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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 13 | Issue 1
Page Nos. 1-98

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EDITORIAL  

Infodemics - Are We Losing Knowledge in Information? p. 1
Girish Malleshappa Sogi
DOI:10.4103/ccd.ccd_172_22  
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ORIGINAL ARTICLES Top

Evaluation the relationship between mandibular molar root apices and mandibular canal among residents of the moscow population using cone-beam computed tomography technique p. 3
Svetlana Razumova, Anzhela Brago, Ammar Howijieh, Haydar Barakat, Yuliya Kozlova, Nikolay Razumov
DOI:10.4103/ccd.ccd_388_19  
Background: The relationship between the inferior alveolar nerve and the root apices of the mandibular molars and premolars is of clinical importance. The aim of this study was to determine the relationship between the mandibular canal (MC) and the mandibular molar root apices using cone-beam computed tomography (CBCT) scanning among residents of the Moscow population. Materials and Methods: Three hundred CBCT scans for patients aged 20–70 years were analyzed. Patients were divided into three age groups: young group (20–44 years), middle-age group (45–59 years), and elderly group (60–70). The distance from the MC and the mandibular molar root apices was measured in each group in the coronal view of CBCT scans. Statistical analysis was set on P < 0.05. Results: The mean distance from the mesial root apices of the first, second, and third molars to the MC was 4.92, 2.85, and 2.24 mm, respectively. The distal root showed to be the closest root to the MC in multirooted teeth. The young age group showed smaller distances to MC than other age groups (P < 0.05). Females showed smaller distances to MC in mandibular molars than males (P < 0.05). Conclusions: The distance between the root apices and the MC has to be taken into consideration when performing surgical or endodontic procedures.
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Evaluation of platelet-rich fibrin matrix as a regenerative material in the surgical management of human periodontal intraosseous defects – A randomized controlled trial p. 9
Komal Deep Walia, Sphoorthi Anup Belludi, Neha Pradhan, Vipin Jain, Sharaz Shaik
DOI:10.4103/ccd.ccd_832_20  
Background: Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects. Materials and Methods: Fifteen patients (age: 30–55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction. Results: The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%). Conclusion: PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.
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Efficacy of 1.5% metformin gel as an adjuvant to scaling, root planing, and curettage for the treatment of infrabony defects in chronic periodontitis patients p. 18
Kuldeep S Patil, Monica Mahajani, Sneha H Choudhary, Sami D Aldhuwayhi, Amar Thakare, Mohammed Ziauddeen Mustafa
DOI:10.4103/ccd.ccd_271_20  
Context: To compare and evaluate clinically and radiographically the efficacy of 1.5% metformin (MF) gel and placebo gel as an adjunct to scaling and root planing (SRP) and Curettage for the treatment of infrabony defects (IBDs) in chronic periodontitis patients. Subjects and Methods: The study was conducted randomly on 15 patients of both the genders. Each patient contributed two sites (total 30 sites - Split mouth design) which was randomly assigned to one of the two treatments: (i) Site A (Control Site) in which SRP was done along with curettage and intrapocket application of Placebo Gel and (ii) Site B (Test Site) in which SRP was done along with curettage and intrapocket application of 1.5% MF Gel. The Periodontal status {which included plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), IBD Depth} was assessed both clinically and radiographically at baseline, 3 months, and 6 months after treatment. Results: It was found that there was statistically significant difference in the periodontal status (PI, SBI, PPD, CAL, IBD depth) of the two sites when compared from baseline to 6 months. Conclusions: Local delivery of 1.5% MF improves the clinical outcomes of traditional treatment (SRP) and curettage and should be considered particularly as an adjunct to it.
