Conventional Periodontal Treatment Research Articles

Recent Advances of Therapeutic Targets for the Treatment of Periodontal Disease.

Periodontal disease is primarily associated with bacterial infection such as dental plaque. Dental plaque, an oral biofilm harboring a complex microbial community, can cause various inflammatory reactions in periodontal tissue. In many cases, the local bacterial invasion and host-mediated immune responses lead to severe alveolar bone destruction. To date, plaque control, non-surgical, and surgical interventions have been the conventional periodontal treatment modalities. Although adjuvant therapies including antibiotics or supplements have accompanied these procedures, their usage has been limited by antibiotic resistance, as well as their partial effectiveness. Therefore, new strategies are needed to control local inflammation in the periodontium and host immune responses. In recent years, target molecules that modulate microbial signaling mechanisms, host inflammatory substances, and bone immune responses have received considerable attention by researchers. In this review, we introduce three approaches that suggest a way forward for the development of new treatments for periodontal disease; (1) quorum quenching using quorum sensing inhibitors, (2) inflammasome targeting, and (3) use of FDA-approved anabolic agents, including Teriparatide and sclerostin antibody.

Ozone Therapy in the Prevention of Dental Plaque Formation in Dogs.

This study aims to assess ozonized mineral oil ointment application as an antiplaque therapy for dogs. Domestic healthy dogs received dental scaling and polishing under general anesthesia. Under standard feeding and homecare during 7 days, 20 dogs were randomly placed into 2 different groups for dental treatment. The control group (CG) was given a single placebo application and the ozone group (O3G) received daily ozonized ointment application. The average age (CG = 4.4; O3G = 5.7 years old), body weight (CG = 15.7; O3G = 15.3 kg) and the gingivitis index obtained on the first day (D0) allowed initial homogeneity between the groups. The dental plaque index, including clinical and computerized analysis on the seventh day, was obtained from the buccal aspect of specific dental locations. Both analyses revealed significant statistical association between daily application of ozone and antiplaque effect. There was no evidence of toxicity during the study. These results suggest that ozone therapy may be an efficient adjuvant to conventional periodontal treatment in decreasing initial dental plaque formation.

Periodontal therapy and treatment of hypertension-alternative to the pharmacological approach. A systematic review and meta-analysis

AimQuantitative comparison of the effects of intensive (IPT) or conventional (CPT) periodontal treatment on arterial blood pressure, endothelial function and inflammatory/metabolic biomarkers. Materials and methodsA systematic search was conducted to identify randomized controlled trials (RCT) of IPT (supra and subgingival instrumentation). Eight RCTs were included in the meta-analysis. Difference in change of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after IPT or CPT were the primary outcomes. The secondary outcomes included: endothelial function and selected inflammatory/anti-inflammatory (CRP, IL-6, IL-10, IFN-γ) and metabolic biomarkers (HDL, LDL, TGs). ResultsThe overall effect estimates (pooled Weighted Mean Difference (WMD)) of the primary outcome for SBP and DBP was −4.3 mmHg [95%CI: −9.10–0.48], p = 0.08 and −3.16 mmHg [95%CI: −6.51–0.19], p = 0.06 respectively. These studies were characterized by high heterogeneity. Therefore, random effects model for meta-analysis was performed. Sub-group analyses confirmed statistically significant reduction in SBP [WMD = −11.41 mmHg (95%CI: −13.66, −9.15) P < 0.00001] and DBP [WMD = −8.43 mmHg (95%CI: −10.96,−5.91)P < 0.00001] after IPT vs CPT among prehypertensive/hypertensive patients, while this was not observed in normotensive individuals. The meta-analyses showed significant reductions in CRP and improvement of endothelial function following IPT at all analysed timepoints. ConclusionsIPT leads to improvement of the cardiovascular health in hypertensive and prehypertensive individuals.

