Relative Attachment Level Gain Research Articles

Comparative Evaluation of Coronally Advanced Flap with and without Amniotic Membrane in the treatment of Localised Miller’s Class I and Class II Gingival Recession Defects: A Randomised Controlled Trial

Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group IITest Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The α error of 5% (p-value=0.05) and β error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach.

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.

Comparative evaluation of regenerative potential of injectable platelet-rich fibrin and platelet-rich fibrin with demineralized freeze-dried bone allograft in the treatment of intrabony defects: A randomized controlled clinical study.

Injectable platelet-rich fibrin (i-PRF) being in liquid form keeps graft particles clumped together forming agglutinated steak of bone graft. It has been shown to contain more platelets and long-term deliverance of growth factors in comparison with platelet-rich fibrin (PRF). The aim of the present study was to assess regenerative potential of i-PRF and comparing it with PRF, along with demineralized freeze-dried bone allograft (DFDBA) in the treatment of intrabony alveolar defects. Thirty defect sites in 15 patients with bilateral intrabony defects were assigned randomly into two groups (Group I (Control group)- DFDBA + PRF and Group II (Test group)-DFDBA + i-PRF). Gingival index (GI), plaque index (PI), pocket probing depth (PPD), and relative attachment level (RAL) were recorded at baseline, 3 months, and 6 months. Linear bone growth (LBG) was recorded radiographically at baseline and 6 months. ANOVA test and post hoc Tukey test were used to assess intragroup comparison of clinical parameters. Paired t-test was used to assess intragroup comparison of the radiographic parameter. Unpaired t-test was used to assess intergroup variations in all the clinical as well as radiographic parameters. Statistically significant PPD reduction (P = 0.005) and RAL gain (P = 0.003) were found in Group II than in Group I, and no significant difference was found in other parameters. Percentage LBG was higher in Group II than Group I but the difference was not statistically significant. i-PRF with DFDBA showed more favorable results as compared to PRF with DFDBA in the management of intrabony periodontal defects.

Efficacy of Chlorhexidine Intracanal Medicament on Periodontal Healing in Concomitant Endodontic-Periodontal Disease with Communication: A Randomized Clinical Trial

Background: Chlorhexidine has been extensively used in various periodontal and endodontic infections. However its use in combined endo perio lesion has not been defined clearly. The aim of this study was to evaluate the efficacy and synergistic effect of chlorhexidine intra canal medicament with combination of comprehensive periodontal therapy in endodontic periodontal lesions. 
 Materials and Methods: The patients were randomly assigned group 1 and group 2. Both the groups were treated by phase 1 and phase 2 periodontal treatments while group 1patients received conventional root canal treatment and group 2 patients were treated by chlorhexidine intracanal medicament for 6 months. The primary outcome measures are probing pocket depth, relative attachment level and bleeding on probing. 
 Results: Both groups showed improvement on primary outcome measures. However, group 2 showed significant more reduction in probing pocket depth (PPD) and bleeding on probing (BOP) and gain in relative attachment level (RAL) after complete 6 months treatment with chlorhexidine. Postoperative measurements from group1 and group 2 showed reductions in mean PPD of 2.63±0.98 and 3.57±1.13 mm, mean BOP reduction of 76.78±31.41and 87.54±22.35 and mean RAL gains of 2.42±1.27 and 3.42±0.94 mm, respectively. 
 Conclusion: 2% CHX gel used as an intracanal medicament along with periodontal treatment demonstrated more favourable treatment response in terms of periodontal healing.

Effect of diode laser as an adjunct to open flap debridement in treatment of periodontitis - A randomized clinical trial.

The goals of periodontal therapy are to prevent the disease, arrest the disease progression, and regeneration of lost periodontium. Diode laser gained popularity in periodontal practice with a wide range of potential benefits. This study aims to evaluate and compare the clinical effects of laser-assisted open flap debridement (OFD) versus conventional OFD for the periodontitis treatment. A split-mouth, randomized clinical trial was conducted on fifteen participants with periodontitis having probing pocket depths (PPD) ≥5 mm. A total of 30 sites, two sites in each patient, were randomly divided into two groups. Group A received conventional OFD, and Group B received laser-assisted OFD. The assessment of PPD, relative attachment level (RAL), modified sulcular bleeding index (mSBI) was done at baseline, 3 months, and 6 months. Wound healing index (WHI) was assessed at 3rd and 7th day postsurgery, patient response to pain using visual analog scale (VAS) was assessed immediately, 1 day, and 1 week after surgery. The results revealed a significant reduction in PPD, mSBI, and gain in RAL within the groups from baseline to 3 months and 6 months. Intergroup comparison showed a significant difference in PPD, RAL, mSBI, WHI and VAS scores. The use of 980 nm diode laser provided additional benefits over conventional flap therapy.

