Clinical Attachment Level Scores Research Articles

Effectiveness of Oral Care in Implant Denture Restoration in Chronic Periodontitis

Objective: To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis. Methods: 80 patients with chronic periodontitis implant denture restoration admitted from March 2022 to March 2023 in the hospital were selected. They were randomly divided into an observation group and a control group, with 40 cases in each group. Both groups of patients received routine treatment and care. The patients in the control group used routine oral care methods to carry out oral care, the patients in the observation group carried out oral care on the basis of the control group, observation and analysis of the patients’ mastery of oral knowledge, as well as the depth of the probing and the level of clinical attachment. Results: The oral knowledge mastery of the observation group was 72.31 ± 6.98 after the nursing intervention, which was significantly higher than the score of 86.12 ± 7.36 of the patients in the control group who used conventional oral care, and the difference was statistically significant at P < 0.05; the depth of probing and the clinical attachment level of the observation group were 2.43 ± 0.58 and 4.31 ± 0.86 respectively, which were significantly better than those of the control group. The depth of probing and clinical attachment level scores of the observation group were 2.99 ± 0.54 and 5.36 ± 1.02 respectively, and P < 0.05 was considered statistically significant. Conclusion: The combination of conventional treatment and oral care can effectively improve the treatment effect of implant denture prosthesis for chronic periodontitis. However, it is necessary to pay attention to the psychological counseling of the patients in the specific clinical application to ensure that the patients can actively cooperate with the clinical treatment.

Identification of Porphyromonas gingivalis in Periodontally Healthy Adults and Chronic Periodontitis Patients Using Polymerase Chain Reaction

Context: Periodontitis, a complex multifactorial, polymicrobial infection, involves deterioration of the supporting tissues surrounding teeth. Among the polymicrobiota, Porphyromonas gingivalis is a keystone pathogen implicated in chronic periodontitis. Aim: Identification of P. gingivalis in periodontally healthy adults and chronic periodontitis patients using polymerase chain reaction (PCR). Settings and Design: This cross-sectional study was conducted at the Department of Periodontics, KLE V. K. Institute of Dental Sciences, Belgaum. The 60 patients were selected from the outpatient department considering the selection criteria, using convenience sampling. Materials and Methods: Patients were categorized into three groups: periodontally healthy, moderate, and severe periodontitis. Plaque index, probing depth, and clinical attachment level (CAL) were measured. The plaque samples were collected from patients and were cultured and analyzed for black-pigmented colonies, followed by biochemical characterization and DNA isolation. Samples showing bacterial DNA bands were further selected for PCR analysis with species-specific primer to confirm P. gingivalis. Statistical Analysis: Descriptive analysis was done using Kruskal–Wallis ANOVA, Chi-square, and Mann–Whitney U-test (P < 0.05). Results: Age and gender showed no significance in the prevalence of P. gingivalis. P. gingivalis was absent in periodontally healthy patients and detected in 10% of moderate periodontitis and 50% of severe periodontitis patients (P = 0.0001). No statistical significance with the prevalence of P. gingivalis was observed between moderate and severe periodontitis patients. In severe periodontitis patients, P. gingivalis was significantly associated with higher mean pocket probing depth scores (P = 0.0073) and CAL scores (P = 0.0022). Conclusion: The prevalence of P. gingivalis was significant in both moderate and severe periodontitis patients; however, a higher prevalence was observed in severe periodontitis patients. PCR analysis revealed a significant rise in the frequency of P. gingivalis with an increased periodontal pocket depth and clinical attachment loss, indicating a correlation with the severity of periodontal destruction.

Evaluation of minimally invasive esthetic crown lengthening using an open flap versus flapless surgical approach: A randomized controlled clinical trial.

