Full-mouth Scaling And Root Planing Research Articles

Comparison of the effectiveness of Morus alba and chlorhexidine gels as an adjunct to scaling and root planing on stage II periodontitis - A randomized controlled clinical trial.

The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis. A single-blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full-mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann-Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively. Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002). Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis.

Effectiveness of ozone in the management of chronic periodontitis: A clinico-microbiological study

Aim: To evaluate the efficacy of ozonated water with NSPT compared with scaling and root planing (SRP) alone in treating chronic periodontitis. Settings and Design: The current study is a double-masked, randomized clinical trial. Methods and Material: A total of 30 patients aged 25 to 55 years were divided randomly into two groups having probing pocket depths of ≥ 5 mm. Full mouth SRP were performed in group 1 followed by additional sub-gingival irrigation of ozonated water in group 2. Assessment of plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment levels (CAL) was performed at baseline and six months. Microbiologic assessment with real-time polymerase chain reaction was performed for Dialister pneumosintes and Micromonas micros by collecting plaque samples. Statistical Analysis Used: The data were subjected to statistical analysis with IBM SPSS Software version 21. The results were presented under the headings of various parameters considered for this study. Results: The results revealed that there was a reduction in PI, GI, PD, CAL, and microbiologic parameters in both groups following SRP; the results were more significant in group 2 treated by sub-gingival irrigation with ozonated water, when compared with SRP alone in group 1. Also, it was noted that there was a statistically significant reduction of M. micros compared to D. pneumosintes in the ozone-treated group. Conclusions: The Subgingival irrigation of ozonated water in conjunction with SRP has beneficial effects in treating patients with chronic periodontitis.

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

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

Effects of One-Stage Full-Mouth Scaling and Root Planing with Azithromycin on Diabetes and Periodontal Disease: A Randomized Controlled Trial.

Recent reports show that hemoglobin A1c (HbA1c) can be lowered by improving chronic inflammation in periodontal patients with diabetes mellitus and that full-mouth scaling and root planing (FM-SRP), in combination with azithromycin (AZM) treatment, can reduce early periodontal inflammation. However, the association of FM-SRP and AZM with periodontitis and HbA1c in patients with diabetes is largely unknown. This study investigated periodontitis and HbA1c in patients with diabetes after receiving FM-SRP and AZM to evaluate which clinical parameters most reflect the diabetic condition. Fifty-one periodontal patients with diabetes mellitus were included in this study. In total, 25 patients were assigned to the FM-SRP group in which patients were treated with FM-SRP in combination with AZM, and 26 patients were assigned to the control group in which only supragingival calculus removal was performed along with the provision of oral hygiene instructions. We evaluated periodontal parameters (probing pocket depth, periodontal inflamed surface area (PISA), bleeding on probing), and periodontal bacteria and biochemical parameters (HbA1c, high-sensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1)) at baseline (BL) and 1, 3, 6, and 9 months after treatment. Compared with BL values, the FM-SRP group showed improved clinical parameters, reduced periodontal pathogens, and significantly lower HbA1c. Inflammatory cytokines (hs-CRP, TNF-α, IL-6) were significantly reduced one month after treatment and remained low thereafter. MCP-1 did not change significantly during the experimental period. PISA showed a strong correlation with HbA1c, hs-CRP, and TNF-α. FM-SRP, in combination with AZM, produced clinical, microbiological, and HbA1c improvements in periodontal patients with previously diagnosed diabetes mellitus. Additionally, PISA was shown to be a useful index for assessing the diabetic status of patients with periodontal disease.

Effects of diode and erbium lasers as an adjunct to scaling and root planing on clinical and immunological parameters in non-surgical periodontal treatment: a split-mouth randomized controlled clinical trial-"effects of lasers on immunological parameters".

