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1. Dr.Yogender Singh
Evaluation And Comparison of Healing of Periodontal Interdisciplinary Periodontics
Flaps when Approximated with Silk Sutures and N-
Butylcyanoacrylate: A Clinico- Histological Study
Guide: Dr. H.S. Grover
Guide: Dr. Mini Saluja
Co-guide: Dr. H.S. Grover
Aim: To assess and compare plaque accumulation and Interdisciplinary Dentistry can be described as the mutual
gingival tissue response to N-butyl-2-cyanoacrylate & permeation of various dental specialties accompanied by
silk suture, when used for approximation of flap after expansion of the scope of each. Interdisciplinary Dentistry is
periodontal surgery. Materials and Methods: A total of marked by the application of perspectives, concepts and
30 subjects diagnosed with chronic Periodontitis were methods that go beyond the limits of individual specialties.
included in the study. A split mouth design was Interdisciplinary Dentistry may either be interpreted in a very
employed, in which quadrants were randomly assigned narrow sense as the actual fusion of specialties, or in a wider
as control group (silk suture used for flap sense as a multidisciplinary phenomenon in which
approximation) and the test group (NBC used for flap independent specialties work jointly to resolve a problem,
approximation). Clinical evaluation was done at each from its own conceptual viewpoint. Periodontal health is
baseline, 1st, 3rd & 6th weeks and histological the "sine qua non" a prerequisite, of successful,
assessment was done by dividing the subjects into 3 comprehensive dentistry2.The normal periodontium provides
groups of 10 each i.e. A, B and C. Results: A highly the support necessary to maintain teeth in function. It consists
statistically significant increase in Plaque scores and of four principal components: Gingiva, Periodontal ligament,
Gingival Index scores was found at first week (p< 0.001) Cementum and Alveolar bone. Essentially these structural
in silk group as compared to cyanoacrylate group. components must be in excellent health in order to provide
Although gingival inflammation was found to be successful periodontal support. This library dissertation
significantly more in silk group up to third week clinically discusses the importance of interdisciplinary approach for
as well as histologically, but at sixth week no difference treatment planning so as to preserve biological environment
was evident between two groups. Conclusion: Thus, it while maintaining or restoring aesthetics, comfort and
was concluded that N-butyl-2-cyanoacrylate leads to the function. The real art of dentistry is to co-ordinate and
lesser plaq9ue accumulation and a better gingival tissue interface these perspectives and provide the best quality of
response as compared to silk suture, during initial phase care to the patient.
of healing.
Keywords: Periodontal Surgery, N-Butyl-2-
multidisciplinary, periodontitis
Cyanoacrylate, Silk Suture.

2. Dr.Rohit Saini
Correlation between Periodontitis and Renal Function Immunology of periodontal diseases
in Systemically Healthy Patients
Guide: Dr. H. S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Anshu Blaggana
Introduction: Periodontal disease is a microbial-induced Immunity is divided into 2 parts - the Innate and Adaptive
infection, so there exists a substantial infectious burden responses. The innate immune system relies upon limited
for the entire body by the release of bacteria, bacterial receptors to detect invading pathogens, but compensates by
toxins, and other inflammatory mediators into the targeting conserved microbial components that are shared by
bloodstream. Recent reports also suggest the large groups of pathogens. Various cells involved in innate
periodontitis may be associated with reduced renal immune responses include neutrophils, macrophages,
function which ultimately leads to chronic kidney dendritic cells, mast cell, neutrophils, natural killer (NK) cells
disease which is a progressive loss in renal function.
and eosinophils.The innate immune responses are the first line Materials and Methods: The subjects for the study were of defense against invading pathogens. They are also required
selected with age ranging from 30 – 60 years (mean age to initiate specific adaptive immune responses. The second
45.6 ± 10.2 years) of both sexes who were undergoing kind of protection is adaptive immunity which develops
routine blood examination. They were then assessed for throughout our lives. It uses two basic strategies- Humoral
their periodontal health status. To assess the kidney immunity which works to eliminate antigens that are
function, four markers were recorded in both groups extracellular and Cellular immunity which deals with antigen
including; serum creatinine, serum urea, serum uric acid residing within a host cell.
and estimated glomerular filtration rate. The results of T- and B-lymphocytes are the main self-defense weapons of
kidney function tests and eGFR were then compared in the adaptive immune system. Adaptive immunity relies upon a
both the groups with appropriate statistical analysis and clonal system with each T cell and B cell expressing its own
conclusions were drawn.
unique receptor. Results: All the clinical parameters were highly Keywords: Innate immunity, Adaptive Immunity,
significant on comparison between cases and controls. Dendritic cells, Langerhans cells, DAMPs, CD8
with cytotoxic T-cell mediated immunity, CD4 T- cell
periodontitis did not suffer any alteration in levels of
indicators of kidney function relative to control group mediated immunity.
and furthermore these markers stayed within their
normal range in both groups suggesting that severe
periodontitis does not affect renal function. Within the
limitations of study and methodology utilized, chronic
periodontitis is not associated with any alteration in
kidney function in the studied population.
Discussion: In our study we did not include patients with
established kidney disease but rather assessed kidney
function in systemically healthy patient with or without
periodontitis. The results are coinciding with published
data showing that dogs having mild ,moderate or severe
periodontitis in dogs had normal renal function,
assessed by serum levels of creatinine, urea and by
urine density. This study does not include patients with
established kidney disease but rather assessed kidney
function in systemically healthy patient with or without
function, eGFR,
3. Dr. Shweta Dikshit
Whole Saliva Levels of Some Inflammatory Mediators-
(Myeloperoxidase, Alkaline Phosphatase, Interleukin 1 periodontology
Β) Pre And Post Phase I Therapy In Subjects With
Chronic Periodontitis: A Clinico-Biochemical Study .

