Root Planing Research Articles

Evaluating the Effects of Diode Laser 940 nm Adjunctive to Conventional Scaling and Root Planning for Gingival Sulcus Disinfection in Chronic Periodontitis Patients

Background: Chronic periodontitis (CP) can lead to the loss of tooth-supporting structures. Scaling and root planning (SRP) is the standard treatment, but lasers may provide additional benefits. This study evaluated a 940 nm diode laser as an adjunct to SRP for CP treatment. Methods: In this split-mouth, randomized clinical trial, 32 CP patients with at least two teeth with a pocket depth of more than 4 mm were treated with regular treatment of SRP plus health education with or without the intervention group. Further, a 940 nm diode laser was applied for the decontamination of the gingival groove. Probing pocket depth, clinical attachment loss (CAL), gingival index (GI), bleeding on probing (BOP), and plaque index (PI) were evaluated at baseline, 4 weeks, and 8 weeks after scaling. The data were analyzed by SPSS software (version 21), where descriptive methods and statistical tests such as the analysis of variance test were used with repeated measurements, and P<0.05 was accepted as statistically significant. Results: All parameters improved significantly in both groups (P<0.05), except for GI, which decreased significantly more with a laser versus SRP alone (P<0.05). The results revealed no other statistically significant between-group differences. Conclusion: The adjunctive diode laser provided limited additional improvements compared to SRP alone over 8 weeks. The significant GI reduction indicated that a diode laser may provide some benefits for enhancing non-surgical periodontal treatment. Larger trials are needed to determine if this extra improvement is clinically meaningful in the long term. Clinical Relevance: Diode laser adjuncts to SRP demonstrated minimal short-term benefits over SRP alone in CP patients. The role of lasers in periodontal therapy requires further study. Trial Registration: IRCT20120215009014N234 (retrospectively registered).

Systemic Observation-Surgical Periodontic Approach In The Management Of Amlodipine Induced Gingival Enlargement

Background: Drug induced gingival enlargement is frequently observed in patients taking three main group of drugs like calcium channel blockers (CCBs), immunosuppressant’s and anticonvulsants. Amlodipine belongs to the dihydropyridine-a third generation calcium channel blockers agents that may cause the side effect of drug-induced gingival enlargement and oral bacteria intervention due to calculus retention. This case report describes the management of gingival enlargement in a hypertensive patient taking amlodipine. Purpose: This case report was aimed to discuss the treatment and maintenance of systemic observationsurgical periodontic approach to restore gingival enlargement. Case Report: A 47-years old man was referred to the Department of Periodontology, Faculty of Dentistry, Airlangga University complaining of swellings and bleeding on his gingiva in all region. He felt very uncomfortable as the swelling interfered while chewing and sometimes there was bleeding spontaneously and halitosis. He had hypertension since 5 years and was on medications Captopril 12,5 mg daily during 4 years and Amlodipine 5mg daily during last 1 year. A provisional diagnosis and systemic observation-periodontal phases treatment were taken to restore gingival enlargement condition. Case Management: Systemic observation of medication use, periodontal phases treatment such as scaling root planning, periodontal surgery as flap surgery, home oral hygiene maintenance, control recall every month during first 3 months were taken. Conclusion: The successful of combination carefully systemic observation-surgery periodontal approach are promising to maintain Amlodipine induced gingival enlargement.

Clinical and Microbiological Evaluation of Diode Laser and Systemic Doxycycline as an Additive to Scaling and Root Planing for Stage II and Stage III Periodontitis Patients.

