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French D, Larjava H, Ofec R. Retrospective cohort study of 4591 Straumann implants in private practice setting, with up to 10‐year follow‐up. Part 1: multivariate survival analysis. Clin Oral Implants Res 2014; 26:1345-54. [DOI: 10.1111/clr.12463] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 12/14/2022]
Affiliation(s)
- David French
- Faculty of Dentistry Division of Periodontics University of British Columbia Vancouver BC Canada
- Private Practice Calgary AB Canada
| | - Hannu Larjava
- Faculty of Dentistry Division of Periodontics University of British Columbia Vancouver BC Canada
| | - Ronen Ofec
- Department of Statistics and Operations Research Tel‐Aviv University & Private Dental Practice Tel‐Aviv Israel
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Implant diameter and length influence on survival: interim results during the first 2 years of function of implants by a single manufacturer. IMPLANT DENT 2014; 22:394-8. [PMID: 23811719 DOI: 10.1097/id.0b013e31829afac0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the influence of implant length and diameter on implant survival. METHODS A retrospective cohort of 787 consecutive patients from 2 private practices between the years 2008 and 2011 had been evaluated. Patient demographics, site and implant characteristics, and time of follow-up were recorded from the medical files. RESULTS Overall, 3043 implants were investigated. Overall survival rate was 98.7% with 39 implant failures recorded. Survival rates for narrow- (<3.75 mm), regular- (3.75-5 mm), and wide- (>5 mm) diameter implants were 98.2%, 98.7%, and 98.5%, respectively (P = 0.89). Survival rates of short (<10 mm) and regular (10 mm and above) implants were 97% and 98.7%, respectively (P = 0.22). CONCLUSIONS Implant length and diameter were not found to be significant factors affecting implant survival during the first 2 years of function in the present investigation of this specific implant system by a single manufacturer. Further long-term follow-up studies are warranted because 2-years are only interim short-term results when dealing with dental implants.
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Chrcanovic BR, Albrektsson T, Wennerberg A. Diabetes and oral implant failure: a systematic review. J Dent Res 2014; 93:859-67. [PMID: 24928096 DOI: 10.1177/0022034514538820] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative infections, and marginal bone loss. An electronic search without time or language restrictions was undertaken in March 2014. The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included clinical human studies. The search strategy resulted in 14 publications. The I (2) statistic was used to express the percentage of total variation across studies due to heterogeneity. The inverse variance method was used for the random effects model when heterogeneity was detected or for the fixed effects model when heterogeneity was not detected. The estimates of an intervention for dichotomous outcomes were expressed in risk ratio and in mean difference in millimeters for continuous outcomes, both with a 95% confidence interval. There was a statistically significant difference (p = .001; mean difference = 0.20, 95% confidence interval = 0.08, 0.31) between diabetic and non-diabetic patients concerning marginal bone loss, favoring non-diabetic patients. A meta-analysis was not possible for postoperative infections. The difference between the patients (diabetic vs. non-diabetic) did not significantly affect implant failure rates (p = .65), with a risk ratio of 1.07 (95% confidence interval = 0.80, 1.44). Studies are lacking that include both patient types, with larger sample sizes, and that report the outcome data separately for each group. The results of the present meta-analysis should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.
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Affiliation(s)
- B R Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - T Albrektsson
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden Department of Biomaterials, Göteborg University, Göteborg, Sweden
| | - A Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Rasperini G, Siciliano VI, Cafiero C, Salvi GE, Blasi A, Aglietta M. Crestal Bone Changes at Teeth and Implants in Periodontally Healthy and Periodontally Compromised Patients. A 10-Year Comparative Case-Series Study. J Periodontol 2014; 85:e152-9. [DOI: 10.1902/jop.2013.130415] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meyle J, Gersok G, Boedeker RH, Gonzales JR. Long-term analysis of osseointegrated implants in non-smoker patients with a previous history of periodontitis. J Clin Periodontol 2014; 41:504-12. [DOI: 10.1111/jcpe.12237] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Joerg Meyle
- Department of Periodontology; Dental School Justus-Liebig-University of Giessen; Giessen Germany
| | | | - Rolf-Hasso Boedeker
- Institute of Medical Statistics; Faculty of Medicine Justus-Liebig-University of Giessen; Giessen Germany
| | - José Roberto Gonzales
- Department of Periodontology; Dental School Justus-Liebig-University of Giessen; Giessen Germany
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Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Smoking and the risk of peri-implantitis. A systematic review and meta-analysis. Clin Oral Implants Res 2014; 26:e62-e67. [PMID: 24438442 DOI: 10.1111/clr.12333] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to assess the role of smoking as a risk factor for peri-implantitis. MATERIAL AND METHODS Six electronic databases and a manual search resulted in 5876 unique publications. After selection, only seven studies were included in the systematic review. Dichotomous data were expressed as risk ratios (RRs) and 95% confidence intervals (CIs). A generic inverse variance statistical model was used. Due to the expected interstudy heterogeneity, a random effect model was used for both data types. Heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The pooled effect was considered significant for a P-value <0.05. RESULTS The implant-based meta-analysis revealed a higher and significant risk of peri-implantitis in smokers (RR: 2.1, 95% CI: 1.34-3.29, P = 0.001) compared with nonsmokers, but the patient-based meta-analysis did not reveal any significant differences for risk of peri-implantitis in smokers (RR: 1.17, 95% CI: 0.78-1.75, P = 0.46). No evidence of significant heterogeneity was detected for the two analyses (χ(2) = 0.64, P = 0.89; I(2) = 0% and χ(2) = 2.44, P = 0.30; I(2) = 18%, respectively, for implant- and patient-based meta-analyses). CONCLUSION There is little evidence that smoking is a risk factor for peri-implantitis. However, given the low number of included studies, future studies are needed to confirm these results.
