Rajesh Kumar Thakur

Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar

An aberrant frenum is postulated to create functional and aesthetic problems. Archers ‘classical frenectomy’ is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edwards frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.

Clinical evaluation of hydroxyapatite and β-tricalcium phosphate composite graft in the treatment of intrabony periodontal defect: A clinico-radiographic study

Background and Objective: Hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) grafts have shown to be effective in promoting the clinical signs of periodontal regeneration in intrabony defects. The aim of our study was to clinically and radiographically evaluate the efficacy of HA and β-TCP composite bone graft material in the treatment of intrabony three-wall defect. Materials and Methods: Twenty patients participated in this study. Interproximal bony defects were surgically treated with a combination of HA–βTCP (biphasic calcium phosphate). Changes in clinical parameters such as gingival status, probing pocket depth, clinical attachment, and radiographic estimation of the amount of bone fill were evaluated after 6 months postoperatively. Statistical Analysis Used: Students “t” test. Results: This treatment modality resulted in significant pocket depth reduction and clinical attachment gain which were observed to be 2.938 mm (47.04%) and 3.188 mm (29.09%), respectively. The defect fill as seen radiographically was 3.204 mm (63.195%). All the differences were highly significant and in favor of postoperative group. Conclusion: The results of this study suggest that HA–βTCP (biphasic calcium phosphate) provides an added regenerative effect in promoting the clinical resolution of intrabony three-wall defects in patients with periodontitis.

Angiofibroma on cheek mucosa: A rare entity and its management with laser

A rare presentation of an angiofibroma in the oral cavity is reported, which was treated with a diode laser. The benefits of laser treatment include bloodless procedure with instant precise coagulation of vessels. Although rare and unusual, it is suggested that angiofibroma should be included as one of the differential diagnoses of soft tissue swellings in the oral cavity.

Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead

Background: Periodontal dressings have been used for several years as a protection over injured tissue to shield the area from further insult. Several dressings are commercially available. A recently introduced light-cured resin, claimed to be more biocompatible and esthetic, needs critical evaluation. Aim: To compare this dressing with most widely used non-eugenol pack in the perspective of esthetics, acceptance, and healing following periodontal flap surgery. Materials and Methods: Twenty patients suffering from generalized chronic periodontitis, requiring periodontal flap surgery on contralateral sides of the arch, were selected and divided randomly into Group I (control) and Group II (test). In Group I, a non-eugenol dressing and in Group II light-cured dressing were applied after flap surgery. Pain and discomfort scores were recorded on day 1, 2, and 3 while plaque scores, gingival index, and bleeding index were recorded on day 7. Patients subjective evaluation and preference for the dressing material were recorded. The data was collected and statistically analyzed. Results: Group II showed better results than Group I when plaque scores, bleeding scores, modified gingival index scores, and pain and discomfort scores were compared though the differences were not statistically significant. Subjects found no unpleasant taste/smell and perceived the light-cured dressing to be better. A significantly higher number of patients preferred light-cured resin as a post-surgical dressing over Coe-pak. Conclusion: The light-cured dressing showed better patient acceptability and proves to be a better alternative to Coe-pak as a dressing material.

Comparative evaluation of efficacy of three treatment modalities – tetracycline fibers, scaling and root planing, and combination therapy: A clinical study

Background: Tetracycline is one of the primary antibiotics prescribed for antimicrobial therapy in periodontics. It has a broad spectrum of activity being effective against most bacteria as well as spirochetes. Due to limitations of systemic drug therapy, recent formulations of the drug for local administration in the subgingival area have been introduced, including collagen fibers impregnated with tetracycline. Aims and Objective: To compare the effectiveness of tetracycline fibers alone or in combination with scaling and root planing (SRP) on clinical parameters in chronic periodontitis patients. Materials and Methods: A total of twenty patients comprising of both sexes in the age group of 35-60 years with chronic periodontitis were selected. Split-mouth design was used, and three teeth from each patient with periodontal pocket measuring > 5 mm were selected which were treated with different treatment modality. They were randomly divided into site A (SRP), site B (tetracycline fibers only), and site C (combination therapy). Clinical parameters of plaque index (PI), gingival index (GI), pocket probing depth, and clinical attachment level (CAL) were recorded at 0, 30, and 45 days. The data obtained was compiled and put to statistical analysis. Results: All the three groups showed improvement in PI, GI, probing pocket depth, and CAL. Results of the study showed greater improvements in clinical parameters in Group C compared to Group A and Group B. Conclusion: The results indicate that the adjunctive use of tetracycline fibers with SRP is a clinically effective and simple nonsurgical treatment method to improve periodontal health.

Implanto-gingival complex: An indispensable junctional complex for the clinical success of an implant

Meticulous assessment of gingival and periodontal status around a future implant site is must for optimizing healthy esthetic gingival appearance and to establish a functionally successful implant-supported restoration. A successful osseointegrated implant requires a direct bone-to-implant interface to provide long-term support for a prosthesis. However a cause-effect relationship between bacterial plaque accumulation and the development of inflammatory changes in the soft tissues surrounding oral implants has been shown and known to exist. Thus maintaining a healthy peri-implant status becomes an integral component for the success of implant-supported restorations.