To assess and contrast the effectiveness of systemic doxycycline and diode laser as supplements to scaling and root planing (SRP) in terms of clinical and microbiological parameters. A total of 33 patients diagnosed with periodontitis stages II and III were included and randomized into group A (SRP + diode laser), group B (SRP + doxycycline), and group C (SRP alone). Selected sites were assessed for clinical and microbial parameters-plaque index (PI), gingival index (GI), pocket probing depth (PPD), relative attachment level (RAL), and colony-forming units (CFUs). Every clinical parameter was noted at baseline and after three months. The arithmetic mean, followed by the standard deviation, was calculated for the required assessment intervals. Analysis of variance (ANOVA) was used to compare all parameters between groups, and if the results of the ANOVA test were significant, post hoc analysis was performed. For intragroup comparison, student t-tests were performed. The clinical parameters significantly improved within three months for all groups. In terms of relative attachment level, a statistically significant difference (P < 0.001) was obtained at the three-month interval compared to the baseline value, with the most statistically significant difference seen in group A (3.36±0.50 to 0.64±0.50), followed by group B (3.18±0.40 to 2.18±0.40). The mean pocket probing depth observed at three months, compared to the baseline value, showed a statistically significant difference (P < 0.001) in group A (5.91±0.70 to 2.18±0.40) compared to group B (6.18±0.75 to 4.36±0.50), followed by group C (5.82±0.75 to 5.27±0.64). The use of diode laser-assisted pocket disinfection and systemic doxycycline, in addition to scaling and root planing, has proven to be efficient for treating periodontal pockets.

Efficacy of photodynamic therapy as an adjunct to scaling and root planing on clinical parameters and microbial composition in subgingival plaque of periodontitis patients: A split-mouth randomized clinical trial.

The aim of this study was to assess the efficacy of photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) on clinical parameters and microbial composition in subgingival plaque of periodontitis patients. Seventeen patients were included in this split-mouth randomized clinical trial. Sites with probing pocket depth (PPD) ≥5mm in combination with bleeding on probing in different quadrants were randomized into the control group, the group with a single PDT application right after SRP, and the group with three repeated PDT applications 1week after SRP. The subgingival plaque was collected for 16S rRNA gene sequencing at baseline, Week 2, and Week 8. Seventeen patients with 60 sites completed this 8-week follow-up, and 157 subgingival plaques were successfully analyzed by sequencing. Significant improvements were observed in two primary outcomes: PPD at Week 8 and subgingival microbial composition. Compared to the control group, the repeated-PDT group showed a notable improvement in PPD, substantial alterations in the microbial profile, including a reduction in α-diversity and anaerobic bacteria, and an increase in aerobic bacteria at Week 2. Secondary outcomes, such as clinical attachment level and sulcus bleeding index, also showed improvement at Week 8. Furthermore, both the single- and repeated-PDT groups exhibited a decrease in periodontopathogens and an increase in beneficial bacteria compared with baseline. PDT promotes changes in the microbial composition of periodontitis patients' subgingival plaque in a direction favorable to periodontal health, and repeated PDT is a promising adjunctive therapy for periodontal treatment.

Radiographic evaluation of the S2-complex drug on the alveolar bone height

The S2-complex drug is a chemical preparation of a low molecular weightsynthetic organometalic complex, and it has experimented in many researches to proveit’s activity in the treatment of the cancerous tumors, without any side effects. This drugis a potent immunomodulat or that stimulates both, the humoral a.nd cell mediated,immune responsesTo examine the effect of S2—complex administered locally and was designed totest the potential effectiveness of S2-complex in the management of periodontal disease.associated bone loss by radiographic evaluationThirty six pairs of similarly involved periodontal pockets in (20) patients agedbetween (30-50) years old with pocket depth more than 6 mm were selected. Split mouth,randomized study was carried out. Scaling and root planing was carried out in both sidesin test side received S2- complex for five days in a daily dose of O.l mm/kg injecteddeeply until reaching the bone of affected site, while the control side was received distalwater for 5 days in a daily dose of 0.l mm/kg injected in the same way as that for testside. S2 complex was infiltrated locally through the gingival tissue of the effected site.deeply until reach the defect bone using disposable insulin syringesClinical attachment level of gingiva were recorded at baseline and repeatedonce every 2 weeks. Periapical radiographs were taken for both test and control sides atbaseline and at the termination of the treatment after 2 months. A long the time of study,the patients put on a program of motivation to keep a good stander of oral hygieneClinical and radiographical parameters in general showed improvement with both test.and control groups, with a statical significant difference between themRadiographical evaluation showed high differences in hight and density of bone forboth groups, and effect to S2-complex was on sites of anterior and molar areas according

Roduction of Polyvinyl Pyrrolidone (PVP) in the non surgical periotherapy of aggressive periodontitis

