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.

Efficacy of leukocyte-platelet-rich fibrin membrane in immediate postextraction implant placement: A randomized controlled trial.

Background: Leukocyte-platelet-rich fibrin (L-PRF) membrane is an emerging autologous healing biomaterial that promotes angiogenesis and healing in immediate implant sites. The purpose of the study was to evaluate hard and soft tissue outcomes of immediate implant placement with or without L-PRF. Materials and Methods: A total of 18 immediate implants were divided randomly into two groups of 9 implants each, i.e., Group 1 and Group 2. All sites received a definitive restoration after 3 months of implant placement and were followed up for a period of 6-months. Results: Addition of L-PRF in the extraction sockets when placing immediate implants resulted in statistically nonsignificant benefit in terms of clinical and radiographic parameters when compared to immediate implant placement without L-PRF. Conclusion: Immediate implant placement in Group 2 demonstrated marginal but statistically significant benefit as compared to sites in Group 1.

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.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

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.

A comparative evaluation of biphasic calcium phosphate material and bioglass in the treatment of periodontal osseous defects: a clinical and radiological study.

AIM: The aim of this study was to evaluate the efficacy of biphasic calcium phosphate (ossifi) and bioactive glass in the treatment of periodontal osseous defects clinically and radiographically and compare them with open-flap debridement. METHODS AND MATERIALS: A total of 45 sites in two test groups (test 1, ossifi; test 2, bioactive glass) and a control group (open-flap debridement), in 35 patients, were selected in this study conducted at the department of Periodontics and Oral Implantology, D.A.V.(C) Dental College, Yamuna Nagar, India. Clinical parameters like plaque index, gingival index, pocket depth, and clinical attachment level were recorded at the baseline and at three months and six months postoperatively. Radiological parameters like the amount of defect resolution and the percentage of defect resolution were recorded at the baseline and at three months and six months postoperatively. RESULTS: Statistically significant difference in mean values of the plaque index, gingival index, pocket depth reduction, clinical attachment level, gain amount of defect resolution, and percentage of defect resolution were observed in all the groups at subsequent time periods. CONCLUSION: Both test groups showed significant improvement over the control in both the clinical and radiological parameters. CLINICAL SIGNIFICANCE: A greater percentage of defect resolution was noticed in test 1 as compared to test 2, followed by the control.

Evaluation of the efficacy of subgingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries.

BACKGROUND: In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations. AIMS: The aim of this study was to evaluate of the efficacy of sub-gingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries. SETTINGS AND DESIGN: Randomized comparative parallel group interventional clinical trial. MATERIALS AND METHODS: Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06% chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12% CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks' postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows). RESULTS: A statistically significant difference was seen with the use of 0.06% CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12% CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing. CONCLUSION: The adjunctive use of subgingival home irrigations using 0.06% CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India.

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis.

AIM: The aim of this study was to evaluate and compare the efficacy of subgingivally delivered 10% doxycycline hyclate and xanthan based chlorhexidine gels when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS AND MATERIALS: A randomized, controlled, single center study was conducted involving 90 sites in 30 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of doxycycline gel [SRP+DH], SRP + insertion of chlorhexidine gel [SRP+CHX]), and SRP alone [SRP]. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 1 month, and 3 months post therapy. RESULTS: All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (p<0.001). At 3 months, sites treated with SRP+DH and SRP+CHX showed an additional reduction in PPD of 0.86 +/- 1.0 mm and 0.66 +/- 1.58 mm, respectively, significantly greater than SRP alone (p<0.02). Differences in mean PPD reduction between SRP+DH and SRP+CHX were not significant (p=0.46). At 3 months, differences in relative CAL between both SRP+DH (0.80 +/- 0.92) and SRP+CHX (0.63 +/- 1.47) and SRP alone were statistically significant (p<0.02). Differences in relative CAL between SRP+DH and SRP+CHX were not significant (p=0.54). CONCLUSION: The results suggest treatment with 10% doxycycline hyclate and xanthan based chlorhexidine gels as an adjunct to SRP improves PPD and CAL patients with periodontitis compared to SRP alone. CLINICAL SIGNIFICANCE: The use of local drug therapy may refocus the need for surgical periodontal therapy toward deeper pockets.

Clinical and radiological evaluation of an osseous xenograft for the treatment of infrabony defects.

