Defects In Chronic Periodontitis Patients Research Articles

Demineralized freeze-dried bone allograft with/without i-Platelet-rich fibrin in 3 wall intrabony defects

Demineralized freeze-dried bone allograft (DFDBA) contains bone morphogenetic proteins (BMPs), hence is osteoinductive. Autologous platelet concentrates exhibit a higher quantity of growth factors. Both these biomaterials aid in bone regeneration when placed in three-wall intrabony defects. However, their efficacy when used alone and in conjugation is not clear. Aim: To assess clinical and radiographic efficacy of injectable platelet-rich fibrin (i-PRF) with microsurgical access flap in the treatment of three-wall intrabony defects in chronic periodontitis patients. Methods: Thirty sites with three-wall intrabony defects were randomly assigned to control and test group by computer generated method. The test group obtained i-PRF mixed with DFDBA while the control group received only DFDBA. Clinical parameters such as site-specific Plaque index (PI), Radiographic intrabony defect depth (IBDD), modified- Sulcular bleeding index (mSBI), Clinical attachment level (CAL), and Probing pocket depth (PPD) were measured at baseline, three and six months. Results: Intragroup comparison within the control group and test group exhibited statistically highly significant variation of mean PI, mSBI, PPD, CAL, and IBDD score from baseline to 3 months and from 3-6 months (p<0.001). However, intergroup comparison demonstrated no statistically significant variation of mean IBDD at all 3 intervals (p>0.05). Conclusion: i-PRF combined with DFDBA enhanced the radiographic and clinical parameters as opposed to DFDBA alone. The role of i-PRF is promising in its capacity for easy obtainability and increased potential to aid in regeneration.

Comparing the Clinical and Radiographic Outcomes of Two Different Surgical Approaches for Treating Infrabony Defects in Chronic Periodontitis Patients

ABSTRACT Background: Chronic periodontitis is a prevalent oral health issue, affecting a substantial portion of the population. Infrabony defects, characterized by bone loss around teeth, are a hallmark of this condition and require surgical intervention to prevent further damage and tooth loss. Two commonly used surgical approaches are open flap debridement (OFD) and guided tissue regeneration (GTR). Materials and Methods: This prospective cohort study included 60 patients with chronic periodontitis and infrabony defects. Patients were randomly assigned to either the OFD or GTR group. Clinical parameters, including probing depth (PD) and clinical attachment level (CAL), were recorded at baseline and at 6-month and 12-month follow-up appointments. Radiographic assessments were conducted using periapical radiographs. The primary outcome measures were changes in PD and CAL, while secondary outcomes included radiographic evidence of bone regeneration. Results: At the 6-month follow-up, the OFD group demonstrated an average reduction in PD of 2.4 mm (SD = 0.8) and an increase in CAL of 1.6 mm (SD = 0.5). In contrast, the GTR group showed a reduction in PD of 2.1 mm (SD = 0.7) and an increase in CAL of 1.9 mm (SD = 0.6). These differences were not statistically significant (P > 0.05). Radiographic analysis indicated a mean bone fill of 1.2 mm (SD = 0.4) in the OFD group and 1.4 mm (SD = 0.3) in the GTR group at 12 months, with no significant difference observed between the two groups (P > 0.05). Conclusion: In this study, both OFD and GTR approaches demonstrated comparable clinical and radiographic outcomes in the treatment of infrabony defects in chronic periodontitis patients.

Comparing the Clinical and Radiographic Outcomes of Two Different Surgical Approaches for Treating Infrabony Defects in Chronic Periodontitis Patients

