Clinical Efficacy of the Probiotic Weissella cibaria CMU in Adults with Gingivitis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

The aim of this clinical study was to evaluate and compare the clinical efficacy of subgingival ultrasonic mechanical instrumentation (UMI) irrigated with essential oils (EOs) and chlorhexidine (CHX) at the furcation involvements (FI). Forty-five patients (244 FI) who presented with Class II FI were recruited to the study. Patients were randomly assigned to CHX (UMI irrigated with 0.2% CHX), EO (UMI irrigated with EOs) or control (UMI irrigated with distilled water) groups. All treatments were performed in one session. For all groups, plaque index (PI), gingival index (GI), position of gingival margin (PGM), pocket depth (PD), bleeding on probing (BOP), clinical attachment level (CAL) and horizontal attachment level (HAL) scores were recorded at baseline and 1 and 3 months after therapy. In all groups, there were significant reductions in PI, GI, PD and BOP, increase in PGM scores and gain in CAL and HAL scores, at 1 and 3 months compared to baseline. Except in BOP scores, there were no significance differences among the groups at any time point. At 1 and 3 months, there were significant reductions in the BOP scores of the EO group compared with the CHX and control groups. Within the limits of this study, the use of EOs as a cooling liquid of UMI may promote slight adjunctive effects at FI compared to CHX and water.

Objective: The objective of this study was to evaluate the efficacy of the novel approach of non- surgical therapy using photodynamic laser therapy for treatment of periodontal lesions. Material and Methods: This study included 60 patients with at least one periodontal pocket ≤4 mm in all four quadrants of the mouth, without systemic disease and without prior 6-month use of antibiotics. A split-mouth design was used to compare treatment options for four quadrants: Scaling and Root Planning (SRP), SRP + Photodynamic Therapy (PDT), SRP + Low-Level-Laser-Therapy (LLLT) and basic therapy. Baseline, 3 and 6 months’ post-treatment periodontal examinations included Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (GR), Gingival Index (GI), and Bleeding-on-Probing (BOP). Microbiological sampling from the periodontal pockets for anaerobic periopathogens using commercially available kits took place simultaneously with periodontal examinations. An examiner blinded to the treatment procedure used sterile paper point #50 for sampling from each quadrant and cultivated the material from the paper in a Schaedler terrain. The culture was put in a hermetically sealed bag with anaerobic-generator sacculus, incubated for 48 h and read with commercially available anaerobic ID cards in the Vitek-2? machine. Results: The results showed a significant reduction of PPD, CAL, GI and BOP for the quadrants treated with SRP + PDT, while SRP + LLLT and SRP alone showed similar results. When comparing CAL between the working groups, the SRP + PDT group showed significantly higher CAL gain than the other two study groups after 3 and 6 months (p < 0.01 and p < 0.001, respectively). The analysis of variance between the groups regarding the periodontal parameters, except for the GR, showed better results for the SPR + PDT group, but without any difference in microbiological findings. Conclusion: Photo-dynamic therapy, as an adjunct to the non-surgical method, may enhance mechanical debridement.

Periodontal regeneration refers to procedures aimed at restitution of lost supporting tissue around the periodontally compromised tooth. Regenerative procedures very often include the use of barrier materials to encourage the growth of key surrounding tissues. The current study aimed to evaluate the effectiveness of autogenous periosteal graft as a barrier membrane for the treatment of intrabony defects in chronic periodontitis patients. A total of four data bases MEDLINE (by PubMed), Cochrane database, EBSCO, and Google Scholar were explored to identify the studies in English up to December 2022. An additional hand search of relevant journals was also done. A team of three independent reviewers screened the retrieved articles using the inclusion criteria. Randomized control trials (RCTs) evaluating the effectiveness of autogenous periosteal grafts in the treatment of intrabony defects in chronic periodontitis cases were included in the study. A total of six relevant articles were recognized for data procurement. A total of 117 patients with 68 sites with an age range between 18 years and 55 years were selected. Outcome variables examined were pocket depth (PD), clinical attachment level (CAL), radiographic bone defect fill (BDF), gingival recession (GR), plaque index (PI), gingival index (GI) and bleeding on probing (BOP). Data were analyzed using Revman 5.3 software. The mean differences and 95% confidence interval were used to illustrate the estimate of effect size. There is an equal effect in both groups for the PI, GI, and BOP reduction. For PD reduction, the result was in the favor of periosteal graft with open flap debridement (OFD) group. For CAL gain, radiographic BDF and GR, results also favored the periosteal graft, but no statistically significant difference was found amongst the groups. Within the limitation of the study, it seems that the autogenous periosteal graft can be used successfully along with OFD to treat intrabony defects in chronic periodontitis patients.

