Root Planing Research Articles

Comparative Evaluation of Morphological Characteristics of Root Surfaces after Scaling and Root Planing under Naked Eye and Magnification: An In vitro Scanning Electron Microscope Study

Abstract Introduction: The primary aetiologies of periodontitis include bacterial plaque and calculus. Effective periodontal treatment necessitates the thorough removal of these deposits through scaling and root planing (SRP) using manual and ultrasonic instruments. However, the roughness introduced by these instruments can impact bacterial colonisation, plaque formation and calculus deposition. This study aims to evaluate and compare the morphological characteristics of root surfaces after SRP performed under the naked eye and magnification using a scanning electron microscope (SEM). Materials and Methods: This in vitro study included single-rooted extracted teeth from patients with chronic generalised or localised periodontitis. The teeth were divided into two main groups: manual instrumentation with Gracey curettes and ultrasonic instrumentation. Each group was further subdivided based on the method of visualisation during SRP: naked eye, dental loupes (×2.5 magnification) and dental operating microscope (×12 magnification). The samples were evaluated for root surface roughness, remaining calculus and smear layer presence using indices such as the remaining calculus index (RCI) and roughness and loss of tooth substance index. Results: A total of 60 samples were analysed, with 30 samples in each main group, further divided into three subgroups of 10 each. The results indicated statistically non-significant differences in smear layer presence between groups. However, significant differences were observed in root surface roughness and remaining calculus between manual and ultrasonic instrumentation, particularly under higher magnifications. Ultrasonic instrumentation under magnification provided smoother root surfaces compared to manual instrumentation, although manual instrumentation showed lesser RCI in comparison to ultrasonic instrumentation. Conclusion: SRP performed under magnification, particularly with ultrasonic instruments, results in smoother root surfaces with less remaining calculus. The use of magnifying tools such as dental loupes and operating microscopes enhances the efficacy of periodontal treatment by providing better visualisation and illumination.

Antibiotics as adjunct to non-surgical periodontal therapy in diabetic patients.

A comprehensive literature search was performed via MEDLINE/PubMed, Scopus, and Web of Science, including all relevant publications accessed on March 2023 and subsequently updated up to July 2024. Additionally, grey literature was searched, and there was no restriction on publication data and languages. All randomized clinical trials comparing topical/systemic antibiotics as an adjunct to scaling and root planning (SRP) with SRP alone for the treatment of diabetic patients with periodontitis were included. Literature reviews, case reports and series, preclinical studies or studies lacking periodontal data were excluded. Clinical attachment level was considered as the primary outcome. Bleeding on probing, pocket depth, and gingival index were the secondary outcomes. The risk of bias was evaluated using the Cochrane Collaboration Tool, and for each domain, bias risk was judged as low, unclear and high risk of bias. Selection, removing duplicates, screening, extracting data, and assessing the quality of studies were done by two investigators and findings were tabulated. Meta-analysis was conducted, generating forest plots to compare different treatment modalities, time periods, and antibiotic types. Key periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP) were analysed. Upon screening and further evaluation of 690 articles, 43 were considered for full-text eligibility. Finally, 30 studies were included in the systematic review, and 27 were included in meta-analysis. Out of 30 randomized clinical trials, 9 studies focused on topical and antibiotics, and 21 involved systemic administration of antibiotics. Five of the nine studies focussing on topical administration of antibiotics, were classified as having a low risk of bias and four as having a high risk of bias. Out of 21 studies on systemic antibiotics, eight were classified as having a low risk of bias, two were undefined, and eleven showed a high risk of bias. Authors concluded that adjunctive use of antibiotics could lead to improvement in periodontal clinical parameters CONCLUSION: The findings showed that the adjunctive use of antibiotics led to slight improvements in clinical outcomes. However, keeping in mind antibiotic resistance, and side effects of antibiotics, their use should be approached cautiously and only when necessary.