Guide: Dr. Anshu Blaggana
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover, Dr. Veenu Hans Madan, Dr.
Megha Maheshwari

Objective: Presently oral examination of a patient is carried
Background: A major factor for tooth loss observed
out by three methods –clinical or visual examination, globally as well as in Indian adults is periodontitis. periodontal examination and radiography. However each of Hence identification and treatment of the disease these has their own limitations. Optical coherence tomography process at an early stage is imperative to prevent it. (OCT) is a3dimensional,non-invasive imaging modality that Salivary biomarkers are an early indicator of disease produces high resolution images in cross section through in process and this paper aims to establish their validity homogeneous samples such as biological tissue. Colston et al by evaluating the whole saliva levels of some in 1998 first used OCT in dentistry. inflammatory mediators viz., Myeloperoxidase, Alkaline Method: OCT is of 3 main types- Time domain OCT (TD-OCT),
Phosphatase and Interleukin1β ,pre and post Phase I Fourier domain OCT (FD-OCT) and Parallel OCT. There are therapy in subjects with chronic periodontitis. various scanning procedures depending on the engine Materials And Methods: Thirty subjects with chronic
performing the imaging and its application, A scan, B scan, C periodontitis provided saliva at baseline (before Phase I scan and T scan. It has various uses in non-medical fields, therapy) and 3weeks and 8 weeks post treatment. medical field and dentistry. The dental optical coherence Clinical parameters viz., Plaque index (PI), Pocket tomography (OCT) system aims to produce images of dental probing depth (PPD), Bleeding on probing (BOP) and microstructure In vivo,that help in assessing the qualitative Clinical Attachment loss (CAL) were recorded along and quantitative status of oral tissue health. This review has with biochemical assessment of the saliva samples taken into consideration all these imaging modalities. collected at all pre designated time intervals employing Conclusion: Through these images, the clinically anatomical
ELISA. Results: Participants with periodontitis
structures can be correlated such as location of the soft tissue demonstrated significantly higher plaque index (PI), attachment, morphological changes in gingival tissue, tooth Pocket probing depth (PPD), Bleeding on probing (BOP) decay, and structural integrity of dental restorations. and Clinical Attachment loss (CAL) at Baseline and a Keywords: Dental, Medical, OCT Periodontitis,
significant drop in these parameters 3 and 8 weeks post-treatment. ( p<0.001). Following Phase I therapy ,
mean biomarker concentrations decreased significantly
from baseline , p <0.001).Conclusions: Salivary
Interleukin1β significantly decreased in chronic
periodontitis patients post Phase I therapy thus
indicating a positive correlation between the various
periodontal parameters and the currently available
salivary diagnostics.
periodontitis, saliva.

4. Dr. Nitin Kaushik
Association Of Maternal Periodontitis In Women Evidence based periodontology
Delivering Pre- Term, Low Birth Weight and Pre-Term
Low Birth Weight Infants- A Cross Sectional Study

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Akshay Munjal
Dentistry as a profession has developed a store of Objective: It has been suggested that periodontal specialized knowledge that serve as a basis of professional
disease is an important risk factor for preterm low birth decision making. The world in which we learn and practice
weight (PLBW). The purpose of this study was to dentistry is changing at an astonishing rate. Our desire to
determine the association of maternal periodontitis keep upto date is often tinged with dilemma whether
with preterm birth (PB), low birth weight (LBW) and pre something new is better than our current strategy.1 Now the
term low birth weight infants.(PTLBW). Materials and practice of dentistry is becoming more complex and
Methods: Pregnant women (n=500) aged 18-46 were challenging because of the continually changing in dental
examined and enrolled by visiting hospital's maternity materials and equipments, an increasing litigious society, an
wards. The periodontal examination and birth weight of increase
in emphasis of continuing professional the neonate were recorded within 72 hours after development , In keeping abreast with advances in delivery. Probing pocket Depth and Clinical Attachment dentistry, we are inundated with information about new techniques, tests, procedures, materials and products. Two were recorded for all teeth present in the dentition phenomena - information explosion and consumer except third molars. Results: This study showed that movement, both of which are fortified by the extraordinary
when periodontal health status of the mothers was advancement of the internet, are coming together to change assessed based on maternal age The total incidence of the way all businesses including health care will function in periodontitis and health were 424 (84.8%) and 76 the future. (15.2%) respectively. The incidence of 14 pre term birth Keywords: evidence based, periodontitis,
neonates were (18.4%) mothers delivering pre term
neonates were periodontally healthy and 110 (25.9% ) advances in dentistry
suffered from some form of periodontal disease, the
incidence of low birth weight were according to
maternal age were 55 (72.4%) mothers were having no
periodontal disease whereas 258 (60.8%) suffered from
some form of periodontal disease and also the incidence
of pre term and low bith weight neonates were 7 (9.2%)
mothers delivering pre term low birth weight neonates
were having no periodontal disease whereas 56 (13.2 %)
suffered from some form of periodontal disease.
Conclusion: Statistical analysis showed there was no
statistical significance found in adverse pregnancy
outcomes in mothers whether they suffered from
periodontal diseases or not but clinically there was a
weak association between periodontitis and adverse
pregnancy outcomes. This may be due to non suitable
periodontal case definition used in our study and the
risk of confounders such as socioeconomic status,
nutrition, obesity, exercise, stress etc.
Keywords: pre-term neonates, low birth
weight neonates, periodontitis, pregnancy

5. Dr. Himanshu Deswal
Efficacy Of Diode Laser As Adjunct To Scaling And Root Phytotherapeutic and naturopathic adjunct therapies in
Planing in the Treatment of Chronic Periodontitis: A periodontology
Comparative Clinical Study

Guide: Dr. Amit Bhardwaj
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Background: In present study the use of Diode Laser The oral cavity is the principal pathway through which the (800-980nm) with or without conventional scaling and body is exposed to external environment and considered to be root planing (SRP) was compared for treatment of the gateway of infection. Oral diseases continue to be a major periodontal pockets. health problem worldwide. Dental caries and periodontal Methods: 40 patients with Probing Pocket Depth of 5 to diseases are among the most important global oral health 9 mm were included. In a split-mouth design, each site problems, although conditions such as oral and pharyngeal was allocated to a treatment group: 1) SRP and 2) cancers and oral tissue lesions are also significant health SRP+Diode Laser. Clinical parameters of pocket probing concerns. Despite general advances in the overall health status depth (PPD), bleeding on probing (BOP), and clinical of the people living in industrialized countries, including oral attachment level (CAL) were evaluated at baseline, 1 and dental health. Naturopathy system of Medicine is a system month and 3 months after treatment. Inter-group and of healing science stimulating the body's inherent power to intra-group statistical analyses were performed. regain health. Naturopathy is a call to "Return to Nature" and Results: PPD was decreased for both the groups (P to resort to simple way of living in harmony with the self, <0.001) at 1 month and 3months after treatment. BOP society and environment. Naturopathic dentists believe that also decreased for both SRP and SRP+Diode Laser group. healthy teeth and gums are reflective of a healthy body, and There was significant gain in CAL for SRP+Diode Laser (P vice versa. Naturopathic dentistry will treat the symptoms of <0.0001) at 1 month and 3 months post-operatively. unhealthy teeth but also look to identify and then treat the Conclusion: Non-surgical periodontal treatment with cause of the affliction.
Diode laser is useful as an adjunctive treatment to SRP Keyword: Phytotherapeutic, Naturopathic, Adjunct
for reduction of pocket depth and for the improvement Therapies,Periodontology
clinical attachment level as well Periodontitis patients. Keywords:
Therapy, Scaling And Root Planing.
6. Dr. Pearl Bhardwaj
Assessing the antimicrobial efficacy ( against Periodontal Splinting
Prophyromonas gingivalis) of Green tea brewed at
various concentrations, time combinations and its
comparison with various commercially available

