Journal of Nepalese Society of Periodontology and Oral Implantology

Clinical Evaluation of Diode Laser Compared to Systemic Antibiotics in the Treatment of Chronic Periodontitis

Dr. Sujata Rana — 2025-02-28

Introduction: Periodontitis is an inflammatory disease of the periodontium. The most commonly used treatment modality involves scaling and root planing. However, complete removal of bacterial deposits is not always possible. Thus, adjunctive therapeutic strategies like systemic antibiotics and laser therapy have evolved.

Objective: To evaluate the clinical effect of diode laser compared to systemic antibiotics in the treatment of chronic periodontitis.
Methods: A non-randomised clinical trial was conducted in the department of Periodontics and Oral Implantology, People’s Dental College and Hospital from 2022 April to 2023 March after ethical approval. Thirty-two patients with chronic periodontitis were assigned into two groups using convenience sampling. Group A received diode laser (980 nm) applications, and Group B received adjunctive systemic Amoxicillin 500 mg three times daily and Metronidazole 400 mg three times daily for seven days. Clinical parameters: probing depth, clinical attachment level, plaque index, and gingival index were evaluated at one month, three months, and six months post-treatment. Data were analysed in SPSS v.20.

Results: Mean values of probing depth, clinical attachment level, plaque index, and gingival index reduced significantly after treatment in both treatment groups, with more clinical improvement in the diode laser group. However, for the intergroup comparison, the clinical parameters were not significant.

Conclusions: The findings of the current study showed significant improvement in all clinical parameters as compared with baseline in both treatment groups. However, no significant differences between the treatment modalities were found regarding an increase in periodontal probing depth and clinical attachment level.

Prevalence of Third Molar Agenesis among Patients Visiting a Tertiary Health Centre in Nepal: A Radiographic Study

Dr. Sagar Adhikari — 2025-02-28

Introduction: Tooth agenesis is the developmental absence of a tooth. The most commonly involved tooth in agenesis is the third molar. The variation of agenesis of the third molar may vary in different populations.

Objective: To assess the pattern of prevalence of third molar agenesis and explore its variation based on gender among patients attending Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel Hospital (DH), a tertiary health care centre in Nepal.

Methods: This was an analytical cross-sectional study conducted in the Department of Oral Medicine and Radiology, KUSMS, DH from 2024 June to 2024 October 2024 after ethical approval. A total of 638 panoramic radiographs of patients above 18 years of age were included in the study to assess the agenesis of third molars using convenience sampling. Data were entered in Microsoft Excel 2019 and analysed in SPSS v.25. Cross-tabulation was done using descriptive statistics. The Chi-square test and Fischer’s exact test were used to compare the pattern of prevalence of missing third molars based on gender.

Results: The prevalence of third molar agenesis in the present study was 22.26% (n=142), with a prevalence of 20.32% (n = 63) in males and 26.22% (n = 86) in females, the difference being statistically significant (p=0.013).

Conclusions: In this study group, the prevalence of third molar agenesis was higher among females than males.

Comparison of Effectiveness of Salvadora persica Mouthwash with Chlorhexidine and Scaling Alone in Gingivitis

Dr. Garima Khadka — 2025-02-28

Introduction: Mechanical plaque control, despite best efforts, sometimes fails to completely remove dental biofilm. Variety of chemical agents have also been used as an adjunct to those mechanical aids. Among them, Chlorhexidine (CHX) is the most studied and effective agent. However, due to its unwanted side effects, the use of herbal components that are relatively safe are considered these days.

Objective: To compare the effectiveness of Salvadora persica (SP) with Chlorhexidine mouthwash as an adjunct and scaling alone in the treatment of gingivitis.

Methods: A non-randomised clinical trial was done among 63 participants with gingivitis at Periodontology and Oral Implantology Unit, Bir Hospital between 2022 February to 2023 September. Patients recruited after ethical approval, using convenience sampling method, were divided into three groups - CHX, SP, and scaling alone. Plaque index (PI) and Gingival index (GI) for all three groups were recorded at baseline and day 21. Intragroup comparison of PI and GI at baseline and day 21 and intergroup comparisons between each groups were performed.

Results: For CHX, SP, and Scaling alone group, the mean PI and GI was significantly decreased on day 21 (p <0.05). However, on multiple comparisons there were no statistically significant differences between the means of the groups being compared.

Conclusions: The absence of statistically significant differences between the intervention groups suggests a comparable efficacy among the three approaches in treatment of gingivitis.

Comparison of Diode Laser-assisted Pocket Therapy with Open Flap Debridement in the Treatment of Periodontitis

Dr. Sagun Regmi — 2025-02-28

Introduction: Periodontal disease results from inflammation of the supporting structures of the teeth in response to chronic infections caused by various periodontopathic bacteria. Diode laser, being an excellent soft tissue laser, is indicated for soft tissue curettage or sulcular debridement.