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Clinical evaluation of lateral pedicle flap stabilized with cyanoacrylate tissue adhesive: A randomized controlled clinical trial p. 24
M Jeevitha, Chandra Sekhara Prabhahar, M Narendra Reddy, VK Vijay, M Navarasu, M Umayal
DOI:10.4103/ccd.ccd_338_20  
Context: Gingival recession is the most common mucogingival defect and is susceptible to tooth hypersensitivity, root caries, and esthetic problems if left untreated. A lateral pedicle flap is used to cover denuded roots that have adequate donor tissue laterally and adequate vestibular depth. A carefully planned surgery needs proper immobilization of the flap at the recipient site and this can be achieved by proper wound closure technique with appropriate material such as sutures or tissue adhesives. Aim: The aim of the present study is to evaluate the clinical outcomes of lateral pedicle flap stabilized with cyanoacrylate tissue adhesive and resorbable sutures. Materials and Methods: Twenty-two patients with Miller's class I and class II gingival recession were randomly divided into two groups: lateral pedicle flap stabilized with cyanoacrylate tissue adhesive (test) and lateral pedicle flap stabilized with resorbable sutures (control). Plaque index, gingival index, probing pocket depth, clinical attachment level, recession depth and width, height and thickness of keratinized gingiva were evaluated at baseline and 1st and 3rd month postoperatively. The percentage of root coverage was evaluated at the end of 3rd month postoperatively. Statistical Analysis Used: Intergroup comparisons for the clinical attachment level, recession depth, recession width, thickness of keratinized gingiva, and height of keratinized gingiva were made by Mann–Whitney test by analyzing the difference of two time periods. Intragroup comparisons were made by the Kruskal–Wallis test. Mann–Whitney test was used to compare the difference between various time periods within the group for all the selected variables. Results: The mean plaque index and gingival index at the 1st and 3rd month were found to be statistically significant and did not present any significant influence over other clinical parameters evaluated. A partial root coverage was observed in both the groups (71.97% for the test group and 61.36% for the control group). Conclusions: Cyanoacrylate tissue adhesive is clinically effective in the stabilization of the lateral pedicle flap and can be used as an alternative to resorbable sutures.
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Evaluation and correlation of condylar cortication by cone-beam computed tomography: A retrospective study p. 30
KS Sethna Muthlakshmi, CL Krithika, Kannan Asokan
DOI:10.4103/ccd.ccd_341_20  
Background: Temporomandibular joint (TMJ) is a ginglymo-diarthroidial joint with fibroelastic cartilage. The chondrogenesis initiates from the 12th week of intrauterine life and the development of condyle is associated with growth. The condylar cortication shows distinct morphological variation for each individual in each stage of their life. The cortical bone around the condyle could be used as a factor for chronological age assessment and it can act as a tool in forensic medicine. Aim and Objective: The study was carried out to evaluate the cortical grading in mandibular condyle using two different applications and to correlate their grades with chronological age. Setting and Design: Hospital-based retrospective observational cross-sectional study. Materials and Methods: The study was carried out in 40 patients and 80 TMJs were assessed for cortication grades in Carestream 3D imaging and Image J applications. These grading from both the applications were correlated with the chronological age. Statistical Analysis: SPSS (Statistical Analysis for the Social Science) – Cohen's Kappa inter-examiner reliability and Spearman's correlation coefficient were used. Results: The radiological assessment of condylar cortication in individual application showed significant results and the relationship of cortication with chronological age showed a significant correlation. Conclusion: The condylar cortication grading is a simple technique and can be used as a factor for chronological age assessment. This is an initial study which used two different applications to view the cortication of the mandibular condyle and to correlate the cortication with chronological age. Hence, a large sample size-based study is required for further research.
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Correlation of ponticulus posticus with dentofacial skeletal patterns p. 35
Sepideh Falah-Kooshki, Nafiseh Nikkerdar, Mohammad Moslem Imani, Reza Faraji, Amin Golshah
DOI:10.4103/ccd.ccd_621_20  
Background: This study aimed to assess the correlation of ponticulus posticus (PP) with dentofacial skeletal patterns on lateral cephalograms of an Iranian population. Methods: This retrospective study evaluated 1000 lateral cephalograms of 690 females and 310 males. Demographic information of patients was recorded, and two observers evaluated all radiographs for the presence of PP. The dentofacial skeletal pattern was also determined as Class I, II, or III. Disagreements were resolved by discussion with a third observer. Data were analyzed using the Chi-square test. Results: The mean age of patients was 19.47 ± 8.37 years (range 7–64 years). The prevalence of PP was 38.3%. PP had a significant correlation with gender (P = 0.022) such that PP was more common in males (43.5%). No significant correlation was noted between PP and age or dentofacial skeletal pattern (P > 0.05). Conclusions: PP was relatively common in our study population. PP had no correlation with age or dentofacial skeletal pattern of patients.