Clinicoradiographic evaluation of advanced-platelet rich fibrin block (A PRF + i PRF + nanohydroxyapatite) compared to nanohydroxyapatite alone in the management of periodontal intrabony defects.

Background:Several bone grafting formulations have been given clinically acceptable outcomes in treating intrabony defects. Platelet rich fibrin (PRF), an autologous platelet concentrate holds potential to be used for regenerative treatment. The purpose of this study was to evaluate clinical and radiographic outcomes in periodontal intrabony defects treated with advanced-PRF block (A PRF + i PRF + nanohydroxyapatite [nHA]) compared to nHA alone.Methods:Twenty-eight sites in chronic periodontitis patients having probing pocket depth (PPD) ≥6 mm and 3 walled intrabony defects (depth of ≥3 mm) were selected, randomly allotted into two groups: Group A was treated with A-PRF block and Group B with nHA (Sybograf™). Clinical parameters including plaque index (PI), gingival index (GI), PPD, relative attachment level (RAL) and radiographically linear and volumetric defect fill were assessed using cone beam computed tomography at baseline and 6 months postoperatively.Results:Intragroup comparison using paired t-test and intergroup comparison using unpaired t-test was done. Group A demonstrated significantly higher reduction in PPD and gain in RAL when compared to Group B (P ≤ 0.05) at the end of 6 months. Similarly gain in bone volume was greater in Group A (0.1 ± 0.05) as compared to Group B (0.04 ± 0.02) (P ≤ 0.05).Conclusion:Advanced-PRF block showed significant clinical and radiographic improvement as compared to nHA alone which depicts that, it may be an ideal graft to be used for the treatment of periodontal intrabony defects.

A clinical and microbiological study to assess the efficacy of Acmella oleracea and Acacia catechu herbs as local drug delivery in treatment of chronic generalized periodontitis patients.

Aim:A randomized controlled clinical trial was conducted to evaluate the effect of local drug delivery (LDD) of Acmella oleracea (Akarkara) and Acacia catechu (kattha) gels as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis patients.Materials and Methods:Thirty patients with ninety sites aged 25–65 years with generalized chronic periodontitis having pocket probing depth (PPD) of more than or equal to 5 mm on the basis of inclusion and exclusion criteria were selected. They were treated according to split-mouth design protocol. The placement of gel containing A. oleracea (1%) (Group 1) and A. catechu (1%) (Group 2) as LDD was placed at the two test sites, respectively, and only SRP was done in the control group (Group 3). Periodontal dressing was applied to all the three sites after procedure, and patients were given oral care guidelines. Evaluation of clinical parameters gingival index (GI), plaque index (PI), gingival bleeding index (GBI), PPD, clinical attachment level (CAL), and relative attachment level (RAL) was done at baseline, 1, 3, and 6 months, and microbiological parameter was assessed at baseline and 6 months. N-benzoyl-DL-arginine-2-napthylamide (BANA) test was used for the microbiological analysis.Results:Clinical parameters from baseline to 6 months at different time intervals demonstrated a significant reduction in mean GI, PI, GBI, and PPD and gain in CAL and RAL over a period of 6 months, and results were statistically significant in all the three treatment groups. However, on intergroup comparison, clinically significant difference was observed, but statistically, results were significant at few intervals. The microbiological analysis revealed a statistically nonsignificant reduction at the end of 6 months on intra- and intergroup comparison.Conclusion:The study concluded that the use of A. catechu gel and A. oleracea gel clinically showed improvement in clinical parameters when combined with SRP, attributing to better anti-inflammatory and healing properties.

Comparative Evaluation of Autogenous Bone Graft and Autologous Platelet-Rich Fibrin with and Without 1.2 mg in situ Rosuvastatin Gel in the Surgical Treatment of Intrabony Defect in Chronic Periodontitis Patients.

