Journal of Nepalese Society of Periodontology and Oral Implantology <p>The Journal of Nepalese Society of Periodontology and Oral Implantology (JNSPOI) is the official, peer-reviewed journal of the Nepalese Society of Periodontology and Oral Implantology. The journal can also be found on its own <a href="" target="_blank" rel="noopener">website</a>.</p> Nepalese Society of Periodontology and Oral Implantology en-US Journal of Nepalese Society of Periodontology and Oral Implantology 2542-2863 <p>© Nepalese Society of Periodontology and Oral implantology (NSPOI)</p> <p>Licenced by <a href="" target="_blank" rel="noopener">Creative Commons Attribution 4.0 International License</a>.</p> Assessment of Labial Alveolar Bone Thickness in Maxillary Central Incisor using Cone Beam Computed Tomography <p><strong>Introduction: </strong>The maxillary anterior region is becoming a major concern due to its aesthetic relevance. The buccal bone thickness is important for implant placement, orthodontic treatment and restorative treatment.</p> <p><strong>Objective:</strong> To assess the thickness of alveolar bone in the maxillary central incisor using cone beam computed tomography (CBCT).</p> <p><strong>Methods:</strong> A cross-sectional observational study was conducted at Department of Dental Surgery, Bir Hospital where CBCT of 53 samples from July 2019 till December 2019, the archived CBCT images was assessed retrospectively. The thickness of the labial bone in a direction perpendicular to the outer surface of the tooth root was measured at a distance of 2 mm from the cementoenamel junction (CEJ). The measurement was taken thrice and the mean measurement was considered.</p> <p><strong>Results:</strong> The labial alveolar bone thickness in maxillary central incisor was found to be 0.55±0.27 mm at a distance of 2 mm from the CEJ. Only 2 (3.8%) of the samples had an alveolar thickness of &gt;1 mm. No statistically significant difference was found with respect to gender and age.</p> <p><strong>Conclusion:</strong> The average thickness of the labial alveolar bone in maxillary central incisor using cone beam computed tomography was found to be thin.&nbsp;</p> Shaili Pradhan Rejina Shrestha Ranjita Shrestha Gorkhali Pramod Kumar Koirala Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 2 6 10.3126/jnspoi.v5i1.38175 Relationship Between Body Mass Index and Chronic Periodontitis <p><strong>Introduction:</strong> Obesity is regarded as unnecessary body fat in ratio to lean body mass. Besides being an established risk factor for cardiovascular and other systemic diseases, obesity has been suggested to be a potential threat for periodontitis as well.</p> <p><strong>Objective:</strong> The objective of the study was to learn relationship between body mass index (BMI) and periodontal disease.</p> <p><strong>Methods: </strong>This analytical cross-sectional study was conducted at People’s Dental College from February 16 to April 15, 2021 after ethical approval. Seventy-two participants were selected conveniently who, on the basis of calculation of weight and height were allocated into two groups: Group A: participants with normal BMI, Group B: Obese/ overweight individuals. Plaque index, gingival index, periodontal pocket, and clinical attachment loss were recorded in both the groups to assess the periodontal disease status. On basis of findings, the two groups were statistically compared.</p> <p><strong>Results:</strong> The result showed clinical attachment loss was significantly higher (P &lt;0.001) in overweight/obese group than in normal BMI group (P =0 .001).</p> <p><strong>Conclusion:</strong> The findings of this study suggest that obesity and overweight can be a possible predisposing factor for periodontal disease.</p> Shreeya Aryal Ameena Pradhan Shilu Shrestha Surendra Man Shrestha Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 7 10 10.3126/jnspoi.v5i1.38176 Evaluation of Serum C-Reactive Protein, Plasma Fibrinogen, and Blood Leukocytes in Patients with Chronic Periodontitis <p><strong>Introduction:</strong> Periodontal health is crucial and indispensable element of general health. Epidemiologically, it has been linked with cardiovascular diseases with elevated acute phase reactant C-reactive protein, fibrinogen and rheological variables such as total leukocyte count and differential leukocyte counts, which are potential predictors of cardiovascular diseases.</p> <p><strong>Objective:</strong> To evaluate and compare cardiovascular disease-related biochemical markers in periodontally healthy subjects, and patients with moderate and severe chronic periodontitis.