OBJECTIVE: To evaluate the effectiveness of demineralized bone matrix (DMBM), an osteoconductive and osteoinductive graft material, as a bone graft for the treatment of osseous defects, both clinically and radiographically. MATERIALS AND METHODS: The effectiveness of DMBM was assessed at 40 sites in 30 patients who had infrabony defects. Grafted test sites were compared with control sites treated with open-flap debridement. RESULTS: Significant improvement in all variables was found, including reduction of probing depth, and gain in clinical attachment level and bone fill for test and control sites at 3 months and 6 months postoperatively. For test sites, reduction of probing depth was 2.80 mm at 3 months and 4.05 mm at 6 months, and for control sites, 1.75 mm at 3 months and 2.65 mm at 6 months. Gain in the level of clinical attachment for test sites was 2.80 mm at 3 months and 4.00 mm at 6 months; for control sites, this gain was 1.75 mm at 3 months and 2.60 mm at 6 months. The mean amount of defect resolution was 2.02 mm and 3.27 mm for test sites and 0.82 mm and 1.17 mm for control sites, at 3 months and 6 months, respectively. The mean percentage of defect resolution was 37.1% and 56.5% for test sites compared with 20.5% and 28.6% for control sites, at3 months and 6 months, respectively. CONCLUSIONS: DMBM improves healing outcomes, namely, reduction of probing depth, resolution of osseous defects and gain in clinical attachment, compared with open flap debridement.

Clinical evaluation of a bioresorbable membrane (polyglactin 910) in the treatment of Miller type II gingival recession.

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Comparison of two techniques of harvesting connective tissue and its effects on healing pattern at palate and recession coverage at recipient site.

AIM: To compare the healing pattern in palate following harvestation of connective tissue graft by two different techniques and to compare the recession coverage at the recipient sites. MATERIALS AND METHODS: 30 recession sites with Miller's class I and II recession in 16 patients were recruited for this study. Sites were randomly divided into 2 treatment groups. Group I used Unigraft Knife to harvest the connective tissue whereas in group II patients Langer & Langer techniques was used to harvest the connective tissue graft from the palate. Healing was evaluated at the donor site using- wound size(WS), immediate bleeding (iB) and delayed bleeding (dB), complete wound epithelialization (CE), sensibility disorders (S) and post operative pain (PP) at baseline, 1(st), 4(th), and 12(th) week postoperatively. Recession coverage was assessed by measuring Clinical Attachment Level (CAL), vertical recession (VR), width of keratinized gingiva (KT). RESULTS: On comparison between Group I and II, a statistically significant larger wound size was observed in Group I. CWE was higher in Group II. A non significant difference was observed when SD, and delayed bleeding were compared at all time intervals. A non-significant difference was observed in the clinical parameters at the recipient site. CONCLUSION: When evaluating the WS and CWE, the Langer and Langer technique was found to be better than the Unigraft knife technique for harvesting the connective tissue graft, whereas both the techniques were found to be effective in root coverage procedure outcomes.

2% sodium fluoride-iontophoresis compared to a commercially available desensitizing agent.

BACKGROUND: Dentin hypersensitivity is a common clinical condition and age-old complaint, presenting problems to both the patient and the dentist. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. The failure to practice satisfactory plaque control has well-established consequences on gingival and periodontal health. Thus, a cycle of sensitive teeth leading to reduced plaque control, more periodontal disease, and more recession may be established. METHODS: The hypersensitive teeth were identified by the patient and verified by the light stroke of a dental explorer along the cervical area of all teeth present. Subjects fulfilling the inclusion and exclusion criteria were evaluated using tactile, 1-second air blast, and cold water stimuli, and the subject's response was recorded on the verbal rating scale. A total of 425 teeth from 50 patients included in this study were randomly divided into two groups: group 1, who received 2% sodium fluoride-iontophoresis (NaF) and group 2, who received an aqueous solution of hydroxy-ethyl-methacrylate and glutaraldehyde (HEMA-G). The teeth were evaluated immediately after treatment and at 2 weeks, 1 month, and 3 months. In case of failure at the 2-week interval, the affected tooth was retreated with the same drug as before and evaluated further. RESULTS: The results were statistically analyzed, and it was found that group 1 treatment was more effective than group 2 at 1- and 3-month intervals. There was a comparatively greater recurrence of hypersensitivity in group 2. A comparable number of teeth required repeat dosage in both groups. Teeth which required repeat dosage had greater mean discomfort scores at baseline for all three tests than the teeth which did not require a repeat dose. CONCLUSIONS: Both agents showed significant reduction in sensitivity at all time intervals compared to baseline; however, NaF had a comparatively greater effect than HEMA-G at both the 1- and 3-month intervals; an almost equal number of teeth in both groups required repeat doses. Teeth with a higher initial sensitivity score required a repeat dose. Both agents were found to be equally effective immediately after application; the 2% NaF was comparatively better than HEMA-G in providing long-term relief.

Semilunar vestibular technique: A novel procedure for multiple recession coverage (a report of two cases).