A chewing gum containing ethylenediaminetetraaceticacid (EDTA), methyl sulfonyl methane (MSM) and xylitol works comparable to chlorehexidine mouthrinse.

Dental plaque provides a proper environment for the growth and activity of bacteria responsible for periodontal diseases and caries. As a result, it should be removed by individuals to prevent periodontal diseases and caries. There are different mechanical and chemical plaque control methods. In one study is shown that dental plaque removal efficacy of dentifrice containing Ethylenediaminetetraaceticacid(EDTA)/Methylsulfonylmethane(MSM) was nearly five times that of commercially available fluoride toothpaste. In another study, authors found that xylitol-containing chewing gums caused a marked reduction in the count of Streptococcus Mutans compared to conventional ones. This difference was highly prominent in individuals with poor oral hygiene. In this study we assessed the synergic effects of Xylitol, EDTA and MSM in a chewing gum in comparison with chlorhexidine mouthwash. This study was a crossover, randomized clinical trial. Twenty-four patients were divided in two groups randomly. At the baseline scaling and root planing was done for each patient. Group1 used chlorhexidine mouthwash twice a day. Group2 used novel chewing gum for 15min twice a day. After 14 days, for every patient O'leary plaque index, gingival index and sulcus bleeding index were reevaluated and recorded. Professional brushing was done for patients. 14 days were considered as wash-out period. After that, method of plaque control of groups was changed. After 14 days, all patients were reevaluated and recorded and were compared with previous data. Samples in 2 groups had no significant difference in age and sex. Paired sample t test revealed that there were significant differences between first and second period for O'leary plaque index, gingival index and sulcus bleeding index in Group1 (P < 0.05). But in Group2 there were no differences between first and second period for all indexes. Also independent sample t test showed that there were no significant differences between baseline, after first treatment and after second one for all indexes in both groups (P > 0.05). According to regression model results, type of treatment had no effect on mean of all indexes. According to our findings which showed the similar efficiency of novel chewing gum and chlorhexidine mouthwash in improving and reducing plaque and gingival indexes, we can conclude that novel chewing gum can be introduced as an effective, cheap and accessible tool for dental plaque control.

The Efficacy of Ozonated Water in One-stage Full-mouth Disinfection amongst Chronic Periodontitis Patients: A Randomised Control Trial

Abstract Introduction: Periodontal disease, causing tooth-supporting structure damage due to bacterial build-up, is linked to various risk factors. Traditional treatment involved scheduled scaling and root planing. Full-mouth disinfection (FMD), introduced in 1995, involves comprehensive cleaning and chlorhexidine (CHX) application within 24 h to prevent bacterial spread. CHX, a potent antimicrobial, is widely used in FMD, but concerns about emerging resistance have led to the exploration of alternatives like ozonated water, which has shown promising antimicrobial properties and the potential to improve periodontal health. Materials and Methods: This is a randomised controlled trial involving 40 participants with Stage II or III periodontitis who were randomly grouped into two groups. Group A was advised to use 0.2% CHX solution, and Group B used a 10 μg concentration of ozonated water. Both the groups cleaned their dorsum of the tongue, rinsed their mouth, had a pharyngeal spray and had periodontal pockets irrigated using the respective solutions. Plaque index, papillary bleeding index, gingival index, relative attachment level and probing depth were measured at baseline, 3 months and 6 months. Results: Significant differences were found at baseline, 3-month and 6-month values of periodontal index, papillary bleeding index, probing depth, gingival index and relative attachment level amongst Group A and B participants. Differences were noted in between Groups A and B in the periodontal index at 6 months between CHX and ozonated water and between 3 and 6 months for probing depth. Around 68%, 70%, 66%, 68% and 63% improvements were noted in the periodontal index, probing depth, gingival index, papillary bleeding index and relative attachment loss amongst Group B. Conclusion: Ozonated water represents a promising adjunctive therapy for chronic periodontitis, demonstrating significant clinical efficacy in one-stage FMD protocols.

