Reduction In Clinical Attachment Level Research Articles

Assessing the Impact of Stem Cell-based Therapy on Periodontal Health: A Meta-analysis of Clinical Studies.

While clinical trials exploring stem cells for regenerating periodontal tissues have demonstrated positive results, there is a limited availability of systematic literature reviews on this subject. To gain a more comprehensive understanding of stem cell interventions in periodontal regeneration, this meta-analysis is undertaken to assess the beneficial effects of stem cells in human periodontal regeneration. "PubMed," "Cochrane Library," "Web of Science," "Embase," "Wanfang," and "CNKI," were used to extract clinical studies related to the utilization of stem cells in repairing periodontal tissue defects. This search included studies published up until October 5, 2023. The inclusion criteria required the studies to compare the efficacy of stem cell-based therapy with stem cell-free therapy for regenerating periodontal tissues. Meta-analysis was conducted using Review Manager software (version 5.4). This meta-analysis synthesized findings from 15 selected studies investigating the impact of stem cell interventions on periodontal tissue regeneration. The "stem cell" group displayed a substantial reduction in clinical attachment level (CAL) compared to the "control" group within 3 to 12 months post-surgery. However, no significant differences in CAL gain were found between groups. Probing pocket depth (PPD) significantly decreased in the "stem cell" group compared to the "control" group, particularly for follow-up periods exceeding 6 months, and dental stem cell treatment exhibited notable improvements. Conversely, no significant differences were observed in PPD reduction. Gingival recession (GR) significantly decreased in the "stem cell" group compared to the "control" group at 3 to 12 months post-surgery. No significant differences were observed in GR reduction between groups. No significant differences were identified in cementoenamel junction-bone distance reduction, infrabony defect reduction, or bone mineral density increase between the two groups. Furthermore, no significant changes were observed in the gingival index, plaque index, or width of keratinized gingiva. In conclusion, while stem cell-based therapy offers promising prospects for periodontal defect treatment, there are notable limitations in the current body of research. Larger, multicenter, double-blind RCTs with robust methodologies are needed to provide more reliable evidence for stem cell-based intervention in periodontitis.

Community Water Fluoridation and its Influence on Periodontal Health in Different Age Groups.

Community water fluoridation is a well-recognized public health initiative known for its efficacy in preventing dental cavities. The positive effects of fluoride on tooth enamel have led to widespread implementation of water fluoridation programs. This cross-sectional study involved 1,000 participants from diverse age groups, spanning children, adolescents, adults, and older adults, residing in both fluoridated and non-fluoridated communities. Comprehensive periodontal assessments included measurements of probing depth (PD), clinical attachment level (CAL), and the presence of gingival inflammation. Participants were categorized into "fluoridated" or "non-fluoridated" groups based on their residential history. Fluoridated communities consistently displayed lower mean PDs, CALs, and rates of gingival inflammation across all age groups. Notably, the reduction in PD and CAL reached approximately 0.5 millimeters and 0.3 millimeters, respectively, while the decrease in gingival inflammation ranged from 3% to 5. This study suggests a potential link between community water fluoridation and enhanced periodontal health, as evidenced by improved PDs, CALs, and reduced gingival inflammation.

Assessing the Impact of Smoking Cessation Interventions on Periodontal Health and Gingival Inflammation in Smokers with Periodontitis

ABSTRACT Background: Smoking is a well-established risk factor for periodontitis, a chronic inflammatory disease of the oral cavity. While smoking cessation has been linked to improved overall health, its specific impact on periodontal health and gingival inflammation in individuals with periodontitis remains less explored Materials and Methods: We conducted a prospective cohort study involving 200 smokers diagnosed with periodontitis. Participants were divided into two groups: Group A received comprehensive smoking cessation interventions, including counseling and pharmacotherapy, while group B continued smoking without intervention. Periodontal health was assessed through clinical parameters, including probing depth (PD) and clinical attachment level (CAL), at baseline and 6 months post intervention. Gingival inflammation was evaluated using the Gingival Index (GI). Results: After 6 months, group A exhibited a significant reduction in mean PD (from 4.5 mm to 3.2 mm) and CAL (from 5.0 mm to 3.5 mm) compared to group B. Conversely, group B showed no significant change in these parameters. The GI score significantly decreased in group A (from 2.8 to 1.2) but remained unchanged in group B. Furthermore, group A demonstrated a higher rate of smoking cessation (72%) compared to group B (14%) Conclusion: Smoking cessation interventions play a crucial role in improving periodontal health and reducing gingival inflammation in smokers with periodontitis. The observed reductions in PD, CAL, and gingival inflammation highlight the potential benefits of smoking cessation on oral health outcomes in this high-risk population.