The procedures for root coverage have been greatly refined over the past few decades. Still as compared to the other periodontal surgical procedures, predictability of mucogingival procedures remains uncertain which is more in patients who present with multiple recessions or recession complicated with periodontal involvement. Techniques which claim success almost always involve a second surgical site. A novel technique avoiding second surgical site and good predictability for multiple recessions was described by Dr. P.D. Miller in a conference at Pune in 2011. A semilunar vestibular incision technique described by Dr. P.D Miller was performed on two patients who presented with multiple recessions in the maxillary anterior teeth. About 90-100% root coverage was observed when the patients were on a follow-up for 1-year with a significant increase in the vestibular depth. The semilunar vestibular incision technique used in two cases resulted in predictable root coverage with a good color blend, an esthetic marginal morphology and most importantly the avoidance of the second surgical site.

Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: A randomized split mouth study.

AIMS: The aim was to compare the recession coverage outcomes when done macrosurgically and microsurgically. BACKGROUND: Increasing interest in esthetics and the related problems such as hypersensitivity and root caries have favored the development of many root coverage procedures. Recession coverage up to a certain extent has solved these problems, but these procedures need good maintenance after the surgery for long-term benefits. With increasing advances in the field of recession coverage, microscope has added another dimension in undertaking the surgical procedure. MATERIALS AND METHODS: Thirty Miller's Class I and II recession were treated using the sub-epithelial connective tissue graft from the palate. In 15 sites, the graft was placed at the recipient site with unaided eye (Group A) and in other 15 sites the graft was placed using surgical microscope (Group B). Clinical evaluation was done at baseline, 12 weeks and 24 weeks postoperatively using plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), width of attached gingiva, papilla height (PH) and width, malalignment index (MI) and esthetic appearance. STATISTICAL ANALYSIS USED: Paired and unpaired Student's t-test along with Wilcoxon Z-test were used to analyze the results and probability of P < 0.05 were accepted to reject the null hypothesis. Pearson correlation was used to correlate two parameters such as VR and CAL and MI and VR. RESULTS: Both the techniques demonstrated predictable mean root coverage (Group A 61.78% and Group B 67.58%) at 6 months postsurgery. CAL gain was slightly better in Group B patients when compared to Group A patients. A moderate positive correlation for Group A while a mild correlation in Group B was seen between the MI and VR. CONCLUSION: The use of the microscope enhances the results, but obtaining an expertise in using needs a lot of practice. The periodontal healing by both techniques should be evaluated histologically.

Stress distribution of posts on the endodontically treated teeth with and without bone height augmentation: A three-dimensional finite element analysis.

AIMS: Adequate bone support is an essential factor to avoid undue stress to the tooth. This is important when the tooth is endodontically treated and requires a post. The purpose of the present finite element (FE) analysis study was to evaluate the stress distribution of post on endodontically treated tooth with reduced alveolar bone height support and after bone augmentation. The null hypothesis was that there is no difference between the stress distribution of post on endodontically treated teeth with reduced alveolar bone height support and after alveolar bone height augmented using bone graft substitute. MATERIALS AND METHODS: The three-dimensional model was fabricated using ANSYS Workbench version 13.0 software to represent an endodontically treated mandibular second premolar restored with a full ceramic crown restoration and was analyzed using FE analysis. A load of 300N at an angle of 60° to the vertical was applied to the triangular ridge of the buccal cusp in a buccolingual plane. The stresses on the tooth with normal alveolar bone height, reduced alveolar bone height, and after bone augmentation because of reduced bone height were calculated using von misses stresses. RESULTS: A maximum stress value of 136.04 MPa was observed in dentin with an alveolar bone height of 4 mm from the cemento-enamel junction (CEJ). However, after 2 mm of alveolar bone augmentation, the stress value was 104.32 MPa, which was comparable to the stress value of 105.56 observed with the normal bone height of 2 mm from the CEJ. CONCLUSION: Similar values of stresses were observed in teeth with normal and augmented bone height. Increased stresses were observed with alveolar bone loss of 4 mm from the CEJ.

The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study.

BACKGROUND: Calcium sulphate(CS) is one of the oldest alloplastic graft materials used because of its biocompatibility, handling characteristics, porosity, different rates of dissolution, chemico-physical resemblance to bone mineral, ability to induce release of growth factors and potentially unlimited supply at a modest cost. Aim of the study was to evaluate the efficacy of 3 forms of calcium sulphate i.e. Nanogen (nCS)(+), BoneGen(+) and Dentogen(+) in treatment of infrabony defects and to compare their efficacy as bone grafting substitutes. MATERIALS AND METHODS: A prospective randomized, double blind controlled study was conducted on 45 sites from 16 subjects having Moderate to Advanced Periodontitis who were divided into 3 groups i.e. Group I (Nanogen), Group II (Dentogen) and Group III (BoneGen) clinical along with radiographic measurements were taken at baseline, 6 and 12 months postoperatively. RESULTS: There was no significant inter-group difference in mean clinical attachment level (CAL) values at different time intervals whereas Intra-group changes in CAL at 6 and 12 months as compared to baseline were significant statistically. In Group I, changes in CAL between 6 and 12 months were found to be statistically significant in comparison with Group II and III. CONCLUSION: Both Nanogen and BoneGen TR can be considered valuable options in the treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential.