Clinical Comparison of Guided Biofilm Therapy and Scaling and Root Planing in the Active Phase of Periodontitis Management.

The aim of this randomized, controlled, split-mouth study was to compare full-mouth air polishing followed by ultrasonic debridement (known as Guided Biofilm Therapy [GBT]) versus traditional Scaling and Root Planing (SRP), in terms of pocket closure in patients with stages III and IV periodontitis. The patients underwent periodontal therapy in two sessions. At the beginning of the first session, quadrants I and IV and II and III were randomly assigned to GBT or SRP treatment. Periodontal parameters were collected at baseline, 6 weeks (T1), and 3 months (T2) after therapy. The primary outcome was the number of experimental sites (pocket probing depth [PPD] >4 and <10 mm) becoming closed pockets (PPD ≤ 4 mm bleeding on probing [BOP] negative) at T1 and T2. Secondary outcomes were PPD, recession, clinical attachment level, BOP, and plaque index variations at the experimental sites and treatment time. A 10% difference in the primary outcome between the two protocols was set as the threshold to define inferiority/noninferiority of the test treatment. The primary outcome was modeled using a generalized estimating equation model to account for intrapatient measurement correlation. The estimates are reported as differences between groups' percentages (treatments or time points) and corresponding 95% confidence interval (95% CI). All analyses assumed a significance level of 5%. A total of 32 patients were selected. Mean PPD (mm) reduced from 6.23 (6.06-6.40) to 3.33 (3.06-3.61) at T2 for GBT, and from 6.21 (6.04-6.38) to 3.32 (3.11-3.53) at T2 for SRP. Both treatments reached a comparable percentage of closed pockets at T1 (77.9% for GBT vs. 80.1% for SRP, p = 0.235) and T2 (84.1% for GBT vs. 84.4% for SRP, p = 0.878), with no statistically or clinically significant difference. GBT and traditional SRP with ultrasonic and hand instruments reach satisfactory clinical results in the active treatment of patients with stages III and IV periodontitis, with comparable rates of closed pockets and treatment time. GBT is a suitable option in the active phase of periodontitis management in patients with stages III and IV periodontitis.

Effects of Probiotic Therapy on Periodontal and Peri-implant Treatments: An Umbrella Review.

The effectiveness of nonsurgical periodontal treatment is related to patient- and tooth-related factors. To overcome the limitations of the conventional approach, probiotics are one of the adjunct therapies that have been studied. This umbrella review answered the focused question: in adult patients with periodontal diseases or peri-implant diseases, does the use of probiotic therapy as an adjuvant to nonsurgical periodontal treatment when compared with nonsurgical periodontal treatment alone affect treatment effectiveness and clinical disease parameters? A systematic electronic search to identify systematic reviews according to PICOS criteria, defined a priori, was used, and 5 electronic databases were searched (Medline, LILACS, Cochrane Central Registry of Controlled Trials, Google Scholar, and DANS EASY). Included systematic reviews were rated using quality assessment tools by 2 independent reviewers. Thirty systematic reviews were identified evaluating the effectiveness of probiotics in periodontal and peri-implant disease treatment. A quantitative analysis of the results was not possible due to the high heterogeneity of clinical data. Seventeen of 31 reviews reported clinically relevant benefits of probiotic therapy as an adjuvant to scaling and root planning. Twenty-two reviews had a low risk of bias, 7 had a moderate risk, and 2 had a high risk. The evidence from the available studies is conflicting, which means that no definitive conclusions can be made about the effectiveness of probiotic therapy as an adjuvant to nonsurgical periodontal treatment. High-quality primary research studies are needed that control for known confounding variables. This umbrella review provides some evidence regarding the efficacy of probiotics as an adjunct to nonsurgical periodontal therapy, despite some equivocal findings. However, short-term probiotic use alongside therapy appears to be advantageous; there is currently no evidence supporting their long-term benefits. We have also identified that probiotic research is primarily constrained by its origins in gastrointestinal applications, resulting in a lack of approved probiotics for dental use. This review highlights the need for extensive clinical research to ascertain their effectiveness in the oral environment. Nevertheless, the utilization of probiotics alongside periodontal treatment seems safe, with no reported adverse effects in patients. Thus, further clinical validations in oral health care settings are crucial.

