Conventional Periodontal Therapy Research Articles

Comparison of Antimicrobial Efficacy of Ocimum sanctum (Tulsi) Extract and Chlorhexidine Against Tannerella forsythia: An In Vitro Study.

Periodontitis, a chronic inflammatory disease affecting the periodontium, is primarily caused by gram-negative anaerobic bacteria. Conventional periodontal therapy aims to eradicate pathogenic microflora through mechanical debridement, often supplemented with chemical agents. However, the use of these chemical adjuvants is frequently associated with adverse drug reactions and the development of antimicrobial resistance. Consequently, researchers are increasingly exploring herbal antibacterial agents, such asOcimum sanctum(Tulsi), as viable alternatives due to their broad-spectrum antimicrobial properties and reduced side effect profile. This study aims to analyze the antibacterial efficacy of the ethanolic extract ofO. sanctum(Tulsi) againstTannerella forsythia, a key bacterium of the red complex, using chlorhexidine as a reference standard. Traditionally, chlorhexidine has been utilized as an adjunct to nonsurgical therapy in the treatment of patients with periodontal disease. The cold extraction method was used to prepare the ethanolic extract ofO. sanctumleaves. The resultant substance was mixed into five different concentrations (3.13%, 6.25%, 12.5%, 25%, and 50%) using dimethylformamide as the solvent. The antimicrobial activity of these varying concentrations was assessed againstT. forsythiain culture plates employing the agar well diffusion method, with 0.2% chlorhexidine serving as the positive reference. The zone of inhibition of bacterial growth has been determined and compared with that of 0.2% chlorhexidine. The ethanolic extract ofO. sanctumexhibited highly statistically significant antibacterial activity againstT. forsythia(p < 0.001). At a dosage of 25 mg/mL, the extract created a zone of inhibition measuring 17 mm, while at 50 mg/mL, the zone of inhibition increased to 25 mm. However, when compared to 0.2% chlorhexidine, which had a zone of inhibition of 32 mm,O. sanctumshowed a slightly smaller inhibitory effect. The extract ofTulsishowed notable antibacterial activity againstT. forsythia, with the antibacterial impact observed at the 50 mg/mL dilution.

A Low-Cost Protocol Using the Adjunctive Action of Povidone-Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III-IV Periodontitis: A Single-Blind, Randomized Controlled Trial.

In severe stages of periodontitis, conventional periodontal therapy and maintenance care are usually insufficient due to the viral and bacterial etiology; thus, a mechanical approach alone may not be sufficient to eliminate a substantial portion of subgingival pathogens, especially in deep periodontal sites. Background and Objectives: This single-blind, randomized clinical trial aimed to compare the clinical and microbiological efficacy of a low-cost protocol using povidone-iodine and sodium hypochlorite formulations as adjuncts to non-surgical therapy for patients with stage IV periodontitis when compared with chlorhexidine, the most commonly employed substance to date for antimicrobial regimens in periodontal therapy. Materials and Methods: Forty-five patients were randomly divided into two groups: control (subgingival instrumentation, chlorhexidine-assisted) and test (antiviral medication, subgingival instrumentation with povidone-iodine, sodium hypochlorite rinsing solution, and antibiotics). Clinical measurements and microbiological analyses were performed at baseline and after three months. Results: After three months, notable differences were found in the bacterial detection scores for Porphyromonas gingivalis (a significant reduction in detection frequency was observed in the test compared to the control (p = 0.021)), and there were significant reductions in detection in the test group for Tannerella forsythia and Treponema denticola, showing undetectable levels (p < 0.0001 for both). In the test group, the pocket probing depth median value was reduced significantly (p = 0.0005); similarly, bleeding on probing showed a marked decrease (p < 0.0001). However, changes in clinical attachment loss and full-mouth plaque score were not statistically significant. Conclusions: Using the proposed protocol, substantial improvements in clinical and microbiological parameters were obtained when compared with the current antimicrobial recommendations.