ABSTRACT Background: Chronic periodontitis is a prevalent oral health issue, affecting a substantial portion of the population. Infrabony defects, characterized by bone loss around teeth, are a hallmark of this condition and require surgical intervention to prevent further damage and tooth loss. Two commonly used surgical approaches are open flap debridement (OFD) and guided tissue regeneration (GTR). Materials and Methods: This prospective cohort study included 60 patients with chronic periodontitis and infrabony defects. Patients were randomly assigned to either the OFD or GTR group. Clinical parameters, including probing depth (PD) and clinical attachment level (CAL), were recorded at baseline and at 6-month and 12-month follow-up appointments. Radiographic assessments were conducted using periapical radiographs. The primary outcome measures were changes in PD and CAL, while secondary outcomes included radiographic evidence of bone regeneration. Results: At the 6-month follow-up, the OFD group demonstrated an average reduction in PD of 2.4 mm (SD = 0.8) and an increase in CAL of 1.6 mm (SD = 0.5). In contrast, the GTR group showed a reduction in PD of 2.1 mm (SD = 0.7) and an increase in CAL of 1.9 mm (SD = 0.6). These differences were not statistically significant (P > 0.05). Radiographic analysis indicated a mean bone fill of 1.2 mm (SD = 0.4) in the OFD group and 1.4 mm (SD = 0.3) in the GTR group at 12 months, with no significant difference observed between the two groups (P > 0.05). Conclusion: In this study, both OFD and GTR approaches demonstrated comparable clinical and radiographic outcomes in the treatment of infrabony defects in chronic periodontitis patients.

Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial.

This study aims to evaluate the efficacy of calcium phosphate-poly(lactide-co-glycolide) composite graft in the regeneration of intrabony defects in chronic periodontitis patients over a period of 12 months. A total of 11 systemically healthy chronic periodontitis patients with 22 graftable sites were treated with calcium phosphate cement (CPC) bone graft (control group) and CPC-poly(lactic-co-glycolic acid)(PLGA) composite (test group) after flap reflection and debridement. Clinical parameters such as probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and 3, 6, 9, and 12 months. Bone probing depth (BPD) and radiographic parameters such as defect depth (DD), changes in alveolar crest level (ALR), defect depth reduction (DDR), and percentage in defect depth reduction (PDDR) were calculated at baseline, and 6 and 12 months. The data were recorded and statistically analyzed. On intragroup comparison, there was a significant improvement in all the parameters over a period of 1 year (clinically and radiographically). However, there was no statistically significant difference between the two groups in any of the parameters though there was a slightly higher bone fill noted in the test group. Even though the CPC-PLGA composite bone graft showed a slight improvement in clinical and radiographic parameters as compared to the CPC graft, it was not statistically significant. A major drawback of Calcium Phosphate cements as bone grafts is their poor degradability. The PLGA microspheres degrade to expose macropores and interconnected pores in the graft substrate which in turn would promote the ingrowth of osteoblasts. Also, this composite graft is mouldable, and resorbable and has been shown to snugly fit into the defects making them a suitable scaffold material. How to cite this article: Ojha M, Pawar Chandrashekara Rao D, Gowda V. Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial. J Contemp Dent Pract 2023;24(12):921-927.

Appraising and comparing the role of autogenous periosteal graft as a barrier membrane in the treatment of intrabony defects in chronic periodontitis cases: A systematic review and meta-analysis.

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

Comparing the Effectiveness of Conventional and Microsurgical Access Flap Techniques in Managing Horizontal Bony Defects in Chronic Periodontitis Patients: A Clinical and Radiographic Study

Abstract Objective Periodontal microsurgery is descendant of conventional periodontal surgery to reduce surgical trauma, improve wound healing, and enhance patient compliance. This study compared the efficacy of conventional and microsurgical access flap in the management of horizontal bony defects in chronic periodontitis patients. Materials and Methods Eight pairs of contralateral horizontal bone defects in chronic periodontitis patients were randomly allocated to control group and test group. Microsurgical access flap was carried out in test group under magnification, while control group received conventional access flap. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), relative attachment level (RAL), and relative gingival marginal level (RGML) were recorded at baseline, 3 months, and 6 months. Wound healing index (WHI) was evaluated after 1 week, 2 weeks, and 4 weeks. Pain perception was evaluated using visual analog scale (VAS) post-surgery and after 24 hours. Radiographic defect depth was measured at baseline and after 6 months. Statistical Analysis The statistical analysis was done by SPSS statistical software. The intragroup comparison was done by repeated measures analysis of variance. The intergroup difference between both groups was done by Student's t-test. The descriptive statistics for VAS and WHI was done by Wilcoxon signed rank test. The mean difference between clinical parameters from baseline to follow-up intervals was calculated by post-hoc least significance difference analysis. Results There was significant reduction in PI, GI, PPD, and RAL within both the groups (p < 0.05). There was increase in RGML within both the groups from baseline to 6 months (p < 0.05). In the intergroup comparison, test group showed better WHI and better pain perception (VAS) compared to control group (p < 0.05). No difference was found between both the groups in terms of radiographic defect depth (p > 0.5). Conclusion Both the procedures were effective in improving the clinical parameters but the microsurgical group showed better results in terms of wound healing and less postoperative pain. Both procedures showed no significant effect on radiographic defect depth.

