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Aggressive periodontitis with a history of orthodontic treatment

Gupta VV, Ramachandra SS

J Indian Soc Periodontol, 2019 8 2;23(4):371-376.
PMID: 31367137 DOI: 10.4103/jisp.jisp_654_18

This report presents a 29-year-old aggressive periodontitis patient from Morocco with a history of orthodontic treatment. Despite all the first molars showing advanced bone loss, the maxillary anterior teeth did not show any periodontal destruction. The scientific literature rarely reports cases of aggressive periodontitis without involving maxillary anterior teeth. The treatment provided includes extraction of hopeless tooth, removal of overhanging restoration, scaling, root debridement, and regenerative periodontal therapy. The discussion highlights the dilemma during diagnosis of the case as either "iatrogenic periodontitis due to orthodontic treatment" or "localized aggressive periodontitis." The age group of 15-35 years is the common age group for patients' seeking orthodontic treatment and the occurrence of aggressive periodontitis. Sound knowledge of periodontitis and identification of early signs of aggressive periodontitis through meticulous periodontal examination may help in earlier identification and minimalistic treatment. Education regarding periodontitis, especially aggressive periodontitis, is essential among orthodontists and general dentists. This case report aims to discuss the dilemma involved during diagnosis of localized aggressive periodontitis.
Fulltext Case sharing - an approach for improving clinical experience to cases of advanced complexity among undergraduate dental students

Ramachandra SS, Gupta VV, Muttalib KA

J Oral Biol Craniofac Res, 2020 11 10;11(1):1-4.
PMID: 33344152 DOI: 10.1016/j.jobcr.2020.11.001

Introduction/Problem: Clinical experience in cases of advanced complexity/rare cases is limited among undergraduate dental students. This commentary narrates a module termed "case sharing", wherein a small group of undergraduate dental students treat/assist, document and present advanced or rare cases to their entire cohort in eight weeks.
Approach: Undergraduate students perform procedures of straightforward and moderate complexity, and later assisted the clinical specialists during procedures of advanced complexity. students document these cases with clinical photographs and case notes to make presentations that were uploaded in the faculty's online management system to be reviewed by the entire cohort. student groups presented their cases with their entire cohort. an independent assessor assessed the groups for their organization of the case, information collected on the topic, critical analysis of the case, defending the diagnosis and treatment plan, teamwork and presentation skills.
Evaluation: Students reported improvement in the depth of knowledge on particular diseases/procedures, a better understanding of holistic management of advanced cases, improved rapport, team spirit and communication among group members. they also reported difficulties in recruiting and completing the procedures within eight weeks.
Discussion: Apart from improving the clinical experience of undergraduate students, the module provides an opportunity for the development of teamwork, communication skills, and ethical presentations among students, which are invaluable to the faculty to meet its programme learning outcomes. case sharing provides a platform for holistic learning and serves as an alternative learning method aside from didactic lectures and routine clinical supervision.
Salvaging a Periodontally Compromised and Endodontically Involved Three-Rooted Mandibular First Molar With Cervical Enamel Projection

Western JS, Gupta VV, Ramachandra SS

Compend Contin Educ Dent, 2019 Mar;40(3):172-177.
PMID: 30829499

This case report describes the management of a mandibular first molar with an additional distolingual root (radix entomolaris) and grade III cervical enamel projection through a multidisciplinary approach. Diagnosis for the case was endodontic-periodontal lesion due to non-vitality and associated advanced periodontal destruction. The patient was treated with drainage of the periodontal abscess with adjunct antibiotics, phase I periodontal therapy, endodontic therapy, radiculoplasty, regenerative periodontal therapy, replacement of the missing right mandibular second molar, and long-term maintenance. Follow-up of the patient up to 9 months has been uneventful. Cases of advanced periodontal destruction typically show some degree of tooth mobility, which was absent in this case. The article discusses the tripod effect as well as the increased surface area for periodontal attachment provided by the additional root contributing to the non-mobility of the involved tooth.
Fulltext Early prediction of mandibular third molar eruption/impaction using linear and angular measurements on digital panoramic radiography: A radiographic study

