This study evaluated a surgical technique combining modified apically repositioned flap surgery with vestibular deepening using diode laser to increase attached gingiva in the lower anterior teeth. 16 patients underwent phase I therapy followed by flap surgery, bone grafting, and laser-assisted vestibular deepening. Post-operative increases were seen in attached gingiva, keratinized gingiva, and vestibular depth. The one-step procedure helped relieve tension on the gingiva while regenerating periodontal tissues, with minimal discomfort and complications. The technique aims to prolong the life of compromised lower front teeth in a cost-effective manner.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
“Perio-Implant Synergy”- Two lectures on “Lost Buccal Plate- Complications and Management” and “Failing to Plan is Planning to Fail”. Organized by the Society of Periodontists and Implantologists of Kerala” at PMS Dental College, Trivandrum, India on 17/9/2018.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
Recent advances in prosthodontics / crown & bridge courses by indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Prosthodontic rehabilitation of maxillary defect in a patientNishu Priya
Restoration of maxillectomy defects demand varied modifications in prosthesis fabrication, to make them lighter and well-tolerated by the patient.
Literature suggests the use of various retentive aids for the construction of conventional obturator to improve retention and oral function.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
Healing of Periapical Bone Lesion After Periradicular Surgery And Graft Place...QUESTJOURNAL
Objectives: 1.To clinically evaluate the healing process following periapical surgery with Chitra granules 2.To radiographically evaluate healing, following periapical surgery with Chitra granules. 3.To compare the bone healing in the study group, clinically and radiographically following the modalities of treatment, with that of the control group (without graft). Materials: 1.Chitra hydroxyapatite granules. 2. Gutta-percha — for root canal obturation by lateral condensation. 3. High Copper amalgam used as retrofilling materials. To evaluate healing after periapical surgery using Chitra granules, 22 patients were selected from out patient section of Department of Conservative Dentistry and Endodontics, Govt. Dental College, Kozhikode,based on clinical and radiographical evaluation. The study group consisted of 13 males and 9 females. All were of the age group 15-35 years. After selection they were randomly divided into two groups A and B. In group A the Chitra granule were placed in the bony defect and in group B the defect were left as such after surgery. Results: Clinical parameters showed better early symptom free condition in group A compared to group B. But data found statistically insignificant (t-7.27,df-1.8, P >0.05). Radiographical evaluation data analysis showed statistically significant difference among group A and group B. Conclusion: Biocompatible Chitra granule not only obliterates the cavity but act as a scaffold for bone growth and prevent scar tissue formation.It is osteoconductive. In comparison to the conventional periapical surgery, the placement of Chitra granules facilitates bone regeneration more easily. The material is found to be very cost effective, easily available, easy to manipulate and involves least complication to both clinicians and patients.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
“Perio-Implant Synergy”- Two lectures on “Lost Buccal Plate- Complications and Management” and “Failing to Plan is Planning to Fail”. Organized by the Society of Periodontists and Implantologists of Kerala” at PMS Dental College, Trivandrum, India on 17/9/2018.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
Recent advances in prosthodontics / crown & bridge courses by indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Prosthodontic rehabilitation of maxillary defect in a patientNishu Priya
Restoration of maxillectomy defects demand varied modifications in prosthesis fabrication, to make them lighter and well-tolerated by the patient.