The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis

BackgroundThe effect of treating periodontal disease (PD) during pregnancy on adverse birth outcomes, such as preterm birth (PTB) and/or low birth weight (LBW), remains unclear. This is partially due to the fact that Randomized Controlled Trials (RCTs) have used different combinations of treatment approaches to test this hypothesis. In this meta-analysis of RCTs, we assessed the impact of treating PD during pregnancy with scaling and root planning (SRP) and mouthwash use on PTB and LBW.MethodsA systematic review with meta-analysis was conducted following PRISMA guidelines. A comprehensive search strategy was employed across electronic databases, including PubMed/Medline, Embase, and Google Scholar. Quality assessment was performed using the Cochrane Risk of Bias 2 Tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effect models.ResultsOut of 133 initially identified reports, 9 RCTs involving 3,985 pregnant women met the inclusion criteria. Periodontal treatment with SRP and mouthwash use in pregnancy was associated with a lower risk of PTB and LBW in meta-analysis with random effects models (pooled RR for PTB = 0.44, 95% CI: 0.22–0.88) and (pooled RR for LBW = 0.33, 95% CI: 0.13–0.84). Substantial heterogeneity was observed among studies (I2 = 91% and 90% for PTB and LBW, respectively), with sensitivity analysis suggesting potential sources of heterogeneity. Funnel plot assessment for publication bias showed evidence of asymmetry.ConclusionSRP with mouthwash use during pregnancy were associated with significantly lower risks of PTB and LBW. Larger, well-conducted RCTs are warranted to address this issue, as existing trials are small and exhibit methodological and statistical heterogeneity.

Treating apical fenestration in a previously endodontically treated tooth

Apical fenestration is a defect in the alveolar cortical plate, exposing the root without involving the alveolar bone margin, often linked to trauma, periodontal disease, and orthodontic treatment, leading to symptoms such as pain and abscesses from endodontic infections. This case report describes managing a mucosal fenestration in an endodontically treated tooth with nonsurgical root canal therapy and periodontal surgery. A 44-year-old male presented with mucosal fenestration and pain in the upper front jaw due to trauma and an inadequately treated root canal. Examination revealed an ill-fitting crown and an open apex with periapical radiolucency. Treatment included scaling, root planing, nonsurgical root canal therapy, apexification using Biodentine, and obturation with bioceramic sealer. Persistent fenestration necessitated periodontal surgery to remove extruded material and place an alloplastic graft. Apical fenestrations, although uncommon, require coordinated endodontic and periodontal treatment for successful outcomes.

A cluster randomized trial of xylitol chewing gum for prevention of preterm birth: The PPaX trial.

