Vishal Anand

Host modulation therapy: An indispensable part of perioceutics.

Traditionally, only antimicrobials have been used as the chemotherapeutic modality for the treatment of periodontitis. Though bacteria are the primary etiologic factors of periodontal diseases, yet the extent and severity of tissue destruction seen in periodontitis is determined by the host immuno-inflammatory response to these bacteria. This increasing awareness and knowledge of the host-microbial interaction in periodontal pathogenesis has presented the opportunity for exploring new therapeutic strategies for periodontitis by means of targeting host response via host-modulating agents. This has lead to the emergence of the field of “Perioceutics” i.e. the use of parmacotherapeutic agents including antimicrobial therapy as well as host modulatory therapy for the management of periodontitis. These host-modulating agents used as an adjunct tip the balance between periodontal health and disease progression in the direction of a healing response. In this article the host-modulating role of various systemically and locally delivered perioceutic agents will be reviewed.

Computerized implant-dentistry: Advances toward automation

Advancements in the field of implantology such as three-dimensional imaging, implant-planning software, computer-aided-design/computer-aided-manufacturing (CAD/CAM) technology, computer-guided, and navigated implant surgery have led to the computerization of implant-dentistry. This three-dimensional computer-generated implant-planning and surgery has not only enabled accurate preoperative evaluation of the anatomic limitations but has also facilitated preoperative planning of implant positions along with virtual implant placement and subsequently transferring the virtual treatment plans onto the surgical phase via static (guided) or dynamic (navigated) systems aided by CAD/CAM technology. Computerized-implant-dentistry being highly predictable and minimally invasive in nature has also allowed implant placement in patients with medical comorbidities (e.g. radiation therapy, blood dyscrasias), in patients with complex problems following a significant alteration of the bony anatomy as a result of benign or malignant pathology of the jaws or trauma and in patients with other physical and emotional problems. With significant achievements accomplished in the field of computerized implant-dentistry, attempts are now been made toward complete automation of implant-dentistry.

Two dimensional alveolar ridge augmentation using particulate hydroxyapatite and collagen membrane: A case report

BACKGROUND Ridge augmentation procedures require bone regeneration outside of the existing bony walls or housing and are therefore often considered to be the most challenging surgical procedures. The bony deficiencies can be managed with GBR techniques involving bone grafting material and membrane while vertical augmentation may require the use of space-creating support mechanisms. Non-degradable membranes have been used for ridge augmentation with encouraging results however; requirement of second surgery for its removal and associated infection on exposure may compromise the desired results. These problems can be overcome by employing resorbable collagen membranes. Different bone graft materials are also used in combination with resorbable membranes, for prevention of membrane collapse and maintenance of space, as they lack sufficient rigidity. Particulate hydroxyapatite bone graft may be better alternative, because it treats the underlying bone defect to restore the natural support of the tissue architecture. Moreover, its use avoids potential donor site complications associated with autogenous block grafts. METHOD Patient described in this report presented with missing right maxillary incisor with ridge deficiency. A treatment approach involving localised ridge augmentation with particulate hydroxyapatite and collagen membrane was used. RESULT Six month post-operative periapical radiograph demonstrated a significant vertical bone fill. CONCLUSION The clinical and radiographic findings of the present case suggests that HA in conjunction with a resorbable collagen membrane may be an acceptable alternative to the autogenous block graft and non-resorbable membrane in the treatment of compromised alveolar ridge deficiencies.

Evaluation of stress patterns in bone around dental implant for different abutment angulations under axial and oblique loading: A finite element analysis.

Introduction: The replacement of missing anterior teeth presents peculiar challenges to the Prosthodontist. Implants are increasingly gaining favour for the same. The morphology of existing bone in the premaxilla often dictates that implants are placed at angles that are difficult to restore with conventional abutments. However, the angulated abutments might transfer unfavourable forces to the implant or bone, thereby compromising the prognosis of the treatment. Because, it is difficult to assess the generated forces clinically, a finite element analysis was chosen for the present study as it is useful tool in estimating stress distribution in the contact area of the implant with the bone. Materials and Methods: In this study, the frontal region of the maxilla was modelled with a cortical layer 1.5 mm thick containing an inner cancellous core. The implant was cylindrical, round ended, with length 13 mm and diameter 4.1 mm. The abutment was modelled as 7 mm in height with a 5 degree occlusal taper. The different abutment angulations used were 0°, 10°, 15° and 20°. The amount of loads used were 100, 125, 150, 175 and 200 N axially, and 50 N in oblique direction, to approximate the kind of loads seen in clinical situations. Result: It was seen that, as the abutment angulation changes from 0° to 20° both the compressive as well as tensile stresses increased; but, it is within the tolerance limit of the bone. Conclusion: It seems reasonably safe to use angled abutments in anterior implant supported prostheses, in the maxillary arch.