Juvenile trabecular ossifying fibroma.

Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion with highly aggressive clinical behavior, higher incidence in young adults, and a strong tendency to recur. Two categories, trabecular JOF (TrJOF) and psammomatoid JOF (PsJOF), based on histologic criteria and a distinct predilection for specific age groups have been identified. Juvenile trabecular ossifying fibroma of peripheral variety is an uncommon clinical entity with aggressive local behavior and high recurrence rate. This article reports a case of aggressive JTOF in the anterior mandibular region in a 13-year-old boy with history of recurrence. Complete surgical resection of the growth was done along with involved periodontal ligament and periosteum to minimize the possibility of recurrence. The case was followed up for more than 3 months without recurrence.

Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft.

OBJECTIVE: Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. The search for the appropriate root coverage techniques has resulted in many different approaches. The goal of this study was to evaluate the degree of patient acceptance with acellular dermal matrix (ADM) allograft in the treatment of buccal gingival recession and to compare it with subepithelial connective tissue graft. MATERIALS AND METHODS: Thirty patients with Miller's class II recessions were treated and randomly assigned to the test group (ADM) and control group (subepithelial connective tissue graft). All patients underwent full periodontal evaluation and pre-surgical preparation, including oral hygiene instructions and scaling and root planing. The exposed roots were thoroughly planed and covered by a graft without any further root treatment. Results were evaluated based on the parameters measuring patient satisfaction and clinical outcome after 6 months of the surgical procedure. RESULTS: Postoperatively, significant root coverage, reduction in probing depth, gain in clinical attachment level, and increase in widths of keratinized tissue and attached gingiva were observed on intra-group comparison. There was no significant difference in any of the parameters between test and control groups. CONCLUSION: The subepithelial connective tissue graft and ADM graft were able to successfully treat gingival recession defects; however, the ADM showed better patient acceptance than the connective tissue graft.

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis.

OBJECTIVE: The aim of this study was to evaluate and compare the efficacy of subgingivally delivered Minocycline microspheres and 25% Metronidazole gel when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A randomized, controlled, single center study was conducted involving 60 sites in 20 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of Minocycline microspheres at day 1 (Group A), SRP + insertion of Metronidazole gel at day 1 and at day 7 (Group B), and SRP alone (Group C). Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at day 1, 1 month, and 3 months post therapy. RESULTS: All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (P < 0.001). At 3 months, sites treated with minocycline showed an additional reduction in PPD of 0.85 ± 0.03 mm, significantly greater than SRP alone. Differences in mean PPD reduction between Group B and Group C and between Group A and Group B were not significant. At 3 months, difference in CAL gain between Group A and C was 0.50 ± 0.45, which was statistically significant and between Group B and C was 0.35 ± 0.11, which was not found to be statistically significant (P = 0.20). Differences in relative CAL between Group A and Group B were also not found to be statistically significant (P = 0.53). CONCLUSION: The results concluded that treatment with Minocycline microspheres and Metronidazole gel improve PPD and CAL in patients with periodontitis compared to SRP alone.

Comparative evaluation of two commercially available desensitizing agents for the treatment of dentinal hypersensitivity.

AIMS: A randomized clinical trail was designed to compare the efficacy of two commercially available desensitizing agents (fluoride varnish containing 6% sodium fluoride and 6% calcium fluoride and a gel containing 6% potassium nitrate and 0.11% fluoride ions) in the treatment of dentinal hypersensitivity. SETTINGS AND DESIGN: Randomized clinical trial. MATERIALS AND METHODS: Twenty-one patients were selected. Subjects were evaluated using three different stimuli, i.e., tactile test, air blast test and cold water test. They were then randomly divided into two groups. Patients in group I were treated with fluoride varnish and group II patients were treated with gel containing 6% potassium nitrate and 0.11% fluoride ions. The patients were examined at baseline, immediately after application of the agent, at 1 week, 1 month and 3 months interval. STATISTICAL ANALYSIS: Statistical analysis was done using unpaired "t" test, paired "t" test and Chi-square test with Yate's correction. RESULTS: The results were analyzed; it was seen that patients treated in group I showed significantly better results compared to group II patients at 1 month and 3 months interval. Teeth which required repeat dose and those which did not require repeat dose were comparable in number. CONCLUSIONS: Both the agents showed significant reduction in sensitivity at all time intervals compared to baseline. A comparatively significant reduction in sensitivity score was seen in patients treated with fluoride varnish and it appeared to be more effective in providing long-term relief against all the three test stimuli. Teeth with initial high sensitivity score required repeat doses, which was comparable for both the groups.