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Annisa ZU, Sulijaya B, Tadjoedin ESS, Hutomo DI, Masulili SLC. Effectiveness of chlorhexidine gels and chips in Periodontitis Patients after Scaling and Root Planing: a systematic review and Meta-analysis. BMC Oral Health 2023; 23:819. [PMID: 37899443 PMCID: PMC10613372 DOI: 10.1186/s12903-023-03241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023] Open
Abstract
Periodontal pockets are characteristic of periodontitis. Scaling and root planing is the gold standard for periodontitis treatment. Additional local antimicrobials are recommended in patients with a probing depth of ≥ 5 mm. This study aims to determine the effectiveness of chlorhexidine compared to other local antimicrobials in periodontitis. Searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Meta-analysis was performed on studies that met inclusion criteria after risk of bias assessment. Meta-analysis between chlorhexidine chips and other antimicrobials showed a mean difference in probing depth after one month of 0.58 mm (p < 0.00001) whereas after three months the mean difference in probing depth was 0.50 mm (p = 0.001), index plaque 0.01 (p = 0.94) and gingival index - 0.11 mm (p = 0.02). Between chlorhexidine gel and other antimicrobials showed a mean difference in probing depth of 0.40 mm (p = 0.30), plaque index of 0.20 mm (p = 0.0008) and gingival index of -0.04 mm (p = 0.83) after one month. Chlorhexidine chips were more effective on the gingival index than other antimicrobials after three months. The other antimicrobials were more effective than chlorhexidine chips on probing depth after one and three months, and than chlorhexidine gels on plaque index after one month.
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Affiliation(s)
- Zahratul Umami Annisa
- Undergraduate Program, Faculty of Dentistry, Universitas Indonesia, Jl. Salemba Raya No. 4, 10430, Jakarta Pusat, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jl. Salemba Raya No. 4, 10430, Jakarta Pusat, Indonesia.
| | - Ette Soraya Shahnaz Tadjoedin
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jl. Salemba Raya No. 4, 10430, Jakarta Pusat, Indonesia
| | - Dimas Ilham Hutomo
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jl. Salemba Raya No. 4, 10430, Jakarta Pusat, Indonesia
| | - Sri Lelyati C Masulili
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jl. Salemba Raya No. 4, 10430, Jakarta Pusat, Indonesia
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Kulkarni R, Akintoye S. A Patient with a Diagnosis of Gonococcal Arthritis and Symptomatic Bilateral Temporomandibular Joints Presents for Scaling and Root Planing. Dent Clin North Am 2023; 67:641-643. [PMID: 37714614 DOI: 10.1016/j.cden.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
A young female patient presents to the dental clinic for scaling and root planing with known gonococcal arthritis. The patient is undergoing treatment for the condition with antibiotics. She endorses bilateral temporomandibular joint pain. For treatment, the scaling and root planning procedure was completed by quadrant. The patient tolerated the procedure well in this fashion.
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Affiliation(s)
- Roopali Kulkarni
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
| | - Sunday Akintoye
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Strauch KA, Robbins MR. Scaling and Root Planing in a Patient with Atherosclerosis, Arrhythmia, and Anticoagulation. Dent Clin North Am 2023; 67:393-396. [PMID: 37244699 DOI: 10.1016/j.cden.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients with cooccurring coronary artery disease and arrhythmias are frequently encountered by dental providers. Individuals with comorbid cardiovascular disease who require dual anticoagulant and antiplatelet therapy are a clinical challenge with regard to the need to balance the risks and benefits of intensive antithrombotic therapy. Modifications to dental care will need to be individualized considering the current disease state and medical management. Oral health promotion and good oral hygiene measures are recommended among this population.
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Affiliation(s)
- Kimberly A Strauch
- Department of Oral Medicine, The University of Pennsylvania School of Dental Medicine, Care Center for Persons with Disabilities, 240 South 40th Street, Philadelphia, PA 19104, USA; The University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
| | - Miriam R Robbins
- Department of Oral Medicine, The University of Pennsylvania School of Dental Medicine, Care Center for Persons with Disabilities, 240 South 40th Street, Philadelphia, PA 19104, USA
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Shetty B, Divakar DD, Jameel AHA, Almalki SA, Gowdar IM, Dewan H. Effect of non-surgical periodontal therapy with adjunct photodynamic therapy on periodontal and glycemic statuses in prediabetic patients with periodontal disease. Photodiagnosis Photodyn Ther 2023; 42:103362. [PMID: 36841278 DOI: 10.1016/j.pdpdt.2023.103362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Studies have shown that non-surgical periodontal therapy (NSPT) helps reduce periodontal inflammation and glycemic levels in patients with type-2 diabetes mellitus; however, the role of NSPT with adjunct photodynamic therapy on glycemic status and periodontal parameters in prediabetic patients remains unclear. The aim of the present study was to assess the effect of NSPT with and without adjunct PDT on periodontal and glycemic statuses in prediabetic patients with periodontal disease. METHODS Prediabetic (Group-1) and non-diabetic (Group-2) patients diagnosed with periodontal inflammation were included. In both groups, patients were randomly assigned to test and control-groups. In the test- and control groups, patients underwent NSPT with and without adjunct PDT, respectively. The following parameters were assessed at baseline and at four weeks' follow-up: plaque index (PI); gingival index (GI), probing depth (PD), clinical attachment loss (CAL) and hemoglobin A1c (HbA1c). Collection of demographic data and assessment of full mouth marginal bone loss was performed at baseline. Level of significance was set at P < 0.05. RESULTS At baseline, there was no difference in PI, GI and PD among patients with and without prediabetes. At 3-weeks' follow up there was no difference in PI, GI and PD among patients without prediabetes. PI (P < 0.01), GI (P < 0.01) and PD (P < 0.01) were significantly higher in the control-group compared with the test-group at 3-weeks' follow-up in patients without prediabetes. The HbA1c levels were significantly higher in patients with prediabetes throughout the study duration compared with individuals without prediabetes. CONCLUSION One session of NSPT with or without PDT reduce periodontal inflammation but do not influence glycemic levels in prediabetic patients.
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Affiliation(s)
- Bharathraj Shetty
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, (ABSMIDS), Department of Prosthodontics and Crown & Bridge, Mangalore, India.
| | - Darshan Devang Divakar
- Department of Oral Medicine and Radiology, Sharavathi Dental College and Hospital, Shivamogga, Karnataka 577204, India; Department of Oral Medicine and Radiology, Faculty of Dentistry, Ministry of Health, Levy Mwanawasa Medical University (LMMU), Lusaka 10101, Zambia
| | - AlBandary Hassan Al Jameel
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P. O. Box 60169, Riyadh 11545, Saudi Arabia
| | - Sultan Abdulrahman Almalki
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin AbdulAziz University, P.O Box 173, Al-kharj 11942, Saudi Arabia
| | - Inderjit Murugendrappa Gowdar
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin AbdulAziz University, P.O Box 173, Al-kharj 11942, Saudi Arabia
| | - Harisha Dewan
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
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Zeng J, Wang Y, Yuan Q, Luan Q. The effect of (-)-epigallocatechin gallate as an adjunct to non-surgical periodontal treatment: a randomized clinical trial. Trials 2022; 23:368. [PMID: 35505441 PMCID: PMC9066833 DOI: 10.1186/s13063-022-06298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 08/29/2023] Open
Abstract
Background EGCG is proven to be of good effect to relieve periodontal inflammation, but it has not been applied as a local delivery medicine in patients with periodontitis widely. The aim of this clinical trial was to evaluate the adjunctive effect of (-)-epigallocatechin gallate (EGCG) aqueous solution as a coolant during scaling and root planing in the management of chronic periodontitis. Methods A double-blind, randomized controlled study was performed on 15 patients with moderate to severe chronic periodontitis. The bilateral maxillary teeth were randomly divided into the test side and the control side on every individual. On the control side, the periodontal therapy was routinely performed. And on the test side, in the process of periodontal therapy, the distilled water in the ultrasonic scaler was replaced with a 5-mg/mL EGCG solution. The probing depth (PPD), clinical attachment level (CAL), bleeding index (BI), gingival index (GI), and plaque index (PI) were recorded at baseline and 6 and 12 weeks after the treatment. Results PPD, CAL, BI, GI, and PI generally improved after treatment in both groups. At the sixth week and the twelfth week of review, PPD, CAL, GI, and PI had no statistical difference (p >0.05) between the two groups. At the review of the twelfth week, BI on the test side decreased significantly (p <0.05). Conclusions Using EGCG solution as the irrigant instead of water has an additional benefit on the bleeding index at the 12-week review. However, the rest clinical parameters had no additional benefit. Trial registration ClinicalTrials.gov ChiCTR2000029831, date of registration: Feb 15, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06298-6.
