Journal of Dental Anesthesia and Pain Medicine, 2020
Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported t... more Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Method: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.
Background: Marginal gingival recession can cause major functional and esthetic problems. Advance... more Background: Marginal gingival recession can cause major functional and esthetic problems. Advanced flaps are the simplest, yet unpredictable procedures for managing these conditions. The predictability of root coverage can be increased by combining coronally advanced flap (CAF) or its modified approach with other regenerative techniques. Objective: To ascertain the potential benefits of platelet‑rich fibrin (PRF) on modified CAF for the treatment of gingival recession. Materials and Methods: Study comprised of 12 patients with Millers’ class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split‑mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months. Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits. Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.
Journal of Dental Anesthesia and Pain Medicine, 2019
Background: Profound anesthesia with adequate duration is required in periodontal flap surgery, w... more Background: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. Methods: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. Results: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. Conclusions: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.
Journal of Dental Anesthesia and Pain Medicine, 2019
Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but a... more Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.
Journal of Indian Society of Periodontology , 2018
Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of th... more Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of the most challenging situations in implant practice. With the increase in popularity of dental implants, augmentation of the alveolar ridge and soft tissue has also become a routine procedure in most of the cases. Although hard‑tissue augmentation is performed by other specialists also, a periodontist needs to master the skills of soft‑tissue management to deliver esthetic and functional results in implant‑supported prostheses. This case report presents a single‑staged ridge split approach using piezoelectric surgery with simultaneous implant placement followed by connective tissue grafting at second‑stage surgery. Single‑staged segmental ridge split technique not only reduces the total treatment duration but also the surgical morbidity for the patient. A subepithelial connective tissue graft is strongly advocated around implants as it is highly predictable while ensuring better esthetic results in terms of tissue color, texture, and long‑term stability of the surrounding mucosa.
Gingival recession in anterior teeth not only catches the eyes of a dentist, it also is of concer... more Gingival recession in anterior teeth not only catches the eyes of a dentist, it also is of concern to the patient. The goal of the periodontist in such cases is not limited to relieving the offending condition, but also to achieving optimum aesthetics. While planning the treatment of gingival recession, it is important to consider the predictability of various techniques. This report describes a successful case of semilunar coronally repositioned flap in Miller’s Class I recession defects on maxillary central incisors.
Cases of negligence in orthodontics are not as frequent as in other dental or medical specialties... more Cases of negligence in orthodontics are not as frequent as in other dental or medical specialties. However, sometimes we come across a case of negligence that cannot be ignored. Here, we present a very uncommon finding of a molar tube embedded in the labial vestibule, between mandibular central and lateral incisors, for more than a month. The uniqueness of this finding is that a molar tube, as the name suggests, is supposed to be bonded on molars and if it gets dislodged due to any reason, it should have been embedded near the respective molar. With this dilemma in mind, this case offers many things to learn from errors.
Gingival enlargement is a clinical condition that has been widely studied. Usually, it is related... more Gingival enlargement is a clinical condition that has been widely studied. Usually, it is related to specific local or systemic factors. However, it is difficult sometimes to find out a definite etiology, and treatment has to be done according to presenting clinical features. This article presents an unusual case of gingival enlargement that occurred after pregnancy without any clear underlying etiology. A female aged 31 years reported with gingival enlargement and mobility of teeth during lactation period. Gingival enlargement had started 2 months after child birth. All female sex hormones were found to be within normal limits. Karyotyping was also found to be normal, without any genetic alteration. Radiographic analysis revealed generalized severe crestal bone loss. After phase I periodontal therapy, enlargement was managed surgically under local anaesthesia. On histological examination of excised specimen, tissue was found to be hyperplastic. Although a definite etiology could not be ascertained, the treatment was successful and there has been no recurrence after one year post-treatment interval.
