Improvement In Clinical Attachment Level Research Articles

Evaluation of Osteogenic Potential of Fucoidan Containing Chitosan Hydrogel in the Treatment of Periodontal Intra-Bony Defects-A Randomized Clinical Trial.

Periodontal diseases significantly impact about half of the global population, and their treatment often encompasses relieving symptoms as well as regenerating the destroyed tissues. Revolutionary research in the management of periodontal disease includes biomaterials, a boon to re-generative dentistry owing to their excellent biological properties: non-toxicity, anti-inflammatory, biocompatibility, biodegradability, and adhesion. This study aimed to fabricate an injectable fucoidan containing chitosan hydrogel and prove its effectiveness in periodontal bone regeneration. The injectable hydrogel was prepared using the sol-gel method and was subjected to various physical, chemical, and biological characterizations to understand its efficacy in formation of new bone. The effectiveness of the developed hydrogel was assessed in periodontal bony defects to study the soft and hard tissue changes. A total of 40 periodontitis patients with bony defects were recruited and randomized into two groups to receive fucoidan-chitosan hydrogel and concentrated growth factor, respectively. Customized acrylic stents were used to guide the hydrogel placement into the defect site. Post-surgical changes in clinical parameters were assessed at 3, 6, and 9 months to appreciate the soft and hard tissue changes using repeated measures analysis of variance and Bonferroni's post hoc test. Significance was kept at 5%. The porosity, water uptake of the prepared hydrogel showed good efficacy, with particle size of the fucoidan containing chitosan hydrogel of 6.000 nm. The MG-63 osteoblasts cell line revealed biocompatibility, biodegradability and showed slow and sustained drug release, increased cell proliferation, and enhanced alkaline phosphatase secretion. Mineralization assay was greatest in the fucoidan containing chitosan hydrogel. Clinically, it exhibited significantly lower probing depth values and a higher mean improvement in clinical attachment level as compared to the concentrated growth factor (CGF) group at the end of 3 and 6 months (p < 0.05). The mean of the defect fills in the fucoidan containing chitosan group was 1.20 at the end of 9 months (p < 0.001) as compared with defect fills observed in the CGF group. The presence of fucoidan in the hydrogel significantly contributed to bone regeneration in humans, thus strengthening its potential in tissue engineering. Fucoidan-chitosan will be a promising biomaterial for bone tissue regeneration.

Effect of Scaling and Root Planing in Conjunction with Antimicrobial Therapy on Glycated Hemoglobin Levels in Type 2 Diabetes Mellitus Patients.

Scaling and root planing with systemic doxycycline had an effect on blood glucose levels in type 2 diabetes patients, according to the results of a glycosylated hemoglobin assay. The trial was conducted to determine whether periodontal therapy affected blood sugar regulation as a result of this finding. A total of 60 people with type 2 diabetes (diabetes mellitus not caused by insulin deficiency) were split into three groups. Group I (control group) consists of patients who are only taking an oral anti-diabetic medication. Patients on an oral anti-diabetic drug plus scaling and root planing make up group II. Patients on an oral anti-diabetic drug, scaling, root planing, and doxycycline constitute Group III. The patients were re-evaluated for glycated hemoglobin levels and periodontal status using the clinical parameters of gingival index by Loe and Silness and clinical attachment level at baseline, 30th, 60th, and 90th day. Compared with group II, the findings showed a statistically significant decrease in glycated hemoglobin values (p =0.001) and improvements in clinical attachment level (p =0.022, 0.05) and gingival index (p = 0.009.,01) in group III. In the control group (group I), no such finding was made. The average gingival index, however, increased statistically significantly (p = 0.032, 0.05). Various studies have been showing the benefits of non-surgical periodontal therapy as a benefit for improving the overall glycemic status of the patient. Non-surgical mechanical periodontal therapy combined with systemic administration of antimicrobials such as doxycycline enhances the metabolic status of type 2 diabetes mellitus patients better than non-surgical mechanical periodontal therapy alone.

