Management Of Chronic Periodontitis Research Articles

A Comparative Clinical Evaluation of Subgingivally Delivered 0.5% Azithromycin Gel and 1% Chlorhexidine Gel as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis

ABSTRACT Background: Chronic periodontitis is a prevalent inflammatory condition affecting the supporting structures of teeth. Adjunctive therapies to scaling and root planing (SRP) play a crucial role in enhancing treatment outcomes. This study aimed to compare the clinical effectiveness of subgingivally delivered 0.5% azithromycin gel and 1% chlorhexidine gel as adjuncts to SRP in the management of chronic periodontitis. Materials and Methods: A comparative clinical evaluation was conducted involving 60 participants diagnosed with chronic periodontitis. They were randomly assigned to two groups: Group A received subgingival application of 0.5% azithromycin gel after SRP, whereas Group B received 1% chlorhexidine gel in a similar manner. Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), and gingival index (GI) were recorded at baseline and 3-month follow-up. Results: Both groups demonstrated significant improvements in clinical parameters after treatment. However, Group A exhibited a greater reduction in PPD (mean decrease of 2.5 mm) compared with Group B (mean decrease of 1.8 mm). Similarly, Group A showed a higher gain in CAL (mean gain of 2.3 mm) compared with Group B (mean gain of 1.5 mm). In addition, a significant reduction in GI was observed in both groups, with Group A showing slightly better outcomes. Conclusion: Subgingivally delivered 0.5% azithromycin gel demonstrated superior clinical efficacy as an adjunct to SRP in the treatment of chronic periodontitis compared with 1% chlorhexidine gel. The findings suggest that azithromycin gel may serve as a promising therapeutic option in managing periodontal disease.

The efficacy of bacteriophage/probiotic combination therapy in periodontal treatment

Relevance. Periodontal inflammations result from chronic, persistent infections triggered by dysbiosis-induced shifts within the microbial community. The high prevalence, multifactorial nature and challenging management of periodontal disease create an environment ripe for ongoing advancements in treatment modalities.Study objective: To validate, using clinical and laboratory test data, the efficacy of combined treatment involving bacteriophages and probiotics in managing chronic periodontitis.Materials and methods. A total of 100 patients aged 18 to 45 with periodontal inflammation underwent clinical laboratory examinations before receiving combination treatment. The patients were divided into two groups: Group 1 received conventional treatment based on clinical recommendations, while Group 2 received sequential treatment with a bacteriophage cocktail (targeting 81 phages against A. actinomycetemcomitans, B. licheniformis, B. fragilis, E. cloacae, E. faecalis, K. pneumonia, S. aureus, S. pyogenes, Wolinella spp. among others) followed by a probiotic containing S. Salivarius. Periodontal pocket lavages served as study material. Periodontal pathogens were isolated using real-time PCR, and proinflammatory cytokines were identified via enzyme immunoassay. Statistical analysis was conducted using STATA v.12 software.Results. Following bacteriophage/probiotic combination treatment, positive changes in study indices and a reduction in periodontopathogenic microbiota were observed. Significant decreases were noted in the levels of key periodontal pathogens: P. gingivalis (5.2-fold decrease, p < 0.001), P. intermedia (3.6-fold decrease, p < 0.001; T. forsythia (3.8-fold decrease, p = 0.905), T. denticola 4-fold decrease, p < 0.001. Levels of IL1-β decreased by factors of 4.29 (p < 0.001) and 8.59 (p = 0.02) in severity subgroups, while IL6 levels decreased by factors of 4.39 (p < 0.001) and 5.94 (p = 0.0002). The lowest TNF-α levels (2.13 in mild CGP subgroup and 2.11 in moderate CGP subgroup) were observed post-treatment (p < 0.001; p = 0.0005).Conclusion. The combination treatment involving the selected drugs exhibited notable therapeutic effectiveness in the management of chronic periodontitis. This approach not only avoided the necessity for systemic antibacterial agents but also facilitated prolonged remission by eradicating periodontopathogenic microbiota in patients with chronic periodontitis. The etiopathogenetic nature of this treatment represents a promising paradigm in the management of periodontal inflammation.