Maternal periodontal disease is associated with preterm and low-birthweight deliveries, but randomized trials of likely efficacious treatments (e.g., dental scaling and root planing) during pregnancy have not reduced these adverse outcomes. As an alternative, we hypothesized that periconception initiation of xylitol chewing gum would reduce the occurrence of preterm or low-birthweight deliveries among a historical high-prevalence population in Malawi. We conducted an open-label, parallel-enrollment, matched-pair, cluster-randomized, controlled clinical trial across eight health centers (sites) in and around Lilongwe, Malawi. Sites were paired by anticipated delivery volume and randomized to prenatal and oral health education alone (active control) or with twice-daily xylitol chewing gum (intervention) throughout the periconception and antenatal periods. Forthe primary prevention of preterm (<37weeks) and low-birthweight (<2,500 g) deliveries (co-primary outcomes), comparison by allocation group was performed using generalized linear mixed models for each outcome as a fixed factor and the site(s) as a random factor. 10,069 participants were enrolled (n= 4,549 at intervention sites, n= 5,520 at active control sites), with >95% available for analyses. Initiation of xylitol chewing gum resulted in significant reductions in the co-primary outcomes: preterm birth (12.6% [549/4,349] vs. 16.5% [878/5,321]; relative risk [RR] 0.76, 95% confidence interval [CI] 0.57-0.99) and <2,500-g neonates (8.9% [385/4,305] vs. 12.9% [679/5,260]; RR 0.70, 95% CI 0.49-0.99). Xylitol chewing gum use also led to fewer neonatal demises (0.2% [8/4,305] vs. 0.4% [22/5,260]; RR 0.41, 95% CI 0.19-0.89). Periconception initiation and ongoing use of xylitol chewing gum significantly reduced the occurrence of preterm and low-birthweight deliveries in Malawi. E.W. Al Thrasher Foundation (to K.A.) and USAID Saving Lives at Birth Grand Challenges Grant AID-OAA-G-11-00062 (to K.A.). Additional financial and in-kind support was graciously provided by Texas Children's Hospital and Baylor Foundation Malawi.

Outcomes of Nonsurgical Periodontal Therapy in Gingivitis and Periodontitis Patients Treated by Senior Dental Students.

This retrospective study aimed to evaluate the outcomes of nonsurgical periodontal therapy performed by senior dental students. Electronic records of patients treated by senior dental students at the comprehensive care clinic in King Abdulaziz University Dental Hospital were reviewed retrospectively. Patients diagnosed with gingivitis or periodontitis who had undergone at least one session of scaling and root planing were included in this study. The following periodontal parameters were assessed: BOP, PI, PD and number of residual pockets. A total of 618 patients were included in this study (60.2% females and 39.8% males). BOP reduced from a median of 40% (IQR: 26.0%-62.0%) at baseline to 13% (IQR: 9.0%-20.3%) at re-evaluation in the gingivitis group (p < 0.0005). Similarly, a significant reduction in BOP, from 45% (IQR: 28.0%-64.3%) at baseline to 14% (IQR: 9.0%-21.5%) after phase I therapy, was observed in the periodontitis group (p > 0.001). In both groups, 31%-32% of patients had BOP < 10 at re-evaluation. PD of ≥ 5 mm was observed in 50.8% of patients with periodontitis at baseline; however, 38% of these patients had no residual pockets at re-evaluation. NSPT performed by senior dental students was effective in improving the periodontal status of the patients. Both gingivitis and periodontitis patients showed significant improvement in BOP and PI. Approximately, 32% of patients showed a reduction in BOP suggestive of a bleeding score associated with periodontal health. Moreover, patients diagnosed with periodontitis exhibited a significant reduction in the number of sites with deep probing (≥ 5).

Study on the Mechanism of Nd:YAG Laser-Assisted Therapy on the Changes of Subgingival Flora in Periodontitis.

This study evaluated the therapeutic efficacy of combining Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser with subgingival curettage and root planing (SRP) in generalised stage III/grade C periodontitis patients and its effects on cytokine dynamics and microbial community. Fifteen patients diagnosed with stage III/grade C periodontitis were included in the cohort. The right and left sides of the mouth were randomly assigned either the conventional SRP (control) group or the SRP supplemented with Nd:YAG laser group (experimental group, 160 mJ, 4 W) in a split-mouth design. Clinical periodontal indices were recorded at baseline and at the 6-week follow-up post-treatment. ELISA was utilised to measure IL-1β and TNF-α levels in gingival crevicular fluid. The subgingival microbiota's composition and variations were characterised using 16S rDNA amplicon sequencing, while quantitative real-time polymerase chain reaction (qRT-PCR) was employed to analyse the changes in the red-complex bacteria in subgingival plaque. The SRP&#43;Nd group exhibited a statistically significant reduction in record probing depth (PD) and bleeding on probing (BOP) compared to the SRP group after treatment (p0.05). The SRP&#43;Nd group showed a markedly lower IL-1β level than the SRP group (p0.05). Furthermore, there was no statistically significant difference in the dominant subgingival microbiota composition and level of the red-complex bacteria between the two groups (p>0.05). The adjunctive use of Nd:YAG laser with SRP demonstrates promising short-term therapeutic benefits for patients with extensive stage III/grade C periodontitis. Both SRP as a standalone treatment and its combination with Nd:YAG laser effectively facilitate a transition in the dominant bacterial community from periodontitis-associated to periodontal health-associated microbiota.

