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.

Prevalence, Location, and Variations of the Posterior Superior Alveolar Canal With Age and Gender in the Indian Population: A Cone Beam Computed Tomography (CBCT)-Based Retrospective Study.

BACKGROUND: Enhancing the availability of bone in the vertical dimension for implant insertion is thought to be possible through implant site preparation using direct or indirect sinus lift. The posterior superior alveolar (PSA) canal is extremely vulnerable to trauma during this procedure. The anatomy of this region should be thoroughly evaluated to prevent traumatizing this artery and eventual perioperative bleeding. Due to a lack of relevant knowledge and the clinical importance of this problem, the position, diameter, detectability, and proximity of this canal to the alveolar ridge were assessed on cone beam computed tomography (CBCT) scans which were the main objectives of this study. METHODOLOGY: A total of 240 CBCT scans were examined, and the position of the PSA canal, its diameter, the perpendicular distance from the inferior border of the PSA canal to the alveolar crest, and the perpendicular distance from the inferior border of the canal to the maxillary sinus floor was measured. RESULTS: Intraosseous PSA canals were the most prevalent, followed by intrasinusal and extraosseous canals. Males had larger canal diameters and greater distances between the maxillary sinus floor and alveolar crest and the canal (P < 0.05). CONCLUSION: CBCT was proven to be a useful method for assessing and localizing the PSA artery to prevent intraoperative bleeding and further complications.

Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study.

BACKGROUND: To evaluate and compare efficacy of pinhole surgical technique (PST) alone and with advanced platelet rich fibrin (A-PRF) in the management of bilateral multiple adjacent gingival recession defects (MAGRD). METHODS: One hundred and sixty five MAGRD were randomly assigned to control group (treated with PST) and test group (PST with A-PRF). Clinical parameters of gingival recession depth (GRD), gingival recession width (GRW), width of keratinised gingiva (WKG), complete root coverage (CRC) and gingival thickness (GT) on ST-CBCT was measured at 2, 4 and 6 mm apically from the gingival margin. Also, root coverage aesthetic score and patient satisfaction ratings were recorded at baseline, 6 and 12 months postoperatively. RESULTS: Substantial reduction in GRD (Test: 1.29 ± 0.69 mm and Control 0.98 ± 0.30 mm) (p < 0.001) and GRW (Test: 2.03 ± 0.90 mm and control 1.73 ± 0.99 mm) (p < 0.05) with associated gain in WKG and GT was observed (p < 0.001). Mean GT values were increased in both the groups at 2, 4 and 6 mm from the crest. Comparison of Test and Control groups yielded significant reductions in GRD (-0.17 ± 0.56 mm) and WKG (0.73 ± 1.07 mm) favoring the Test group (p < 0.05). Similar increase in GT was observed with better results in Test than control group. (p < 0.001). CONCLUSION: Both groups exhibited sound clinical outcomes with test group offering better resolution of MAGRD in comparison to control group. Also, it enhances clinical and therapeutic end results in terms of attaining reduction in GRD and GRW along with greater gain in KTW and GT. CLINICAL SIGNIFICANCE: PST as a minimally invasive approach has numerous benefits, some of which include the absence of scarring and improved aesthetics linked to faster wound healing. The addition of A-PRF enhances the intended therapy outcomes, which is beneficial for both patients and professionals in the field of periodontics.

Evaluation and correlation of extraoral and intraoral attributes on smile esthetics.

AIM: The harmonious existence of the extraoral and intraoral attributes are critical and capable of enhancing smile esthetics. Therefore, the present study was planned as a gender-based evaluation and correlation of interpupillary width (IPW) and intercommisural width (ICOW) with the combined width of the maxillary central incisors and anterior teeth and gingival thickness (GT) in periodontally healthy patients. MATERIALS AND METHODS: A total of 120 patients within an age range of 20 to 40 years were divided equally into two groups based on gender. The extraoral parameters were recorded on digitized photographs, the intraoral parameters on a stone cast with dental floss and a digital caliper, and the GT clinically. RESULTS: The mean values of IPW and GT in males and females were 63.95 ± 4.40 mm and 60.55 ± 2.43 mm, and 2.14 ± 0.37 mm and 1.07 ± 0.21 mm, respectively. Similarly, the mean combined width of the maxillary central incisors and anterior teeth in males and females differed significantly, being 18.69 ± 1.16 mm and 17.86 ± 1.09 mm, and 55.70 ± 3.14 mm and 51.46 ± 2.18 mm, respectively. CONCLUSIONS: Although the correlations between the parameters in the present study were found to be weak and positive, they can be accepted as preliminary findings that may require further exploration. The gender variability of the extraoral and intraoral parameters such as IPW, GT, combined width of the maxillary anterior teeth (CMA), and combined width of the maxillary central incisors (CMI) provide valuable guidelines that can be implemented in restorative procedures in the maxillary anterior sextant.