THE EFFECTIVENESS OF METRONIDAZOLE GELS IN THE MANAGEMENT OF PERIODONTAL DISEASE

Introduction : Metronidazole is one of the antimicrobial and antimicrobial that has been widely used as antibacterial and antiprotozoal agent for treatment. Metronidazole is antimicrobial have been used as an adjuvant to mechanical plaque removal. Periodontal disease is a chronic inflammatory disease that develops from dental plaque that affects periodontal supporting tissues. Many chemical agents that have been evaluated to determine their effect on plaque, gingivitis and periodontitis, one of which is metronidazole, has been successfully introduced and studied extensively. This literature review explains effectiveness of metronidazole gels in the management of periodontal disease. Review : Metronidazole (MTZ) is frequently used in the treatment for periodontal diseases since it can be against several Gram-negative anaerobic rods, the pathogenesis of periodontitis. It can be administered via oral and topical routes. However, the systemic adverse effects may in the oral cavity if used peroral. Hence, topical administration is preferable. The bacterial reservoirs not eliminated by conventional periodontal therapy can be further suppressed with the use of chemotherapeutic agents. Localized antimicrobial therapy, in particular, has evoked growing interest because of the site‑specific nature of periodontal infections, the higher concentration of anti‑microbial agent subgingivally and reduced side‑effects of systemic antibiotic use. Among the various locally delivered chemotherapeutic agents metronidazole, a has bactericidal action against anaerobes, such as Prevotela intermedia, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium species and spirochetes like Treponema denticola, Treponema vincentii, which are generally believed to be the main pathogens associated with periodontitis. Conclusion : Treatment of periodontal pockets with metronidazole gel in addition to scaling and root planning, provides a significant increase in reducing pocket depth and microbial count and effective in the treatment of periodontal disease.

Human gingival fibroblasts are a source of B cell-activating factor during periodontal inflammation.

Host-modulating therapy is a possible treatment for individuals that respond poorly to conventional periodontal therapy. B cells, abundant in periodontitis lesions, require the cytokines B cell-activating factor (BAFF) and A proliferation-inducing ligand (APRIL) for survival and maturation. Although mRNA levels of BAFF and APRIL are increased in tissue from periodontitis lesions, it is unknown if periodontal resident cells express BAFF and/or APRIL during periodontal inflammation. In this study, we aim to analyze the expression of BAFF and APRIL in human gingival fibroblasts after stimulation with proinflammatory cytokines. Furthermore, we perform protein analysis in tissues and serum from periodontitis patients and healthy controls. Human gingival fibroblasts were cultured and stimulated with the proinflammatory cytokines' tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β). The mRNA expression of BAFF and APRIL was analyzed by real-time quantitative polymerase chain reaction (qPCR), and the protein was detected in tissue sections using immune staining. Serum levels of BAFF were analyzed with enzyme-linked immunosorbent assay (ELISA). In gingival fibroblasts, TNF-α upregulated BAFF mRNA, but APRIL was unaffected. IL-1β affected neither BAFF nor APRIL expression. BAFF protein was detected in the oral epithelium and in cells of the underlying connective tissue in periodontitis tissue, and BAFF protein was increased in the serum of periodontitis patients. Periodontal resident cells express BAFF during periodontal inflammation and participate in providing a favorable milieu for the survival and action of B cells.

Efficacy of a single antimicrobial photodynamic therapy session as an adjunct to non-surgical periodontal therapy on clinical outcomes for periodontitis patients. A systematic review

Background: periodontitis is a multifactorial and multi-etiological disease associated with destructive events to the periodontium. Non-surgical periodontal therapy (NSPT) is considered an efficient, gold-standard approach to treat this disease; however, several variables could hinder the success rate. Combining antimicrobial photodynamic therapy (aPDT) with NSPT showed promising results but the available literature show variations in results. Aim: whether using single episode of aPDT as adjunct to NSPT for adults affected by periodontitis can improve clinical outcomes, with a minimum 3 months follow up after terminating active treatment, as compared to conventional manual instrumentation? Methods: Three databases (PubMed, ScienceDirect, and Cochrane Library) were searched to retrieve relevant articles. The keywords matrix used for the search process consisted of the following terms: periodontitis OR periodontal disease AND photodynamic therapy OR antimicrobial photodynamic therapy OR Laser. Results: A total of 4104 articles were retrieved from the search process for the last 10 years. After removing duplicates and applying filters, 44 article were eligible for full-text reading. The last step resulted in 6 randomized controlled trials that were used for data synthesis. Conclusions: Retrieved data from this study indicated that adjunctive aPDT has a potential beneficial effect on short-term mainly reflected by improving bleeding scores and microbiological outcomes for patients with periodontitis. However, longer term advantage was not evident as compared to conventional periodontal therapy. Further studies are advised to draw a solid conclusion about using aPDT as adjunct to NSPT

Treatment of mandibular Grade II furcation defects using demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane – A randomized controlled clinical trial.