Improvement of salivary biomarkers vitronectin and fetuin-A levels in periodontitis patients with coronary artery disease post scaling and root planing.

Two biomarkers that are gaining attention for their roles in the progression of both periodontal and cardiovascular diseases are vitronectin and fetuin-A. This study evaluated vitronectin and fetuin-A expression in saliva samples of periodontitis (P) patients with and without coronary artery disease (CAD) after scaling and root planing (SRP). Sixty patients were divided into three groups: PH+SH (periodontally and systemically healthy), P (stage II/III grade B periodontitis), and P+CAD (periodontitis with CAD). Demographic, periodontal, and cardiac parameters were recorded. Unstimulated saliva samples were collected at baseline (day 0) and after SRP. On day 90, periodontal parameters and vitronectin/fetuin-A expression were reassessed. P+CAD patients had higher age, weight, BMI, and lower income (p<.001,.025,.002,<.001, respectively), along with elevated plaque index, bleeding on probing, probing pocket depth, and reduced clinical attachment levels (p<.001). Vitronectin was elevated, while fetuin-A was lower in P+CAD, but both improved post-SRP (p<.001). Enhanced vitronectin and fetuin-A levels post-SRP indicate their potential as biomarkers and therapeutic targets for both periodontal and CAD.

Periodontitis Treatment by Scaling and Root Planing with Antimicrobial and Anti-Inflammatory Solutions in a Patient with Systemic Lupus Erythematosus

Introduction: Systemic Lupus Erythematosus is a chronic autoimmune disease of unknown cause in which patients regularly consume immunosuppressants, causing a decrease in body fluids of proteins such as mucins, immunoglobulin A and G antibodies, which causes destruction of periodontal tissue. Objective: To report a clinical case on the benefits of scaling and root planing (srp) with solutions based on hypochlorous acid (HOCl) and modified diallyl disulfide oxide (mddo) in the periodontal inflammatory process in a patient with systemic lupus erythematosus patient, tubulointerstitial nephritis and periodontitis. Case presentation: A 32-year-old woman, with systemic lupus erythematosus, tubulointerstitial nephritis and, according to the 2017 global workshop on the classification of periodontal diseases and conditions, was diagnosed with Stage 2 and Grade B periodontitis. Periodontal assessment revealed a high overall dental plaque index, with high-risk plaque being the most prevalent. srp treatment was carried out by quadrants, applying a HOCl solution during periodontal debridement and periodontal pockets were irrigated with mddo solution to disinfect them. Conclusions: The antimicrobial and anti-inflammatory solutions used as adjuvants to srp in this novel periodontal irrigation therapy helped to reduce gingival inflammation and high-risk plaque, which favoured healing of periodontal tissues in a patient with systemic lupus erythematosus.