The non surgical periotherepy are based on the baeteriologic back ground ofperiodontal diseases. More than 46 different verulant species were composing thebacterial flora. Tetracyclin , Doxycyline , Minocyline were used systemically and / ortopicaly in association with conventional scaling and root planning , as wellchlorhixidine and wide variety of antiseptics were used . Generalized and localizedaggressive periodontitis being a complex disease showing a specific entity and acomplex bacterial flora, a curative non surgical remedy not yet well realized. The,polyvinyl pynolidone (PVP) a highly effective wide broad spectrum bactericidalfungycidal and virocidal antiseptic used in low concentration (3%) as an intrapocketirrigation solution accompanied with conventional ultrasound scaling and rootplanning . Eight patients having aggressive were involved in this study, 12 therapeuticsessions were performed during 6 months. Once a week , in the first month , twice amonth in the next 3 months , then once a month in the later 2 months . The resultshowed a significant improvement of the clinical parameters, gingival bleeding indexGBI), clinical pocket depth (CPD) , and clinical tooth mobility (CTM) , with(. radiologic evidences of bone formationThe result suggests that PVP could be the promising effective, save clinically. applicable , easy to use , and cheap remedy of complex periodontal diseases

Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study.

The purpose of the present study was to evaluate the smear layer removal efficacy of three various agents on periodontally compromised tooth. The current study included 75 molar teeth that were extracted due to periodontal disease. After that, 25 samples were randomly assigned using a simple random technique to the three different agent groups, group A: Scaling and root planing (SRP) and application of SofScale agent, group B: SRP and application of QMix agent, group C: SRP and application of MTAD agent. Using a diamond circular saw, the treated portions were divided into horizontal and vertical halves. All samples were viewed under Scanning Electron Microscope. Every tooth was focused at the coronal third, middle third, and apical third portion with a magnification of 1000×. Data were recorded and statistically analyzed. The smear layer removal efficacy was more in the QMix agent (3.06 ± 0.04) group followed by MTAD agent (3.28 ± 0.09) and SofScale agent (4.14 ± 0.10) group on the root surface. On intra group comparison, there was a statistically significant difference found in all the intra group agents with all the three levels. On inter group evaluation, at coronal third, there was no significant difference found between the different agents. There was a significant difference found between the different agents at middle and coronal third. On conclusion, the current investigation found that, the root surfaces treated with QMix shown a greater ability to remove smear layers compared to tooth surfaces treated with MTAD and SofScale agent. Conventional therapies such as SRP effectively eliminate calculus, plaque, and necrosed cementum; nevertheless, they leave behind a smear layer that could impede normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. The traditional root conditioning agents such as citric acid have certain disadvantages, though, such as an acidic pH that could harm the root surface. As a result, researchers have been looking for biocompatible root conditioning treatments that are more effective. How to cite this article: Singh DK, BS Raj H, Soans CR, et al. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024;25(2):156-159.

Assessment of the Antibacterial Effect of Vitamin D3 against Red Complex Periodontal Pathogens: A Microbiological Assay.

The study aims is to evaluate the antibacterial effect of vitamin D3 against the red complex bacteria, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia in chronic periodontitis patients. The study comprised 98 participants with chronic periodontitis. All clinical parameters including plaque index (PI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and a microbiological assay of P. gingivalis, T. denticola, T. forsythia were assessed at the baseline. All study participants who underwent scaling and root planning were divided into two groups, A and B, each with 49 patients and only group B patients were advised to take vitamin D supplementation of 60,000 IU granules, once daily for 2 months. All the patients of both the groups were recalled at the end of 2nd month and all the clinical and microbiological parameters were reassessed. After two months, there was a reduction in all the clinical markers in both groups, but the group B patients showed more improvement following non-surgical treatment vitamin D intake. There was also a statistical reduction in P. gingivalis, T. denticola, and T. forsythia following administration of vitamin D in group B patients compared to group A. These discoveries proposed that vitamin D has a superb antimicrobial impact against red complex periodontal microbes and might be considered a promising compound in the counteraction of periodontal disease. Vitamin D is considered to possess anti-inflammatory and antimicrobial activity, which may help to delay the progression of periodontitis. So, vitamin D3 can be used as a potential supplement that could be employed to stop the advancement of periodontal disease. How to cite this article: Govindharajulu R, Syed NK, Sukumaran B, et al. Assessment of the Antibacterial Effect of Vitamin D3 against Red Complex Periodontal Pathogens: A Microbiological Assay. J Contemp Dent Pract 2024;25(2):114-117.