Efficacy of subgingival ozone irrigation as an adjunct to non-surgical periodontal therapy in management of chronic periodontitis

: Aim of the study was to determine the adjunctive role of subgingival irrigating solutions i.e., ozonated water, 0.2% chlorhexidine and 5% Povidine Iodine in Phase-I periodontal treatment and to compare the efficacy of subgingival irrigating medicament being used in studyRandomized controlled clinical trial was performed on 45 patients that were divided into three groups, the ozone group (Group A), chlorhexidine group (Group B) and povidone iodine group (Group C). Patients underwent scaling and root planing (SRP) in a single visit followed by irrigation with ozone water, chlorhexidine and povidone iodine in. The clinical parameters of Gingival Index (GI), Plaque Index (PI), probing pocket depth (PPD), Clinical Attachment Level (CAL) and modified sulcular bleeding index were measured at baseline, at 1 month and at the end of 3 months.All clinical parameters like plaque index, gingival index, probing pocket depth, clinical attachment level and modified sulcus bleeding index at baseline, 1 month and after 3 months. Ozone group was found to be superior than chlorhexidine followed by Povidone Iodine in terms of reduction of Plaque Index. However, intergroup comparison for other parameters did showed difference but it was not statistically significant.: It can be concluded that use of ozone can serve as beneficial irrigating solution to treat chronic periodontitis for home care and professional practice. More studies with a larger sample size may be used to evaluate the potential of these irrigating agents.

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.

Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis – A consolidated report of two randomized controlled clinical trials

BackgroundOral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. ObjectivesStudy 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. MethodsThe novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. ResultsSignificant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. ConclusionThe results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. Clinical trial registration NumberFor Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Evaluation of different local drug delivery systems in the management of chronic periodontitis: A comparative study

Periodontal disease is an immune-inflammatory disease affecting the soft tissues and alveolar bone and surrounding periodontal tissues. The standard treatment involves scaling and root planing (SRP) which removes the sub gingival microbial deposits effectively and the gingival health is maintained. Sometimes the treated areas may show regrowth of the microorganisms and the non-surgical periodontal treatment alone cannot eliminate the micro-organisms in mild periodontitis cases due to the difficulty in reaching the subgingival areas which are deeper and in complex root morphologies. So now a days the non-surgical periodontal treatment combined with the use of systemic antimicrobial agents and host modulating agents has shown to use effectively in the treatment of periodontal diseases.All the patients who were diagnosed with chronic periodontitis underwent initial therapy i.e., full-mouth scaling and root planing. Then the oral hygiene instructions were given to the patients and were recalled after 1 week (baseline visit). A total of 20 patients who met the inclusion criteria and showed satisfactory condition after the initial therapy with persistent periodontal pockets were included in this study. They were randomly assigned into two groups i.e., Group-A: metronidazole gel (metrogyl) and Group B: tetracycline fibre groups with 10 patients in each group. The periodontal clinical parameters like plaque index (PI), gingival index (GI) and periodontal pocket depth (PPD) were evaluated at the baseline visit before the application of local drug delivery and 15 and 30 days after the local drug delivery application.The mean plaque scores were reduced from 1.41±0.04 at baseline to 1.04±0.14 at 30 days. Likewise in Group-B the mean PI scores reduced from 1.50±0.10 at baseline to 1.25±0.18 at 30 days. The mean gingival index scores reduced from 1.41±0.04 at baseline to 1.01±0.04 at 30 days. Likewise in Group-B mean GI Scores reduced from 1.36±0.03 at baseline to 0.99±0.06 at 30 days. The mean PPD scores were reduced from 5.65±0.12 at baseline to 3.15±0.10 at 30 days in Group-A. Likewise in Group-B mean PPD scores reduced from 5.68±0.06 at baseline to 3.26±0.10 at 30 days. This study demonstrated that although thorough SRP is an effective treatment method for elimination of chronic periodontal pockets, improved results can be obtained by adjunctive use of locally administered metronidazole gel and tetracycline fibers.

Comparative Assessment of the Effect of Three Various Local Drug Delivery Medicaments in the Management of Chronic Periodontitis.