Literature suggests the use of various retentive aids for the construction of conventional obturator to improve retention and oral function.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
Healing of Periapical Bone Lesion After Periradicular Surgery And Graft Place...QUESTJOURNAL
Objectives: 1.To clinically evaluate the healing process following periapical surgery with Chitra granules 2.To radiographically evaluate healing, following periapical surgery with Chitra granules. 3.To compare the bone healing in the study group, clinically and radiographically following the modalities of treatment, with that of the control group (without graft). Materials: 1.Chitra hydroxyapatite granules. 2. Gutta-percha — for root canal obturation by lateral condensation. 3. High Copper amalgam used as retrofilling materials. To evaluate healing after periapical surgery using Chitra granules, 22 patients were selected from out patient section of Department of Conservative Dentistry and Endodontics, Govt. Dental College, Kozhikode,based on clinical and radiographical evaluation. The study group consisted of 13 males and 9 females. All were of the age group 15-35 years. After selection they were randomly divided into two groups A and B. In group A the Chitra granule were placed in the bony defect and in group B the defect were left as such after surgery. Results: Clinical parameters showed better early symptom free condition in group A compared to group B. But data found statistically insignificant (t-7.27,df-1.8, P >0.05). Radiographical evaluation data analysis showed statistically significant difference among group A and group B. Conclusion: Biocompatible Chitra granule not only obliterates the cavity but act as a scaffold for bone growth and prevent scar tissue formation.It is osteoconductive. In comparison to the conventional periapical surgery, the placement of Chitra granules facilitates bone regeneration more easily. The material is found to be very cost effective, easily available, easy to manipulate and involves least complication to both clinicians and patients.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
1. Periodontal Flap Surgery along with Vestibular
Deepening with Diode Laser to Increase
Attached Gingiva in Lower Anterior Teeth: A
Prospective Clinical Study
ASHU BHARDWAJ, ZEBA JAFRI, NISHAT SULTAN, MADHURI SAWAI & ANIKA DAING
EDITOR : PROFESSOR WANG WANG
INDIANS IN EDITORIAL TEAM IS DR. MANJUL TIWARI (SHARDA UNIV) AND DR. SHIBU THOMAS SEBASTIAN, PUSHPAGIRI
COLLEGE OF DENTAL SCIENCES, KERALA
JOURNAL OF NATURAL SCIENCE, BIOLOGY AND MEDICINE ¦ VOLUME 9 ¦ ISSUE 1 ¦ JANUARY-JUNE 2018
4. IMPORTANCE OF WIDTH OF ATTACHED
GINGIVA
1) GOLDMAN AND COHEN – TISSUE BARIER CONCEPT
Dense collagenous band of connective tissue retard or obstruct the spread of inflammation
better than does the loose fibre arrangement of alveolar mucosa.
2) FRIEDMAN – PULL SYNDROME
Inadequate zone of a. gingiva would facilitate subgingival plaque formation because of
improper pocket closure resulting from the movability of marginal tissue.
3) LANG AND LOE (1972)
2mm of keratinized gingiva with 1 mm of attached gingiva is adequate to maintain
gingival health.
5. IMPORTANCE OF WIDTH OF ATTACHED
GINGIVA
4) MIYASTO ET AL 1977
Area of minimal width of attached gingiva may not be prone to development of plaque
induced inflammatory changes.
5) LINDHE AND NYMAN 1980
Narrow width of attached gingiva is not more susceptible to recession rather it is the
volume of connective tissue which has greater significance
6. METHODS OF INCREASING THE WIDTH
OF ATTACHED GINGIVA
METHOD FOR GINGIVAL AUGMENTATION
APICAL TO THE AREA OF RECESSION :
1) FREE GINGIVAL AUTOGRAFT
2) SUB-EPITHELIAL CONNECTIVE
TISSUE GRAFT
3) APICALLY REPOSITIONED FLAP
4) VESTIBULOPLASTY
CORONAL TO THE AREA OF RECESSION:
1) FREE GINGIVAL AUTOGRAFT
2) SUB-EPITHELIAL CONNECTIVE TISSUE
GRAFT
3) PEDICLE AUTOGRAFT
4) LATERALLY POSITIONED PEDICLE
FLAP
5) CORONALLY ADVANCED FLAP
6) GUIDED TISSUE REGENERATION
11. Periodontitis
Chronic periodontitis is a multifactorial infectious disease characterized by slow
irreversible damage of periodontal supporting tissue loss in a period.
RESULTING IN
1) Attachment loss
2) Periodontal pockets
3) Bone loss
4) Mobility
5) Gingival recession (GR)
6) Decreased vestibular depth (VD)
13. Modified apically repositioned flap (MARF)
technique
Carnio and Miller in 1999 - for single tooth
Carnio and Camargo in 2006 - for multiple teeth
prerequisite factor should be a minimum of 0.5 mm of attached
gingiva for performing surgery.
