Journal of Nepalese Society of Periodontology and Oral Implantology

Gingival Crevicular Fluid in Periodontitis

Surendra Man Shrestha — Fri, 31 May 2019 01:40:09 +0000

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Psychosocial Stress and its Effect on Periodontal Tissues using Malondialdehyde as Oxidative Stress Biomarker

Fri, 31 May 2019 01:40:18 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23610

Background: Stress is playing a major role as an aetiologic factor in the initiation of many systemic diseases. Similarly, it is also thought to be an aetiologic factor in the progression of periodontal diseases.

Aim: The production of free radical species is associated with various inflammatory diseases and also during stressful conditions. Hence, an effort in the present study is done to correlate psychosocial stress and periodontitis using serum MDA as an oxidative stress biomarker.

Materials and Methods: A current cross-sectional study included 201 individuals between 20 to 60 years of age. A periodontal examination included Probing Pocket Depth, CAL, Plaque Index, and Gingival Index. According to CAL individuals were divided into four groups i.e. healthy, slight (CAL = 1-2 mm), moderate (CAL = 3-4 mm) and severe (CAL = ≥5 mm) periodontitis. Psychosocial stress of the individuals was evaluated using occupational stress index. Serum MDA level was evaluated using spectrochromatometer.

Results: Patients with stress demonstrated increased levels of MDA along with a higher loss of attachment.

Conclusion: The results revealed statistically significant association between psychosocial stress and periodontitis indicating psychosocial stress as a risk factor for developing periodontitis.

Keywords: Free radicals, malondialdehyde, oxidative biomarker, periodontitis, psychosocial stress

Probing Pocket Depth and Clinical Attachment Level between Non-Surgical and Surgical Periodontal Therapy in Chronic Periodontitis Patients: A Randomised Controlled Clinical Trial

Fri, 31 May 2019 01:40:30 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23611

Background: : Chronic periodontitis is one of the most common form of periodontal diseases which either require non-surgical periodontal therapy or open flap debridement-surgical therapy or both. To date, it is unclear as of how much changes occur after NSPT or OFD and which therapy provides the best outcome in chronic periodontitis having probing pocket depth ≥ 5-7 mm.

Aim: The aim of this randomized controlled clinical trial was to evaluate the Probing Pocket Depth and Clinical Attachment Level between NSPT and OFD in chronic periodontitis patients.

Materials and Methods: A total of 52 healthy patients with PPD ≥ 5-7 mm were included in the present study. Half of the patients assigned for the NSPT and half in the OFD group. The PPD and CAL were measured at baseline, three and six months. Independent sample t-test was used to compare the change in mean PPD and CAL between NSPT and OFD group at three and six months, respectively.

Results: The difference in the mean decrease of PPD between NSPT and OFD group at three and six months were 0.15 mm (P<0.05) and 0.19 mm (P<0.05), respectively. The difference in the mean gain of CAL between NSPT and OFD group at three and six months were 0.03 mm (p>0.05) and 0.12 mm (P<0.05), respectively.

Conclusion: Substantial improvement in periodontal status occurred with both the therapies, however, significantly higher decrease in PPD and gain in CAL were seen with surgical therapy.

Keywords: Clinical attachment level, non-surgical periodontal therapy, probing pocket depth, surgical periodontal therapy

Locally Delivered Tetracycline Fibres in the Treatment of Chronic Periodontitis

Shristi Kafle, Shaili Pradhan, Sujaya Gupta — Fri, 31 May 2019 01:40:40 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23612

Background: Chronic periodontitis is a highly prevalent and recurrent form of periodontal disease and locally delivered tetracycline fibres are considered to exert tremendous benefits for its treatment.

Aim: The aim of the study was to observe the clinical results of locally delivered tetracycline fibres in the treatment of chronic periodontitis.

Materials and Methods: Patients aged 35-54 years diagnosed with chronic periodontitis of both gender fulfilling the inclusion criteria were selected. A sample size of 30 was calculated and total number of 60 posterior sites were selected. These sites were divided into two sets in a split mouth design as control sites treated with SRP alone and test sites treated with SRP plus tetracycline fibres.