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Mini Saluja, Dr. Akshay Munjal
Introduction: Periodontal disease has an infectious Tooth Mobility is the movement of a tooth in a horizontal or
inflammatory etiology. Several periopathogens have vertical plane of space. Trauma from occlusion could be a
been identified to which the destruction is attributed. major reason for tooth mobility. Occlusion and its relationship
Of these Porphyromonas gingivalis has several to periodontal disease has been and remains an area of
pathogenic factors. Camellia sinensis is the plant whose considerable controversy. Occlusal considerations also should
leaves are used to produce green tea. The polyphenols, be taken into account before splinting the teeth.
a large group of plant chemicals that includes the Management of mobile teeth present as a perplexing problem,
catechins, are responsible for the antimicrobial benefits more so when underlying cause is not properly defined.
attributed to green tea. Aims and Objective: To test the Treatment should be planned so that the occlusal forces are
anti- microbial efficacy of various concentrations of transmitted to those teeth with greatest bone support.
green tea brewed for various time intervals at 90° C Contemporary treatment therapies aim at ensuring the arrest
gingivalis. of the periodontal disease progression and the regeneration of Material and Methods: Green tea was measured with lost structures A wide variety of techniques have been
an electronic weighing machine and brewed at 90° C to proposed for successful splinting of teeth. The method chosen
obtain fifteen concentration time combinations. Pure should be the simplest, least expensive, least time consuming
culture of Porphyromonas gingivalis was obtained from to construct, should be esthetically acceptable to the patient
subgingival plaque samples by inoculating them on a and should meet the needs of the individual. Effective personal
culture media specific for Porphyromonas gingivalis. The plaque control, professional caries risk assessment and
antimicrobial properties of green tea were tested using periodontal maintenance are crucial to the longevity of the
paper disk diffusion. The mean values of zones of splint and health of the splinted teeth. Splint therapy offers
inhibition thus obtained were used for comparing the numerous therapeutic advantages ranging from increased
antibacterial properties of brewed green tea with periodontal resistance to occlusal relationship correction.
Various Although function has been the paramount and most critical preventive protocols have been advised for control of issue when placing a periodontal splint, esthetics now also play
periodontitis. Inspite of their benefits, their chemical an important role. Regardless of the type of splint design,
nature offers many drawbacks such as microbial material, and method of fabrication, it must provide good
resistance and opportunistic infections. Thus they access to oral hygiene, rigid fixation, and also elimination of
cannot be advised for a long period of time. Green tea occlusal trauma by providing force distribution and resistance
on the other hand is consumed on daily basis by to occlusal overload.
patients and instead of drawbacks offers additional Keywords:
health benefits. As green tea provides similar benefits as occlusion
these commercially available mouthwashes, in plaque
reduction, it is a breakthrough in preventive oral health
antimicrobial, paper disc diffusion

7. Dr. Saumya Saluja
Comparative evaluation of radiographic mandibular Periodontium meet restoration: A friend or an enemy
bone quality, bone mass quality and clinical
periodontal parameters in Pre- and post menopausal

Guide: Dr. Anshu Blaggana
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover, Dr. Amit Bhardwaj
Introduction: Osteoporosis is defined as a systemic A healthy Periodontium constitutes the foundation for a
skeletal disease characterized by low bone mass and successful restorative as well as prosthetic treatment.
micro architectural deterioration of bone tissue, this Therefore, we come across the concept of "Periodontium and
generalized bone resorption throughout the body Restoration". Knowledge in periodontology has evolved at a
usually affects elderly women i.e. during menopause. very rapid pace in the past decade, including new knowledge
The present study involves the assessment of about the structure and function of periodontal tissues. This
mandibular bone in terms of both quantity and quality work discusses regarding the requirement of successful
based on the study done by utilizing radiologic and integration of periodontal and restorative dentistry for both
clinical parameters.

natural teeth and prosthesis as they require knowledge and
application of both mechanical and biological principles. All
Aims & Objectives: To study the periodontal status and phases of clinical dentistry are intimately related to a
prevalence of periodontal status in pre- and post common objective of preservation and maintenance of the
menopausal women alongwith the bone mass and natural dentition in health. In an integrated multidisciplinary
quality in pre- and post menopausal women. Thereby approach to dental care, it is logical that periodontal
establishing the correlation between periodontal treatment precede final restorative procedures. For
status and bone mineral density (osteoporosis) in pre- restorations to survive long-term, the periodontium must
and post menopausal women.

remain healthy so that the teeth are maintained. For the
periodontium to remain healthy, restorations must be
Materials and Methods: 150 females will be selected critically managed in several areas so that they are in
within an age range of (22-65 years) reporting to the harmony with their surrounding periodontal tissues. The
Department of Periodontology. Female patients, based integration of periodontal considerations with restorative

periodontal planning is now the standard of care. Direct and frequent
assessment, females will be divided into four groups communication between the periodontist and restorative
and will be subjected to both clinical and periodontal dentist is a prerequisite for predictable and satisfactory
parameters. Panoramic radiographs will be taken for results.
all the subjects using the same Orthopantomograph. Key words: Dentist, Periodontium, periodontist,

All the findings will be subjected to statistical analysis
Key words: pre menopausal post menopausal,

8. Dr.Parul
Clinical and radiographic evaluation of 1% Metformin Biostatistics in periodontology
gel with platelet rich fibrin in mandibular class II (In progress)
furcation defects.

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co- guide: Dr. Veenu Hans Madan
Platelet-rich fibrin (PRF) is a second
generation platelet concentrate that releases various
growth factors that promote tissue regeneration.
Metformin(MF), a member of biguanide group, has
been shown to facilitate osteoblast differentiation and
thus may exhibit a favourable effect on alveolar bone.
Aim: The current study is designed to assess the efficacy
of open flap debridement(OFD) with PRF and PRF+1%
MF gel in the treatment of mandibular Grade II furcation
defects in patients with chronic periodontitis. Method:
A total of 30 sites with Grade II furcation in mandibular
molars will be categorized in two equal groups for
surgical procedure.OFD with PRF and OFD with 1%MF
gel+PRF. Clinical parameters as site specific PI, sulcus
bleeding index (SBI), PD from the gingival margin,
relative vertical attachment level (RVAL) and relative
horizontal attachment level (RHAL) along with gingival
marginal level (GML) at baseline and 6months
postsurgery.RVG image (Sirona® Germany).will be used
for comparative evaluation of defect at baseline and 6
months. Results: Statistical analysis will be carried out
using appropriate test via a suitable software after
collection of all the data.
Keywords: Metformin, Platelet Rich Fibrin,
Alveolarbone, Osteoblast differentiation.