This study evaluated the effects of diode and erbium lasers, as an adjunct to scaling and root planing (SRP), on clinical and immunological parameters in non-surgical periodontal therapy. In this split-mouth randomized controlled clinical trial, 17 participants with at least one periodontally involved tooth in each quadrant received oral hygiene instruction and full-mouth SRP. At baseline, probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and full-mouth plaque index (FMPI) were measured, and gingival crevicular fluid (GCF) sampling was performed. Next, one random quadrant in each participant received 940nm diode laser (1W, continuous-wave), and another quadrant received 2780nm Er,Cr:YSGG laser (1.5W, 30Hz) irradiation. The GCF levels of interleukin (IL)-10 and matrix metalloproteinase (MMP)-13 were measured at baseline, and after 2 and 6months using ELISA. The clinical parameters were also measured. Data were analyzed by repeated measures ANOVA. Significant clinical improvement was noted in all groups (P < 0.05). CAL in the control group was higher at 6months than 2months. The increase in IL-10 in erbium group was significantly greater than that in other groups (P < 0.001). The MMP-13 level was significantly lower in laser groups with greater reduction in erbium group (P < 0.001). Application of 940nm diode and 2780nm Er,Cr:YSGG lasers as an adjunct to SRP significantly decreased the GCF level of MMP-13, with no significant clinical advantage over SRP monotherapy. Application of 2780nm Er,Cr:YSGG laser in addition to SRP increased the GCF level of IL-10.Trial registration numbers:IRCT20140318017053N11 and IRCT20140318017053N9.

Analysing adipokine Omentin-1 in periodontal disease and type-2 diabetes mellitus: An interventional comparative study

Background and objectiveOmentin-1 is an anti-inflammatory adipokine associated with metabolic disorders including insulin resistance, glucose intolerance and type 2 diabetes mellitus (T2DM). Diabetes is a crucial systemic risk factor for occurrence of periodontitis. Periodontitis is deliberated as a complication of diabetes. This study aimed to estimate salivary and serum levels of Omentin-1 in chronic periodontitis with or without diabetes mellitus before and after scaling and root planing (SRP) and also the level of glycemic control. Materials and methodsBased on history and clinical parameters, 70 subjects were allocated into two groups i.e. chronic periodontitis (Group 1) and chronic periodontitis with well controlled T2DM (Group 2). Baseline saliva and serum samples were collected from both groups followed by full mouth SRP. Subjects were recalled 3 months post SRP for salivary and serum sample collection and measurement of clinical parameters. Serum as well as salivary samples collected were further analysed using enzyme-linked immunosorbent assay to determine the Omentin-1 concentration in each sample. ResultsThe levels of Omentin-1 in saliva and serum were significantly lower in both the groups at baseline. Clinical parameters exhibited a significant reduction 3 months post SRP in both groups. Salivary and serum Omentin-1 levels significantly increased in both the groups, 3 months post SRP. HbA1c levels also reduced significantly post therapy. ConclusionA significant relation exists between salivary and serum Omentin-1 in chronic periodontitis and chronic periodontitis with T2DM. In consequence, Omentin-1 level can have possible application as inflammatory marker of T2DM, periodontal disease and treatment outcome.

A thermosensitive gel with an active hyaluronic acid ingredient that contains an octenidine preservation system as an adjunct to scaling and root planning: a randomized prospective clinical study.

To evaluate the adjunctive effect of a thermosensitive gel formulation that contains 0.8% oligo hyaluronic acid (HA) combined with a preservation system of octenidine HCl 0.625% and phenoxyethanol to scaling and root planing (SRP) as compared with SRP alone in the treatment of residual pockets of patients with stage 3 periodontitis. Thirty-four patients (21 males and 13 females) aged 29-78years (51.3 ± 13.1) with stage 3 periodontitis were recruited to participate in the present split-mouth study. None of the patients has been previously treated for periodontitis. Plaque index (PI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were evaluated at baseline and at 3 and 6months posttreatment. Full-mouth SRP was performed in all residual pockets ≥ 5mm. Treatment was performed by means of ultrasonic and hand instruments and lasted 45-60min. The gel was applied subgingivally in the test sites immediately after SRP (baseline) and 1month later. The paired t-test for two means was applied to test the statistical significance of the change from baseline within each arm and determine the difference between groups. The level of significance was set at 0.05 for all tests. Mean PD reductions between baseline and 3 and 6months were 1.98mm and 2.79mm for the test and 1.22mm and 1.50mm for the control group, respectively. Comparisons between the test and control groups revealed that SRP + gel yielded statistically significantly higher PD reductions compared to SRP alone (p < 0.0001). Compared to baseline, CAL and BOP values improved statistically significantly in both groups, although the test group presented statistically significantly higher CAL gains and BOP reductions than the control group (P < 0.0001). In residual pockets of stage 3 periodontitis patients, the local application of a thermosensitive gel with an active HA ingredient and a preservation system of octenidine HCl 0.625% in conjunction with SRP may additionally improve the clinical outcomes obtained with SRP alone. A novel HA and octenidine containing thermosensitive gel effectively improved the clinical parameters in stage 3 periodontitis patients over a 6-month period.