Guava leaf extract - Phytochemical therapy for periodontitis patients

Introduction: Periodontitis is one of the most prevailing diseases associated with the oral cavity. It is important to treat the disease effectively as it results in tooth loss and also affects the host extensively. Treatment of periodontitis includes various surgical and non-surgical modalities. Non-Surgical modalities include Scaling and Root Planing (SRP), Local Drug Delivery (LDD), laser and HMT therapy. In the present study, the effect of guava leaf extract gel as a local drug delivery agent for the treatment of chronic periodontitis is evaluated. Aim: The aim of this study is to analyze the efficacy of guava gel extract as a local drug delivery agent in patients with periodontitis following scaling and root planing (SRP). Materials and method: A randomized, controlled study was conducted in 21 systemically healthy patients suffering from moderate periodontitis with isolated pockets (pocket depths 45mm). Clinical parameters GI, PI and PPD were recorded at baseline and subsequently after 7th, 14th and 21st day. The study design consisted of three groups, each group having 7 subjects, allocated in these groups randomly. Group A - Guava leaf extract gel (7), Group B – Chlorhexidine group (7), Group C - Control group (7). Results: Both the groups, Group A and Group B showed similar reduction in Gingival Index, Plaque Index and Probing Pocket Depth values when compared at baseline and on 21st day but the differences failed to reach the level of significance. Conclusions: The results suggest that Guava leaf extract gel as a local drug delivery is highly effective and comparable to gold standard.

Effectiveness of Antimicrobial Photodynamic Therapy as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Localized Periodontitis

Effectiveness of Antimicrobial Photodynamic Therapy as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Localized Periodontitis

Automated Quantification of Simple and Complex Aortic Flow Using 2D Phase Contrast MRI

(1) Background and Objectives: Flow assessment using cardiovascular magnetic resonance (CMR) provides important implications in determining physiologic parameters and clinically important markers. However, post-processing of CMR images remains labor- and time-intensive. This study aims to assess the validity and repeatability of fully automated segmentation of phase contrast velocity-encoded aortic root plane. (2) Materials and Methods: Aortic root images from 125 patients are segmented by artificial intelligence (AI), developed using convolutional neural networks and trained with a multicentre cohort of 160 subjects. Derived simple flow indices (forward and backward flow, systolic flow and velocity) and complex indices (aortic maximum area, systolic flow reversal ratio, flow displacement, and its angle change) were compared with those derived from manual contours. (3) Results: AI-derived simple flow indices yielded excellent repeatability compared to human segmentation (p &lt; 0.001), with an insignificant level of bias. Complex flow indices feature good to excellent repeatability (p &lt; 0.001), with insignificant levels of bias except flow displacement angle change and systolic retrograde flow yielding significant levels of bias (p &lt; 0.001 and p &lt; 0.05, respectively). (4) Conclusions: Automated flow quantification using aortic root images is comparable to human segmentation and has good to excellent repeatability. However, flow helicity and systolic retrograde flow are associated with a significant level of bias. Overall, all parameters show clinical repeatability.

Effectiveness of 0.2% Hyaluronic Acid on Clinical, Biomolecular and Microbiological Parameters in Type 2 Diabetes Mellitus Patients with Periodontitis.

This double-blind randomized clinical trial assessed the effectiveness of 0.2% hyaluronic acid (HA) gel as an adjunct to scaling and root planning (SRP) in patients with periodontitis and type 2 diabetes mellitus (DM), focusing on changes in clinical periodontal parameters, the expression of inflammatory mediators, and oral pathogens. The randomized clinical trial involved 36 participants, 18 DM patients, and 18 healthy patients. The participants in each group were randomly assigned to receive placebo or HA gel after SRP. Gingival crevicular fluid and subgingival plaque samples were taken before treatment and at 4-week follow-up. Clinical parameters, interleukin-1β (IL-1β) and IL-10 levels, and proportions of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) were evaluated at baseline and follow-up. Paired t-test (parametric data) or Wilcoxon signed-rank test (nonparametric data) was used for intragroup comparison between baseline and follow-up, and comparisons between groups one-way analysis of variance test (parametric data) or Kruskal-Wallis test (nonparametric data). At 4 weeks, most of the groups showed statistically significant decreases (p ≤ 0.05) in various clinical and biomolecular parameters. However, there were exceptions: the pocket probing depth (PPD) and clinical attachment loss (CAL) parameter did not significantly decrease for the placebo (p > 0.05) non-DM group, and the IL-10 parameter in the DM HA gel group (p = 0.108). Regarding bacterial proportions, the non-DM and DM placebo group exhibited significant test results for Pg after 4 weeks (p ≤ 0.05). In the case of Fn bacteria proportions, they decreased in all groups, but these results were not statistically significant (p ≥ 0.05). An intergroup analysis revealed no significant differences (p ≤ 0.05) for bleeding on probing (BOP), PPD, and both proinflammatory and anti-inflammatory cytokines. Only clinical attachment loss (CAL) exhibited a statistically significant intergroup difference 0.042. The use of 0.2% HA gel into periodontal pockets alongside SRP, for both diabetic and healthy individuals, showed no statistically significant variances in clinical, biomolecular, and microbiological measures.