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted in patients attending Department of Periodontology and Oral Implantology, Chitwan Medical College and Teaching hospital, Bharatpur, Chitwan, Nepal from September 2019 to January 2021. A total of 81 individuals of both gender of which 27 periodontally healthy individuals, 27 diagnosed with moderate and 27 diagnosed with severe periodontitis based on gingival index, probing pocket depth and clinical attachment level were enrolled in a study. After which, peripheral blood samples were drawn and serum C-reactive protein, plasma fibrinogen, total leukocyte count and differential leukocyte counts were quantified using the turbidimetric immunoassay. Convenience sampling technique was done. Data was analysed in SPSS v.26.0.</p> <p><strong>Results:</strong> The mean serum levels of C-reactive protein, plasma fibrinogen, total leukocyte and differential leukocytes were found to be statistically (P value &lt;0.001) higher in severe and moderate periodontitis subjects compared to periodontally healthy subjects.</p> <p><strong>Conclusion:</strong> The increased levels of serum C-reactive protein, plasma fibrinogen, total leukocyte count, and differential leukocyte counts in chronic periodontitis contribute to the inflammatory burden of the individual potentially striking toward an increasing risk for cardiovascular events. &nbsp;</p> Shristi Kafle Erika Shrestha Sanjay Yadav Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 11 18 10.3126/jnspoi.v5i1.38177 Prevalence of Gingival Pigmentation and its Association with Gingival Biotype and Skin Colour <p><strong>Introduction:</strong> The facial appearance depends on several oral and extraoral factors including colour of facial skin and pigmentation of gingival epithelium. The colour of the gingiva varies among individuals and is thought to be associated with cutaneous pigmentation which ranges from light to dark brown or black colour.</p> <p><strong>Objective:</strong> To assess the prevalence of physiological gingival pigmentation, gingival biotype and their association with skin colur in Nepalese subjects visiting Kantipur Dental College and Hospital (KDCH).</p> <p><strong>Methods:</strong> This was an analytical cross-sectional study which was carried out from February 2020 to June 2020 in all patients of age-group 16 to 80 years visiting the Department of Periodontics at KDCH after ethical approval. Patients were recruited by convenience sampling and examined thoroughly to find out gingival biotype and extent of gingival pigmentation intraorally as well as skin colour extraorally.</p> <p><strong>Results:</strong> In this study, 210 patients were examined among which, 105 (50%) were males and 105 (50%) were females. Out of 210, 33 (15.7%) had pink tissue without pigmentation, 84 (40%) had pigmentation only in attached gingiva, 58 (27.6%) in attached gingiva and interdental papilla, 32 (15.2%) had diffuse pigmentation involving all parts of gingiva, 2 (1%) had in marginal gingiva only, and 1 (0.5%) in marginal gingiva and interdental papilla.</p> <p><strong>Conclusion:</strong> A strong association was found between gingival pigmentation and facial skin colour in present study (P &lt;0.001). Establishing the pattern of gingival pigmentation in Nepalese population will help to choose a specific depigmentation therapy that will harmonise with skin colour. &nbsp;</p> Arjun Hari Rijal Bhageshwar Dhami Nashib Pandey Deepa Aryal Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 19 25 10.3126/jnspoi.v5i1.38178 Pattern of Malocclusion in Patients undergoing Orthodontic Treatment at a Tertiary Care Teaching Hospital <p><strong>Introduction: </strong>Malocclusion can cause dental caries, periodontal disease and aesthetic problems. Malocclusion is most common dentofacial abnormality found in human population. However, the awareness for orthodontic treatment is increasing.</p> <p><strong>Objective:</strong> The aim of this research was to evaluate pattern of malocclusion in patients undergoing orthodontic treatment at Nobel Medical College Teaching Hospital of Biratnagar, Nepal.</p> <p><strong>Methods:</strong> Two hundred and eighty preoperative study casts (2018 Jun to 2020 Jun) of orthodontic patients aged from 12-55 years were selected from 680 patient’s records of department of orthodontics of Nobel medical college teaching hospital, Biratnagar. Standard protocol of Angle’s classification of malocclusion was used to classify malocclusion and its traits were recorded. Data were entered in Microsoft Excel and descriptive statistics were calculated.