Aim: The aim was to compare the gingival tissue response following placement of a light cure dres... more Aim: The aim was to compare the gingival tissue response following placement of a light cure dressing (Barricaid®) and a non‑eugenol periodontal dressing (Coe‑Pak™) after periodontal flap procedure. This was carried out by evaluating plaque deposition underneath both the dressings, healing response and the patient preference for each. Materials and Methods: A total of 12 patients with chronic generalized periodontitis requiring surgery in at least two different quadrants were enrolled for this split‑mouth study. After periodontal flap surgery, Coe‑Pak™ was placed in the quadrant assigned to Group I and Barricaid® was placed in the other quadrant assigned to Group II. Clinical parameters were recorded on day 7 and day 14. Patient comfort and pain levels were also evaluated by a questionnaire. Results: There were no statistically significant differences in wound healing and the clinical gingival parameters between two groups. The only significant difference was found in the plaque attached underneath the dressing, with Coe‑Pak™ showing greater plaque accumulation than Barricaid®. Seventy five (75) % of the patients preferred Barricaid® over Coe‑Pak™, based on its appearance and taste. Conclusion: The non‑eugenol dressing seemed to retain more plaque on its undersurface than light‑cure dressing. However, this did not have much influence on the healing outcome and clinical gingival parameters, which were optimal and comparable in both groups. The greater number of patients showed a preference for light cure dressing, based on its superior esthetics and taste.
Hemisection of a molar denotes removal or separation of a root along with its accompanying part o... more Hemisection of a molar denotes removal or separation of a root along with its accompanying part of crown. It is a suitable treatment option when the caries, resorption, perforation, or periodontal damage is restricted to one root while the other root is relatively healthy. Hemisection of the affected tooth helps to retain the tooth structure, surrounding alveolar bone, and may also facilitate the placement of fixed prosthesis. This case report describes the hemisection as a successful treatment method to save a grossly carious mandibular first molar with periodontal and periapical involvement. Hemisection and prosthetic rehabilitation yielded a satisfactory result. With careful treatment planning and precise surgical management, undesirable consequences of tooth loss were prevented.
Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may res... more Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts. Keywords: Mucocele; Mucus extravasation Cyst; Diode laser; Low-level laser therapy.
Introduction: The periodontal therapy is primarily targeted at removal of dental plaque and plaqu... more Introduction: The periodontal therapy is primarily targeted at removal of dental plaque and plaque retentive factors. Although the thorough removal of adherent plaque, calculus and infected root cementum is desirable, it is not always achieved by conventional modalities. To accomplish more efficient results several alternative devices have been used. Lasers are one of the most promising modalities for nonsurgical periodontal treatment as they can achieve excellent tissue ablation with strong bactericidal and detoxification effects. Methods: Thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A (n = 30) was taken as control and no instrumentation was performed. Part B (n = 30) was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser. Part C (n = 30) was treated by piezoelectric ultrasonic scaler. Part D (n = 30) was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average (Ra) value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope (SEM). The means across the groups were statistically compared with control using Dunnett test. Results: Among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness (mean Ra value of 4.14 μm) as compared to ultrasonic scaler (1.727 μm) and curette group (1.22 μm). However, surface with smear layer were found to be maximum (50%) in curette treated samples and minimum (20%) in laser treated ones. Maximum cracks (83.34%) were produced by ultrasonic scaler, and minimum (43.33%) by curettes. Crater formation was maximum (50%) in laser treated samples and minimum (3.33%) in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes. Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects.
Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatme... more Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatment. Scaling and root planing (SRP) alone may not suffice in cases where surgical therapy cannot be undertaken. Various recent studies have suggested the use of antimicrobial Photodynamic Therapy (aPDT) for the management of periodontal infections. The aim of this study was to evaluate the effects of using aPDT along with SRP, compared to SRP alone for the management of deep periodontal pockets. Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals. Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group). Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.
Gingival enlargement is a common side effect of calcium channel blocker drugs. Many over the
cou... more Gingival enlargement is a common side effect of calcium channel blocker drugs. Many over the counter available drugs contain extracts of Lepidium sativum and Acacia arabica that have been found to block calcium channels to exert their pharmacological effects. In this report, we describe a case of severe gingival enlargement in an 18‑year‑old female which developed after taking a height promoting drug containing extracts of L. sativum and A. arabica. She was successfully treated with nonsurgical and surgical periodontal therapy, after discontinuation of the growth supplement.