The aim of this study was to evaluate the efficacy of three different local drug delivery medications in the treatment of chronic periodontitis. Sixty participants, aged 30-55 years, were involved in the current research. Participants who fulfilled the inclusion criteria entered the study and were allocated at random to one of the three groups, each comprising 20 patients as: group A: Scaling and root planing (SRP) with local application of doxycycline gel, group B: SRP with local application of tetracycline fibers, and group C: SRP with local application of chlorhexidine gel. The plaque index (PI), the gingival index (GI), and periodontal pocket depth (PPD) were documented at baseline visit (prior to local drug delivery), and these indices were again documented 30 and 90 days post-local drug delivery. At baseline, GI score for doxycycline gel use decreased from 1.38 ± 0.05 to 0.94 ± 0.02, 1.36 ± 0.11 to 0.76 ± 0.19 for tetracycline fibers use, as well as from 1.38 ± 0.10 to 0.84 ± 0.21 for chlorhexidine gel use post 90 days. The PI value at baseline for doxycycline gel use lessened from 1.26 ± 0.01 to 1.02 ± 0.06, 1.30 ± 0.14 to 0.82 ± 0.16 for tetracycline fibers use, as well as 1.30 ± 0.22 to 0.98 ± 0.11 for chlorhexidine gel use post 90 days. At baseline, PPD values for doxycycline gel use decreased from 5.88 ± 0.24 to 3.72 ± 0.11, tetracycline fibers use lessened from 5.90 ± 0.09 to 3.02 ± 0.06, as well as for chlorhexidine gel group from 5.82 ± 0.18 to 3.44 ± 0.16 post 90 days. Within the limitations of the current research, it may be inferred that tetracycline fibers exhibited somewhat superior enhancement to chlorhexidine as well as doxycycline gel. Local administration of antibacterial agents in continued or regulated delivery arrangement is employed to augment the actions of nonsurgical periodontal management, and it may be likely to attain gingival well-being by eliminating the requirement for invasive methods with the aid of local drug delivery arrangements. Chosen elimination or prohibition of microbial pathogens with locally administered antibacterial agents coupled with SRP is an efficient move toward treatment of chronic periodontitis.

Evaluation of Efficacy of 4% Ocimum sanctum Gel in the Management of Chronic Periodontitis

ABSTRACT Aim: The present experimental study was performed with the aim of assessing the efficacy of Ocimum sanctum (OS) gel as an adjunct to scaling and root planing (SRP) in the management of chronic periodontitis. Materials and Methods: Minimum inhibitory concentrations and minimum bactericidal concentration of OS on Porphyromonas gingivalis, Prevotella intermedia (Pi), Fusobacteria nucleatum, and Aggregatibacter actinomycetemcomitans was carried out as a pilot study. Further, a total of 60 patients (mean age of 34.5 ± 8.3 years) were enrolled in this study (n = 30 in each group). In the control group (A), Phase I periodontal therapy was performed, whereas in the test group (B), 4% OS gel was inserted into the pockets at baseline after the same. The clinical parameters recorded included plaque index (PI), sulcus bleeding index, probing depth, and clinical attachment level were recorded at baseline and after 45 days. Results: The results obtained by in vivo assessment following the placement of 4% OS gel demonstrated that the mean PI score at baseline was 2.29 ± 0.21, which was reduced to 0.97 ± 0.293 at the 45th day (P = 0.001) for Group A, whereas it was 2.18 ± 0.22, which was reduced to 1.46 ± 0.29 at the 45th day (P = 0.001) for Group B. The mean Modified Sulcular Bleeding Index score at baseline was 3.56 ± 0.77, which was reduced to 1.55 ± 0.62 at the 45th day after local drug delivery of OS gel for Group A, whereas it was 3.08 ± 0.69, which was reduced to 1.45 ± 0.51 at the 45th day (P < 0.001). The difference between Group A and Group B was statistically not significant (P > 0.05). The mean probing depth at baseline was 8.07 ± 1.60, which was reduced to 4.83 ± 1.38 for Group A (P < 0.001), whereas it was 7.50 ± 1.63 at baseline and 5.68 ± 1.29 at the 45th day for Group B (P < 0.001). The mean clinical attachment level at baseline was 4.26 ± 1.02, which was reduced to 2.78 ± 0.84 for Group A at the 45th day (P < 0.001), whereas it was 4.05 ± 1.08 at baseline and 3.27 ± 0.97at the 45th day for Group B (P < 0.001). The difference between Group A and Group B was statistically highly significant (P < 0.01). Conclusions: The subgingival delivery of 4% OS gel can be used as an adjunct to SRP for superior clinical outcomes in chronic periodontitis cases as compared to SRP alone. CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY This study emphasizes the anti-inflammatory role of Ocimum sanctum in nonsurgical management of periodontal infection which need to be tackled before any other procedures of orthodontics, prosthetic or restorative dentistry.