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Affiliation(s)
- Jiajun Zeng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Yanfeng Wang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Qiao Yuan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Qingxian Luan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
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Bankur PK, Awasthi N, Devi KB, Prasanth PS, Azamulla M, Reddy U. An In Vitro Evaluation of the Smear Layer Removal Efficacy of Three Different Chemical Decalcifying Agents on Periodontally Compromised Root Surfaces: A Scanning Electron Microscopy Study. J Contemp Dent Pract 2022; 23:527-531. [PMID: 35986461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM Aim of the current research was to assess the smear layer removal efficacy of SofScale, Carisolv gel, and QMix chemical decalcifying substances on periodontally weakened radicular surfaces. MATERIALS AND METHODS The sample size constituted 60 recently extracted periodontally compromised teeth having a poor prognosis. The samples were allocated at random to one of the following three groups (20 in each): Group I: Scaling and root planing (SRP) with SofScale, Group II: SRP with Carisolv gel, and group III: SRP with QMix. The surfaces thus subjected to treatment were washed with 20 mL of saline and the crown portion was detached at the cementoenamel junction (CEJ). Following this, samples were horizontally and vertically segmented employing a diamond circular disk with 150-200 μm thickness. Every sample segment was subjected to rinsing in normal saline and positioned in 2.5% glutaraldehyde solution in 0.1 M phosphate buffer at a pH of 7.4 for at least 24 hours. Samples were evaluated in a scanning electron microscopy (SEM) at a magnification of 2000×, and photomicrographs were assessed to establish the degree of radicular biomodification by eliminating the smear layer. RESULTS QMix group showed the highest smear layer elimination at 3.56 ± 0.13 in pursuit by Carisolv gel at 3.64 ± 0.11 and SofScale group with 4.68 ± 0.08. The differences amid the groups were statistically significant with p <0.001. On multiple contrast assessments of smear layer elimination effectiveness of the dissimilar chemical decalcifying substances employing Tukey's HSD, statistically significant differences were noted between group I and group II, as well as group I and group III (p <0.001). However, there were no significant differences between group II and group III (p >0.001). CONCLUSION In conclusion, QMix was noted to have a superior smear layer elimination capacity in comparison with the radicular surfaces conditioned with Carisolv and SofScale. CLINICAL SIGNIFICANCE Modifying the surface of teeth by radicular conditioning causes the enhanced attachment of connective tissues coupled with progression in the final aim of reconstructive periodontal therapy. The utility of chemical substances along with physical management characterizes the probability of reduced trauma during treatment, avoiding the sacrifice of radicular portions of teeth.
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Affiliation(s)
- Praveen Kumar Bankur
- Department of Periodontology, Al Badar Dental College and Hospital, Kalaburagi, Karnataka, India, Phone: +91 9886542751, e-mail:
| | - Naman Awasthi
- Department of Dentistry, Government Medical College, Shahdol, Madhya Pradesh, India
| | - Konsam Bidya Devi
- Department of Periodontology, Dental College, JNIMS, Porompat, Imphal, Manipur, India
| | - P S Prasanth
- Department of Orthodontics, Indira Gandhi Institute of Dental Sciences, Kothamangalam, Kerala, India
| | - Mohammed Azamulla
- Department of Periodontology, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Upasana Reddy
- Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Daralakatte, Mangaluru, Karnataka, India
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Roccuzzo A, Imber JC, Stähli A, Kloukos D, Salvi GE, Sculean A. Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022. [PMID: 35389113 DOI: 10.1007/s00784-022-04474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). Materials and Methods A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. Results Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). Conclusions Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. Clinical relevance The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04474-1.
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Yu S, Zhao X, Zhang Y, Liu Y, Li A, Pei D. Clinical effectiveness of adjunctive diode laser on scaling and root planing in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis. Lasers Med Sci 2021; 37:759-769. [PMID: 34536183 DOI: 10.1007/s10103-021-03412-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify the optimal combination of usage mode and application regimen of DL. Eight electronic databases were searched up to January 2021. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI) were assessed at short-term (4-6 weeks), 3-month, and 6-month follow-ups. Based on DL usage mode, studies were divided into three groups: inside, outside pocket, and combined modes. As for application regimen, studies in each group were further subdivided into single- and multiple-session subgroups. Thirty randomized controlled trials with 825 participants were included. For inside mode, single-session DL showed significant improvements for PPD (short-term, and 3-month, p < 0.05), CAL (short-term, and 3-month, p < 0.05), PI (3- and 6-month, p < 0.05), and GI (short-term, 3-month, and 6-month, p < 0.05). For outside mode, multiple-session DL showed notable improvements for most clinical outcomes (p < 0.05). The effect of combined mode was still uncertain. Adjunctive DL had additional clinical benefits in the treatment of periodontitis. One session laser treatment is suggested when DL is applied inside pocket in future clinical practice. Meanwhile, more than one session laser treatment presents better outcomes when DL is used outside pocket. PROSPERO: CRD42020156162.
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Affiliation(s)
- Shuchen Yu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, China
| | - Xiaodan Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, China
| | - Yuchen Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, China
| | - Yujiao Liu
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Ang Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, China. .,Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
| | - Dandan Pei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, China. .,Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
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Aoki A, Mizutani K, Mikami R, Taniguchi Y, Ohsugi Y, Meinzer W, Izumi Y, Iwata T. Residual periodontal pocket treatment with Er:YAG laser-assisted comprehensive periodontal pocket therapy: a retrospective study. Clin Oral Investig 2021. [PMID: 34278521 DOI: 10.1007/s00784-021-04054-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Recently, the application of erbium-doped yttrium aluminum garnet (Er:YAG) laser has been increasing in periodontal therapy. In this retrospective study, we evaluated the safety and effectiveness of a novel pocket therapy using Er:YAG laser in combination with conventional mechanical scaling and root planing treatment (Er:YAG laser-assisted comprehensive periodontal pocket therapy). METHODS Forty sites in 29 elderly patients having residual periodontal pockets of ≥ 5 mm depth were treated by curette and Er:YAG laser from 2006 to 2009. After root debridement by curette, laser irradiation was performed on the root surfaces. Then, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided by curette and laser. Furthermore, in most cases, removal of the outer epithelium and coagulation of the blood clot in the pocket entrance were additionally performed with laser. Clinical parameters were evaluated before and 3, 6, and 12 months after treatment. RESULTS With Er:YAG laser-assisted pocket therapy, debridement of pockets was thoroughly and safely performed, and favorable clinical improvements were observed in most cases, without any adverse side effects and complications. After 1 year, probing pocket depth significantly decreased from 6.4 ± 1.4 to 3.5 ± 1.3 mm (p < 0.001, 3.0 mm reduction), and clinical attachment level significantly decreased from 7.5 ± 1.6 to 5.2 ± 1.9 mm (p < 0.001, 2.3 mm gain). CONCLUSION The results of this study indicate that Er:YAG laser-assisted therapy is useful for the treatment of residual pockets as a minimally invasive flapless surgery. CLINICAL RELEVANCE Er:YAG laser-assisted comprehensive pocket therapy reduces the necessity of more conventional surgical therapies.
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Huang Y, Zhang Z, Zheng Y, Zhao Z, Zhong Y, Zhang Q, Xia D, Ma N, Zhang L. Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis. BMC Oral Health 2021; 21:340. [PMID: 34246253 PMCID: PMC8272313 DOI: 10.1186/s12903-021-01695-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients. Methods We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method. Results Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs. Conclusions SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01695-w.
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Affiliation(s)
- Yu Huang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Zheng Zhang
- School of Medicine, Tianjin Stomatological Hospital, Nankai University, Tianjin, 300041, China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, 300041, China
| | - Youli Zheng
- Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Zhulan Zhao
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Yang Zhong
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Qingyu Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Degeng Xia
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Ning Ma
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
| | - Li Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
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Chen YF, Zhan Q, Wu CZ, Yuan YH, Chen W, Yu FY, Li Y, Li LJ. Baseline HbA1c Level Influences the Effect of Periodontal Therapy on Glycemic Control in People with Type 2 Diabetes and Periodontitis: A Systematic Review on Randomized Controlled Trails. Diabetes Ther 2021; 12:1249-1278. [PMID: 33481189 PMCID: PMC8099950 DOI: 10.1007/s13300-021-01000-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The question of whether periodontal therapy is an effective strategy for achieving glycemic control in people with type 2 diabetes mellitus (T2DM) and periodontitis continues to be open to debate. To clarify this issue, we conducted a systematic review and meta-analysis. METHODS A systematic literature search of randomized controlled trials (RCTs) was carried out by searching four electronic databases and four journals up to April 2020. RCTs that evaluated the effect of periodontal therapy on glycemic control in people with T2DM were included. RESULTS A total of 23 RCTs were included in this systematic review and meta-analysis. We found that after 3 and 6 months, periodontal therapy could significantly reduce glycosylated hemoglobin (HbA1c) level (3-month: weighted mean difference [WMD] - 0.514, 95% confidence interval [CI] - 0.730, - 0.298, p = 0.000; 6-month: WMD - 0.548, 95% CI - 0.859, - 0.238, p = 0.000). However, huge heterogeneity existed. Further analyses on 11 potential sources of heterogeneity found that baseline HbA1c of the included studies was the most significant factor causing heterogeneity. The benefit of periodontal therapy on glycemic control was much more obvious in studies with a higher baseline HbA1c level than in those with a lower baseline HbA1c level. CONCLUSIONS Periodontal therapy significantly contributed to glycemic control in T2DM patients, especially in patients with higher baseline HbA1c level.
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Affiliation(s)
- Ya-Fei Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Zhan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Chen-Zhou Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi-Hang Yuan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan-Yuan Yu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Long-Jiang Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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12
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Dalvi S, Benedicenti S, Hanna R. Is antimicrobial photodynamic therapy an effective treatment modality for aggressive periodontitis? A systematic review of in vivo human randomized controlled clinical trials. Photodiagnosis Photodyn Ther 2021; 34:102314. [PMID: 33932563 DOI: 10.1016/j.pdpdt.2021.102314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limitations of scaling and root planing (SRP) have directed research to utilize additional therapies to enhance conventional techniques. The present systematic review was conducted to evaluate and present a comprehensive overview on effectiveness of antimicrobial photodynamic therapy (aPDT) in the management of aggressive periodontitis (AgP). METHODOLOGY The PRISMA statement guidelines and Cochrane Collaboration recommendations were followed to conduct this systematic review. The review protocol is registered in PROSPERO (CRD 42019143316). A structured electronic and manual search strategy was implied to gather the relevant published data on in vivo human RCTs from their earliest records until 31st October 2019. Relevant data was extracted from the eligible studies, analysed and impartially appraised for its quality. RESULTS Eleven papers met the eligibility criteria and included in this review. The data on standardized study protocol, ideal photosensitizer (PS) dye-wavelength combination, optimal parameters was inconclusive and a high risk of bias in majority of the studies noted, which are fundamental in establishing a standardized and replicable protocol. CONCLUSION Ultimately researchers should conduct well-designed and robust RCTs performed by trained clinicians in order to determine the effectiveness of aPDT, if any, after acknowledging the drawbacks highlighted in this systematic review.