Enhanced immunomodulation and periodontal regeneration efficacy of subgingivally delivered progranulin-loaded hydrogel as an adjunct to non-surgical treatment for Class II furcation involvement in dogs.

To evaluate the effect of subgingival delivery of progranulin (PGRN)/gelatin methacryloyl (GelMA) complex as an adjunct to scaling and root planing (SRP) on an experimental periodontitis dog model with Class II furcation involvement (FI). A Class II FI model was established, and the defects were divided into four treatment groups: (a) no treatment (control); (b) SRP; (c) SRP + GelMA; (d) SRP + PGRN/GelMA. Eight weeks after treatment, periodontal parameters were recorded, gingival crevicular fluid and gingival tissue were collected for ELISA and RT-qPCR, respectively, and mandibular tissue blocks were collected for micro computed tomography (micro-CT) scanning and hematoxylin and eosin (H&E) staining. The SRP + PGRN/GelMA group showed significant improvement in all periodontal parameters compared with those in the other groups. The expression of markers related to M1 macrophage and Th17 cell significantly decreased, and the expression of markers related to M2 macrophage and Treg cell significantly increased in the SRP + PGRN/GelMA group compared with those in the other groups. The volume, quality and area of new bone and the length of new cementum in the root furcation defects of the PGRN/GelMA group were significantly increased compared to those in the other groups. Subgingival delivery of the PGRN/GelMA complex could be a promising non-surgical adjunctive therapy for anti-inflammation, immunomodulation and periodontal regeneration.

The effect of virtual reality glasses on dental anxiety during scaling and root planing in patients with periodontitis: A randomized controlled clinical trial.

This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01). The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses.

Clinical effects of Lactobacillus reuteri probiotic in chronic periodontitis - a systematic review.

This systematic review examines the effectiveness of Lactobacillus reuteri as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Scopus, PubMed, and Web of Science databases were searched according to specific inclusion and exclusion criteria in October 2022. Randomized control trials that evaluated the effects of Lactobacillus reuteri in patients with periodontitis were included. The primary outcome was pocket depth and clinical attachment levels, while the secondary outcome considered was bleeding on probing, microbial levels, and gingival index score. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool. A total of eleven studies that examined 369 subjects were included in the review. Adults in the age group of 18-70 years of age suffering from chronic periodontitis were evaluated. Eight out of the eleven studies reported statistically significant improvement in the intergroup pocket depths, whereas seven studies showed a statistically significant reduction in the clinical attachment levels in the probiotic group. Three studies showed no significant improvement in the pocket depth levels in the probiotic group as compared to the controls. Four studies showed no significant reduction in clinical attachment levels between the two groups. The overall risk of bias was high in four studies, while seven studies reported some concerns about the risk of bias. Based on the limited evidence available, the adjunctive use of Lactobacillus reuteri to scaling and root planing may provide some additional benefit in improving periodontal parameters.

Effect of Glycine Subgingival Sandblasting on the Incidence of Peri-Implantitis and Expression of Inflammatory Factors in Gingival Crevicular Fluid in Patients with Titanium-Nickel-Chromium Alloy Porcelain-Fused-To-Metal Crowns

