. The Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), and Beck's anxiety inventory were used to report the pain and anxiety levels while injecting local anesthesia. Statistical analysis of the results was performed using the Shapiro-Wilks test and Paired t-test. Results: Patients reported greater comfort with JA. The VAS and VRS values were statistically significant-(p = 0.003) and (p = 0.001), respectively. Patients showed fear and were nervous about receiving a local anesthetic using a CS. A few subjects experienced lingering pain with the CS, whereas greater comfort and no lingering soreness were reported post-operatively at the site of JA administration. Conclusions: This study provides the first comprehensive assessment of using JA for periodontal surgical procedures. Lower pain scores were consistently observed with the use of jet injectors. Patients were at ease and reported lesser anxiety and greater comfort with jet injectors, making it ideally suited for providing local anesthesia in periodontal surgery.

Use of Collagen Membrane in the Treatment of Periodontal Defects Distal to Mandibular Second Molars Following Surgical Removal of Impacted Mandibular Third Molars: A Comparative Clinical Study.

The study aims to assess the efficacy of using collagen membrane in the treatment of distal periodontal defects of mandibular second molars following the removal of mesioangularly or horizontally impacted mandibular third molars surgically. Forty sites in twenty patients with bilaterally impacted mandibular third molars (mesioangular or horizontal) were considered for the study. In 20 test sites (Group A), after surgical removal of the mandibular third molar, a resorbable collagen membrane barrier was placed on the distal aspect of the mandibular second molar to cover the post-surgical bone defect. In the other control 20 sites (Group B), the same surgical procedure was repeated without placing any membrane barrier. The clinical parameters recorded were Oral Hygiene Index Simplified (OHI-S), Probing pocket depth (PPD), Clinical attachment level (CAL), and radiographic assessment of alveolar bone level (ABL). OHI-S score of most of the patients was observed to be satisfactory. Group A was observed to achieve a statistically significant reduction in PPD, CAL, and ABL gain compared to Group B. The improvements indicated that the use of collagen membrane facilitates early wound stabilization and promotes primary closure of the defect. This recovery is achieved through its unique property to assist fibrinogenesis over osteoconduction. Further longitudinal studies are needed to confirm the present findings.

Laser-Assisted Lip Repositioning With Smile Elevator Muscle Containment and Crown Lengthening for Gummy Smile: A Case Report.

INTRODUCTION: Treating the patients with excessive gingival display to provide a pleasant smile is a challenge to the periodontist. Gummy smile can be due to excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, or altered passive eruption. Gummy smile associated with hyperactivity of smile elevator muscles can be treated by surgical techniques like lip repositioning, botulinum toxin injection, lip elongation with rhinoplasty, detachment of the lip muscles, and myectomy. Regardless of the technique used, to achieve a predictable result with long-term stability limiting upper lip movement when the patient smiles, firm muscle containment is imperative. CASE PRESENTATION: The case report describes the excessive gingival display having a multifactorial etiology in a 25-year-old female patient. Altered passive eruption in upper anterior teeth was treated by crown lengthening followed by management of hyperactive lip using a diode laser-assisted lip repositioning along with traction and muscle containment. Excellent and predictable results were obtained after a 1-year follow-up without the relapse of gummy smile. CONCLUSIONS: The case report showed an excellent result when treated by a combined approach of an innovative procedure with laser-assisted lip repositioning aimed at maintaining the traction and containment of the smile elevator muscles along with crown lengthening procedure by gingivectomy.

Diode Laser as an Adjunct to Kirkland Flap Surgery-A Randomized Split-Mouth Clinical and Microbiological Study.