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Assessment of the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate p. 40
Amin Golshah, Roghaye Hajiazizi, Bahram Azizi, Nafiseh Nikkerdar
DOI:10.4103/ccd.ccd_652_20  
Background: This study aimed to assess the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate (UCLP) using photography, cone-beam computed tomography (CBCT), and digitized three-dimensional casts. Methods: This case–control study was conducted on photographic, CBCT, and digital cast records of 14 UCLP patients and 24 healthy controls between 10 and 16 years. Totally, 65 variables were measured on photographs, CBCT scans, and on digitized casts. Measurements were compared between the two groups and within each group between the two sides. For easier measurement, in patients who had right side CLP, the cleft was transferred to the left side and in subjects without cleft, mild chin deviation was transferred to the left side. Results: The anteroposterior dimensions of the two condyles in the UCLP group were greater than those in the control group, while the mediolateral dimensions of the left condyle and ramus height, mandibular body length, and total length of the mandible in the control group were greater than those in the UCLP group. Right ocular, nasal, and angular variables were greater in the UCLP group. Other variables except for the palatal width from the right canine to midline were greater in the control group. Conclusion: Our findings highlighted the presence of asymmetry in the nasal and palatal areas in patients with UCLP while these patients had no significant difference with healthy controls in the relationship of condyles with the temporomandibular fossa.
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Assessment of serum parameters in stable coronary artery disease patients in correlation with healthy and chronic periodontitis patients p. 50
Mukta V Sanikop, Shivanand Aspalli, G Nagappa, Rafia Nawab Jabeen, Nagaveni Aspalli, C Hemachandra Babu
DOI:10.4103/ccd.ccd_659_20  
Background: Periodontitis is a chronic inflammatory disease and has been strongly associated with elevation of systemic markers such as C-reactive protein (CRP), fibrinogen (FIB), and lipid profile, which have also been significantly associated with coronary heart disease (CHD). Hence, there is a need to assess the possible association between chronic periodontitis and coronary artery disease. Materials and Methods: A study included 100 subjects divided into four groups. Group I: stable coronary artery disease with chronic periodontitis, Group II: stable coronary artery disease without chronic periodontitis, Group III: chronic periodontitis without coronary artery disease, and Group IV: healthy controls. Gingival index, Russell's periodontal index, pocket depth, and clinical attachment level were recorded. Venous blood was collected from the patients, and serum fibrinogen, CRP, and lipid profile levels were estimated. Results: The intragroup comparison of biochemical and periodontal parameters showed statistically significant results with P < 0.05. The intergroup comparison of serum FIB, total cholesterol, high density lipoprotein, low density lipoprotein, and clinical attachment level showed statistical significant results (P = 0.000, P = 0.000, P = 0.001, P = 0.025, and P = 0.000, respectively) between Groups I and III. Conclusion: The results of the study indicate that there might a possible correlation between coronary artery disease and chronic periodontitis, but periodontitis-cardiovascular link is complex and difficult to define though there is sufficient evidence for their association. Leakage of pro-inflammatory cytokines from the ulcerated periodontium causes the production of acute-phase proteins by the liver. To prove the relationship, further studies should be considered making use of other markers of inflammation with prospective randomized controlled studies involving large population.
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Comparative evaluation of fracture resistance of fiber-reinforced composite and alkasite restoration in class I cavity p. 56
G Rajaraman, AR Senthil Eagappan, S Bhavani, R Vijayaraghavan, S Harishma, P Jeyapreetha
DOI:10.4103/ccd.ccd_707_20  
Background and Aim: Tooth-colored restorative materials for the restoration of decayed posterior teeth continue to gain popularity both among dental practitioners and patients. These materials have undergone a number of improvements in recent years to enhance their physical properties and diversify their use as a restorative material relevant to clinical practice. The aim of this study was to evaluate and compare the fracture resistance of two such advanced restorative materials, namely EverX Posterior, a fiber-reinforced composite and Cention N, an alkasite material in a Class I Cavity. Materials and Methods: Forty intact, caries-free human maxillary premolar teeth extracted for orthodontic purposes were divided randomly into four groups of 10 teeth each. Group I were unprepared teeth (intact teeth); Group II were unrestored teeth with class I cavity; Group III were teeth restored with fiber-reinforced composite (EverX Posterior); and Group IV were teeth restored using alkasite material (Cention N). Fracture resistance was recorded for all samples using a universal testing machine. Results: Higher fracture resistance was recorded in intact teeth group followed by EverX Posterior, Cention N and unrestored teeth, respectively. The teeth restored with EverX Posterior showed higher mean fracture resistance to fractures than those restored with Cention N. Teeth restored with EverX Posterior showed no significant difference in mean fracture resistance from Intact teeth while restored teeth with Cention N and unrestored teeth did. Conclusion: Fracture resistance of EverX Posterior was comparable to that of the natural tooth and was higher as compared to Cention N.