This research was aimed to demonstrate impacts of glycine subgingival sandblasting on peri-implantitis (PI), periodontal clinical parameters, and inflammatory factor expression in gingival crevicular fluid (GCF) in patients with titanium-nickel-chromium (TiNiCr) alloy porcelain-fused-to-metal crown (APC) restorations. A total of 159 patients with TiNiCr APCs were randomly rolled into glycine subgingival sandblasting group (Exp 1 group), erythritol subgingival sandblasting group (Exp 2 group), and conventional scaling and root planing (SRP) treatment group (Con group), with 53 patients in each group. The quantity of oral biofilm was assessed based on plaque staining, and the plaque index (PLI), bleeding index (BI), probing depth (PD), and clinical attachment level (CAL) preoperatively (baseline) and at 3-, 6-, and 12-months postoperatively in various groups were compared. Microbial species and quantities in the GCF were determined using microbial counting, and the incidence of PI postoperatively was calculated in each group. The inflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6 in the GCF were measured using enzyme-linked immunosorbent assay (ELISA). The results showed that at 3-, 6-, and 12-months postoperatively, the PLI, BI, PD, CAL, TNF-α, IL-1β, and IL-6 in Exp 1 group were dramatically inferior to those in Con group (P &lt; 0.01). The PLI, BI, PD, CAL, bacterial counts (rods, cocci, and spirochetes) in Exp 2 group were inferior to those in Con group (P &lt; 0.05) at the same time points. Furthermore, the PLI, BI, PD, CAL, TNF-α, IL-1β, and IL-6 in Exp 1 group were inferior to those in Exp 2 group (P &lt; 0.05) at 3-, 6-, and 12-months postoperatively. The incidence of PI postoperatively in Exp 1 and Exp 2 groups was 5.66% and 3.77%, respectively, which was dramatically inferior to Con group’s incidence of 9.43% (P &lt; 0.05). These findings indicate that glycine subgingival sandblasting can greatly enhance the periodontal condition of patients undergoing TiNiCr APC restorations, reduce the incidence of PI, and lower the levels of inflammatory factors in the GCF.

Effect of adjunctive photodynamic therapy on gingival crevicular fluid interleukin-1β in Stage III and IV periodontitis: A systematic review and meta-analysis.

Interleukin-1β (IL-1β) is a main pro-inflammatory cytokine that is used for the assessment of treatment efficacy in periodontitis. This meta-analysis aimed to assess the effect of antimicrobial photodynamic therapy (aPDT) on Stage III-IV (severe) periodontitis-induced local IL-1β. This review study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and registered in PROSPERO (CRD42024522546). Electronic and manual search of the literature was conducted in four databases for English articles from the first record up until June 30, 2022 comparing the effects of aPDT versus conventional scaling and root planing on IL-1β levels at different follow-up times. The mean gingival crevicular fluid level of IL-1β with 95% confidence interval (CI) was pooled using the random effect model. The I 2 statistics were applied to analyze the heterogeneity of the findings. The risk of bias (RoB) was analyzed using the revised Cochrane RoB. Analysis of 11 retrieved studies revealed that after the application of aPDT, a significant reduction in IL-1β level occurred at 1-2 (standardized mean difference [SMD]: 0.29, 95% CI: -0.57-1.15; P = 0.0002), 4-6 (SMD: 0.53; 95% CI: -0.36-1.42; P < 00001), and 12-13 (SMD: 1.04; 95% CI: -0.22-2.3; P < 0.00001) follow-up weeks. The application of aPDT can serve as an effective adjunctive therapy for the treatment of Stage III-IV periodontitis. Although the results of this meta-analysis showed that increasing the session frequency of aPDT had a higher effect size, further studies without the limitations of the existing studies are required to confirm the present results.

Antimicrobial effect of indocyanine green-mediated photodynamic therapy in patients with periodontal disease: A systematic review

Abstract Aim: This systematic review assessed the antimicrobial effect of indocyanine green-mediated photodynamic therapy (ICG-PDT) in patients with periodontal disease. Materials and Methods: Four electronic databases that is, MEDLINE, MEDLINE-In-Process, EMBASE, and Cochrane Library were systematically searched from their inception until December 22, 2022. Randomized controlled trials (RCTs) reporting the antimicrobial effect of ICG-PDT in patients with periodontal disease and published in English were included. The Cochrane risk of bias tool was used to assess the quality of the included RCTs. Two independent reviewers performed all the steps involved in a systematic review (primary and secondary screening, data extraction, and quality assessment). As the data extracted was not suitable for meta-analysis, the evidence was synthesized qualitatively. Results: Overall, seven RCTs from seven publications were included. All included studies had PDT, laser, or photothermal with ICG as the test group while the control group included low-level laser therapy, root surface debridement, and scaling and root planning. The bacterial species assessed across the included studies included Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Fusobacterium nucleatum, and Treponema denticola. With subtle exceptions, ICG-PDT in combination with root surface debridement and scaling and root planning significantly reduced the growth of periodontal pathogens from baseline. Conclusion: Based on the evidence from the limited studies, ICG-PDT seems to exhibit potent antimicrobial activity against an array of periodontal pathogens in patients with periodontal disease.

