Changes In Probing Pocket Depth Research Articles

Assess the effect of periodontal treatment on glycemic control in type 2 diabetes patients

Background: Diabetes mellitus and periodontitis are common diseases, there is a two-way relationship between oral health and systemic disease. Periodontal treatment helps glycaemic control, and in contrast, glycaemic control can make periodontal status better. Aim: To assess the effect of periodontal treatment on glycemic control in type 2 diabetes mellitus (DM) patients Materials and Methods: Study design of clinical trials without control group, the sample included 50 type 2 diabetes patients with moderated periodontitis status. Patients received oral hygiene instructions, full-mouth scaling and root planing. Data collection included plaque index (PlI), gingival index (GI), probing pocket depth (PPD), clinical attachment levels (CAL), bleeding on probing (BOP) and glycated haemoglobin (HbA1c) were recorded at baseline and three month after treatment. Results: After 3-month treatment, there were a significant change in PlI, GI, PPD, CAL, BOP and HbA1c levels (p < 0.01). A statistically significant effect could be demonstrated for PlI, GI, PPD, CAL, BOP and HbA1c levels. Conclusion: The results of this study showed that non-surgical periodontal treatment is improved not only periodontal health and also glycaemic control in type 2 diabetes mellitus patients. Key words: Type 2 diabetes mellitus, periodontitis, glycemic control

Autologous platelet concentrates for treating periodontal infrabony defects.

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, LILACS BIREME Virtual Health Library, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform. Searches were conducted with no limitations on the language or date of publication.Study selection Parallel and split-mouth randomised controlled trials (RCTs) conducted on patients with infrabony defects requiring surgical treatment were considered. Studies needed to compare a specific surgical technique with and without the use of with autologous platelet concentrates (APC).Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias with data being analysed using standard Cochrane methodology. Changes in probing pocket depth (PD), clinical attachment level (CAL) and radiographic bone defect filling (RBF) were the primary outcomes assessed. Changes in PD and CAL were reported as mean difference (MD) millimeters and 95% confidence intervals with RBF as MD percentage change (5). Data was organised in four groups related to specific surgical techniques, 1. APC + Open Flap Debridement (OFD) versus OFD, 2. APC + OFD + Bone Grafting (BG) versus OFD + BG, 3. APC + Guided Tissue Regeneration (GTR) versus GTR, and 4. APC + Enamel Matrix Derivative (EMD) versus EMD.Results Thirty eight RCTs evaluating 1402 defects were included. Twenty-two trials used a split-mouth design and sixteen a parallel approach. Most studies (36) had a high overall risk of bias with two having an unclear risk. Twelve studies (510 infrabony defects) were included for the comparison between APC + OFD versus OFD alone providing evidence of an advantage in using APC globally from split-mouth and parallel studies for all three primary outcomes.PD (MD) = 1.29 mm (95%CI; 1.00 to 1.58 mm); CAL (MD) = 1.47 mm (95% CI; 1.11 to 1.82 mm); RBF (MD) = 34.26% (95% CI; 30.07% to 38.46%).Seventeen studies (569 infrabony defects) were included for the comparison between APC + OFD + BG versus OFD + BG. When all follow-ups, as well as 3 to 6 months and 9 to 12 months are considered, there is very low-quality evidence of an advantage in using APC from both split-mouth and parallel studies for all three primary outcomes; PD (MD) = 0.54mm (95% CI; 0.33 to 0.75 mm); CAL (MD) = 0.72 mm (95% CI; 0.43 to 1.00 mm); and RBF (MD) 8.10% (95% CI 5.26% to 10.94%)For the comparison APC + GTR versus GTR alone seven studies (248 infrabony defects) were included Considering all follow-ups, there is very low-quality evidence of a probable benefit for APC for both PD (MD) = 0.92 mm (95% CI; -0.02 to 1.86 mm) and CAL (MD) 0.42 mm (95% CI; -0.02 to 0.86 mm). As confidence intervals are wide there is a possibility of a slight benefit for the control. For 3 to 6 months and a 9 to 12 months follow-up no benefits were evidenced, except for CAL at 3 to 6 months MD = 0.54 mm (95% CI; 0.18 to 0.89 mm). No RBF data were available.Only two studies (75 infrabony defects) were included in the comparison of APC + EMD versus EMD. There was insufficient evidence of an overall advantage of using APC for all three primary outcomes: A survival rate of 100% for the treated teeth was reported in all studies for all groups, while no complete pocket closure was reported. It was not possible to perform a quantitative analysis regarding patients' quality of life. Conclusions For two types of treatment, open flap debridement and open flap debridement with bone graft there is very low-quality evidence that the adjunct of APC when treating infrabony defects may improve probing pocket depth, clinical attachment level, and radiographic bone defect filling. There was insufficient evidence of an advantage in using APC for GTR or EMD.