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Comparative evaluation of anesthetic efficacy of 4% articaine and 2% lidocaine for buccal infiltration in adult patients with irreversible pulpitis of maxillary first molar: A prospective randomized study p. 61
Gufaran Ali Syed, Sanjyot A Mulay
DOI:10.4103/ccd.ccd_710_20  
Objective: The purpose of this prospective, randomized study was to evaluate and compare the anesthetic efficacy of 0.8 ml of 4% articaine and 1.6 ml of 2% lidocaine administered through buccal infiltration (submucosal) only in adult male and female patients with irreversible pulpitis of maxillary 1st molar. Study Design: Two hundred patients with irreversible pulpitis of the maxillary first molar were divided into four study groups and received only buccal infiltration of either 0.8 ml of 4% articaine or 1.6 ml of 2% lidocaine. Endodontic access was begun 7 min after the solution deposition. The success was defined as “no pain (0 mm)” or “weak/mild pain (>0 mm and ≤54 mm)” during access opening, and during the first file insertion till working length. Results: The compiled data of the number of failed cases were analyzed by two sample proportion test and of mean pain scores were analyzed by Student's unpaired t-test. P < 0.05 was taken as statistically significant. No significant difference was found in the number of failed cases on using 4% articaine and 2% lidocaine (P > 0.05). Moreover, no significant difference was found in the number of failed cases between the genders in Group I (4% articaine with 1:100,000 epinephrine) and also in Group II (2% lidocaine with 1:80,000 epinephrine). On comparing the mean pain scores of failed cases, it has been found that females experience more pain than males in Group I (not significant) and Group II (significant). Conclusion: The efficacy of 4% articaine with 1:100,000 epinephrine has been found to be better than 2% lidocaine with 1:80,000 epinephrine, as only 0.8 ml of 4% articaine with 1:100,000 epinephrine was effectively used as compared to 1.6 ml of 2% lidocaine with 1:80,000 epinephrine. Furthermore, females experience more pain as compared to males.
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Comparative evaluation of autogenous bone graft and autologous platelet-rich fibrin with and without 1.2 mg in situ rosuvastatin gel in the surgical treatment of intrabony defect in chronic periodontitis patients p. 69
Kompal Gautam, Anjali Kapoor, Setu Mathur, A Rizwan Ali, Aparna Choudhary, Arpana Shekhawat
DOI:10.4103/ccd.ccd_740_20  
Context: Rosuvastatin (RSV) is a new synthetic, hydrophilic statin with potent anti-inflammatory and osseodifferentiation actions. Autogenous bone graft (ABG) is still considered the gold standard in reconstructive bone surgery. Addition of platelet-rich fibrin (PRF) to ABG provides sustained release of various growth factors and facilitates survival of the graft. Aims: The study aims to clinically and radiographically compare the effectiveness of ABG and PRF with and without 1.2 mg RSV gel in the surgical treatment of intrabony defect in chronic Periodontitis patient. Settings and Design: This was a randomized controlled clinical trial. Subjects and Methods: Thirty-nine patients (one site per participant) with chronic periodontitis were randomly divided into three groups: Group 1 (open flap debridement [OFD] + placebo), Group 2 (OFD + ABG + PRF), and Group 3 (OFD + ABG + PRF + 1.2 mg RSV). Relative attachment level (RAL) and probing pocket depth (PPD) were recorded at baseline, 3, 6, and 9 months. Radiographic measurements such as defect height (A and B) and defect width (C) were calculated at baseline and 9 months. Statistical Analysis Used: Intergroup comparison was done using Kruskal–Wallis ANOVA. An intragroup comparison was done using Friedman test and Wilcoxon signed-rank test. Results: The mean PPD reduction and mean RAL gain were highly significant in Group 3 and Group 2 than Group 1. For Group 3, a significant reduction of defect height and width and a significant amount of bone fill were achieved than Group 2 and Group 1. Conclusions: Addition of 1.2 mg RSV gel, PRF, and ABG has synergistic effects, explaining their role as a regenerative material in the treatment of intrabony defects.