Sub-gingival delivery of simvastatin and rosuvastatin for treatment of chronic periodontitis with diabetes mellitus: A randomized controlled clinical-radiographic pilot study.

Statins are lipid-lowering medications that work by blocking rate-limiting enzyme in cholesterol formation. In patients with Chronic periodontitis (CP) and Diabetes mellitus (DM), subgingival delivery of simvastatin (SMV) and rosuvastatin (RSV) have demonstrated to have bone-stimulatory and anti-inflammatory properties. The current study intended to assess and compare the efficacy of sub-gingivally delivered SMV gel and RSV gel as an adjunctive medication to scaling and root planing (SRP) in the management of intrabony defects in CP patients with type 2 DM. 30 patients with CP and type 2 DM were classified into three treatment groups - SRP+placebo, SRP +1.2% SMV and SRP +1.2% RSV. Clinical parameters: site-specific plaque index, modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment level (RAL) were documented at baseline, 3 and 6 months and radiographic parameter: intrabony defect depth (IBD) at baseline and 6 months post-treatment. - LDD of 1.2% SMV and 1.2% RSV demonstrated greater clinical and radiographic improvement than placebo, the improvement being statistically significant for PI, mSBI, and PPD for 1.2% SMV and statistically significant for all clinical and radiological parameters for the 1.2% RSV. 1.2% RSV demonstrated greater IBD fill and RAL gain than 1.2% SMV. - Localized sub-gingival delivery of statins was beneficial in the treatment intrabony defects in patients with CP and well-controlled type 2 DM. IBD fill and RAL gain were higher with 1.2% RSV than with 1.2% SMV.

Predictability and Clinical Stability of Barrier Membranes in Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

The adjunctive use of GTR membranes helps us to achieve predictable periodontal regeneration. The aim of this systematic review was to evaluate and compare the treatment efficacy of resorbable versus non-resorbable barrier membranes used in guided tissue regeneration in the treatment of intrabony defects in chronic periodontitis patients. The following databases were searched: Medline, the Cochrane Central Register of Controlled Trails (CENTRAL), SCOPUS, EMBASE. Randomized clinical trials (RCTs) published in English languages over the past 25 years were included. The primary outcomes assessed were: change of probing pocket depth (PD), change in clinical attachment level (CAL) and gingival recession coverage (GRC), and intrabony defect fill (IBDF). A total of eight RCTs were included for systematic review. The outcome of GR at a six-month interval revealed a significant difference in treatment effect with a mean difference of 0.42, 95% CI [0.02, 0.81]; Z = 2.09, (p = 0.04) favouring the resorbable membrane group. The intrabony defect depth fill at a 12-month interval revealed a significant difference in treatment effect with MD of 0.79, p = 0.00001; favoring the resorbable membrane group. The resorbable membrane showed a significant improvement in gingival recession coverage and intrabony defect fill, owing to its advantage of avoiding the second surgical intervention.