9 Dr. Tabeyadeep Kaur
Chronic Supportive Periodontal Therapy
Periodontitis and Sleep Deprivation and evaluation of (in progress)
this inter-relationship with Stress Hormone (Cortisol)
Levels: A Clinico-immunological study

Guide: Dr. Amit Bhardwaj
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Objectives :
to explore the association between Chronic
Periodontitis and Sleep Deprivation ii) to evaluate this
inter-relationship with stress hormone (cortisol) levels.
Study Design: Present study was divided in two phases:
Phase-I and Phase-II. The Study sample consisted of 100
patients who were diagnosed as chronic periodontitis
patients according to the criteria of the 1999
International Workshop on the Classification of
Periodontal Diseases conducted by the American
Academy of Periodontology. All subjects participating in
the study signed a consent form to willingly participate
in the study. Appropriate medical and dental history
was evaluated for each subject. All data was collected in
the presence of the trained examiner in the local
language or language suitable for the participant.
Phase-I of the study
The patients who were diagnosed as chronic
periodontitis patients were included in Phase-I of the
study. Probing Pocket Depth (PPD) was measured with
UNC-15 probe for the diagnosis of Chronic Periodontitis.
They were asked to fill Pittsburgh Sleep Quality Index
(PSQI) for estimation of Sleep deprivation.
Phase-II of the study
In phase II there was the estimation of serum cortisol
levels by the CLIA method from an authorized
Keywords: sleep apnoea, periodontitis, cortisol

Evaluation of Interleukin (IL)-35 levels in Gingival Perio-esthetics
Crevicular Fluid (GCF) of Chronic Periodontitis Patients (in progress)
following Non-Surgical Periodontal Therapy (Scaling &

Root Planing)
Guide: Dr. Mini Saluj
Guide: Dr. H.S. Grover
Co- guide: Dr. H.S. Grover
Chronic Periodontitis is an inflammatory
condition of the supporting tissues of the teeth caused
by microorganism that stimulates the host immune
and inflammatory response, which is characterized by
the infiltration of the tissues by neutrophils,
macrophages, B cells and T cells and the generations of
high concentrations of locally, produced cytokines and
other mediators. Cytokines play a major role in
initiation as well as progression of inflammatory
response arrested by periodontal therapy. Among the
body fluids, gingival crevicular fluid (GCF) provides a
unique non-invasive method for the analysis of the
periodontal condition. Aim: Co-relation of Interleukin
(IL) -35 levels in Gingival Crevicular Fluid (GCF) with the
periodontal therapy (Scaling & Root planing) in chronic
periodontitis patients. Materials And Method: Total of
20 subjects, age group of 35-65 yrs of both the sexes
diagnosed with chronic periodontitis with atleast 20
natural teeth present, probing pocket depth ≥4 mm in
30% of the sites, clinical attachment loss (CAL) ≥1mm
in 30 % of sites with radiographic evidence of bone loss
will be included in the study. Results: Results will be
statistically analysed
Keywords: Gingival Crevicular Fluid, Cytokine,

Dr. Jayashree
Comparative evaluation of the clinical efficacy of Maintenance of implants and Peri-implantitis
chorion membrane with Demineralized Freeze Dried (in progress)
Bone Allograft (DFDBA) vis-à-vis amnion membrane
with DFDBA for treating gingival recession defects

Guide: Dr. Anshu Blaggana
Guide: Dr. H.S.Grover
Co-guide: Dr. H.S. Grover
A variety of surgical techniques have been
developed throughout the years and among these the
coronally advanced flap (CAF) is a root-coverage
technique which is being used extensively because of its
high success rate, safety, predictability & superior
aesthetics. However, few authors have documented
much stable, long term outcomes on using CAF in
conjunction with GTR membrane. A variety of non-
resorbable and bioabsorbable occlusive membranes
have been used in the past. One of the oldest
biomaterials used as a scaffold is the foetal membrane.
Therefore, in this study we aim to compare one of the
established gold standard techniques of root coverage
that is coronally advanced flap (CAF) alone vis-à-vis
chorion membrane with Demineralized Freeze Dried
Bone Allograft (DFDBA) and amnion membrane with
DFDBA for treating gingival recession defects. Aim: To
comparatively evaluate the clinical efficacy of coronally
advanced flap (CAF) alone vis-à-vis chorion membrane
with Demineralized Freeze Dried Bone Allograft (DFDBA)
and amnion membrane with DFDBA for treating Miller's
class I & II gingival recession defects. Material and
The sample size will consist of 30 sites , (10
for each group i.e. group 1(Control Group): recession
defects treated with Coronally Advanced Flap only with
vertical releasing incisions , group II (1st Test group):
recession defects treated with chorion membrane
allograft in conjunction with DFDBA bone allograft with
coronally advanced flap , group III (2nd Test group):
recession defects treated with amnion membrane
allograft in conjunction with DFDBA bone allograft with
coronally advanced flap) , presenting Miller's Class I and
Class II gingival recession greater than or equal to 2 mm
in depth and width , which shall be surgically treated.
Results: Results thus obtained will be put to statistical
demineralized freeze-dried bone allograft ,
coronally advanced flap.
Dr.Narender Yadav
Assessment of Periodontal Treatment Need in Rural, Risk assessment of periodontal disease
(2012- 15)
Urban, Semi-urban and Metropolitan in district
Gurgaon,Haryana state.