Efficacy of Periodontal Endoscopy during Subgingival Debridement to Treat Periodontitis: A Systematic Review of Randomized Clinical Trials.

This study aims to evaluate the clinical efficacy of periodontal endoscopy (PEND) during subgingival debridement to treat periodontitis. A systematic review of randomized clinical trials (RCTs) was performed. The search strategy included four databases: PubMed, Web of Sciences, Scopus, and Scielo. The initial online exploration generated 228 reports, and 3 RCTs met the selection criteria. These RCTs described a statistically significant decrease in probing depth (PD) in the PEND group compared to controls after 6 and 12 months of follow-up. The improvement in PD was 2.5 mm for PEND and 1.8 mm for the control groups, respectively (p < 0.05). It was also described that the PEND group presented a significantly inferior proportion of PD 7 to 9 mm at 12 months (0.5%) as compared to the control group (1.84%) (p = 0.03). All RCTs noted improvements in clinical attachment level (CAL). It was described as having significant differences in bleeding on probing (BOP) in favor of PEND, with an average reduction of 43% versus 21% in the control groups. Similarly, it was also presented that they were significant differences in plaque indices in favor of PEND. PEND during subgingival debridement to treat periodontitis demonstrated efficacy in reducing PD. Improvement was also observed in CAL and BOP.

Hyaluronic acid for periodontal tissue regeneration in intrabony defects. A systematic review.

To evaluate the clinical and radiographic outcomes of hyaluronic acid (HA) application alone and in combination with other therapies for the surgical treatment of periodontal intrabony defects. This review was designed in accordance with the PRISMA (preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused question. A literature review with no restrictions regarding the status or language of publication was performed until June 2022. Randomised clinical trials, controlled clinical trials, case series, and case reports were considered eligible for inclusion. The Cochrane risk of bias tool was used to assess the methodology of the included studies. The use of HA was divided into four categories depending on whether it was a) applied alone, b) in combination with barriers, c) in combination with growth factors, or d) in combination with bone grafts. Nine studies were included in the analysis. Some of the studies presented variable heterogeneity and a high risk of bias. Every group resulted in a statistically significant improvement in clinical attachment level (CAL) and probing pocket depth after 6–12 months of follow-up. Three studies showed significant results for bone defect filling on using HA. The application of HA can provide moderate and beneficial clinical and radiographic results for the surgical treatment of periodontal regeneration. The heterogeneity and high risk of bias of the included studies reveal the need to perform randomised clinical trials with an appropriate methodological design to evaluate the effect of HA in periodontal regeneration.

Comparison of simvastatin 1.2% gel and alendronate 1% gel in chronic periodontitis as local drug delivery: A randomized clinical trial.

Simvastatin (SMV) is used for the treatment of hypercholesterolemia. Long-term systemic administration of SMV has been shown to result in increased bone mineral density. Alendronate (ALN) is known to inhibit osteoclastic bone resorption and has osteostimulative properties. To compare percentile changes in gain in clinical attachment level and reduction of pocket depth, and to radiographically evaluate osseous defect fill with subgingival local drug delivery of 1.2% SMV gel and 1% ALN gel. A split-mouth study was conducted with 40 infrabony defects from 20 patients diagnosed with chronic periodontitis. The sites were assigned as test site 1 (SMV gel) or test site 2 (ALN gel). After phase I therapy, a single application of SMV gel or ALN gel was done into periodontal pockets. Clinical periodontal parameters and percentage of bone fill were evaluated at baseline, 3 and 6 months. There was a statistically significant reduction in pocket depth, plaque index, and bleeding index scores, gain in Clinical attachment level (CAL) and bone defect fill from baseline to 6 months at both sites. On comparison between the groups, test site 2 showed significant improvement in clinical attachment level than in test site 1 at 6-month follow-up. Test site 2 showed more percentage bone fill than test site 1. Usage of both SMV and ALN gels in periodontal intra bony defects can lead to significant improvements in clinical and radiographic parameters; however, ALN showed better osseous defect fill.