Hyaluronic Acid Gel as Adjunct to Scaling and Root Planing Versus Scaling and Root Planing Alone in Treatment of Intraosseous Defects in Chronic Periodontitis Patients

Context: Wound healing and associated tissue regeneration process are significant to successful outcomes during periodontal therapy. Hyaluronic acid (HA) is one of the important promoting factors that facilitate cell migration and differentiation during this process. Aim: The aim of the present study was to evaluate the efficacy of HA as a therapeutic bone regenerant in conjunction with scaling and root planing in the treatment of intra-osseous defects in chronic periodontitis patients. Settings and Design: The present study was planned as a randomized controlled trial on chronic periodontitis patients aged between 25 and 55 years comprising 120 sites with clinically confirmed intrabony pockets ≥5 mm. Materials and Methods: The patients were allocated to two groups using simple randomization process as Group A, wherein mechanical disruption of plaque biofilm was followed by placement of HA gel (HA gel) and Group B, wherein scaling and root planing alone were used as a treatment modality. The clinical parameters recorded at baseline and on follow-up visits after 4 and 6 weeks of the procedure included gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL). Statistical Analysis Used: Statistical analysis was performed using IBM SPSS statistics 17 (Chicago, USA). A comparison of different parameters within the group was made using unpaired t-test, while a comparison between the groups was made using paired t-test. P < 0.05 was considered statistically significant. Results: On intragroup comparisons, for GI, there was seen a statistically significant decrease in the mean GI scores at different time intervals in both the groups (P < 0.001 for both Group A and Group B for baseline vs. 4th week and baseline vs. 6th week comparisons, while P = 0.04 for Group A and P = 0.008 for Group B for 4th week vs. 6th week comparisons). For PI, there was seen a statistically significant decrease in the mean PI values at different time intervals in Group A and B except from the 4th- to 6th-week interval. For PPD, there was seen a statistically significant decrease in the PPD at different time intervals in Group A (P < 0.001 for Group A for baseline vs. 4th-week and baseline vs. 6th-week comparisons, while P = 0.01 for 4th week vs. 6th-week comparison), though, for Group B, statistically significant only when compared from baseline versus 6th week (P = 0.006). For CAL, the results were statistically significant in the baseline versus 4th-week and baseline versus 6th-week interval while insignificant in the 4th-week to 6th-week interval in Group A while on the contrary, the results were statistically significant only in the baseline to 6th-week interval in Group B and insignificant in the baseline versus 4th week and 4th week to 6th-week interval. On intergroup analysis, the results were statistically significant for all the parameters at the 4th- and 6th-week interval (P < 0.001), though, insignificant at baseline. Conclusion: HA gel in conjunction with scaling and root planing aided regeneration of bone in intraosseous defects in chronic periodontitis patients, leading to significant improvement in the clinical parameters recorded.

Efficacy of 1.5% Metformin Gel as an Adjuvant to Scaling, Root Planing, and Curettage for the Treatment of Infrabony Defects in Chronic Periodontitis Patients.

Context: To compare and evaluate clinically and radiographically the efficacy of 1.5% metformin (MF) gel and placebo gel as an adjunct to scaling and root planing (SRP) and Curettage for the treatment of infrabony defects (IBDs) in chronic periodontitis patients.Subjects and Methods: The study was conducted randomly on 15 patients of both the genders. Each patient contributed two sites (total 30 sites - Split mouth design) which was randomly assigned to one of the two treatments: (i) Site A (Control Site) in which SRP was done along with curettage and intrapocket application of Placebo Gel and (ii) Site B (Test Site) in which SRP was done along with curettage and intrapocket application of 1.5% MF Gel. The Periodontal status {which included plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), IBD Depth} was assessed both clinically and radiographically at baseline, 3 months, and 6 months after treatment. Results: It was found that there was statistically significant difference in the periodontal status (PI, SBI, PPD, CAL, IBD depth) of the two sites when compared from baseline to 6 months.Conclusions: Local delivery of 1.5% MF improves the clinical outcomes of traditional treatment (SRP) and curettage and should be considered particularly as an adjunct to it.