Photodynamic Periodontal Therapy vs. Diode laser as an Adjunctive to Conventional periodontal treatment in Management of Chronic Periodontitis

Purpose: This study was made to evaluate and compare the efficacy of photodynamic periodontal therapy and diode laser as an adjunctive approach to conventional periodontal therapy in management of chronic periodontitis. Subjects and methods: 30 patients with chronic periodontitis and age range from 30-40 years old were divided randomly into three groups. Group I (control group) 10 patients received conventional periodontal therapy alone. Group II (laser group): patients received SRP + additional application of a 940-nm diode laser. Group III (photodynamic group): patients received SRP + antimicrobial photodynamic therapy by using low level 670 nm diode laser application in addition to application of 1% toluidine blue as photosensitizer. Results: there were a significant difference of PD, CAL, IL-1β, IL6, NO, NO2 between three groups with superior result found in photodynamic group, but there were no significant differences between three groups in the term of NO3. Conclusion: Diode laser and photodynamic therapies add a beneficial effect in clinical and biochemical parameters when used as adjunctive to scaling and root planning but there was no significant difference between them.

Comparative Evaluation of Metformin Gel and Chlorhexidine Gel as Adjunct to Scaling and Root Planning in the Treatment of Chronic Periodontitis: A Clinical Study

Introduction: Pyorrhoea is an inflammatory gum disease in which destruction of tooth supporting tissues that results ultimate tooth mobility and exfoliation. In local drug delivery (LDD), which includes the delivery of therapeutic agents like Irrigating systems, fibers, gels, strips, films, microparticles, nanoparticles and low dose antimicrobial agents via systemic and local route as an adjunct to mechanical therapy which has beneficial for periodontal therapy. Aim: To evaluate and compare the efficacy of subgingivally delivered 1% Metformin gel and Chlorhexidine gel as an adjunct to scaling and root planing in the management of patients with chronic periodontitis. Materials and Method: Twenty systemically healthy patients with the age group of 20-60 years irrespective of gender suffering from generalized chronic periodontitis were selected, in which fourty sites were randomized at split mouth level and divided into two groups: (Group A -SRP+1% Metformin gel and Group B - SRP+ 0.2% Chlorhexidine gel). Parameters such as, Plaque index (PI), Modified gingival index (MGI), Probing pocket depth (PPD), and Relative clinical attachment level (R-CAL) were measured at baseline and after 1 month and 3 months. The significance of difference within and between the groups was evaluated with paired and unpaired t-tests. Result: In our study, the mean Plaque index (PI), Modified gingival index (MGI), Probing pocket depth (PPD), and Relative clinical attachment level (R-CAL) showed a statistically significant difference from baseline to 1 month and 3 months (p≤0.05) in both Group A and Group B. But, Mean PPD reduction and mean R-CAL gain was found to be greater in Group-A than Group B at 1 month and 3 months. Conclusion: Both Metformin and 0.2% Chlorhexidine gel can be considered as effective as a LDD agent adjunct to scaling and root planning (SRP) in the management of chronic periodontitis. But, 1% Metformin gel was more effective as a LDD adjunct to SRP in curative of chronic periodontitis patient than Chlorhexidine gel (Cevitec gel).

PENGGUNAAN SPLINT EKSTRAKORONAL PADA PERAWATAN PERIODONTITIS KRONIS (LAPORAN KASUS)

