Comparative Study of Azithromycin Versus Doxycycline Effect on the Resistin Level in Periodontitis Patients With Type 2 Diabetes: A Randomized Controlled Clinical Trial

AIM

The present study aimed to determine if azithromycin (AZM) and doxycycline therapy, as an adjunct to scaling and root planning (SRP), modulate host response and improve clinical outcomes in periodontitis patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

Forty-five periodontal sites in 15 periodontitis patients with T2DM received nonsurgical periodontal therapy (NSPT). In Group I, patients were placebo (not receiving any medication), Group II patients received systemic AZM therapy (AZM 250 mg/day for five days), and Group III patients received doxycycline (20 mg twice per day for three months. The resistin level was collected and measured by enzyme-linked immunosorbent assay (ELISA). Gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, one-month, and three-month intervals.

RESULTS

All groups showed improvement in clinical parameters and resistin levels throughout the study. The mean resistin level at three months was the highest in Group I and the lowest in Group III. Patients in Group II showed a larger decrease in mean PD than those in Group I and III. Group III had the highest gain in mean CAL, with an increase of 1.78 mm in attachment.

CONCLUSION

Resistin might be a useful indicator of current disease status. In addition, benefits from adjunctive systemic use of AZM and doxycycline have been administered with non-surgical periodontal therapy.

The Effects of Periodontal Treatment on Rheumatoid Arthritis and of Anti-Rheumatic Drugs on Periodontitis: A Systematic Review

Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases that widely spread and share the same patterns of pro-inflammatory cytokines. This systematic review aims to evaluate the effects of non-surgical periodontal treatment (NSPT) on RA and, conversely, the impact of disease-modifying anti-rheumatic drugs (DMARDs) on periodontitis. PubMed, Embase, and Web of Science were searched using the MESH terms "periodontitis" and "rheumatoid arthritis" from January 2012 to September 2023. A total of 49 articles was included in the final analysis, 10 of which were randomized controlled trials. A total of 31 records concerns the effect of NSPT on parameters of RA disease activity, including a 28-joint disease activity score, anti-citrullinated protein antibodies, rheumatoid factor, C reactive protein, erythrocyte sedimentation rate, pro-inflammatory cytokines and acute phase proteins in serum, saliva, gingival crevicular fluid, and synovial fluid. A total of 18 articles investigated the effect of DMARDs on periodontal indexes and on specific cytokine levels. A quality assessment and risk-of-bias of the studies were also performed. Despite some conflicting results, there is evidence that RA patients and periodontitis patients benefit from NSPT and DMARDs, respectively. The limitations of the studies examined are the small samples and the short follow-up (usually 6 months). Further research is mandatory to evaluate if screening and treatment of periodontitis should be performed systematically in RA patients, and if the administration of DMARDs is useful in reducing the production of cytokines in the periodontium.

The "double-edged" role of progesterone in periodontitis among perimenopausal women undergoing or not undergoing scaling and root planing

Objective

Progesterone (PG) is an important sex steroid hormone commonly administered to protect the endometrium in perimenopausal women. The present study aimed to explore differential responses of periodontitis to PG in perimenopausal women who did or did not undergo scaling and root planing (SRP).

Methods

A total of 129 perimenopausal women with mild-to-moderate periodontitis were enrolled and underwent treatment as follows: SRP (n = 35); SRP + PG (n = 34); PG (n = 31); and no treatment (s) (n = 29). Pocket probing depth (PPD), clinical attachment level (CAL), sulcus bleeding index (SBI), and bleeding on probing (BOP) were measured using periodontal probes. Three inflammatory markers, including C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-α) in gingival crevicular fluid (GCF) were measured using ELISA techniques.

Results

PPD, CAL, SBI, BOP, and levels of inflammatory factors in GCF were all significantly decreased in perimenopausal women with periodontitis after SRP. In patients who did not undergo SRP, 6 months of PG treatment significantly elevated PPD, SBI, BOP, and GCF levels of CRP, IL-6, and TNF-α. In contrast, PG exhibited inhibitory effects on periodontal inflammation in patients who underwent SRP, evidenced by significantly decreased BOP and IL-6, and slightly decreased SBI, CRP, and TNF-α. PG-induced changes dissipated 6 months after withdrawal of PG (at 12 months).

Conclusions

Among perimenopausal women with periodontitis, PG enhanced periodontal inflammation in the absence of SRP but inhibited periodontal inflammation in those who underwent SRP.

Microbiological and Clinical Evaluation of Efficacy of Locally Delivered Tetracycline in Conjunction with Scaling and Root Planning

Introduction

Chronic periodontitis is an infectious disease which is multifactorial in etiology. The red complex bacteria have an enzyme capable of hydrolyzing the synthetic trypsin substrate, N-benzoyl-DL-arginine-2-napthylamide (BANA). Tetracycline as a bacteriostatic agent is used in the treatment of periodontitis.

Objective

The aim of this study was to evaluate clinically and microbiologically the efficacy of tetracycline fibers in conjunction with scaling and root planning in chronic periodontitis patients.

Methodology

A Split mouth clinical and microbiological randomized control study was done to compare the clinical effects of subgingivally delivered antimicrobial bioabsorbable controlled release 2 mg tetracycline fibers as an adjunct to scaling and root planning on one side and comparing the other side treated only with scaling and root planning only.

Result

Showed both scaling and root planning and the use of tetracycline an adjunct with scaling and root planning are equally effective.

Conclusion

It can be concluded that Scaling and root planing (SRP) with or without use of adjunct local drug delivery agent like tetracycline is effective in treating chronic periodontitis.

Salivary Soluble CD44 Level in Chronic Periodontitis - A Comparative Assessment between Preoperative and Postoperative Scaling and Root Planing

Background

Salivary biomarkers can be used to diagnose illnesses, track their course, and gauge a patient's response to therapy. Inflammatory circumstances result in higher sCD44 levels. The most typical inflammatory disorder connected to periodontal tissue is called periodontitis. Therefore, the purpose "of the current study was to compare the levels of sCD44 in patients with chronic periodontitis before and after scaling and root planing.

Objectives

1) Determining CD44 concentrations in healthy individuals' spit. 2) To quantify CD44 levels in the saliva of individuals with persistent periodontitis. The third objective is to compare the levels of CD44 that can be dissolved in saliva between those with healthy gums and those with active periodontitis. 4) Assessing CD44 levels in saliva after "scaling and root planing in patients with chronic periodontitis."