Effectiveness of Conventional Periodontal Treatment With Tetracycline Fiber Versus Minocycline Gel Application Subgingivally in Periodontitis Patients.

Locally delivered antibiotics are adjunctive therapies for the selective removal or inhibition of pathogenic microbes in combination with scaling and root planing (SRP) for the management of periodontitis. The primary objective of this study was to evaluatethe effectiveness of tetracycline fibers against minocycline gel when used as local drug delivery in conjunction with SRP for treating periodontitis. This is a pilot randomized open single, blinded trial study comparing three treatment modalities: SRP with topical tetracycline fibers (SRP+T), SRP with topical minocycline HCL 2% gel (SRP+M), and SRP only as a control group. Probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) percentages were recorded at baseline, one month, and at the end of three months. The data were subjected to analysis using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Repeated measures ANOVA was used to compare the clinical outcomes between the three treatment groups, accounting for the repeated measurements at baseline, one month, and three months. A p-value less than 0.05 at a 95% confidence interval was deemed statistically significant. There were statistically significant changes within the groups in all the clinical parameters, including pocket depth, clinical attachment loss, and bleeding on probing score, at different time intervals, with the greatest mean pocket depth changes seen in the tetracycline group after one month (mean changes = 1.4 mm, P< 0.001) and over three months (mean changes = 1.79 mm, p< 0.001). For clinical attachment loss, after one month, the highest improvement in clinical level was seen in the minocycline group (mean changes = 0.7mm,p < 0.05), and the overall improvement was seen in the control group (mean changes = 1.1mm,p< 0.05). The minocycline group showed greater mean changes in bleeding on probing percentage, with the greatest changes after one month (mean changes = 19.34%, p < 0.001) and over three months (mean changes = 26.42%, p <0.001). However, there was no significant difference between the groups. Locally delivered tetracycline and minocycline gelare effectiveas adjuncts to SRP and may improve the healing outcome in the management of periodontitis.

Management of frenectomy anterior upper arch before orthodontic treatment

Abnormal labial frenum may affect gingival health and cause periodontal disease. Abnormalities of the frenum also cause diastema of central incisors and irritation of the periodontal tissues, interfering with the teeth cleaning process, movement of orthodontic tools, and the proper fit of the denture and affecting the aesthetics. This case report shows that frenectomy is an alternative treatment due to abnormal labial frenum, in this case, caused by central diastema on maxillary incisors teeth. A-19 years old female patient came with chief complaints of midline diastema that affect her smile. She wants to get orthodontic treatment after the frenectomy management. The frenum was clinically high and elongated to the palatal side. Scaling and root planing were done at the first appointment, continued with frenectomy using a conventional technique (classical frenectomy) a week after the control. The treatment result showed that the frenectomy attachment was repaired and can continue the orthodontic treatment.

Clinical and microbiological efficacy of intra-pocket application of diode laser in grade C periodontitis: a randomized controlled clinical trial

BackgroundPeriodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis.MethodsA randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis.ResultsCompared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration.ConclusionLaser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage.Trial registrationNCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov.

Assessment of the Efficiency of Tulsi Extract as a Locally Administered Medication Agent and Its Comparison With Curcumin in the Treatment of Periodontal Pockets.