Esthetic crown lengthening (ECL) is commonly advocated to treat patients with altered passive eruption (APE). Since the introduction of the minimally invasive surgical concept, a limited number of studies have investigated this technique in a standardized manner, with further studies required to verify the validity and predictability of the minimally invasive FL-technique. The current randomized trial compares a minimally invasive (ECL), using piezosurgery with flapless-approach (FL), versus an open-flap (OF) approach in the management of patients with APE Type 1B. Twenty-four patients diagnosed with APE Type 1B were randomly assigned into test (FL) with tunneling approach or control (OF) group with minimally invasive flap reflection (n = 12/group). Postoperative pain was assessed during the first 48 h. Gingival margin (GM) level relative to a custom-made stent (rGM) and patient satisfaction were assessed preoperative, immediately after surgery, at 3 and 6 months postsurgically. Postoperative swelling was reported for the first week postsurgically. Plaque index (PI), bleeding on probing (BoP), clinical attachment level (CAL), pocket depth (PD) and pink esthetic score (PES), were evaluated at baseline and 6 months. Linear regression analysis was conducted for pain. OF-group reported significantly higher pain and swelling scores than FL-group during the first 48 h (p < 0.05). FL-group showed no significant differences regarding rGM between 3 and 6 months, in contrast to OF-group, where a significant decrease in rGM was notable (p < 0.05). No significant differences in PI, BoP, CAL, PD, PES, and patient satisfaction scores were evident between groups (p > 0.05). Regression analysis demonstrated that treatment and gender were significant predictors for pain (p < 0.05). Within the current study's limitations, piezo-surgical ECL with FL-approach presented significantly lower postoperative pain, swelling, and early GM stability compared to OF-approach. Piezosurgical ECL with a FL-approach can be considered a predictable technique with advantages over the OF-approach in the management of patients with APE Type1B.

Comparative Evaluation of Coronally Advanced Flap with Modified Coronally Advanced Flap in the Management of Gingival Recession: A Randomized Clinical Trial

Gingival recession is one of the most common esthetic concerns associated with periodontal tissues. As the conventional technique of coronally advanced flap ends up with different disadvantages, a modified technique has been introduced to overcome the limitations. Thus, the two techniques has been planned to compare and evaluate. The study was conducted on 11 randomly selected subjects. In phase I, scaling was done and in phase II, coronally advanced flap technique in control group and modified coronally advanced flap technique in test group was done. Clinical attachment level, probing pocket depth, keratinized tissue width, length and width of recession, pain and healing index was assessed. Results showed a statistically significant reduction in pain index scores, clinical attachment level scores, probing depth scores, recession length and width scores in both the groups were observed. Also, statistically significant increase in healing index scores and keratinized tissue width scores were observed on intragroup comparison. However, on intergroup comparison, test group revealed better results as compared to control group in all the parameters. Thus, from the observation, it was concluded that both the groups has better clinical outcomes but test group showed better results in all the clinical parameters as compared to control group.

An evaluation of the long-term wear of a distal extension-removable partial denture on abutment teeth that have undergone periodontal therapy

Although the evidence is clear on the long-term effects of removable partial dentures (RPDs) on the periodontal health of abutment and non-abutment teeth, little work has been done on the periodontal outcomes of the remaining teeth previously treated with periodontal therapy. The aim of this study was to evaluate the effect of denture loading on teeth previously exposed to periodontal treatment with additional photo-disinfection. Twelve partially edentulous patients classified as having mandibular Kennedy Class I arches were included. In each quadrant of the mandibular arch, the terminal abutment was diagnosed to have untreated chronic periodontitis. Initially, all the affected abutments received a conservative periodontal treatment in form of scaling and conventional root debridement. Patients were randomly received additional treatment with photodynamic therapy in one of the mandibular quadrants (test group). After the periodontal treatment, a 4-week load-free period was planned. Mandibular distal extension RPDs was fabricated to restore the missing teeth. The clinical periodontal parameters including plaque index (PI), gingival index (GI), gingival recession (GR), probing pocket depth (PD), clinical attachment level (CAL) and tooth mobility (TM) were assessed at baseline, and then for two additional 6-month recall appointments over a period of twelve months after prosthetic treatment. In addition, the mean annual vertical bone loss was also assessed. Except for the PI, GR, and PD, values for the mean GI, CAL, and TM scores at the test group were significantly lower than those in the control group. Better annual vertical bone loss results were observed on the proximal sides of abutments treated with additional photodynamic therapy. The results of this study suggest that RPD abutments affected by chronic periodontitis may perform better as abutments for distal extension RPDs when treated with both conventional root debridement and additional antimicrobial photodynamic therapy.