Comparative evaluation of semaphorin-4D, peptidylarginine deiminase-2, and matrix metalloproteinase-8 levels of gingival crevicular fluid in periodontally healthy and Stage III periodontitis smoker and non-smoker patients before and after non-surgical periodontal therapy.

BACKGROUND: This study was designed to assess the influence of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) levels of semaphorin-4D (SEMA-4D), peptidylarginine deiminase-2 (PAD-2), and matrix metalloproteinase-8 (MMP-8) levels in periodontally healthy, Stage III periodontitis non-smoker and smoker patients. METHODS: Sixty patients were equally divided into three groups, Group I: Periodontally healthy, Group II: Non-smokers with Stage III periodontitis, and Group III: Smokers with Stage III periodontitis. The patients underwent NSPT with clinical and biochemical parameters examined at baseline and 3 months post therapy. GCF was collected for levels of SEMA-4D, PAD-2, and MMP-8 through enzyme-linked immunosorbent assay (ELISA). RESULTS: Greater values of PPD (8.06 ± 0.19 mm), CAL (8.94 ± 0.19 mm), PI (2.58 ± 0.19) while lower PBI (1.39 ± 0.19%) and GI (1.72 ± 0.19) scores were seen in Group III as compared to Group II, which reduced significantly from baseline to 3 months in both the groups after NSPT. Minimum values of SEMA-4D, PAD-2, and MMP-8 levels in GCF were seen for Group I, which increased incrementally to Group II and III. Also, among Group II and III the SEMA-4D, PAD-2, and MMP-8 levels in GCF reduced from baseline to 3 months indicating a favorable response within the tissues. CONCLUSION: Greater levels in GCF of Levels of SEMA-4D, PAD-2, and MMP-8 in Group II and III, which reduced significantly post NSPT, implied that these biomarkers play a pivotal role in the inflammatory process and can be utilized for early diagnosis.

Clinicoradiographic comparative evaluation of 1% melatonin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

BACKGROUND: The present study aims to evaluate and compare the effects of 1% melatonin gel plus platelet-rich fibrin (PRF) and PRF alone in treatment of furcation defects, clinically and radiographically using cone-beam computed tomography. METHODS: This split-mouth clinical trial included 23 patients with 46 bilateral Grade II furcation defects in first or second maxillary or mandibular molars. Control group was treated with PRF alone while the test group was treated with 1% melatonin gel and PRF. Clinical attachment level (CAL) and horizontal probing depth (HPD) were primary outcome parameters while secondary outcome parameters were pocket probing depth (PPD) and defect volume (DV) assessed at 3 and 6 months postoperatively. RESULTS: Significantly greater mean reduction of PPD, HPD, and CAL gain was observed in test group (2.23 ± 0.41, 2.36 ± 0.68, and 2.97 ± 0.62 mm, respectively) in comparison with control group (2.83 ± 0.78, 2.85 ± 0.67, and 3.21 ± 0.86 mm, respectively) at 6 months. A significant reduction in the mean DV was exhibited radiographically in test group (1.06 ± 0.5 mm3 ) as compared with control group (3.94 ± 1.32 mm3 ) at the end of 6 months. Both the groups showed improvements in assessed parameters. CONCLUSIONS: In Grade II furcation defects the combination therapy of 1% melatonin + PRF shows a statistically significant degree of bone fill within the periodontal tissues and also better results in terms of decrease in PPD, HPD, and a greater CAL gain.

Effect of Nonsurgical Periodontal Therapy on Metabolic Control and Systemic Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with Stage III Periodontitis.