Guide: Dr. Amit Bhardwaj
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Introduction: Role of various etiologic factors in Chronic periodontitis is a multifactorial disorder. Effective
periodontal disease has been investigated by means of disease management should include identification of risk
epidemiologic surveys and clinical studies. The factors for periodontitis and an assessment of disease risk due
community periodontal index of treatment needs to these factors. Based on available evidence it can be
(CPITN) provides a picture of the public health concluded that careful analysis of the data is needed before
requirements in the periodontal field, which is essential assigning any variable as a true risk factor for periodontal
for national oral health policy-making and specific disease. An accurate diagnosis can only be made by a
interventions. Materials and Methods: This study was thorough evaluation of data that have been systematically
conducted on 4000 individuals among rural, semi-urban, collected by patient interview, medical consultation, clinical
and metro population of Gurgaon District, Haryana examination, radiographic evaluation and laboratory test as
State, to find out the oral health status and periodontal need.
treatment needs (TNs) using CPITN index. Results: An Keywords: risk factors, diagnosis, risk assessment.
inference was drawn from the results that among 4000
participants from all the four population groups'
maximum, i.e., 63.80% of individuals needed TN2
whereas 18.20% of individuals needed TN3 and 18.10%
of individuals needed TN1. Conclusion: It can be
concluded with a word of hope and a word of warning.
Hope lies in the fact that the measurement of
periodontal diseases by epidemiological study of this
condition is improving and receiving wide spread
attention. The warning lies in the varied nature of the
condition which goes to make up periodontal disease
and perplexing ways in which these conditions blend. In
addition to dental practitioner, periodontist and public
health workers must devote more time and effort
toward controlling periodontal disease than they seem
to be devoting at present.
Keywords: epidemiology, urban population,
sub- urban population, metropolitan, CPITN,


Dr.Pankaj Chaudhary
Comparative evaluation of occluding effectiveness of Tooth mobility and implant mobility
(2012- 15)
Nd:YAG, CO2 and Diode lasers on exposed human
dentinal tubules: An in vitro Scanning Electron
Microscopic study.

Guide: Dr. Mini Saluja
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Introduction: dentinal hypersensitivity Is one if the most Tooth mobility is an important part of complete periodontal
frequent problems causing discomfort. Recently, diode examination and helps not only in arriving at a diagnosis but
laser has been presented as a potential alternative for also guides the treatment plan. Tooth mobility can be either
the treatment of dentinal hypersensitivity. Materials physiological or pathological. Several etiological factors have
and Methods: root specimens were obtained from been identified for pathologic tooth mobility and thorough
extracted human premolars. Four sections were knowledge of these help in determining the treatment to be
prepared from a single tooth and thus 40 specimens provided. Over the years several methods and instruments
were obtained and then randomly divided in 4 different have been employed for correct measurement of mobility.
groups-Grp I: control, treated with saline, Grp II:Nd:YAG These include bulky devices to latest techniques such as laser
laser, Grp III:CO2 laser and Grp IV: 810-nm diode laser. and ‘Periotest'. Apart from determining the degree of mobility,
Results & Conclusion: all three lased groups showed its management remains a perplexing problem. Splinting the
more effective occlusion of dentinal tubules other than mobile teeth to achieve load distribution enhances the
control group
longevity of teeth. This review aims to enhance the existing Keywords: dentinal hypersensitivity, laser, knowledge of tooth mobility and its applications in clinical set
tubule occlusion.
Keywords: Tooth mobility, Periodontal, Bone
Dr.Ajita Singh
Effect of subgingivally delivered 1.2mg simvastatin on Oral malodour: where we stand today
(2012- 15)
the levels of interleukin-6,8, and10 in gingival
crevicular fluid of chronic periodontitis patients. A
clinic biochemical study.

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Anshu Blaggana
Introduction: Cytokines are pivotal to the immune Halitosis is a term used to define an unpleasant odour
response of chronic periodontitis. The present study emanating from the mouth. Oral malodour arises from
investigated the changes of gingival crevicular fluid microbial degradation of organic substrates like glucose,
(GCF) interleukin-4 (IL-4) and interferon-gamma (IFN-
mucins and peptides in saliva, GCF and retained debris. gamma) in patients with chronic periodontitis before Organoleptic assessment by a trained judge is considered the and after initial nonsurgical periodontal therapy (NSPT). gold standard in the examination of malodour. The treatment GCF was collected from 17 patients by means of of halitosis should be cause related. Chemical reduction of oral Periopaper at baseline and 1 month after NSPT. IL-4 and microbial load can be obtained by using mouthrinses with IFN-gamma enzyme-linked antimicrobial agents. immunoabsorbent assay. NSPT resulted in decreased Keywords: malodour, mouthrinse, organoleptic.
total amount of IFN-gamma, increased concentration of IL-4, and increased ratio of IL-4 to IFN-gamma levels. We
suggest that a low ratio of IL-4 to IFN-gamma levels
might be involved in the destruction (diseased sites) of
periodontal tissue, whereas an increased ratio of IL-4 to
IFN-gamma levels could be related to the improvement
of clinical periodontal health.
Keywords: simvastatin, Interleukin, elisa

Dr.Neha Saini
Detection and Measurement of Oral Malodor in Biomimetics in periodontal regeneration
(2012- 15)
Chronic Periodontitis Patients and its Correlation with
levels of select Oral Anaerobes in Subgingival Plaque.

Guide: Dr. Anshu Blaggana
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Introduction: Oral malodor is generally ascribable to Treatment of periodontal disease has evolved from just
oral microbial putrefaction generating malodorous fighting bacteria to a combined effort to eliminate the
volatile sulfur compounds. The aim of the present study offending microorganisms to arresting the progression of
is to correlate organoleptic recordings with a small tissue damage and to regenerate lost tissues. Repair of tooth
handheld portable volatile sulfide monitor and supporting alveolar defects is a major goal of periodontal
periodontal clinical parameters and correlate the levels regeneration. The biomimetic approach along with all other
of halitosis causing bacteria in plaque between baseline, strategies to reproduce the design rules of biological systems
1-week, and 1-month. Materials and methods: A total do not completely mimic nature.
of 20 systemically healthy subjects with self-reported Keywords: biomimetics, periodontal regeneration,
halitosis were subjected to organoleptic examination alveolar defects.
and FitScan(®). Subgingival plaque samples for
anaerobic culturing were harvested followed by an
assessment of plaque index (PI), gingival bleeding index
(GBI), and pocket probing depth. Data derived were
subjected to statistical analysis using Wilcoxon signed
rank test and Spearman's rank test (P < 0.05). Results:
No correlation was seen between organoleptic
measurements and portable volatile sulfide monitor at
any time interval. There was a statistically significant (P
< 0.05) correlation between the scores of PI, gingival
index, GBI, and myeloproliferative disease with organoleptic readings at all-time intervals. Anaerobic culture has shown to identify Fusobacterium species, Porphyromonas Tannerella forsythia. However, no correlation could be
established in between total microbial load with
organoleptic and FitScan(®) reading at any time interval
(P < 0.05). Conclusion: Significant correlation could be
established between organoleptic readings and
periodontal parameters.
Keywords: Anaerobic microflora; malodor;
organoleptic; portable sulfide monitor;
volatile sulfur compound