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Affiliation(s)
- Snehal Dalvi
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy; Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India.
| | - Stefano Benedicenti
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy.
| | - Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy; Department of Oral Surgery, King's College Hospital NHS Foundation Trust, London, UK.
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Retamal-Valdes B, Teughels W, Oliveira LM, da Silva RN, Fritoli A, Gomes P, Soares GMS, Temporão N, Furquim CP, Duarte PM, Doyle H, Faveri M, Figueiredo LC, Feres M. Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial. Trials 2021; 22:283. [PMID: 33858486 PMCID: PMC8048221 DOI: 10.1186/s13063-021-05246-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis. METHODS Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines. STATISTICAL ANALYSES The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%. TRIAL REGISTRATION ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.
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Affiliation(s)
- Belen Retamal-Valdes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium
| | - Laryssa Macedo Oliveira
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Rebeca Nascimento da Silva
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Aretuza Fritoli
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Patricia Gomes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | | | - Natalie Temporão
- Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Camila Pinheiro Furquim
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Helio Doyle
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Marcelo Faveri
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Luciene Cristina Figueiredo
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
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Povšič K, Čuk K, Milavec S, Erčulj V, Seme K, Gašperšič R. Systemic azithromycin as an adjunct to scaling and root planing in patients with stage III/IV periodontitis: 12-month results of a randomized controlled clinical trial. Clin Oral Investig 2021; 25:5997-6006. [PMID: 33786649 DOI: 10.1007/s00784-021-03906-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/23/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine whether azithromycin (AZI) as an adjunct to scaling and root planing (SRP), when compared to placebo, decreases the number of sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 12 months post-treatment in stage III/IV periodontitis patients. MATERIALS AND METHODS In a double-blind randomized parallel-arm placebo-controlled trial, 40 stage III/IV periodontitis patients received steps 1 and 2 of periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20; AZI 500 mg/day, 3 days) or placebo (n = 20). Additional instrumentation of residual diseased sites (DS) - sites with PD ≥ 5 mm and BOP - was performed at the 3-, 6- and 9-month follow-ups. The primary outcome variable was the number of DS at the 12-month re-evaluation. Using a multivariate multilevel logistic regression model, the effects of gender, age, antibiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS The number of DS after 12 months was similar in the test (median (Me) = 4, interquartile range (IQR) = 0-6) and control (Me = 3, IQR = 1-6.5) groups. Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroup differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio (OR) for the healing of DS on molars (OR = 0.29; p < 0.001) and in smokers (OR = 0.36; p = 0.048). CONCLUSION Stage III/IV periodontitis patients showed significant but comparable improvements in periodontal parameters and the number of residual DS at the 12-month revaluation regardless of treatment type. This may have been the result of the additional instrumentation received by patients at residual DS in both treatment groups. CLINICAL RELEVANCE Treatment with AZI + SRP provided no additional benefits after 12 months in terms of periodontal parameters or the number of persisting sites with PD ≥ 5 mm + BOP as compared to SRP plus placebo. TRIAL REGISTRATION EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.
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Affiliation(s)
- Katja Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
| | - Katarina Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | | | - Vanja Erčulj
- Rho Sigma Research & Statistics, 1000, Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
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15
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Isola G, Polizzi A, Iorio-Siciliano V, Alibrandi A, Ramaglia L, Leonardi R. Effectiveness of a nutraceutical agent in the non-surgical periodontal therapy: a randomized, controlled clinical trial. Clin Oral Investig 2021; 25:1035-1045. [PMID: 32556659 DOI: 10.1007/s00784-020-03397-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical agent as an adjunct to Scaling and root planing (SRP) versus SRP alone for the treatment of periodontitis. MATERIALS AND METHODS Sixty-six patients with moderate periodontitis were enrolled. Through a randomized design, the patients were randomly assigned to SRP + nutraceutical agent (test group) or SRP alone (control group). Patients were regularly examined the clinical, inflammatory mediators and visual analogue scale (VAS) changes over a 6-month period. Clinical attachment level (CAL) was the primary outcome variable chosen. Gingival crevicular fluid (GCF) inflammatory mediator change and the impact of treatment on VAS were evaluated through a linear regression model. RESULTS Both treatments demonstrated an improvement in periodontal parameters compared with baseline. After 6 months of treatment, compared with the control group, the test group determined a significant probing depth (PD) (p = 0.003) and bleeding on probing (BOP) reduction (p < 0.001), while CAL gain was significantly obtained at 30 and 60 days after treatment (p < 0.05). In the test group, the level of inflammatory mediators was significantly reduced compared with the control group (p < 0.05). The linear regression analysis demonstrated that the nutraceutical agent exerted, in the test group, a significant influence on VAS at 6, 12, 24, and 48 h after treatment (p < 0.05). CONCLUSIONS Nutraceutical agent resulted in a more significant reduction in clinical, inflammatory mediators and short-term pain compared with SRP alone. CLINICAL RELEVANCE Nutraceutical agent, when combined with SRP, was demonstrated to be effective in reducing periodontal parameters and controlling the levels of inflammatory mediators and pain in patients with periodontitis.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Vincenzo Iorio-Siciliano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Piazza Pugliatti 1, Messina, 98123, Italy
| | - Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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16
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Shetty B, Divakar DD, Al-Kheraif AA, Alharbi AO, Almutairi MST, Alanazi MM. Role of PDT as an adjunct to SRP on whole salivary RANKL and OPG ratio in type-2 diabetic and normoglycemic individuals with chronic periodontitis. Photodiagnosis Photodyn Ther 2021; 34:102220. [PMID: 33610736 DOI: 10.1016/j.pdpdt.2021.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim was to assess the effect of scaling and root planing (SRP) with and without adjunct photodynamic therapy (PDT) on the levels of osteoprotegerin (OPG) receptor activator of NF-kappa B ligand (RANKL) in the unstimulated whole saliva (UWS) of type-2 diabetic and normoglycemic individuals with chronic periodontitis (CP). METHODS Type-2 diabetic and normoglycemic subjects with CP (Groups 1 and 2, respectively) were divided into test- (SRP + PDT) and control (SRP only) groups. Patient demographics were recorded; and periodontal parameters (marginal bone loss [MBL], probing depth [P.D], plaque index [PI], gingival index [GI], and clinical attachment loss [CAL]) were assessed at baseline and at 3-months-follow-up. Rate of flow of unstimulated whole saliva and levels of RANKL and osteoprotegerin were measured at both time intervals. P < 0.05 was considered statistically significant. RESULTS Eighty-four persons with CP (42 with and 42 without type-2 DM) were included. At baseline, clinicoradiographic parameters were comparable in all groups. At 3-months of follow-up, there was no significant difference in the clinicoradiographic parameters in all groups. At 3-months of follow-up, there was no significant reduction in whole salivary RANKL and osteoprotegerin levels among individuals in the test and control groups among CP patients with and without CP. CONCLUSION The whole salivary RANKL/OPG ratio remains high in patients with poorly-controlled type-2 DM after SRP with or without adjunct PDT.
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17
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Morales A, Contador R, Bravo J, Carvajal P, Silva N, Strauss FJ, Gamonal J. Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planning in the treatment of stage III periodontitis: a pilot randomized controlled clinical trial. BMC Oral Health 2021; 21:12. [PMID: 33413320 PMCID: PMC7792194 DOI: 10.1186/s12903-020-01276-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this triple-blind placebo-controlled parallel-arm randomized clinical trial was to evaluate the clinical effects of Lactobacillus rhamnosus SP1 or azithromycin as an adjunct to scaling and root planing (SRP) in patients with stage III periodontitis.
Methods Forty-seven systemically healthy participants with stage III periodontitis were recruited. Following SRP, the participants were randomly assigned to one of three treatment modalities; (1) placebo (n = 15), (2) probiotics (n = 16) and (3) antibiotics-azithromycin (n = 16). The participants were monitored at baseline, 3, 6, 9 and 12 months after therapy. Probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment loss (CAL) and plaque accumulation (PI) were evaluated.
Results All 47 participants completed the study. At 12 months, all groups showed significant improvements of PPD and PI (p < 0.012) irrespective of the treatment modality and without significant differences between the groups. Probiotics and azithromycin showed no added benefit in terms of CAL. While the placebo (p = 0.002) and the antibiotic-azithromycin (p = 0.002) group showed a significant reduction of BOP, only the placebo group revealed a significant reduction of CAL at 12 months follow-up (p = 0.003). The number of sites and teeth with PPD ≥ 5, ≥ 6 and ≥ 7 mm were significantly reduced in all groups at 12 months follow-up (p < 0.025) irrespective of the treatment regime and without significant differences between the groups. Conclusion The use of probiotics or azithromycin as an adjunct to SRP failed to provide additional benefits in the treatment of stage III periodontitis. The benefits of these two treatment regimes as an adjunct to SRP remain unclear. Trial registration NCT02839408, 10/28/2017, Clinicaltrial.gov.