If the distance between the bottom of the pocket and the crest of the
bone is >2.0 mm, MARF technique is not advisable, as there is a
chance of postoperative recession to occur because of the bone
dehiscence
14. horizontal bevel incision with its bevel away from the crest
of alveolar bone, and this incision was given at a distance of
0.5 mm from MGJ toward attached gingiva so that this
tissue remains intact with flap
A partial-thickness flap was raised so that the flap can be
moved apically and simple interrupted absorbable sutures
with Vicryl 4-0 were placed for securing the flap to the
periosteum.
For preventing dead space between the flap and periosteal
bed, a gentle finger pressure was applied and the
periodontal pack was placed
15. Mechanism
Epithelial cells on the wound edges will migrate over exposed periosteum.
As the surgical area is surrounded by KT, this serves as a source of cells of
keratinized phenotype and prevents non keratinized epithelial cells originating
from the oral mucosa proliferating onto the surgical area.
The connective tissue and keratinized epithelial cells surrounding the wound
migrate from the margins to cover the exposed surgical site, resulting in
augmentation of the attached gingiva.
16. LASER - Light Amplification by the
Stimulated Emission of Radiation
Laser is an amplified light wave whose energy
has been increased by the process of
STIMULATED EMISSION
17. LASER - Light Amplification by the
Stimulated Emission of Radiation
19. MATERIALS AND METHODS
Prospective, clinical study was conducted on 16 patients (4 males and 12 females; mean
age ± standard deviation [SD]: 35.06 ± 7.52) diagnosed as having generalized moderate-
to-severe chronic periodontitis.
INCLUSION CRITERIA
No systemic disease
Good compliance with plaque control instructions
Generalized moderate-to-severe chronic periodontitis
At least two mandibular anterior teeth with radiographic
bone loss, shallow vestibule, CAL ≥5 mm, and limited
attached gingiva
No smoking
Absence of traumatic occlusion
EXCLUSION CRITERIA
Pregnant patients
Use of any medication known to
influence periodontal tissues
20. MATERIALS AND METHODS
STEP1: Phase I therapy including the oral hygiene instructions, full mouth scaling, and root
planing for generalized chronic periodontitis was performed on all the patients.
STEP 2 : GR, PD, CAL, width of keratinized gingiva, width of attached gingiva, and VD were
assessed preoperatively after Phase I therapy and 6-month postoperatively.
STEP 3 : Occlusal adjustment and temporary esthetic fiber splinting wherever required were
done on lingual aspect of teeth with mobility to facilitate the periodontal flap surgery.
21.
22. MATERIALS AND METHODS
STEP 4: Phase II
conventional periodontal flap.
Periodontal surgical debridement was done followed by placement of sterile
synthetic hydroxyapatite and β-tricalcium phosphate bone graft material
(Sybograf™ Plus, Eucare pharmaceuticals, Chennai, India)
suturing with 3-0 silk sutures.
23. MATERIALS AND METHODS
A horizontal incision was given with diode laser (DenLase, Diode Laser Therapy System,
Daheng Group Inc., China; Laser parameters: Wavelength - 810 nm, output power: 0.5–7
W, continuous wave [CW], contact mode), to detach the fibers from underlying
periosteum leaving 1–2 mm of marginal gingiva
sutures
Care was taken to direct the laser away from the periosteum and bone.
VD of 6–8 mm was achieved by separating the muscle attachments.
noneugenol periodontal dressing (Coe-pak) (COE-PAK™, Periodontal Dressing, GC
America Inc., USA)
26. DISCUSION
Periodontitis is a chronic disease and lack of severe pain allows the patient to report only
when the teeth are either mobile or there is loss of clinical attachment manifested as GR.