Peripheral Ossifying Fibroma is one of the commonest occurring reactive lesions on gingiva. It is... more Peripheral Ossifying Fibroma is one of the commonest occurring reactive lesions on gingiva. It is associated with local irritational factors and often interferes with speech, mastication and maintenance of oral hygiene, in addition to being aesthetically unpleasant. It is usually treated with surgical excision using scalpel and removal of irritational factors, often resulting in mucogingival defect. Other modalities such as radiosurgery and electrocautery have also been used for its management, but they cause changes in microarchitecture of biopsy specimen, altering the histologic picture for true diagnosis. We are presenting a case of excisional biopsy of this lesion in an adult female using a diode laser with excellent post-operative results, without affecting microarchitecture of biopsy specimen. The patient is being followed for last 1 year and no sign of recurrence has been found. A diode laser may offer a good alternative modality for management of such cases.
Photodynamic therapy (PDT) has emerged as an adjunct to conventional periodontal therapy since it... more Photodynamic therapy (PDT) has emerged as an adjunct to conventional periodontal therapy since its antimicrobial effect has been discovered. The oral health of patients with head and neck cancer undergoing radiotherapy or those who have completed such treatment deteriorates as oral tissues, including the periodontium, are adversely affected. Vascular changes, in particular, predispose the periodontium for degeneration and also reduce the potential of tissues to regenerate following periodontal surgery. Since periodontal surgical procedures or extraction of teeth carries the risk of osteoradionecrosis (ORN) in such cases, a conservative approach with nonsurgical measures is preferred for the treatment of periodontal diseases. This report highlights a case of treatment of localized chronic periodontitis around endodontically treated teeth in a patient with history of radiotherapy for the treatment of oral cancer. In addition to mechanical debridement, PDT was used to disinfect the moderately deep periodontal pockets, resulting in significant improvement. No complication was observed after therapy and good periodontal health has been maintained for the last 18 months.
Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional... more Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.
Dental materials especially orthodontic elastics often get embedded in gingival tissues due to ia... more Dental materials especially orthodontic elastics often get embedded in gingival tissues due to iatrogenic factors. If retained for a long time, inflammatory response starts as asymptomatic crestal bone loss and may progress to severe periodontal abscess. Unsupported orthodontic elastics used for diastema closure may result in exfoliation of teeth, while elastic separators may get embedded in interdental gingiva if banding is performed without removing it. These cases of negligence are detrimental for survival of affected teeth. This paper highlights a case of orthodontic elastic embedded in interproximal gingiva of a 23-year-old healthy female for 7 years after completion of fixed orthodontic treatment. Surprisingly, there was no clinical sign of inflammation around elastic band and it was removed easily without any local anaesthesia. However, mild crestal bone loss was observed on periapical radiograph. The gingiva healed completely after sub gingival debridement.
Journal of Dental Anesthesia and Pain Medicine, 2020
Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported t... more Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Method: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.
Background: Marginal gingival recession can cause major functional and esthetic problems. Advance... more Background: Marginal gingival recession can cause major functional and esthetic problems. Advanced flaps are the simplest, yet unpredictable procedures for managing these conditions. The predictability of root coverage can be increased by combining coronally advanced flap (CAF) or its modified approach with other regenerative techniques. Objective: To ascertain the potential benefits of platelet‑rich fibrin (PRF) on modified CAF for the treatment of gingival recession. Materials and Methods: Study comprised of 12 patients with Millers’ class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split‑mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months. Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits. Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.
Journal of Dental Anesthesia and Pain Medicine, 2019
Background: Profound anesthesia with adequate duration is required in periodontal flap surgery, w... more Background: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. Methods: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. Results: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. Conclusions: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.
Journal of Dental Anesthesia and Pain Medicine, 2019
Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but a... more Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.