Background: A reciprocal relationship is understood to exist between periodontal disease and type 2 diabetes mellitus (T2DM), and this intervention study aimed to evaluate the effects of nonsurgical periodontal therapy (NSPT) on metabolic control, systemic inflammation, and cytokines in patients of T2DM with Stage III periodontitis. Materials and Methods: Sixty patients of T2DM with Stage III periodontitis were divided equally into two groups: intervention group (IG) and control group. Clinical parameters such as bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months, and the serum samples were collected and processed at baseline and 6 months following NSPT to evaluate fasting plasma glucose, Glycosylated hemoglobin (HbA1c), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and high-sensitivity capsule-reactive protein (hs-CRP). Results: The results indicated a significant improvement in clinical parameters of PPD and CAL 6 months after NSPT (P = 0.005) in both the groups. However, a significant decrease (P < 0.0001) in the TNF-α, hs-CRP, blood glucose, and HbA1c levels was seen after NSPT. On the other hand, an increase in anti-inflammatory cytokine IL-10 was observed after NSPT in the IG. The changes in the pretreatment and posttreatment levels of all clinical, biochemical, and metabolic parameters, were found to be significant in both the groups except BOP. Conclusion: NSPT effectively improves periodontal condition, systemic inflammatory status, and glycemic control in patients of T2DM with Stage III periodontitis and decreases hs-CRP levels.

Gender-based evaluation of interproximal dimensions.

OBJECTIVE: The present study was formulated as a gender-based evaluation of the vertical apicocoronal (VAC), horizontal mesiodistal (HMD), and horizontal faciopalatal (HFP) dimensions of the interproximal area and their influence on the presence of interdental papillae and gingival thickness (GT) in maxillary anterior teeth. MATERIALS AND METHODS: A total of 120 patients in an age range of 20 to 40 years, divided equally into two groups based on gender, were evaluated for interproximal VAC, HMD, and HFP dimensions through radiovisiographic (RVG) images. Additionally, the existence of interdental papillae and GT were assessed clinically in the maxillary anterior sextant. RESULTS: The overall mean VAC dimensions in between the central incisors were greater in females than in males, with maximum mean values of 5.91 ± 0.33 mm and 5.03 ± 0.23 mm, respectively. The mean values for HMD and HFP showed a reverse trend, being greater in males than in females, with the differences being statistically significant. Similarly, the mean GT was greater in males than in females (P < 0.0001). It was also shown that as the VAC dimension increased, the existence of complete papillae in the interproximal areas reduced. CONCLUSIONS: The gender variability of intraoral characteristics such as VAC and GT dimensions and their influence on the existence of interdental papillae provide valuable guidelines that can be implemented in procedures in the maxillary anterior sextant. The associations between HMD and HFP dimensions and interdental papillae were not clearly evident, and further exploration in participants of different age groups would be useful and informative.

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.

Efficacy of simultaneous placement of dental implants in osteotome-mediated sinus floor elevation with and without bone augmentation: A systematic review and meta-analysis.

Background: The aim of the present systematic review was to assess the effectiveness of simultaneous placement of implant in osteotome-mediated sinus floor elevation (OMSFE) procedure with and without bone augmentation. Materials and Methods: An exploration of randomized clinical trials (RCTs) was systematically done in three databases comprising PubMed, Cochrane, and Google Scholar complemented by a thorough manual search of periodontology/implantology-related journals. A final inclusion of 6 RCTs (2010-2020) was done to investigate the efficiency of simultaneous implant placement with OMSFE in conjunction with bone augmentation. A meta-analysis was further conducted with comparable studies which assisted in attaining a final conclusion regarding the survival rate, endosinus bone gain (ESBG), and marginal bone loss (MBL). Results: Data synthesis was performed on the basis of 6 trials and further meta-analysis was performed to statistically validate the clinical and radiographic outcomes. Meta-analysis on the parameters indicated greater ESBG (mean difference [MD]: 0.82; [95% confidence interval [CI]: 0.72-0.91, P ≤ 0.0001]), which was also associated with minimal MBL (MD: -1.11; [95% CI: -1.53-0.68, P ≤ 0.0001)] in the bone augmentation group. However, the parameter of implant survival rate (risk ratio: 1.04; [95% CI: 0.83-1.31, P = 0.6849)] failed to reveal significant difference between the two groups. Conclusions: In the restoration of masticatory apparatus, simultaneous placement of implant in OMSFE with bone augmentation can be considered as successful and predictable treatment approach in deficient posterior maxillary ridges. It contributes toward bone neoformation resulting in greater ESBG as well as a substantial decrease in MBL.

Patient-centered outcome measures comparing the autogenous and allogenic bone blocks in the augmentation of deficient alveolar ridges: A pilot study.