Effect of the Surgeon's Dominant Hand on Postoperative Periodontal Status of Adjacent Molars After Removal of Lower Third Molars

The purpose was to investigate the effect of the surgeon's dominant hand and the side (right orleft) of surgical removal of third molars in the mandible on the probing pocket depth and probing attachment level on the adjacent secondmolars. This study included 73 patients (46 female and 27 male patients; average age, 15.9±1.9years) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars surgically removed by a right-handed surgeon. The probing pocket depth and probing attachment level (outcome variables), as well as the gingiva and plaque indexes (other variables), were documented preoperatively and 6months after surgical removal. Descriptive and bivariate statistics were computed, and the P value was set at .05. The mean probing pocket depth decreased by 0.69mm on the lower left second molar and by 0.64mm on the lower right second molar over the follow-up of 6months.The mean attachment gain was 0.45mm for the lower left second molar and 0.40mm for the lower right second molar. The side differences between these changes in probing pocket depth (P=.620) and probing attachment level (P=.545) were not significant. The gingival index (P=.029) and plaque index (P=.007) deteriorated significantly for the lower right compared with the lower left second molar. For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent secondmolars.

Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects-A randomized controlled trial.

The present study aims to evaluate and compare the clinical and radiographic changes obtained through Bioactive Glass (BG) with and without autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects in chronic periodontitis patients. The present study was a split-mouth randomized controlled clinical trial comprising 20 chronic periodontitis patients (mean age: 35.9 years) having at least one pair of bilateral intrabony defect. Group 1 included 20 sites treated with a combination of BG and autologous PRF whereas 20 sites in Group 2 were treated with BG alone. Probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR) were evaluated at 3 and 6 months and bone fill at 6 months by using cone beam computed tomography (CBCT) analysis. Primary study outcomes were changes in PPD, CAL, GR, and bone fill. CAL gain was greater in Group 1 (5.05 ± 1.09mm) when compared with Group 2 (4.2 ± 1.70mm). Furthermore, a significantly greater bone fill was found in Group 1. At 6 months, statistically significant reduction in PPD in Group 1 and Group 2 was evident. BG morsel when used in combination with PRF is found to be more effective in gain in CAL, reduction in PPD and achieving greater bone fill as compared with treatment with BG alone in periodontal intrabony defects and is indicative of enhanced periodontal regeneration.

Autologous platelet concentrates for treating periodontal infrabony defects.

Autologous platelet concentrates for treating periodontal infrabony defects.

Stability of Periodontal Healing Distal to the Mandibular Second Molar After Third Molar Coronectomy: A 3-Year Follow-Up Study

The stability of the periodontal attachment distal to the mandibular secondmolar after coronectomy of the third molar is still unclear. This study addressed the question of whether periodontal measures are stable over time among patients undergoing coronectomy. This prospective cohort study enrolled 30 patients treated at the Unit of Oral and Maxillofacial Surgery of the University of Bologna. The predictor variables were the probing pocket depth (PPD), distance between the marginal crest and the bottom of the osseous defect (BOD), and distance between the cementoenamel junction and the BOD. Three points on the distal surface of the secondmolar were recorded: distobuccal, distomedial, and distolingual sites. The distobuccal site was used as the statistical unit. The Wilcoxon test for paired data and Kendall τb were used to evaluate all variables. The significance level was set at P<.05. The 3-year follow-up was completed by 27 patients (7 male and 20 female patients; mean age, 28±7years) with 30 third molars. At 3years, the PPD was 4±1.25mm; no significant changes in PPD were recorded for all sites from 9months to 3years. For the marginal crest-BOD distance and the cementoenamel junction-BOD distance, significant reductions were evident between preoperative values and those at 9 to 36months (P=.001) and between values at 9 and 36months (P=.02). A clinical healthy periodontium distal to the secondmolar was observed 36months after coronectomy. However, further studies are necessary to confirm these preliminary clinical results.

Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial

ObjectivesThe aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment.Material and methodsThirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS).ResultsAfter 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity.ConclusionsThe adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites.Clinical relevanceAdjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions.

Effects of lateral bone augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis.

This systematic review evaluated the evidence on the effect of the interventions aimed for lateral ridge augmentation (both simultaneously with implant placement or as a staged procedure) on peri-implant health or disease. A protocol was developed to answer the following PICO question: "In patients with horizontal alveolar ridge deficiencies (population), what is the effect of lateral bone augmentation procedures (intervention and comparison) on peri-implant health (outcome)?" Included studies were randomised controlled trials or controlled clinical trials with a follow-up of at least 12months after implant loading. Meta-analyses were performed whenever possible, including subgroup analysis based on follow-up. Twelve final publications from eight investigations were included. The results from the meta-analysis indicated that irrespective of the type of intervention, the inflammatory changes, based on bleeding on probing (%) were minimal, both at short- (n=1; weighted mean difference [WMD]=-1.00; 95% CI [-14.04; 12.04]; p=.881) and long-term (n=5; WMD=-5.63; 95% CI [-18.42; 7.16]; p=.881). When comparing different treatment modalities, no significant differences were observed (n=6; WMD=-3.36; 95% CI [-12.49; 5.77]; p<.471). Similarly, changes in probing pocket depth and marginal bone levels were not significantly different among groups. The incidence of peri-implantitis was evaluated in three investigations and varied from 16% to 26% after a follow-up period of 6-8years. The results from this systematic review and meta-analysis have shown that lateral ridge augmentation procedures can maintain peri-implant health over time with low mucosal inflammatory changes and a relatively small incidence of peri-implant bone loss.

The impact of periodontal treatment on inflammatory markers and cellular parameters associated with atherosclerosis in patients after myocardial infarction

IntroductionThe aim of this study was to analyze whether periodontal treatment affects the cardiovascular risk profile of patients after myocardial infarction (MI).Material and methodsThe study included 30 patients with chronic periodontitis (ChP). Sociodemographic and medical variables were collected. Patients were provided with scaling and root planing (SRP) 3 months after MI (1st visit). Periodontal examination and blood tests were performed immediately before SRP, then 1 month and 6 months after treatment (2nd and 3rd visit, respectively).ResultsA statistically significant decrease in blood hsCRP concentration and a decrease in the number of white blood cells (WBC) and neutrophils between the first and the second visit were observed. At 6 months after SRP, the mean platelet volume (MPV) had increased with respect to the value at 1 month after treatment. Multivariate analysis showed that the associations between: 1) change in LDL-C concentration and change in approximal plaque index value (b = –0.546, p = 0.005); 2) change in the number of monocytes and change in the plaque index value (b = 0.616, p = 0.01); 3) change in MPV and change in probing pocket depth (b = 0.567, p = 0.018) are all independent of the classic cardiovascular risk factors.ConclusionsThe obtained results indicate the existence of a relationship between the state of periodontal tissues on one hand and mediators of atherosclerosis and the number of immunologically competent cells on the other hand.

Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults.

Periodontitis is chronic inflammation that causes damage to the soft tissues and bones supporting the teeth. Mild to moderate periodontitis affects up to 50% of adults. Conventional treatment is quadrant scaling and root planing. In an attempt to enhance treatment outcomes, alternative protocols for anti-infective periodontal therapy have been introduced: full-mouth scaling (FMS) and full-mouth disinfection (FMD), which is scaling plus use of an antiseptic. This review updates our previous review of full-mouth treatment modalities, which was published in 2008.