TriCalcium phosphate combined with collagen membrane in treatment of intraosseous defects in chronic periodontitis patients

Aim: This study aims to evaluate clinically and radiographically the effect of tricalcium phosphate combined with collagen membrane in treatment of intraosseous defects in chronic periodontitis patients. Patients and methods: Fifteen patients with chronic periodontitis with intraosseous defects has pocket depth > 6 mm and CAL ≥ 5 mm after course related therapy on both sides, with radiographic evidence of vertical bone loss. Following phase I therapy were classified into two groups, group A received defects received open flap debridement alone and group B received open flap surgery augmented with tricalcium phosphate bone graft covered with collagen membrane . Clinical and radiographic parameters were recorded at baseline,3, 6,9 and 12 months postoperatively. Results: Both treatment groups showed a significant probing pocket depth (PPD) reduction, clinical attachment gain, increase bone density 12 months after surgery compared with baseline. However, there was a highly significant PPD reduction and clinical attachment gain when collagen membrane was added to β-TCP. Conclusion: β-TCP plus collagen membrane may lead to improved clinical outcomes compared to open flap debridement alone.

Tri-Calcium Phosphate Combined With Collagen Membrane in Treatment of Intraosseous Defects in Chronic Periodontitis Patients (Clinical and Radiographic Study)

Aim: This study aims to evaluate clinically and radiographically the effect of tricalcium phosphate combined with collagen membrane in treatment of intraosseous defects in chronic periodontitis patients. Subjects and methods: Fifteen patients with chronic periodontitis with intraosseous defects has pocket depth > 6 mm and CAL ≥ 5mm after cause related therapy on both sides, with radiographic evidence of vertical bone loss. Following phase I therapy were classified into two groups, group A received defects received open flap debridement alone and group B received open flap surgery augmented with tricalcium phosphate bone graft covered with collagen membrane . Clinical and radiographic parameters were recorded at baseline,3, 6,9 and 12 months postoperatively. Results: Both treatment groups showed a significant probing pocket depth (PPD) reduction, clinical attachment gain, increase bone density 12 months after surgery compared with baseline. However, there was a highly significant PPD reduction and clinical attachment gain when collagen membrane was added to β-TCP. Conclusion: β-TCP plus collagen membrane may lead to improved clinical outcomes compared to open flap debridement alone.

Prevalence of Angular Bone Defects in Chronic Periodontitis Patients with and without Systemic Diseases

The aim of the current study was to assess the distribution of angular defects in both maxillary and mandibulararches in chronic periodontitis patients with and without systemic diseases. This retrospective study wasconducted among 200 patients who reported to Saveetha Dental College and Hospitals, Chennai from June2019 to March 2020. A total of 200 chronic periodontitis patients were enrolled and assessed for numberof angular bone defects using panoramic radiographs. The study participants were divided into two groups.Group 1 (n=100, 50 males and 50 females): chronic periodontitis patients with systemic diseases; Group 2(n=100, 50 males and 50 females): chronic periodontitis patients without systemic diseases. Data regardingthe number of angular defects of the study population were collected and analysed. Among 100 systemicallyhealthy patients, 102 sites presented with angular defects. Among 100 systemically diseased patients, 320sites presented with angular defects. In gender wise comparison, the number of angular defects were higherin females as compared to males. When the distribution of angular bone defects were compared betweenmaxillary and mandibular arches, angular bone defects were predominantly observed in mandibular arch.Therefore, this study showed higher prevalence of angular bone defects in chronic periodontitis patientswith systemic diseases (320 sites) as compared to the ones without systemic diseases (102 sites).

Clinical and radiographic evaluation of platelet-rich fibrin as an adjunct to bone grafting demineralized freeze-dried bone allograft in intrabony defects.

Background:Several bone graft materials are popularized in the treatment of intrabony defects. Demineralized freeze-dried bone allograft (DFDBA) is widely used in the treatment of intrabony defects. Platelet-rich fibrin (PRF) is autologous blood preparation which helps in wound healing and regeneration. Hence, this study focuses on evaluation of PRF, DFDBA, and their combination in the regeneration of intrabony defects.Materials and Methods:A total of 39 sites with intrabony defects were randomly assigned into three groups: (Group I - Open flap debridement, Group II - DFDBA alone, and Group III- DFDBA + PRF). Parameters such as probing pocket depth (PPD), relative attachment level (RAL), and radiographic bone fill were measured at baseline, 3 months, and 6 months. Intragroup comparison at various study intervals was made using one-way ANOVA test. Intergroup comparison was made using Tukey's multiple post hoc test.Results:Reduction in the PPD and greater difference in RAL was observed over the study period in all the three groups with greater reduction in DFDBA + PRF group. Reduction in the radiographic defect depths was observed over the study period in all the three groups with the greatest reduction of 38.99% in the DFDBA + PRF group. However, no statistically significant difference was reported by DFDBA versus DFDBA + PRF group.Conclusion:Combination of DFDBA and PRF improved the clinical and radiographic parameters compared to PRF and DFDBA alone. PRF was combined with DFDBA to produce a synergistic effect for treating intrabony defects in chronic periodontitis patients.