Locally Delivered Chlorhexidine Chip and Diode Laser in the Treatment of Periodontitis

Introduction: Scaling and root planing (SRP) reduces periodontal inflammation but complete removal of bacterial deposits and toxins is not always feasible. Thus, adjunctive therapeutic strategies like use of local delivery of chlorhexidine (CHX) chip and laser therapy have evolved. Objective: To compare effectiveness of locally delivered CHX chip with diode laser in treatment of periodontitis. Methods: The non-randomised trial was done in Department of Periodontics at Peoples Dental College and Hospital (PDCH) from August 2019 to July 2020 after ethical clearance from Nepal Health Research Council. Study population was patients with chronic periodontitis with bilateral periodontal pockets in contralateral hemiarches exhibiting periodontal probing depth (PPD) of ≥5-7 mm attending PDCH. Written informed consent was obtained from all participants. Baseline parameters were recorded one week after full mouth SRP. In group A CHX chip was placed and in group B diode laser treatment was done. The parameters: Oral Hygiene Index-Simplified, Plaque Index, Gingival Index, PPD, and Clinical Attachment Level (CAL) were recorded at one month, three months, and six months. Results: Fifteen patients were analysed. Comparison showed that PPD scores at one month and three months were significantly lower in Group A compared to Group B. Comparison of CAL scores at baseline of both the groups were same. At subsequent visits, CAL for Group A was lower than Group B, but mean difference was not statistically significant. Conclusions: Both groups showed significant improvements compared with baseline. However, the difference in improvement of the PPD and CAL between groups was not significant.

Comparing the effectiveness of boric acid and chlorhexidine irrigation as an adjunct to mechanical periodontal therapy in chronic periodontitis patients – A randomized clinical trial

Introduction: Oral health is a part of the overall health and has a significant impact on both the physical and the psychological state. Dental caries and periodontal disease are the two major oral diseases that affect the human population worldwide. Aim: The aim of the study is to compare the effectiveness of boric acid and chlorhexidine (CHX) irrigation as an adjunct to scaling and root planing in chronic periodontitis patients visiting VS Dental College and Hospital, Bengaluru. Materials and Methodology: A total of 123 subjects were randomly allocated to three groups (group 1 - boric acid, group 2 - CHX, group 3 - distilled water as a control group). The study subjects were assessed for all the clinical parameters at baseline and 1 and 3 months after the intervention. ANOVA test was used to compare the results between the groups. Results: The mean age among group 1 was 50 ± 5.1 years, in group 2 was 49 ± 5.4 years, and in group 3 was 48 ± 7.1 years. There was a significant reduction in plaque scores, gingival scores, and bleeding on probing scores in the boric acid group compared to distilled water group and CHX group at 1 and 3 months after treatment. Probing depths (PDs) and clinical attachment level scores are significantly decreased from baseline level to 1 and 3 months after intervention in the boric acid group compared to the CHX group and distilled water group. Conclusion: Boric acid or CHX can be used effectively in periodontal pockets as an adjunct to nonsurgical periodontal treatment compared with conventional treatment.

Evaluation of relationship between stress and periodontal disease in different professional college students.

Background:To evaluate the association between stress and periodontitis in different professional college students.Subjects and Methods:The study was conducted in 360 professional college students which includes Medical, Dental, Pharmacy, Nursing, Engineering, and Chartered Accountancy. From each group, 60 students were included in the study. Self-reported Depression, Anxiety, and Stress Scale questionnaire was given to all the students and clinical examination was conducted in all the participants to assess the Oral hygiene index - simplified (OHI-S), clinical attachment level (CAL), and Gingival Index Simplified (GI-S).Statistical Analysis:Statistics was performed using the ANOVA test, post hoc test, and Pearson correlation test to compare the psychological parameter of stress with periodontal parameters among six groups of students. P <0.05 was considered to be statistically significant.Results:Group I showed higher mean stress scores (10.78 ± 0.76) compared to other groups. The mean OHI-S (1.61 ± 0.15), mean CAL (3.68 ± 0.79), and mean GI-S (1.43 ± 0.15) scores also increased with elevated stress levels among medical students. Followed by Group VI and Group II showed almost similar results.Conclusion:The present study showed strong association between stress and periodontal disease and have an adverse effect over oral hygiene factors among the students.

Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial.