Kaur R, Kumar AC, Garg R, Sharma S, Rastogi T, Gupta VV

Indian J Dent, 2016 Apr-Jun;7(2):66-9.
PMID: 27433048 DOI: 10.4103/0975-962X.184644

The impaction rate is higher for the third molars than for any other tooth in modern human population. This study was conducted with the aim to evaluate the validity of linear and angular measurements on the digital panoramic radiograph as a reference for early prediction of mandibular third molar eruption/impaction.
Fulltext Differential Diagnosis between Chronic versus Aggressive Periodontitis and Staging of Aggressive Periodontitis: A Cross-sectional Study

Ramachandra SS, Gupta VV, Mehta DS, Gundavarapu KC, Luigi N

Contemp Clin Dent, 2017 Oct-Dec;8(4):594-603.
PMID: 29326511 DOI: 10.4103/ccd.ccd_623_17

Background: Differentiating between chronic periodontitis (CP) and aggressive periodontitis (AgP) is challenging. The aim of this study was to assess the variations in diagnosis between CP versus AgP and the staging of AgP based on the disease-staging index for AgP among periodontists, specialists in oral medicine, and general dental practitioners (GDPs).

Materials and Methods: Fifteen cases diagnosed as either CP or AgP were included in a "case document" and sent electronically to 75 respondents. Case document included a detailed history with periodontal charting, clinical features, images, and radiographs for all the cases. Diagnosis and staging for the case (if diagnosed as AgP) were requested. A reordered case document (cases in a different sequence) was again sent to respondents after a gap of 1 month.

Statistical analysis: Descriptive statistics including frequency and percentage were calculated. Pearson's Chi-square test was used to analyze the data collected.

Results: For the "case document," 10.17% of the responses were different from those of the authors for diagnosis, whereas 4.48% of the responses were different from those of the authors for the staging of AgP. The agreement in the overall responses was in the range of 0.69-0.84, which was considered good. Comparison of the responses for diagnosis showed statistically significant (P = 0.009) difference between specialists in oral medicine and GDPs.

Conclusions: Variations exist among respondents regarding the diagnosis of CP versus AgP. Staging of AgP based on the listed criteria showed low variations.
Fulltext A New Diagnostic Criteria and Grading System of Rhino-Maxillary Mucormycosis based on Cone Beam Computed Tomographic Findings

Muley P, Garg R, Jambure R, Gupta VV, Mahesh KP, Thind G

Contemp Clin Dent, 2023;14(1):52-56.
PMID: 37250003 DOI: 10.4103/ccd.ccd_413_21

BACKGROUND: Mucormycosis is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. It is the need of the hour to diagnose and treat the increasing cases urgently.
AIM: The aim of this article is to study the common radiographic features of rhinomaxillary mucormycosis (RMM), find diagnostic criteria, and grade the disease according to the radiographic features.
SETTINGS: This study was conducted at Face Three-Dimensional Cone-Beam Computed Tomography (CBCT) Center, Aurangabad, Maharashtra.
MATERIALS AND METHODS: CBCT scans of 30 patients who were referred for CBCT scanning of suspected RMM were retrospectively evaluated for relevant radiological data.
RESULTS: The most common CBCT features of RMM were osteolytic lesions in alveolar bone, palate, nose and nasal cavity, and zygoma along with involvement of paranasal sinuses. About 76.66% of patients had a history of COVID-19 infection.
CONCLUSION: According to the collected data, the scans of probable rhinomaxillary mucormycosis were graded in three groups - mild, moderate, and severe. The goal of this article is to emphasize the most overlook diagnostic entity - CBCT and its significant importance in early diagnosis, treatment, and prognosis of RMM. Early diagnosis of RMM can save the patients from the extent of morbidity and mortality.