Journal of Indian Society of Periodontology最新文献

In clinical practice, it is common to encounter dental implants with insufficient keratinized mucosa width (KMW) and decreased peri-implant mucosa thickness (MT). Research indicates that such soft-tissue deficiencies can lead to unsatisfactory esthetic results and decreased bone stability over time. This case report presents a variation of standard free gingival graft and connective tissue graft (CTG) techniques, termed the inverted partially epithelialized CTG (IPE-CTG). Three patients (2 males and 1 female) experiencing insufficient attached gingiva and reduced peri-implant tissue volume were effectively treated with the IPE-CTG. This approach involves placing a partially epithelialized graft as an onlay graft on the recipient site, with the epithelialized surface oriented apically and the de-epithelialized surface directed coronally. This technique aims to address KMW and MT deficiencies in a single procedure. All cases treated with the IPE-CTG exhibited stable results over a 12-month period, with notable improvements in both KMW and MT.

Background: A noncarious cervical lesion (NCCL) is defined as the loss of tooth structure in the cervical one-third of the tooth due to causes other than dental caries. Descriptive epidemiological studies on NCCLs are justified because of their high frequency and their potential consequences for the periodontium. The present study aimed to analyze the trend of NCCLs in teeth with gingival recession, determine the prevalence and associated risk factors for these combined lesions, and evaluate patient acceptance of various treatment modalities, with emphasis on the minimally invasive restoration-guided creeping attachment (RGCA) technique.

Materials and methods: A total of 150 patients were enrolled in the present study. A total of 1200 teeth were examined clinically using ×3.5 magnification loupes and a UNC-15 probe to evaluate the cementoenamel junction and step-like defects according to the Pini-Prato classification of gingival recession. All patients were interviewed regarding potential etiological factors using a specially designed questionnaire. The questionnaire also included attitudinal factors related to willingness for treatment in general and specifically for the RGCA technique.

Results: Among the 1200 teeth with exposed root surfaces, 543 exhibited Class A - defects, 442 Class A+, 149 Class B+, and 66 Class B- defects. The distribution of combined defects across tooth types was incisors 39%, premolars 32%, canines 22%, and molars 6%, with 92% located in the anterior esthetic zone.

Conclusions: Combined lesions were predominantly found in incisors, premolars, and canines located within the smile arc.

Alveolar ridge resorption following tooth extraction is a progressive and inevitable process, particularly critical in the maxillary anterior region where esthetics are paramount. Conventional approaches to restoring hard and soft tissue contours often yield unpredictable results, especially in recreating papillary form and ridge architecture. The root submergence technique (RST), which involves the intentional decoronation and submergence of nonrestorable teeth, aims to preserve the periodontal ligament and maintain surrounding tissue integrity. This case report presents two clinical scenarios in which submerged roots were retained beneath implant-supported fixed prostheses in the anterior maxilla. In both cases, careful case selection and precise execution of RST resulted in preservation of the interdental papilla, stable crestal bone levels, and harmonious soft-tissue profiles over a 1-year follow-up. These outcomes highlight the potential of RST as a biologically driven alternative to extensive ridge augmentation procedures, offering superior esthetic results in challenging anterior prosthetic rehabilitations.

Background and objectives: Periodontology is a crucial component of dental education, focusing on the supporting structures of teeth and the prevention, diagnosis, and treatment of periodontal diseases. This scoping review aims to explore various educational approaches and outcomes related to periodontology, highlighting their effectiveness and identifying areas for improvement.

Materials and methods: A comprehensive search of the PubMed, Education Resource Information Center, and Scopus databases was conducted using the search terms related to dental education, periodontology, and educational methods. Inclusion criteria included original dental education articles that described periodontology as the subject of interest. Twenty-two studies met the inclusion criteria and were included in this scoping review.

Results: The studies used a variety of educational methods to teach periodontology, including lecture-based teaching, problem-based learning, simulation-based education, hands-on training, flipped classrooms, and team-based learning. The results suggest that different educational methods have varying levels of effectiveness in achieving knowledge gain, clinical skills, and student satisfaction. Simulation-based education and hands-on training were found to be more effective in improving clinical skills than lecture-based teaching.

Conclusion: This scoping review highlights the importance of innovative educational strategies in periodontology, including active learning and blended learning. The findings suggest that a variety of educational methods can be effective in teaching periodontology and that the choice of method depends on the specific learning objectives and outcomes desired. The results of this review can inform the development of effective educational programs in periodontology and highlight the need for further research in this area.

Introduction: Periodontitis is a chronic inflammatory disease, modified by host immune response, where the host-microbial interaction damages proteoglycan, hyaluronan, and collagen, leading to connective tissue breakdown and impaired wound healing due to increased oxidative stress (OS). Afamin (AFM) is a Vitamin E-binding protein that plays a role in antiapoptotic cellular processes related to OS and has been previously associated with the development of insulin resistance (IR). Type II diabetes mellitus (TIIDM) is a major risk factor for periodontitis. The aim of this study was to assess plasma AFM levels in subjects diagnosed with periodontitis, with and without TIIDM.

Materials and methods: Seventy-five participants were divided into 3 groups: Group I - 25 healthy controls, Group II - 25 systemically healthy individuals with periodontitis, and Group III - 25 individuals with periodontitis and TIIDM. All periodontal parameters, i.e. plaque index, gingival index, and probing pocket depth, were recorded. Glycemic control in Group III individuals was assessed by glycated hemoglobin (HbA1c) levels. Plasma AFM levels were analyzed using the enzyme-linked immunosorbent assay technique. P < 0.05 was considered to be statistically significant.