Journal of Indian Society of Periodontology , 2018
Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of th... more Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of the most challenging situations in implant practice. With the increase in popularity of dental implants, augmentation of the alveolar ridge and soft tissue has also become a routine procedure in most of the cases. Although hard‑tissue augmentation is performed by other specialists also, a periodontist needs to master the skills of soft‑tissue management to deliver esthetic and functional results in implant‑supported prostheses. This case report presents a single‑staged ridge split approach using piezoelectric surgery with simultaneous implant placement followed by connective tissue grafting at second‑stage surgery. Single‑staged segmental ridge split technique not only reduces the total treatment duration but also the surgical morbidity for the patient. A subepithelial connective tissue graft is strongly advocated around implants as it is highly predictable while ensuring better esthetic results in terms of tissue color, texture, and long‑term stability of the surrounding mucosa.
Gingival recession in anterior teeth not only catches the eyes of a dentist, it also is of concer... more Gingival recession in anterior teeth not only catches the eyes of a dentist, it also is of concern to the patient. The goal of the periodontist in such cases is not limited to relieving the offending condition, but also to achieving optimum aesthetics. While planning the treatment of gingival recession, it is important to consider the predictability of various techniques. This report describes a successful case of semilunar coronally repositioned flap in Miller’s Class I recession defects on maxillary central incisors.
Cases of negligence in orthodontics are not as frequent as in other dental or medical specialties... more Cases of negligence in orthodontics are not as frequent as in other dental or medical specialties. However, sometimes we come across a case of negligence that cannot be ignored. Here, we present a very uncommon finding of a molar tube embedded in the labial vestibule, between mandibular central and lateral incisors, for more than a month. The uniqueness of this finding is that a molar tube, as the name suggests, is supposed to be bonded on molars and if it gets dislodged due to any reason, it should have been embedded near the respective molar. With this dilemma in mind, this case offers many things to learn from errors.
Gingival enlargement is a clinical condition that has been widely studied. Usually, it is related... more Gingival enlargement is a clinical condition that has been widely studied. Usually, it is related to specific local or systemic factors. However, it is difficult sometimes to find out a definite etiology, and treatment has to be done according to presenting clinical features. This article presents an unusual case of gingival enlargement that occurred after pregnancy without any clear underlying etiology. A female aged 31 years reported with gingival enlargement and mobility of teeth during lactation period. Gingival enlargement had started 2 months after child birth. All female sex hormones were found to be within normal limits. Karyotyping was also found to be normal, without any genetic alteration. Radiographic analysis revealed generalized severe crestal bone loss. After phase I periodontal therapy, enlargement was managed surgically under local anaesthesia. On histological examination of excised specimen, tissue was found to be hyperplastic. Although a definite etiology could not be ascertained, the treatment was successful and there has been no recurrence after one year post-treatment interval.
Aim: The aim was to compare the gingival tissue response following placement of a light cure dres... more Aim: The aim was to compare the gingival tissue response following placement of a light cure dressing (Barricaid®) and a non‑eugenol periodontal dressing (Coe‑Pak™) after periodontal flap procedure. This was carried out by evaluating plaque deposition underneath both the dressings, healing response and the patient preference for each. Materials and Methods: A total of 12 patients with chronic generalized periodontitis requiring surgery in at least two different quadrants were enrolled for this split‑mouth study. After periodontal flap surgery, Coe‑Pak™ was placed in the quadrant assigned to Group I and Barricaid® was placed in the other quadrant assigned to Group II. Clinical parameters were recorded on day 7 and day 14. Patient comfort and pain levels were also evaluated by a questionnaire. Results: There were no statistically significant differences in wound healing and the clinical gingival parameters between two groups. The only significant difference was found in the plaque attached underneath the dressing, with Coe‑Pak™ showing greater plaque accumulation than Barricaid®. Seventy five (75) % of the patients preferred Barricaid® over Coe‑Pak™, based on its appearance and taste. Conclusion: The non‑eugenol dressing seemed to retain more plaque on its undersurface than light‑cure dressing. However, this did not have much influence on the healing outcome and clinical gingival parameters, which were optimal and comparable in both groups. The greater number of patients showed a preference for light cure dressing, based on its superior esthetics and taste.