Context: Rosuvastatin (RSV) is a new synthetic, hydrophilic statin with potent anti-inflammatory and osseodifferentiation actions. Autogenous bone graft (ABG) is still considered the gold standard in reconstructive bone surgery. Addition of platelet-rich fibrin (PRF) to ABG provides sustained release of various growth factors and facilitates survival of the graft.Aims:The study aims to clinically and radiographically compare the effectiveness of ABG and PRF with and without 1.2 mg RSV gel in the surgical treatment of intrabony defect in chronic Periodontitis patient.Settings and Design: This was a randomized controlled clinical trial.Subjects and Methods: Thirty-nine patients (one site per participant) with chronic periodontitis were randomly divided into three groups: Group 1 (open flap debridement [OFD] + placebo), Group 2 (OFD + ABG + PRF), and Group 3 (OFD + ABG + PRF + 1.2 mg RSV). Relative attachment level (RAL) and probing pocket depth (PPD) were recorded at baseline, 3, 6, and 9 months. Radiographic measurements such as defect height (A and B) and defect width (C) were calculated at baseline and 9 months.Statistical Analysis Used: Intergroup comparison was done using Kruskal–Wallis ANOVA. An intragroup comparison was done using Friedman test and Wilcoxon signed-rank test.Results: The mean PPD reduction and mean RAL gain were highly significant in Group 3 and Group 2 than Group 1. For Group 3, a significant reduction of defect height and width and a significant amount of bone fill were achieved than Group 2 and Group 1.Conclusions: Addition of 1.2 mg RSV gel, PRF, and ABG has synergistic effects, explaining their role as a regenerative material in the treatment of intrabony defects.

Evaluation of Effectiveness of Platelet Rich Fibrin Matrix (PRFM) Membrane and Platelet Rich Fibrin (PRF) Membrane using Vestibular Incision Subperiosteal Tunnel Access (VISTA) Approach Technique for the Treatment of Multiple Gingival Recession Defects in Humans – A Study Protocol

Background: To evaluate the effectiveness of Platelet Rich Fibrin Matrix (PRFM) membrane and Platelet Rich Fibrin (PRF) membrane using Vestibular Incision Subperiosteal Tunnel Access (VISTA) Approach method for the management of multiple gingival recession (GR) defects in humans.
 Methodology: 20 subjects with gingival recession will be enrolled. 10 patient will be randomly allotted to test group (PRFM membrane) or control group (PRF membrame). Primary outcome will be gain in root coverage (RC) and secondary outcome will be Plaque index (PI), Papillary bleeding index (PBI), probing pocket depth (PPD), relative attachment level (RAL), relative gingival margin level (RGML), recession depth (RD), gingival thickness (GT) and width of keratinized gingiva (WKG). Clinical evaluation will be performed at 3 & 6 months of therapy.
 Expected Results: When all the parameters will be compared at 6 months post-operatively to baseline data, both the treatment group (test and control) will be expected to show significant gain in RC, RAL gain, PPD reduction, decrease in RD, increase in GT and WKG. PRFM membrane will result in significant gain in RC, RAL gain, PPD reduction, and decrease in reduction depth, increase in GT and WKG at 6 months when compared to PRF membrane.
 Conclusion: PRFM membrane will be effectual in management of gingival recession. PRFM membrane is expected to have significantly greater outcome as compared to PRF membrane group.

Efficacy of Calcium Phosphate Composite Bone Graft in Treatment of Periodontal Intrabony Defects: Clinico-radiographic Study

Introduction: Regeneration of periodontium is always difficult to achieve regardless of all advancement. In an attempt to refine, various materials have been tried and tested. The present study was carried out to evaluate regenerative potential of easy-graft CRYSTAL in intrabony defects, clinically, and radiographically.
 Methods: This randomised split-mouth study was conducted at Rungta College of Dental Sciences and Research from 2015 October to 2015 October. Intrabony pockets more than 5 mm and radiographic evidence of vertical bone loss were selected from 15 patients having two sites each. The chosen sites were randomly divided into test sites: open flap debridement (OFD) with easy-graft CRYSTAL and control sites (OFD). The clinical parameters evaluated were Plaque Index, Gingival Index, Probing Pocket Depth, Relative Attachment Level, and Gingival Recession at baseline, three months, and six months postoperatively. Radiographic parameters recorded were Defect Fill and Percentage of Defect Fill at baseline, three months, and six months. Data were analysed in SPSS v.20.
 Results: At six months, improved clinical and radiographic values were obtained compared to baseline. The plaque and gingival index showed statistically significant reduction. Both groups showed statistically significant reduction in mean probing pocket depth and gain in relative attachment level. Mean gingival recession score was increased in both the group but was not significant. There was significant increase in Defect Fill and Percentage of Defect fill in both groups with better bone fill in test group.
 Conclusion: Easy-graft CRYSTAL is a potential regenerative material for the treatment of periodontal intrabony defects.