Papillon Lefevre syndrome associated with recurrent pyogenic abscess of facial skin followed by scarring: A case report

Papillon-Lefévre syndrome (PLS) is an autosomal recessive disorder that is characterised by severe generalized early-onset periodontitis and palmoplantar hyperkeratosis. Besides these cardinal features some patients rarely exhibits recurrent pyogenic infections of skin, hair follicle infection (frunculosis), multiple abscess of skin, hyperhidrosis. This article represents a rare case of 17 year old young male patient with cardinal features of PLS along with history of recurrent pyogenic abscess of facial skin followed by scarring since childhood. There are multiple etiological factors like genetic, immunological, and microbial factors, consanguineous marriage and reduced host defense mechanism. Patients with PLS have increased susceptibility to infections. Over 300 cases have been reported till now in dental and medical literature with most of the cases discovered amongst Africans, Arabs and, Indians with 25% patients showing recurrent pyogenic infections. Management of the disorder primarily involves conventional periodontal treatment; oral hygiene instructions, antiseptic mouth rinses; and systemic antibiotic. Skin lesions are usually treated with topical application of emollients, keratolytic agents, steroids, and oral retinoid.

Lemuru fish oil gel as host modulation therapy in periodontal ligaments induced with Porphyromonas gingivalis

Background: Periodontitis affects approximately 20%–50% of the global population and is caused by gram-negative bacteria, such as Porphyromonas gingivalis (P. gingivalis). Host modulation therapy (HMT) is part of a periodontal therapy that is used as an adjunct to conventional periodontal treatment to reduce tissue damage. Lemuru fish oil containing EPA and DHA can reduce the formation of MMPs and will further increase the number of fibroblasts there by stimulating collagen formation. Purpose: To determine the effect of lemuru fish oil gel on the collagen density and width of the periodontal tissue induced by P. gingivalis and the correlation between these parameters. Methods: Thirty male Wistar rats were divided into five groups. Induction of P. gingivalis was carried out first, then lemuru fish oil gel was applied to the gingival sulcus for 14 days, according to collagen scores in histological preparations using Masson's trichrome (MT). The width of the periodontal ligament was measured with an image raster program in µm. The data were analysed using statistics to test hypotheses using SPSS version 24. Results: Significant differences in the results of the collagen density were observed between groups K- and K+ and groups K+ and P2. Meanwhile, no significant difference was observed between groups K- and P2, P3, P2 and P3 and K+ and P1. The mean values of the periodontal ligament widths were K- (299.61 ± 51.82µm), K+ (425.85 ± 61.54µm), P1 (346.93 ± 33.53µm), P2 (370.15 ± 49.42µm) and P3 (379.6 ± 49.26). Conclusion: Lemuru fish oil can affect the width of the ligament and the collagen density with an optimal concentration of 20%. The correlation between the collagen density and the periodontal ligament width was negative and not significant.

Clinical research progress in the treatment of intrabony defect by minimally invasive periodontal surgery

Minimally invasive surgery develops rapidly in the periodontal treatments, especially in the periodontal regenerative treatment, in recent years. It supplements, to a certain extent, the insufficiency of the conventional periodontal regenerative treatment. The minimally invasive surgery has many advantages such as enhancing the healing process, reducing surgical chair time and minimizing patient discomfort, etc. It has been proved to improve the clinical effect and provide additional benefits compared to conventional approaches. At present, there are many studies on minimally invasive techniques used in tooth extraction or implant placement in China, but there are few reports on the application of periodontal minimally invasive surgical techniques. Thus based on the reviews of the literatures, this article describes the applications, advantages, indications, microsurgical instruments of minimally invasive periodontal surgery on the treatment of intrabony defect, including various minimally invasive surgical procedures. The review also demonstrates the therapeutic effects and research progress of minimally invasive periodontal surgery combined with biomaterials used in the treatments of intrabony defect. The present article may also provide reference for clinicians applying minimally invasive surgeries to treat intrabony defects.