Background: Mechanical methods of periodontal therapy alone may fail to eliminate the tissue-invasive pathogenic flora; therefore, considerable attention has been given to adjunctive antimicrobial measures. Objective: The aim of this study was to investigate and compare the clinical and microbiological effects of diode laser (DL) as an adjunct to Kirkland flap surgery versus Kirkland flap surgery alone for the treatment of generalized chronic periodontitis. Materials and methods: A total of 20 patients with generalized chronic periodontitis with probing pocket depth ≥5 mm after phase I therapy were included in this split-mouth study. Two contralateral quadrants of each patient were randomly assigned to either test or control group. Control group was treated with Kirkland flap surgery alone, whereas test group was treated with DL as an adjunct to Kirkland flap surgery. Periodontal parameters were recorded, and subgingival plaque samples were collected from both the control and test groups at baseline and third and sixth month. The plaque samples were then analyzed for red complex organisms using quantitative real-time polymerase chain reaction. Results: Compared with baseline, both treatments showed an improvement in periodontal parameters at the third and sixth month. However, test group produced a significant improvement in plaque index (1.039 ± 0.069 vs. 1.392 ± 0.17, p < 0.001), bleeding on probing (16.512 ± 5.982 vs. 37.051 ± 7.459, p < 0.001), probing pocket depth (1.727 ± 0.39 vs. 3.016 ± 0.47, p < 0.001), and clinical attachment level (2.054 ± 0.524 vs. 3.354 ± 0.728, p < 0.001) at third and sixth month compared with the control group. Moreover, in the test group, levels of red complex bacteria were significantly reduced at third and sixth month compared with the control group. Conclusions: DL as an adjunct to Kirkland flap surgery has resulted in a greater reduction in clinical and microbiological parameters compared with Kirkland flap surgery alone, thereby offering additional benefit in treating generalized chronic periodontitis patients.

Anesthetic efficacy of 4% articaine and 2% lignocaine in achieving palatal anesthesia following a single buccal infiltration during periodontal therapy: A randomized double-blind split-mouth study.

BACKGROUND: The aim of this randomized split-mouth double-blind study was to evaluate whether 4% articaine hydrochloride with 1:100,000 epinephrine administered as a single buccal infiltration in the maxillary posterior sextant can provide palatal anesthesia when compared with 2% lignocaine with 1:100,000 epinephrine during scaling and root planing and access flap surgery (AFS). MATERIAL AND METHODS: A total of 40 patients with chronic generalized periodontitis requiring periodontal therapy in the maxillary posterior sextants were recruited in this study. About 4% articaine and 2% lignocaine were administered as buccal infiltration in a split-mouth design randomly. The pain scores in the palatal aspect were recorded during scaling and root planing and open flap debridement using Heft-Parker visual analog scale. The onset of anesthesia was also recorded and compared. RESULTS: The success rate for maxillary buccal infiltration to induce palatal anesthesia using articaine was 90% during scaling and root planing and 82.5% during AFS and for lignocaine solution was 20% and 15%, respectively. The difference between the two agents was statistically significant (P < 0.05). The onset of anesthesia between articaine and lignocaine was also found to be statistically significant (P < 0.05). CONCLUSION: In this study, we observed that the efficacy of 4% articaine was superior to 2% lignocaine to induce palatal anesthesia following maxillary buccal infiltration in maxillary posterior sextants.

Self-perceived halitosis and oral hygiene habits among undergraduate dental students.

BACKGROUND: Halitosis or oral malodor is characterized by unpleasant odor arising from the oral cavity. The prevalence of halitosis however is not studied extensively. The aim of this study was to evaluate the self perception of oral malodor and oral hygiene habits amongst dental students. MATERIALS AND METHODS: A structured questionnaire consisting of ten questions was administered to 285 undergraduate students of Madha Dental College and Hospital. The questionnaire was designed to evaluate the self perception of halitosis, oral hygiene aids used, presence of dental caries, gingival bleeding, and dryness of mouth. RESULTS: Of the 285 students, 259 students completed the questionnaire. The response rate was 90%, with male response rate being 85.7% and female 95.8%. Self-perceived halitosis was reported by 44.1% males and 45.32% females. The difference in reporting self-perception of halitosis between females and males was found to be statistically significant (P < 0.05). Significant difference was found for use of mouth wash, presence of carious teeth, bleeding gums, and use of tongue cleaners between females and males (P < 0.05). CONCLUSION: The results of this study indicate higher prevalence of halitosis among this population consisting of dental students. The awareness of halitosis was also higher among this population. The awareness of halitosis as an individual entity should be promoted to the general population and the therapeutic measures should be made available to all.

Double laterally rotated bilayer flap operation for treatment of gingival recession: A report of two cases.

Esthetic concerns of the patient have become an essential part of dentistry, especially Periodontics. Periodontal plastic surgery is a rapidly emerging field, which helps us to meet this criterion. Root coverage is being achieved by a variety of techniques namely pedicle grafts and free soft tissue grafts. This article highlights on 2 case reports in which a new pedicle graft technique has been used for root coverage.