Introduction: The use of splints is one of the stages of treatment in periodontitis accompanied by tooth mobility. Based on the location of the splint, there are two types of splinting, namely extra-coronal and intra-coronal splinting. Treatment using splints is based on the condition of the periodontal tissue, occlusion, articulation, and the severity of periodontitis. This article discusses two case reports regarding the management of chronic periodontitis with tooth mobility. Case report and Management: The first case was a 45-year-old female patient with a diagnosis of localized chronic periodontitis in teeth 32, 31, and 41 with tooth mobility. Initial treatments were scaling-root planning (SRP), plaque control, occlusion adjustment, endodontic treatment, and extra-coronal splinting using fiber-reinforced and composite resins. The second case was a 47-year-old woman with controlled diabetes, and a diagnosis of localized chronic periodontitis on teeth 12, 11, 21, 33, 32, 31, 41, and 42. Initial treatment was SRP, plaque control, occlusion adjustment, and extra-coronal splinting using 0.03 diameter wire and composite resin. The patient stated that she was satisfied with the results of the initial treatment carried out because the teeth that experienced mobility were maintained and remained in the oral cavity. The next therapy is periodontal flap surgery accompanied by the addition of bone grafts. Conclusion: The use of extra-coronal splints in the initial therapy phase of chronic periodontitis cases aims to stabilize loose teeth. Extra-coronal splinting treatment is carried out to support the success of periodontitis treatment.

Clinical Assessment of the Effectiveness of Three Different Controlled-release Drugs in the Management of Chronic Periodontitis: An In vivo Study

Clinical Assessment of the Effectiveness of Three Different Controlled-release Drugs in the Management of Chronic Periodontitis: An In vivo Study

The impact of lifestyles on the periodontal health among 35–44 years old adult population in Lucknow district: A cross-sectional study

Background: Periodontal disorder continues to be a major issue worldwide. It is closely related to lifestyles and strongly determined by behavioral factors. Aim: To assess the different lifestyle factors and overall lifestyle variables affecting the periodontal health among 35–44 years old adult population in Lucknow district. Objectives: (1) To determine the influence of various lifestyle factors on adult periodontal health among urban and rural population. (2) To measure the effect on periodontal adult health of the overall lifestyle variables measured by the health practice index (HPI). Materials and Methods: A cross-sectional research w as performed on 400 participants aged 35–44 years, consisting of a standardized questionnaire on HPI, oral health-related behavior, and personal behaviors, as well as sociodemographic variables. Clinical examination for periodontal status was done by recording the loss of attachment (LOA) scores using the community periodontal index (WHO-2013). Statistical Analysis: Statistical Package for the Social Sciences (SPSS) software version 21.0 was used for statistical analysis. Statistical analysis was done using the Chi-square test and multivariate regression analysis. Results: The variables that showed an independent association with periodontitis were location, smoking, sleeping hours, physical exercise, eating breakfast, nutritional balance, mental stress with LOA of periodontal tissues; the results of multivariate regression analysis are statistically significant (P < 0.001). Conclusions: This study supports an overall management of chronic periodontitis using different lifestyles. Vital public health action is needed on factors that define unhealthy lifestyle habits across the community, which is achievable through promoting healthy lifestyles through patient engagement in self-care.

Evaluation of a novel local drug delivery system containing tetracycline hydrochloride microparticles as an adjunct to mechanotherapy in the management of chronic periodontitis

Background: Tetracycline hydrochloride is a primarily used antimicrobial for periodontitis. Due to its limitations when used systemically, local application in the subgingival zone is encouraged. The local concentration of the drug can be maximized further by optimizing its delivery vehicle. Aim and Objectives: The aim was to compare and assess the efficacy of novel drug formulation containing tetracycline microparticles with commercially available tetracycline fibers as local drug delivery agents in patients with chronic periodontitis. Materials and Methods: A total of 10 patients in the age group of 23–53 years with chronic periodontitis were selected. Patients having isolated periodontal pockets with probing pocket depth (PPD) >5 mm were selected. They were randomized into Group A (scaling and root planning [SRP] + tetracycline microparticles) and Group B (SRP + tetracycline fibers). Clinical parameters such as plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at 0 and 90 days. The data obtained were consolidated and subjected to statistical analysis. Results: Both the groups confirmed statistically significant improvement in all the clinical parameters. Results of the study showed enhanced CAL gain in Group A compared to Group B. Conclusion: The novel drug formulation is equally efficacious to the commercially available formulation, with decreased manufacturing cost and greater drug availability. Nevertheless, more clinical trials are necessary to study the long-term results.