Effect of adjunctive systemic antibiotics on microbial populations compared with scaling and root planing alone for the treatment of periodontitis: A pilot randomized clinical trial.

To investigate the microbial shift after periodontitis being treated by scaling and root planing (SRP) with or without adjunctive antibiotics, and to assess the relationship between oral microbiota and systemic factors. A 6-month pilot randomized controlled trial recruited 14 subjects with severe periodontitis, divided into test group and control group to receive full-mouth SRP with or without amoxicillin (500mg) and metronidazole (200mg) (three times a day for 7 days). Clinical examination, collection of subgingival plaque and saliva, and blood tests were performed at baseline pre-treatment, 3 months, and 6 months post-treatment. The V3V4 region of 16S DNA was sequenced; taxonomic assignment was based on the Human Oral Microbiome Database. The periodontal condition significantly improved in both groups; the test group showed a greater improvement in plaque index, probing depth, and bleeding index than the control group. The test group demonstrated significantly lower microbial richness and diversity, and less abundant Porphyromonas than the control group at 3 months for both subgingival microbiome and salivary microbiome. However, the microbial differences narrowed within 6 months. The subgingival and salivary microbiota shifted synergistically. Glucose was positively related to subgingival Porphyromonas; mean platelet volume was positively related to subgingival Leptotrichia. Systemic administration of amoxicillin and metronidazole along with SRP had an advantage over SRP alone in clinical improvement and infection control in both the subgingival region and saliva 3 months post-treatment. Microbial advantage nearly disappeared at 6 months; however, the clinical advantage lasted longer. The use of antibiotics also has potential benefits for systemic inflammation and glucose.

Evaluation of multiple subgingival irrigations with 10% povidone-iodine after scaling and root planing: a randomized clinical trial.

This 6-month randomized controlled study aimed at evaluating the clinical outcomes of multiple irrigations of 10% povidone-iodine (PVP-I) as an adjunct to full-mouth scaling and root planing (SRP) in the treatment of chronic periodontitis. Seventeen patients were included. A split-mouth design randomly assigned one side as the test side (SRP + PVP-I) and the other side as the control side (SRP + NaCl). After full-mouth SRP, the control side received subgingival irrigation with 10 mL 0.9% NaCl solution. The test side received 10 mL of PVP-I 10%. Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 3 and 6 months. During recall visits (3 and 6 months), residual deep periodontal pockets of ≥ 6 mm were cleaned with the same protocol and randomization. PI, BOP, PPD, and CAL were improved in both sides after 6 months. No significant differences were seen between control and test sides for the all clinical parameters after 6 months. Multiple subgingival irrigations of 10% PVP-I or 0/9% NaCl combined to one-stage full mouth SRP in patients with chronic periodontitis showed a reduction of all clinical parameters until 6 months. There was a trend in favor of the povidone group for PPD. ( 2021;52:496-504; doi: 10.3290/j.qi.b1044059).

Effect of non-surgical periodontal therapy on glycemic control of patients with chronic periodontitis and type-2 diabetes mellitus: A 3 month follow-up intervention study

Periodontal pathogens and their by-products trigger production of cytokines, acute phase proteins and oxidative stress molecules that impair insulin sensitivity or action. The effect of mechanical treatment alone on metabolic control in diabetes is controversial. The present study compared changes in glycaemic control following full-mouth scaling and root planing (SRP) by measuring glycated haemoglobin (HbA1c) level in 15 chronic periodontitis patients with diabetes. At baseline, periodontal examination, HbA1c evaluation and full-mouth SRP was done. Periodontal examination and HbA1c evaluation were repeated after 3 months. Change in HbA1c levels at 3 months was the primary outcome and changes in clinical parameters were secondary outcomes. Statistically significant improvement in periodontal status and HbA1c levels were seen after a follow up of 3 months following SRP. Periodontal treatment improved clinical measures of chronic periodontitis in patients with diabetes, supporting use of nonsurgical periodontal treatment for lowering HbA1c levels.

Evaluation of a unique subgingival irrigation with 10% povidone-iodine after scaling and root planing: A randomized clinical trial.