Recent studies that investigated the effects of systemic doxycycline as an adjuvant to scale and root planing (SRP) in the treatment of diabetic periodontitis have yielded controversial results. The aim of this meta-analysis is to evaluate the effect of systemic doxycycline as an adjunct to SRP against SRP alone for improving clinical outcomes of periodontitis in diabetic individuals. A systematic literature search was performed using PubMed, Cochrane library, China National Knowledge Infrastructure (CNKI), and VIP Data from the beginning of the database until March 2024. For probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), mean difference (MD) and the 95% confidence interval (CI) were computed. Heterogeneity was assessed using the Q test and the I2 statistic. Evaluation of publication bias was conducted using Egger's and Begg's tests. A total of 12 articles were included for meta-analysis. No statistically significant difference was indicated in the improvement of PD, CAL, PI and GI between a treatment group receiving SRP combined with short-term antimicrobial dose doxycycline and controls receiving SRP alone. However, short-term antimicrobial dose doxycycline plus SRP significantly reduced BOP by 8.14% (95%CI 2.23-14.05) at 3months. Furthermore, after the adjunctive use of long-term sub-antimicrobial dose doxycycline, significant reductions in GI (MD: 0.72, 95% CI: 0.34-1.10) and BOP (MD: 12.8, 95% CI: 0.24-25.36) were observed at 3months. The robustness of the results was further confirmed by sensitivity analysis, despite the truth that significant heterogeneity was found among the included studies. Gingival inflammation in diabetic patients can be reduced more successfully by SRP combined with systemic doxycycline than by SRP alone, but this is insufficient in preventing periodontal tissue destruction.

Purpose:To comparatively evaluate the effect of a 5% boric acid (BA) irrigant on periodontal condition, bacterial level and oral neutrophil numbers with a 1% povidone iodine (PVP-I) irrigant as an adjunct to scaling and root planing (SRP) in chronic periodontitis (CP) treatment.Materials and Methods:A single-masked, randomised clinical trial with 36 CP patients was conducted at the Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Subjects were randomly divided into two treatment groups: 1) SRP plus PVP-I 0.1% irrigant and 2) SRP plus BA 0.5% irrigant. Clinical measurements, including the plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), bacterial level in subgingival plaque (BANA test) and the quantification of oral neutrophils were evaluated at baseline, 4, 6 and 8 weeks after treatment (T0, T4, T6 and T8).Results:Whole-mouth (PI, GI, BOP, PD, CAL and PD) parameters, bacterial level in subgingival plaque and number of oral neutrophils decreased statistically significantly after treatment compared to baseline in both groups (p < 0.01). Between the two groups, whole-mouth PI, GI, BOP, PD and CAL reduction in the BA 0.5% group were higher than those in the PVP-I 0.1% group, but statistical significance was found only for GI and BOP after treatment (p < 0.05). The PD and CAL reductions for moderately deep pockets (PD ≥ 5 mm and < 7 mm) were significantly greater in group 2 compared to group 1 after treatment compared to baseline (p < 0.01). This difference was not found for deep pockets (PD ≥ 7 mm).Conclusion:The results of this study suggest that BA 0.5% could be an alternative to PVP-I 0.1%, and might be more favourable because it provided superior results regarding whole-mouth BOP, GI as well as PD and CAL reduction for moderately deep pockets after CP treatment.

