Amitabh Srivastava

An innovative cosmetic technique called lip repositioning

A clinical report describing the successful use of the lip repositioning technique for the reduction of excessive gingival display. A female patient aged 34 years reported with a chief complaint of gummy smile and was treated with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from maxillary buccal vestibule and creating a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.

Combined endodontic - Periodontal lesion: A clinical dilemma

Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.

An in vitro scanning electron microscope study to evaluate the efficacy of various root conditioning agents.

Aim: The purpose of present study was to investigate the scanning electron microscopic alterations produced on scaled and root planed dentin surfaces after application of different etching modalities namely citric acid, tetracycline hydrochloride and ethylenediaminetetraacetic acid (EDTA). Materials and Methods: Eighty specimens of teeth were collected and categorized into four groups. In group 1, control group specimens were treated with normal saline for 3 min, group 2 specimens were treated with citric acid, group 3 specimens were treated with tetracycline hydrochloride for 3 min and group 4 specimens were treated with 15% EDTA. Results: Opening of dentinal tubules was seen in all specimens except for control group that was treated with normal saline. The total number of tubules seen was highest in citric acid group as compared to tetracycline hydrochloride and EDTA Group. The total number of patent tubule opening was highest in citric acid as compared to EDTA and tetracycline. The diameter of patent dentinal tubules in citric acid group was more than EDTA and tetracycline. Conclusion: The study showed that all the three agents were effective in removing the smear layer however number of patent and wider diameter dentinal tubules was seen in vitro best in citric acid than EDTA and then in tetracycline hydrochloride. Hence, citric acid group is more efficient than EDTA and tetracycline HCl group in removing the smear layer and in opening of number of patent dentinal tubules.

A comparative clinico-radiographic study of guided tissue regeneration with bioresorbable membrane and a composite synthetic bone graft for the treatment of periodontal osseous defects

Aim: The aim was to evaluate the bonefill in periodontal osseous defects with the help of guided tissue regeneration, bioresorbable membrane (PerioCol) + bone graft (Grabio Glascera) in combination and with bonegraft (Grabio Glascera) alone. Materials and Methods: The study involved total 30 sites in systemically healthy 19 patients. The parameters for evaluation includes plaque index sulcus bleeding index with one or more periodontal osseous defects having (i) probing depth (PD) of ≥ 5 mm (ii) clinical attachment loss (CAL) of ≥ 5 mm and (iii) ≥3 mm of radiographic periodontal osseous defect (iv) bonefill (v) crestal bone loss (vi) defect resolution. The study involved the three wall and two wall defects which should be either located interproximally or involving the furcation area. The statistical analysis was done using Statistical Package for Social Sciences, the Wilcoxon signed rank statistic W + for Mann-Whitney U-test. Results: The net gain in PD and CAL after 6 months for Group I ([PerioCol] + [Grabio Glascera]) and Group II (Grabio Glascera) was 3.94 ± 1.81 mm, 3.57 ± 2.21 mm and 3.94 ± 1.81, 3.57 ± 2.21 mm, respectively. The results of the study for Group I and Group II with regards to mean net bonefill, was 3.25 ± 2.32 (58%) mm and 5.14 ± 3.84 (40.26 ± 19.14%) mm, crestal bone loss − 0.25 ± 0.68 mm and − 0.79 ± 1.19 mm. Defect resolution 3.50 ± 2.34 mm and 5.93 ± 4.01 mm, respectively. Conclusion: On comparing both the groups together after 6 months of therapy, the results were equally effective for combination of graft and membrane versus bone graft alone since no statistical significant difference was seen between above parameters for both the groups. Thus, both the treatment modalities are comparable and equally effective.