Dr.Neha Saksena
To determine and compare the labial gingival thickness Critical issues in periodontal research
(2012- 15)
(Biotype) in two major racio-ethnic groups of Indian
population using Ultrasonographic Method – A Clinical

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Anshu Blaggana
Periodontal research is increasing nowadays. Various number ABSTRACT
of scientific papers are published highlighting the various Introduction: gingival biotype can affect the results of aspects of periodontal research methodology. There are still
periodontal therapy.ultrasonographic determination is a current issues which need to be emphasized in both basic and
rapid, atraumatic, non- invasive technique. Material and clinical periodontal research methodology. The purpose of this
Methods: A total of 100 patients of both genders were review paper is to summarize the unresolved issues pertaining
divided into two groups ANI and ASI on the basis of to prevalence, etiology, pathogenesis, diagnosis and therapy in
racio-ethnicity. Results: no significant difference in the periodontology.
gingival thickness was seen in both groups.Conclusion: A Keywords: Current issues, periodontics, research
reliable ultrasonographic method was devised to reveal
significant variation in the gingival biotype.
Keywords: gingival biotype, ultrasonography,

Dr. Kartika Chawla
Analysis of the qualitative shift in the periodontal Wound healing in periodontal therapy
(2012- 15)
microbiota using Polymerase Chain Reaction- based
test (micro-I Dent® plus) in patients undergoing fixed
orthodontic mechanotherapy.

Guide: Dr. Amit Bhardwaj
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover
Periodontal healing is a complex process requiring coordinated Introduction: Dental plaque is a complex organization responses involving gingival epithelium and connective tissue,
with a biofilm structure. The progression of periodontal PDL, cementum and bone. To attain the new attachment
disease is related to periodontopathogens. Materials scientific basis were given to understand the various wound
and Methods: 20 healthy subjects undergoing fixed healing factors involved in periodontal regeneration. These
orthomechanical therapy were selected. Results: purple factors include early clot stabilization, epithelial exclusion, root
complex was absent. Red complex was increased. Green surface modification and reduced PDL. These different types of
complex showed a gradual increase.
regenerative procedures and mediators may increase the Keywords: periopathogens, plaque, ortho- probability for regeneration of lost periodontal tissues.
perio interrelation
Keywords: wound healing, repair, regeneration
Dr. Prateek Gupta
Osteotomy timing of the implant surgical site: A Role of viruses in the pathogenesis of periodontal disease
comparative study of early osteotomy with delayed
implant placement (2 weeks) and conventional implant

Guide: Dr. Adosh Lal
Guide: Dr. H.S. Grover
Co-guide: Dr. H.S. Grover, Dr. Anil Yadav
Introduction: the replacement of missing teeth is Periodontal disease is attributable to multiple infectious
carried out frequently with implants these days. Current agents. Recently, it has been suggested that certain viruses
trends have revealed the need for faster restoration also influence the development and severity of periodontal
using implants. Aim: the aim of the study was to disease. Several studies show association between HIV, HCMV,
compare the efficacy of early osteotomy with delayed EBV and HCM- EBV co-infection and some distinct forms of
placement and conventional implant placement using periodontal infection. Viral infections are difficult to treat since
RVG. Materials and Methods: the study included 9 current anti-viral drugs are only virustatic and viral pathogens
patients with 24 healthy sites and were randomly are developing sophisticated methods to exclude the toxic
divided into 2 groups of 12 sites each. Group I had effects of drugs. Drug therapy is therefore limited but
subjects treated with conventional implant placement occasionally successful and is often relegated to palliative care.
and Group II had subjects with early osteotomy and Keywords: virus, periodontal pathogenesis, anti-
delayed implant placement. Results: All implants in both viral therapy
control and test group had no significant difference in implant stability quotient values, indicating that all
implants achieved excellent primary and secondary
Keywords: delayed implant placement,
implant stability, osseointgration

Dr. Sagrika Shukla
Comparative evaluation of calcium phospho silicate Importance of collagen in periodontal health & disease
putty with and without platelet rich plasma in
periodontal intrabony defects using computer assisted

densitometric image analysis: A clinico radiographic

Guide: Dr. H.S. Grover
Collagen is the most abundant protein in mammals and every ABSTRACT
tissue contains collagen. Less than 40 years ago, only one type In periodontal disease, rate of alveolar bone loss can be of collagen was known. Since then, due to advances in medical
slow or continuous or episodic and can manifest as field, about 29 types of collagen and collagen like proteins are
horizontal or angular. Materials and Method: Non- known. It occurs as fibrils, microfibrils and networks. Many
randomized clinical trial was designed in a split mouth natural polymers and their synthetic analogues are used as
fashion containing a total of 40 intrabony defect sites in biomaterials. Collagen is used as collagen shields, sponges,
20 patients suffering from chronic –periodontitis. Group mini-pellets and tablets, gel formulations and nanoparticles for
I had 20 sites treated with open flap debridement and gene delivery. In surgery, it is used as surgical suture,
Novabone putty while group II had open flap haemostatic sutures and tissue engineering as scaffolds.
debridement and novabone plus PRP. Results: novabone Keywords: collagen, tissue, biomaterials.
putty alone is a good bone graft material and mixing it with PRP does not greatly enhance bone density
Keywords: intrabony defects, PRP, Novabone

Dr. Shruti Maroo
Comparison of Coronally advanced flap technique with Unraveling the periodontium at a molecular level
and without using orthodontic buttons in the
treatment of Miller Class I and II recession defects- A
clinical study.

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
During the last decade progress has been made to understand Introduction: Esthetics has become an essential the molecular and cellular biology of the periodontium.
criterion of the overall treatment plan in dentistry that Today's knowledge of periodontal disease is not based on a
comprises of a healthy and beautiful smile at any age. direct succession of events, but rather a synthesis of theories
Multidisciplinary approach involving orthodontics and and discoveries. Results of recent studies have suggested that
periodontics results in the maintenance of a beautiful periodontal regeneration recapitulates the process of
smile and a healthy periodontium. The continuous morphogenesis, histogenesis and cytodifferentiation that
endeavor for innovation of newer interdisciplinary occurs during the development of the periodontium. Advances
treatment modalities has resulted in the use of a passive made in the fields of molecular biology, human genetics and
object like the orthodontic button being used to provide stem cell biology have set the stage for significant discoveries
the initial stabilization in cases of root coverage using a that will pave the way for the development of procedures
Coronally advanced flap (CAF). Objective: The objective needed for the predictable regeneration of periodontal tissues.
of this case report is to evaluate the effectiveness of a Keywords: molecular biology, histogenesis
new treatment approach which consists of coronally advanced flap (CAF) procedure combined with orthodontic button application for the treatment of
Miller's class III recession defects. Methodology: After
the application of orthodontic buttons in middle third of
tooth surface, a split-full split flap was raised from tooth
#22 to #24 and the flap was sutured 3 to 4 mm coronal
to cementoenamel junction and the central part of flap
was suspended with sutures to the orthodontic button
to maximize the stabilization of the immediate
postoperative flap location. Clinical parameters were
recorded at 1 and 3 months postoperatively. Results:
Complete root coverage was achieved when evaluated
from baseline to 3 months along with gain in clinical
attachment level and keratinized tissue. The final
esthetics, both color match and tissue contours, were
highly acceptable.
Keywords: CAF, CAF with orthodontic
button, recession coverage

Dr. Shailly Luthra
Comparative evaluation of C- Reactive Protein and Periodontal microsurgery
Complete Blood Count in chronic periodontitis patients
following Phase I Therapy- A serological and
hematological study.