</p> <p><strong>Results:</strong> The prevalence of malocclusion were 59.65% (167) of Angle’s class I, 35.71% (100) of Angle’s class II and 4.64% (13) of Angle’s class III malocclusion. Among various attributes of malocclusion, deep bite was the most common trait (188, 67.14%). Increased overjet was found in 169 (60.35%) subjects. Crowding and spacing were found in 164 (58.57%), and 109 (38.92%) respectively.</p> <p><strong>Conclusion:</strong> Angle’s class I malocclusion is most prevalent malocclusion seen followed by Angle’s class II and Angle’s class III.</p> Nidhi Giri Anand Acharya Rajkumar Jha Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 26 28 10.3126/jnspoi.v5i1.38179 Occurrence of Extra Roots in Permanent Mandibular Molars: A Cone Beam Computed Topography Study <p><strong>Introduction:</strong> Permanent mandibular first and second molars may display extra roots namely radix entomolaris and radix paramolaris which may have implications in endodontic treatment outcome, if missed.</p> <p><strong>Objective:</strong> To evaluate the occurrence of extra roots in permanent mandibular first and second molars in a sample of Nepalese population.</p> <p><strong>Methods:</strong> This analytical cross-sectional study was done at Dhulikhel hospital. Convenience sampling technique was utilised for data collection of 773 CBCT images. Images from June 2018 to June 2020 were retrospectively screened for presence of fully erupted bilateral mandibular first and second molars. Presence of extra roots were recorded and laterality, gender, and racial variations were analysed by Fisher’s exact test and Chi-square test using SPSS v.20.</p> <p><strong>Results:</strong> For mandibular first molars, out of 517 patients, 65 (11.38%) had radix entomolaris: 38 (13.2%) female and 27 (9.54%) male. Among 38 females; occurrence was 21 (7.3%) bilateral, 16 (5.56%) unilateral right and 1 (0.34%) unilateral left side. Likewise, among 27 males, the occurrence was 15 (5.3%) bilateral, 6 (2.1%) unilateral right and 6 (2.1%) unilateral left side. Regarding races, 50 (14.6%) were Mongoloids and 15 (6.6%) were Aryans. No radix paramolaris was found in mandibular first molars. For mandibular second molars, out of 623 patients, radix entomolaris and paramolaris were observed in 0.8% and 0.48% respectively.</p> <p><strong>Conclusion:</strong> The overall occurrence of radix entomolaris in mandibular first and second molars was found to be 11.38% and 0.8%, respectively. Practitioners should be aware of these unusual variations to avoid iatrogenic mishap due to missed canal. &nbsp;</p> Anil Chakradhar Manisha Nepal Siras Pradhan Nisha Acharya Pratibha Poudel Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 29 33 10.3126/jnspoi.v5i1.38180 Variations in Maxillary Frenal Morphology in a Sample of Newari Children of Bhaktapur <p><strong>Introduction:</strong> Frenum attachments are fold of mucous membrane attaching the lips to alveolar mucosa and underlying periosteum. Aberrant location of attachment of maxillary labial frenum poses many clinical problems such as mucogingival problems and midline diastema.</p> <p><strong>Objective:</strong> The study was performed to assess the variations in morphology of maxillary labial frenum in a sample of Newari children of Bhaktapur, Nepal.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was performed enrolling 340 Newari children residing in Bhaktapur from August 14, 2020 to March 30, 2021. The study comprised both genders within age group of 6 to 16 years. The frenal attachment was recorded according to Mirko and Sewerin classification. The data was analysed with Statistical Package for the Social Sciences version 16 using descriptive statistics.</p> <p><strong>Results:</strong> In total, 340 Newari children participated in this study. The mucosal type was observed in 204 (60%) of the participants followed by gingival type 101 (29.7%). More than 80% of the participants had simple frenum (283, 83.2%). The frenum with nodule was present in 25 (7.4%) and frenum with appendix in 22 (6.5%) of study participants. Frenum with appendix was mostly present in males 18 (10.1%) than females 4 (2.5%).</p> <p><strong>Conclusion:</strong> Within the Newari children, the mucosal type of maxillary labial frenum was more prevalent followed by gingival type. The simple frenum was the most common type on basis of morphology. &nbsp;</p> Ujjwal Joshi Megha Pradhan Aastha Neupane Nita Lawaju Nirma Khadka Rajib Chaulagain Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 34 38 10.3126/jnspoi.v5i1.38181 Efficacy of Calcium Phosphate Composite Bone Graft in Treatment of Periodontal Intrabony Defects: Clinico-radiographic Study <p><strong>Introduction:</strong> Regeneration of periodontium is always difficult to achieve regardless of all advancement. In an attempt to refine, various materials have been tried and tested. The present study was carried out to evaluate regenerative potential of easy-graft CRYSTAL in intrabony defects, clinically, and radiographically.