Effectiveness Of 1.2% Simvastatin Gel as an Adjunct to Non-Surgical Therapy in The Treatment of Chronic Periodontitis: A Split Mouth Randomized Controlled Trial

BACKGROUND: Periodontitis is an inflammatory disease that results in bone resorption creating bony defects, which may cause tooth loss. AIM: The present study aimed to evaluate the effectiveness of 1.2% Simvastatin gel as an adjunct to non-surgical therapy to treat chronic periodontitis (CP). MATERIALS AND METHOD: 25 patients with 50 sites were categorized into two treatment groups: Scaling and Root Planing plus 1.2% Simvastatin, and Scaling and Root Planing with placebo. Clinical parameters; site-specific plaque index, modified sulcus bleeding index (mSBI), pocket probing depth (PD), and relative attachment level (RAL) were recorded at baseline, 3, 6, and 9 months. RESULTS: Mean PD reduction and mean RAL gain was found to be greater in Simvastatin group than the placebo group, at 3, 6, and 9 months. CONCLUSION: Locally delivered Simvastatin was found to be effective in the treatment of chronic periodontitis (CP).

Clinical and Radiographic Analysis of Novabone Putty with Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Randomized Control Trial.

Background:Periodontal regeneration remains one of the crucial issues in the field of periodontology. Periodontal intrabony defects could be treated by surgical intervention through various alloplastic bone graft substitutes. The Food and Drug Administration approved, Novabone putty is one of the recently marketed bone graft substitutes, which has been used in the present study. This study also incorporates the placement of platelet-rich fibrin (PRF) in combination with Novabone putty.Materials and Methods:Twenty patients were included in the study and were allocated to either Group A or Group B through randomization. Group A included the placement of Novabone putty in the periodontal intrabony defects, whereas Group B included the placement of Novabone putty along with PRF. Statistical analysis of plaque index, gingival index, probing pocket depth, relative attachment level, and intraoral periapical radiographs was performed.Results:Statistical more significant difference (P < 0.05) in probing pocket depth, and relative attachment level was observed in Group B (Novabone putty and PRF) in comparison to Group A (Novabone putty).Conclusion:Evaluation of efficacy of Novabone putty along with PRF produced more favorable results in relative attachment level gain and more reduction in probing pocket depth when compared to Novabone putty alone.

Comparative assessment of periodontal regeneration in periodontal intraosseous defects treated with PepGen P-15 unaided or in blend with platelet-rich fibrin: A clinical and high-resolution computed tomography scan-assisted volumetric analysis.

Background:PepGen P-15, a xenograft, has proven its periodontal regenerative potential. Platelet-rich fibrin (PRF) is an autologous platelet concentrate which too contributes to periodontal redevelopment through the release of different polypeptide progression factors. The present study intended to evaluate the regenerative potential of PepGen P-15 xenograft when used unaccompanied or in blend with PRF in periodontal intraosseous defects in humans through clinical and a novel computed tomography (CT) scan analysis technique.Materials and Methods:Twelve chronic periodontitis individuals with paired periodontal intraosseous defects were randomly treated either with PepGen P-15 exclusively (Control/Group A) or in concoction with PRF (Test/Group B) utilizing split-mouth study design. Pocket probing depth (PPD), relative attachment level (RAL), and relative position of gingival margin were assessed at 3- and 6-month interval, whereas the linear and volumetric bone defect regeneration were assessed at 6 months postoperatively using CT scan.Results:Both the groups validated statistically significant PPD reduction, RAL gain at 3 and 6 months, but on intergroup comparison, test group CT images revealed significantly greater linear bone gain and volumetric bone gain, with mean difference of 0.73 ± 0.28 (P = 0.018) and 2.70 ± 1.36 (P = 0.06) at 6 months in comparison to the baseline data.Conclusions:PepGen P-15 and PRF blend had better regeneration potential for the management of intrabony defects. Further long-term investigations on large sample size are recommended to authenticate the same.

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial.