Evaluation of the Effect of Local Melatonin Gel Application in the Treatment of Intrabony Defects in Chronic Periodontitis Patients:

Evaluation of the Effect of Local Melatonin Gel Application in the Treatment of Intrabony Defects in Chronic Periodontitis Patients:

NovaboneTM dental putty as a potential regenerative material for treating horizontal defects in chronic periodontitis patients.

ntroduction: Periodontitis is a multifactorial disease, which, when not adequately treated, is followed with progressive attachment loss which leads to tooth mobility and eventually tooth loss. Periodontal regenerative surgery aims to regenerate and reconstruct the lost periodontal tissue. Regeneration with novabone putty has shown to be effective in reducing probing pocket depth, gain in clinical attachment level and increase in horizontal bone level. Aim: This interventional clinical trial was to evaluate the osseous regenerative potential of a calcium phosphosilicate bioactive glass NOVABONE TM in the treatment of horizontal bone defects. Materials and method: A total of 20 sites with horizontal bone defect was treated with open flap debridement with intra marrow penetration and novabone putty. Statistical analysis: Plaque index, gingival index and radiographic determination were analysed by paired t test. Probing pocket depth and clinical attachment levels were analysed by Wilcoxon Signed Ranks Test. Result: There was significant reduction seen in plaque index, gingival index, probing pocket depth and radiographic crestal level when compared between baseline and 12 months respectively (2.48 ± 0.44, 2.92 ± 0.39, 6.80 ± 0.89, 8.29 ± 0.87) and (1.89 ± 0.42, 1.92± 0.51, 3.00± 0.67, 5.48 ± 0.89) and significant gain in clinical attachment level from 4.40 ± 0.96 to 1.20 ± 0.91. Conclusion: The present study showed novabone putty significantly improved the clinical parameters in horizontal bone defects.

Effect of in-situ application of simvastatin gel in surgical management of osseous defects in chronic periodontitis–A randomized clinical trial

BackgroundThe present randomized controlled clinical study was designed to investigate the effect of in situ application of 1.2mg Simvastatin (SV) gel in the surgical management of Intrabony defects in chronic periodontitis patients. Methodology20 patients contributing 40 sites were categorized into two treatment groups: Open flap debridement plus 1.2mg SV gel (Group 1) and Open flap debridement plus Placebo gel (Group 2). Gingival index (GI), Plaque index (PI), Pocket depth (PD) and clinical attachment level (CAL) were recorded at baseline, 3 months, 6 months and 9 months. At baseline and at the end of 6 and 9 months Radiographic evaluation of Intrabony defect fill was done using Image j software. ResultsSignificant reduction of GI, PD and gain in CAL was observed at the end of 9 months in both groups. Amount of bone fill and percentage of original defect fill in Group 1 was statistically highly significant than Group 2 at the end of 6 and 9 months. ConclusionHigher amount of decrease in GI and PD along with more amount of CAL gain was observed in treatment group than control group. Radiological assessment confirmed that significant intrabony defect fill and percentage fill of original defect in treatment group than controlled group.

Clinical and Radiographic Evaluation of Citric Acid-Based Nano Hydroxyapatite Composite Graft in the Regeneration of Intrabony Defects - A Randomized Controlled Trial.