Periodontal surgery using rhFGF-2 with deproteinized bovine bone mineral or rhFGF-2 alone: 2-year follow-up of a randomized controlled trial.

AimTo compare outcomes of rhFGF‐2 + DBBM therapy with rhFGF‐2 alone in the treatment of intrabony defects. This study provides 2‐year follow‐up results from the previous randomized controlled trial.Materials and MethodsDefects were randomly allocated to receive rhFGF‐2 + DBBM (test) or rhFGF‐2 (control). Treated sites were re‐evaluated at 2 years postoperatively, using original clinical and patient‐centred measures.ResultsThirty‐eight sites were available for re‐evaluation. At 2 years, both groups showed a significant improvement in clinical attachment level (CAL) from baseline. A gain in CAL of 3.4 ± 1.3 mm in the test group and 3.1 ± 1.5 mm in the control group was found. No significant inter‐group difference was noted. Both groups showed a progressive increase in radiographic bone fill (RBF). The test treatment yielded greater RBF (56%) compared with the control group (41%). The control treatment performed better in contained defects in terms of CAL and RBF. There was no significant difference in patient‐reported outcomes between groups.ConclusionsAt 2‐year follow‐up, the test and cotrol treatments were similarly effective in improving CAL, whereas the test treatment achieved a significantly greater RBF. In both treatments, favourable clinical, radiographic, and patient‐reported outcomes can be sustained for at least 2 years.Trial registrationThe University Hospital Medical Information Network‐Clinical Trials Registry (UMIN‐CTR) 000025257.

Treatment of intrabony periodontal defects using rhFGF-2 in combination with deproteinized bovine bone mineral or rhFGF-2 alone: A 6-month randomized controlled trial.

AimTo evaluate the use of recombinant human fibroblast growth factor (rhFGF)‐2 in combination with deproteinized bovine bone mineral (DBBM) compared with rhFGF‐2 alone, in the treatment of intrabony periodontal defects.Materials and MethodsPatients with periodontitis who had received initial periodontal therapy and had intrabony defects of ≥ 3 mm in depth were enrolled. Sites were randomly assigned to receive a commercial formulation of 0.3% rhFGF‐2 + DBBM (test) or rhFGF‐2 alone (control). Clinical parameters and a patient‐reported outcome measure (PROM) were evaluated at baseline and at 3 and 6 months postoperatively.ResultsTwenty‐two sites in each group were evaluated. A significant improvement in clinical attachment level (CAL) from baseline was observed in both groups at 6 months postoperatively. CAL gain was 3.16 ± 1.45 mm in the test group and 2.77 ± 1.15 mm in the control group, showing no significant difference between groups. Radiographic bone fill was significantly greater in the test group (47.2%) than in the control group (29.3%). No significant difference in PROM between groups was observed.ConclusionsAt 6 months, no significant difference in CAL gain or PROM between the two treatments was observed, although combination therapy yielded an enhanced radiographic outcome.

CLINICAL AND RADIOGRAPHIC EVALUATION OF DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS HYALOURONIC ACID VERSUS DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS PLATELET-RICH PLASMA FOR THE TREATMENT OF PERIODONTAL INTRABONY DEFECTS – A RANDOMIZED BLIND STUDY

Objectives: The present study aimed to evaluate the effect of ; 1- combined demineralized freez dried bone allograft( DFDBA)plus hyaluronic acid(HA) compared to DFDBA alone, and 2) combined DFDBA/HA compared to DFDBA /PRP in treatment of periodontal infrabony defects(PIDs). Subjects and methods:45 infrabony defects in subjects with chronic periodontitis were randomly divided into 3 groups treated with, group 1: DFDBA/HA, group 2: DFDBA/PRP and group 3: DFDBA alone. Clinical and radiographic measurements were made at baseline and 12 months after surgery. ANOVA followed by Tukey’s post hoc test were used to analyze the data. Results: A statistically significant improvement in clinical attachment level( Cal) and pocket depth ( PD) as well as radiographic bone fill were reported in group 1 and 2 compared to DFDBA alone( p ≤ 0.05), a non significant difference was reported between group 1 and group 2 regarding clinical and radiographic parameters(p > 0.05).Conclusion : Results of the present investigation suggests that the combination of DFDBA/HA is more effective both clinically and radiographically than DFDBA alone in treatment of PIDs and that both HA and PRP combined with DFDBA are equally effective in treatment of these defects.