Adjunctive effect of collagen membrane coverage to L-PRF in the treatment of periodontal intrabony defects: a randomized controlled clinical trial with biochemical assessment

BackgroundThe innovation of leukocyte platelet-rich fibrin (L-PRF) has added enormous impact on wound healing dynamics especially the field of periodontal regeneration. The release of growth factors (GF) is thought to improve the clinical outcomes in infrabony defects. The aim of this study was to evaluate the clinical effect of covering L-PRF contained infrabony defects with collagen membranes (CM), and to compare their GF release profile to uncovered L-PRF defects and open flap debridement (OFD).MethodsThirty non- smoking patients with infrabony pockets participated to be randomly assigned to OFD group (n = 10), L-PRF group (n = 10), or L-PRF protected CM group (n = 10). Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and the radiographic defect base fill (DBF) were measured at baseline and at 6 month following surgical intervention. Gingival crevicular fluid samples were obtained on days 1, 3, 5, 7, 14, 21 and 30 days following surgery for the Platelet Derived Growth Factor-BB (PDGF-BB) and Vascular Endothelial Growth Factors (VEGF) release profile evaluation.ResultsFor all patients, a statistically significant (P ≤ 0.05) reduction in PI, GI, PD and CAL were reported throughout the study period. Differences between the three treatment modalities were not statistically significant. PRF + CM showed a statistically significant DBF compared to OFD and L-PRF groups at follow up. Quantitative analysis of PDGF-BB and VEGF levels demonstrated a statistically significant (P < 0.001) decline between measurement intervals for all groups with no statistically significant differences between the three groups.ConclusionWithin the limitations of this study, L-PRF coverage with CM may augment defect base fill through its mechanical protective effect without enhancement in the release profile of VEGF and PDGF. The non-significant intergroup differences question the validity of the claimed extra physiologic concentration of GF offered by L-PRF harvests.Trial registrationThe present study was registered at ClinicalTrials.gov (NCT05496608), (11/08/2022).

Third Molar Coronectomy vs Total Removal in Second Molar Periodontal Healing

The objective of this randomised controlled trial was to compare the periodontal healing at the distal of the adjacent second molar after coronectomy or surgical removal and the surgical morbidities of the 2 techniques. This is a pilot study of a split-mouth randomised clinical trial comparing the periodontal healing of the adjacent second molar after coronectomy or total removal of lower third molars, which was registered with the University of Hong Kong Clinical Trial Centre as HKUCTR-2948 on 21 February 2020. Cone beam computed tomography (CBCT) scans were taken preoperatively and at 6 months postoperatively. Changes in the bone level from the cemento-enamel junction, periodontal probing depth (PPD), and clinical attachment level (CAL) at the distal of the adjacent second molar were compared. Surgical morbidities in terms of pain, infection, neurologic deficit, root exposure, and need for second surgery for removal were assessed. Forty patients (22 male, 18 female) with mean age of 26.7 years were evaluated at 6 months postoperatively. Both coronectomy and total removal groups demonstrated statistically significant reduction in PPD and CAL. There was an alveolar bone gain of 1.28 ± 0.88 mm in the coronectomy group and 1.13 ± 0.73mm in the control group, which was statistically significant (P < .001 for both groups). Early findings show the periodontal healing at the adjacent second molar of coronectomy was as good as that of total removal of lower third molar. There were no differences in terms of surgical morbidities between both groups.

Effect of interproximal home oral hygiene on clinical parameters and inflammatory biomarkers in patients receiving periodontal maintenance.