Materials and Methods

Half of the study participants were classified as having chronic periodontitis, while the other half had healthy gums. Participants with healthy gums and those with chronic periodontitis had their plaque levels, gingival status, and testing depths measured. All the same, data were calculated in persons with chronic periodontitis one month after they had "scaling and root planing done. Clinical attachment levels were evaluated before scaling and root planing was performed on patients with chronic periodontitis and again one month afterwards. Patients with chronic periodontitis," those whose condition had not improved following scaling and root planing (SRP), and healthy individuals all had spit tests conducted after a month. The concentration of sCD44 in the saliva was determined with a chemically coupled immunosorbent assay.

Results

Salivary sCD44 levels were substantially greater in people with chronic periodontitis than in people without the condition. After one month of scaling and root planing in patients with chronic periodontitis, sCD44 levels drastically dropped (p < 0.0001).

Conclusion

Chronic periodontitis is linked to elevated levels of salivary sCD44. sCD44 can be employed as a possible salivary biomarker for chronic Periodontitis.

Probiotic adjuvant treatment in combination with scaling and root planing in chronic periodontitis: a systematic review and meta-analysis

This systematic review and meta-analysis assessed the impact of probiotic supplementation on treating chronic periodontal (CP) disease based on clinical and microbiological findings. Four databases were searched: Medline, Embase, Cochrane Library, and the Web of Science databases. The references to relevant studies were also manually searched. Analyses were conducted using the Review Manager 5.2 software, while the quality of randomised controlled trials was assessed with the Cochrane Risk of Bias tool. In total, 19 studies were included in the meta-analysis. Pooled results revealed that the adjuvant use of probiotics in the treatment of patients with periodontal disease was largely associated with good clinical efficacy. Resulting in statistically significant improvements in plaque index (P<0.05), periodontal probing depth (P<0.05), clinical attachment level (P<0.05), gingival index (P<0.05), bleeding on probing (P<0.05), deep probing depth (P<0.05), and levels of subgingival microbes (P<0.05) following probiotic supplementation. In summary, the results of this meta-analysis suggest that the administration of probiotics together with scaling and root planing can somewhat improve CP patient clinical outcomes and reduce levels of periodontal pathogens. However, more comprehensive experiments are needed to standardise probiotics and maximise their adjuvant therapy.

Efficacy of a Revised Prototype Solution to Facilitate the Removal of Dental Calculus: A follow-up proof-of-concept study

Purpose The purpose of this follow-up proof-of-concept study was to determine the efficacy of a revised calculus disruption solution in facilitating the removal of both supragingival and subgingival calculus in-vivo, as measured by time, difficulty, and pressure required to remove supragingival and subgingival calculus.Methods Patients from a dental school in Minnesota were recruited to participate in a randomized, split-mouth, cross sectional proof-of-concept study comparing time, difficulty and pressure used with hand instrumentation alone compared to the use of a calculus disruption solution and hand instrumentation. Quadrants were randomized to either treatment or control group. Descriptive and inferential statistics were used to analyze the amount of time used. A paired Student's t-test was used to analyze the primary outcome (α = 0.05). Post-treatment questionnaires were completed by the investigator and participants to score the perceived difficulty and pressure required to remove calculus.Results Thirty participants completed the study. An average of 3.1 minutes less time was needed to remove supra and subgingival calculus in the treatment quadrants although this was not statistically significant (p=0.5757). The secondary outcomes, the investigator and participants' perceived difficulty and pressure used for calculus removal showed either no difference, or slight improvements in the treatment quadrants. Overall, the product was well tolerated by participants.Conclusion Quadrants treated with a calculus disruption solution, required slightly less time than control quadrants for calculus removal with hand instruments although the difference was not statistically significant. Reformulation to increase the viscosity of the solution may improve efficacy. Future studies should include a larger sample size, using multiple operators, and a double-blind study design.

The effect of antibiotics on the periodontal treatment of diabetic patients with periodontitis: A systematic review and meta-analysis

Background: The aim of this meta-analysis was to compare the effects of periodontal treatment with or without adjunctive antibiotic on periodontal status and blood glucose level in diabetic patients with periodontitis. Methods: A search using electronic database (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) and a manual search were performed up to July 2022. Eligible 13 RCTs were included according to inclusion and exclusion criteria. Reviewers independently performed data screening, data selection, data extraction, and risk of bias. Quality assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Weighted mean differences and 95% confidence intervals (CIs) for continuous outcomes were calculated using random or fixed-effects models. This review is registered in the PROSPERO database (CRD42022347803). Results: Of the 13 included articles, eight were on the use of systemic antibiotics and five on topical antibiotics. The results showed statistically significant improvement in periodontal status (probing depth, clinical attachment loss and bleeding on probing) at 6 months with systematic antibiotics use (PD-6M p = 0.04, BOP-6M p < 0.0001, CAL-6M p = 0.002). The improvement in PD with topical antibiotics was statistically significant at 1 month (p = 0.0006). However, there was no statistically significant improvement in periodontal status at 3 months with adjuvant systemic antibiotics. Conclusion: Antibiotics can improve the periodontal condition of diabetic patients with periodontitis to a certain extent. In clinical practice, it is necessary to comprehensively consider the balance of benefits and risks before deciding whether to use antibiotics. Systematic Review Registration: Identifier CRD42022347803, https://www.crd.york.ac.uk/PROSPERO/.

Effects of periodontitis and periodontal treatment on systemic inflammatory markers and metabolic profile in obese and non-obese rats

BACKGROUND

Little is known about a synergistic effect of periodontitis and obesity on systemic biomarkers and a possible effect periodontal treatment may exert. This study aimed to evaluate the impact of periodontitis and periodontal treatment on systemic inflammation and metabolic profile in obese and non-obese rats.

METHODS

60 male Wistar rats were randomly divided in six groups differentiated by diet and periodontal status: no periodontitis (G1 and G4), untreated ligature-induced periodontitis (G2 and G5) and treated ligature-induced periodontitis (G3 and G6). Groups G4, G5 and G6 were exposed to cafeteria diet to induce obesity. Periodontitis was induced by silk ligatures over 4 weeks (G2, G3, G5, G6). Rats in G3 and G6 received scaling and root planning and were followed for additional 4 weeks. After sacrifice, serum levels of C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-10, IL-17a, tumor necrosis factor alfa (TNF-α), glucose, triglycerides, and total cholesterol (TC) were compared between groups.