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Rate of compliance with infection control practices while taking dental radiographs in a dental health care center, Saudi Arabia p. 78
Radhika Doppalapudi, Sudhakar Vundavalli, Mahmoud Gamal Salloum, Ghanam Alazmi
DOI:10.4103/ccd.ccd_811_20  
Background: Infection control guidelines are aimed at preventing cross-contamination in clinical settings. Radiographs are indispensible part of oral diagnosis and assessing prognosis. Strict adherence to infection control protocol while taking dental radiographs are mandatory. Aims and Objectives: To assess the rate of compliance with infection control practices while taking dental radiographs in the dental clinic center of a teaching institution in Saudi Arabia. Materials and Methods: An observational study was undertaken for the infection control practices in the dental radiology wing of a university teaching center in Saudi Arabia. Data were collected from dental faculty, dental assistants, and dental students working in dental clinics. Both pretested questionnaire and by direct observation of infection control practices was used for data collection. Chi-Square test for categorical variables and Independent samples t-test for compare mean self-reported infection control practice scores were used. Binary logistics regression was used to identify the factors influencing participant's compliance with infection control practices. P ≤ 0.05 was considered statistically significant. Results: 129 participants were included in this study, among those 26 were faculty, 19 were dental auxiliaries and 84 were dental students. On direct observation, the overall compliance rate was 79.5%; Dental auxiliaries have the highest compliance rate (94.5%) followed by dental faculty (88.5%) and students (68.6%). Binomial logistic regression predicted that females had 2.94 times more compliance than male counterparts, which is statistically significant. Conclusion: Students and faculty need continuing dental education programs for reinforcement on infection control practices.
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Association of salivary statherin, calcium, and proline-rich proteins: A potential predictive marker of dental caries p. 84
Deepak Gowda Sadashivappa Pateel, Shilpa Gunjal, Sulagna Dutta
DOI:10.4103/ccd.ccd_859_20  
Background: Salivary factors modulate the balanced dynamic mineralization process of the dental enamel. Salivary proteins such as statherin and acidic proline-rich proteins (PRPs) protect oral surfaces by regulating oral calcium homeostasis and remineralization of enamel. Thus, they possibly play vital roles in dental caries. Aim: The present study aims to find the association of salivary statherin, proline-rich protein, and calcium levels with dental caries. Methods: A descriptive, cross-sectional study was conducted among 188 healthy participants (age between 18 and 50 years), from dental clinic of MAHSA University, Malaysia. Dental caries was measured using standard WHO criteria. Stimulated whole mouth saliva was collected, and salivary statherin, acidic PRP (aPRP), and calcium levels were estimated using ELISA Kit and calorimetric assay kit, respectively. Data were analyzed using Spearman's rho and Pearson's correlation coefficient (SPSS statistical package-version 25.0) to find correlation of salivary statherin, calcium, and proline-rich protein levels with dental caries. Results: A statistically significant (P < 0.001) moderate negative correlation (r = −0.500) was found between salivary statherin and proline-rich protein levels. There was no statistically significant association of dental caries with salivary statherin, calcium, and aPRP levels. Conclusion: Salivary statherin and aPRP levels appear to perform mutually complementing functions and thus may have potential role in the maintenance of tooth integrity.
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CASE REPORTS Top

Alveolar ridge augmentation using autogenous bone graft and platelet-rich fibrin to facilitate implant placement p. 90
Nayana Paul, Shivangini Jyotsna, MP Keshini
DOI:10.4103/ccd.ccd_154_20  
The maxillary anterior region is considered to be the esthetic zone of human dentition. Missing teeth in this area leads to severely compromised esthetics and function. Endosseous implants are a viable treatment option in this scenario, but the placement of endosteal implants requires adequate bone volume for successful osseointegration. When the morphology of the bone does not allow proper implant placement, there are various bone augmentation procedures which aid in reconstruction of the residual alveolar ridge for ideal implant placement. The mandibular parasymphysis can act as an excellent source of autogenous bone for the augmentation of alveolar ridge deficiencies. This article describes successful augmentation of the maxillary alveolar ridge using block bone autografts harvested from the mandibular symphysis along with platelet-rich fibrin. At 6 months after surgery, implant was inserted, and after a healing period of 5 months, permanent restoration was placed.
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Transfiguration of smile by anterior tooth replacement through remodeling of hard and soft tissue profile with adjunct to implant osseointegration p. 95
Devendra Chopra, Kaushitaki Bhaumik, Sumit Kumar Mishra
DOI:10.4103/ccd.ccd_870_20  
The treatment choice for the recovery of missing teeth has been expanded for two patients and clinicians with the utilization of dental implants. For the success of dental implants, the quality and the amount of the available bone and soft tissues in the recipient site are very important factors. However, because of the tumor, injury, periodontal ailment, and so on, these variables might be undermined or inaccessible which again brings out the need for extra hard and soft tissue manipulation. This paper outlines a technique using a modified rolled palatal pedicle connective tissue graft with an autogenous bone graft from the mandibular symphysis area to achieve a predictable long-term success of dental implants prosthesis.
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