Guide: Dr. H.S. Grover
Guide: Dr. H.S. Grover
Co-guide: Dr. Adosh Lal
Introduction: the systemically dispersed bacteria from Historically, periodontal microsurgery has had its origin in the
periodontal lesion produce an acute phase response development of reconstructive gingival surgery. It is an
resulting in the production of CRP. Material and evolution of surgical techniques to permit reduced trauma and
Method: 30 systemically healthy patients with chronic improve healing. Microsurgery offers new possibilities to
periodontitis were selected. The patients underwent an improve periodontal care in a variety of ways. Benefits of
mechanical microsurgery include improved cosmetics, rapid healing and instrumentation. Blood samples were taken before minimal discomfort and enhanced patient acceptance.
treatment, at day one, one week and one month after Microsurgery presents special challenges in dexterity and
treatment. Results: CRP increased upto 10 fold one day perception. Its execution is technique sensitive and more
after treatment and settled to baseline values 1 month demanding than conventional periodontal procedures.
acute Keywords: microsurgery, reconstructive gingival
inflammatory response.
Dr.Sanjay Lal
Patient's response and recurrence following gingival Medical emergencies in dental practice
depigmentation using laser and scalpel technique: A
clinical study.

Guide: Dr. H.S. Grover
Aim: The present study was undertaken to evaluate Medical emergencies can and do happen anywhere at anytime
patient response and recurrence of pigmentation and that includes dental offices. Medical emergencies are very
following gingival depigmentation carried out with a stressful events. Under these types of conditions, anxiety and
surgical blade and diode laser. Materials And Methods: confusion can exist as well as the inability to recall proper
Twenty patients who were esthetically conscious of treatment protocols. Many facilities have an emergency drug
their dark gums and requested treatment for the same kit but are not familiar with its contents. The dentist and the
were selected for this study. Complete phase I therapy entire team need to be proficient in handling these
was performed for all the patients before performing emergencies until EMS arrives.
the gingival depigmentation procedures with laser and
scalpel on a split-mouth basis. Patients were evaluated Keywords: medical emergency, emergency kit
for pain (1 day, 1 week), wound healing and melanin immediately and at 1 week, 1 month and 3 months,
respectively. Results: The final results were statistically
analyzed and significance was evaluated. The results of
this study indicated that both scalpel and laser were
efficient for gingival depigmentation. Comparative pain
assessment (P = 0.148) and repigmentation scores (P =
0.288) at various time intervals between the two groups
did not show any statistical significance. Conclusion:
Both the procedures did not result in any post-operative
complications and the gingiva healed uneventfully.
When compared, both the techniques were found to be
equally efficacious. Care must be taken to assess the
gingival biotype and the degree of pigmentation in
deciding which technique is to be used.
Keywords: Diode lasers; gingiva; melanin

scalpel surgery

Dr. Yaswin Singh
Clinical evaluation of the efficacy of two commercially Smoking and periodontal disease
available controlled- release drugs – Chlorhexidine Gel
(CHLO-SITE) and tetracycline fibres (Periodontal Plus
AB) as an adjunct to SRP in the treatment of chronic

Guide: Dr. H.S. Grover
Chronic periodontitis is the result of a response of the host to of bacterial aggregations on the tooth surface. Progression and delivered severity of the disease depends on the complex interactions antimicrobials, combined with scaling and root planning between several risk factors such as microbial, immunological,
(SRP) is an effective approach for the management of environmental and genetic factors. The utilization of tobacco
chronic periodontitis. Aim: Evaluation of the efficacy of products has long been linked to periodontal disease. Cigarette
two commercially available controlled release drugs - smoking alone does not cause periodontal disease but
tetracycline fibers (periodontal plus AB TM) and aggravates the clinical conditions. There is clear association
chlorhexidine gel (CHLO-SITE TM as an adjunct to SRP in between smoking and both the existence and severity of
the treatment of chronic periodontitis. Materials and periodontal diseases.
Methods: Twenty systemically healthy patients in the Keywords: Tobacco, progression of disease.
age group of 30-50 years suffering from generalized chronic periodontitis were selected. Three experimental sites were chosen that had probing depth 5-8 mm in
maxillary and mandibular posterior segment. First site
receiving tetracycline fibers, other chlorhexidine gel and
one site was taken as control after SRP. Plaque score,
bleeding score, probing pocket depth (PPD), and relative
attachment level (RAL) gain were recorded on baseline,
1 month and at the end of 3 months. Results and
: In all groups, there was statistically highly
significant reduction in all the clinical parameters that is
plaque score, bleeding score, PPD, and RAL gain were
seen at different time intervals. Inter-comparison shows
that tetracycline fibers and chlorhexidine gel are equally
efficacious for treatment of chronic periodontitis, but
more efficient than SRP alone.
Keywords: local drug delivery, tertracycline
fibers, chlorhexidine gel

Dr. Nidhi Aggarwal
Immediate implant placement and provisionalization Guided tissue regeneration
in esthetic zone: A clinical evaluation
Guide: Dr. H.S. Grover
The preservation of the hard and soft tissue complex in Surgical debridement and regenerative procedures are the the esthetic zone following the loss of one or more traditional treatment modalities used to improve periodontal teeth presents an intimidating and highly visible disease parameters and arrest its progression. GTR has proved restorative challenge. Collapse of the hard and soft to be more effective than open flap debridement in the gain of tissues following tooth extraction is frequently clinical attachment. Several options are available for GTR and associated with significant resorption, remodeling, and grafting materials. Clinicians need to be able to select the deformity. This study describes a surgical technique for proper cases for appropriate treatment. the preservation of anterior esthetics combining Keywords: GTR, open flap debridement.
minimally invasive or flapless extraction with immediate implant placement.
Keywords: Implant; Restoration; immediate