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Affiliation(s)
- Alicia Morales
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Avenida Sergio Livingstone 943, Comuna de Independencia, Santiago, Chile.,Centro de Epidemiología Y Vigilancia de Las Enfermedades Orales (CEVEO), Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Rafael Contador
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Avenida Sergio Livingstone 943, Comuna de Independencia, Santiago, Chile
| | - Joel Bravo
- University of Antofagasta, Antofagasta, Chile
| | - Paola Carvajal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Avenida Sergio Livingstone 943, Comuna de Independencia, Santiago, Chile.,Centro de Epidemiología Y Vigilancia de Las Enfermedades Orales (CEVEO), Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Nora Silva
- Laboratory of Microbiology, Department of Medicine and Oral Pathology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Franz-Josef Strauss
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Avenida Sergio Livingstone 943, Comuna de Independencia, Santiago, Chile.,Department of Oral Biology, Medical University of Vienna, Vienna, Austria.,Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jorge Gamonal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Avenida Sergio Livingstone 943, Comuna de Independencia, Santiago, Chile. .,Centro de Epidemiología Y Vigilancia de Las Enfermedades Orales (CEVEO), Faculty of Dentistry, University of Chile, Santiago, Chile.
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18
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Li MM, Jia JH, Wu MX, Zhao CY, Jia LY, Shi H, Zhang XL. Clinical effectiveness of Er,Cr:YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials. Lasers Med Sci 2021; 36:889-901. [PMID: 33037559 DOI: 10.1007/s10103-020-03156-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
The meta-analysis aimed to systematically evaluate all the available pieces of evidence concerning the clinical effectiveness of Er,Cr:YSGG lasers (erbium, chromium, yttrium scandium gallium garnet laser) in the non-surgical treatment of patients with chronic periodontitis, and provide guidance for clinicians about the application of Er,Cr:YSGG lasers during the process of non-surgical periodontal treatments. The meta-analysis was conducted with data extracted from 16 randomized controlled clinical trials (RCTs) that compare Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing (SRP) with SRP alone for the treatment of chronic periodontitis published in English or Chinese from January 2000 to January 2020. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analogue scale (VAS) score. Heterogeneity of each study was evaluated with the Q test. The publication bias was measured using Begg's adjusted rank correlation test. Sixteen RCTs with 606 patients were included in the meta-analysis. There were statistically significant differences between Er,Cr:YSGG lasers adjunct/substitute to SRP and SRP alone in the PD reduction at 1-month follow-up (WMD = ‑ 0.35, 95% CI [- 0.63, ‑ 0.07], P = 0.013), 3-month follow-up (WMD = - 0.342, 95% CI [- 0.552, - 0.132], P = 0.001), CAL gain at 3-month follow-up (WMD = - 0.17, 95% CI [- 0.31, 0.03], P = 0.017), and VAS score (WMD = - 2.395, 95% CI [- 3.327, - 1.464], P = 0.000) immediately after treatment. There were no significant differences of PD reduction and CAL change at 6-month follow-up. The present meta-analysis indicated that Er,Cr:YSGG lasers provided additional effectiveness in PD reduction and CAL gain at short-term follow-ups and there was less pain compared with SRP alone.
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19
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Affiliation(s)
- Fawad Javed
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, United States.
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20
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Čuk K, Povšič K, Milavec S, Seme K, Gašperšič R. Influence of adjunctive azithromycin on microbiological and clinical outcomes in periodontitis patients: 6-month results of randomized controlled clinical trial. BMC Oral Health 2020; 20:241. [PMID: 32873290 PMCID: PMC7465355 DOI: 10.1186/s12903-020-01209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment. METHODS In a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS The number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0-11) and control (Me = 5, IQR = 1-22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p < 0,001). CONCLUSION Despite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP. TRIAL REGISTRATION EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.
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Affiliation(s)
- Katarina Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - Katja Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | | | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
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Schär D, Ramseier CA, Eick S, Mettraux G, Salvi GE, Sculean A. Transgingival photodynamic therapy (tg-aPDT) adjunctive to subgingival mechanical instrumentation in supportive periodontal therapy. A randomized controlled clinical study. Photodiagnosis Photodyn Ther 2020; 32:101971. [PMID: 32835882 DOI: 10.1016/j.pdpdt.2020.101971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recent data from preclinical studies and case series suggest that transgingival irradiation with diode lasers may represent a novel modality for antimicrobial photodynamic therapy (aPDT). However, at present, there is lack of data from controlled clinical studies on the use of transgingival antimicrobial photodynamic therapy (tg-aPDT) in the treatment of periodontitis. OBJECTIVE To evaluate the clinical effects of tg-aPDT used in conjunction with nonsurgical mechanical instrumentation during supportive periodontal therapy (SPT). MATERIALS AND METHODS Forty stage II and III periodontitis patients enrolled in SPT were randomly assigned to two groups of equal size. At baseline, study sites had to show sites with pocket probing depth (PPD) of ≥ 5 mm and Bleeding on Probing (BOP). Full mouth and site-specific Plaque-Index scores (PI), BOP, PPD, and Clinical Attachment Level (CAL) were recorded at baseline (BL), three months (3 M), and 6 months (6 M), respectively. The primary outcome variable was the change in the number of sites with BOP. Treatment was performed under local anaesthesia after random allocation to one of the following groups 1) Subgingival scaling and root planing (SRP) + tg-aPDT (test) or 2) SRP alone (control). RESULTS Thirty-nine patients completed the study. Full mouth PI and BOP improved over six month, however without statistically significant difference between the groups. At 6 M, BOP-levels were statistically significantly lower in test sites (25.0 %) compared to the control sites (65.0 %), (p < 0.025). PPD improved in both groups with comparable mean values at 3 M (PPD test: 5.21 ± 0.92 mm; PPD control: 4.45 ± 1.36 mm) and 6 M (PPD test: 5.11 ± 1.10 mm; PPD control: 4.35 ± 1.14 mm). Additionally, CAL slightly improved in both groups with comparable mean values at 3 M (CAL test: 6.79 ± 1.72 mm; CAL control: 5.30 ± 2.43 mm) and 6 M (CAL test: 6.26 ± 1.70 mm; CAL control: 5.50 ± 2.33 mm). CONCLUSIONS Within its limits, the present results appear to indicate that the use of tg-aPDT adjunctive to SRP may represent a new modality for controlling inflammation and further bleeding in residual periodontal pockets.
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Pudgar P, Povšič K, Čuk K, Seme K, Petelin M, Gašperšič R. Probiotic strains of Lactobacillus brevis and Lactobacillus plantarum as adjunct to non-surgical periodontal therapy: 3-month results of a randomized controlled clinical trial. Clin Oral Investig 2020; 25:1411-1422. [PMID: 32666349 DOI: 10.1007/s00784-020-03449-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/07/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine if periodontitis patients benefit from treatment with Lactobacillus brevis and Lactobacillus plantarum strains, applied into periodontal pockets as gel and thereafter taken as lozenges, as an adjunct to scaling and root planing (SRP). MATERIALS AND METHODS In a double-blind, randomized, placebo-controlled trial, 40 patients received scaling and root planing (SRP) in two sessions within 7 days. Patients then received either probiotic gel and lozenges (n = 20) or placebo (n = 20). The primary outcome variable was the number of diseased sites (DS: PD > 4 mm + BOP) at the 3-month re-evaluation. The effects of gender, age, probiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated using a multivariate multilevel logistic regression model. RESULTS The number of DS after 3 months was similar in the test (Me = 8, IQR = 5-11) and control (Me = 5, IQR = 1-10) groups. Both groups showed substantial but equivalent improvements in periodontal parameters. The logistic regression showed higher odds for the healing of gingival bleeding (OR = 2.12, p = 0.048) and lower odds for the healing of DS (OR = 0.51; p < 0.001) in the probiotic group. CONCLUSIONS Patients with periodontitis benefit from adjunctive use of probiotics containing L. brevis and L. plantarum in terms of reduction of gingival bleeding. However, adjunctive probiotics increase the number of persisting diseased sites with PD > 4 mm and BOP. CLINICAL RELEVANCE The adjunctive use of probiotics containing L. brevis and L. plantarum strains in treating chronic periodontitis results in a higher number of residual diseased sites when compared with SRP + placebo; its use is therefore unfounded.
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Affiliation(s)
- P Pudgar
- Public Health Centre, 2360, Radlje ob Dravi, Slovenia
| | - K Povšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - K Čuk
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - K Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - M Petelin
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia
| | - R Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.
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Graetz C, Fecke P, Seidel M, Engel AS, Schorr S, Sentker J, Dörfer CE, Sälzer S. Evaluation of a systematic digitized training program on the effectivity of subgingival instrumentation with curettes and sonic scalers in vitro. Clin Oral Investig 2020; 25:219-230. [PMID: 32474807 PMCID: PMC7785550 DOI: 10.1007/s00784-020-03356-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
Objectives Whereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators’ experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA. Material and methods Before baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1–T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0–T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured. Results At T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; (p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % (p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001). Conclusions After systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers. Clinical relevance It can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.
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Affiliation(s)
- Christian Graetz
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany.
| | - Paula Fecke
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Miriam Seidel
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Anne Sophie Engel
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Susanne Schorr
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Johanna Sentker
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Christof E Dörfer
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Sonja Sälzer
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
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Komara I, Alfa Winata E, Susanto A, Hendiani I. Periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Saudi Dent J 2020; 32:194-199. [PMID: 32405222 PMCID: PMC7211895 DOI: 10.1016/j.sdentj.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE Clinical improvement after periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis was studied for a period of 30 days. MATERIALS AND METHODS The tray fabrication was performed in a dental laboratory using the Soft - Tray Sheets (Ultradent™), whereas scaling and root planing were done using ultrasonic scaler and hand instruments. A total of 36 subjects with chronic periodontitis were divided into 3 treatment groups: group I was treated with SRP procedure combined with the prescription-tray application of chlorine dioxide gel; group II was treated with SRP procedure with the application of chlorine dioxide alone; and group III was treated with SRP procedure alone. Clinical parameters examined were probing pocket depth (PPD) and papillary bleeding index (PBI); measurements were taken at baseline (day0) and 30 days after SRP (day 30). Comparison between treatment groups was tested statistically by Kruskal Wallis test and Analysis of Variance (ANOVA). RESULTS There were significant differences in the decrease of the average pocket depth and bleeding index in all the 3 treatment groups (P = 0.001). Decreases in the pocket depth of groups I, II, and III were 50.9%, 47.9%, and 27.8%, respectively. Decreases in the papillary bleeding index of groups I, II, and III were 88.2%, 68.9%, and 51.1%, respectively. CONCLUSION The application of chlorine dioxide gel using the custom tray after SRP in the treatment of chronic periodontitis showed better clinical improvement in pocket depth reduction and bleeding index compared to SRP alone.