Results: A combination of scaling, root planing and local drug delivery in the form of tetracycline fibres resulted in added benefits in the control of chronic periodontitis on the basis of the clinical findings from this study.

Conclusion: This study further adds to the evidence that tetracycline fibres as locally delivered agent are safe and effective adjunct to scaling and root planing, and can produce significant clinical benefits when compared to scaling and root planing alone in the treatment of chronic periodontitis.

Keywords: Chronic periodontitis, local drug delivery, tetracycline

Platelet Rich Fibrin and Bone Graft in the Treatment of Intrabony Defect in Periodontitis Patients

Shilu Shrestha, Surendra Man Shrestha, Ameena Pradhan, Shreeya Aryal — Fri, 31 May 2019 01:40:54 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23614

Background: Porous hydroxyapatite and β-tricalcium phosphate (β-TCP + HA) bone grafting material has resulted in clinically acceptable responses when used to fill the periodontal intrabony defects. PRF is an autologous leukocyte and platelet preparation that concentrates various polypeptide growth factors which therefore holds potential to be used as regenerative treatment for periodontal defects.

Aim: The purpose of this study was to evaluate clinical and radiographic outcomes in periodontal intrabony defects treated with platelet rich fibrin compared to alloplastic bone graft material.

Materials and Methods: Twenty subjects (10 subject per group, one site/subject) were treated either with platelet rich fibrin or alloplastic bone graft (30% β-TCP+ 70% HA). Primary clinical parameters: PD, CAL were taken at baseline, three months, six months and nine months post-operatively. Standardised radiographic data were collected at baseline, six months and nine months postoperatively.

Results: Preoperative parameters were similar for both groups. Postsurgical measurements revealed a greater reduction in pocket depth in bone graft group (2.5 mm), greater CAL gain (2.2 mm) and greater defect fill (1.30 mm) as compared to platelet rich fibrin group (1.50 mm, 1.6 mm and 0.80 mm respectively ) at nine months.

Conclusion: Treatment of intrabony defects with alloplast (30% β TCP+ 70% HA) or platelet rich fibrin both resulted in a significant probing depth reduction, CAL gain and bone depth reduction, with significantly better improvement in bone graft group.

Keywords: Bone graft, clinical attachment loss, periodontitis, platelet rich fibrin, pocket depth, regeneration

Pain Perception after Periodontal Therapies

Shaili Pradhan, Regina Shrestha, Ranjita Shrestha Gorkhali — Fri, 31 May 2019 01:41:07 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23615

Background: Pain perception is a complex sensory experience which is perceived by different individuals in different manners. The pain perceived by the patient after periodontal surgery may vary based on different parameters.

Aim: This observational study was conducted to evaluate the perception of pain after periodontal therapies.

Materials and Methods: A total of 63 surgeries were carried out in 50 patients and the surgeries were divided into three categories: open flap debridement, resective and regenerative surgeries, and periodontal plastic surgeries. The pain experienced by the patient was recorded on the visual analog scale that ranged from 0 to 10.

Results: The mean VAS score for different periodontal surgeries was 2.49. The study showed highest mean VAS in open flap debridement (2.74) followed by periodontal plastic surgery (2.5) and the lowest in resective and regenerative procedures (2.13). Among various variables such as age, sex, periodontal dressing, arch, amount of local anaesthesia and time duration, the data showed statistical difference between VAS score and sex (p = 0.04) and between VAS score and amount of local anaesthesia (p = 0.012).

Conclusion: The study showed there is low pain perception after different periodontal surgeries as measured by VAS. Proper understanding of the variables that affect pain is important as they may produce emotional responses that could influence compliance and the therapy result. Inadvertent use of large dose of anaesthetics beforehand assuming high anticipation of pain should be discouraged as the increase in volume relates to increased pain.