Context:Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets.Materials and Methods:Forty-five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day.Results:The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria.Conclusion:The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

Clinical Evaluation of Chlorhexidine and Essential Oils’Adjunctive Effects in Subgingival Ultrasonic Instrumentation on Periodontal Parameters and Halitosis

The aim of this trial was to establish the clinical efficacy of essential oils (EO) and chlorhexidine digluconate (CHX) when used as a cooling agent with ultrasonic instrumentation, on periodontal parameters and halitosis. Ninety patients with periodontal disease were divided into the control and test group on a non- bias selection method. All patients completed a questionnaire and standard periodontal outcome variables were assessed. For both groups, the plaque index (PI), gingival index (GI), pocket depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL) scores were assessed at the beginning and at the end of the treatment period. Volatile sulphur compound (VSC) levels were evaluated by a Halimeter (Interscan Corp., Chatsworth, CA, USA) prior to treatment, immediately after treatment, and 7, 14 and 30 days post-treatment. In all the groups periodontal parameter scores decreased throughout the study. Only on the 30th day the difference of PD and CAL scores were statistically significant between the control and the EO treated group. When groups were compared in relation to the VSC values a significant reduction was identified in both EO and CHX groups at the baseline and 30th day. However, the intergroup comparisons of the VSC values showed no significant differences at any time point. Within the limits of this study, ultrasonic mechanical instrumentation is effective for the management of periodontal disease and halitosis. However, using EOs as a cooling agent with ultrasonic devices has little beneficial effects on periodontal parameters when compared control and CHX groups.

Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial.

Objective:This study aims to evaluate the clinical and biochemical (oxidative stress and pro-inflammatory mediators) effects of the gaseous ozone use accompanied by scaling and root planning (SRP) in periodontal treatment.Material and Methods:The study population consisted of 40 patients with chronic periodontitis (CP) randomly sorted into two groups of 20. The experimental group received SRP plus 3 watts gaseous ozone in two separate applications five days apart, whereas the control group received SRP plus placebo. Clinical periodontal parameters were assayed and saliva samples were taken before the initial and one month after the second treatment. Periodontal examination assessed plaque index (PI), gingival index (GI), probing depth, and clinical attachment level (CAL). Total antioxidant status (TAS), total oxidant status (TOS), nitric oxide (NO), 8-hydroxy-2'-deoxyguanosine (8-OHdG), myeloperoxidase (MPO), glutathione (GSH), malondialdehyde (MDA), and transforming growth factor-beta (TGF-β) levels were evaluated from saliva samples.Results:Changes following treatment in PI, GI, probing depth, and CAL scores were similar for both groups (p>0.05). Of note, TGF-β levels were observed to be higher in the treatment group than in controls (p<0.05). Changes in 8-OHdG, TAS, TOS, NO, MPO, GSH and MDA levels, however, were not significantly different between groups (p>0.05).Conclusion:The findings of this study indicate that SRP plus gaseous ozone versus SRP alone does not correlate to a significant improvement in periodontal recovery.

Consanguinity increases the risk for aggressive periodontitis

Genetic predisposition is an important factor for developing aggressive periodontitis (AgP); however, previous studies only focused on individual families where consanguineous marriages have not been considered. Thus, there is a debate in the understanding of the genetic features of this disease. The present study aims to compare the genetic features of AgP in individuals with and without history of consanguineous marriages. Thirty-three probands from 16 pedigrees with history of consanguineous marriage and 17 pedigrees without history of consanguineous marriage were analyzed in terms of heritability of AgP. Detailed clinical evaluations of the probands showing their periodontal health and their family medical histories were obtained. The gingival index, plaque index, bleeding on probing, suppuration, probing pocket depth and clinical attachment level data were analyzed and compared between groups. The gender differences were also taken into account to determine the mode of inheritance of AgP. The gingival index, bleeding on probing, suppuration, probing pocket depth and clinical attachment level scores were significantly different between the affected and unaffected groups for both genders, which were consistent with the diagnosis of AgP. Strikingly, when the consanguineous group and the non-consanguineous group were compared, the siblings of the consanguineous group displayed approximately 8 times more prevalence of AgP (15.15%) compared to the siblings of the probands in the non-consanguineous group (1.89%) (P=.022). In addition, the mode of transmission of the disease was found to fit better to the autosomal recessive inheritance pattern. Current findings indicate that AgP is segregated on autosomal chromosomes and consanguineous marriage increases the likelihood of developing this disease.

Unveiling the Link between Prostatitis and Periodontitis.