RESULTS

CRP was significantly higher in obese rats with than without periodontitis (G5 = 10.15μg/L vs. G4 = 4.47μg/L, p = 0.01). No beneficial effects of periodontal treatment were observed for CRP levels, IL-6, IL-1β, IL-17a, TNF-α, glucose and triglycerides. Treated periodontitis (G6) exhibited significantly lower TC than the periodontitis group (G5) in obese rats.

CONCLUSION

Periodontitis increased serum CRP in obese rats, indicating a synergistic role of periodontitis in the systemic inflammatory burden triggered by obesity. The treatment of induced periodontitis reduced TC levels in obese rats. This article is protected by copyright. All rights reserved.

Improved Healing after Non-Surgical Periodontal Therapy Is Associated with Higher Protein Intake in Patients Who Are Non-Smokers

The aim of this study was to determine whether a relationship between periodontal healing and protein intake exists in patients undergoing non-surgical treatment for periodontitis. Dietary protein intake was assessed using the 2005 Block food frequency questionnaire in patients with chronic generalized periodontitis undergoing scaling and root planing (n = 63 for non-smokers, n = 22 for smokers). Protein intake was correlated to post-treatment probing depth using multiple linear regression. Non-smoking patients who consumed ≥1 g protein/kg body weight/day had fewer sites with probing depth ≥ 4 mm after scaling and root planing compared to patients with intakes <1 g protein/kg body weight/day (11 ± 2 versus 16 ± 2, p = 0.05). This relationship was strengthened after controlling for baseline probing depth, hygienist and time between treatment and follow-up (10 ± 2 versus 16 ± 1, p = 0.018) and further strengthened after controlling for potential confounders including age, sex, body mass index, flossing frequency, and bleeding on probing (8 ± 2 versus 18 ± 2, p < 0.001). No associations were seen in patients who smoked. Consuming ≥1 g protein/kg body weight/day was associated with reductions in periodontal disease burden following scaling and root planing in patients who were non-smokers. Further studies are needed to differentiate between animal and plant proteins.

Comparison of the effects of different instrumentation techniques on root surface roughness and cement loss using micro-computerized tomography: An in-vitro study

OBJECTIVES

The purpose of this study was to compare the effectiveness of three different instruments on the cement loss and roughness of the root surface following scaling and root planning (SRP) using micro-computerized tomography (micro-CT).

METHODS

In this experimental study, 60 single-rooted extracted human teeth were used and divided into three groups. All teeth were scanned with micro-CT before and after SRP. Group 1: SRP was performed by Gracey-curette, Group 2: SRP was performed by using an ultrasonic device and Group 3: SRP was performed by using a piezo ultrasonic device. Cement loss and porosity of the root surface were analysed by micro-computerized tomography, which is a current imaging technique that provides high-quality images and allows for qualitative and quantitative analysis of samples.

RESULTS

Results of our study revealed that initial porosity values were 1.60%, 1.25%, 1.59% for the group 1, 2, 3, and 0.93%, 0.86 and 0.80 after SRP respectively. Although Group 3 had the least surface roughness, there was no statistically significant difference between the groups. Cement loss following SRP was 47.15 μmin the piezo ultrasonic device group, 59.44 µm in the ultrasonic device, and 134.163 µm in the Gracey-curette group respectively. The highest cement loss was seen in the Gracey-curette group, and there was a significant difference between the three groups.

CONCLUSIONS

In conclusion, it was observed that surface roughness decreased and similar surface roughness was obtained with all three methods, but more cementum loss was observed with Gracey-curette. Therefore, ultrasonic devices appear to be a viable alternative to manual instrumentation with curettes.

Salivary Pro-Inflammatory Markers and Smoking Status Influences the Treatment Effectiveness of Periodontal Disease Patients with Hypertension

BACKGROUND

Hypertension and periodontal diseases share several risk factors. Inflammation biomarkers in saliva are related to hypertension and periodontal disease. The aim of this study was to explore the role of the salivary inflammatory biomarkers in the treatment effectiveness of patients with hypertension and periodontal disease.

METHODS

This observational study enrolled 160 subjects diagnosed with periodontitis, 40 of which had a history of hypertension. All subjects had completed scaling and root planning therapeutic procedures within four weeks. The clinical periodontal parameters (i.e., bleeding on probing, plaque control record (PCR), and probing depth (PD)) were evaluated before and after the treatment. Pro-inflammatory markers were determined using a commercial kit.

RESULTS

The recovery rate (PD 4-9 mm) in non-hypertensive subjects was significantly higher than in hypertensive subjects (60.47% vs. 52.60%, respectively; p = 0.04). All clinical parameters, excluding PCR, positively correlated with salivary IL-1β at baseline and after completing treatment. Our results showed that increased salivary IL-1β levels were positively associated with decreased PCR (β = -27.65 and p = 0.05) and PD recovery rate (β = -17.05 and p = 0.02) in hypertensive subjects.

CONCLUSIONS

The present study sheds important light on the clinical use of salivary pro-inflammatory cytokines as valuable biomarkers for predicting the treatment effectiveness of patients suffering from hypertension and periodontitis.

Clinical outcomes of using erythritol powder by means of air polishing with ultrasonic debridement in the treatment of initial periodontal pockets in hand of dental students: A split-mouth, randomized, comparative, controlled study. Part I

OBJECTIVE

The purpose of this trial was to evaluate the clinical efficacy and patient acceptance of using the erythritol powder air polishing with mechanical debridement in non-surgical periodontal therapy.

METHODS

The trial was conducted as a split-mouth design study of 6 weeks' duration including 13 patients with gingivitis and stage I periodontitis with grade A. Each patient received ultrasonic debridement and polishing (UD+P) on one side, whereas the contralateral side was treated by erythritol powder air polishing and ultrasonic instrumentation (EPAP+UI) when required. Clinical variables were as follows: papillary bleeding index (PBI), bleeding on probing (BOP), full mouth plaque index (FMPI), calculus index (CI), modified gingival index (MGI), probing pocket depth (PPD), the time needed and rate the pain for each group.

RESULTS

The FMPI, MGI, CI, PBL and BOP parameters improved significantly for both treatment procedures; however, there were no statistically significant differences between the two groups at any of the examinations intervals, except for MGI and CI which showed a significant reduction at 2 weeks compared with baseline. PPD was significantly decreased in EPAP+UI group. Perceived pain intensity was lower for EPAP+UI group than UD+P group without any significant difference during follow-up periods between the two groups. Seven patients favoured air polishing. The treatment's time was (24.92 ± 9.260 and 34.08 ± 9.106) minutes for the test and control side, respectively.