Local delivery of hyaluronic acid as an adjunct to scaling and root planing in the treatment of chronic periodontitis in smokers and non-smokers: A clinical and microbiological study

The objective of the study is to assess the effects of adjunctive use of hyaluronic acid (HA), clinically and microbiologically in smokers and nonsmokers, in the management of chronic periodontitis. 48 sites from 24 chronic periodontitis patients, including smokers and nonsmokers with probing depth >5 mm, were selected for the study. A split-mouth design was followed. Scaling and root planing (SRP) was performed for all the patients. The test sites received 0.8% HA gel whereas the control site received placebo gel. The clinical parameters plaque, gingival and bleeding indices, Pocket Probing Depth (PPD), and clinical attachment level (CAL) were evaluated at baseline, 1 and 3 months. Microbiological parameters were evaluated at baseline and 1 month. The results showed reduction in PPD and gain in CAL in both smokers and nonsmokers at the end of 3rd month. The improvements in the test sites were statistically significant when compared with that of control sites. The microbiological analysis showed a significant reduction in Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis at the test sites when compared to the controls in both the groups. The findings in both groups suggest that the use of locally delivered 0.8% HA gel may be valuable as an adjunct to SRP in the treatment of chronic periodontitis.

COMPARATIVE EVALUATION OF EFFICACY OF SCALING AND ROOT PLANING WITH AND WITHOUT CHLORHEXIDINE CHIP AND DIODE LASER IN CHRONIC PERIODONTITIS PATIENTS

Introduction: The motive of the present study is to comparatively measure the competence and effectiveness of diode laser and chlorhexidine chip as adjuncts to the scaling and root planing procedure, in patients with chronic periodontitis.&#x0D; Aim: To evaluate the efficacy of diode laser and chlorhexidine chip before and after scaling and root planing in the management of chronic periodontitis. The objective is to compare the efficacy of chlorhexidine chip and diode laser before and after scaling and root planning on clinical parameters.&#x0D; Study and design: Randomized clinical trial with split mouth design done in the Department of Periodontics and Implantology.&#x0D; Materials and methods: Twenty chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were selected in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). All subjects received a clinical periodontal examination by single examiner who recorded all the variables by manual procedure. Clinical parameters namely Plaque index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Results were statistically analysed using one-way ANOVA followed by Post Hoc Analysis.&#x0D; Results: The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p&lt;0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group.&#x0D; Conclusion: Within the limitations in the present study, the following conclusions were derived, i.e., chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in improving oral hygiene, reducing gingival inflammation, reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis.&#x0D; Keywords: Diode laser decontamination, Local drug delivery, Scaling and root planing.

Evaluation of the Efficacy of Coenzyme Q10 in the Management of Chronic Periodontitis: A Clinical Study

Abstract Aim The present study was aimed to clinically evaluate the effectiveness of coenzyme Q10 (CoQ10) in the management of chronic periodontitis. Materials and Methods A total of 60 patients aged between 30 and 60 years with bleeding on probing and probing pocket depth (PPD) of 3 to 5 mm were selected and divided into three groups, with group I receiving scaling and root planing, group II CoQ10 formulation for 6 weeks, and group III receiving both scaling and root planning, followed by coenzyme Q10 administration for 6 weeks. PPD, relative attachment level (RAL), and gingival index were recorded in all the groups at baseline, 6 weeks, and 3 months, respectively. The data was statistically analyzed using Kruskal–Wallis, Mann–Whitney, and Wilcoxon signed rank tests. Result Intragroup comparison showed statistically significant difference (p ≤ 0.05) between the clinical parameters of all the groups at all time intervals, whereas intergroup comparison of all the parameters showed high statistically significant difference (p ≤ 0.001) in group III at various time intervals followed by group I and group II. Conclusion It was concluded from the study that CoQ10 is a useful adjunct in treating chronic periodontitis by boosting the host resistance to periodontal disease.

Impact of Adjunctive Diode Laser Application to Non-Surgical Periodontal Therapy on Clinical, Microbiological and Immunological Outcomes in Management of Chronic Periodontitis: A Systematic Review of Human Randomized Controlled Clinical Trials.