Objective: To evaluate and compare the clinical outcomes of diode laser-assisted periodontal pocket therapy and open flap debridement (OFD) in the treatment of periodontitis

Methods: An experimental study (non-randomised trial) was done in the Department of Periodontics and Oral Implantology at People’s Dental College and Hospital from 2019 August to 2020 July after ethical clearance from Nepal Health Research Council. Convenience sampling was used to select patients with chronic periodontitis with bilateral periodontal pockets in contralateral hemiarches exhibiting periodontal probing depth (PPD) of ≥5-8 mm. In group A, diode laser-assisted pocket therapy was performed and in group B, OFD was done. The parameters were evaluated accordingly at baseline, one, three, and six months.

Results: Comparison of baseline mean PPD scores of OFD group was significantly higher than diode laser associated pocket therapy group (p-value = 0.001). Comparison of baseline mean clinical attachment level (CAL) scores of OFD group was significantly higher than diode laser- assisted pocket therapy group (p-value = 0.012). At subsequent visit higher reduction in PPD was observed in OFD group, while higher reduction in CAL was observed in diode laser group.

Conclusions: Both groups showed significant improvements compared with baseline. However, the difference in improvement of the PPD and CAL between groups was not significant.

Supracrestal Tissue Attachment: A Narrative Review

Dr. Sunita Sah — 2025-02-28

The supracrestal tissue attachment (SCTA) space, formerly known as biologic width, forms an organic seal around the alveolus to maintain the health of the periodontium, which in turn affects the health of the tooth. Any violation to SCTA may lead to periodontal disease thereby compromising the prognosis of the teeth. The SCTA violation can be prevented by increasing the clinical crown height by moving the bone away from the gingival margin so that restorative margins can be placed at sound tooth structure at distance away from alveolar bone crest, which can be achieved through crown lengthening surgery, orthodontic extrusion or, surgical extrusion.

No universal dimension of SCTA appears to exist. It can be different at sites even within the same individual. Although the 2 mm of SCTA advised by Garguilo et al. has been the norm for use in all clinical situations, each individual site has to be assessed separately as many studies have shown that there is large variation in the epithelial and the connective tissue attachment and even a minimum encroachment will lead to its violation. Therefore, adequate understanding of SCTA along with its preservation and maintenance is essential to ensure form, function and aesthetics of the dentition.

Management of Endodontic-Periodontal Lesion in Two-rooted Maxillary Lateral Incisor with Root Resection

Dr. Asmita Koju — 2025-02-28

Variation in the number of roots of maxillary lateral incisors have been reported in literature. Failure to identify the presence of the extra roots and canals in these teeth may lead to compromised treatment outcome. Such multi-rooted teeth can sometimes be successfully managed with root resection. Careful preoperative evaluation and radiographs may help in accurate diagnosis, treatment planning, and management of these anatomical variations. This case report demonstrates the successful management of an endodontic-periodontal lesion in a maxillary lateral incisor with two roots with use of root resection procedure in a one-year follow up time.

Z-plasty Frenectomy: An Aesthetic Approach for an Aberrant Labial Frenum

Dr. Sushmita Baral — 2025-02-28

Aberrant frenum can cause midline diastema, gingival recession, speech impairment, and inadequate vestibular depth. It can be treated by either frenotomy or frenectomy. Frenectomy can be accomplished by routine scalpel technique, electrocautery, or by using laser. Several surgical techniques including simple classic technique, Millers technique, V-Y plasty, and Z-plasty are used to treat an aberrant frenum. This case report describes treatment of an aberrant frenum using Z- plasty technique in a 20-year-old patient.

Immediate Implant Placement with Immediate Loading in Mandibular Anterior Region: A Twenty-month Follow Up Report

Dr. Srishti Poudel — 2025-02-28

Immediate implant placement and provisionalisation following tooth extraction have been documented as a predictable treatment modality. This case report illustrates immediate implant placement with immediate loading to replace failing teeth on lower front teeth region. The dental implant and provisional restoration provided the patient with immediate aesthetics, function, comfort, and most importantly preservation of tissues.

Root Resection: Management of Multirooted Tooth with Furcation Involvement

Dr. Binita Bartaula — 2025-02-28

Multirooted teeth in periodontitis patients are difficult to be treated with only conventional periodontal treatment (scaling and root planing). Multirooted teeth are difficult to access in furcation entrance sites and in teeth with anatomic problems like (severe curvature, developmental grooves, root flutings, accessory, or multiple canals). In these cases root resection has resulted into better outcomes, where one or more roots are removed at the level of furcation. This case report presents a root resection done in upper left first molar after flap debridement with follow up at 12 months and 18 months.

World Workshop 2017 Classification of Periodontal Disease and its Implications in the Nepali Scenario

Dr. Arjun Hari Rijal — 2025-02-28

World Workshop 2017 Classification of Periodontal Disease and its Implications in the Nepali Scenario