Impact of Bariatric Surgery and Diet Modification on Periodontal Status: A Six Month Cohort Study.

Nutrition is an essential component of oral health and improper nutrition is an important aetiological factor in the development of obesity as well. This study aimed to evaluate effect of diet modification and oral hygiene maintenance after bariatric surgery on the periodontal status of Class III and IV obese patients. Two hundred and twenty four patients between the age ranges of 18 -64 years, from both sexes, were subjected to complete periodontal examination prior to bariatric surgery and 6 months post surgery. Patients were advised diet modification which included more fibrous food intake & decreased intake of soft and sugary food along with supragingival scaling & oral health care regime after bariatric surgery with a 6 month follow up. No periodontal surgical intervention was performed. The patients showed a mean differences in the bleeding score, plaque and gingival index which was found to be statistically significant (p<0.001). The improvement in clinical attachment level and probing pocket depth before and after surgery were found to be statistically insignificant (p>0.05). Thus we conclude that fibrous diet along with good periodontal care can help to improve the oral hygiene status of patients undergoing bariatric surgery, even if periodontal surgical intervention is not performed resulting in freedom from periodontitis, thus improving quality of life of the patient.

Long-term periodontal tissue outcome in regenerated infrabony and furcation defects: a systematic review.

This study aimed to systematically evaluate the long-term results of periodontal tissues in regenerated infrabony and furcation defects. A search of the Medline database was performed (1960 to 2012), complimented by an additional hand search. For inclusion in the review, clinical trials had to include the long-term evaluation of infrabony and furcation defects submitted to periodontal regeneration for up to 3 years of follow-up. Changes in clinical attachment level (CAL) from pre-surgery, at the first post-surgical, and final evaluations were used to analyze the effects of regenerative treatments over time. A total of 866 articles were found using the descriptors employed. Of these, 216 papers were selected for abstract reading by two evaluators. One hundred and eighty-nine were excluded for not fulfilling the eligibility criteria. Twenty-seven papers were selected for the analysis of the full texts, and 13 were excluded. Two studies were included after a manual search. Finally, 16 papers were selected for the present review. Regenerative techniques for the treatment of infrabony and furcation defects resulted in improved CAL during long-term follow-up periods, even when attachment losses occurred during this period. This improvement should be carefully evaluated with regard to its clinical relevance for dental longevity. The improvement in clinical attachment level achieved by regenerative techniques with biomaterials demonstrated satisfactory results over the long-term. However, regenerative techniques still present different success rates with regard to gain in clinical attachment level.

Effects of periodontal non‐surgical therapy plus azithromycin on glycemic control in patients with diabetes: a randomized clinical trial

Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes. One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca=37) and supragingival prophylaxis plus azithromycin (AZ-Pro=35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9mo after treatment. Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p<0.05) in HbA1C was observed in the AZ-Sca at 9mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195mg/dL to 159.2mg/dL (∆35.8mg/dL; p<0.05) in the AZ-Sca group whereas a decrease from 194mg/dL to 174.8mg/dL (∆19.2mg/dL) in the PB-Sca group at 9mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed. A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.