Background– Periodontal disease, if not interfered, will headway further with attachment loss involving the bifurcation or trifurcation of multirooted teeth. Furcation involved molar teeth respond less favorably to conventional periodontal therapy alone resulting into tooth loss. Combining osseous grafting with guided tissue regeneration membrane may enhance the response to treatment as compared to graft – only therapy by achieving mechanical stabilization and preventing micromovement of the bone graft material.&#x0D; &#x0D; Aim &amp; Objective – To compare the efficacy of demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane in the treatment of mandibular Grade II furcation defects.&#x0D; &#x0D; Materials &amp; method - In this study a total number of 20 patients with 20 mandibular sites (buccal grade II furcation involvement) were evaluated. They were divided into two groups: Control group (bone graft only) and test group (bone graft + GTR). The clinical parameters assessed were vertical probing depth, horizontal probing depth and relative clinical attachment level.&#x0D; &#x0D; Results – In this study the statistical analyses comparing test and control sites at baseline revealed no significant differences between the two groups for any of the clinical parameters considered. At 6 month evaluation, significant difference was found between two groups regarding VPD, HPD and rCAL.&#x0D; &#x0D; Conclusion – It was concluded that there is a significant enhanced effect of using DFDBA bone graft in combination with GTR membrane over bone graft alone for the treatment of mandibular Grade II furcation defects.&#x0D;

A Local Desiccant Antimicrobial Agent as an Alternative to Adjunctive Antibiotics in the Treatment of Periodontitis: A Narrative Review.

Periodontitis is one of the most common oral polymicrobial infectious diseases induced by the complex interplay between the altered subgingival microbiota and the host's dysregulated immune-inflammatory response, leading to the initiation of progressive and irreversible destruction of the periodontal tissues and eventually to tooth loss. The main goal of cause-related periodontal therapy is to eliminate the dysbiotic subgingival biofilm in order to arrest local inflammation and further periodontal tissue breakdown. Because, in some cases, subgingival mechanical instrumentation has limited efficiency in achieving those goals, various adjunctive therapies, mainly systemic and locally delivered antimicrobials, have been proposed to augment its effectiveness. However, most adjunctive antimicrobials carry side effects; therefore, their administration should be precociously considered. HybenX® (HY) is a commercial therapeutical agent with decontamination properties, which has been studied for its effects in treating various oral pathological conditions, including periodontitis. This review covers the current evidence regarding the treatment outcomes and limitations of conventional periodontal therapies and provides information based on the available experimental and clinical studies related to the HY mechanism of action and effects following its use associated with subgingival instrumentation and other types of dental treatments.

Evaluation of the adjuvant effect of topic Bach floral in the clinical response to non-surgical periodontal treatment in patients with type 2 diabetes: pilot study

Objective: To evaluate the clinical response of periodontal tissues after periodontal therapy associated with the use of Bach Flower (Rock Rose gel) in participants with type 2 diabetes mellitus. Methodology: This randomized, doble-blind, split-mouth, single-center, placebo-controlled clinical trial selected 20 participants with moderate, severe, or advanced periodontitis (stage II, III, and IV). They were divided into groups, where group 1 received Floral Rock Rose gel and group 2, saline gel. All groups received conventional periodontal treatment characterized by scaling and root planing before gel application. Clinical evaluation was performed using periodontal clinical parameters: Plaque Index (PI), Gingival Index (GI), probing depth (PPD), gingival recession (GR), and Clinical Insertion Level (CAL). Biometric parameters and hematological parameters were also evaluated. All clinical and laboratory parameters were obtained at baseline and after three months. Results: There was an improvement in periodontal clinical parameters before and after treatment in both groups (P&lt;0.05). There was no statistically significant difference between the intervention, control, and floral groups (P&gt;0.05). Conclusion: The periodontal treatment performed with Rock Rose adjuvant gel (Bach Flower) was safe, efficient, and promoted the improvement of periodontal clinical parameters. However, it did not show superior results to conventional periodontal therapy.