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Affiliation(s)
- Ira Komara
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
| | - Edwin Alfa Winata
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
| | - Agus Susanto
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
| | - Ina Hendiani
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
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Kaufmann ME, Wiedemeier DB, Zellweger U, Solderer A, Attin T, Schmidlin PR. Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review. Clin Oral Investig 2020; 24:1091-1100. [PMID: 31938962 DOI: 10.1007/s00784-020-03198-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gingival recessions inevitably occur during healing after scaling and root planing, but synoptic data on this topic is still lacking. This review compared the recession formation with and without the administration of systemic antibiotics. OBJECTIVES To evaluate the formation of recession with and without the administration of antibiotics during the healing after scaling and root planing. MATERIALS AND METHODS This study re-analyzed publications that reported clinical attachment levels (CAL) and probing pocket depths (PD) up to January 2019, including the pivotal review by Zandbergen and co-workers (2013). Whereas these studies traditionally focused on PD and CAL, the present analysis compared recession formation (ΔREC) after adjunctive systemic administration of amoxicillin (amx) and metronidazole (met) during scaling and root planing (SRP) and SRP alone. The mean increase in ΔREC, if not reported, was calculated from CAL and PD values and statistically analyzed. Recession formation was compared after 3 and 6 months after therapy. Results were separately reported for chronic periodontitis (CP) as well as aggressive periodontitis (AP) cases. RESULTS Recessions increased consistently between baseline and follow-up. In the AP group, median ΔREC was 0.20 mm after 3 months, irrespective of whether antibiotics were administered or not. After 6 months, median ΔREC increased to 0.35 mm after AB and remained stable at 0.20 mm with SRP alone. In the CP group, after 3 months with and without antibiotics, median ΔREC accounted for 0.30 mm and 0.14 mm, respectively. After 6 months, median ΔREC accounted for 0.28 mm (with AB) and 0.20 mm (without AB). The quantitative assessment by meta-analyses also yielded small values (≤ 0.25 mm) for the estimated differences in recession formation between AB and noAB; however, none of them reached statistical significance. CONCLUSIONS Although a slight tendency towards higher recession formation after SRP in combination with AB could be observed in many studies, quantitative meta-analyses showed no clinically relevant difference in recession formation due to the administration of AB. In general, the description and discussion of recessions in the literature seems not to be a major focus so far. CLINICAL RELEVANCE Since the preservation of gingival tissues is important by preventive and therapeutic means, e.g., when avoiding postoperative root sensitivity or performing regenerative surgery, these aspects should not be neglected. We thus suggest to report REC measurements along with PD and CAL values for more direct recession formation (ΔREC) assessments in the future.
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Affiliation(s)
- Manuela E Kaufmann
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11 8032, Zurich, Switzerland.
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | - Alex Solderer
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11 8032, Zurich, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11 8032, Zurich, Switzerland
| | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11 8032, Zurich, Switzerland
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Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. BMC Oral Health 2019; 19:176. [PMID: 31387569 PMCID: PMC6685286 DOI: 10.1186/s12903-019-0829-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/23/2019] [Indexed: 02/07/2023] Open
Abstract
Background Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice. Methods We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane’s risk of bias tool was used to assess the risk of bias. Results Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI − 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11). Conclusion The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results. Electronic supplementary material The online version of this article (10.1186/s12903-019-0829-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruoyan Cao
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Qiulan Li
- Department of Stomatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Qiqi Wu
- Department of Operative Dentistry and Endodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Mianfeng Yao
- Department of Oral Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410083, China
| | - Yu Chen
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Hongbo Zhou
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China.
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Al-Qahtani SM. Evaluation and Comparison of Efficacy of Gluma ® and D/Sense ® Desensitizer in the Treatment of Root Sensitivity Induced by Non-Surgical Periodontal Therapy. Open Access Maced J Med Sci 2019; 7:1685-1690. [PMID: 31210824 PMCID: PMC6560292 DOI: 10.3889/oamjms.2019.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Dentinal hypersensitivity is one of the most common sequels of non-surgical periodontal therapy. Resulted discomfort may restrain patients from oral hygiene maintenance, thus affects the long-term success of periodontal therapy. So, it becomes a prime concern of the clinician to manage the post-operative hypersensitivity. AIM: This clinical investigation aimed to evaluate and compare the efficacy of D/Sense® and Gluma® in preventing post-operative sensitivity after non-surgical periodontal therapy. MATERIAL AND METHODS: The present randomised, double-blind, split-mouth study was conducted on forty-five (22 male, 23 female) systemically healthy patients, with the mean age of 40 ± 17.5 years. Visual Analogue scale was used to evaluate root sensitivity after application of tactile and cold stimuli at baseline, 1, 2, 4 and 6 weeks after scaling and root planing. After scaling and root planning, the sites were randomly divided into different groups for the application of desensitising agents. Collected data were analysed by using, analysis of variance (ANOVA) for inter-group and paired t-test for intra-group comparisons. RESULTS: No adverse or side effects were reported by any of the patients throughout the study period. Gluma® showed a statistically significant reduction in the VAS score for root sensitivity as compared to D/Sense®, at 1, 2- and 4-weeks follow-up period (p < 0.05). Whereas, at 6th-week follow-up, both the solution showed almost similar score for root hypersensitivity. Intragroup comparison for D/Sense® revealed a significant difference in scores from baseline to all intervals (p < 0.05), except baseline to 6 weeks (p > 0.05). Whereas Gluma® showed a significant difference in scores from baseline to 2nd-week follow-up (p < 0.05). CONCLUSION: The result of the present investigation revealed that application of Gluma® resulted in better control on iatrogenic root hypersensitivity as compared to the D/Sense® during the initial follow-up period.
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Affiliation(s)
- Saad Mohammed Al-Qahtani
- Department of Periodontics and Community Dental Sciences, King Khalid University, Abha, Asir, Saudi Arabia
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Graetz C, Schorr S, Christofzik D, Dörfer CE, Sälzer S. How to train periodontal endoscopy? Results of a pilot study removing simulated hard deposits in vitro. Clin Oral Investig 2019; 24:607-617. [PMID: 31111282 DOI: 10.1007/s00784-019-02913-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators' experience and training with such a device on treatment results is unclear. Therefore, we compared in an in vitro study the use of PE for scaling and root planing (SRP) with the conventional non-surgical therapy, hypothesizing that using a PE allows to remove more simulated hard deposits than without (nPE), influenced by the operators' experience and training. MATERIAL AND METHODS A sonic device and Gracey curettes were utilized by 11 operators (six dentists, five dental hygienists) in periodontitis manikins heads. The time required for treatment and the proportion of removed simulated hard deposits by SRP were measured. RESULTS Using the PE led to a significant difference in removal of simulated hard deposits (%) (mean ± SD) irrespective of operators' experience (PE 90.78 ± 12.10% (range 58.80-100%); nPE 79.98 ± 22.15% (range 38.10-100%, p < 0.001)), sub-analyses for different tooth types demonstrated a significant difference in favor of PE for front teeth (p < 0.001) and in the upper jaw independent of the tooth type (p < 0.001). Comparison of treatment times for two quadrants with and without PE showed a significantly longer treatment time with PE (∆22.27 ± 17.98 mins, p <0.001). CONCLUSIONS Within the present pilot study, the use of PE led to more removal of simulated hard deposits but was concomitantly related to more time and financial effort. Using PE was most beneficial in the front area. CLINICAL RELEVANCE PE may provide additional benefits for the removal of hard deposits compared to traditional SRP. The beneficial effect of PE seems not to be influenced by operators experience nor by pocket probing depth.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts - University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
| | - Susanne Schorr
- Clinic of Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts - University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany
| | - David Christofzik
- Clinic of Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts - University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany
| | - Christof E Dörfer
- Clinic of Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts - University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts - University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany
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Almeida ML, Duarte PM, Figueira EA, Lemos JC, Nobre CMG, Miranda TS, de Vasconcelos Gurgel BC. Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes. Clin Oral Investig 2019; 24:333-341. [PMID: 31102044 DOI: 10.1007/s00784-019-02927-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics. MATERIAL AND METHODS Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR. RESULTS Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05). CONCLUSIONS Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year. CLINICAL RELEVANCE There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02643771.
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Affiliation(s)
- Mariana Linhares Almeida
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil.,Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
| | - Eduardo Aleixo Figueira
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | - Janaína Cavalcante Lemos
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | - Cintia Mirela Guimarães Nobre
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil
| | | | - Bruno César de Vasconcelos Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 Lagoa Nova, Natal, Rio Grade do Norte, 59056-000, Brazil.
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Raut CP, Sethi KS, Kohale B, Mamajiwala A, Warang A. Subgingivally delivered coenzyme Q10 in the treatment of chronic periodontitis among smokers: A randomized, controlled clinical study. J Oral Biol Craniofac Res 2019; 9:204-8. [PMID: 31211037 DOI: 10.1016/j.jobcr.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022] Open
Abstract
Background Coenzyme Q10 is an antioxidant whose efficacy in periodontal diseases is well known. However studies regarding its efficacy in smokers with periodontitis are few. Coenzyme Q10 serves as an endogenous antioxidant and its increased concentration in the diseased gingiva effectively suppresses advanced periodontal inflammation. Objectives The aim of this study is to evaluate the efficacy of coenzyme Q10 as an adjunct to scaling and root planing in smokers with chronic periodontitis. Methods Total of 40 patients were enrolled for the study. The subjects were divided into control (Scaling and root planing only) and test group (Coenzyme Q10 plus Scaling and root planing). Clinical parameters such as plaque index, modified sulcular bleeding index, probing pocket depth and clinical attachment level. These were assessed at baseline, at 1 month and 3 month. The results were subjected to appropriate statistical analysis. Results There was a significant improvement in all clinical parameters in the test sites seen at the end of the 1 month and 3 month period. Conclusions Coenzyme Q10 can be said to have a beneficial effect on smokers with periodontitis when used as an adjunct to scaling and root planing.