</p> <p><strong>Methods:</strong> This randomised split-mouth study was conducted at Rungta College of Dental Sciences and Research from 2015 October to 2015 October. Intrabony pockets more than 5 mm and radiographic evidence of vertical bone loss were selected from 15 patients having two sites each. The chosen sites were randomly divided into test sites: open flap debridement (OFD) with easy-graft CRYSTAL and control sites (OFD). The clinical parameters evaluated were Plaque Index, Gingival Index, Probing Pocket Depth, Relative Attachment Level, and Gingival Recession at baseline, three months, and six months postoperatively. Radiographic parameters recorded were Defect Fill and Percentage of Defect Fill at baseline, three months, and six months. Data were analysed in SPSS v.20.</p> <p><strong>Results: </strong>At six months, improved clinical and radiographic values were obtained compared to baseline. The plaque and gingival index showed statistically significant reduction. Both groups showed statistically significant reduction in mean probing pocket depth and gain in relative attachment level. Mean gingival recession score was increased in both the group but was not significant. There was significant increase in Defect Fill and Percentage of Defect fill in both groups with better bone fill in test group.</p> <p><strong>Conclusion:</strong> Easy-graft CRYSTAL is a potential regenerative material for the treatment of periodontal intrabony defects. &nbsp;</p> Shruti Bhatnagar Surangama Debnath Sriniwasa Tenkasale Siddeshappa Ramreddy K Yeltiwar Vikas Dewan Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 39 44 10.3126/jnspoi.v5i1.38182 The Impact of Dental Neglect on Oral Health Among 16-30-Year-Olds in Dhulikhel, Kavrepalanchok, Nepal <p><strong>Introduction:</strong> Oral health status is linked to oral health behaviour and dental neglect can be an important parameter for assessment of oral health status. Such evaluation will help in providing and planning appropriate health promotion activities to target population.</p> <p><strong>Objective:</strong> To assess socio-demographic variations in Dental Neglect (DN) and to determine the association between DN and oral health.</p> <p><strong>Methods:</strong> Analytical cross-sectional study done at dental hospital in Dhulikhel from September-November 2020. A sample of 327 aged 16-30 years were selected by convenience sampling technique. Demographic details along with DN were collected through the DN questionnaire. Both self-reported oral health and oral health status were assessed. Oral health status was determined by using the Oral Hygiene Index-simplified (OHI-S) and the Decayed Missing Filled index (DMFT).</p> <p><strong>Results:</strong> Majority 170 (52%) of the sample were from high DN group. A total of 187 (57.2%) of the participants rated their oral health status as all right. Higher number of participants were seen in the fair group of oral hygiene status. Significant correlations were found between education and OHI-S scores. Mean DMFT score was 3.6±1.6 which had higher mean Decayed (D) component as compared to the Missing (M) and Filled (F) components in the index.</p> <p><strong>Conclusion:</strong> Dental neglect is present among the study population and is associated with self-reported oral health status. Disparities were observed between the socio-demographic variables and DN. The DN Scale can be used in dental health promotion and also in evaluation of health promotion interventions. &nbsp;</p> Swagat Kumar Mahanta Manoj Humagain Chandan Upadhyaya Dilip Prajapati Ritesh Srii Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 45 48 10.3126/jnspoi.v5i1.38192 Bicuspidisation: Two is Better than None - A Case Report <p>A periodontally compromised tooth with severe furcation involvement may as well be retained of their roots rather than its removal in toto. Bicuspidisation (Premolarisation) is a surgical technique of sectioning mandibular molar roots with their respective crown portions followed by rehabilitation with fixed prosthesis in the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. The present case report demonstrates the successful management of grade III furcation involved mandibular molar by bicuspidisation followed by subsequent prosthodontic rehabilitation. It gives a better alternative to salvage a periodontally compromised tooth rather than opting for extraction.