Fibrous Epulis: The Reactive Gingival Enlargement to Excise or Not to Excise

The volume thickening of soft tissue covering the alveolar ridges, designed gingival enlargement, is one of the frequent findings in clinical practice. However, they fail under varied presentations and their distinction allows a clinical diagnosis and defines an appropriate treatment to reduce recurrence. Among the diverse types of enlargement, fibrous epulis is the most common one. It is a localized uniform gingival overgrowth caused by tissue oedema and inflammatory hyperplasia in response to local irritations. This report outlines a case of fibrous epulis concerning a 56 years old male patient, in our periodontology department. A careful medical history, examination of the gingival, periodontal health status, and its reevaluation were assessed. Conventional periodontal treatment has been sufficient to minimize the gingival size. After an excisional biopsy, the histopathological examination was the determinants tool to accurate the diagnosis of fibrous epulis. Patient motivation and compliance during and after therapy has been a critical factor in the success of periodontal treatment and a key to prevent the recurrence of such lesions.

The effect of non- surgical periodontal therapy on periostin level in the gingival crevicular fluid of type II diabetic patients with periodontitis

Abstract: Background and Objective: periostin is a protein highly expressed within extracellular matrix of bone and periodontal ligament responsible for tissue integrity and play significant role in wound repair and bone remodeling. The present study designed to estimate the effectiveness of non surgical periodontal therapy (NSPT) on level of periostin in the gingival crevicular fluid (GCF) of diabetic patient with periodontitis. Materials and Methods: 36 subjects were admitted in this study. The subjects allocated into 3 groups, group I involve 12 periodontally healthy subjects, group II involve 12 participants with periodontitis. Group III: involve 12 participants with periodontitis diagnosed with diabetes mellites type II. Group II and III were received conventional periodontal treatment scaling and root planning (S&RP). Clinical parameters: pocket depth (PD), clinical attachment loss (CAL), gingival index (GI), plaque index (PI) were measured and the GCF samples were gathered for assessment of periostin at baseline and at 3 months postoperatively. Results: periostin level in the GCF were significantly increased in healthy subjects (P≤0.001) compared to those with diabetic patients with periodontitis and patients with periodontitis only. NSPT in group II and III resulted in significant increase (P≤0.001) in periostin level at 3 months postoperatively. Conclusion: NSPT can significantly increase the level of periostin in the GCF of diabetic patients with periodontitis and those with periodontitis only. Moreover, periostin suggested to be inflammatory marker reliable for diagnosis and evaluation of the outcome of periodontal treatment.

Antimicrobial and anti-inflammatory thermo-reversible hydrogel for periodontal delivery

In periodontal treatment, topical adjunctive therapy with antimicrobials or anti-inflammatory agents is frequently applied. However, currently available drug carrier biomaterials often exhibit poor perfusion into small crevices, such as the deep and irregular periodontal pockets, due to relatively high viscosity. Moreover, high polymer concentrations of the polymer can potentially be cytotoxic upon confined local administration. This study aimed to formulate an antimicrobial and anti-inflammatory treatment option, by incorporating doxycycline (DOX) and/or lipoxin A4 (LXA4) into 0.5 wt% thermo-reversible polyisocyanopeptide (PIC). PIC can form hydrogels upon low polymer concentration, and we hypothesized that the thermo-reversible nature of the material would allow for application into the periodontal pocket. The formulations were characterized in vitro and finally tested in dogs with naturally occurring periodontitis, which were not euthanized afterward. Results showed that PIC/DOX/LXA4 hydrogel could be easily prepared and injected into periodontal pockets. The PIC hydrogel facilitated the release of DOX or LXA4 for around 4 days in vitro. When applied in dogs, the hydrogel exerted no local or systemic adverse effects. Gels loaded with LXA4 and/or DOX reduced the subgingival bacterial load and pro-inflammatory interleukin-8 level. In addition, PIC-DOX and PIC-DOX+LXA4 improved gingival clinical attachment by 0.6 mm compared with conventional periodontal treatment alone (i.e. mechanical debridement). In conclusion, the thermo-reversible PIC hydrogel is a safe and effective vehicle for periodontal drug delivery.