(Korman KS)
Lower anterior teeth are esthetically important, single rooted
Chronology of tooth extraction due to periodontitis
Lower anterior teeth > upper anterior >upper second molars
However, in long-term maintenance studies molars were lost most frequently
Results of a 40-year follow-up study on fate of 455 teeth with questionable prognosis
showed that teeth with significant loss of periodontal tissues could be functionally
maintained. (Chance R Sr et al)
27. DISCUSION
The average prognosis of the teeth postactive treatment changed very little from initial
to 5–8 years, with prognosis being more accurate for single-rooted teeth than
multirooted teeth. (MCGuire MK)
Long-term preservation of hopeless teeth following periodontal surgery is an attainable
goal with no detrimental effect on adjacent surfaces of neighboring teeth. (Wojcik MS et
al)
Miller Grade 1 tooth mobility – periodontitis treatment and occlusal adjustment.
( Strassler HE et al)
Miller Grade 2 tooth mobility - periodontitis treatment, occlusal adjustment and
Splinting (Cole EG)
Miller Grade 3 tooth mobility – extraction or splinting where tooth extraction is not
acceptable or contraindicated.
28. DISCUSION
advantages of lasers - excellent homeostasis, precision, tissue surface sterilization,
decreased swelling and edema, decreased pain, faster healing, and increased patient
acceptance. (Rossman J et al)
A diode laser is a solid-state semiconductor laser that typically uses a combination of
gallium, arsenide, and other elements, such as aluminum and indium, to change
electrical energy into light energy. (Prabhu ji)
It does not interact with dental hard tissues, making it an excellent soft-tissue surgical
laser
It is used for cutting and coagulating gingiva and oral mucosa and for soft-tissue
curettage or sulcular debridement. (Mani A et al)
results are more predictable and less stressful to patients and clinicians. (Sawai MA)
29. DISCUSION
The conventional periodontal flap surgery allowed use of bone graft for periodontal
reconstruction
vestibular deepening with diode laser helped in maintaining the mucogingival complex
at the presurgical level by apically repositioning the frenal and muscle attachments.
The combination of the two surgical procedures in one sitting resulted in highly
significant increase in attached gingiva, keratinized gingiva, and VD over multiple
teeth while simultaneously relieving the tension on the gingiva.
There were minimal patient discomfort and postoperative complications.
This one-step surgical technique does not involve any other site as in soft tissue graft.
30. FROM WHERE THE KT CAME
A rapidly dividing group of cells from mesial and/or distal aspects of the wound grows
around a more slowly dividing group mucosal cells present in the coronal and apical areas
of the wound
The initial incision made dissipates the tension that was exercised by the muscular fibers of
the alveolar mucosa onto the marginal soft tissue margin. This reduction in tension over
the granulation tissue covering the exposed periosteum may induce genotypic changes to
the epithelial cells that favor immobility and therefore keratinization.
As a response to the surgical insult, the periodontal ligament may proliferate coronally,
which may induce the keratinization of the epithelial cells over it.
31. CONCLUSION
The surgical technique described in this article is a cost-effective method to prolong the
life of lower anterior teeth with questionable prognosis.
The increase in VD and attached gingiva can improve the success of implants if required
in the future.
Limitations of the study - long-term follow-up of patients with regard to bone
regeneration and effect on tooth mobility.
Editor's Notes
Buffer zone bcz it dissipates the forces exerted by the mobile skeletal muscles of the a. mucosa
Vestibular depth, defined as the distance from the free gingival margin to the mucogingival junction, was measured with a periodontal probe positioned vertically. Using the classification system of H.Y. Pakalns, vestibular depth was defined as shallow– less than 5 mm; medium– 5-10 mm; and deep – more than 10 mm.
It was observed that only 1 site with Grade 3 mobility coincided with bone loss >2/3rd root surface.
Teeth with Grade 2 mobility included 3 incisors and had >2/3rd bone loss.
Out of the tooth sites with Grade 1 mobility, 1 incisor and 1 canine had 1/3rd bone loss, 17 incisors had up to 2/3rd bone loss; and 11 incisors had >2/3rd bone loss.
In the sites with no clinical tooth mobility, 1/3rd bone loss was seen in 7 incisors and 13 canines, up to 2/3rd bone loss in 15 incisors and 2 canines; and >2/3rd bone loss in 1 lateral incisor and no bone loss in 2 canines.