CONCLUSION

This study generally revealed no significant differences in clinical outcomes between two groups for gingivitis and stage I periodontitis treatment. However, EPAP+UI had higher patient's preference and less time-consuming compared with UD+P.

Association of preterm low-birth-weight infants and maternal periodontitis during pregnancy: An interventional study

CONTEXT

The impact of periodontal disease during pregnancy and its effect on adverse pregnancy outcomes is seen in the literature. When it comes to the link of disease related to periodontium to that of adverse pregnancy outcomes, a need can arise if a significant cause-effect relationship does exist or not between them.

AIM

The study was aimed to determine the association of periodontal health status in pregnant women with the occurrence of preterm low birth weight (LBW) infants in Vadodara, Gujarat.

SETTINGS AND DESIGN

An interventional study with 100 patients was conducted, of which 67 participants were included in the control group and 33 participants were included in the intervention group. A total of 12 participants dropped out from the study and 88 were analyzed for the outcome.

SUBJECTS AND METHODS

The Community periodontal Index of Treatment needs index was taken for all enrolled participants and then were divided into interventional group and control group. Participants in the interventional group underwent scaling and root planning. Data related to the time of delivery and weight of the baby was taken from the hospital records.

STATISTICAL ANALYSIS

A comparison of baseline characteristics was made using unpaired t-test. Chi-square test was used for the analysis of intergroup comparison. The odds ratio and the relative risk calculation were also done. P ≤ 0.05 was considered for statistical significance.

RESULTS

The odds ratio for both preterm and LBW were 3.86 times and 2.96, respectively. The Chi-square statistical test analysis was statistically significant for both preterm and LBW infants on the intergroup comparison.

CONCLUSION

Periodontal disease can be considered as one of the risk factors for preterm LBW babies as not only the presence of disease condition causes an increase in inflammatory mediator but also the elimination of the disease condition reduces the adverse pregnancy outcomes.

Subgingival instrumentation for treatment of periodontitis. A systematic review

OBJECTIVES

To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis.

METHODS

Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate.

RESULTS

As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS-1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise versus full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups.

CONCLUSIONS

Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887.

Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis-A Narrative Review

This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA’s). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA’s to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.

Clinical and microbiological effects of 1% Matricaria chamomilla mouth rinse on chronic periodontitis: A double-blind randomized placebo controlled trial

BACKGROUND

Several herbal mouth rinses are assessed in the literature as an adjunct to scaling and root planning (SRP) for the treatment of periodontal diseases. The objective of this study was to evaluate and compare the clinical and microbiological effects of Matricaria chamomilla (MTC) mouth rinse with chlorhexidine (CHX) and placebo mouth rinse for the management of chronic periodontitis.

MATERIALS AND METHODS

This double-blind, randomized, placebo controlled, clinical trial involved seventy five patients, suffering from chronic periodontitis, which were randomly divided into three groups: negative control (SRP + placebo), positive control (SRP + 0.12% CHX), and test group (SRP + 1% MTC mouth rinse). Mouth rinsing (adjunctive therapy) was continued for 1 month while clinical parameters (plaque index, gingival index, sulcus bleeding index, probing pocket depth [PPD], clinical attachment level, gingival recession [GR], stain index) and microbial colony forming units were evaluated at base line, 6 weeks, and 3 months.

RESULTS

All groups showed a significant change in parameters (except GR for placebo group) between base line and 3 months. MTC mouth rinse suggested added significant benefits over placebo group over the study period. However, it determined more but nonsignificant improvement in PPD (3.68 mm vs. 3.36 mm) and CAL (3.00 mm vs. 2.72 mm) as compared to CHX rinse at 3 months' period as compared to baseline.

CONCLUSION

Advantages of using test group were comparable to CHX associated group; therefore, MTC mouth rinse can be used as an effective adjunct during nonsurgical periodontal therapy for chronic periodontitis.

Single application of 0.8% hyaluronic acid as a coadjuvant of nonsurgical treatment in nonsmoking patients with periodontitis: A split-mouth, randomized, controlled pilot clinical trial

Background:

Topical coadjuvants might be indicated to increase the results of nonsurgical periodontal treatment and overcome some of its limitations. The aim of this study was to evaluate the clinical benefits of a single topical application of 0.8% hyaluronic acid (HA) as a coadjuvant to scaling and root planing (SRP) in periodontal patients.

Materials and Methods:

Sixteen patients diagnosed with periodontitis were recruited to participate in this split-mouth randomized controlled trial. At baseline, oral hygiene instructions, prophylaxis, and SRP were performed in both sides; additionally, a subgingival application of HA at 0.8% was made in the test side. Several clinical parameters were assessed at baseline, 6, and 12 weeks later: full mouth plaque score, gingival score, bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL).

Results:

At the end of 12 weeks, there was a overall improvement in all periodontal parameters in both sides (P < 0.05). Test sides showed less BoP when compared to the control sides (9.4 ± 4.0 vs. 14.9 ± 8.9, P < 0.05). Other periodontal parameters such as PD and CAL showed a slight improvement in comparison with the control sides, but the difference was not statistically significant (P > 0.05).

Conclusion:

Results from this study indicate that a single subgingival application of 0.8% HA seems to reduce gingival inflammation and improve clinical parameters, particularly BoP. Further studies are needed to evaluate the effect of repeated application of HA and long-term results.

[Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning]

OBJECTIVE

Our research aimed to detect the efficacy of non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning (SRP) for chronic periodontitis.

METHODS

We recruited chronic periodontitis patients who have more than four teeth with clinical pocket depth of 4-8 mm. These teeth were distributed in four different zones within the oral cavity. Moreover, the teeth were single root teeth and not adjacent to each other. The subordinated teeth were randomized into four groups, as follows: no treatment (C group), simple SRP (SRP group), Nd: YAG laser after SRP treatment (SRP+L group), and SRP after Nd: YAG laser treatment (L+SRP group). The four experimental observation points were as follows: before treatment (baseline) and 1 week, 1 month, and 3 months after treatment. We measured clinical indicators and collected subgingival deposits in the four time points to analyze changes of red complex in periodontitis.

RESULTS

The clinical indicators were better in all treatment groups than in the control group. Comparison among treatment groups indicated that the value of bleeding on probing, periodontal probing depth, and clinical attachment loss showed no difference. However, the value of plaque index in SRP+L and L+SRP presented a significant reduction at 3 months after treatment. The percentages of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola in all treatment groups decreased after clinical treatment, and differences were observed among the treatment groups at different time points.