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Affiliation(s)
- Fabrizio Sgolastra
- School of Dentistry, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ambra Petrucci
- School of Dentistry, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Severino
- School of Dentistry, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Gatto
- School of Dentistry, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Monaco
- School of Dentistry, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clin Oral Implants Res 2013; 26:e8-e16. [PMID: 24382358 DOI: 10.1111/clr.12319] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of the present systematic review and meta-analysis was to assess the role of periodontal disease as a risk factor for implant loss, peri-implantitis and implant-bone loss. MATERIALS AND METHODS Six electronic database and a manual search resulted in 7391 unique publications; after selection only 16 studies were included in systematic review. Dichotomous data were expressed as risk ratio (RR) and 95% confidence interval (CI), while continuous data were expressed as standardized mean difference (SMD). Due to the expected inter-study heterogeneity, a random effect model was used for both type of data. The pooled effect was considered significant for a P < 0.05. RESULTS Meta-analysis revealed that an higher and significant risk for implant loss was present in patients affected by PD (RR: 1.69, 95% CI: 1.31-2.17, P < 0.0001). A higher and significant IBL was present in patients with periodontal disease, when compared with patients periodontally healthy (SMD: 0.38, 95% CI: 0.18-0.58, P = 0.0002). Patients periodontally compromised showed an increased risk of PI, when compared with patients without periodontitis (RR: 2.17, 95% CI: 1.51-3.12, P < 0.0001) No evidence of significant heterogeneity was detected for the three outcomes. CONCLUSION Strong evidence suggests that periodontitis is a risk factor for implant loss; moderate evidence revealed that periodontitis is a risk factor for peri-implantitis and that patients with periodontitis have higher implant-bone loss.
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Affiliation(s)
- F Sgolastra
- Department of Life Health and Environmental Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy
| | - A Petrucci
- Department of Life Health and Environmental Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy
| | - M Severino
- Department of Life Health and Environmental Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy
| | - R Gatto
- Department of Life Health and Environmental Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy
| | - A Monaco
- Department of Life Health and Environmental Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy
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58
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Lagervall M, Jansson LE. Treatment Outcome in Patients With Peri-Implantitis in a Periodontal Clinic: A Retrospective Study. J Periodontol 2013; 84:1365-73. [DOI: 10.1902/jop.2012.120555] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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59
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60
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Roccuzzo M, Bonino L, Dalmasso P, Aglietta M. Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res 2013; 25:1105-12. [PMID: 23865554 DOI: 10.1111/clr.12227] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare the long-term outcomes of sandblasted and acid-etched (SLA) implants in patients previously treated for periodontitis and in periodontally healthy patients (PHP). MATERIAL AND METHODS One hundred and forty-nine partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their periodontal condition: PHP, moderately periodontally compromised patients (PCP) and severely PCP. Implants were placed to support fixed prostheses, after successful completion of initial periodontal therapy. At the end of active periodontal treatment (APT), patients were asked to follow an individualized supportive periodontal therapy (SPT) program. Diagnosis and treatment of peri-implant biological complications were performed according to cumulative interceptive supportive therapy (CIST). At 10 years, clinical and radiographic measures were recorded by two calibrated operators, blind to the initial patient classification, on 123 patients, as 26 were lost to follow up. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was registered. RESULTS Six implants were removed for biological complications. The implant survival rate was 100% for PHP, 96.9% for moderate PCP and 97.1% for severe PCP. Antibiotic and/or surgical therapy was performed in 18.8% of cases in PHP, in 52.2% of cases in moderate PCP and in 66.7% cases in severe PCP, with a statistically significant differences between PHP and both PCP groups. At 10 years, the percentage of implants, with at least one site that presented a PD ≥ 6 mm, was, respectively, 0% for PHP, 9.4% for moderate PCP and 10.8% for severe PCP, with a statistically significant difference between PHP and both PCP groups. CONCLUSIONS This study shows that SLA implants, placed under a strict periodontal control, offer predictable long-term results. Nevertheless, patients with a history of periodontitis, who did not fully adhere to the SPT, presented a statistically significant higher number of sites that required additional surgical and/or antibiotic treatment. Therefore, patients should be informed, from the beginning, of the value of the SPT in enhancing long-term outcomes of implant therapy, particularly those affected by periodontitis.