Background:Chlorhexidine (CHX) gluconate has long been considered the “gold standard” chemical plaque control agent due to its broad antimicrobial spectrum and high substantivity. However, its use is often limited by adverse effects such as tooth staining, mucosal irritation, and taste alteration. Herbal mouthwashes, containing plant-based bioactive agents with antimicrobial and anti-inflammatory properties, are gaining attention as safer and more biocompatible alternatives. Objective:This randomized clinical trial aimed to compare the clinical efficacy of a standardized herbal mouthwash and 0.12% chlorhexidine gluconate in improving gingival health among patients with plaque-induced gingivitis. Methods:Ninety participants aged 18–45 years with plaque-induced gingivitis were randomly allocated into three equal groups: Group I – 0.12% chlorhexidine gluconate, Group II – herbal mouthwash (green tea + aloe vera + triphala formulation), and Group III – placebo (distilled water). All participants were instructed to rinse twice daily for 30 days. Clinical parameters including Plaque Index (PI), Gingival Index (GI), and Bleeding on Probing (BOP) were recorded at baseline, Day 7, Day 14, and Day 30. Adverse effects and patient acceptability were also assessed. Data were analyzed using repeated-measures ANOVA with p &lt; 0.05 considered significant. Results:Both CHX and the herbal mouthwash demonstrated significant reductions in PI, GI, and BOP from baseline to Day 30 (p &lt; 0.001). Mean reduction in GI for CHX was 0.95 ± 0.30, for the herbal rinse 0.88 ± 0.29, while placebo achieved 0.30 ± 0.25. No statistically significant difference was observed between CHX and the herbal rinse for either PI or GI (p &gt; 0.05). However, the herbal group exhibited superior taste acceptability and minimal staining or mucosal irritation compared to CHX (p &lt; 0.01). Conclusions:The herbal mouthwash demonstrated comparable clinical efficacy to chlorhexidine in reducing plaque and gingival inflammation, with better tolerance and fewer side effects. Herbal formulations thus represent a promising adjunct in gingivitis management and may serve as effective long-term alternatives to CHX

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.

Adjunctive therapies play a crucial role in enhancing the efficacy of non-surgical periodontal therapy (NSPT) by addressing the multifactorial nature of periodontal disease. Injectable platelet-rich fibrin (i-PRF) and metronidazole-infused PRF gel have emerged as potential biomaterials that promote periodontal regeneration and antibacterial effects, respectively. To evaluate and compare the clinical efficacy of i-PRF and metronidazole-infused PRF gel as adjuncts to NSPT in patients with periodontitis. ology: A randomized controlled trial was conducted on 20 periodontal sites in patients with Stage II-III periodontitis. Sites were divided into two groups (n=10 each), receiving either i-PRF or metronidazole-infused PRF gel following NSPT. Clinical parameters, including Oral Hygiene Index (OHI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL), were assessed at baseline, 4 weeks, and 3 months. Statistical analyses included the Mann-Whitney U test for intergroup comparisons and the Friedman test for intragroup comparisons. Both groups showed significant improvement in PPD and CAL over the study period (p<0.001). The metronidazole-infused PRF gel group demonstrated a more pronounced reduction in GI and BOP compared to the i-PRF group (p=0.01 and p=0.66, respectively). Improvements in OHI were observed in both groups but were not statistically significant. The study highlights the potential of metronidazole-infused PRF gel as a superior adjunct to NSPT due to its enhanced antimicrobial effects and periodontal tissue healing properties. Personalized therapeutic strategies incorporating bioactive materials can optimize periodontal treatment outcomes.

