RESUMO
Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.
RESUMO
INTRODUCTION: Grafting in oral implantology involves bone augmentation procedures with various bone graft materials. Success of such procedures is evaluated through the amount of bone volume and bone formed at the grafted site. The primary aim of this prospective study was to histomorphometrically evaluate and compare the new bone formation with Bio Oss or Cerabone in the lateral approach sinus augmentation procedure. MATERIALS AND METHODS: The research targeted 22 patients who were either partially or completely edentulous posterior maxilla with residual alveolar height 3 mm at the site of implantation and underwent a two staged surgical protocol, with a lateral approach sinus grafting with either Bio Oss or Cerabone. Bone trephine biopsies for histological analysis were harvested 6 months after augmentation while preparing the osteotomies for implant placement trephine. The histologic evaluation was performed comparing the newly formed bone, marrow spaces, biomaterial particles remnants, and presence of osteocytes embedded in both trabecular bone and bone tissue near the anorganic bovine bone. RESULTS: The present study showed that neither of the graft material showed any active osteoclasts and host inflammatory reaction. From sites grafted with Cerabone, an ample amount of mature lamellated bone formation was seen, also host inflammatory response was indicative of minimal reactive inflammatory response suggestive of good acceptability of the graft material by the host. No significant differences between the groups could be detected with regard to new bone formation and residual bone substitute. CONCLUSION: The results of the study illustrates that both the bone substitute materials allow predictable new bone formation in sinus augmentation procedures.
RESUMO
BACKGROUND: Guided tissue regeneration-based root coverage has emerged as a promising treatment modality in the treatment of gingival recession. A variety of nonresorbable and bioresorbable membranes have been successfully used. Among resorbable membranes, collagen has been extensively studied. Recently, a third generation barrier membrane derived from placenta has been introduced for periodontal regeneration. AIM: The objective of the present study is to clinically compare the efficacy of placental membrane (Amnion) and collagen membrane (Healiguide) for the treatment of gingival recession. MATERIALS AND METHODS: Twelve patients having isolated bilateral gingival recession defects were included in the study and were divided into two groups randomly. Group I were treated by coronally positioned flap and amnion membrane and Group II were treated by coronally positioned flap and collagen membrane (Healiguide)™. Clinical parameters, including dental plaque index (PI), gingival index (GI), gingival recession depth, probing pocket depth, clinical attachment level, and gingival biotype, were recorded before surgery at baseline and then reevaluated at 3 and 6 months postoperatively. STATISTICAL ANALYSIS: Nonparametric test, i.e., Wilcoxon Signed-Ranks Test was used in the present study. Significance was reported at 95% confidence level. RESULTS: The results of the present study revealed statistically no significant difference (P > 0.05) in dental PI improved, GI and probing pocket depth in both groups. Significant reduction in gingival recession defects and gain in clinical attachment level was observed in both the groups. Intergroup comparison of gingival recession defects and clinical attachment level yielded nonsignificant differences. However, a statistically significant increase (P < 0.05) in gingival tissue thickness was observed in Group II as compared to Group I. CONCLUSION: Both membranes are equally efficacious in the treatment of gingival recession. More gingival tissue thickness (gingival biotype) enhancement was observed in sites treated with collagen membrane.
RESUMO
INTRODUCTION: Platelet-Rich Fibrin (PRF) and bioactive glass putty have been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal defects. The individual role played by bioactive glass putty in combination with PRF is yet to be elucidated. AIM: To compare the clinical effectiveness of the combination of PRF and bioactive glass putty and bioactive glass putty alone as regenerative techniques for intrabony defects in humans. MATERIALS AND METHODS: Ten pairs of intrabony defects were surgically treated with PRF and bioactive glass putty (Test group) on one side or bioactive glass putty alone (Control group) on other side. The primary outcomes of the study included changes in probing depth; attachment level and bone fill of osseous defect. The clinical parameters were recorded at baseline, 3, 6, and 9 months. Radiographic assessment was done using standardized intraoral periapical radiographs. Differences between baseline and postoperative measurementsbetween the control and test groups were calculated using independent t-test. Comparisons were made within each group between baseline, 3 months, 6 months and 9 months using the ANOVA test followed by Bonferroni test. RESULTS: The mean probing depth reduction was greater in the test group (bioactive glass putty and PRF) i.e., (3.2±2.3 mm) than in the control group (bioactive glass putty alone) i.e., (3.15±1.06 mm). The mean CAL gain was also greater in the test group (4.1±1.73 mm) as compared to the control group (3.15±1.06 mm), (p-value<0.95). Furthermore significantly greater mean bone fill was found in the test group (7.1±1.37 mm) as compared to the control group (5.7 ± 1.64 mm), (p-value<0.043). CONCLUSION: The results of this study showed both the groups bioactive glass putty alone (Control Group) and the combination of PRF and bioactive glass putty (Test Group) are effective in the treatment of intrabony defects. The bioactive glass putty appears to be a suitable vehicle to administer biologic substances like PRF and growth factors to induce the new bone regeneration.