PurposeThe modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects.MethodsThis randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery.ResultsIntragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up.ConclusionsM-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST.Trial RegistrationClinicalTrials.gov Identifier: NCT03169920

Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic–periodontal lesions with communication—A randomized clinical trial

Background and objectiveManagement of combined endodontic–periodontal lesions needs more clinical investigations. The aim of this prospective randomized clinical trial was to evaluate the effect oftime interval between the non-surgical endodontic treatment (ET) and open flap debridement (OFD) on periodontal healing in combined endodontic periodontal lesions with apical communication. MethodsForty patients were randomly allocated to two treatment protocols. Group 1(immediate periodontal surgery): OFD was performed at 21days of initiation of ET and SRP, and Group 2(delayed periodontal surgery): OFD was performed after 3 months of initiation of ET and SRP. The primary parameters included probing pocket depth (PPD), relative attachment level (RAL) and bleeding on probing (BOP) and tooth mobility (TM). ResultsSignificantly more reduction in PPD, TM and gain in RAL was observed in Group 1 at 3 months of OFD. (P<0.05) Whereas at 6 months follow up of OFD (6 and 9 months of ET in Group1 and Group 2, respectively), intergroup analysis showed statistically comparable reduction in BOP (%), PPD, TM and gain in RAL (P>0.05) in both the groups. ConclusionImmediate periodontal surgery may not affect the outcome of the treatment of combined endo-perio lesions with apical communication.

Titanium-prepared platelet-rich fibrin provides advantages on periodontal healing: A randomized split-mouth clinical study.

The aim of this study to evaluate the contributions of titanium-prepared platelet-rich fibrin (T-PRF) combined with open flap debridement (OFD) on biological markers in gingival crevicular fluid (GCF)and periodontal outcomes. Twenty-nine participants with chronic periodontitis were treated either with autologous T-PRF+OFD or OFD alone. GCF growth factor levels and relative receptor activator nuclear factor kappa-B/osteoprotegerin (RANKL/OPG) ratio at baseline and 2, 4, and 6weeks postoperatively were analyzed, and clinical parameters such as probing depth (PD), relative attachment level (RAL) and gingival margin level (GML) at baseline and 9 months after surgery were compared. The mean PD reduction, RAL gain, and GML change were significantly greater in the OFD+T-PRF sites than in the OFD sites (P=0.033, P=0.029, and P=0.026, respectively). Both groups demonstrated increased growth factor levels at week 2 compared with baseline, followed by reductions at weeks 4 and 6. GCF growth factor levels in the test group were seen at higher concentrations with respect to control group until 6weeks post-surgery. During this 6-week period, relative RANKL/OPG ratio was found significantly lower in the OFD+T-PRF group compared to the OFD group(P<0.05). Using T-PRF membrane combined with OFD provided significantly higher concentrations of growth factors and lower RANKL/OPG ratio in GCF for approximately 4 to 6weeks, and improved periodontal healing compared to conventional flap sites.

Evaluation of Turmeric Chip Compared with Chlorhexidine Chip as a Local Drug Delivery Agent in the Treatment of Chronic Periodontitis: A Split Mouth Randomized Controlled Clinical Trial.

The aim of this study was to evaluate and compare the effect of chlorhexidine (CHX) chip and turmeric chip as a local drug delivery (LDD) agent in the treatment of patients with chronic periodontitis. A total of 120 sites with pocket depths 5-8 mm were chosen as a split mouth design at 3 sites in the same patient. Selected sites were randomly divided into three groups to receive CHX chip in addition to scaling and root planing (SRP) in group A, turmeric chip in addition to SRP in group B, and SRP only in group C. Clinical parameters, that is, plaque index (PI), gingival index (GI), probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month, and 3 months interval. On applying statistical analysis, results revealed that there was a significant reduction in all the clinical parameters, that is, PI, GI, PPD, and gain in RAL from baseline to 1 month and 3 months in all the three groups. These results were found to be significantly high in the CHX group and turmeric group than in the SRP group. Also, the results in both the test groups were maintained till the end of the study periods, but SRP group showed a significant deterioration after 1 month as was seen by increase in PPD and decrease in RAL scores after 3 months in the SRP group. Both the treatment modalities with the application of LDD as an adjunct to SRP proved to be equally beneficial in the treatment of chronic periodontitis.