The study aims to compare the effectiveness of scaling root planing alone and scaling root planing with oxygen-releasing gel in the treatment of chronic periodontitis. A split-mouth randomized controlled trial was designed on 25 systemically healthy participants with 50 sites having chronic periodontitis. Two sites were selected for each patient and were randomly allocated into two groups. A total of 50 sites were selected and divided into two groups with 25 test sites in group I (Test group) and 25 control sites in group II (Control group). Group I received scaling and root planing (SRP) followed by placement of BlueM oral gel, while group II received SRP alone. Probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and after 6 weeks and were compared accordingly. The results revealed a reduction in PPD, CAL, GI, and BOP in both groups. However, the test group showed a statistically significant reduction when compared with the control group in the above-mentioned clinical parameters. The results suggested that the use of oxygen-releasing gel with SRP provided additional benefits in the management of chronic periodontitis by promoting greater reductions in the clinical parameters. BlueM oral gel, i.e. the oxygen-releasing gel as a local drug delivery, may be an excellent adjunct to SRP in treating chronic periodontitis. How to cite this article: Singh A, Vasudevan S, Palle AR, et al. Comparative Evaluation of Scaling and Root Planing with and without Oxygen-releasing Gel in the Treatment of Chronic Periodontitis: A Split-mouth Study. J Contemp Dent Pract 2024;25(5):445-452.

Although a growing body of evidence indicates that oral irrigation with water has therapeutic benefits in periodontitis, the mechanisms of action have not been elucidated. The aims of this study were: (1) to analyze the effects of oral irrigation (Water Pik Oral Irrigator) on the clinical signs of adult periodontitis (AP) and on the levels of interleukin-1 beta (IL-beta), prostaglandin-E2 (PGE2), interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) in GCF, and (2) to analyze the influence of the periodontitis-related IL-1 genotype (IL-1GT) on these variables. A single-center, blinded study in otherwise healthy humans (n= 52) with localized mild to moderate AP was carried out, using the following groups: group A (n= 12), no oral hygiene for 14 days; group B (n=20), routine oral hygiene (ROH) for 14 days; group C (n=20), supra-gingival oral irrigation plus ROH for 14 days. Group A patients were crossed-over to group C for 14 days (=day 28) after a professional prophylaxis. Group assignment was randomized by a coin toss, with the exception of group A subjects, who were self-selected as per recommendations of the internal review board for human subjects. GCF was sampled from 3 study teeth per patient and analyzed for IL-1 beta, PGE2, IL-10 and IFN gamma by ELISA on days 0, 7, 14 and 28. Probing pocket depths (PPD), clinical attachment levels (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were measured by a calibrated examiner (TWS) on days 0, 14 and 28. Analysis of covariance was performed using SAS 6.12 and Proc Mixed with group and IL-1GT as the factors and the baseline levels as the covariate, with output being least squares means and least significant difference (LSD). Significant differences were declared if the p-value for the F-statistic was < or =0.05. Oral irrigation plus ROH resulted in a significant reduction in PPD, BOP, GI and PI, as well as IL-beta levels by 7 days and PGE2 levels by 14 days, relative to ROH or no oral hygiene. Interestingly, decreased IL-1 beta levels in patients using oral irrigation plus ROH was accompanied by a trend for increased levels of the "anti-inflammatory" cytokine IL-10. ROH reduced GI, BOP and PI, and PGE2 levels by 14 days, but had no effect on IL-1 beta or IL-10 levels relative to no oral hygiene. The effects of no oral hygiene were reversed by a prophy followed by oral irrigation plus ROH for 14 days. No clinical differences were evident between IL-1 GT (+) patients (n= 1) and GT (-) patients (n=40), but the former had significantly elevated levels of GCF IL-10 and borderline increases in IL-1 beta (p=0.07). Oral irrigation with water for 14 days had an improved therapeutic benefit for AP over that of routine oral hygiene alone and this improvement was accompanied by a down-modulation of the pro-inflammatory cytokine profile in GCF.