Results: Mean plasma AFM concentrations in Group I were 30.64 ± 5.88 ng/ml. A significant increase in mean AFM was seen in Group II and III, i.e. 50.76 ± 9.65 ng/ml and 86.44 ± 12.10 ng/ml, respectively. A correlation was seen between deep pockets and increased AFM concentration in both the test groups. It was also found that mean AFM concentrations increased with worsening of glycemic control, i.e. 80.25 ng/ml, 84.25 ng/ml, and 90.92 ng/ml in good, fair, and poor HbA1c control patients, respectively.

Conclusions: Plasma AFM is increased in patients with periodontitis. A higher concentration is seen in patients with periodontitis and TIIDM. OS being the reason for its increase, plasma AFM levels can be used as a marker to identify the incidence of TIIDM in individuals with periodontitis or other inflammatory conditions associated with increased OS.

Background: Periodontal regeneration is particularly challenging in complex anatomical areas such as furcation defects. This study clinically and radiographically evaluated the outcomes of treating mandibular molar furcation defects in Stage II and III, Grade A and B periodontitis patients using either 0.8% hyaluronic acid (HA) gel combined with deproteinized bovine bone mineral (DBBM) or DBBM alone.

Materials and methods: A total of 20 furcation defects were treated. Group 1 received open flap debridement with DBBM alone, whereas Group 2 received DBBM mixed with 0.8% HA gel. An amniotic membrane (AM) was placed as the guided tissue regeneration (GTR) membrane for both the groups. Clinical parameters including plaque index (PlI), gingival index (GI), horizontal probing pocket depth (H-PPD), vertical probing pocket depth (V-PPD), and relative attachment level (RAL), along with radiographic parameters such as defect depth, bone fill (BF), and percentage bone fill (BF%), were recorded at baseline, 3 months, and 6 months.

Results: At 6 months, significant improvements were observed in both the groups, with Group 2 demonstrating superior outcomes. The PlI and GI showed mean reductions of 0.47 ± 0.06 and 0.56 ± 0.08, respectively. Group 2 exhibited greater reductions in H-PPD (3 ± 0.59 mm), V-PPD (4.7 ± 1.72 mm), and RAL (4.6 ± 1.02 mm). Radiographically, Group 2 showed a mean BF of 1.26 ± 0.35 mm at 3 months and 3.01 ± 0.41 mm at 6 months, with corresponding BF% values of 38.40 ± 6.04% and 83.80 ± 6.12%.

Conclusion: The combination of 0.8% HA gel with DBBM and AM demonstrated superior clinical and radiographic improvements in furcation defect management compared to DBBM alone.

Background: Titanium (Ti) implants are known to be bioinert, stress shielding, and poor osseointegration, due to modulus discrepancy with native bone. This research aims to design a porous Ti6Al4V implant with controllable oxidation to mimic the natural bone properties for better osseointegration.

Materials and methods: Porous Ti6Al4V foams were manufactured by coagulant-assisted metal foaming with egg white protein and citric acid as stabilizing matrix. The detailed characterization was conducted using X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy, nanoindentation, and microcomputed tomography (micro-CT) to characterize microstructural, porosity, and mechanical properties. MTT assay and dual staining were used to study in vitro cytocompatibility using the human amniotic mesenchymal stem cells. In vivo biocompatibility and bone regeneration were evaluated through the rabbit femoral defect model at 4 and 12 weeks, using histology and micro-CT for bone ingrowth quantification.

Results: The fabricated porous Ti6Al4V implants had 71%-75% porosity, facilitating nutrient transport and cellular ingrowth. Compressive modulus (284 MPa), measured via mechanical testing, was comparable to that of trabecular bone. In vitro studies demonstrated good cell viability and proliferation. In vivo, robust new bone formation was observed (~52% increase in bone volume), with over 90% tissue integration compared to control.

Conclusions: Controlled oxidation of porous Ti6Al4V foam could provide a potential way to overcome the current limitations of dental implants. The improved biomechanical compatibility and osseointegration support its potential for clinical application in implantology.

Background: Platelet-rich fibrin (PRF) is a widely used second-generation blood concentrate in periodontal regeneration. It has a few disadvantages, such as the fragile nature of the membrane, difficulty in suturing, and unpredictability of outcomes. The present study aims to evaluate the clinical outcomes, healing, and postoperative morbidity following the use of frozen advanced PRF (-20°C for 24 h) with modified coronally advanced tunnel (MCAT) technique in the treatment of multiple adjacent recession defects (MARDs).

Materials and methods: This is a prospective, split-mouth, randomized controlled clinical trial including 42 teeth with bilateral MARD in 10 participants. Sites were randomized to frozen (Fz-PRF) and fresh advanced PRF (A-PRF) groups and treated with Fz-PRF using MCAT and A-PRF using MCAT, respectively. Root coverage parameters (recession depth [RD], recession width [RW], complete root coverage, percentage root coverage [%RC], mechanical characteristics [needle passage ease, surgical handling of the membrane, and membrane fraying], postoperative healing [Wachtel's Healing Index], and patient-reported outcomes [discomfort and esthetic satisfaction]) were assessed.

Results: Mean %RC (P = 0.025), RW (0.044), mechanical characteristics (P = 0.000), and esthetic satisfaction (P = 0.015) were significantly better in the Fz-PRF group. No significant variation was observed in patient discomfort and postoperative healing.

Conclusions: Fz-PRF showed better root coverage, mechanical properties, and esthetic satisfaction than A-PRF; as a result, it might be an effective alternative to conventional methods of treating gingival recessions.