Comparative evaluation of root canal treatment alone and in combination with periodontal flap surgery in the treatment of endodontic-periodontal lesions: Randomized controlled clinical trial

Background: Endodontic-periodontal lesions are described as the lesions due to inflammatory products found in varying degrees in both pulp and periodontal tissues. In all cases of concurrent periodontal and pulpal disorders, the clinician must determine whether the existing tissue change originated from one or both processes so that appropriate treatment could be initiated. Aims: The aim of the present randomized controlled clinical trial was to evaluate and compare the two treatment approaches for the treatment of primary endodontic lesions with secondary periodontal involvement, i.e., root canal treatment (RCT) with RCT and periodontal flap surgery. Subjects and Methods: In this study, twenty cases aged between 18 and 55 years with good systemic health diagnosed as cases of primary endodontic lesion with secondary periodontal involvement were selected for the study. In ten cases, only RCT was performed (control group), and in another ten, after 1 month of completion of RCT, periodontal flap surgery was performed (test group). The patients were evaluated for changes in the gingival index, plaque index, gingival bleeding index, probing depth (PD), and relative attachment level (RAL) at baseline, 1 month, and at 4 months postoperatively. Results and Conclusion: Results showed statistically significant (P < 0.05) reduction from baseline to 1 and 4 months in the PD and gain in RAL both on intergroup and intragroup comparison. Thus, from the results of the study, it could be concluded that both treatment approaches revealed a significant improvement in the PD reduction and attachment level gain 4 months postoperatively. However, test group showed a significant difference in the reduction of PD and gain in attachment level.

Comparative evaluation of efficacy of subgingivally delivered 1.2% Atorvastatin and 1.2% Simvastatin in the treatment of intrabony defects in chronic periodontitis: a randomized controlled trial.

Background. Statins are the recently evolved agents that aid in periodontal regeneration and ultimately in attaining periodontal health. Atorvastatin (ATV) and Simvastatin (SMV) are specific competitive inhibitors of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. The current study was conducted to compare the effectiveness of 1.2% ATV and 1.2% SMV, in addition to scaling and root planing (SRP), in the treatment of intrabony defects in subjects with chronic periodontitis.Methods. Ninety-six individuals were categorized into three treatment groups: SRP plus 1.2% ATV, SRP plus 1.2% SMV and SRP plus placebo. Clinical parameters of full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and relative attachment level (RAL) were recorded at baseline before SRP and at 3, 6 and 9 months. Bone fill was assessed using percentage radiographic defect depth reduction at baseline, 6 months and 9 months.Results. Both ATV and SMV showed significant PD reduction and RAL gain than placebo. ATV group showed greater mean PD reduction and mean RAL gain as compared to SMV group at 3, 6 and 9 months. Furthermore, ATV group sites exhibited a significantly greater percentage of radiographic defect depth reduction (33.23 ± 3.11%; 34.84 ± 3.07%) as compared to SMV (30.39 ± 3.36%; 32.15 ± 3.37%) at 6 and 9 months.Conclusion. ATV resulted in greater improvements in clinical parameters with higher percentage of radiographic defect depth reduction as compared to SMV in the treatment of intrabony defects in CP subjects.

Bioactive glass versus autologous platelet-rich fibrin for treating periodontal intrabony defects: A comparative clinical study.

Background:To compare treatment modalities: Open flap debridement (OFD) alone (Group I), OFD in combination with PerioGlas® (Group II), and OFD in combination with autologous platelet-rich fibrin (PRF) (Group III) for periodontal intrabony defects (IBDs).Aim:To evaluate on clinical and radiographic basis, effectiveness of PerioGlas®, and PRF in treating IBDs.Settings and Design:IBDs selected on the basis of the inclusion criteria were randomly assigned to Groups I, II, and III by coin toss method.Materials and Methods:The study was conducted on patients reporting to the department of periodontology and oral implantology. Thirty-eight patients with ninety periodontal IBDs of moderate to severe periodontitis were selected and assigned to Groups I, II, and III. In each patient, a minimum number of two sextants were present with pocket depths ≥5 mm in at least three teeth.Statistical Analysis:Statistical analysis based on mean values, standard deviation, and P values.Results:Compared to baseline, 9 months postoperatively: (1) mean probing pocket depth reduction for Group I was 3.68 mm ± 0.72, for Group II was 5.57 mm ± 1.10, and for Group III was 6.11 mm ± 0.92. (2) The mean relative attachment level gain for Group I was 4.14 mm ± 0.76, for Group II was 6.57 mm ± 1.45, and for Group III was 6.74 mm ± 1.55. (3) Mean radiographic IBD fill for Group I was 69.29% mm ± 7.73, for Group II was 74.44% mm ± 8.57, and for Group III was 75.01% mm ± 7.85.Conclusion:This study shows marked improvements in the clinical parameters and radiographic outcomes with both PerioGlas® and autologous PRF to treat periodontal IBDs as compared to OFD alone.