Photodynamic Periodontal Therapy vs. Diode laser as an Adjunctive to Conventional periodontal treatment in Management of Chronic Periodontitis

Purpose: This study was made to evaluate and compare the efficacy of photodynamic periodontal therapy and diode laser as an adjunctive approach to conventional periodontal therapy in management of chronic periodontitis. Subjects and methods: 30 patients with chronic periodontitis and age range from 30-40 years old were divided randomly into three groups. Group I (control group) 10 patients received conventional periodontal therapy alone. Group II (laser group): patients received SRP + additional application of a 940-nm diode laser. Group III (photodynamic group): patients received SRP + antimicrobial photodynamic therapy by using low level 670 nm diode laser application in addition to application of 1% toluidine blue as photosensitizer. Results: there were a significant difference of PD, CAL, IL-1β, IL6, NO, NO2 between three groups with superior result found in photodynamic group, but there were no significant differences between three groups in the term of NO3. Conclusion: Diode laser and photodynamic therapies add a beneficial effect in clinical and biochemical parameters when used as adjunctive to scaling and root planning but there was no significant difference between them.

Yoga as an Integrated Holistic Approach to Oral Health: A Review.

The association between various systemic diseases and periodontitis has been explored extensively. A sedentary lifestyle plays a significant role in systemic and periodontal disease progression. Therefore, lifestyle modification has been considered a component of therapeutic aspects for periodontal disease and systemic disease. This review focuses on how yoga may reduce chronic gingival inflammation by improving the body's defense, which can act more efficiently on periodontal bacteria and help maintain healthy gingiva. A literature search was performed in PubMed/MEDLINE CINAHL, Web of Science, and Google Scholar for all the published articles related to yoga and its systemic benefits and potential role in reducing periodontal breakdown, and the findings were summarized. The practice of yoga therapy has been proven to show several benefits, such as reduced stress levels, anxiety and depression, increased antioxidant levels, reduced insulin resistance, and improved respiratory function. It also helps to improve the immune system. Yoga can be used as a potential treatment modality adjunct to conventional periodontal therapy as it has been shown to have a potential benefit in controlling systemic risk factors.

Viability and Adhesion of Periodontal Ligament Fibroblasts on a Hydroxyapatite Scaffold Combined with Collagen, Polylactic Acid-Polyglycolic Acid Copolymer and Platelet-Rich Fibrin: A Preclinical Pilot Study.

Background: Conventional periodontal therapy relies on bone regeneration strategies utilizing scaffolds made of diverse materials, among which collagen, to promote cell adhesion and growth. Objective: To evaluate periodontal ligament fibroblast (HPdLF) cell adhesion and viability for periodontal regeneration purposes on hydroxyapatite scaffolds containing collagen (HAp-egg shell) combined with polylactic acid–polyglycolic acid copolymer (PLGA) and Platelet-Rich Fibrin (PRF). Methods: Four variations of the HAp-egg shell were used to seed HPdLF for 24 h and evaluate cell viability through a live/dead assay: (1) (HAp-egg shell/PLGA), (2) (HAp-egg shell/PLGA + collagen), (3) (HAp-egg shell/PLGA + PRF) and (4) (HAp-egg shell/PLGA + PRF + collagen). Cell adhesion and viability were determined using confocal microscopy and quantified using central tendency and dispersion measurements; significant differences were determined using ANOVA (p < 0.05). Results: Group 1 presented low cell viability and adhesion (3.70–10.17%); groups 2 and 3 presented high cell viability and low cell adhesion (group 2, 59.2–11.1%, group 3, 58–4.6%); group 4 presented the highest cell viability (82.8%) and moderate cell adhesion (45%) (p = 0.474). Conclusions: The effect of collagen on the HAp-egg shell/PLGA scaffold combined with PRF favored HPdLF cell adhesion and viability and could clinically have a positive effect on bone defect resolution and the regeneration of periodontal ligament tissue.

Concise evaluation and therapeutic guidelines for severe periodontitis: A public health perspective.