The beneficial effects of antiseptics in the treatment of periodontitis are still controversial. The goal of this randomized split-mouth study was to evaluate the clinical and microbiologic results of a unique subgingival irrigation of 10% povidone-iodine in addition to a full-mouth scaling and root planing for the treatment of chronic periodontitis. Twenty patients with chronic periodontitis took part in this investigation. In each patient, four initially untreated pockets ≥ 4 mm were randomly selected for one subgingival irrigation. After a one-session full-mouth treatment with scaling and root planing (SRP), two pockets of a split mouth received one unique irrigation with 10 mL 0.9% NaCl solution (control group, CG). Two pockets on the other side received 10 mL of povidone-iodine 10% (test group, PIG). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 1, 3, and 6 months (M). Bacterial samplings with sterile paper points were taken at M0 and after M1, M3, and M6. These samplings were separately cultured under aerobic and anaerobic conditions before CFU evaluation. Pl, GI, PPD, and CAL were significantly improved in both groups after 6 months. The major difference was seen between M0 and M3 (P < .001). No significant differences were seen between the groups, except for deep pockets (> 6 mm) where a statistical difference was observed in favor of PIG after 6 months; in these subgroups the mean probing reduction was 2.68 ± 0.37 mm for CG versus 3.93 ± 0.23 mm in PIG (P < .001). No significant differences were seen between CG and PIG regarding the microbiologic results after 6 months. One single irrigation of 10% povidone-iodine associated with full-mouth SRP would bring a small additional benefit in deep pockets. More studies are needed to yield additional results.

Influence of periodontal treatment on blood microbiotas: a clinical trial.

ObjectiveTo investigate the effects of periodontal treatment on the abundance and diversity of blood microbiota.Methods and MaterialsTwenty-seven periodontitis patients were randomly allocated to a control group (A) and two test groups (B1 and B2). Group A patients received full-mouth scaling and root planing (SRP), group B1 patients received subgingival glycine air polishing (GAP) right after SRP, and group B2 patients received subgingival glycine air polishing right before SRP. Peripheral blood samples were obtained at the baseline, the day after periodontal treatment, and 6 weeks after treatment and evaluated using nested polymerase chain reaction and 16SrRNA Gene Sequencing (Miseq platform).ResultsAll participants exhibited significant improvements in the clinical parameters evaluated at the 6-week follow-up visit compared to the values at the baseline, but no significant differences were observed between the three groups. The total bacterial count was lowest in group B2. The bacterial species diversity (α-diversity) in group B1 was significantly higher (Chao-1 index, P = 0.03) and Porphyromonas and Pantoea were the dominant genera (linear discriminant analysis (LDA > 2)) in this group the day after treatment compared to the baseline. No significant difference was detected in the relative abundance and α-diversity of blood microbiota between the baseline and 6 weeks after treatment.ConclusionLocal periodontal treatment merely disrupts the stability of blood microbiota in the short term. Periodontitis treatment using full-mouth SRP followed by adjunctive GAP is a promising approach to reduce the introduction of bacteria into the bloodstream during the procedure.

Clinical, inflammatory and microbiological outcomes of full-mouth scaling with adjunctive glycine powder air-polishing: A randomized trial.

To determine the effects of glycine powder air-polishing (GPAP) as an adjunct to full-mouth scaling and root planing (SRP) on clinical, inflammatory and microbiological outcomes in patients with untreated periodontitis. Forty-one patients were randomly assigned to the control group A (SRP) and test groups B1 (subgingival GPAP right after SRP) and B2 (subgingival GPAP right before SRP). Clinical examinations and sample collections (saliva, subgingival plaque, serum and gingival crevicular fluid) were performed at assessment visits and before therapies at clinical visits of baseline, 6-week and 3-month. C-reactive protein, IL-6 and TNF-α were assessed in serum and gingival crevicular fluid, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were measured in saliva and subgingival plaque. Patients in control and test groups did not significantly differ by age, sex and disease severity at baseline. Participants in control and intervention groups had similar improvements in clinical parameters (PD, BOP, PLI and BI). All groups had a similar percentage of sites showing PD reduction of ≥2mm between baseline and follow-up visits, with a few exceptions. Reduced C-reactive protein, IL-6 and TNF-α in serum were found after treatments. Full-mouth SRP with and without GPAP resulted in largely similar clinical, inflammatory and microbiological outcomes in the care of untreated periodontitis.

Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

BackgroundSubgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of systematic review and meta-analysis justifying the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.MethodsAn electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.ResultsSeventeen studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth ≥ 4 mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15 mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.ConclusionAdjunctive subgingival administration of XAN-CHX gel at individual selected sites in NSPT appears to provide slight benefits in PPD reduction compared to NSPT alone for CP. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.

Effect of nonsurgical periodontal therapy on serum levels of interleukin-1β and interleukin-8 in smokers and nonsmokers with chronic periodontitis

ABSTRACTAim:The aim of this study was to evaluate the effect of nonsurgical periodontal therapy on serum levels of interleukin-1β (IL-1β) and interleukin-8 (IL-8) in smokers and nonsmokers with chronic periodontitis before and after scaling and root planing (SRP).Materials and Methods:This was a comparative interventional study including a total of 52 (26 smokers and 26 nonsmokers with chronic periodontitis) subjects. Clinical parameters (gingival index [GI], plaque index [PI], recession, probing pocket depth [PPD], and clinical attachment level [CAL]) were recorded at baseline and 4 weeks after initial periodontal therapy. Initial periodontal therapy included oral hygiene instructions and full mouth SRP. Venous blood sample of 5 mL was collected from each subject at baseline and 4 weeks after initial periodontal therapy to evaluate serum IL-1β and IL-8. These biochemical parameters were assayed using enzyme-linked immunosorbent assay (ELISA) method.Results:The periodontal parameters such as PI, GI, recession, PPD, and CAL were reduced after nonsurgical periodontal therapy. Smokers with chronic periodontitis showed statistically significant lower GI and higher PI, gingival recession, PPD, and CAL as compared to nonsmokers with chronic periodontitis. Statistically significant reduction in periodontal parameters was seen in both groups after periodontal therapy. IL-1β and IL-8 were increased in both groups at baseline; after SRP both groups showed statistically significant reduction in IL-1β and smokers with chronic periodontitis showed statistically significant increase in IL-8 after SRP.Conclusion:Smokers with chronic periodontitis showed more periodontal destruction and systemic inflammatory markers compared to nonsmokers with chronic periodontitis. After periodontal therapy both groups showed statistically significant improvement in clinical parameters and biochemical parameters excluding IL-8.

Comparative Evaluation of Subgingivally Delivered 2% Curcumin and 0.2% Chlorhexidine Gel Adjunctive to Scaling and Root Planing in Chronic Periodontitis

This study aimed to compare the effects of subgingival delivery of 2% curcumin gel and 0.2% chlorhexidine gel as an adjunct to scaling and root planing (SRP) on clinical and microbiological parameters in the management of patients with chronic periodontitis. In total, 25 systemically healthy individuals with age group ≥30 years diagnosed with chronic periodontitis were included in the study. The study was a double-blind split-mouth randomized control clinical trial. Two sites were selected in each patient and were randomly allocated to experimental and control sites. At baseline, measurements of site-specific periodontal parameters and collection of subgingival plaque sample were done. After full-mouth SRP, subgingival delivery of 2% curcumin gel in experimental sites and 0.2% chlorhexidine gel in control sites was done. At 1 and 3 months, subgingival plaque samples were collected again and site-specific periodontal parameters were measured. The experimental group (2% curcumin gel) showed statistically significant improvements in periodontal [i.e., sulcus bleeding index (SBI), probing pocket depth (PPD), and relative attachment level (RAL)] and microbiologic parameters in the form of colony-forming units (CFUs) in comparison with control group (0.2% chlorhexidine gel). Subgingival delivery of curcumin has shown effective anti-inflammatory and antibacterial properties. Since it is biologically accepted by the patients and its delivery in periodontal pockets can be recommended as an adjunct to SRP therapy for the treatment of patients with localized, moderate chronic periodontitis and in patients under the periodontal maintenance phase. Curcumin being a herbal agent may be excellent alternative to chlorhexidine. It is biologically accepted by the patients and can be recommended as an adjunct to SRP in the treatment of localized moderate chronic periodontitis and periodontal maintenance patients.

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

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

Biological responses following one-stage full-mouth scaling and root planing with and without azithromycin: Multicenter randomized trial.