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Hofer D, Gartenmann SJ, Wiedemeier DB, Sener B, Attin T, Schmidlin PR. Preclinical competency in scaling/root planing: comparing dental and dental hygiene student’s outcomes. Swiss Dent J 2019; 129:186-191. [PMID: 30806511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dental students in Zurich receive 8.5 hours of preclinical training in scaling/root planing. Dental hygiene students receive a multiple of this amount. This study was undertaken to assess the students’ acquired preclinical competencies and to what degree they may differ. 34 undergraduate dental students and 20 dental hygiene (DH) students from two different schools in Zurich were tasked with scaling/root planing a maxillary left canine, coated with black lacquer from the apex to ca. 5 mm above the cemento-enamel junction, after completing their preclinical periodontal instrumentation course. The students were allowed to use any instrument in their set (Gracey or universal curettes) for a 5-minute period. Positive (experienced DHs) and negative (laypeople) control groups performed the same task. After instrumentation, teeth were scanned and planimetrically assessed. The percentage of cleaned tooth surface was calculated and statistically analysed (Kruskal-Wallis rank sum test, Conover’s test for pairwise comparisons). The dental students achieved the highest median cleaning efficacy (80.6%), followed by the experienced DHs (65.3%), the DH students (62.0%) and the laypeople (26.7%). When split by schools, a significant difference in instrumentation efficacy by the student DHs was seen (p <0.001). Despite their limited instruction time, the dental students acquired preclinical scaling/root planing skills comparable to, or better than, DH students with more training time.
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Affiliation(s)
- Deborah Hofer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
| | - Stefanie J. Gartenmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
| | - Daniel B. Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Switzerland
| | - Beatrice Sener
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
| | - Thomas Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
| | - Patrick R. Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzerland
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Petersilka GJ, Arweiler NB, Otto J, Wittig T. Non-interventional study to collect data for the application of lidocaine gel 2% during scaling and root planing and professional mechanical plaque removal. Clin Oral Investig 2019; 23:551-558. [PMID: 29717361 PMCID: PMC7735999 DOI: 10.1007/s00784-018-2468-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 04/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Evaluation of the safety and efficacy of a topical lidocaine gel 2% (LG) during scaling and root planing (SRP) and professional mechanical plaque removal (PMPR). MATERIALS AND METHODS The anesthetic effects as well as unwanted effects of LG prior to or during SRP and PMPR were evaluated in an observational, non-randomized, non-interventional study design. A total of 385 treatments were recorded in 68 study centers all over Germany. Rating of the anesthetic effect of LG by treating personnel and patients using a four-item verbal rating scale (VRS), tolerability, safety (adverse effects), and need for additional local injection anesthesia (ALI). RESULTS In SRP as well as in PMPR, application of LG allowed a sufficiently pain-free therapy in more than 90% of the patients as stated on the VRS (SRP: 97.8%, PMPR: 93.75%). Overall, ALI was needed in only 4.23% of the patients treated (SRP: 5.3%, PMPR: 2.62%). One adverse effect occurred within the observation. CONCLUSIONS Application of LG may offer a safe and effective way to achieve pain-free therapy in periodontal patients. CLINICAL RELEVANCE Patient compliance is key to the success of periodontal maintenance therapy. Effective and safe pain control during various kinds of periodontal therapy might increase patient compliance and therefore contribute to the long-term treatment success, among other factors. With regard to the patients observed in this study, 47% had previously received periodontal maintenance therapy and were therefore familiar with the treatment and the associated pain.
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Affiliation(s)
- Gregor J Petersilka
- Private Practice, Wuerzburg, Germany
- Department of Periodontology, Philipps-University of Marburg, Marburg, Germany
| | - Nicole B Arweiler
- Department of Periodontology, Philipps-University of Marburg, Marburg, Germany
| | - Joachim Otto
- Medical-Scientific Department, Chemische Fabrik Kreussler & Co. GmbH, Rheingaustrasse 87-93, 65203, Wiesbaden, Germany
| | - Tobias Wittig
- Medical-Scientific Department, Chemische Fabrik Kreussler & Co. GmbH, Rheingaustrasse 87-93, 65203, Wiesbaden, Germany.
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Bansal V, Gupta R, Dahiya P, Kumar M, Samlok JK. A clinico-microbiologic study comparing the efficacy of locally delivered chlorhexidine chip and diode LASER as an adjunct to non-surgical periodontal therapy. J Oral Biol Craniofac Res 2019; 9:67-72. [PMID: 30294538 PMCID: PMC6170259 DOI: 10.1016/j.jobcr.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Considering the microbial etiology of the periodontal disease, the periodontal therapy aims to control or abolish the pathogenic microbes. The gold standard scaling and root planing procedure has been used since time immemorial but the drawbacks associated with it have led to the development of various adjunctive means. The current study was therefore, performed to comparatively assess the efficacy of local delivery of chlorhexidine and 808-nm diode LASER as an appurtenance to scaling and root planing in patients with chronic periodontitis. METHODS In a randomized split mouth evaluation, 30 patients having probing depth of ≥5 mm which bled on probing at least at 3 different sites were included. At baseline, the evaluation of plaque index, bleeding index, probing pocket depth and clinical attachment level was done and the microbial samples were collected for the assessment of spirochetes, motile rods and coccoid cells. The 3 selected sites of each subject were allocated to 3 different groups A, B, C viz; Scaling and root planing (SRP) + chlorhexidine chip, SRP + diode LASER and SRP respectively. The patients were recalled after 4 weeks to re-evaluate the clinical and microbiological parameters. RESULTS All the parameters significantly reduced from baseline to 4 weeks in all the 3 groups. Intergroup comparisons revealed remarkable difference between group A and C and group B and C, respectively; no notably significant difference was found between group A and B. CONCLUSION The additional use of LASER and chlorhexidine chip assures anti-inflammatory effect and anti-microbial effect that allows reduction in bacterial counts and promotes healing. The use of adjuncts have been found to be efficacious in controlling disease and promoting periodontal health and thereby reducing the need for surgical procedures to be undertaken.
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Affiliation(s)
| | - Rajan Gupta
- Department of Periodontics, Himachal Institutes of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
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Derman SHM. Intrapocket and/or Topical Anesthetic Options Offer an Alternative to Injected Anesthesia During Scaling and Root Planing in Patients With Shallow to Moderate Periodontal Pockets. J Evid Based Dent Pract 2018; 18:240-2. [PMID: 30077376 DOI: 10.1016/j.jebdp.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients: systematic review and meta-analysis. Wambier LM, de Geus JL, Boing TF, Chibinski ACR, Wambier DS, Rego RO, Loguercio AD, Reis A. J Am Dent Assoc 2017;148(11):814-24.e812. SOURCE OF FUNDING Institutional, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil. TYPE OF STUDY/DESIGN Systematic review with meta-analysis of data.
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Uraz A, Karaduman B, Isler SÇ, Gönen S, Çetiner D. Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects. J Dent Sci 2018; 14:27-37. [PMID: 30988877 PMCID: PMC6445981 DOI: 10.1016/j.jds.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/30/2018] [Indexed: 12/01/2022] Open
Abstract
Background/purpose The application of ozone as an adjunctive treatment represents a new approach in the management of chronic periodontitis. The purpose of this study was to evaluate the clinical, biochemical and microbiological efficacy of ozone treatment as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis (GCP) patients. Materials and methods Eighteen patients (9 males and 9 females; aged from 28 to 47 years, mean age of 40 ± 6.51 years) with GCP were recruited in the study. In a split mouth design, two quadrants in each patient were randomly allocated to SRP-alone or SRP-ozone therapy (SRP + OT) groups by coin toss method. Subgingival plaque and gingival crevicular fluid (GCF) samples were collected at baseline, following 1st and 3rd months. The clinical parameters were monitored at baseline and after 3 months. Microbiological parameters were analyzed by quantitative-PCR and GCF biomarkers were determined by ELISA. Results were analyzed statistically. Results Statistically significant improvements in all clinical parameters were accompanied by a reduction in microbiological and biochemical parameters in both treatment groups. SRP treatment resulted in a significant reduction of Porphyromonas gingivalis (Pg) at 1st month and Tannerella forsythia (Tf) and Prevotella intermedia (Pi) at 3 months. Following SRP treatment the interleukin (IL)-8 levels were significantly reduced at month 1. There were no significant differences between two treatments for any of the parameters. Conclusion Within the limitations of this study, adjunctive ozone therapy did not provide additional benefits to clinical, microbiological and biochemical parameters over SRP in chronic periodontitis patients.