Background:Conventional periodontal therapy with various bone grafts has limited scope and the results are not predictable. To improve their utility, the hybridization of bioceramics and biodegradable polymers has been widely adopted to reform the mechanical properties of bone grafts. One such biodegradable polymer is POC (Poly 1,8 octanediol). Secondly, citric acid is considered as the key material in bone mineralization, which is related to the overall stability, strength and fracture resistance of bone. Hence citric acid is incorporated in a polymer and Nano hydroxyapatite to form a composite graft, for periodontal bone regeneration. This study attempts to evaluate the efficacy of citric acid based Nano-hydroxyapatite composite graft for the treatment of intrabony defects in chronic periodontitis patients over 12 months.Methods:A split mouth study, which consists of 10 systemically healthy patients, were randomly treated with Citric acid based Nano hydroxyapatite composite graft (test sites, n=18) or with Nano hydroxyapatite alone (control sites, n=15). Plaque index, gingival index, gingival bleeding index, probing pocket depth (PPD), clinical attachment level (CAL), bone probing depth (BPD) and hard tissue parameters such as amount of defect fill, percentage of defect fill, and changes in alveolar crest were assessed over a period of 12 months. Statistical analysis used was student's t-test and One-Way ANOVA.Results:Both test and control sites demonstrated statistically significant reduction of PD, BPD, gain in CAL and radiographic bone fill. Nevertheless the test sites showed Statistically significant improvements in all the parameters as compared to control sites at 12 months.Conclusion:Citric acid based Nano hydroxyapatite composite graft can be considered as a newer material for periodontal regeneration.

Adjunctive Effect of Autologus Platelet-Rich Fibrin to Barrier Membrane in the Treatment of Periodontal Intrabony Defects.

Autologous platelet-rich fibrin (PRF) and barrier membranes in the treatment of intrabony defects in chronic periodontitis patients have shown significant clinical benefits. This study evaluates the additive effect of autologous PRF in combination with a barrier membrane versus the use of barrier membrane alone for the treatment of intrabony defects in chronic periodontitis patients. A randomized split-mouth design was used. Sixteen patients with 32 paired intrabony defects were included. In each patient 1 defect was treated using a resorbable collagen membrane along with PRF (test group) and the other defect by guided tissue regeneration alone (control group). The following clinical parameters were measured at baseline and after 9 months: plaque index, modified sulcus bleeding index, probing pocket depth, clinical attachment level, and gingival marginal level. The radiographic defect depth was also assessed at baseline and after 9 months. Test group showed a statistically significant improvement for probing depth (P = 0.002), clinical attachment level (P = 0.001), and radiographic defect depth (P < 0.001) after 9 months as compared with the control sites. Radiographic defect depth reduction was 58.19 ± 13.24% in the test group as compared with 24.86 ± 9.94% reduction in the control group. The adjunctive use of PRF in combination with barrier membrane is more effective in the treatment of intrabony defects in chronic periodontitis as compared with barrier membrane alone.

Evaluation of gingival crevicular fluid transforming growth factor-β1 level after treatment of intrabony periodontal defects with enamel matrix derivatives and autogenous bone graft: A randomized controlled clinical trial.

The present study aimed to evaluate the effects of enamel matrix derivatives (EMD) either alone or combined with autogenous bone graft (ABG) applied to intrabony defects in chronic periodontitis patients on clinical/radiographic parameters and gingival crevicular fluid (GCF) transforming growth factor-β1 (TGF-β1) level and to compare with open flap debridement (OFD). A total of 30 deep intrabony defects in 12 patients were randomly treated with EMD + ABG (combination group), EMD alone (EMD group), or OFD (control group). Clinical parameters, including plaque index, gingival index, bleeding on probing, probing depth, relative attachment level, and recession were recorded at baseline and 6 months postsurgery. Intrabony defect fill percentage was calculated on the standardized radiographs. TGF-β1 level was evaluated in GCF just before surgery and 7, 14, 30, 90, 180 days after surgery using enzyme-linked immunosorbent assay. All treatment procedures led to significant improvements at 6 months (P < 0.01). Gain in attachment level (P < 0.01) and radiographic defect fill (P < 0.05) of the combination and EMD groups were found to be significantly higher than those of the control group, while the use of EMD either with ABG or alone was observed to produce significantly less recession than the OFD (P < 0.05). The findings suggest no clinical and radiographic differences between the combination and EMD groups whereas GCF TGF-β1 level demonstrates an increase during the healing phase and is positively affected from EMD.