The Effect of Gaseous Ozone Therapy in Conjunction with Periodontal Treatment on Glycated Hemoglobin Level in Subjects with Type 2 Diabetes Mellitus: An Unmasked Randomized Controlled Trial

Background: It is established that inflammation is involved in the pathogenesis of Type 2 Diabetes Mellitus (T2DM) by promoting insulin resistance and impaired beta cell function in the pancreas. Among the hypothesized independent risk factors implicated in the pathogenetic basis of disease, periodontal infection has been proposed to promote an amplification of the magnitude of the advanced glycation end product (AGE)-mediated upregulation of cytokine synthesis and secretion. These findings suggest an interrelationship between periodontal disease and type 2 diabetes, describing poor metabolic control in subjects with periodontitis as compared to nondiabetic subjects and more severe periodontitis in subjects with T2DM as compared to a healthy population, with a significant positive correlation between periodontal inflammatory parameters and glycated hemoglobin level. Results from clinical trials show that periodontal treatment is able to improve glycemic control in subjects with diabetes. Many therapeutic strategies have been developed to improve periodontal conditions in conjunction with conventional treatment, among which ozone (O3) is of specific concern. The principal aim of this trial was to compare the clinical effectiveness of an intensive periodontal intervention consisting of conventional periodontal treatment in conjunction with ozone gas therapy in reducing glycated hemoglobin level in type 2 diabetic patients and standard periodontal treatment. Methods: This study was a 12-month unmasked randomized trial and included 100 patients aged 40–74 years older, with type 2 diabetes mellitus diagnosed. All the patients received conventional periodontal treatment, or periodontal treatment in conjunction with ozone gas therapy in a randomly assigned order (1:1). The primary outcome was a clinical measure of glycated hemoglobin level at 3, 6, 9 and 12 months from randomization. Secondary outcomes were changes in periodontal inflammatory parameters. Results: At 12 months, the periodontal treatment in conjunction with ozone gas therapy did not show significant differences than standard therapy in decreasing glycated hemoglobin (HbA1C) level and the lack of significant differences in balance is evident. Conclusions: Although the change was not significant, periodontal treatment in conjunction with the gaseous ozone therapy tended to reduce the levels of glycated hemoglobin. The study shows a benefit with ozone therapy as compared to traditional periodontal treatment.

Papillon-Lefèvre syndrome: Oral aspects and treatment.

Papillon-Lefèvre syndrome (PLS) is a rare disorder characterized by diffuse palmoplantar erythematous, fissured hyperkeratosis, and aggressive periodontal disease that starts in the early periods of childhood. Periodontal disease occurs with the early loss of deciduous teeth at the age of 2 to 4 years, followed by the loss of permanent teeth during adolescence. Prosthodontics management of PLS patients is very complex and sometimes requires invasive therapeutic treatments. Early diagnosis is essential for correct treatment management avoiding the possibility that patients are early edentulous. Management could be a conventional periodontal treatment and pharmacological therapy but in severe cases, digital techniques, could be help the clinician for increased patient comfort and minimized tissue damage.

Antimicrobial photodynamic chemotherapy mediated by PapaMBlue on chronic periodontal disease: Study protocol for a randomized, blind, controlled trial.

Background:The elimination of the pathogenic microorganisms of the periodontal pocket is one of the main points for success in periodontal treatment. The objective of this study is to investigate the clinical and antimicrobial effect of papain-mediated photodynamic therapy in the clinical treatment of periodontal disease.Methods:Twenty patients with chronic periodontitis will be selected. Patients will be randomly divided into 2 groups (n = 10). Group 1 will receive conventional periodontal treatment and group 2 will receive conventional treatment and antimicrobial photodynamic therapy (PACT). Conventional treatment will consist of oral hygiene guidance, with brushing technique instructions and recommendation of daily flossing. The calculus deposits on the teeth will be removed with ultrasound equipment and curettes for scraping and root planning. The PACT will be performed at the end of each periodontal treatment session, at sites with bags ≥4 mm. PapaMblue photosensitizer will be deposited in the periodontal pockets with a syringe and a pre-irradiation time of 1 minute will be adopted. Then, the laser emitting wavelength of 660 nm, with power of 100 mW, for 2 minutes, radiant exposure of 30 J/cm2 and power density of 250 mW/cm2 will be applied. Patients will undergo clinical evaluations before treatment (day 1) at 30, 60, and 90 days after the end of treatment; and microbiological evaluations before and immediately after treatment. The distribution of the data within each group and the homogeneity of the variances will be verified. With this information, the most appropriate statistical test in each evaluation will be used. The sample calculation is based on the literature and the significance level of 5% will be adopted.Discussion:The combination of PACT with methylene blue in a papain gel and the conventional treatment may increase the reduction of bacteria in periodontal pockets.