Dr.Prashant Nanda
A comparative evaluation of the efficacy of citric acid, Osseointegration
ethylene diamine tetra acetic acid (EDTA) and
tetracycline hydrochloride as root biomodification
agents : An in vitro SEM study

Guide: Dr. H.S. Grover
is Dental implantology has come a long way from its introduction recommended as an adjunct to mechanical root surface into dental practice. The concept of osseointegration is much debridement to re-move smear layer and root better understood now. Various implant surface modifications, associated endotoxins. The aim of this study was to concepts of immediate implant placement and immediate compare loading have all added a new dimension to osseointegration. enediaminetetraacetic acid (EDTA), and tetracycline Numerous studied have indicated that a typical initial interface
hydrochloride as root biomodification agents. Materials will have some regions with direct bone implant contacts and
and methods. Fifteen freshly extracted teeth were root other regions with bone implant gaps.
planed and specimens obtained from the cervical two-
Keywords: osseointegration, delayed placement.
thirds of the root. Each tooth root provided four specimens to be treated by saline (used as control, citric acid, EDTA and tetra-cycline hydrochloride for a total of three minutes using the passive burnishing technique. The specimens were then observed under a scanning electron microscope (SEM). The specimens were evaluated for presence or absence of smear layer, total number of tubules visible, number of patent tubules and diameter of patent tubules. Statistical analysis was performed using paired -test. Results. All three test groups effectively removed the smear layer in comparison to the control. The number of patent tubules present in the citric acid and EDTA test groups was significantly higher than those in the tetracycline hydrochloride test group. However, the average diameter of the patent tubules was greater in the tetracycline hydrochloride group compared with citric acid and EDTA groups. Conclusion. All three agents are equally effective root biomodification agents. In clinical practice, EDTA might be more useful owing to its neutral pH.
Key words: Citric acid, EDTA, root


Dr. Deepti Sharma
To evaluate and compare gingival crevicular fluid Periodontal plastic procedures
vascular endothelial growth factor (VEGF) levels
amongst systemically healthy subjects and patients
suffering from Type II Diabetes Mellitus, in
periodontal health and disease

Guide: Dr. H.S. Grover
Introduction: GCF is serum transudate or inflammatory Periodontal plastic surgery are surgical procedures performed
exudate that derives from the periodontal tissues and to prevent or correct anatomic, developmental, traumatic or
can be collected at the orifice or from within the gingival disease induced defects of the gingival, alveolar mucosa or
crevice. Material and Method: Study sample had 30 bone. Periodontal plastic procedures have the potential to
subjects, grp A had 15 systemically healthy patients Grp create soft tissue environment that permits esthetic
B had 15 patients suffering from Type II diabetes reconstruction of even the most challenging cases. The
mellitus. Results: Human VEGF is present in GCF in difference between an acceptable and an outstanding surgical
periodontal health and disease. With increased treatment depends on effective treatment planning and
periodontal destruction, there is substantial increase in multidisciplinary coordination.
GCF VEGF concentration.
Keywords: GCF, VEGF, Diabetes
multidisciplinary dentistry.


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A FRD Market Entry Services Romania Report THE PHARMA AND FOOD SUPPLEMENTS MARKET IN ROMANIA DEMO REPORT by FRD CENTER MARKET ENTRY SERVICES ROMANIA The Pharma and Food Supplements Market in Romania – March 2010 A FRD Market Entry Services Romania Report 1. Pharma market in Romania. 3 1.1 Situation of the pharma market in Romania . 3 1.1. Non-prescription drugs. 4 1.2 Prescription drugs. 5


Ang1-TURP Syndrome: a complication that can occur despite precautions S. BOUDARI, Y. ZARROUKI, O. CHOUKA, M. KHALLOUKI, MA. SAMKAOUI Service d'Anesthésie-Réanimation Hôpital Ibn-Tofail, CHU Mohammed VI, Marrakech Introduction: The TURP (transurethral resection of the prostate) syndrome is the most serious complication of transurethral resection of the prostate, it can be fatal. The incidence of TURP syndrome is decreasing, especially because of observance of requirements relating to the use of glycine, and utilization of technologic advances (laser techniques and bipolar circuitry). We report the case of a patient who presented a severe TURP syndrome following glycine irrigation despite the observance of all precautions of use. Case report: A 72-year-old man, followed for arterial hypertension under amlodipine, proposed for TURP for Benign prostatic hyperplasia revealed by lower urinary tract symptoms, and which the size of prostate is sonographically estimated 40 grams. The preanesthetic assessment has shown a patient with a good physical activity (more than 4 MET) and echocardiography, an abnormal relaxation pattern related to age and hypertension. Biological tests were correct, in particular Hb = 12.4 g/dL and natremia = 138 mEq/L. The procedure was performed under spinal anesthesia and consisted on a monopolar TURP. Irrigation of bladder made with a total of 6 L of 1.5% glycine with 1% ethanol at a pressure of up to 60 cm water. 35 minutes after the beginning of the procedure when the surgeon finalizing hemostasis, the patient became slightly disoriented, so the TURP syndrome was suspected, surgeon advised and irrigation stopped. Despite stopping of irrigation of glycine, evolution was marked by rapid clinical deterioration, with apparition in few minutes of a respiratory distress with crepitations on auscultation, hemodynamic instability (bradycardia, hypotension 70/40 mmHg) and then quickly occurrence of partial seizures of left upper limb. After this the patient was put under mechanical ventilation, correction of hyponatremia started by saline serum 3.3% and an internal jugular catheter was placed. Initial biological assessment showed : pH=7.31 PCO2 = 46.4 mmHg PO2 = 52.1 mmHg HCO3- = 23.5 mmol Na+ = 108.3 mmol/l K+ = 5.47 mmol/l After restoration of effective circulation, furosemide was given and the patient was transferred to surgical intensive care unit. The sedation was stopped and 2 hours later, extubation done in a patient respiratory and hemodynamically stable, persistent slightly confused. The hyponatraemia was slowly corrected to 132 mmol/l and the patient discharged day 3 from ICU with a good recovery especially neurological. Commentaries: In this clinical observation, the patient has presented a life threatening TURP syndrome, despite the small prostate size, the not elevated irrigation pressure and the short duration of resection. That illustrates how regional anesthesia is superior than general anesthesia, by allowing an early detection of any change in mental status, enabling an early recognition of the syndrome and avoiding thereby its expression by an intraoperative cardiac arrest. Under general anesthesia, the diagnosis of TURP Syndrome is difficult, generally delayed and the cardiovascular signs are prominent.