CONCLUSIONS

Non-surgical periodontal treatment with SRP and Nd: YAG laser is not more effective than SRP monotherapy. The sequence of laser treatment and SRP has no significant effect on the treatment. However, SRP with Nd: YAG laser was beneficial for plaque control. Non-surgical periodontal treatment with Nd: YAG laser may be used as an alternative to reduce and control the proliferation of microorganisms in persistent periodontitis, but it still needs further verification.

Comparative effectiveness of hand scaling by undergraduate dental students following a two-week pre-clinical training course

BACKGROUND

The Bologna reform resulted in a drastic restructuring of pre-clinical training courses at the University of Zurich. The aim of this study was to assess student pre-clinical scaling/root planning skills after just 8.5 hours of manual training.

MATERIAL AND METHODS

Three consecutive classes of dental students (n = 41; n = 34; n = 48) were tasked with removing lacquer concrement from the maxillary left canine on a typodont using Gracey and universal (Deppeler M23A) curettes. At baseline (prior to instruction), a timed five-minute session of scaling/root planning was undertaken. The second scaling/root planning session was held immediately following training. Eight experienced dental hygienists and eight lay people served as positive and negative controls, using the same instruments and time limit, respectively. Instrumented teeth were collected, scanned and planimetrically analysed for the percentage of tooth surface cleaned. Statistical analyses were performed to assess the dental students' improvement after the training (Wilcoxon signed-rank test) and to compare it to that of laypeople and dental hygienists (Kruskal-Wallis rank sum test followed by Conover's post hoc test).

RESULTS

At baseline, the dental students' mean scaling scores of the cleaned surfaces were not significantly different than those of laypeople (29.8%, 31.0%, 42% vs 27.9%). However, after 8.5 hours of manual training, the students' ability to clean the maxillary tooth improved significantly and they achieved mean removal values of 61.7%, 79.5% and 76% compared to the 67.4% (P < .001) of the experienced dental hygienists (Tables Tables  and ). There were no statistically significant differences between the scores achieved by students after training and those achieved by experienced dental hygienists.

CONCLUSION

A shortened pre-clinical training time was sufficient for students to acquire the basic scaling/root planning skills needed in preparation for clinical training. Further research is needed to identify ways to help students consistently reach highest skill levels.

Adjunctive Effects of a Sub-Antimicrobial Dose of Doxycycline on Clinical Parameters and Potential Biomarkers of Periodontal Tissue Catabolism

Objectives: The aim of the present randomized, double-blind, placebo-controlled, parallel-arm study was to examine the effectiveness of a sub-antimicrobial dose of doxycycline (SDD) in combination with nonsurgical periodontal therapy, compared to nonsurgical periodontal therapy alone, on potential gingival crevicular fluid (GCF) biomarkers of periodontal tissue catabolism related to the clinical outcomes over a 12-month period. Materials and Methods: GCF was collected and clinical parameters were recorded from 30 periodontitis patients randomized either to an SDD or placebo group. The SDD group received SDD (20 mg) b.i.d for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d for 3 months plus SRP. The patients were evaluated every 3 months during the 12-month study period. At each visit, clinical parameters and GCF sampling were repeated. Matrix metalloproteinase (MMP)-8, MMP-9, MMP-13, myeloperoxidase (MPO), osteoprotegerin (OPG), and tartrate-resistant acid phosphatase-5 (TRAP-5) were determined by IFMA and ELISA. Results: Significant improvements were observed in all clinical parameters in both groups over 12 months (p < 0.0125) while the SDD group showed significantly better reduction in gingival index (GI) and pocket depth and a gain in clinical attachment compared to the placebo group (p < 0.05). GCF MMP-8 and OPG levels significantly reduced in the SDD group compared to baseline (p < 0.05). GCF MMP-9 significantly decreased in both groups compared to baseline (p < 0.05). GCF MPO significantly decreased at 3 and 9 months in the SDD group, while it significantly decreased at 6 months in the placebo group (p < 0.05). TRAP and MMP-13 could be detected in none of the samples. Conclusions: The present results indicate that three months of adjunctive usage of SDD to nonsurgical periodontal therapy compared to nonsurgical periodontal therapy alone in periodontitis patients results in further improvement of clinical periodontal parameters and GCF markers of periodontal tissue breakdown over a 12-month period. Beneficial effects of adjunctive SDD therapy is likely to be related to the reduced levels of two major periodontitis-associated MMPs, MMP-8 and -9, and their potential oxidative activator MPO.

Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: A systematic review and meta-analysis

Background:

There is enough evidence, which suggests that nonsurgical periodontal therapy (NSPT) improved the glycemic control in patients of Type 2 diabetes mellitus (T2DM) with chronic periodontitis (CP). This meta-analysis is aimed to explore the effect of NSPT, exclusively scaling and root planing (SRP) as monotherapy on glycemic control and periodontal parameters in patients of T2DM with CP.

Materials and Methods:

Two databases, MEDLINE and EMBASE, were searched from June 2006 to June 2016. Initially, 464 potentially relevant studies were evaluated. Randomized controlled trials with duration of ≥3 months, based on the treatment group managed with SRP without any supportive use of local drug delivery or systemic antibiotics, while the control group received no periodontal therapy, were selected. This resulted in six appropriate articles with a total of 812 patients of T2DM with CP. Alteration in glycated hemoglobin (HbA1c) was the primary outcome measure, whereas the changes in clinical attachment level (CAL) and probing pocket depth (PPD) were the secondary outcome measures.

Results:

SRP treatment resulted in a decrease in HbA1c by 0.26% (P = 0.17) at 3–4 months compared to the control group. Further, on subgroup analysis, SRP therapy revealed a decrease in PPD and CAL at 3–4 months, though statistically insignificant.

Conclusion:

SRP treatment leads to modest improvement in glycemic status and periodontal parameters in T2DM patients with CP at 3–4 months.

Comparison of the clinical and microbiological effects of antibiotic therapy in periodontal pockets following laser treatment: An in vivo study

BACKGROUND

Laser technology in periodontal therapy could help in reducing total bacterial count.

OBJECTIVES

The aim of this study was to evaluate the effects of pocket debridement using an erbium-doped yttrium aluminium garnet laser (Er:YAG laser - ERL), scaling and root planing (SRP) with photodynamic therapy (PDT), or SRP alone. Teeth vitality and soft tissue carbonization were also assessed.