Little evidence for the use of diode lasers as an adjunct to non-surgical periodontal therapy.

Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases. Randomised controlled trials (RCTs) using thermal diode lasers as an adjunct to non-surgical conventional periodontal initial therapy conducted in patients ≥18 years old written in English or Dutch were considered. Study assessment data extraction and quality assessment was carried out independently by two reviewers. The main outcome variables were probing pocket depth (PPD) and clinical attachment loss (CAL), but plaque scores (PS), bleeding scores (BS) and the Gingival Index (GI) were also considered. Meta-analysis was carried out using a random effects model. Nine studies involving 247 patients were included. Seven studies were of split mouth design and two were parallel group studies. The study designs showed considerable heterogeneity and follow up ranged from six weeks to six months. Meta-analysis found no significant effect on PPD, CAL and PS. There was however a significant effect for GI and BS favouring adjunctive use of the diode laser. The collective evidence regarding adjunctive use of the diode laser with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. With respect to BS the results showed a small but significant effect favouring the diode laser, however, the clinical relevance of this difference remains uncertainStandard . This systematic review questions the adjunctive use of diode laser with traditional mechanical modalities of periodontal therapy in patients with periodontitis. The strength of the recommendation for the adjunctive use of the diode laser is considered to be 'moderate' for changes in PPD and CAL.

A 3-year follow-up of ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/A) frameworks for fixed dental prostheses

PurposeZirconia/alumina nanocomposite stabilized with cerium oxide (Ce-TZP/A) shows significantly higher mechanical strength than yttrium-oxide-partially-stabilized zirconia (Y-TZP) and allows post-sintered machining that does not require any subsequent treatment. The aim of this prospective study was to assess the clinical performance of veneered Ce-TZP/A frameworks for fixed dental prostheses. MethodsFifteen patients with 22 Ce-TZP/A fixed prostheses were included in this study. The fixed dental prostheses were cemented with resin cement (baseline) and were evaluated at baseline and at 1, 6, 12, 24 and 36 months after cementation. Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The biologic outcome was judged by comparing the pre-treatment and post-treatment bleeding on probing (BOP), and probing pocket depth (PPD) of the abutment teeth. Radiographic examination was also performed at 12, 24 and 36 months. ResultsThe mean observation period was 35.9±5.5 months. During this period, one abutment tooth was extracted due to root fracture and the survival rate was 95.2%. No significant change in BOP, PPD, and radiographic image was found during the 36-month follow-up period. ConclusionWithin the limitations of this study, Ce-TZP/A was found to provide sufficient stability as a framework material in all regions. Special attention, however, must be paid to designing framework that provides sufficient support for the veneer. Furthermore, studies with longer observation periods and more patients are needed.

The effect of the thermal diode laser (wavelength 808–980 nm) in non‐surgical periodontal therapy: a systematic review and meta‐analysis

What is the adjunctive effect of a diode laser (DL) following non-surgical periodontal debridement (SRP) during the initial phase of periodontal therapy on the clinical parameters of periodontal inflammation. The MEDLINE-PubMed, Cochrane-Central Register of Controlled Trials and EMBASE databases were searched up to September 2013. Probing pocket depth (PPD) and clinical attachment loss (CAL) were selected as outcome variables. Also plaque scores (PS), bleeding scores (BS) and the Gingival Index (GI) were considered outcome measures. Data were extracted and a meta-analysis (MA) was performed where appropriate. Independent screening of 416 unique papers resulted in nine eligible publications. The MA evaluating PPD, CAL and PS showed no significant effect. The only significance favouring adjunctive use of the DL was observed for the outcome parameters GI and BS. The collective evidence regarding adjunctive use of the DL with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. That is for PPD and CAL. The body of evidence considering the adjunctive use of the DL is judged to be "moderate" for changes in PPD and CAL. With respect to BS, the results showed a small but significant effect favouring the DL, however, the clinical relevance of this difference remains a question. This systematic review questions the adjunctive use of DL with traditional mechanical modalities of periodontal therapy in patients with periodontitis.