Clinical evaluation for treatment of chronic inflammatory gingival enlargement using Diode Laser versus Electrocautery gingivectomy

Introduction: Management of gingival enlargement starts with conventional periodontal treatment and might be followed by surgical intervention to return the gingiva to its normal anatomical and physiological contour. Gingivectomy can be done by various techniques as laser and electrocautery. Diode laser as a semiconductor transfer electrical energy into light energy allowing easy manipulation of soft tissue. Electrocautery is a controlled, precise application of heat used with carefully designed electrodes. Materials and Methods: A split mouth study design was done on ten patients having bilaterally symmetrical gingival hyperplasia in lower anterior teeth due to chronic inflammatory gingival enlargement. In each patient, gingivectomy was done with diode laser at the right side and electrocautery at the left side.Results: Intraoperative parameters included haemostasis and duration of surgery which showed no significant difference between both sides while laser showed significant improvement over electrocautery regarding instrument sticking. Postoperative parameters included pain which showed statically significant difference between both sides at 72hs in favor of electrocautery side, and healing index (HI) which showed no significant difference between both sides at 72hs, one week and one month postoperatively. Conclusion: Both treatment modalities were efficient in performing gingivectomy however, Electrocautery was superior to diode laser regarding postoperative pain and diode laser has advantage over electrocautery regarding instrument performance and showed better improvement in healing process.

Clinical-Statistical Study on the Use of a Magnesium-Terpene-Based Substance in Polymeric Trays for Periodontal Treatment

Periodontal diseases are inflammatory diseases that cause lesions of the dento-periodontal system and can even lead to the loss of teeth. A successful treatment of periodontal diseases includes procedures aimed at reducing inflammation, by mechanical and chemical means, which have the role to decrease the pathogenicity of microorganisms found in the bacterial plaque. The study was conducted on a group of 50 patients, of whom a control group of 25 patients followed conventional periodontal treatment, while the other 25 patients received magnesium-terpene therapy by using polymeric thermoforming mouth custom trays, along with conventional periodontal treatment. The statistical and clinical assessment of the study revealed the efficiency of the magnesium-terpene active gel for the treatment of periodontal disease.

A influência do tratamento periodontal convencional não cirúrgico no controle glicêmico de pacientes diagnosticados com diabetes mellitus e periodontite – revisão de literatura

Objetivo: revisar a literatura sobre a influência do tratamento periodontal convencional não cirúrgico (TPC) no controle glicêmico em pacientes diabéticos e diagnosticados com periodontite. Material e Métodos: utilizou-se os descritores Diabetes mellitus, Periodontitis e Therapy, em inglês, combinados, para busca na base de dados PubMed, de 2015 a 2019. Um total de 233 artigos foram encontrados, após leitura de seus resumos, selecionou-se 25, que estavam relacionados ao tema. Estes foram lidos na íntegra. Revisões de literatura, pesquisas in vivo e ensaios clínicos que não analisaram sistemicamente os pacientes, especialmente quanto aos exames glicêmicos, ou que objetivaram avaliar efeitos de fármacos foram excluídos. Resultados: a maioria dos ensaios clínicos selecionados analisou prospectivamente a presente associação. Vinte estudos indicaram que o TPC pode influenciar positivamente no controle glicêmico em pacientes com DM e periodontite. As citocinas pró-inflamatórias são reconhecidas por aumentarem a resistência celular periférica à ação da insulina e possuírem relação causal com DM. O presente resultado foi associado ao potencial do TPC, realizado através de raspagens supra e subgengivais, em reduzir a carga microbiana local e, consequentemente, a concentração maciça de mediadores inflamatórios no sulco ou bolsa periodontal, reduzindo a disseminação sérica dos mesmos. Conclusão: o TPC apresenta benefícios sistêmicos ao facilitar o controle glicêmico em pacientes diabéticos. Sugere-se que as visitas ao cirurgião-dentista sejam protocolizadas no tratamento de pacientes diabéticos