Background: The aim of the present study was to evaluate and compare the patient-reported experience and outcome measures (PREMS and PROMS) and three-dimensional augmentation efficacy of the autogenous and allogenic bone block grafts in deficient alveolar ridges through cone beam computed tomography (CBCT). Materials and Methods: Twenty patients were equally divided into Groups I and II treated with autogenous and allogenic bone block grafts for ridge augmentation, respectively. The radiographic parameters including the apico-coronal defect height (DH) as well as buccolingual defect depth (DD) and mesiodistal defect width (DW) at apical, middle, and cervical zone were measured using CBCT at baseline, 6 months and 1 year. The PREMS and PROMS were evaluated using Visual analogue scale (VAS) scale and questionnaire method. Results: The mean DH, apical DD and DW, middle and cervical zone DW were significantly different between two study groups (P < 0.05). The mean apical 11.6 ± 1.91 and middle zone 9.43 ± 0.89 DD were significantly higher (in Group I as compared to Group II, with P values 0.016 and 0.004, respectively). The mean bone gains in apico-coronal DH and mesio-distal DW dimension in the apical and middle zone was significantly higher in Group I (P < 0.0001). The comparison of PROM revealed better patient satisfaction in Group II as depicted by significantly higher VAS score (P < 0.0001). Conclusion: Superior bone gain and reduced graft resorption was observed in Group I when compared to Group II. On the contrary, better PROMs and PREMs were obtained with the allogenic bone block augmentation.

Association between tooth loss and risk of occurrence of oral cancer - A systematic review and meta-analysis.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067-3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00-68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Efficacy of platelet rich fibrin with and without metformin in the treatment of periodontal osseous defects: a systematic review and meta-analysis.

OBJECTIVE: The systematic review and meta-analysis aimed to evaluate the efficacy of Metformin (MF) with Platelet Rich Fibrin (PRF) over PRF alone in the treatment of periodontal osseous defects. MATERIALS AND METHODS: An extensive electronic search for articles published up to September 2021 was conducted on 'Embase', 'PubMed' and other library databases accompanied with manual searching. Randomized controlled trials (RCTs), comparing MF plus PRF Vs PRF alone in periodontal osseous defects were identified in which periodontal pocket depth (PPD), Clinical attachment level (CAL) and Intrabony defect depth (IBD Depth) were the outcome measures. RESULTS: Four studies compared MF plus PRF vs .PRF alone in periodontal osseous defects. Meta-analysis was carried out for PPD reduction, CAL gain and IBD Depth changes. A standardized mean difference (SMD) of 1.86 for PPD reduction, 1.95 for CAL gain and 1.31 for IBD Depth reduction in all the studies was observed and the findings were statistically significant favouring test group. CONCLUSION: The systematic review indicates supplemental benefits of combination therapy of MF + PRF over monotherapy in resolving periodontal osseous defects. In our quest to achieve maximum regeneration in periodontal osseous defects, combination therapies such as MF + PRF have reported to be better treatment choices over other modalities.

Assessment and correlation of the influence of non-surgical periodontal therapy on serum lipid profile and cytokines in patients with stage III periodontitis.

BACKGROUND: Interleukins are the markers of inflammation and the lipid profile reveals the likelihood of arising cardiovascular disease (CVD). The present study aimed to assess and correlate the influence of non-surgical periodontal therapy (NSPT) on serum lipid profile and Interleukin-6 (IL-6) and Interleukin-8 (IL-8) in patients with Stage III periodontitis. METHODS: Sixty patients with the age range of 35-60 years with Stage III periodontitis were included by evaluating for periodontal parameters such as Probing pocket depth (PPD) and clinical attachment levels (CAL). NSPT was performed at baseline, 3 and 6 months. Biochemical parameters like serum lipid parameters of total cholesterol (TC), triglycerides (TG), low-density lipopolysaccharide (LDL), high-density lipopolysaccharide (HDL), and IL-6 and IL-8 serum levels were assessed at baseline and 6 months' post-NSPT. RESULTS: The results indicated a significant reduction (p < 0.0001) in the PPD (2.75 ± 0.41), CAL (3.23 ± 0.56), lipid profile, and serum cytokine levels 6 months' post-NSPT as compared to baseline. A highly significant (p < 0.0001) percentage reduction was observed in the IL-6 (35.3%), IL-8 (41.6%), TC (7.5%), TG (1.78%), LDL (6.2%), and HDL (-21.8%) clinical and biochemical parameters at 6 months' recall post-NSPT. CONCLUSION: Non-surgical periodontal therapy caused a significant reduction in the levels of serum pro-inflammatory cytokines IL-6 and IL-8 as well as the lipid biomarkers TC, TG, LDL, and increase values of HDL. These findings imply a considerable reduction in the risk of developing CVD in patients with Stage III periodontitis.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial.

BACKGROUND: The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level. METHODS: 30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12 months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12 months. RESULTS: The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW. CONCLUSION: The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV. CLINICAL RELEVANCE: The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.