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Affiliation(s)
- Ahu Uraz
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Burcu Karaduman
- Department of Periodontology, Faculty of Dentistry, Biruni University, İstanbul, Turkey
| | - Sila Çagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Sevim Gönen
- Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Çetiner
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Pockpa AD, Soueidan A, Louis P, Coulibaly NT, Badran Z, Struillou X. Twenty Years of Full-Mouth Disinfection: The Past, the Present and the Future. Open Dent J 2018; 12:435-442. [PMID: 29988213 PMCID: PMC5997853 DOI: 10.2174/1874210601812010435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Conventional periodontal treatment, performed quadrant by quadrant in multiple visits, was re-evaluated in the early 1990s when the full-mouth disinfection concept was introduced. Over the years, several modifications to the full-mouth disinfection approach have been suggested. Objective: The purpose of this article is to review the evolution of full-mouth disinfection during the past 20 years, to specify its indications and to consider the prospects for this approach. Materials and Methods: An electronic and manual search of the literature, ending in December 2016, was performed by two independent researchers. Only pivotal studies and randomized controlled clinical trials published in the English language that evaluated a new approach to full-mouth disinfection were selected. Results: According to the studies included in our analysis (21 articles), several modified full-mouth disinfection protocols have been designed including: full-mouth treatment without chlorhexidine, the extension of hygiene methods and an increase in the duration of post-treatment chlorhexidine use, the replacement of chlorhexidine with other antiseptics, supplementation with antibiotics or probiotics, full-mouth antimicrobial photodynamic therapy and one-stage full-mouth disinfection combined with a periodontal dressing. Conclusion: Since 1995, several modifications have been suggested to improve the effectiveness of full-mouth disinfection. The majority of the studies demonstrate that the results obtained with full-mouth disinfection and its variants are equivalent to each other and to those obtained with the conventional quadrant method. Currently, the selection of this technique remains empirical and depends on the preferences of the practitioner and the patient. In the future, a patient-centered approach should be the best indication for the use of this technique.
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Affiliation(s)
- Ange Désiré Pockpa
- Clinical Investigation Unit 11 Odontology, CHU Nantes, Nantes, France.,Department of Periodontology, Faculty of Dental Surgery, University of Felix Houphouët Boigny, Abidjan, Ivory Coast
| | - Assem Soueidan
- Clinical Investigation Unit 11 Odontology, CHU Nantes, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France.,Department of Periodontology, Faculty of Dental Surgery, University of Nantes, Nantes, France
| | - Pauline Louis
- Department of Periodontology, Faculty of Dental Surgery, University of Nantes, Nantes, France
| | - Nadin Thérèse Coulibaly
- Department of Periodontology, Faculty of Dental Surgery, University of Felix Houphouët Boigny, Abidjan, Ivory Coast
| | - Zahi Badran
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France.,Department of Periodontology, Faculty of Dental Surgery, University of Nantes, Nantes, France.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Xavier Struillou
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France.,Department of Periodontology, Faculty of Dental Surgery, University of Nantes, Nantes, France
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Isola G, Matarese G, Williams RC, Siciliano VI, Alibrandi A, Cordasco G, Ramaglia L. The effects of a desiccant agent in the treatment of chronic periodontitis: a randomized, controlled clinical trial. Clin Oral Investig 2018. [PMID: 28624914 DOI: 10.1007/s00784-017-2154-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Chemotherapeutic agents have been widely used as adjuncts for the treatment of chronic periodontitis (CP). This study investigated and compared a desiccant agent as an adjunct to scaling and root planing (SRP) versus SRP alone for the treatment of CP. MATERIALS AND METHODS Thirty-six patients with CP were studied. Using a split-mouth design, the maxillary right and left quadrants were randomly assigned to SRP plus desiccant (Hybenx® EPIEN Medical, Inc. St. Paul, MN, USA) or SRP alone. Patients were examined on a regular basis for clinical, microbiological, and inflammatory mediator changes over a 1-year period. Clinical attachment level (CAL) was the primary outcome variable. In addition, the red complex bacteria and gingival crevicular fluid (GCF) inflammatory mediators were monitored. RESULTS Compared to baseline, both treatments demonstrated an improvement in periodontal parameters. Compared to SRP alone, SRP plus desiccant yielded a significant improvement in probing depth (PD) (SRP: 2.23 ± 0.31 mm vs. desiccant: 3.25 ± 0.57 mm, p < 0.05), CAL (SRP: 3.16 ± 0.29 mm vs. desiccant: 4.21 ± 0.34 mm, p < 0.05 mm) and bleeding on probing (BOP) (SRP: 4.56 ± 1.5% vs. desiccant: 34.23 ± 4.2%, p < 0.001) at 12 months. Similarly, in the SRP plus desiccant group, the bacteria of the red complex were significantly reduced (p < 0.05); and the level of inflammatory mediators was significantly reduced (p < 0.003) compared to SRP alone. CONCLUSIONS SRP plus the desiccant resulted in a greater reduction in clinical, microbial and inflammatory mediators compared to SRP alone. CLINICAL RELEVANCE Desiccant, when combined to SRP, was demonstrated as a significant approach to control the levels of certain periodontal pathogens, inflammatory mediators in patients with CP.
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Affiliation(s)
- Gaetano Isola
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, Unit of Periodontology, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
| | - Giovanni Matarese
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, Unit of Periodontology, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Ray C Williams
- Department of Periodontology, UNC School of Dentistry, Campus Box #7450, Chapel Hill, NC, 27599-7450, USA
| | | | - Angela Alibrandi
- Department of Economics, Unit of Statistics and Mathematical Sciences, University of Messina, Via Pugliatti 1, 98122, Messina, Italy
| | - Giancarlo Cordasco
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, Unit of Periodontology, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via G. Pansini 5, 80131, Naples, Italy
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Singhal R, Agarwal V, Rastogi P, Khanna R, Tripathi S. Efficacy of Acacia arabica gum as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized controlled clinical trial. Saudi Dent J 2017; 30:53-62. [PMID: 30166872 PMCID: PMC6112319 DOI: 10.1016/j.sdentj.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of the present study was to explore the adjunctive use of Acacia arabica gel in the treatment of chronic periodontitis. Methods Single centre, randomised, triple blind, controlled trial on mild to moderate chronic periodontitis patients; Group I (SRP + Acacia arabica, n = 40) and Group II (SRP + placebo, n = 40); were analysed for clinical improvements in periodontal pocket depth (PPD) and clinical attachment levels (CAL) at baseline, 15 and 90 days on application of gels. Gingival index and plaque index were assessed as secondary parameters. Results Statistically significant PPD reduction (p < .05) and CAL gain (p < .05) was observed with use of Acacia arabica gel. The reduction in sites with moderate PPD was observed more among Group I than Group II and the difference was statistically significant (p = .001). Secondary outcome variables; Plaque Index and Gingival Index showed better resolution with Acacia arabica gel. Conclusion Acacia arabica leads to better clinical outcomes in patients with mild to moderate chronic periodontitis with effective antiplaque and anti-gingivitis action. It may be recommended adjunct to SRP for maintenance in patients with mild to moderate chronic periodontitis.
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Affiliation(s)
- Rameshwari Singhal
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, UP, India
| | - Vivek Agarwal
- Department of Medicine, Mayo Institute of Medical Sciences, Barabanki, UP, India
| | - Pavitra Rastogi
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, UP, India
| | - Richa Khanna
- Department of Pediatric Dentistry, Faculty of Dental Sciences, King George's Medical University, Lucknow, UP, India
| | - Shuchi Tripathi
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, UP, India
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Everett JD, Rossmann JA, Kerns DG, Al-Hashimi I. Laser Assisted Non-surgical Periodontal Therapy: A Double Blind, Randomized Clinical Trial. Open Dent J 2017; 11:79-90. [PMID: 28357001 PMCID: PMC5345326 DOI: 10.2174/1874210601711010079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/18/2016] [Accepted: 12/22/2016] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to examine potential benefits of using laser therapy for secular decontamination in conjunction with scaling and root planing in the treatment of chronic periodontitis. The study was performed on 173 teeth in 14 patients in a split-mouth design, one side received scaling and root planing followed by laser therapy using a carbon dioxide (CO2) laser with an ablative handpiece (test group); the contralateral side received scaling and root planing without laser (control group). Clinical and laboratory parameters were evaluated prior to treatment and at 3 and 6 months following therapy; clinical measurements were performed by two blinded examiners. The clinical parameters included measurement of gingival recession (REC), bleeding on probing (BOP), clinical attachment level (CAL), pocket depth (PD), furcation involvement (FUR), and tooth mobility (MOB). Laboratory testing to determine the levels of periodontal pathogens was performed using PCR techniques. The results of the study revealed statistically significant differences in clinical and laboratory parameters at 3 and 6 months after therapy for both test and control groups, but no significant difference was observed between the two groups. However, sites receiving laser therapy tended to show a greater decrease in probing depths, gain in clinical attachment level, and reduced bacterial levels. In conclusion, the overall results of the study suggest a potential benefit of using laser therapy in conjunction with scaling and root planing for the treatment of chronic periodontitis.
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Affiliation(s)
- Joseph D. Everett
- Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - Jeffrey A. Rossmann
- Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - David G. Kerns
- Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
| | - Ibtisam Al-Hashimi
- Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas, TX 75246, USA
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40
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Xue D, Tang L, Bai Y, Ding Q, Wang P, Zhao Y. Clinical efficacy of photodynamic therapy adjunctive to scaling and root planing in the treatment of chronic periodontitis: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2017; 18:119-127. [PMID: 28188919 DOI: 10.1016/j.pdpdt.2017.01.183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/07/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the clinical efficacy of photodynamic therapy (PDT) adjunctive to scaling and root planing (SRP) in patients with untreated chronic periodontitis based on up-to-date evidence. METHODS MEDLINE and the Cochrane Library were systematically searched to identify eligible randomized controlled trials (RCTs), supplemented by a manual literature search. Mean differences (MD) and the corresponding 95% confidence intervals (CI) of probing depth (PD) reduction and clinical attachment level (CAL) gain were synthesized. The I2 test and Q statistics were used to determine the inter-study heterogeneity. Subgroup analysis based on smoking status was performed. RESULTS Eleven RCTs with a total of 243 subjects were included. Significant improvement in PD reduction (MD=0.13, CI:0.02-0.24, p=0.02) and marginal significant improvement in CAL gain (MD=0.18, CI:-0.005-0.363, p=0.056) were observed in favor of SRP+PDT at 3months. When evaluated at 6months after baseline, the association of PDT with SRP resulted in a significant benefit in PD reduction (MD=0.40, CI:0.05-0.74, p=0.03), but not in CAL gain (MD=0.37, CI:-0.18-0.93, p=0.18). Subgroup analysis revealed that the combined therapy produced no significant improvements in PD and CAL at neither 3months nor 6months for studies with smokers. No treatment-related adverse events or side effects had been reported by the included studies. CONCLUSIONS Pooled analysis suggests a short-term benefit of PDT as an adjunct to SRP in clinical outcome variables. However, evidence regarding its long-term efficacy is still insufficient and no significant effect has been confirmed in terms of CAL gain at 6months. Future clinical trials of high methodological quality are needed to establish the optimal combination of photosensitizer and laser configuration.
