Laterally positioned flap with periosteal graft for the treatment of gingival recession, novel technique – A pilot study

Introduction: Periosteum is a highly vascular connective tissue sheath covering the external surface of all bones except sites of articulation and muscle attachment. Regenerative potential of periosteum is due to inner layer which contains mesenchymal progenitor cells. Laterally pedicle flap technique is frequently used for recession coverage in isolated, denuded roots that have adequate donor tissue laterally and vestibular depth. Pedicle flaps have been modified in past, this pilot study utilized the technique which included auto transplant of periosteum in combination with laterally positioned flap. Materials and methods: 20 teeth with gingival recession, Millers’s class 1 and 2 with ≥ 3 mm defect were included and laterally positioned flap with periosteal graft was performed. Results: After 12 months of follow up, a stable result was obtained and the pilot study revealed significant reduction in recession defect. There was a mean percentage of 95.6% for root coverage, 80% predictability for recession coverage. Conclusion: Laterally positioned flap with periosteal graft technique can successfully be clinically utilized for the treatment of gingival recession defects, with less trauma and good esthetic results.

Local anti-inflammatory and analgesic effect of 0074% diclofenac mouthwash in post-operative periodontally treated patients

Pain is the most pervasive and universal form of human distress. The costs of pain in human suffering and economic resources are extraordinary. It is the most common reason for seeking medical care, and it has been estimated that approximately 80% of physician office visits involve a pain component. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used class of drugs for the management of acute and chronic pain in dentistry. NSAIDs minimize edema, but they are associated with many adverse effects, like gastric irritability, as dyspepsia and gastric bleeding which lead to a number of contraindications. Diclofenac is a powerful anti-inflammatory and analgesic drug that is well suited for local use in the oral cavity. This study was conducted in order to determine the local anti-inflammatory and analgesic effect of 0.074% diclofenac mouthwash on patients with periodontal surgery. Twenty five chronic periodontitis patients (fifteen males and ten females) who were supposed to go for full quadrant flap surgery were selected for the study. The 10-point visual analog scale (VAS) was used to assess pain and the Modified Gingival Index (MGI). Additional parameters like swelling and burning sensation was evaluated on a 5-point scale (0=absent, 1=mild, 2=moderate, 3=intense, 4=not evaluated). Compared to baseline measurements, spontaneous pain was significantly reduced by diclofenac mouthwash on the first day of treatment which showed gradual decrease till 7th day. Other parameters, i.e. gingival inflammation, showed a highly significant reduction in the scores in the test group when compared to baseline. The new 0.074% diclofenac Roobal Behal, Suhail Majid Jan. Local anti-inflammatory and analgesic effect of 0.074% diclofenac mouthwash in postoperative periodontally treated patients. IAIM, 2016; 3(12): 89-94. Page 90 mouthwash is an effective and tolerable medicinal product for post-surgical symptomatic relief. This topical formulation is sufficiently effective for pain relief after minor oral surgical procedures without subjecting the patients to systemic side-effects.

Comparing the efficacy of scaling with root planing and modified widman flap in patients with chronic periodontitis.

The present study was aimed to compare non-surgical treatment (scaling and root planing) with surgical (Modified Widman Flap procedure) treatment for chronic periodontitis. Modified Widman Flap procedure was chosen in our study because it results in removal of pocket epithelium to allow direct approximation of connective tissue with the tooth surface, less mechanical trauma than closed curettage, minimal bone removal, maximal conservation of periodontal tissue, facilitation of oral hygiene, and less root exposure with less sensitivity. The study was performed for a six month period .At initial examination, oral prophylaxis was performed and meticulous oral hygiene instructions were given. The patients were recalled after 21 days. At baseline, 15 subjects were selected with 5-7 mm periodontal pocket in at least 2 quadrants of the mouth. It was a split mouth design, with one quadrant of mouth as Control Group and another quadrant as Test Group. In the Control group, Scaling and Kirmani M, Saima S, Behal R, Jan SM, Yousuf A, Shah AF. Comparing the efficacy of scaling with root planing and modified widman flap in patients with chronic periodontitis. IAIM, 2016; 3(4): 168-174. Page 169 root planning was carried out and in test group modified widman flap procedure was carried out. Sutures were removed after 1 week. Oral hygiene instructions and professional tooth cleaning were repeated once every 2 weeks during study period for both selected quadrants. The clinical assessment was carried out from baseline to 3 months and 6 months to evaluate the respective treatments and to compare between Non surgical mechanical treatment (control group) and surgical treatment (test group).This study demonstrated that both surgical and nonsurgical methods of treatment are effective in eliminating gingivitis and reducing probing depths provided the subgingival plaque is eliminated and reinfection prevented following active therapy. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in low frequency of gingival sites which showed bleeding on probing, a high frequency of sites with shallow pockets 4 mm and disappearance of pockets with probing depth of > 6 mm.