The purpose of this 6-week, single-blinded, randomized clinical trial was to determine if the use of an interproximal brush, with or without a tracking device, is more effective than an oral irrigator in improving interproximal probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and inflammatory markers. Seventy-six patients with Stages III-IV, Grade B periodontitis and a 5-7mm posterior interproximal PD with BOP were randomized: (1) interproximal brush alone (IB; n=26), (2) interproximal brush with tracking device (TD; n=23), (3) oral irrigator (OI; n=27). Participants used devices once daily for 6weeks. Clinical measurements (PD, CAL, PI, BOP, GI) and gingival crevicular fluid (GCF) samples were collected at baseline and 6weeks. All groups showed a significant reduction in PD and CAL (≥1.1mm, p<0.0001) and improvement in BOP (≥56%, p<0.0001) and GI (≥82%, p<0.001) at the experimental site with no differences among groups. The IB and IB+TD groups showed a significant reduction in PI (≥0.9, p ≤ 0.01). Interleukin (IL)-1β was reduced in all groups (p=0.006), but IB+TB more than OI (p ≤ 0.05). IL-10 was reduced among all groups (p=0.01), while interferon-gamma significantly increased (p=0.01) in all groups. IB and OI improved clinical parameters of PD and CAL and reduced inflammatory markers (BOP, GI, GCF IL-1β). IB had better interproximal plaque reduction. Tracking did not significantly improve clinical parameters compared with the IB and OI groups, suggesting future modifications are needed.

Salivary cytokine expression after non-surgical periodontal therapy in smokers: 12-month follow-up.

Diverse smoking trajectories may influence cytokine expression after non-surgical periodontal therapy and supportive periodontal care. Thus, we aimed to describe cytokine profiles in periodontal healing after periodontal therapy in smokers. A smoking cessation program and non-surgical periodontal therapy were offered to 80 smokers with periodontitis. Smoking trajectories (quitters/light, moderate, heavy) were observed. The association of salivary interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) with smoking trajectories and periodontal outcomes was determined using mixed-effects linear regression. Among quitters/light smokers, IL-1β was associated with an increase in mean periodontal pocket depth (PPD) and mean clinical attachment level (CAL). IL-6 was associated with a decrease in mean PPD and CAL in heavy smokers, whereas IL-8 was associated with a decrease in PPD among moderate smokers. TNFα was associated with a reduction in mean PPD and CAL among quitters/light smokers, while among moderate smokers, TNFα was associated with an increase in mean PPD and CAL. IL-12 and IL-13 were associated with a decrease in mean PPD in moderate smokers. Our findings suggest that distinctive smoking exposures induce differential cytokine expression, which, in turn, seems to influence periodontal repair.

Comparative Evaluation of Injectable Platelet Rich Fibrin (I-PRF) with DFDBA and Titatium Prepared Platelet Rich Fibrin (T-PRF) with DFDBA In The Treatment of Infrabony Defects In Chronic Periodontitis Patients - A Clinico-Radiographical Study

Objectives: The main objective of this study was to evaluate the efficacy of Titanium prepared platelet-rich Fibrin (T-PRF) and Injectable Platelet Rich Fibrin (I-PRF) with demineralized freeze-dried bone allograft (DFDBA) in order to improve the clinical and radiographic results obtained in treatment of periodontal infrabony defects.&#x0D; Materials and Methods: This split-mouth randomized controlled clinical trial was conducted on 30 subjects with two comparable bilateral infrabony defects. Plaque Index(PI), Gingival Index(GI) Clinical attachment level (CAL), Periodontal Pocket depth (PD), as well as radiographic parameters IOPA including the radiographic defect size, were measured at six months post-operatively.&#x0D; Results: The mean reductions in PD and CAL were 4.0±0.77 mm and 2.5±0.68 mm in sites treated with I-PRF+DFDBA, respectively (P&lt;0.05); these reductions were 4.2±0.86 mm and 3.1±0.62 mm, respectively in T-PRF+DFDBA group (P&lt;0.05). Radiographic evaluation revealed reduction in the radiographic defect size in the I-PRF+DFDBA and T-PRF+DFDBA sites. Statistically, there were no significant differences between the two treatment modalities.?&#x0D; Conclusion: This study showed that both treatments resulted in significant improvement in the probing depth reduction, clinical attachment level gain and radiographic size of the infrabony defect at six months after surgery. I-PRF with DFDBA membrane in treatment of infrabony osseous defect showed more defect fill followed by T- PRF along with DFDBA membrane.

Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis.

This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery. Prospective studies including patients with third molars requiring removal, with at least 6months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors. Fourteen studies were included in the quantitative synthesis. At 6months, the PPD reduction was 1.06mm (95% CI, 0.72 to 1.39mm) and the remaining PPD was 3.81mm (95% CI, 3.00 to 4.62mm). Baseline PPD was strongly correlated with the remaining PPD at 6months (p < 0.001, adjusted R2 = 70.05%). Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects. This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.

Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial.

(1) Background: This study compared the clinical and esthetic results of the double lateral sliding bridge flap (DLSBF) and the laterally closed tunnel (LCT) techniques, with a subepithelial connective tissue graft (SCTG), for the treatment of single Miller class II-III recessions in the mandibular anterior teeth. (2) Methods: This pseudorandomized clinical trial evaluated 14 patients, 7 of whom were part of the DLSBF + SCTG group, with an average follow-up of 58.7 ± 24.0 months, and 7 of whom were in the LCT + SCTG group, with an average follow-up of 16.7 ± 3.3 months. Clinical and esthetic evaluations of the following parameters were performed and the results for the two groups were compared: gingival recession depth, probing depth, keratinized tissue width, gingival thickness, percentage of root coverage and root coverage esthetic score. (3) Results: After the follow-up period, each technique provided evidence of a reduction in recession depth and clinical attachment level, as well as increased keratinized tissue width and gingival thickness, with statistically significant differences (p < 0.05). The analysis showed that gingival recession depth decreased less in the DLSBF group (4.3 ± 1.2 mm to 0.6 ± 1.1 mm) than it did in the LCT group (4.9 ± 1.1 mm to 0.1 ± 0.4 mm), but no significant difference was found between the two groups. Similarly, a greater reduction in the clinical attachment level parameter was observed in the LCT group, while a greater increase in gingival thickness was observed in the DLSBF group. The presence of scars was the only parameter for which statistically significant differences (p < 0.05) between the two study groups were found. (4) Conclusions: Within the limitations of the study, it indicates that the LCT + SCTG technique may be considered an optimal technique in terms of reducing gingival recession depth, complete root coverage and esthetic results for the treatment of single gingival recessions in the mandibular anterior teeth.

Semilunar vestibular incision technique for treatment of multiple gingival recession in maxillary teeth - An evaluative study.

Recession is a mucogingival condition affecting teeth causing hypersensitivity. Although many techniques are there for recession coverage, semilunar vestibular incision technique (SVIT) is a novel procedure for management of multiple gingival recession in maxillary teeth. To evaluate the efficacy of root coverage in maxillary teeth with multiple gingival recession using SVIT. Twenty systemically healthy patients were recruited with Miller's class I and II gingival recessions in maxillary teeth. Parameters such as recession height (RH), recession weight (RW), avascular surface area (ASA), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and clinical attachment level (CAL) were measured at baseline three and six months post-surgery. The outcome measures were statistically significant at baseline, three and six months. A reduction of 86% was achieved in terms of RH and RW. Gain in WKG and WAG as achieved at six-month follow-up was 31.5% and 55%, respectively. An 87% decrease in ASA was obtained and reduction in CAL was 82.4%. Between three and six months there was a significant increase in WAG. SVIT results in improved measures of attached gingiva on six-month follow-up.

Evaluation of Platelet-Rich Fibrin Matrix as a Regenerative Material in the Surgical Management of Human Periodontal Intraosseous Defects - A Randomized Controlled Trial.

Background: Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects.Materials and Methods: Fifteen patients (age: 30–55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction.Results: The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%).Conclusion: PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.