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Affiliation(s)
- Dong Xue
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China
| | - Lu Tang
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China
| | - Yuhao Bai
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China
| | - Qian Ding
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China
| | - Pengcheng Wang
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China
| | - Ying Zhao
- Department of Stomatology, Capital Medical University Xuanwu Hospital,No. 45 Changchun Street, West District, Beijing, China.
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Azad MF, Schwiertz A, Jentsch HFR. Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial. Altern Ther Health Med 2016; 16:171. [PMID: 27266517 PMCID: PMC4897933 DOI: 10.1186/s12906-016-1117-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis. METHODS Forty-six patients (aged 40-65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n = 23) or placebo (n = 23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis. RESULTS AL, PD, BOP and SBI were significantly improved in both groups after three (p < 0.001) and 6 months (p ≤ 0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p = 0.1). BOP improved better in the test group after 3 months (p = 0.065). Numbers of Treponema denticola (p = 0.044) and Fusobacterium nucleatum (p = 0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p = 0.039). Prevotella micra (p < 0.001, p = 0.035) and Campylobacter rectus (p = 0.002 , p = 0.012) decreased significantly in both groups after 3 months. CONCLUSIONS The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm. TRIAL REGISTRATION 332-12-24092012, DRKS 00009387, German Clinical Trials Register, Freiburg i. Br., 16.09.2015.
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Jose KA, Ambooken M, Mathew JJ, Issac AV, Kunju AP, Parameshwaran RA. Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study. J Clin Diagn Res 2016; 10:ZC76-80. [PMID: 27190958 DOI: 10.7860/jcdr/2016/13241.7669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/25/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. AIM To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. STUDY AND DESIGN Department of Periodontics. Randomized clinical trial with split mouth design. MATERIALS AND METHODS Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. STATISTICAL ANALYSIS Results were statistically analysed using paired T test, one-way ANOVA, Tukey's HSD test and repeated measure ANOVA. RESULTS Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p<0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group. CONCLUSION Chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis.
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Affiliation(s)
- Kachapilly Arun Jose
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Majo Ambooken
- Professor and Head, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Jayan Jacob Mathew
- Professor, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Annie Valayil Issac
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
| | - Ajithkumar Parachalil Kunju
- Post Graduate Student, Department of Periodontics, Mar Baselios Dental College , Kothamangalam, Kerala, India
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Gurav AN. Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough? World J Diabetes 2016; 7:50-66. [PMID: 26962409 PMCID: PMC4766246 DOI: 10.4239/wjd.v7.i4.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
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Jentsch HFR, Buchmann A, Friedrich A, Eick S. Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole. Clin Oral Investig 2015; 20:1765-73. [PMID: 26685849 DOI: 10.1007/s00784-015-1683-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.
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Affiliation(s)
- Holger F R Jentsch
- Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Liebigstr. 12, Haus 1, 04103, Leipzig, Germany.
| | | | | | - Sigrun Eick
- Department of Periodontology, Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Issac AV, Mathew JJ, Ambooken M, Kachappilly AJ, Pk A, Johny T, Vk L, Samuel A. Management of Chronic Periodontitis Using Subgingival Irrigation of Ozonized Water: A Clinical and Microbiological Study. J Clin Diagn Res 2015; 9:ZC29-33. [PMID: 26436042 DOI: 10.7860/jcdr/2015/14464.6303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adjunctive use of professional subgingival irrigation with scaling and root planing (SRP) has been found to be beneficial in eradicating the residual microorganisms in the pocket. OBJECTIVE To evaluate the effect of ozonized water subgingival irrigation on microbiologic parameters and clinical parameters namely Gingival index, probing pocket depth, and clinical attachment level. MATERIALS AND METHODS Thirty chronic periodontitis patients with probing pocket depth ≥6mm on at least one tooth on contra lateral sides of opposite arches were included in the study. The test sites were subjected to ozonized water subgingival irrigation with subgingival irrigation device fitted with a modified subgingival tip. Control sites were subjected to scaling and root planing only. The following clinical parameters were recorded initially and after 4 weeks at the test sites and control sites. Plaque Index, Gingival Index, probing pocket depth, clinical attachment level. Microbiologic sampling was done for the test at the baseline, after scaling, immediately after ozonized water subgingival irrigation and after 4 weeks. In control sites microbiologic sampling was done at the baseline, after scaling and after 4 weeks. The following observations were made after 4 weeks. The results were statistically analysed using independent t-test and paired t-test. RESULT Test sites showed a greater reduction in pocket depth and gain in clinical attachment compared to control sites. The total anaerobic counts were significantly reduced by ozonized water subgingival irrigation along with SRP compared to SRP alone. CONCLUSION Ozonized water subgingival irrigation can improve the clinical and microbiological parameters in patients with chronic periodontitis when used as an adjunct to scaling and root planing.
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Affiliation(s)
- Annie V Issac
- Senior Lecturer, Department of Periodontology, St Gregorios Dental College , Chelad, India
| | - Jayan Jacob Mathew
- Professor, Department of Periodontology, Mar Baselios Dental College , Kothamangalam, India
| | - Majo Ambooken
- Professor and HOD, Department of Periodontology, Mar Baselios Dental College , Kothamangalam, India
| | | | - Ajithkumar Pk
- PG Student, Mar Baselios Dental College , Kothamangalam, India
| | | | - Linith Vk
- Consultant Periodontist, Thrissur, India
| | - Anju Samuel
- Senior Lecturer, Department of Periodontology, ST Gregorios Dental College, Chelad, India
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Abstract
Although scaling and root planing is a cost-effective approach for initial treatment of chronic periodontitis, it fails to eliminate subgingival pathogens and halt progressive attachment loss in some patients. Adjunctive use of systemic antibiotics immediately after completion of scaling and root planing can enhance the degree of clinical attachment gain and probing depth reduction provided by nonsurgical periodontal treatment. This article discusses the rationale for prescribing adjunctive antibiotics, reviews the evidence for their effectiveness, and outlines practical issues that should be considered before prescribing antibiotics to treat chronic periodontitis.
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Affiliation(s)
- John Walters
- Division of Periodontology, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA.
| | - Pin-Chuang Lai
- Division of Periodontology, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA; Division of Biosciences, College of Dentistry, The Ohio State University, 3015 Postle Hall, 305 West 12th Avenue, Columbus, OH 43210, USA
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Anand V, Govila V, Gulati M, Anand B, Jhingaran R, Rastogi P. Chlorhexidine-thymol varnish as an adjunct to scaling and root planing: A clinical observation. J Oral Biol Craniofac Res 2012; 2:83-9. [PMID: 25737841 DOI: 10.1016/j.jobcr.2012.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/17/2012] [Accepted: 05/30/2012] [Indexed: 11/20/2022] Open
Abstract
AIM To evaluate the efficacy of chlorhexidine-thymol varnish (Cervitec Plus(®)) as an adjunct to scaling and root planing in the improvement of periodontal parameters. MATERIAL AND METHODS A split mouth randomized clinical trial was conducted in 25 subjects with chronic periodontitis receiving scaling and root planing alone and as an adjunct to chlorhexidine-thymol varnish (Cervitec Plus(®)) and chlorhexidine-thymol varnish (Cervitec Plus(®)) alone. Clinical examinations were performed at baseline, 1 month and 3 months. RESULTS Short term advantages were observed in the clinical parameters in subjects receiving scaling and root planing and an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)) who showed the greatest improvement in the periodontal parameters at 3 months. CONCLUSION Subjects with chronic periodontitis significantly benefit from scaling and root planing when used with an adjunct, chlorhexidine-thymol varnish (Cervitec Plus(®)).
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Al Hulami H, Babay N, Awartani F, Anil S. The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers. Saudi Dent J 2011; 23:143-8. [PMID: 23960508 PMCID: PMC3723283 DOI: 10.1016/j.sdentj.2011.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 04/02/2011] [Accepted: 04/24/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Locally delivered doxycycline is found to be effective in managing periodontitis as an adjunct to scaling and root planing. AIM To evaluate the effect of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers and to compare it with scaling and root planing alone. METHODS Twelve smokers with chronic periodontitis and a pocket depth (⩾5 mm) on posterior teeth that bleed on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, clinical attachment level (CAL), and probing depth (PD) were recorded at the baseline, 6 and 12 weeks. RESULTS Both groups showed a significant reduction in Plaque, Bleeding on Probing and pocket depth at 6th and 12th week from the baseline. A statistically significant gain of attachment was observed in both groups after treatment. Even though the doxycycline group showed slightly higher attachment gain it was not statistically significant compared to the control group. CONCLUSION The observations of the study reveal that the additional benefit of topical application of doxycycline as an adjunct to scaling and root planing in smokers is not convincing. However, further clinical studies may be necessary to substantiate the present observations.
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Affiliation(s)
| | - Nadir Babay
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia
| | - Fatin Awartani
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia
| | - Sukumaran Anil
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia
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