BackgroundDue to the limitations of scaling and root planing (SRP) in chronic periodontitis (CP) management, research has been focused on utilising additional therapies to enhance conventional treatment methods. The present systematic review is aimed to appraise the accessible scientific evidence of in vivo human studies to establish the effectiveness of adjunctive diode (λ 808- λ 980nm) laser treatment to SRP in CP.MethodologyThis systematic review was conducted following the PRISMA statement guidelines. The review protocol is registered in PROSPERO (CRD 42021227695). The search strategies were based on structured electronic and manual (with appropriate keywords) and were conducted to collect the applicable published data on RCTs studies (in vivo human), spanning over ten years between August 2010 and August 2020. The articles were selected to address the following research focus question: “Does diode laser (λ 808- λ 980nm) therapy have superior effects as an adjunct to SPR, compared to SRP alone, in terms of clinical or microbiological or immunological profiles in the management of CP?”ResultsFifteen articles met the eligibility criteria and are included in this review. A wide range of discrepancies and inconsistencies were shown in the outcomes of the laser and SPR treatment modality, compared to SRP alone. The data on standardised study protocol, optimal laser parameters and outcome measurements were inconclusive, and a high risk of bias in the majority of the studies observed, which are crucial in establishing a homogenous and reproducible protocol.ConclusionIn light of the confined evidence-based data and critical evaluation of this systematic review, the efficacy of adjunctive diode laser treatment ranging between 808 and 980nm to SRP remains debatable. The observational quality of the present systematic review was emphasised after scrutinising the available data, and an attempt to propose a laser protocol for future RCTs consideration was a great challenge due to an absence of clear and standardised recommendations in delivering a reliable laser protocol which can be replicable by future investigators. RCTs with robust methodology are warranted.

Effectiveness of electrospun Ocimum sanctum nanofibers as an adjunct to scaling and root planning in the management of chronic periodontitis: A randomized controlled clinical trial

Aim: Research based on periodontal therapy is focused on the use of natural products rather than chemical agents. Ocimum sanctum has been known to possess various medicinal properties. There is only a limited literature available on the therapeutic effectiveness of O. sanctum for the treatment of periodontal disease. Local drug delivery systems allowed for the direct delivery to the diseased site thereby bypassing systemic circulation and hence attaining maximum concentration at the site that requires the drug. The aim of the study was to analyze the effect of O. sanctum on the anti-inflammatory efficiency [interleukin 1-β (IL-1β)] in patients with periodontitis. Materials and Methods: A randomized, controlled, clinical trial was conducted with a sample size of 15 patients to compare the clinical parameters and IL-1β levels in subjects who underwent nonsurgical periodontal therapy along with local application of O. sanctum fibers and those subjects who had undergone non-surgical periodontal therapy alone. Results: From the present study, a statistically significant difference could not be observed in the IL-1β levels or in the clinical parameters between the test and the control groups at the end of 1 month. There was a significant difference in clinical attachment-level gain between groups (P = 0.046). Conclusion: Ocimum sanctum nanofibers provided benefits in terms of reduction in IL-1β levels. Our study concludes that O. sanctum delivers additional benefit when used as an adjuvant in the treatment of periodontitis.

Efficacy of 3% Psidium guajava local drug delivery in the treatment of chronic periodontitis: A randomized controlled trial

Aim: Herbal products are increasingly used as therapeutic agents in the prevention and management of periodontal diseases to preclude the side effects of antibiotics. A recent addition to the list is the leaves of P guajava, as they possess antimicrobial, anti-inflammatory, and antioxidant properties. This study evaluates the effects of the adjunctive use of 3% P. guajava local drug delivery in the management of chronic periodontitis. Materials and Methods: This was a split-mouth study involving contralateral sites in 15 patients (30 sites), who were randomly treated with either 3% P. guajava gel local drug delivery along with scaling and root planing (SRP) or SRP alone. The primary objective was to evaluate pocket probing depth (PPD), clinical attachment level (CAL), and colony counts of A.actenomycetemcomitans (Aa) and P.gingivalis (Pg); the secondary objective was to evaluate plaque, gingival, and bleeding scores. All parameters were assessed at baseline, one month and three months. The data were analyzed by using SPSS 18.5. Results: There was a significant overall improvement in clinical parameters over the study period. There was a statistically significant reduction in site-specific indices, PPD (2.74 ± 0.283), and gain in CAL (2.8 ± 0.152) in the test sites at three months. Microbiological analysis showed a significant reduction in the colony counts of Aa (17.4 ± 0.026) and Pg (22.7 ± 1.225) in the test sites at one and three months. (P < 0.001). Conclusion: Improvements in clinical and microbiological parameters showed that adjunctive use of locally delivered 3% P. guajava gel is effective in the management of chronic periodontitis.