Keywords: Anxiety, pain perception, periodontal therapy, visual analog scale

Azithromycin in Periodontal Therapy: Beyond the Antibiotics

Fri, 31 May 2019 01:41:21 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23616

Periodontitis is a multifactorial disease, in which microorganisms in plaque biofilm play a major role. Scaling and root planing is the primary mode of non-surgical treatment for periodontal disease. Adjunctive use of an antimicrobial is advocated in certain periodontal disease conditions. Azithromycin might be considered a promising adjunctive drug in the treatment for periodontal disease because of its distinguished characteristic of immunomodulation, anti-inflammatory and antibiotic property along with the accumulation in higher concentration into the acute reactant cells and sustained release at the site of infection. This antibiotic is popular for its very simple dosage regime and limited side effects. The objective of this literature review to highlight the mechanism and potential favourable role in the management of various form of the periodontal disease.

Keywords: Antibiotics, azithromycin, gingival overgrowth, macrolide, periodontal therapy

Improvement of Severe Gummy Smile by Botulinum Toxin Application and Gingivoplasty

Irineu Gregnanin Pedron — Fri, 31 May 2019 01:41:35 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23617

Currently, the search for aesthetic excellence has become the main objective in the dental treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem and social relationship. The development of new techniques, such as the application of botulinum toxin, may be a therapeutic option more conservative, in the treatment of gummy smile. The purpose of this article is to present a case of a patient with dentogingival discrepancy and severe gummy smile, who was treated with gingivoplasty and application of botulinum toxin in order to optimise the harmony of the smile.

Keywords: Botulinum toxins type A, gingival overgrowth, gingivectomy, gingivoplasty, gummy smile, surgical crown lengthening

Immediate Implant Placement in Anterior Maxilla

John Gurung, Bhageshwar Dhami — Fri, 31 May 2019 01:41:51 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23618

This case report describes extraction of a fractured right maxillary lateral incisor tooth which was previously treated endodontically, followed by immediate placement of a dental implant in the prepared socket and temporisation by a removable partial denture. The tooth was extracted with minimal hard and soft tissue trauma. The socket was prepared to the required depth and implant was inserted. An impression was made after four months, and a definitive restoration was placed. The atraumatic operating technique and the immediate insertion of the implant resulted in the preservation of the hard and soft tissues at the extraction site. The patient exhibited no clinical or radiologic complications after loading.

Keywords: Crown, immediate healing abutment, immediate implant, implant, single stage implant

Root Submergence Technique: Forgotten Terrain Revisited

Rejina Shrestha, Shaili Pradhan, Ranjita Shrestha Gorkhali, Anand Verma — Fri, 31 May 2019 01:42:04 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23619

The resorption of the alveolar ridge is an inevitable phenomenon after tooth extraction and continues throughout the lifespan of an individual. Socket preservation, hard and soft tissue augmentation procedures are indicated to compensate alveolar bone resorption. Compensation can also be done by masking with acrylic flanges, pink porcelain and gingival veneers. However, procedures to preserve the bone anticipatory to the loss after extraction should be prioritised. This paper reports a case of fractured non-vital tooth where root submergence technique was done. A follow-up at 6 months presents intact bone aiding in the aesthetics and function of the prosthesis.

Keywords: Alveolar ridge, endodontically treated tooth, root submergence

Five-Year Follow-up of an Immediate Implant Placement in the Aesthetic Zone

Bhageshwar Dhami, Priti Shrestha — Fri, 31 May 2019 01:42:17 +0000

DOI: https://doi.org/10.3126/jnspoi.v2i2.23620

Immediate implants are placed in the site of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 94-100%. Immediate implant placement is most commonly indicated when tooth extraction is done with pathologies not amenable to treatment. The advantages include reduced post-extraction alveolar bone resorption, shortened treatment time, and the avoidance of a second surgical intervention with regard to delayed implantation. This report describes a case of immediate implant placed in a maxillary central incisor followed by evaluation of soft and hard tissue changes occurring during post-operative period with a follow-up at five years.

Keywords: Atraumatic extraction, crown, immediate implant placement, osseointegration.