Hemisection of a molar denotes removal or separation of a root along with its accompanying part o... more Hemisection of a molar denotes removal or separation of a root along with its accompanying part of crown. It is a suitable treatment option when the caries, resorption, perforation, or periodontal damage is restricted to one root while the other root is relatively healthy. Hemisection of the affected tooth helps to retain the tooth structure, surrounding alveolar bone, and may also facilitate the placement of fixed prosthesis. This case report describes the hemisection as a successful treatment method to save a grossly carious mandibular first molar with periodontal and periapical involvement. Hemisection and prosthetic rehabilitation yielded a satisfactory result. With careful treatment planning and precise surgical management, undesirable consequences of tooth loss were prevented.
Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may res... more Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts. Keywords: Mucocele; Mucus extravasation Cyst; Diode laser; Low-level laser therapy.
Introduction: The periodontal therapy is primarily targeted at removal of dental plaque and plaqu... more Introduction: The periodontal therapy is primarily targeted at removal of dental plaque and plaque retentive factors. Although the thorough removal of adherent plaque, calculus and infected root cementum is desirable, it is not always achieved by conventional modalities. To accomplish more efficient results several alternative devices have been used. Lasers are one of the most promising modalities for nonsurgical periodontal treatment as they can achieve excellent tissue ablation with strong bactericidal and detoxification effects. Methods: Thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A (n = 30) was taken as control and no instrumentation was performed. Part B (n = 30) was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser. Part C (n = 30) was treated by piezoelectric ultrasonic scaler. Part D (n = 30) was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average (Ra) value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope (SEM). The means across the groups were statistically compared with control using Dunnett test. Results: Among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness (mean Ra value of 4.14 μm) as compared to ultrasonic scaler (1.727 μm) and curette group (1.22 μm). However, surface with smear layer were found to be maximum (50%) in curette treated samples and minimum (20%) in laser treated ones. Maximum cracks (83.34%) were produced by ultrasonic scaler, and minimum (43.33%) by curettes. Crater formation was maximum (50%) in laser treated samples and minimum (3.33%) in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes. Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects.
Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatme... more Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatment. Scaling and root planing (SRP) alone may not suffice in cases where surgical therapy cannot be undertaken. Various recent studies have suggested the use of antimicrobial Photodynamic Therapy (aPDT) for the management of periodontal infections. The aim of this study was to evaluate the effects of using aPDT along with SRP, compared to SRP alone for the management of deep periodontal pockets. Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals. Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group). Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.
Gingival enlargement is a common side effect of calcium channel blocker drugs. Many over the
cou... more Gingival enlargement is a common side effect of calcium channel blocker drugs. Many over the counter available drugs contain extracts of Lepidium sativum and Acacia arabica that have been found to block calcium channels to exert their pharmacological effects. In this report, we describe a case of severe gingival enlargement in an 18‑year‑old female which developed after taking a height promoting drug containing extracts of L. sativum and A. arabica. She was successfully treated with nonsurgical and surgical periodontal therapy, after discontinuation of the growth supplement.
Peripheral Ossifying Fibroma is one of the commonest occurring reactive lesions on gingiva. It is... more Peripheral Ossifying Fibroma is one of the commonest occurring reactive lesions on gingiva. It is associated with local irritational factors and often interferes with speech, mastication and maintenance of oral hygiene, in addition to being aesthetically unpleasant. It is usually treated with surgical excision using scalpel and removal of irritational factors, often resulting in mucogingival defect. Other modalities such as radiosurgery and electrocautery have also been used for its management, but they cause changes in microarchitecture of biopsy specimen, altering the histologic picture for true diagnosis. We are presenting a case of excisional biopsy of this lesion in an adult female using a diode laser with excellent post-operative results, without affecting microarchitecture of biopsy specimen. The patient is being followed for last 1 year and no sign of recurrence has been found. A diode laser may offer a good alternative modality for management of such cases.