The main goal of periodontology is to prevent and arrest gingivitis and periodontitis to avoid tooth loss and focal infection of periodontal origin. Periodontal scaling or flap surgery of moderate-to-severe periodontitis have shortcomings, most likely because removal of herpesviruses and bacterial pathogens in deep periodontal lesions and the adjacent inflamed gingiva requires systemic antimicrobial treatment (or gingivectomy). Valacyclovir (1000 mg twice daily on day 1, and 500 mg twice daily on day 2 and on day 3) is a potent anti-herpesvirus agent. Antibiotic combinations against bacterial pathogens include amoxicillin-metronidazole (250 mg of each, thrice daily for 4 days; for systemically healthy adults) and ciprofloxacin-metronidazole (500 mg of each, twice daily for 4 days; for immunosuppressed individuals and patients exposed to contaminated water and poor sanitation). Supportive antiseptic treatment may consist of 0.1%-0.2% sodium hypochlorite (regular household bleach) as cooling spray in ultrasonic scalers, flosser fluid in oral irrigators, and mouthrinse in patient self-care. The anti-infective treatment described here helps control cases of severe periodontitis and constitutes an exceedingly inexpensive alternative to conventional (mechanical) periodontal therapy.

Impact of Laser Therapy on Periodontal and Peri-Implant Diseases.

Objective: In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against periodontitis and peri-implantitis has undergone a decisive development that has involved various operational areas. The broadest applications were probably found in the clinical approach to soft tissues. Methods: Laser therapy is a novel technique that may provide further beneficial effects to conventional periodontal and peri-implant therapies. However, clinical evidence for the improvement of periodontal wound healing and tissue regeneration through laser treatment is still limited. Results: This review is aimed at assessing the advantages and disadvantages of the use of lasers in dental procedures and pathologies, focusing more on protocols for the management of periodontal and peri-implant diseases. Conclusions: The adjuvant action of laser therapy, in addition to conventional therapies for the management of periodontal and peri-implant disease, could induce benefits, but further investigation would be necessary to standardize better the protocols applied and to understand the actual tissue response to laser therapy.

SURGICAL AND NON-SURGICAL LASER PREPROSTHETIC PERIODONTAL PREPARATION. LOW-LEVEL LASER THERAPY AND PHOTOACTIVATED DISINFECTION

Background: Clinical success and functional durability of indirect restorations depend on optimal dental health before the prosthetic treatment and the manipulation of the gingival tissues. The aim of the current article is to review the surgical and non-surgical laser methods that can be applied as periodontal preparation in fixed prosthodontics. Review results: Preprosthetic periodontal preparation includes conventional periodontal therapy (non-surgical) and periodontal resective (surgical) procedures - soft and hard tissue crown lengthening. The advantages of lasers in the latter are reduced bleeding, less postoperative discomfort and faster healing. Non-surgical preprosthetic preparation, on the other hand, aims at microorganisms’ level reduction. The variety of protocols, which reduce the microbial number significantly, show photoactivated disinfection as adjunctive therapy in infection treatment, especially in patients with resistant microorganisms and anatomical complications. Conclusion: Lasers can be applied as an alternative to the classic surgical and non-surgical means for periodontal procedures. Low-level laser therapy and photoactivated disinfection ensure faster bacteriolysis and affect the microorganisms locally, whereas systemic medicines influence the whole organism. Photodynamic therapy does not require maintaining high concentrations of the photosensitizer in the infected area, as it is when using antiseptics and antibiotics.

THE APPLICATION OF STEM CELLS IN TISSUE ENGINEERING FOR THE REGENERATION OF PERIODONTAL DEFECTS IN RANDOMIZED CONTROLLED TRIAL: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To systematically evaluate the application of stem cells in tissue engineering for regeneration of periodontal defects and to provide a basis for clinical application. PubMed, The Cochrane Library, EMbase, SinoMed, CNKI and Wanfang database were searched for randomized controlled trial (RCT) studies on periodontal defect regeneration using bone marrow mesenchymal stem cells, adipose tissue-derived stem cells, periodontal ligament stem cells (PDLSCs), dental pulp stem cells (DPSCs), gingival mesenchymal stem cells, stem cells from apical papilla and other odontogenic stem cells. Chinese and English literature as of May 9, 2021 (without limitation on retrieve starting date) were searched, and included RCT studies were followed for at least 3 months. Two reviewers independently screened the literature, extracted basic research information, the situation of the research object and outcome measures including probing depth (PD), clinical attachment level (CAL), bone defect depth (BDD) and gingival recession (GR). Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0) was used to evaluate bias risk in included studies and Meta-analysis was performed using RevMan 5.4 software. A total of 182 teeth were included in 7 RCT studies. The experimental group was treated with stem cell tissue engineering technology (87 cases), and the control group was treated with conventional periodontal regeneration therapy without stem cell (95 cases). In the meta-analysis, a significant difference between experimental and control groups was found for PD [mean difference (MD) = -0.66, 95% CI (-1.11, -0.22), P = .004], CAL [MD = -1.11, 95% CI (-1.45, -0.77), P < .00001], BDD [MD = -0.99, 95% CI (-1.42, -0.57), P < .00001] and GR [MD = -0.35, 95% CI (-0.62, -0.07), P = .01]. By observing the 4 outcome indicators of periodontal tissue regeneration, the improvement of CAL was the best, while the improvement of GR was poor. In the subgroup analysis of follow-up time, PD improved best at 6 months compared with other follow-up times [MD = -1.07, 95% CI (-1.58, -0.55), P < .0001]. However, in the subgroup analysis of CAL, BDD and GR, there was no statistical significance among follow-up time. Compared with conventional periodontal regeneration therapy, the application of stem cells in tissue engineering exhibits a significant advantage in promoting periodontal defect regeneration and allows for complete periodontal regeneration possibly. Due to limitations related to the number and quality of the included studies, additional large-sample and high-quality clinical studies are needed to support future meta-analyses.