A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

The aim of this study is to systematically review the evidence of the efficacy of adjunctive antibiotic therapy to periodontal therapy in smokers with periodontitis. A search was conducted for randomized clinical trials (RCTs) with durations ≥6 months that compared periodontal therapy with and without adjunctive antibiotics for the treatment of periodontitis in smokers. Data sources primarily included PubMed with MeSH terms and free text as well as EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials. In addition, a hand search of selected periodontal journals, bibliographies, and review articles was conducted. Independent reviewers were assigned to make independent searches and quality assessments (MA and DB) of the included studies, and disagreements were resolved by discussion. Five RCTs were selected for quantitative and qualitative assessments. Little evidence was found that supported the use of antibiotic therapy in conjunction with surgical periodontal therapy in smokers. With respect to non-surgical therapy, consistent improvements in clinical attachment level (CAL) gain and probing depth (PD) reduction was reported after the use of a 250-mg azithromycin tablet in one study. Adjunctive doxycycline gel and minocycline microspheres statistically improved CAL gain (in one RCT) and PD reduction (in one RCT), respectively. However, the risk of bias in all studies was estimated as high. Also, inadequate and inconsistent data precluded performing meta-analyses. The present systematic review concludes that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive. Additional well-designed RCTs are required to assess the effect of antibiotics in conjunction with periodontal treatments in smokers.

Photodynamic therapy as an adjunctive treatment for chronic periodontitis: a meta-analysis

Several antimicrobial strategies have been proposed in response to the alarming rise in antimicrobial resistance of periodontal pathogens. Antimicrobial photodynamic therapy (a-PDT) is a promising novel approach that has been used in several clinical applications including in the treatment of periodontal diseases. The aim of this review was to systematically investigate the effectiveness of a-PDT as an adjuvant treatment for chronic periodontitis. The guidelines of the Quality of Reporting of Meta-analyses (QUOROM) conference statement were followed in the preparation of this meta-analysis. An electronic search for randomized controlled trials (RCTs) that investigated the combined use of scaling and root planing (SRP) and a-PDT in comparison with SRP alone was performed without language restriction up to 1 October 2008. RevMan 5.0 software was used to analyze the data. A random effects model was chosen and standardized mean differences with 95% confidence intervals were calculated for continuous data. Four RCTs were included. The use of a-PDT in conjunction with SRP was associated with significantly greater attachment gain (mean difference 0.29, 95% confidence interval 0.08 to 0.50, p=0.007), and greater reduction in probing depth (mean difference 0.11, 95% confidence interval -0.12 to 0.35, p=0.35) at 12 weeks. However, the changes in gingival recession showed slight differences. This review and meta-analysis supported the potential improvements in clinical attachment level and probing depth provided by the combined approach (SRP with a-PDT). Nevertheless, the findings of this review should be interpreted with caution given the small number of included studies.

IL‐1 in gingival crevicular fluid following closed root planing and papillary flap debridement

Interleukin (IL)-1 alpha and beta are cytokines which can mediate inflammatory, bone resorbing, and reparative effects in the periodontium, but few longitudinal data exist exploring their role following periodontal therapy. This study examined gingival crevicular fluid (GCF) concentrations of IL-1 alpha and IL-1 beta at sites with shallow sulci (SS) or inflamed moderate/advanced pockets (M/AP) before and 6 months after treatment with closed scaling/root planing (SC/RP) or papillary flap debridement (PFD), all in the same subject (n = 14 patients). No significant differences were noted in IL-1 alpha or beta concentrations (determined with two-site enzyme-linked immunosorbent assays) between SS and M/AP sites at baseline. While both therapies improved clinical parameters of periodontal disease, IL-1 alpha concentration increased significantly (p < 0.05) in M/AP-PFD sites 6 months after treatment, but were unchanged in other groups. IL-1 beta concentrations were numerically lower after therapy, except for a significant increase (p < 0.05) in M/AP-PFD sites. These data suggest that surgical wound healing in an inflamed, plaque-infected site (M/AP-PFD) results in prolonged production of IL-1, which may be a reflection of the extent of tissue trauma and delayed wound healing. In spite of increased IL-1 levels, these sites demonstrated significant short-term improvement in clinical attachment level (+ 1.8 mm, p < or = 0.001) postoperatively.