Efficacy of hyaluronic acid (hyaluronan) in root coverage procedures as an adjunct to coronally advanced flap in Millers Class I recession: A clinical study.

Background:The purpose of this study was to assess the efficacy of hyaluronic acid (HA) in root coverage procedures as an adjunct to coronally advanced flap (CAF) procedure.Materials and Methods:This was a randomized clinical trial with split mouth design, where 10 patients with 20 sites of Millers Class I recession were treated and followed-up for a period of 6 months. CAF procedure was performed, HA was applied onto the experimental sites before suturing the flap. Recession depth (RD) was measured regularly at baseline 1, 3, 6, 12, and 24 weeks postoperatively. Probing pocket depth (PPD) and clinical attachment level (CAL) were also measured along with RD at baseline and 12 and 24 weeks.Results:There was a significant change in RD, PPD, CAL, and percentage of root coverage in both groups when compared to the baseline values. There was no statistically significant difference between experimental and control group in terms of RD (P = 0.917), PPD (P = 0.917) and CAL (P = 0.761). RD was 3.2 mm ± 0.78 mm in experimental site and control sites 2.9 mm ± 0.73 mm reduced to 1.1 mm ± 0.99 mm in experimental sites and 1.0 mm ± 0.66 mm in control sites. Though, there is no statistically significant difference root coverage in the experimental group appeared to be clinically more stable compared with the control group after 24 weeks.Conclusions:This study suggests that use of HA may improve the clinical outcome of root coverage with CAF procedure.

Guided Tissue Regeneration Using a Collagen Barrier and Bone Swaging Technique in Noncontained Infrabony Defects

This clinical study evaluated the effectiveness of guided tissue regeneration using a resorbable collagen membrane and bone swaging in noncontained infrabony defects by assessing changes in probing pocket depth, probing attachment level, and radiographic bone level after 6 months, 1 year, and 2 years. Postsurgical clinical and radiographic measurements were statistically significantly different from presurgical measurements. The rate of bone fill was positively associated with the baseline depth of the bone defect but not associated with the width. The noncontained infrabony defects treated with this combined regenerative method improved clinically and radiographically.

Local antimicrobials in addition to scaling and root planing provide statistically significant but not clinically important benefit

The databases Medline, Embase and the Cochrane Oral Health Group Trials Register were searched. Handsearching of the Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research was also carried out. Randomised controlled trials published in English were included. Risk of bias and quality assessment were conducted following Cochrane recommendations with data being extracted independently in duplicate. Because of the nature of the available data, qualitative summary is presented with meta-analysis conducted where appropriate. The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in probing pocket depth (PPD) and clinical attachment level (CAL), with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in bleeding on probing (BOP) and plaque index (PlI). Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). In conclusion, the scientific evidence supports the adjunctive use of local antimicrobials to SRP in deep or recurrent periodontal sites, mostly when the vehicle has shown pharmacodynamic properties assuring the sustained release of the antimicrobial. This evidence must be interpreted with caution, as the reported data were highly heterogeneous and most of the selected studies were categorised with a high degree of bias.

Clinical and microbiological results following nonsurgical periodontal therapy with or without local administration of piperacillin/tazobactam

We assessed if adjunct administration of piperacillin/tazobactam added clinical and microbiological treatment benefits. Thirty-six subjects (mean age 52.1 years (SD ± 10.3)) (NS by group) with chronic periodontitis were randomly enrolled receiving subgingival debridement and the local administration of piperacillin/tazobactam (test group) or debridement alone (control group). Bleeding on probing (BOP), probing pocket depth (PPD), and microbiological counts of 74 species were studied by checkerboard DNA-DNA hybridization up to month 6 after treatment. Mean PPD changes between baseline and month 6 in the test and control groups were 1.5 and 1.8 mm, respectively (NS between groups). BOP in both groups decreased from about 80 to 40 %. At 4 and 12 weeks, lower counts of the following bacteria were found in the test group (site level): Fusobacterium species, Parvimonas micra, Pseudomonas aeruginosa, Staphylococcus aureus, Tannerella forsythia, Treponema denticola, and a composite load of nine pathogens (p < 0.001). At week 26, subjects receiving local antibiotics had a lower prevalence at tested sites for Fusobacterium nucleatum sp. polymorphum, Fusobacterium periodonticum, P. micra, and T. denticola. At 26 weeks, treatment with or without piperacillin/tazobactam resulted in similar BOP and PPD improvements. At week 26 and at the subject level, the prevalence of 4/74 pathogens was found at lower counts in the group receiving local antibiotics. Administration of piperacillin/tazobactam reduces the prevalence of Fusobacterium, P. micra, and T. denticola to a greater extent than debridement alone but with no short-term differences in PPD or BOP.