Evaluation of homeopathy effects associated with conventional periodontal therapy in randomized treatment of diabetic and non-diabetic patients with periodontitis

Introduction: Periodontitis and Diabetes Mellitus type 2 (DMII) are chronic diseases treated by conventional practices and traditional medicine. In many cases, when conventional medicine cannot offer a satisfactory treatment, increases the demand for alternative therapies in chronic conditions. The aim of this study randomized was to compare and evaluate for one year clinical and serologic parameters the effects of homeopathy as an adjunct of conventional periodontal therapy in individual with periodontitis and DMII. Materials and Methods: 85 individuals, of both genders, between 35 and 70 years old, participated in this randomized study, which 70 were eligible in Institute of Endocrinology and Diabetes of Rio de Janeiro-Brazil. They were divided into two groups G-1: individuals with periodontitis without systemic conditions and G-2: individuals with periodontitis and DMII. Both groups received homeopathic treatment and were evaluated in clinical and laboratorial examinations. The medication used was chosen based on the similarity principle, following the Berberis 6CH protocol (2 tablets, 2 times a day for 45 days), Mercurius Solubilis / Belladona / Hepar Sulfur - 6CH (2 tablets, 3 times a day for 15 days) and a Pyrogenium 200CH biotherapeutic (single weekly dose, 2 weeks). Medications are prescribed in diluted low concentration doses for all signs and symptoms, while biotherapy is used for chronic stimulation Results: Both groups showed significant improvements throughout the study, clinical and laboratorial, at 1 year baseline: reductions in total cholesterol, triglycerides, glucose, glycated hemoglobin, uric acid and CPR. Statistical and descriptive analyzes were performed. The data obtained after laboratory analysis were tabulated and then submitted to the SPSS 17.0 software for Windows (SPSS Inc., Chicago, IL) and significance level with p &lt;0.05. For most of parameters, G-1 performed better than G-2 (p&lt;0.05). Conclusion: After 1 year follow-up this clinical trial suggest that homeopathy therapy, as an adjunct of periondontal treatment, improves local and systemic parameters and can provide better health condition.

Minimally Invasive Surgery Periodontal Therapy for the Treatment of Intrabony Periodontal Defects: A Systematic Review.

Background:Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects.Materials and Methods:An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted.Results:The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA.Conclusion:Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.

Proposing a model for auditing data quality of long-term periodontal outcome studies

Objective The assessment of the success of conventional periodontal therapy is based on retrospective studies from private practice and university clinics. Due to their marked heterogeneity, it is difficult to assess the data quality and rate these studies. The aim is to test a model for auditing and rating the data quality of periodontal outcome studies. Methods The method was adapted from the NIH Health Care Systems Collaboratory model, which uses three data quality dimensions: completeness (including all the relevant variables), consistency (ensuring that the same variables are compared) and accuracy (proportion of data in error with a gold standard). The model was applied to studies from a Norwegian specialist practice and data from the Norwegian Health database to test if the auditing process was workable using real world data. Results Forty-seven risk and prognostic factors were included for completeness. Seven variables were specified for consistency: tooth loss, smoking, systemic conditions, oral hygiene, individual tooth prognosis, maintenance profiles and timing of extractions. The factors tested showed a 95.7% completeness and an average accuracy deviation from the gold standard of −2.3% for each of the risk/prognostic factors and an overall study score of 93.3%. Conclusions It was possible to develop a method for auditing and rating the quality of periodontal outcome studies. The model was tested using both real world data including risk and prognostic factors from individual outcome studies and national big data. The application of the model to these sets of data showed a high accuracy of the risk/prognostic factors and a close relationship with national big data.