</p> Rebicca Ranjit Pratik Manandhar Soni Bista Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 54 56 10.3126/jnspoi.v5i1.38196 Microinvasive Oral Squamous Cell Carcinoma of Gingiva: An Enigma <p>Microinvasive oral squamous cell carcinoma (MIOSCC) of gingiva is an early stage relatively ‘thin’ tumour without invasion of deep tissues. A 55-year old male reported with the chief complaint of gum swelling in lower right back jaw region for one month. On examination, diffuse, unscrappable, white homogenous plaque extending from 35 to 48 was present with a firm, sessile gingival growth approximately eight millimetre in diameter. A provisional diagnosis of verrucous leukoplakia was made. Hence, biopsy was performed which confirmed MIOSCC and mild dysplasia for different sites. The patient is on regular follow-up and with no signs of recurrence.</p> Prashamsa Shakya Poojan Acharya Shivalal Sharma Ashish Shrestha Nisha Paunju Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 57 60 10.3126/jnspoi.v5i1.38198 Congenital Maxillary Double Lip: A Case Report <p>A double lip is an infrequent anomaly that may either be congenital or acquired. It commonly effects the upper lip with more predilection in males. Double lip may require surgical correction for aesthetic or masticatory reasons. Treatment includes excision of the mucosa and submucosal tissue that gives good result. A 19-year-old male presented with bulge under central portion of upper lip with no constriction. Surgical correction was done using an elliptical incision to remove excess mucosal tissues. Satisfactory aesthetic result was obtained with an uneventful healing.</p> Kashmira Pokhrel Sajeev Shrestha Shivalal Sharma Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 61 63 10.3126/jnspoi.v5i1.38199 ERRATUM of JNSPOI 2019 Volume 3 Issue 5 <p>The online version of the “Periodontal Status of Patients with Non -Insulin Dependent Diabetes Mellitus” available at: (Aryal S, Adhikari B, Agrawal R, Bhuju KG, Karki R. Periodontal Status of Patients with Non -Insulin Dependent Diabetes Mellitus. J Nepal Soc Perio Oral Implantol. 2019;3(5):2-5.) has been updated according to the respective authors’ request published in JNSPOI Vol. 5 No. 1 Issue 9.</p> <p>The following lines were found to be missing in the “METHODS” section: “The data collection was done from September 2018 to November 2018.”</p> <p>Dr. Sameer Aryal,1 Dr. Binod Adhikari,1 Dr. Reshu Agrawal,2 Dr. Krishna Gopal Bhuju,1 Dr. Riwas Karki1</p> <p>1Department of Dentistry, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital (SBH), Kathmandu, Nepal;</p> <p>2School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal</p> Sameer Aryal Binod Adhikari Reshu Agrawal Krishna Gopal Bhuju Riswas Karki Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 64 64 Periodontal Practice, Aerosol Production, and COVID Transmission: A Challenge or An Opportunity? <p>No abstract available.</p> Manoj Humagain Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-06-30 2021-06-30 5 1 1 1 10.3126/jnspoi.v5i1.34234 Gold Standards in Periodontics: A Review <p>The field of dentistry has evolved where people expect the best oral health care from specialists. Periodontics is that specialty of dentistry which deals with prevention, diagnosis, and treatment of diseases of the supporting tissues of the teeth. Almost half of the world's population is suffering from periodontal diseases. Periodontitis is the sixth most common chronic diseases in the world and along with dental caries, the most common cause of tooth loss. Through the effort of various professional organisations and research, various reliable products and treatment modalities have been developed. A gold standard is a benchmark which has been thoroughly tested and has reputation as a reliable modality. Some of established gold standards in periodontics include: periodontal probing, measurement of clinical attachment loss, bone loss, cone beam computed tomography, quantitative polymerase chain reaction tests, biopsies as investigative techniques; periodontal debridement, subepithelial connective tissue graft for recession coverage, lasers, autogenous bone in alveolar ridge augmentation prior to oral implantation, dental implant as reconstruction of missing dentition, and chlorhexidine mouth wash as treatment options. The objective of the review is to provide critical evaluation of the data available from existing studies in Periodontics which can help identify potential research areas to explore. &nbsp;</p> Pramod Kumar Koirala Shaili Pradhan Copyright (c) 2021 Nepalese Society of Periodontology and Oral implantology (NSPOI) 2021-07-01 2021-07-01 5 1 49 53 10.3126/jnspoi.v5i1.38194