Background:One of the important tumor markers having critically important applications in every aspect of treating men with prostatic illness is prostate-specific antigen (PSA), formed by prostate acini's epithelial cells. Where prostate is affected by inflammation or malignancy, the PSA levels rise to/and above 4 ng/ml. This study analyzes the interlink between different severity of periodontitis and prostatitis by assessment of PSA antigen levels and periodontal clinical parameters.Materials and Methods:In this study, 100 chronic prostatitis patients diagnosed to also have periodontal diseases were divided into four batches on the basis of the nature of prostatitis and levels of periodontal clinical attachment. The grouping was as: group 1A – clinical attachment level (CAL) <3 mm and mild prostatitis, Group 2A – CAL ≥3 mm and mild prostatitis, and Group 1B – CAL <3 mm and moderate-to-severe prostatitis, Group 2B – CAL ≥3 mm and moderate-to-severe prostatitis. Readings of CAL, probing pocket depth, bleeding on probing, plaque index, and gingival index (PI and GI) were recorded, followed by calculation and assessment of PSA values and correlation of periodontal parameters, respectively.Results:An important and affirmative correlation (r = 0.5549, P < 0.05) was seen between PSA and CAL scores at significance level of 5%, and also between PSA and probing depths (PD) scores at 5% (r = 0.5315, P < 0.05), indicating that PSA and CAL scores, as also PSA and PD scores are mutually dependent. The similar positive correlation was seen between PSA with PI (r = 0.3231, P < 0.05) and GI (r = 0.3567, P < 0.05) scores, respectively, at 5% level of significance, which shows PSA is also mutually dependent on PI and GI scores.Conclusion:Patients with of grades, moderate-to-severe prostatitis as well as periodontitis were found having higher PSA levels. The clinical readings of periodontal parameters were significantly higher in patients with moderate-to-severe prostatitis which shows a pathological link between the above two.

Interleukin-34 Levels in Gingival Crevicular Fluid and Plasma in Healthy and Diseased Periodontal Tissue in Presence or Absence of Obesity: A Clinico-biochemical Study.

Interleukin (IL)-34 has recently been identified as an alternative ligand for colonystimulating factor-1 receptor and plays an important role in osteoclastogenesis. The aim of this study was to assess and compare IL-34 levels in gingival crevicular fluid (GCF) and plasma in obese individuals in the presence or absence of periodontal disease and to determine whether they showed a correlation with disease severity. Forty patients aged between 25 and 40 yr were enrolled and categorized into 4 groups: 10 non-obese patients with healthy periodontium (Group I); 10 obese patients with healthy periodontium (Group II); 10 non-obese patients with chronic periodontitis (Group III); and 10 obese patients with chronic periodontitis (Group IV). Demographic variables such as age and body mass index score were recorded and assessed, together with clinical periodontal parameters such as the gingival index, probing pocket depth, and clinical attachment level scores in all groups. The GCF and plasma levels of IL-34 were quantified using enzyme-linked immunosorbent assay. The results showed that the mean IL-34 concentrations in GCF or plasma were highest in Group IV, followed by Group III, Group II, and Group I, with the difference among them being statistically significant (p<0.05). These results suggest that obese individuals with periodontitis have higher GCF and plasma IL-34 levels than non-obese individuals with healthy periodontium. This suggests IL-34 as a potential inflammatory marker of periodontal disease and obesity.

Efficacy of glycine powder air-polishing combined with scaling and root planing in the treatment of periodontitis and halitosis: A randomised clinical study.

IntroductionThis study was performed to evaluate the clinical efficacy of using the Perio-Flow device (Electro Medical Systems, Nyon, Switzerland) adjunctively with mechanical instrumentation on periodontal parameters and halitosis.Materials and MethodsSixty patients who presented with a 4- to 6-mm probing pocket depth were recruited for the study. Patients were randomly assigned to scaling and root planing (SRP) or SRP + glycine powder air-polishing (GPAP). For both groups, the plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level scores were recorded at baseline and 1 month. Volatile sulphur compounds (VSCs) were measured by a Halimeter (Interscan Corp., Chatsworth, CA, USA) at baseline, immediately after treatment, and at 7, 14, and 30 days.ResultsBoth groups showed significantly lower plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level gain scores at 1 month than at baseline. No significant differences were found between the groups at any time point. The VSCs were significantly different at 1 month compared with baseline in both groups. However, the intergroup comparisons of VSCs were not statistically significant at any time point.ConclusionWithin the limits of this study, SRP is effective for treatment of periodontitis and halitosis. However, using GPAP adjunctively with mechanical instrumentation has no beneficial effects on halitosis or periodontal parameters.