The use of locally administered medication (LAM) agents such as minocycline, metronidazole, and tetracycline as antimicrobials has drawbacks, including the development of microorganism resistance, exorbitant pricing, and limited accessibility. Thus, there is a need for safer and more affordable alternatives. Numerous natural therapies have been found to be superior in this situation. In this study, the efficacy of tulsi extract as a LAM agent was assessed and it was compared with curcumin, which is currently used for the treatment of periodontal pockets. There were three categories: each categoryhad 30 sites. Category 1 sites underwent scaling along with root planing (SRP) solely, Category 2 sites received curcumin extract as LAM in the periodontal pocket in addition to SRP, and Category 3 sites received tulsi extract as LAM in the periodontal pocket in addition to SRP. The stent was used to ensure consistent and unbiased measurementson the 30thday after treatment. Clinical attachment level (CAL) andprobing pocket depth (PPD)were measured at six points around each tooth. Results: The reduction in values of periodontal parameters such as BAPNA (Nα-benzoyl-DL-arginine-p-nitroanilide) assays, modified sulcus bleeding index (mSBI), gingival index (GI), plaque index (PI), CAL, andPPDin sites within Category 1, Category 2, and Category 3 was statistically significant. The decrease in BAPNA assay resultsindicates that tulsi extract is more effective than curcumin gel at eradicating red-complex bacteria. Although not significantly different, the decrease in PI and GI was observed to be greater when curcumin jelly was used. This suggests that curcumin jelly has a stronger impact on reducing plaque, which in turn decreases gingival inflammation. Based on the overall results of the study, it can be said that both tulsi and curcumin have similar effectiveness in reducing periodontal markers.

Clinical Evaluation of Diode Laser as an Adjunct to Scaling and Root Planing in Patients With Chronic Periodontitis and Type II Diabetes Mellitus: A Split-Mouth Study.

The primary goal of periodontal therapy is to arrest the inflammatory disease process which is done by non-surgical and surgical therapies in order to reduce the microorganisms.The outcome of periodontal therapy may not reveal the desired results owing to inaccessible areas for instrumentation, pathogenicity, resistance of the microorganisms, or even due to compromised host response to the treatment. Thus, adjunctive laser therapy has been proposed as a novel treatment modality in the treatment of periodontal disease. Aim: The aim of this study was to clinically evaluate the effect of a 980 nm diode laser (DEN10B; Wuhan Gigaa Optronics Technology Co., Ltd., Wuhan, China) therapy as an adjunct to scaling and root planing in patients with chronic periodontitis and type II diabetes. Twenty patients were divided into two groups in a split-mouth study design. Group I (Control) comprised mechanical debridement alone and Group II (test) comprised mechanical debridement followed by adjunctive laser therapy. The clinical parameters were recorded at baseline, six weeks, and three months, and the results were analyzed. There was a significant improvement in gingival and plaque index in the test group. Though there was no significant improvement in probing pocket depth and clinical attachment, the results in the test group were superior relative to the control group. Non-surgical periodontal therapy with adjunctive use of diode laser is effective in the management of generalized chronic periodontitis in patients with type II diabetes which led to a significant reduction in plaque score, gingival index score, probing pocket depth, and gain in clinical attachment level.

Lipoxin A4 levels predict site-specific clinical improvements post scaling and root planing and correlate negatively with periodontal pathogens in severe periodontitis

BackgroundServing as a stop signal of inflammation, the role of lipoxin A4 (LXA4) in periodontitis remains to be clarified. This study is aimed to examine the changes in LXA4 levels in gingival crevicular fluid (GCF) after scaling and root planing (SRP) and to determine the relationship between LXA4 levels and treatment outcomes and periodontal pathogens in severe periodontitis.MethodsA total of 74 GCF samples were collected from 21 severe periodontitis participants at the deepest affected sites. These sites were re-sampled at 1, 3, and 6 months after SRP. Besides, GCF samples were also collected from 25 periodontally healthy participants. Clinical parameters including probing depth (PD) and clinical attachment level (CAL) in periodontitis group were recorded. LXA4 levels and periodontal pathogens in the GCF were analyzed by ELISA and PCR, respectively. Correlations between GCF LXA4 levels and treatment effect and periodontal pathogens were assessed.ResultsLXA4 levels in GCF significantly increased after SRP (p < 0.05), but remained lower than those observed in healthy individuals (p < 0.05). Sites with lower baseline LXA4 concentrations were more likely to experience greater improvements in PD at 6 months post-SRP (area under the curve [AUC] = 0.792), and the improvements were positively correlated with the increase of LXA4 at these sites post-treatment (p < 0.05). Furthermore, more elevated LXA4 levels were observed in sites that became negative for Prevotella intermedia or Tannerella forsythia after SRP.ConclusionBaseline LXA4 in GCF has the potential to predict the site-specific response of severe periodontal lesions to SRP. The increase of LXA4 levels after treatment was positively correlated with clinical improvements and negatively correlated with the presence of Prevotella intermedia or Tannerella forsythia.