A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis

To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. The overall effect of the subgingival application of antimicrobials was statistically significant (p=0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4mm). The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.

Comparative analysis of hyaluronan gel and xanthan-based chlorhexidine gel, as adjunct to scaling and root planing with scaling and root planing alone in the treatment of chronic periodontitis: A preliminary study

Aim:The aim of this study was to evaluate the effects of hyaluronan (HA) and chlorhexidine (CHX) gels as adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis.Materials and Methods:Sixty patients within the age group of 30-65 years recruited to participate in the study were randomly equally divided into three groups. Complete SRP and subgingival debridement were performed within 6 h in all the patients. For control (Group I) patients, SRP was the only treatment modality given; for Group II and III patients, at least 8 teeth with 4-8 mm probing pocket depth (PPD) were selected for subgingival application of HA gel and CHX gel, respectively. Clinical periodontal parameters such as gingival index, PPD, and clinical attachment level (CAL) were recorded at baseline and 3 months, whereas plaque index was recorded at baseline, 1 month, and 3 months. For measuring systemic/hematological parameters, blood samples for laboratory tests for total leucocyte count (TLC), differential leucocyte count (DLC), and C-reactive protein (CRP) were obtained using standard 2-mL syringe from each subject in all the three groups at baseline, 24 h, and on the 1 month and 3 months post-baseline.Results:In all the three groups, a significant reduction in PPD and gain in CAL were observed between baseline and 3 months follow-up (P< 0.05); however, at 3 months, change in PPD and CAL was more in Group II than Group III, but the difference was non-significant, and Group I (control) showed less changes in PPD and CAL than both experimental groups. Only one patient revealed positive value for CRP at baseline only, and hence could not be statistically analyzed. In all the three groups, the peak values for TLC count were observed at 24 h. At 1-month and 3-month intervals, a significant improvement in TLC and DLC counts was observed among the experimental (HA gel/SRP and Xan-CHX gel) groups as compared to control group (SRP alone).

Assessment of periodontal changes in patients undergoing radiotherapy for head and neck malignancy: A hospital-based study

Surgical resection, radio and chemotherapy, either used singly or in combination, are the three most common modalities used in head and neck cancer treatment. These modalities are effective in eradicating the tumor; they also negatively impact the normal head and neck structures surrounding the tumor. Direct damage to the oral structures (soft and hard tissue) frequently occurs from radio and chemotherapy, and indirect damage may also arise from systemic toxicity. This prospective study was designed to analyze the effect of radiotherapy on periodontal parameters in oncology patients prior to irradiation in the head and neck area, compared with 6 months following treatment. The statistical analysis was done using SPSS. The study sample consisted of total 29 patients of head and neck malignancy (M = 17, F = 12), of mean age 45.66 years. Only 22% of patients had various habits (smoking, tobacco chewing, and alcohol consumption) and majority (27.59% patients) had tongue malignancy. All periodontal parameters - oral hygiene index Siller (OHIS), clinical attachment level (CAL), gingival recession (GR), except probing pocket depth (PPD) - were significantly increased after radiotherapy. When comparison was made between doses and fractions, only in mandible statistically significant difference were observed in GR. Although there was no significant change in PPD, there was increased GR, CAL, and plaque index associated with radiotherapy. In this study, 61.5% cases of mandibular teeth and 34.4% cases of maxillary teeth showed attachment loss greater than 0.2 mm. So, all patients with head and neck malignancy should undergo an oral examination before the initiation of cancer therapy with adequate prophylaxis.