MATERIAL AND METHODS

This study included 1,169 single-rooted teeth from 84 patients divided into 3 groups (n = 28). The G1 group had ERL with 40 mJ of energy, a frequency of 40 Hz and a fluence of 63.66 J/cm2. The G2 group had SRP + PDT (635 nm diode laser, 12 J of energy and irradiation time of 30 s) and a Toluidine Blue photosensitizer (PS) (application time of 60 s). The G3 group was administered SRP alone. In the 42 subjects (G1: n = 11, G2: n = 14 and G3: n = 17) with high amounts of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf), additional 1-week antibiotic treatments with clindamycin or amoxicillin + clavulanic acid - in doses of 600 mg/day or 1000 mg/day, respectively - were prescribed 3 months after the therapy. Microbiological and clinical analyses of the probing depth (PD), recession (RC), plaque index (PI), bleeding on probing (BOP), and attachment loss (AT) were performed at baseline and at the follow-up of 3 months, 3 months and 1 week, and 6 months.

RESULTS

Plaque index decreased in G1 after 3 months, 3 months and 1 week, and 6 months (p < 0.05) and was lower in G1 vs G2 after 3 months (p < 0.05). The reduction in BOP in G1 after 3 months and 1 week was higher in comparison with G2 or G3 (p < 0.02). Probing depth decreased in all groups (p < 0.05). We found a reduction in the percentage of sites with some bacteria after 3 months - Prevotella intermedia (Pi) (G1 and G2), Capnocytophaga gingivalis (Cg) and Eubacterium nucleatum (En) (G3), and after 3 months and 1 week with En, Td, Tf (G1, G2 and G3), Pi (G1 and G2), Aa, Peptostreptococcus micros (Pm), and Cg (G3), and with Pi (G1 and G2), Tf (G2), Pg, En (G2 and G3), and Pm (G3) after 6 months (p < 0.05). We observed no signs of carbonization or teeth injury.

CONCLUSIONS

Scaling and root planing + PDT and ERL may be an alternative therapy for chronic periodontitis.

Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance

Purpose: The purpose of this study was to evaluate the effects of repeated scaling and root planing (SRP), with or without locally-delivered minocycline microspheres (MM) on residual pockets in patients undergoing periodontal maintenance (PMT).Methods: Patients on PMT were randomized into two groups for treatment of one posterior interproximal inflamed pocket (≥5 mm) with a history of bleeding on probing every 6 months: SRP plus MM (n=30) or exclusively SRP (n=30). Baseline and 24-month measurements included radiographic interproximal alveolar bone height, probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival crevicular fluid (GCF), and salivary interleukin (IL) - 1β, (24 month only). Results were analyzed for baseline data or change in measurements after 24 months of treatment between different treatment groups, as well as whether significant changes occurred after 24 months of treatment for each treatment group individually.Results: Alveolar bone height and GCF IL-1β remained stable over the 24 months. The SRP + MM and SRP groups each demonstrated reduced PD (0.8 ± 0.9 mm and 1.1 ±0.6 mm, respectively, p < 0.001 each), CAL (0.8 ± 0.9 mm and 1.0 ± 0.6 mm, respectively, p < 0.001 each) and BOP (55% and 48%, respectively, p = 0.001 each). However, there were no differences between groups over the 24-month study period.Conclusion: Scaling and root planning alone, of moderately inflamed periodontal pockets at 6-month intervals, produced stable interproximal alveolar bone height as well as sustained improvements in probing depths, clinical attachment level, bleeding on probing over 24 months; minocycline microspheres were not shown to enhance these results.

Effect of scaling and root planing on levels of 8-hydroxydeoxyguanosine in gingival crevicular fluid of chronic periodontitis patients with and without Type II diabetes mellitus

Context:

Chronic periodontitis (CP) and diabetes mellitus are associated with increased oxidative damage to DNA with formation of 8-hydroxydeoxyguanosine (8-OHdG). The aim of this study was to evaluate the change in gingival crevicular fluid (GCF) levels of 8-OHdG and glycosylated hemoglobin (HbA1c) by 3 months after scaling and root planing (SRP), in CP patients with and without Type II diabetes mellitus.

Settings and Design:

Sixteen patients with CP, 16 patients with CP and Type II diabetes mellitus (CP-D), and 16 systemically healthy individuals with clinically healthy periodontium who served as controls were included in the study.

Materials and Methods:

The clinical parameters (plaque index [PI], probing depth [PD], clinical attachment level [CAL], and bleeding on probing [BOP%]), HbA1c levels, and GCF 8-OHdG levels were measured at baseline. All the patients except controls were treated with SRP followed by evaluation of the above-mentioned clinical and biochemical parameters after 3 months.

Statistical Analysis Used:

Statistical analysis was performed using paired t-test, independent t-test, and Mann–Whitney U-test.

Results:

After SRP, CP-D group showed a greater reduction in PI, PD, BOP%, and greater gain in CAL when compared to CP patients (P < 0.05). Levels of 8-OHdG and HbA1c in CP-D patients also showed a greater reduction, 3 months after SRP when compared to CP patients (P < 0.05).

Conclusions:

GCF 8-OHdG levels, HbA1c levels, and clinical parameters were reduced significantly in CP and CP-D patients, with maximum reduction achieved in CP-D patients 3 months after SRP.

One-stage Full Mouth Disinfection Using 20% Propolis Hydroalcoholic Solution: A Clinico-microbiologic Study

Background:

Propolis is a resinous substance produced by honeybees which has many therapeutic properties because of its unique composition. It has been widely used since many years for different medicinal purposes.

Aim:

The aim of this study was to investigate the effects of one-stage full mouth disinfection (OSFMD) using 20% propolis hydroalcoholic solution in chronic periodontitis patients.

Materials and Methods:

Thirty patients diagnosed with chronic periodontitis and presenting three or more nonadjacent teeth with deep pockets were selected for the study. Clinical parameters including gingival index, plaque index, bleeding on probing, probing pocket depth, and clinical attachment level were recorded at baseline in all the patients followed by subgingival plaque sampling. All the thirty patients were randomly allocated into two groups; 15 patients (control group) were subjected to scaling and root planning (SRP) alone, and in remaining 15 patients (test group), SRP was done followed by OSFMD using 20% propolis hydroalcoholic solution after 24 h. All the patients were kept at periodic recall, and clinical and microbiological parameters were again taken at 4 weeks and 12 weeks.