Comparative Evaluation of Open Flap Debridement Therapy with Two Different Types of Platelet Concentrates, T-PRF and L-PRF as Adjuncts- A Systematic Review

Conventional Periodontal therapy such as scaling and root planing and open flap debridement aims to halt the inflammation process and promotes repair of disease-related defects. Current regenerative procedures offers a limited potential toward attaining a complete periodontal restoration and none is considered a gold standard in the treatment of intrabony defects. This study was done to compare the efficiency of Titanium-Platelet Rich Fibrin and Leukocyte-Platelet Rich Fibrin as adjuncts to Open Flap Debridement therapy to treat intra-bony periodontal defects. A search was conducted through PubMed and various other databases such as Cochrane, Google Scholar and EBSCO Host , under the key words, OFD , T-PRF,L-PRF, Clinical Outcomes, Comparison and Randomised Contolled Trials. Six relevant articles were selected for analysis. Compared to non-platelet concentrates, L-PRFproves to be the better adjunct to open flap debridement therapy. When compared to T-PRF, however, L-PRF has comparatively inferior properties of bone defect resolution and fill.We can conclude that T-PRF has better properties, greater bone defect fill and defect resolution as compared to L-PRF.

Comparison of dental pulp periodontal therapy and conventional simple periodontal therapy as treatment modalities for severe periodontitis.

BACKGROUNDSevere periodontitis is a major oral health concern today as it can lead to loss of teeth. Conventional periodontal therapy has numerous pitfalls as it does not address the pulp-periodontal complex in its entirety.AIMTo investigate the effect of dental pulp periodontal therapy on the levels of interleukin-1β (IL-1β) and IL-10 in gingival crevicular fluid (GCF) in patients with severe periodontitis.METHODSEighty-six patients with severe periodontitis were randomly divided into a research group (n = 43) and a control group (n = 43). The control group was treated with simple periodontal therapy, and the research group was treated with dental pulp periodontal therapy. The total effective rates of the treatments; periodontal status before and after treatment through the measurement of the periodontal pocket probing depth (PPD), gingival sulcus bleeding index (SBI), mobility (MD), and plaque index (PLI); the levels of inflammatory factors IL-1β and IL-10 in the GCF; and the incidence of complications were calculated for both groups and compared using the Student’s t test and the χ2 test.RESULTSThe total effective rate of treatment in the study group (93.02%) was higher than that in the control group (76.74%; P < 0.05). While before treatment, there was no significant difference in the PLI, MD, SBI, or PPD between the two groups, the post-treatment values of PLI, MD, SBI, and PPD (4.71 ± 0.16 mm, 0.61 ± 0.09 mm, 0.96 ± 0.17 mm, and 0.76 ± 0.26 mm, respectively) were significantly lower (P < 0.05) in the research group than in the control group (5.35 ± 0.24 mm, 0.93 ± 0.15 mm, 1.35 ± 0.30 mm, and 1.04 ± 0.41 mm, respectively). There was no significant difference in the level of IL-1β or IL-10 in the GCF before treatment between the two groups; after treatment, the IL-1β level in the research group (139.04 ± 15.54 pg/mL) was significantly lower than that in the control group (156.35 ± 18.10 pg/mL), and the level of IL-10 in the research group (7.98 ± 1.01 ug/L) was higher than that in the control group (5.56 ± 0.96 ug/L) (P < 0.05). The incidence of complications in the study group (4.65%) was significantly lower than that of the control group (18.60%; P < 0.05). CONCLUSIONEndodontic therapy and periodontal treatment for patients with severe periodontitis can effectively reduce the levels of inflammatory factors in the GCF and the inflammatory reaction. In addition, it can improve the periodontal condition and the overall treatment effect, reduce the risk of complications, and ensure the safety of treatment.