FABRY DISEASE: ORAL FINDINGS AND POSSIBLE ASSOCIATION WITH AUTOIMMUNE DESQUAMATIVE GINGIVITIS

Fabry disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme α-galactosidase A. We report a case of a 55-year-old woman, with previous diagnosis of Fabry disease that was referred complaining of pain in the gingiva for about 1 year. The physical examination revealed short fingers, angiokeratomas in the neck, fissured tongue and desquamative gingivitis. An incisional biopsy was performed in the gingival lesions and the histopathologic analysis revealed a subepithelial blister, compatible with the diagnosis of mucous membrane pemphigoid. A topical corticosteroid therapy was instituted associated with conventional periodontal treatment. After 3 weeks, all areas of erythema or ulceration were healed, and the symptoms had disappeared. Fabry disease is a rare disorder with a few cases of oral abnormalities described. A high incidence of autoantibodies has been reported in patients with Fabry disease, which may explain the development of the desquamative gingivitis condition. Fabry disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme α-galactosidase A. We report a case of a 55-year-old woman, with previous diagnosis of Fabry disease that was referred complaining of pain in the gingiva for about 1 year. The physical examination revealed short fingers, angiokeratomas in the neck, fissured tongue and desquamative gingivitis. An incisional biopsy was performed in the gingival lesions and the histopathologic analysis revealed a subepithelial blister, compatible with the diagnosis of mucous membrane pemphigoid. A topical corticosteroid therapy was instituted associated with conventional periodontal treatment. After 3 weeks, all areas of erythema or ulceration were healed, and the symptoms had disappeared. Fabry disease is a rare disorder with a few cases of oral abnormalities described. A high incidence of autoantibodies has been reported in patients with Fabry disease, which may explain the development of the desquamative gingivitis condition.

Heat-killed Lactobacillus reuteri and cell-free culture supernatant have similar effects to viable probiotics during interaction with Porphyromonas gingivalis.

In the last decade, numerous studies have been published to clarify the role of probiotics, especially Lactobacillus reuteri, as an adjunct to conventional periodontal treatment. Although the health benefits of probiotics are numerous, they are live bacteria, and the administration of live organisms is not risk-free. We evaluated the antimicrobial effect of Lreuteri and its cell-free culture supernatant on Porphyromonas gingivalis, a keystone periodontal pathogen, in vitro. We also evaluated the influence of this probiotic in its live, heat-killed (HKL, paraprobiotic) form and its supernatant on the Galleria mellonella invertebrate model after infection by Pgingivalis. The interaction assay was conducted with Pgingivalis and Lreuteri preparations (live cells and supernatant preparation). For this, Pgingivalis and Lreuteri preparations were added to tubes containing Brain Heart Infusion broth and incubated for 3days. The suspensions were then seeded onto appropriate culture media for the calculation of colony-forming units per mL (CFU/mL). An in vivo assay with the Gmellonella model was also performed. Live Lreuteri, HKL, or supernatant was inoculated 2hours prior to infection with Pgingivalis. Survival was evaluated over 7days, and the number of hemocytes in the hemolymph was estimated 3hours after Pgingivalis infection. Data were then subjected to statistical testing (α=5%). Both live Lreuteri and its supernatant had antimicrobial activity against Pgingivalis (CFU reduction up to 86%, P<.05). Moreover, treatment with live and HKL had similar effects on Gmellonella survival (increased survival up to 46%, P<.05). However, only live Lreuteri was able to significantly increase the hemocyte density in this invertebrate model. Lactobacillus reuteri antimicrobial activity against Pgingivalis and its effects on Gmellonella survival after infection with a periodontopathogen do not depend on cell viability. This allows the development of products without live bacterium while maintaining similar effects.

The application of antimicrobial photodynamic therapy (aPDT, 670nm) and diode laser (940nm) as adjunctive approach in the conventional cause-related treatment of chronic periodontal disease: a randomized controlled split-mouth clinical trial.