Results:

There was a significant improvement for all the clinical parameters, with higher probing depth reduction and attachment gain in the test group when compared to the control group. Furthermore, the microbiological counts of the periodontopathogens were found to decrease considerably more in the test group.

Conclusion:

SRP followed by OSFMD with propolis extract after 24 h was more effective than SRP alone in chronic periodontitis patients.

Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review

AIMS

The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis.

METHODS

Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model.

RESULTS

Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I²  = 87.38%), CAL (Q value = 13.65, P = 0.008, I²  = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I²  = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone.

CONCLUSIONS

Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable.

Scaling and root planning, and locally delivered minocycline reduces the load of Prevotella intermedia in an interdependent pattern, correlating with symptomatic improvements of chronic periodontitis: a short-term randomized clinical trial

Background

To evaluate the respective or combinatory efficacy of locally delivered 2% minocycline (MO), and scaling and root planning (SRP) by assessing both clinical parameters and the loads of four main periodontal pathogens in treating chronic periodontitis (CP).

Methods

Seventy adults with CP were randomly assigned to the three treatment groups: 1) SRP alone; 2) MO alone; and 3) combinatory use of SRP and MO (SRP + MO). Before and 7 days after the treatments, we evaluated both clinical parameters (pocket depth [PD] and sulcus bleeding index [SBI]) and the gene load of four main periodontal pathogens (Aggregatibacter actinomycetemcomitans [Aa], Fusobacterium nucleatum [Fn], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi]).

Results

The bacterial prevalence per patient was: Aa, 31.25%; Fn, 100%; Pg, 95.31%; and Pi, 98.44%. Seven days after treatment, the three treatments significantly reduced both PD and SBI, but not detection frequencies of the four pathogens. For PD, the reduction efficacy of SRP + MO was significantly higher than that of either MO or SRP. Only Pg responded significantly to SRP. Pg and Fn were significantly reduced in the presence of MO. Only SRP + MO showed a significant reduction effect on the gene load of Pi. The reduction of PD significantly correlated with the gene load of Pi (r=0.26; P=0.042) but not of the other bacteria.

Conclusion

SRP and MO reduced the load of Pi in an interdependent pattern, which correlated with symptomatic improvements of CP.

[Application of Nd:YAG laser in stomatology]

Developments in science and technology include the use of laser as an auxiliary device in treating oral diseases. Nd:YAG laser is convenient and safe to use. Nd:YAG laser irradiation leaves no scabby area on the wound surface, causes a mild reaction postoperation, and promotes high comfort. Therefore, this treatment has attracted increasing attention in the clinical setting. This review enumerates the applications of water-cooled pulsed Nd:YAG laser in hard and soft tissues in oral medicine. Nd:YAG laser in hard tissues can be applied in cavity preparation, acid etching, root canal preparation and sterilization, and dentin desensitization therapy. Meanwhile, the applications of this laser in soft tissues include adjunctive therapy in basic periodontitis treatment, gingival aesthetic treatment, and resection. This review suggests the importance of Nd:YAG laser as an auxiliary device in the clinical diagnosis and treatment of oral diseases.

Effect of Time Lapse between Endodontic and Periodontal Therapies on the Healing of Concurrent Endodontic-Periodontal Lesions without Communication: A Prospective Randomized Clinical Trial

INTRODUCTION

The aim of this prospective randomized clinical trial was to evaluate the effect of a time lapse between endodontic treatment and nonsurgical periodontal treatment on periodontal healing of concurrent endodontic-periodontal lesions without communication.

METHODS

Thirty-one patients were randomly divided into 2 groups: group 1: endodontic treatment and scaling and root planning (SRP) were performed simultaneously and group 2: SRP was performed 3 months after endodontic treatment. Both groups were followed for 3 and 6 months after SRP. Primary outcome variables were the probing depth, clinical attachment level, and periapical index score.

RESULTS

Both the groups showed a significant improvement in all the clinical parameters evaluated after the completion of endodontic and periodontal treatment (P < .05). No statistically significant difference in improvement was observed between the 2 groups at 3 and 6 months after SRP (P > .05). Periodontal healing responses were comparable in the 2 groups, with no apparent detriment resulting from simultaneous treatment. Improvements in periodontal parameters that were achieved in 6 months in group 2 were achieved only in 3 months in group 1 (P > .05).

CONCLUSIONS

Nonsurgical periodontal treatment may be performed simultaneously with endodontic treatment in the management of concurrent endodontic-periodontal lesions without communication, and an observation period after endodontic treatment may not be required.

Gingival enlargement in partial hemifacial hyperplasia

Hemifacial hypertrophy is a rare developmental disorder, characterized by unilateral enlargement of facial tissues. The hemifacial hyperplasia is classified as true hemifacial hypertrophy and partial hemifacial hypertrophy. It is unilateral enlargement of viscerocranial condition in which not all structures are enlarged. We present a rare case of gingival enlargement in partial hemifacial hyperplasia highlighting the clinical and radiological findings with the corrective treatment offered for gingival enlargement.

Estimation of tissue inhibitor of matrix metalloproteinase-1 levels in gingival crevicular fluid in periodontal health, disease and after treatment

Background:

Initial research has shown a negative correlation between the severity of periodontal disease and tissue inhibitor of matrix metalloproteinases (TIMPs) concentrations in gingival crevicular fluid (GCF). However, there are no enough reports to correlate the TIMP-1 concentrations in GCF in periodontal health, disease and after treatment. Hence, the present study aim is to estimate the levels of TIMP-1 in GCF in periodontal health, disease and to evaluate the effect of periodontal therapy on TIMP-1 concentrations in GCF.

Materials and Methods:

Periodontal examination and collection of GCF by extracrevicular method was performed in 25 subjects selected randomly and categorized into three groups. Group I (Healthy, n = 10), Group II (chronic periodontitis (CP), n = 15) and Group III (After treatment group, n = 15). Scaling and root planning was performed and GCF was collected after 8 weeks of treatment. TIMP-1 levels were estimated in GCF samples by using enzyme linked immunosorbent assay.

Results:

TIMPs-1 was detected in all samples. Highest mean TIMP-1 concentrations in GCF were obtained for Group I, whereas the lowest concentrations were seen in Group II. This suggests that TIMP-1 levels in GCF decreases proportionally with the progression of periodontal disease and increases after treatment.