Gingival Crevicular Fluid and Salivary Periostin Levels in Non-Smoker Subjects With Chronic and Aggressive Periodontitis : Periostin Levels in Chronic and Aggressive Periodontitis.

Periostin, an extracellular matrix protein functioning as an important structural mediator and adhesion molecule, has been shown to be an important regulator of connective tissue integrity. This study aimed to evaluate the levels of periostin in chronic periodontitis (CP) and aggressive periodontitis (AgP) compared to non-periodontitis (NP). Individuals were submitted to gingival crevicular fluid (GCF) and saliva sampling. Periodontal examination consisted of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) measurements. Assays for periostin were performed by an enzyme-linked immunosorbent assay. Periodontitis patients presented more severe clinical indices compared to the NP group (p < 0.001). The mean GCF level of periostin was lowest in the AgP group as compared to the other groups and was lower in the CP group as compared to the NP group (p < 0.001). Increased levels of periostin were observed in the saliva of patients with AgP as compared to the CP and NP groups (p < 0.05). There was a negative relationship between GCF periostin levels and clinical parameters (p < 0.01), whereas a positive correlation was observed between salivary periostin levels and full-mouth GI and CAL scores (p < 0.01). To our knowledge, this is the first report investigating periostin levels in GCF and saliva in aggressive periodontitis. The results suggest that subjects with CP and AgP exhibit a different periostin profile. Periostin in GCF may have a protective role against periodontal disease. Furthermore, salivary periostin concentrations may have a promising diagnostic potential for the aggressive forms of periodontal disease.

Correlation between Visfatin and Creatine Kinase Levels with Periodontal Health Status of Patients with Coronary Atherosclerosis and Chronic Periodontitis

Background: Visfatin is a novel adipokine that mainly secreted by visceral adipose tissue, had an important role in inflammation and immune system. Creatine Kinase (CK) which is an enzyme that is involved in energy metabolism, found in large amounts in myocardium, brain and skeletal tissues. This study is carried out To evaluate the periodontal health status of the study groups (chronic periodontitis and chronic periodontitis with coronary atherosclerosis) and control groups, to measure the salivary levels of visfatin and Creatine Kinase in these groups and compare between them, and to determine the correlations between salivary visfatin and Creatine Kinase levels with the periodontal parameters in the three groups. Materials and Methods: eighty participants, males and females were recruited in this study with age ranged from (30-60) years, they were divided into three groups: the first study group was the Chronic periodontitis group (n=30), the second study group was chronic periodontitis and coronary atherosclerosis (n=30) and the control group(n=20) which was healthy systemically with healthy periodontium. Periodontal health status was determined by measuring plaque index(PLI),gingival index (GI), probing pocket depth(PPD), bleeding on probing (BOP) and clinical attachment level (CAL),salivary samples were taken from each participants, salivary visfatin levels were determined by enzyme-linked immune-sorbent assay(ELISA) while the activity of salivary Creatine Kinase was determined spectrometrically by using the International Federation of the Clinical Chemistry (IFCC) method on Hitachi 911 Automatic analyzer. Results: The results of the study showed that the mean values of PLI, GI, visfatin, Creatine Kinase and the percentages of sites according to PPD scores, CAL scores, BOP were higher in the second study group with chronic periodontitis and coronary atherosclerosis than in the other groups with highly significant differences between the groups at (P≤0.01). Also by using Pearson Correlation Coefficient, salivary visfatin levels were correlated positively with all clinical periodontal parameters with a strong and positive correlation between salivary visfatin levels and CAL scores and PPD scores. Salivary Creatine Kinase levels were correlated positively with all clinical periodontal parameters with a strong and positive correlation between its levels and mean values of GI and percentages of BOP. Conclusion: The present study showed that salivary visfatin can be used as a marker for the development of coronary atherosclerosis and its levels are associated with the degree of periodontal destruction and showed that Creatine Kinase may be used as a marker for coronary atherosclerosis and chronic periodontitis.