Full-mouth scaling and root planing (FM-SRP) increases the systemic levels of inflammatory mediators via early inflammation but may be inhibited using an antimicrobial agent. This prospective intervention study evaluates the biological response and clinical effects of FM-SRP with and without systemically administered azithromycin (AZM). A multicenter parallel randomized controlled and open-label trial. A central randomization center used computer-generated tables to allocate treatments. Sixty-three patients with moderate to severe generalized periodontitis (New American Academy of Periodontology Classification: Stage3 or 4, Grade B) were randomly assigned to receive FM-SRP with AZM (test group, n=32) or FM-SRP without AZM (control group, n=31). Clinical parameters and body temperature were measured, and subgingival plaque, peripheral blood, and gingival crevicular fluid were collected before and after treatment. Periodontopathic bacteria and IgG titers were measured by gingival crevicular fluid and peripheral blood. High-sensitivity assays were used to analyze systemic and local inflammatory markers, such as endotoxin, high-sensitive CRP (hs-CRP), and six inflammatory cytokines. Follow-up 6weeks. The total number of bacteria and the number of Porphyromonas gingivalis and Prevotella intermedia were significantly lower in the test group after FM-SRP. IgG titers for Pgingivalis significantly decreased after FM-SRP with AZM, and the body temperature increased significantly after FM-SRP without AZM. In the control group, serum hs-CRP, IFN-γ, IL-12p70, and IL-6 were significantly increased one day after treatment, but subsequently decreased below the original numerical value. In the test group, only hs-CRP showed a significant increase. FM-SRP resulted in similar improvements in clinical parameters with and without the use of AZM. Inflammatory mediators showed no difference between the two groups after FM-SRP treatment. The use of AZM was effective in preventing the elevation of body temperature after FM-SRP.

Shift in the subgingival microbiome following scaling and root planing in generalized aggressive periodontitis.

To investigate the shift in the subgingival microbiota under scaling and root planing (SRP) in patients with generalized aggressive periodontitis (GAgP). After undergoing supragingival scaling, 12 individuals with GAgP were enrolled in this longitudinal study. Full-mouth SRP was accomplished in 3weeks and re-evaluated 6weeks later. Pooled subgingival samples (posterior-mesial, posterior-buccal, anterior-mesial, and anterior-buccal) were obtained from each patient before SRP (pre-treatment group) and at the time of re-evaluation (post-treatment group). 16S rRNA PCR products were generated and sequenced after DNA isolation. Under SRP, the diversity of the subgingival community was consistent, whereas genus-level biomarkers transformed from Porphyromonas, Treponema, and Fretibacterium to Actinomyces, Streptococcus, and Haemophilus. In a network analysis, pathogen-related and non-pathogen-related components were identified in both the pre- and post-treatment groups; the pathogen component was dramatically augmented, while the non-pathogen component shrank after treatment. Hubs were also distributed in both components pre-treatment and were confined to the pathogen component post-treatment. Scaling and root planing decreased periodontal pathogens in the subgingival microbiota of patients with GAgP. However, the shift in the microbiota composition was characterized by the expansion of pathogen-related components and the contraction of non-pathogen-related components 6weeks after SRP. Clinicaltrials.gov #NCT03090282.

Clinical effects of photodynamic therapy as an adjunct to full-mouth ultrasonic scaling and root planing in treatment of chronic periodontitis.

Photodynamic therapy (PDT) is a potential strategy to eliminate infection in the specific tissue. It uses lower-power laser to activate a photosensitizing agent. Studies have shown the benefit of PDT in the periodontal treatment. The aim of this study was to evaluate the periodontal changes after applying PDT as an adjunct to one visit full-mouth SRP (scaling and root planing) with subgingival piezoelectric ultrasonic scaler compared with full-mouth SRP alone. A split-mouth randomized clinical trial was designed. Twenty patients with moderate to severe chronic periodontitis were treated with subgingival piezoelectric ultrasonic device alone in control group and adjunct treated with PDT in the test group. Probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), gingival bleeding index (GBI) and gingival inflammation index (GI) were evaluated at baseline, 1 month, 3 and 6 months after treatment. Only sites with PD ≥ 4 mm at baseline were calculated. All periodontal parameters were significantly improved in both groups at 1 month, 3 and 6 months after treatment. All parameters in test group were better than that control group, with statistically significant differences of GBI and GI (P < 0.05) at 3 and 6 months after treatment but no statistically significant differences of PD, CAL and PI. One visit full-mouth ultrasonic SRP seems to have good enough effort for the periodontal status till 6 months. The adjunct treatment of PDT provided positive effect in term of GBI and GI.