Conclusion:

There is a substantial decrease in the concentrations of TIMP-1 in CP patients than in healthy and after treatment individuals. Since TIMP-1 levels in GCF are negatively correlated with periodontal disease, TIMP-1 may be considered as a biomarker in periodontal disease progression. However, controlled, longitudinal studies are needed to confirm this possibility.

Comparison of matrix metalloproteinase-3 and tissue inhibitor of matrix metalloproteinase-1 levels in gingival crevicular fluid in periodontal health, disease and after treatment: A clinico biochemical study

BACKGROUND

Considering the role of matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in the pathogenesis of periodontitis, the present study is to estimate the levels of MMP-3 and TIMP-1 in gingival crevicular fluid (GCF) in periodontal health, disease and to evaluate the effect of periodontal therapy on MMP-3 and TIMP-1 concentrations in GCF.

MATERIALS AND METHODS

A periodontal examination and collection of GCF by extra-crevicular method was performed in 30 subjects selected randomly and categorized into 3 groups. Group I consists of 10 subjects Group II consists of 20 patients and Group III consists of 20 patients of Group II. Non surgical periodontal therapy was performed, and GCF was collected after 8 weeks from the same site of 20 chronic periodontitis patients who are considered as Group III. MMP- 3 and TIMP-1 levels were estimated in GCF-samples by using enzyme-linked immunosorbent assay. The findings were analyzed using the software and descriptive statistical methods such as Mann- Whitney U-test and Kruskal-Wallis test. P value < 0.001 was considered significant.

RESULTS

MMP-3 and TIMP-1 was detected in all samples. Highest mean MMP-3 concentrations in GCF were obtained for Group II (7.490 ng/ml) while the lowest concentrations were seen in Group I (0.344 ng/ml) and Group III (2.129 ng/ml). This suggests that MMP-3 levels in GCF increases proportionally with the progression of periodontal disease and decreases after treatment. Lowest mean TIMP-1 concentrations in GCF were obtained for Group-II (1.592 ng/ml), while the highest concentrations were seen in Group-I (8.78 ng/ml) and Group-III (6.40 ng/ml). This suggests that TIMP-1 levels in GCF decreases proportionally with progression of periodontal disease and increases after treatment.

CONCLUSION

There is a substantial increase in the concentrations of MMP-3 and decrease in TIMP-1 as periodontal disease progress. Since MMP-3 and TIMP-1 levels in GCF are positively correlated with gingival index, probing pocket depth, and clinical attachment loss, MMP-3, and TIMP-1 may be considered as a Novel Biomarkers in periodontal disease. However, controlled, longitudinal studies are needed to confirm this possibility.

Scanning electron microscopy study to analyze the morphological characteristics of root surfaces after application of Carisolv gel in association with scaling and root planing: In vitro study

Context:

There has been considerable interest in the use of chemical-assisted root detoxification. Chemical agents have been proposed to facilitate calculus removal.

Aims:

A study was carried out to analyze the morphological characteristics of the root surfaces after application of Carisolv gel in association with scaling and root planing under scanning electron microscopy (SEM).

Settings and Design:

The Department of Periodontics of the K. M. Shah Dental College and Hospital, Vadodara, (Gujarat, India).

Materials and Methods:

Sixty periodontally compromised extracted human teeth were randomly assigned to four groups: (1) scaling and root planning (SRP) alone; (2) passive topical application of Carisolv + SRP; (3) active topical application of Carisolv + SRP; (4) multiple applications of Carisolv + SRP. Carisolv gel was applied to the root surfaces for 30 seconds, followed by scaling and root planing, consisting of 30 strokes, with Gracey curettes in an apical-coronal direction, parallel to the long axis of the tooth. The only exception was group 4, where the roots were instrumented until a smooth, hard, and glass-like surface was achieved. All specimens were further analyzed by SEM.

Statistical Analysis:

The Analysis of Variance (ANOVA) method was used.

Results:

Active application of Carisolv gel produced more extensive morphological changes than passive application and SRP alone. When multiple applications of Carisolv with SRP were performed, there was a significant decrease in the smear layer compared to a single application of the gel, either passively or actively.

Conclusions:

The Carisolv gel failed to remove the smear layer completely, especially with a single application, independently of the method of application. This study documented that the Carisolv gel produced changes in the root morphology of periodontally compromised teeth, only when it was applied actively and multiple times.

Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial

Objectives

The aim of this study was to evaluate the effects of Lactobacilli reuteri (Prodentis) alone and in combination with scaling and root planing (SRP) in a double blind, randomized, placebo-controlled clinical trial of volunteers with chronic periodontitis.

Methods

Thirty, otherwise systemically healthy, chronic periodontitis patients (19 males and 11 females, aged between 34 and 50 years) were included. The study period was 42 days. ‘Split-mouth’ design was used for the SRP, which was performed on day 0; two quadrants (either right or left) were treated with SRP whereas the remaining two quadrants were left untreated. The participants received a toothbrush, toothpaste, and brushing instructions. L. reuteri Prodentis lozenges (1×10⁸ CFU DSM17938+1×10⁸ CFU ATCC PTA 5289) or the corresponding placebo lozenges were taken twice daily from day 21 to day 42. Statistical analysis was done for comparisons of clinical parameters (Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), probing pocket depth (PPD), clinical attachment level (CAL)) and microbiological levels of the pathogens Aggregibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi). All p-values less than 0.05 were considered significant. Assessments were made on day 0 before SRP treatment, on day 21 before administration of the lozenges, and on day 42.

Results

At day 42, the PI, GI, and GBI were significantly reduced by all treatment modalities. When ranked, the amount of PI, GI and GBI reduction by the different treatments was SRP + Prodentis Prodentis SRP + placebo placebo; all differences were statistically significant. For PPD and CAL, the best result was obtained with the SRP+Prodentis treatment. PPD was reduced from 5.08±0.75 to 3.78±0.61 mm (p<0.001) and CAL from 3.93±0.93 to 2.85±0.74 mm (p<0.001). Prodentis, either alone or following SRP, reduced Aa, Pi, and Pg by 1 log₁₀ unit (p<0.01). The SRP+placebo combination did not significantly affect the levels of the pathogens.

Conclusion

The present randomized controlled trial confirms the plaque inhibition, anti-inflammatory, and antimicrobial effects of L. reuteri Prodentis. L. reuteri Prodentis probiotic can be recommended during non-surgical therapy and the maintenance phase of periodontal treatment. Considering the beneficial effects of probiotics, this therapy could serve as a useful adjunct or alternative to periodontal treatment when SRP might be contraindicated. Further studies are required in this direction.