Comparative evaluation of 5% Moringa oleifera and 0.2% Chlorhexidine subgingival irrigation as a supplement to non-surgical pocket therapy in Stage I and Stage II Periodontitis: A Clinical study

Background: Although scaling and root planing (SRP) are the gold standard in nonsurgical periodontal treatment, it does not ensure complete eradication of all putative periodontal pathogens. So, subgingival irrigation is performed in addition to non-surgical debridement for removing periodontal pathogens by both mechanical and chemical action. The goal of the present study was to assess and compare the clinical efficacy of two episodes of subgingival irrigation using 0.2 percent chlorhexidine and 5% moringa oleifera combined with SRP. Materials and Methods: Totally 15 patients with less than or equal to 4 mm of attachment loss as seen in Stage I and Stage II Periodontitis were recruited. From each patient, 2 periodontal pockets that are not adjacent and have a probing depth of minimum 6 mm were selected. Each patient's two deep periodontal pockets were given irrigation treatments, one with CHX digluconate 0.2 percent (control group) and the other with Moringa oleifera 5 percent (test group) in two episodes. Pre-irrigation (day 0), days 7, and 28 post-irrigation measurements of the plaque index (PI), gingival index (GI), probing pocket depth (PD), and clinical attachment level (CAL) were recorded. Results: Following irrigation, the mean PI and GI scores decreased for both groups, with the moringa group experiencing a statistically significant greater decrease than the chlorhexidine group. The Moringa group had a greater reduction in PD and CAL than the CHX group. Conclusion: The clinical outcomes of this investigation imply that subgingival irrigation with 5 percent Moringa oleifera may be an effective adjunctive treatment for patients with chronic periodontitis.

Use of Collagen Membrane in the Treatment of Periodontal Defects Distal to Mandibular Second Molars Following Surgical Removal of Impacted Mandibular Third Molars: A Comparative Clinical Study.

Simple SummaryRegeneration of the wounded/lost tissues post-surgery often requires a meticulous treatment plan. The present study assessed the use of a collagen membrane to aid in the regeneration of lost periodontal tissues following extraction of the tooth. The results show that the collagen membrane promoted wound stabilization, as indicated by improvement in all assessed clinical parameters. Thus, collagen membrane can be used regularly in clinical practice post-extraction to augment wound healing.The study aims to assess the efficacy of using collagen membrane in the treatment of distal periodontal defects of mandibular second molars following the removal of mesioangularly or horizontally impacted mandibular third molars surgically. Forty sites in twenty patients with bilaterally impacted mandibular third molars (mesioangular or horizontal) were considered for the study. In 20 test sites (Group A), after surgical removal of the mandibular third molar, a resorbable collagen membrane barrier was placed on the distal aspect of the mandibular second molar to cover the post-surgical bone defect. In the other control 20 sites (Group B), the same surgical procedure was repeated without placing any membrane barrier. The clinical parameters recorded were Oral Hygiene Index Simplified (OHI-S), Probing pocket depth (PPD), Clinical attachment level (CAL), and radiographic assessment of alveolar bone level (ABL). OHI-S score of most of the patients was observed to be satisfactory. Group A was observed to achieve a statistically significant reduction in PPD, CAL, and ABL gain compared to Group B. The improvements indicated that the use of collagen membrane facilitates early wound stabilization and promotes primary closure of the defect. This recovery is achieved through its unique property to assist fibrinogenesis over osteoconduction. Further longitudinal studies are needed to confirm the present findings.

Efficacy of Nd:YAG laser-assisted periodontal therapy for the management of periodontitis: A double-blind split-mouth randomized controlled clinical trial.