Low-calorie diets are commonplace for reducing body weight. However, no information is available on the effects of a reduced-calorie diet on periodontal inflammation and disease. The purpose of this study was to evaluate the clinical effects of a long-term calorie-restriction (CR) diet on periodontitis in an animal model of periodontitis. Periodontitis was induced in 55 young, healthy, adult rhesus monkeys (Macaca mulatta) by tying 2.0 silk ligatures at the gingival margins of maxillary premolar/molar teeth. Animals on a CR diet (30% CR; N = 23) were compared to ad libitum diet controls (N = 32). Clinical measures, including the plaque index (PI), probing depth (PD), clinical attachment level (CAL), modified gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and 1, 2, and 3 months after ligature placement. Significant effects of CR were observed on the development of inflammation and the progression of periodontal destruction in this model. Compared to controls, CR resulted in a significant reduction in ligature-induced GI (P <0.0001), BOP (P <0.0015), PD (P <0.0016), and CAL (P <0.0038). Periodontal destruction, as measured by CAL, progressed significantly more slowly in the CR animals than in the controls (P <0.001). These clinical findings are consistent with available evidence that CR has anti-inflammatory effects. Moreover, these experimental findings are the first observations, to the best of our knowledge, that CR dampens the inflammatory response and reduces active periodontal breakdown associated with an acute microbial challenge.

To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Topical application of Garcinia mangostana L. pericarp gel as an adjunct to periodontal treatment

Background: Gingivitis remains a prevalent oral health condition affecting a significant proportion of the global population. Effective plaque control through mechanical oral hygiene devices is fundamental to gingivitis prevention and management. However, comparative evidence regarding the efficacy of toothbrushing aids versus interdental cleaning devices remains limited. Methods: A total of 120 participants diagnosed with moderate gingivitis were randomly allocated to three groups: powered toothbrush group (n=40), interdental brush group (n=40), and dental floss group (n=40). Clinical parameters including Gingival Index (GI), Plaque Index (PI), and Bleeding on Probing (BOP) were assessed at baseline, 4 weeks, 8 weeks, and 12 weeks. Results: All three groups demonstrated significant improvements in clinical parameters. The powered toothbrush group exhibited the greatest reduction in GI (1.82 ± 0.31 to 0.68 ± 0.22, p&lt;0.001) and PI (2.14 ± 0.28 to 0.72 ± 0.19, p&lt;0.001). The interdental brush group showed superior improvement in interproximal sites (BOP reduction: 78.4% to 22.6%, p&lt;0.001) compared to dental floss (76.2% to 34.8%, p&lt;0.001). Combined use of powered toothbrush with interdental devices yielded optimal outcomes. Conclusion: Both toothbrushing aids and interdental devices effectively manage gingivitis, with powered toothbrushes demonstrating superior overall plaque removal and interdental brushes showing enhanced efficacy at interproximal sites. A combined approach is recommended for comprehensive gingivitis management

Background This clinical trial evaluated the effect of coenzyme Q10 supplementation along with scaling and root planing (SRP) on periodontal and gingival indices in controlled diabetic patients. Methods Forty-two diabetic patients (controlled type), referred to the Department of Periodontics with chronic periodontitis and eligible for the study, were included in the study. Patients suffering from chronic periodontitis with a probing pocket depth of ≥5 mm in different quadrants of the oral cavity with radiographic evidence of bone loss were included in the present randomized, double-masked, placebo-controlled clinical trial. The subjects were instructed to take one capsule of coenzyme Q10 or a placebo every day for 30 days following SRP. Clinical parameters, i.e., plaque index (PI), gingival index (GI), bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD), were recorded at baseline and four weeks after treatment by two masked and calibrated examiners. The study results were reported as (mean ± standard deviations) and frequencies (percentages).Results One month after the intervention, PPD, CAL, BOP, and PI indices in the intervention group were significantly lower than those in the control group. One month after the intervention, the GI was similar in both groups. A significant decrease was observed in the GI in both groups after the intervention. Conclusion The results of the present study showed that Q10 orally with scaling and root planing in patients with controlled diabetes with chronic periodontitis might accelerate the treatment process and significantly reduce the pocket depth.