Photodynamic therapy (PDT) has emerged as an adjunct to conventional periodontal therapy since it... more Photodynamic therapy (PDT) has emerged as an adjunct to conventional periodontal therapy since its antimicrobial effect has been discovered. The oral health of patients with head and neck cancer undergoing radiotherapy or those who have completed such treatment deteriorates as oral tissues, including the periodontium, are adversely affected. Vascular changes, in particular, predispose the periodontium for degeneration and also reduce the potential of tissues to regenerate following periodontal surgery. Since periodontal surgical procedures or extraction of teeth carries the risk of osteoradionecrosis (ORN) in such cases, a conservative approach with nonsurgical measures is preferred for the treatment of periodontal diseases. This report highlights a case of treatment of localized chronic periodontitis around endodontically treated teeth in a patient with history of radiotherapy for the treatment of oral cancer. In addition to mechanical debridement, PDT was used to disinfect the moderately deep periodontal pockets, resulting in significant improvement. No complication was observed after therapy and good periodontal health has been maintained for the last 18 months.
Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional... more Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.
Dental materials especially orthodontic elastics often get embedded in gingival tissues due to ia... more Dental materials especially orthodontic elastics often get embedded in gingival tissues due to iatrogenic factors. If retained for a long time, inflammatory response starts as asymptomatic crestal bone loss and may progress to severe periodontal abscess. Unsupported orthodontic elastics used for diastema closure may result in exfoliation of teeth, while elastic separators may get embedded in interdental gingiva if banding is performed without removing it. These cases of negligence are detrimental for survival of affected teeth. This paper highlights a case of orthodontic elastic embedded in interproximal gingiva of a 23-year-old healthy female for 7 years after completion of fixed orthodontic treatment. Surprisingly, there was no clinical sign of inflammation around elastic band and it was removed easily without any local anaesthesia. However, mild crestal bone loss was observed on periapical radiograph. The gingiva healed completely after sub gingival debridement.
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Materials and Methods: Study comprised of 12 patients with Millers’ class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split‑mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months.
Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits.
Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.
of negligence that cannot be ignored. Here, we present a very uncommon finding of a molar tube embedded in the labial vestibule, between
mandibular central and lateral incisors, for more than a month. The uniqueness of this finding is that a molar tube, as the name suggests, is
supposed to be bonded on molars and if it gets dislodged due to any reason, it should have been embedded near the respective molar. With
this dilemma in mind, this case offers many things to learn from errors.
Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT).
Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts.
Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts.
Keywords: Mucocele; Mucus extravasation Cyst; Diode laser; Low-level laser therapy.
Methods: Thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A (n = 30) was taken as control and no instrumentation was performed. Part B (n = 30) was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser. Part C (n = 30) was treated by piezoelectric ultrasonic scaler. Part D (n = 30) was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average (Ra) value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope (SEM). The means across the groups were statistically compared with control using Dunnett test.
Results: Among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness (mean Ra value of 4.14 μm) as compared to ultrasonic scaler (1.727 μm) and curette group (1.22 μm). However, surface with smear layer were found to be maximum (50%) in curette treated samples and minimum (20%) in laser treated ones. Maximum cracks (83.34%) were produced by ultrasonic scaler, and minimum (43.33%) by curettes. Crater formation was maximum (50%) in laser treated samples and minimum (3.33%) in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes.
Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects.
Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals.
Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group).
Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.
counter available drugs contain extracts of Lepidium sativum and Acacia arabica that have been
found to block calcium channels to exert their pharmacological effects. In this report, we describe a
case of severe gingival enlargement in an 18‑year‑old female which developed after taking a height
promoting drug containing extracts of L. sativum and A. arabica. She was successfully treated
with nonsurgical and surgical periodontal therapy, after discontinuation of the growth supplement.
management, but they cause changes in microarchitecture of biopsy specimen, altering the histologic picture for true diagnosis. We are presenting a case of excisional biopsy of this lesion in an adult female using a diode laser with excellent post-operative results, without affecting microarchitecture
of biopsy specimen. The patient is being followed for last 1 year and no sign of recurrence has been found. A diode laser may offer a good alternative modality for management of such cases.
effect has been discovered. The oral health of patients with head and neck cancer undergoing radiotherapy or those
who have completed such treatment deteriorates as oral tissues, including the periodontium, are adversely affected.