In Vivo Evaluation of Two‐Piece Implants Placed Following One‐Stage and Two‐Stage Surgical Protocol in Posterior Mandibular Region. Assessment of Alterations in Crestal Bone Level

BACKGROUND Endosseous implants can be placed following either two-stage technique requiring second-stage surgery or one-stage technique, which does not involve a second surgical intervention. PURPOSE The present study was undertaken to evaluate and compare the changes in crestal bone level when two-piece implants were placed in posterior mandibular region following one-stage and two-stage surgical protocol. MATERIALS AND METHODS A parallel group randomized prospective study was designed in which 20 two-piece implants were placed in the posterior mandibular region of 16 partially edentulous healthy patients following either one-stage (Group I) or a two-stage surgical protocol (Group II). Alterations in crestal bone level were assessed with the help of DentaScan at baseline, that is, at the time of implant placement, third month and sixth month. RESULTS Nonsignificant differences were seen in both groups in terms of changes in crestal bone level at the final evaluation. CONCLUSIONS Hence, it could be concluded that two-piece implants can be placed following one-stage surgical protocol as predictably as when two-stage surgical technique is followed.Background Endosseous implants can be placed following either two-stage technique requiring second-stage surgery or one-stage technique, which does not involve a second surgical intervention. Purpose The present study was undertaken to evaluate and compare the changes in crestal bone level when two-piece implants were placed in posterior mandibular region following one-stage and two-stage surgical protocol. Materials and Methods A parallel group randomized prospective study was designed in which 20 two-piece implants were placed in the posterior mandibular region of 16 partially edentulous healthy patients following either one-stage (Group I) or a two-stage surgical protocol (Group II). Alterations in crestal bone level were assessed with the help of DentaScan at baseline, that is, at the time of implant placement, third month and sixth month. Results Nonsignificant differences were seen in both groups in terms of changes in crestal bone level at the final evaluation. Conclusions Hence, it could be concluded that two-piece implants can be placed following one-stage surgical protocol as predictably as when two-stage surgical technique is followed.

Periodontium bestows vision

The role of periodontium in supporting the tooth structures is well-known. However, less is known about its contribution to the field of ophthalmology. Corneal diseases are among major causes of blindness affecting millions of people worldwide, for which synthetic keratoprosthesis was considered the last resort to restore vision. Yet, these synthetic keratoprosthesis suffered from serious limitations, especially the foreign body reactions invoked by them resulting in extrusion of the whole prosthesis from the eye. To overcome these shortcomings, an autologous osteo-odonto keratoprosthesis utilizing intraoral entities was introduced that could positively restore vision even in cases of severely damaged eyes. The successful functioning of this prosthesis, however, predominantly depended on the presence of a healthy periodontium for grafting. Therefore, the following short communication aims to acknowledge this lesser-known role of the periodontium and other oral structures in bestowing vision to the blind patients.

Implant Maintenance: A Clinical Update

Introduction. The differences in the supporting structure of the implant make them more susceptible to inflammation and bone loss when plaque accumulates as compared to the teeth. Therefore, a comprehensive maintenance protocol should be followed to ensure the longevity of the implant. Material and Method. A research to provide scientific evidence supporting the feasibility of various implant care methods was carried out using various online resources to retrieve relevant studies published since 1985. Results. The electronic search yielded 708 titles, out of which a total of 42 articles were considered appropriate and finally included for the preparation of this review article. Discussion. A typical maintenance visit for patients with dental implants should last 1 hour and should be scheduled every 3 months to evaluate any changes in their oral and general history. It is essential to have a proper instrument selection to prevent damage to the implant surface and trauma to the peri-implant tissues. Conclusion. As the number of patients opting for dental implants is increasing, it becomes increasingly essential to know the differences between natural teeth and implant care and accept the challenges of maintaining these restorations.

Chlorhexidine–thymol varnish as an adjunct to scaling and root planing: A clinical observation

AIM To evaluate the efficacy of chlorhexidine-thymol varnish (Cervitec Plus(®)) as an adjunct to scaling and root planing in the improvement of periodontal parameters. MATERIAL AND METHODS A split mouth randomized clinical trial was conducted in 25 subjects with chronic periodontitis receiving scaling and root planing alone and as an adjunct to chlorhexidine-thymol varnish (Cervitec Plus(®)) and chlorhexidine-thymol varnish (Cervitec Plus(®)) alone. Clinical examinations were performed at baseline, 1 month and 3 months. RESULTS Short term advantages were observed in the clinical parameters in subjects receiving scaling and root planing and an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)) who showed the greatest improvement in the periodontal parameters at 3 months. CONCLUSION Subjects with chronic periodontitis significantly benefit from scaling and root planing when used with an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)).

Esthetic dentistry for multiple gingival recession cases: Coronally advanced flap with bracket application

Treatment of gingival recession is essential to rectify the esthetic and functional deficiencies of the patient and to combat further periodontal destruction. However, treating multiple recession cases is quite challenging, and therefore requires constant modifications of the prevalent treatment strategies as per the severity of the condition. The objective of this case report was to evaluate the effectiveness of coronally advanced flap (CAF) technique without vertical incisions using CAF brackets (CAF+B) for treating a patient presenting with class II gingival recession defects in relation to maxillary anteriors. Complete root coverage was observed, and the results were consistent even after 6 months. The current case report demonstrates good outcomes of the CAF + B technique without the use of any additional soft tissue grafts or vertical incisions, therefore, endorsing the promising potential of the CAF + B technique in multiple gingival recession cases.

Free gingival autograft for augmentation of keratinized tissue in apical to gingival recession – A case report

BACKGROUND The treatment of the mucogingival problem is one of the main objectives of the periodontal therapy. The insufficient or absent attached gingiva increases the risk of development of gingival recessions. METHOD One patient with Miller class II gingival recession and small vestibule depth in the frontal mandibular region was selected for treatment. Autogenous free gingival grafts harvested from the palatal mucosa were used to gain the attached gingiva. RESULT The initial healing completed in 2 weeks without complication. The augmentation of the attached gingival tissue using the free gingival graft technique led to gain of attached gingiva in the treated regions. CONCLUSION The limitations of the apical mucosal flap displacement for preparation of recipient site in situations with inadequate vestibule depth and small alveolar bone height require a graft with small width. The result from the presented case report with application of the free gingival graft indicates that it could be applied when augmentation of the attached gingiva tissue.