The aim of the present randomized controlled split-mouth clinical trial is to evaluate the effectiveness of the adjunctive use of photodynamic low-level laser therapy (670nm), applying methylene blue as photosensitizer, and the effectiveness of a diode laser (940nm) compared with conventional non-surgical mechanical treatment in a group of patients with chronic periodontal disease. Twenty-one patients with moderate to severe periodontal disease with presence of 3 or more quadrants, each containing at least three sites with periodontal pocket depth (PPD) of ≥ 5mm, were included in the study. Periodontal treatment comprising scaling and root planing (SRP) was accomplished for the whole mouth. Applying a split-mouth design, each quadrant was randomly treated with SRP alone (control group), SRP with diode laser (diode group), and SRP with photodynamic therapy (photodynamic group). All treatment modalities in this study lead to statistically significant improvements in the evaluated clinical parameters at 3months and 6months compared with baseline. There was no statistically significant difference regarding PD and BOP between groups. There was only a tendency for greater reduction of PD in the diode group for deep pockets at 3months, but not statistically significant. After 6months of evaluation, the high intensity diode laser and the antimicrobial photodynamic therapy have not shown any additional benefits to the conventional periodontal treatment. The diode or photodynamic laser therapy in conjunction with conventional SRP does not seem to be superior in reducing probing depth and bleeding on probing than SRP alone 6months after treatment. More studies are necessary to prove the actual need of these types of lasers in the periodontal clinical practice.

Feasibility Controlling Hemoglobin A1c by Oral Hygiene Improvement: A Pilot Study

Purpose: Patients with diabetes mellitus are prone to be bacteremia. The major side effect of diabetes mellitus is caused by bacteremia. However, conventional periodontal treatment does not focus mainly on the elimination of pathogenic bacteria. Therefore, the aim of this study was to the management of oral bacteria improve some symptoms of diabetes mellitus. Material and Method: We monitored Hemoglobin A1c (HbA1c) of five subjects after removed oral bacteria on the tooth surface by antibiotics using custom made tray. By using the results, simulation model was constructed. Result: By the simulation, HbA1c levels declined over time and decreased to 6.0%. However, it took at least 600 days to come up to 6.0%. The higher the level of HbA1c at baseline, the more time takes to improve HbA1c level. Subjects with 7.3% HbA1c at baseline required 2,400 days to achieve 6.0% HbA1c. Conclusion: The results of this study suggest that HbA1c may be improved by oral bacterial control. Clinical studies suggest that a long observational period is required to obtain high quality evidence.? Keywords: Oral hygiene; Hemoglobin A1c; Mixed effect model

The Effectiveness of Vitamin D Supplementation in Chronic Periodontitis Patients: a Randomized Controlled Clinical Trial

Background : Vitamin D deficiency is a common health problem worldwide and linked to some infectious and inflammatory conditions, including periodontal disease. This is a double blind randomized controlled study to evaluate the clinical effectiveness of Vitamin D supplementation as an adjunct therapy to non-surgical periodontal treatment in healthy middle-aged vitamin D deficient patients with chronic periodontitis. Material and Methods: Twenty eight patients with mild to moderate chronic periodontitis were included in this study . They were randomized to two groups: Test Group taking oral Vitamin D supplementation 10,000 IU one tablet daily for five days per week for a total duration of 12 weeks and Control Group taking placebo pills. Both groups were maintained on scaling and root planning sessions. Data was collected at baseline and at three months including the following clinical periodontal parameters: Gingival index (GI), Plaque index (PI), Probing pocket depth (PPD) and Clinical attachment level (CAL). Results: Intra-group analysis showed that both groups had significant improvements in the periodontal measures. However, analysis comparing changes in the mean periodontal indices between groups showed that the mean changes across all periodontal indices between groups were statistically significant at pConclusion: Adjunctive low cost Vitamin D supplementation in mild to moderate chronic periodontitis in middle aged Vitamin D deficient healthy patients significantly improves clinical periodontal outcomes relative to scaling and root planning alone with no side effects. Vitamin D is safe and probably may contribute to decrease health care costs as an adjunctive therapy to conventional periodontal treatment.