Vascular changes, in particular, predispose the periodontium for degeneration and also reduce the potential of tissues
to regenerate following periodontal surgery. Since periodontal surgical procedures or extraction of teeth carries the
risk of osteoradionecrosis (ORN) in such cases, a conservative approach with nonsurgical measures is preferred for the treatment of periodontal diseases. This report highlights a case of treatment of localized chronic periodontitis around endodontically treated teeth in a patient with history of radiotherapy for the treatment of oral cancer. In addition to mechanical debridement, PDT was used to disinfect the moderately deep periodontal pockets, resulting in significant improvement. No complication was observed after therapy and good periodontal health has been maintained for the last 18 months.
were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.
Materials and Methods: Study comprised of 12 patients with Millers’ class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split‑mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months.
Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits.
Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.
of negligence that cannot be ignored. Here, we present a very uncommon finding of a molar tube embedded in the labial vestibule, between
mandibular central and lateral incisors, for more than a month. The uniqueness of this finding is that a molar tube, as the name suggests, is
supposed to be bonded on molars and if it gets dislodged due to any reason, it should have been embedded near the respective molar. With
this dilemma in mind, this case offers many things to learn from errors.
Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT).
Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts.
Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts.
Keywords: Mucocele; Mucus extravasation Cyst; Diode laser; Low-level laser therapy.
Methods: Thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A (n = 30) was taken as control and no instrumentation was performed. Part B (n = 30) was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser. Part C (n = 30) was treated by piezoelectric ultrasonic scaler. Part D (n = 30) was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average (Ra) value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope (SEM). The means across the groups were statistically compared with control using Dunnett test.
Results: Among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness (mean Ra value of 4.14 μm) as compared to ultrasonic scaler (1.727 μm) and curette group (1.22 μm). However, surface with smear layer were found to be maximum (50%) in curette treated samples and minimum (20%) in laser treated ones. Maximum cracks (83.34%) were produced by ultrasonic scaler, and minimum (43.33%) by curettes. Crater formation was maximum (50%) in laser treated samples and minimum (3.33%) in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes.
Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects.
Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals.
Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group).
Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.
counter available drugs contain extracts of Lepidium sativum and Acacia arabica that have been
found to block calcium channels to exert their pharmacological effects. In this report, we describe a
case of severe gingival enlargement in an 18‑year‑old female which developed after taking a height
promoting drug containing extracts of L. sativum and A. arabica. She was successfully treated
with nonsurgical and surgical periodontal therapy, after discontinuation of the growth supplement.
management, but they cause changes in microarchitecture of biopsy specimen, altering the histologic picture for true diagnosis. We are presenting a case of excisional biopsy of this lesion in an adult female using a diode laser with excellent post-operative results, without affecting microarchitecture
of biopsy specimen. The patient is being followed for last 1 year and no sign of recurrence has been found. A diode laser may offer a good alternative modality for management of such cases.
effect has been discovered. The oral health of patients with head and neck cancer undergoing radiotherapy or those
who have completed such treatment deteriorates as oral tissues, including the periodontium, are adversely affected.
Vascular changes, in particular, predispose the periodontium for degeneration and also reduce the potential of tissues
to regenerate following periodontal surgery. Since periodontal surgical procedures or extraction of teeth carries the
risk of osteoradionecrosis (ORN) in such cases, a conservative approach with nonsurgical measures is preferred for the treatment of periodontal diseases. This report highlights a case of treatment of localized chronic periodontitis around endodontically treated teeth in a patient with history of radiotherapy for the treatment of oral cancer. In addition to mechanical debridement, PDT was used to disinfect the moderately deep periodontal pockets, resulting in significant improvement. No complication was observed after therapy and good periodontal health has been maintained for the last 18 months.
were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.