Massive pregnancy gingival enlargement: A rare case

Gingival enlargement related to pregnancy is sometimes seen in the oral cavity. Pregnancy is a physiological state that brings full of changes in a womans life. The metabolism and immunology of the body are modified by progesterone and estrogen as well as other local factors, these sex hormones may modify the oral mucosa and may lead to various periodontal diseases. A case of female patient 23 yrs of age reported during 8th month of pregnancy with a localised gingival enlargement affecting the buccal aspect of left maxillary central incisor upto canine. The hormonal changes occurring during pregnancy may be associated with generalized or localised gingival enlargement and the presence of local factors may accentuate the gingival response. Rarely the enlargement becomes maasive and protrude out extraorally.

Assessment of hard and soft tissue changes around Implants: A clinico-radiographic in vivo study

Introduction: Microbial plaque is the main etiologic factor which causes disease in soft tissue around dental implants. The purpose of this study was to evaluate the bone level around implants using conventional radiography. They were evaluated for radiographic changes in the peri-implant crestal bone at intervals of 1, 3 and 6 months. The radiographic findings were correlated with clinical parameters of mobility, probing depth, bleeding, etc. Aim: The aim of the present study was to evaluate the hard and soft tissue changes around two-stage implant both radiographically and clinically to assess the success of implants. Materials and Methods: Seven patients with 10 dental implants were examined clinically for 6 months after prosthodontic treatment. Plaque index and health indices of soft tissue including pocket depth, mobility, bleeding index, calculus and gingival index were measured. Marginal crestal bone loss and peri-implant radiolucency were checked radiographically. The criteria both subjective and objective were used to evaluate the success of the implant process. The necessary statistical analysis was performed for radiographic and clinical evaluation methods. Results: The results of this study showed that the values of all clinical criteria under study had no significant changes from baseline to 6 months. The vertical crestal bone loss on the mesial and distal side was within the normal range of bone loss given by Branemark. There was no mobility and no peri-implant radiolucency around any of the implants. Conclusion: Our study clearly demonstrated that in a group of patients with no periodontal disease the survival rate of two-stage, countersunk, submerged implants in the edentulous sites is 100% during the follow-up period of 6 months.

Periodontal Barrier Membranes: A Review with Case Report

Abstract: Periodontal regeneration is healing after periodontal surgery that results in the formation of new attachment apparatus, consisting of cementum,periodontal ligament(PDL) and alveolar bone. Although the goal of complete and predictable regeneration still remains elusive, many techniques and materials have been developed that show good clinical and histologic outcomes.Advancements in periodontal regenerative armamentarium have encouraged clinicians to aggressively seek this therapeutic goal. Guided tissue regeneration (GTR) is effective in halting tissue and bone destruction and promoting new tissue and bone formation. Reconstructive dental professionals are constantly looking for an edge that jump starts the healing process to maximize predictability as well as quality and quantity of regenerated bone.

Necrosis of alveolar bone secondary to endodontic treatment and its management

The misuse of various chemicals in dentistry may cause damage to gingiva and alveolar bone. In this case report, we describe necrosis of the gingiva and alveolar bone caused by pulp devitalizer. A paraformaldehyde preparation was applied to an inflamed and symptomatic pulp of the maxillary left first molar (tooth #26), in a 20-year-old male. Spillage of the product was responsible for marked necrosis of the gingiva and the alveolar cortical bone, which resulted in great loss of the supporting bone. Surgical intervention was required wherein the necrosed bone was removed and the bone defect was filled with bone graft. The flap was coronally repositioned and sutured securely. After the treatment, the patients complaints had resolved. Extreme care must be exercised while delivering of such products during treatment.

Palatogingival groove - a silent killer: Treatment of an osseous defect due to it

A male patient of 21 years of age reported to the Department of Periodontology and Implantology with a chief complain of pus discharge in both right and left upper lateral incisors. On clinical examination a deep pocket of about 10–14 mm was noticed in both lateral incisors. Radiographic interpretation shows a teardrop-shaped radiolucency in both the laterals giving suspicion of palatogingival groove, which was later discovered and treated surgically.