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Affiliation(s)
- Mario Roccuzzo
- Department of Maxillofacial Surgery, University of Torino, Torino, Italy; Private Practice, Torino, Italy
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61
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Matarasso S, Iorio Siciliano V, Aglietta M, Andreuccetti G, Salvi GE. Clinical and radiographic outcomes of a combined resective and regenerative approach in the treatment of peri-implantitis: a prospective case series. Clin Oral Implants Res 2013; 25:761-7. [DOI: 10.1111/clr.12183] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Sergio Matarasso
- Department of Periodontology; University Federico II; Naples Italy
| | | | - Marco Aglietta
- Department of Periodontology; University Federico II; Naples Italy
| | | | - Giovanni E. Salvi
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
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Implants in bone: part I. A current overview about tissue response, surface modifications and future perspectives. Oral Maxillofac Surg 2013; 18:243-57. [PMID: 23435578 DOI: 10.1007/s10006-013-0398-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of study paper is to present an overview of osseointegration of dental implants, focusing on tissue response, surface modifications and future perspective. DISCUSSION Great progress has been made over the decades in the understanding of osseous peri-implant healing of dental implants, leading to the development of new implant materials and surfaces. However, failures and losses of implants are an indicator that there is room for improvement. Of particular importance is the understanding of the biological interaction between the implant and its surrounding bone. CONCLUSION The survival rates of dental implants in bone of over 90 % after 10 years show that they are an effective and well-established therapy option. However, new implant materials and surface modifications may be able to improve osseointegration of medical implants especially when the wound healing is compromised. Advanced techniques of evaluation are necessary to understand and validate osseointegration in these cases. An overview regarding the current state of the art in experimental evaluation of osseointegration of implants and implant material modifications will be given in Part II.
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63
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Sadowsky SJ, Bedrossian E. Evidenced-Based Criteria for Differential Treatment Planning of Implant Restorations for the Partially Edentulous Patient. J Prosthodont 2013; 22:319-29. [DOI: 10.1111/jopr.12014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Steven J. Sadowsky
- Department of Integrated Reconstructive Dental Sciences; University of the Pacific Arthur A. Dugoni School of Dentistry; San Francisco CA
| | - Edmond Bedrossian
- Department of Oral Surgery; University of the Pacific Arthur A. Dugoni School of Dentistry; San Francisco CA
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64
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Fardal Ø, O’Neill C, Gjermo P, Fardal E, Sandvik L, Hansen BF, Linden GJ. The Lifetime Direct Cost of Periodontal Treatment: A Case Study From a Norwegian Specialist Practice. J Periodontol 2012; 83:1455-62. [DOI: 10.1902/jop.2012.110689] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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65
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Yoshino K, Kariya N, Namura D, Noji I, Mitsuhashi K, Kimura H, Fukuda A, Kikukawa I, Hayashi T, Yamazaki N, Kimura M, Tsukiyama K, Yamamoto K, Fukuyama A, Hidaka D, Shinoda J, Mibu H, Shimakura Y, Saito A, Ikumi S, Umehara K, Kamei F, Fukuda H, Toake T, Takahashi Y, Miyata Y, Shioji S, Toyoda M, Hattori N, Nishihara H, Matsushima R, Nishibori M, Hokkedo O, Nojima M, Kimura T, Fujiseki M, Okudaira S, Tanabe K, Nakano M, Ito K, Kuroda M, Takiguchi T, Fukai K, Matsukubo T. Influence of age on tooth autotransplantation with complete root formation. J Oral Rehabil 2012; 40:112-8. [DOI: 10.1111/joor.12012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2012] [Indexed: 11/30/2022]
Affiliation(s)
- K. Yoshino
- Department of Epidemiology and Public Health; Tokyo Dental College; Chiba Japan
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - N. Kariya
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - D. Namura
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - I. Noji
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | | | - H. Kimura
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - A. Fukuda
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - I. Kikukawa
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - T. Hayashi
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - N. Yamazaki
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Kimura
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | | | - K. Yamamoto
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - A. Fukuyama
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - D. Hidaka
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - J. Shinoda
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - H. Mibu
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | | | - A. Saito
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - S. Ikumi
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - K. Umehara
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - F. Kamei
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - H. Fukuda
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - T. Toake
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | | | - Y. Miyata
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - S. Shioji
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Toyoda
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - N. Hattori
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | | | | | | | - O. Hokkedo
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Nojima
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - T. Kimura
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Fujiseki
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - S. Okudaira
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - K. Tanabe
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Nakano
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - K. Ito
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - M. Kuroda
- Kyushikai, Kuroda Dental Clinic; Tokyo Japan
| | - T. Takiguchi
- Department of Health Informatics; Niigata University of Health and Welfare; Niigata Japan
| | - K. Fukai
- Fukai Institute of Health Science; Saitama Japan
| | - T. Matsukubo
- Department of Epidemiology and Public Health; Tokyo Dental College; Chiba Japan
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Dhingra K. Oral rehabilitation considerations for partially edentulous periodontal patients. J Prosthodont 2012; 21:494-513. [PMID: 22681519 DOI: 10.1111/j.1532-849x.2012.00864.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.
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Affiliation(s)
- Kunaal Dhingra
- Department of Periodontics, NSVK. Sri Venkateshwara Dental College, Bangalore, Karnataka, India.
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