Subgingival application of 25% metronidazole gel, 1% chlorhexidine gel as adjunctive therapy to scaling and root planing in treatment of chronic periodontitis

Objectives: The aim of this study was to compare the clinical effect of subgingival application of 25% metronidazole gel or 1% chlorhexidine gel as an adjunctive to scaling and root planing over a root planing alone.&#x0D; Materials and Methods: Ten adults (6 females and 4 males) with an age range of (30-60) years, each with at least three non-adjacent periodontally involved teeth with a probing pocket depth of ≥ 5mm and bleeding on probing participated in this randomized, split mouth, clinical study. A total of (394) sites were included in the study, the selected sites in each patient were divided into: Group 1 (root planing plus 25% metronidazole gel), Group 2 (root planing plus 1% chlorhexidine gel) and Group 3 (root planing alone).Clinical evaluation included: plaque index PLI (Silness and Loe, 1964), gingival index GI (Loe and Silness, 1963), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL).&#x0D; Results: All groups showed a fluctuated mean PLI scores between visits and a gradual reduction of GI, BOP, PPD and CAL scores for all groups during subsequent visits. Intergroup comparisons for PLI, BOP, PPD and CAL parameters showed no significance difference between the 3 groups, whereas GI showed a significant difference between groups except at week 2 only; this significance observed when group 1 compared with group 3.&#x0D; Conclusions: The 3 treatment modalities similarly showed improvement in almost all clinical parameters applied in this study. Also, there was no significance difference between the application of metronidazole gel and chlorhexidine gel on improvement of clinical periodontal parameters.

English

The aim of this study was to evaluate the levels of prostaglandin E2 (PGE2) on the gingival crevicular fluid (GCF) of smokers (light and heavy) and non-smokers with gingivitis (G) and chronic periodontal disease (CPD). Forty-five patients were selected: 15 heavy smokers whose daily tobacco consumption was more than 10 cigarettes/day (HS), 15 light smokers whose daily tobacco consumption was fewer than 10 cigarettes/day (LS), and 15 non-smokers who had never smoked tobacco (NS). Clinical periodontal parameters (plaque index (PI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL)) were recorded for all groups. Each group was separated in both sites: G and CPD, and GCF samples were collected, and analyzed for PGE2 content by enzyme-linked immunosorbent assay. The results indicated that the non-smoking group had higher PI (88.53&plusmn;17.08%) and BOP (82.80&plusmn;17.14%) scores than the two smoking groups. PD, GR and CAL scores did not differ significantly among the three groups. Statistically significance differences in GCF-PGE2 were found among G versus CPD sites (P&le;0.05) for the three groups. This study confirms that heavy and light smokers have less BOP and GCF-PGE2 levels than non-smokers and that the GCF-PGE2 was higher to CPD sites when compared with G sites. &nbsp; Key words: Periodontal disease, gingival crevicular fluid, smoker, prostaglandin E2.

Intentional replantation of adhesively reattached vertically fractured maxillary single‐rooted teeth

To evaluate the clinical outcomes of intentionally replanted maxillary single-rooted teeth with vertical root fractures (VRFs) after being repaired extraorally using 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. Twenty-one root filled maxillary single-rooted teeth with VRFs were evaluated. After atraumatic extraction, fractured fragments were adhesively cemented. The teeth were then replanted and splinted to the neighbouring teeth for 2 weeks. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 months, and radiographic evaluations were made using PAI scores at baseline and 12 months. Mobility was evaluated using periotest values (PTV) at baseline, 1, 3, 6 and 12 months. Replanted teeth, contralateral teeth (control teeth) and adjacent teeth were analysed statistically using repeated measures one-way anova, unpaired t-tests and Wilcoxon matched-pairs signed-rank tests. Two teeth were extracted in the first month after surgery. PI, GI, CAL and PD scores of the replanted teeth were significantly lower at 6 month (P < 0.0001 for all) and 12 month (P < 0.0001 for all) postoperatively when compared to baseline, but the values were not significantly different from those of the control and adjacent teeth. PTV of the test teeth increased significantly (P < 0.0001) after the intervention and decreased to baseline levels by month 12. PTVs were significantly higher (P < 0.05) at baseline, 1, 3 and 6 months in the test teeth when compared with the control teeth, but were not significantly different at month 12. PAI scores of teeth with VRF were significantly lower (P < 0.05) at 12 months compared with baseline. Adhesive cementation and intentional replantation were an effective treatment modality for this group of vertically fractured maxillary single-rooted teeth. The clinical periodontal parameters decrease by month 6, and the mobility returned to the physiological limits of natural teeth 12 months after replantation.