Umesh Pratap Verma

Phenytoin-induced severe gingival overgrowth in a child.

Gingival enlargement or overgrowth (GO) is a common complication of the anticonvulsant drug phenytoin (PHT). GO is evident in almost half of the patients receiving PHT therapy. PHT-induced gingival overgrowth (PGO) is more common in children than in adults and affects both males and females equally. PGO may vary from mild to severe and does not seem to be dose dependant. It is supposed that PHT and its metabolites cause a direct effect on the periodontal tissues; however, poor oral hygiene may contribute to the severity of gingival inflammation in patients with PGO. Management of PGO includes meticulous oral hygiene practice to reduce inflammation and surgical excision of the overgrown tissue, known as gingivectomy. We present a case of PHT-induced severe GO in a 10-year-old boy and discuss the clinical features, aetiology, pathogenesis and management of PGO.

Non-invasive treatment of pyogenic granuloma by using Nd:YAG laser

Pyogenic granuloma is a ‘reactive lesion’ in the oral cavity caused due to hormonal imbalance or poor oral hygiene. There are different methods to excise this lesion but most successful is treatment with lasers. Currently, there are different lasers available commercially and are used by clinicians to excise this lesion. In this case report, a 20-year-old female patient reported to the department with a complaint of overgrowth of gingiva on lower canine. It was excised by using neodymium-doped yttrium aluminium garnet laser and the patient was asked for regular follow-up after 1 week and 6 months. The excised lesion was sent to pathology where the lesion was confirmed to be pyogenic granuloma. The patient reported no pain, no blood loss during or postsurgery. Laser is a useful technique for excisional surgeries; it is safe, effective and reduces time of treatment as well as time of healing.

Synergistic Effects of Growth Factor, Bone Graft, and Resorbable Barrier Membrane in Management of Dehiscence and Fenestration of Dental Implants

Aim: The present study was primarily designed to evaluate the outcome of guided bone graft regeneration in peri-implant defects by combining recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and granules of beta-tricalcium phosphate (β-TCP) mounted by resorbable biomesh membrane. Secondary objective was to determine the value of resorbable barrier membrane to improve the efficacy of the growth factormediated regeneration. Materials and methods: A randomized controlled study comprised 14 participants (8 males and 6 females, mean age 37 years, range 19–55 years), in which a total of 15 implants (10 in maxilla and 5 in the mandible) were placed. Fifteen implant sites were randomly divided by picking a code into three groups: Test group I (n = 5) β-TCP + rhPDGF (0.3 mg/mL) + biomesh, test group II (n = 5) β-TCP + rhPDGF, and control (n = 5) β-TCP + biomesh. The experimental site was examined clinically for the gingival status and radiographically for the bone status. Results: Statistically significant difference in preoperative and postoperative measurements was observed for test groups I and II in all the parameters except width; in contrast, there was no significant difference observed for the control group from baseline to 5 months postoperatively. On intergroup comparison, statistically significant difference was observed between test group I vs control group and test group II vs control group, but it was not significant between test groups I and II, which was further confirmed using global performance scale score. Conclusion: It concluded that rhPDGF-BB and β-TCP mounted by resorbable biomesh membrane played a synergistic role in the management of peri-implant defects. Clinical significance: Bone regenerated using β-TCP with rhPDGF-BB in the reversal of peri-implant defects.

Dentascan an excellent tool for assessment of variations in the management of periodontal defects

Background: The purpose of the present study was to envisage the effectiveness of demineralized freeze-dried bone allograft (DFDBA) and bovine bone graft (BBG) for promoting defect fill in periodontal intrabony defects using dentascan. Materials and Methods: A total of 13 subjects (15 intrabony defects) aged between 24 and 56 years affected by moderate to severe periodontitis were randomly divided into Control (CG) and Test groups (TG1 and TG2). In CG only debridement, TG1 debridement plus DFDBA, and TG2 debridement plus BBG were performed. The clinical parameters probing pocket depth (PPD), clinical attachment level (CAL) was used. The radiological analysis was done by dentascan, which is a single-slice spiral computed tomographic scanner. Six months after, regenerative treatment clinical measurements were recorded. The bone fill was assessed using Dentascan as previously mentioned. Results: PPD reduction and CAL gain were significant in all the groups after 6 months whereas, on intergroup comparisons, insignificant finding was observed both at baseline and after 6 months. Coronoapical bone status decreased significantly in all groups, buccolingual measurements decreased significantly in TG1 and TG2, but no such trend was seen in CG. Significant reduction in mesiodistal bone status was noticed only in TG1 whereas insignificant on intergroup comparisons. Conclusion: Dentascan-based analysis attested that DFDBA was superior to BBG.

Comparison of Rehabilitating Missing Mandibular First Molars with Implant‐ or Tooth‐Supported Prostheses Using Masticatory Efficiency and Patient Satisfaction Outcomes

PURPOSE To determine whether a fixed partial denture (FPD) or an implant replacement of a single missing tooth leads to better masticatory efficiency and patient satisfaction. MATERIALS AND METHODS One-hundred and twenty participants with missing mandibular right first molars were selected on the basis of predefined inclusion and exclusion criteria. After obtaining informed consent, 60 participants were randomized to the teeth-supported (FPD) group and 60 to the implant placement group (IMP). The study was divided into the following parts: (i) Completion of a Likert scale satisfaction questionnaire (postrehabilitation) by the participants. (ii) Evaluation of masticatory efficiency and performance 3 months after rehabilitation. Data were evaluated by applying t-test and z-test using statistical analysis (α ˂ 0.05). RESULTS Masticatory efficiency of participants in the IMP and FPD groups was 74.95 ± 0.90% and 74.41 ± 3.35%, respectively (p = 0.607). Total satisfaction questionnaire scores for the two groups were also not significantly different; however, the mean scores of overall satisfaction and function categories in this questionnaire were significantly higher for the IMP group, while the mean score for the duration of treatment question was higher for the FPD group (p < 0.05). CONCLUSION The results of this study suggested that although masticatory performance and efficiency were not statistically different for single teeth replaced with implants or FPDs, patients perceived higher satisfaction with implant restorations; they also preferred the shorter treatment times for rehabilitation in the FPD group.

Platelet-rich fibrin: A paradigm in periodontal therapy – A systematic review

Periodontal tissue regeneration has always been a challenge for the periodontists owing to its structural complexity. Although with tissue engineering as a growing multidisciplinary field, this aim has partially been fulfilled. In recent years, platelet-rich fibrin (PRF) has gained wide attention for its utilization as a biocompatible regenerative material not only in dental but also in medical fields. The following systematic review has gathered all the currently available in vitro, animal, and clinical studies utilizing PubMed electronic database from January 2006 to August 2016 highlighting PRF for soft and hard tissue regeneration and/or wound healing. Although results are encouraging but require further validation from clinical studies to justify the potential role of PRF in periodontal regeneration so that this relatively inexpensive autologous biomaterial can be utilized at a wider scale.