This study aimed to explore the efficacy of Nd:YAG laser-assisted periodontal therapy for management of patients with stage II-IV periodontitis. Patients who presented with residual periodontal pockets were enrolled. After non-surgical periodontal therapy (NSPT), test sites received Nd:YAG laser (first entrance to pocket: 3 W, 100 μs, 20Hz; second entrance: 4 W, 600 μs, 20Hz) and control sites received placebo (laser off). Periodontal probing depth (PPD), clinical attachment level (CAL), gingival recession (GR), bleeding on probing (BOP), and plaque index (PI) were recorded at baseline and 1, 2, 3, 4 and 6-month visits. Twenty patients completed the 6-month period. Significant reductions in PPD, CAL, BOP, and PI values and a significant increase in GR at all follow-up visits compared to the baseline (all P<0.001) were revealed in both groups. Test sites showed significantly greater improvement in PPD (P=0.0002) and greater increase in GR (P<0.0001) compared to the control sites at 6-month visit. There was no difference between two groups regarding CAL gain through the study period (P=0.23). NSPT+Nd:YAG laser with the current protocol results in greater PPD reduction compared to NSPT alone. However, this reduction is likely because of greater GR rather than attachment gain. Therefore, the adjunction of Nd:YAG laser (with the current setting) to the NSPT for the treatment of residual periodontal pockets did not ameliorate the clinical outcomes (ClinicalTrials.gov ID: NCT03365167).

The effects of topical erythropoietin on non-surgical treatment of periodontitis: a preliminary study

BackgroundThe purpose of periodontal treatments is to reduce inflammation, restore gingival health and clinical attachment level gain by controlling microbial plaque formation and other etiological factors. One of the drugs that has been tested in many areas and shown good anti-inflammatory properties is erythropoietin (EPO). We evaluated the effect of this drug on the improvement of periodontitis after the phase I treatment.MethodsThis study was conducted on 30 patients with stage III periodontitis who had at least two bilateral teeth with CAL of ≥ 5 mm and PPD ≥ 6 mm at ≥ 2 non‐adjacent teeth and bleeding on probing. After oral hygiene instruction and scaling and root planning (SRP), EPO gel containing a solution of 4000 units was applied deeply in the test group and placebo gel was deeply administered in the control pockets (5 times, every other day). The clinical parameters of the plaque index (PI), gingival index (GI), clinical attachment level (CAL), probing depth (PD) and bleeding index (BI) were measured at baseline and after three months of follow up. The P-value was set at 0.05.ResultsAll clinical variables improved after treatment in both groups. The BI and GI scores (which reflects the degree of gingival inflammation) showed statistically more reduction in test group. The CAL decreased from 5.1 ± 4.1 to 3.40 ± 2.71 mm; and 5.67 ± 4.32 to 4.33 ± 3.19 mm in test and control group, respectively (P < 0.00). After the treatment, there was a significant greater reduction in CAL and also PD values in test group (P < 0.01).ConclusionLocal application of EPO gel in adjunct to SRP can improve clinical inflammation and CAL gain in periodontitis.Trial registration: This study was registered at 2017-11-06 in IRCT. All procedures performed in this study were approved with ID number of IR.TUMS.DENTISTRY.REC.1396.3139 in Tehran University of medical science.

Effectiveness of Chitosan Nanohydrogel as a Bone Regenerative Material in Intrabony Defects in Patients With Chronic Periodontitis: A Randomized Clinical Trial

Aim: Different procedures have been attempted to regenerate intrabony defects in periodontitis but complete regeneration is still a herculean feat. Nanoparticles could prove to be advantageous because of their small size and increased surface area. The aim was to evaluate the effectiveness of a chitosan nanohydrogel as a periodontal regenerative material in the management of intrabony defects. Materials and Methods: Twenty patients within the age group of 30 to 60 years with intrabony defects &gt;3 mm and clinical attachment levels &gt;5 mm were selected. They were divided randomly into two groups: group-1, which received only open flap debridement with bone graft and acted as control, and group-2, which received open flap debridement, bone graft mixed with a chitosan nanohydrogel, and acted as the test site. Clinical and radiographic measurements were recorded at baseline, three months, and six months. Intragroup comparison was done using a paired t-test and intergroup comparison was done using an unpaired t-test with the statistical value set at P &lt; .05. Results: Chitosan hydrogel incorporated bone grafts showed improved bone regenerative potential. The mean reduction in clinical attachment level in group-2 (8.7 ± 0.6 to 1.6 ± 0.8) was significantly higher than that of group-1 (8.6 ± 0.5 to 2.4 ± 0.7). The mean reduction in probing depths in group-2 (test group) was significantly higher (8.3 ± 0.9 to 1.6 ± 0.8) when compared to group-1 (8 ± 0.8 to 2.3 ± 0.7). Significant amount of defect fill was obtained in both the groups from baseline to six-month period. Conclusion: Organic materials such as chitosan could have potential bone regenerative capacity.

Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis.

This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value. From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW. The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use. To know if EMD could improve the results for root coverage.

Comparison of Subgingival Irrigation Effect of Boric Acid 0.5% and Povidone-Iodine 0.1% on Chronic Periodontitis Treatment.

To comparatively evaluate the effect of a 5% boric acid (BA) irrigant on periodontal condition, bacterial level and oral neutrophil numbers with a 1% povidone iodine (PVP-I) irrigant as an adjunct to scaling and root planing (SRP) in chronic periodontitis (CP) treatment. A single-masked, randomised clinical trial with 36 CP patients was conducted at the Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Subjects were randomly divided into two treatment groups: 1) SRP plus PVP-I 0.1% irrigant and 2) SRP plus BA 0.5% irrigant. Clinical measurements, including the plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), bacterial level in subgingival plaque (BANA test) and the quantification of oral neutrophils were evaluated at baseline, 4, 6 and 8 weeks after treatment (T0, T4, T6 and T8). Whole-mouth (PI, GI, BOP, PD, CAL and PD) parameters, bacterial level in subgingival plaque and number of oral neutrophils decreased statistically significantly after treatment compared to baseline in both groups (p < 0.01). Between the two groups, whole-mouth PI, GI, BOP, PD and CAL reduction in the BA 0.5% group were higher than those in the PVP-I 0.1% group, but statistical significance was found only for GI and BOP after treatment (p < 0.05). The PD and CAL reductions for moderately deep pockets (PD ≥ 5 mm and < 7 mm) were significantly greater in group 2 compared to group 1 after treatment compared to baseline (p < 0.01). This difference was not found for deep pockets (PD ≥ 7 mm). The results of this study suggest that BA 0.5% could be an alternative to PVP-I 0.1%, and might be more favourable because it provided superior results regarding whole-mouth BOP, GI as well as PD and CAL reduction for moderately deep pockets after CP treatment.

Root surface demineralization by citric acid/tetracycline gel and aPDT associated to subepithelial connective tissue graft improves root coverage outcomes. A 12-month preliminary randomized clinical trial

Root conditioners are used to promote root surface biomodification to increase the success rate of root coverage. Citric acid and tetracycline are commonly used. There is recent indication for using antimicrobial photodynamic therapy (aPDT) with this purpose. The aim of this study is to evaluate the effects of citric acid/tetracycline gel and aPDT in root coverage of gingival recessions using subepithelial connective tissue graft. This parallel, double-blinded clinical trial enrolled 17 patients (60 recession defects; 20/group). Experimental groups were: Control group (SRP) - scaling and root planing only; Citric acid/tetracycline gel (CAT) group - SRP plus citric acid/tetracycline gel; aPDT - SRP, toluidine blue O (100 μl/ml) and red laser. At baseline and after 3, 6 and 12 months, the clinical parameters were evaluated: recession depth (RD), percentage of root coverage (%RC), keratinized tissue width (KTW), soft tissue thickness (STT), probing depth (PD), clinical attachment level (CAL), dentin hypersensitivity (HYPER) and esthetic perception by patient (EST). CAT group presented reduction in PD, CAL, RD, increase in KTW and STT, higher %RC (81.6%) and better esthetic in relation to SRP group (p < .05). aPDT treatment promoted CAL reduction, gain of KTW and STT and higher %RC (82.1%) in relation to SRP (57.7%) (p < .05). There was a reduction in dentin sensitivity in all groups. Complete root coverage was higher for CAT group (65%) and aPDT group (70%) in relation to SRP (30%) (p < .05). Root conditioning, with citric acid/tetracycline gel and aPDT, promotes better long-term clinical outcomes and root coverage after SCTG procedures.