Management of Gingivitis: Contemporary Approaches and Recent Therapeutic Advancements

Background: Gingivitis, commonly known as gum disease, refers to several types of inflammatory diseases that impact the connective tissues that surround the teeth. Gingivitis causes swelling, redness, and bleeding of the gums in its early stages. Objective: This article aims to describe the standard gingivitis medication. It emphasizes recent advancements in the initial therapy, treatment, and healing mechanisms of gingivitis for achievement in the clinical testing of medicines that promise to enable disease modification in patients. Also, it aims to review recent advancements and emerging therapeutic developments in the management of gingivitis, including gene-based therapies, nanotherapies, anti-cytokine therapies, stem cell-based therapies, and probiotic therapies. Methods: The information for the review articles was acquired by using Google Scholar and PubMed as search engines, as well as a number of publishers, including Springer Nature, Ben-tham Science, Taylor &amp; Francis, Elsevier, and Frontier. Result and Discussion: Gingivitis is a gum disease and scaling root planning (SRP) is now the most common kind of periodontitis therapy available. It has the potential to deliver significant therapeutic success, but it can also have substantial problems that reduce the quality of life of a patient. Stem cell therapies, gingivitis genetic engineering, nuclear-based medicines, and other advances have given people hope that a wide range of illnesses, especially genetic disorders, can be cured. Conclusion: The current gingivitis therapies are successful and continually evolving, with sev-eral drugs currently in clinical trials. These innovative medicines, when combined, may alter gingivitis treatment in the next few years. Finally, gingivitis therapy requires professional dental care and patient education on oral hygiene. Nonetheless, further research and clinical studies are necessary to validate the efficacy, safety, and long-term benefits of these novel treatment modalities.

Analgesic effect of intrapocket anesthesia gel during scaling and root planing: A randomized crossover study

Analgesic effect of intrapocket anesthesia gel during scaling and root planing: A randomized crossover study

Effect of Hesperidin as an Adjunct to Scaling and Root Planing on Clinical Parameters and Serum C-Reactive Protein Level in Chronic Periodontitis: A Randomized, Triple-Blind, Placebo-Controlled, Clinical Trial

ABSTRACT Background: Periodontitis is a chronic inflammatory disease that damages the supporting structures of the teeth, primarily caused by dental plaque containing Gram-negative bacteria. These bacteria trigger an inflammatory host response leading to tissue destruction. Materials and Methods: A total of 84 patients with moderate to severe chronic periodontitis were randomly assigned to either a test group receiving 500 mg of hesperidin daily or a control group receiving a placebo both alongside scaling and root planing (SRP). Clinical parameters including the gingival index (GI), sulcus bleeding index (SBI), probing depth (PD), and clinical attachment level (CAL) were evaluated at baseline, 3 weeks, and 6 weeks. Serum C-reactive protein (CRP) levels were measured at baseline and 3 weeks to assess systemic inflammation. Results: Of the 84 patients, 80 completed the study, with 60 males and 20 females. The test group showed significant reduction in serum CRP levels from baseline to 3 weeks (mean difference: 1.6300, P &lt; 0.001), while the control group also showed a significant decrease (mean difference: -1.2730, P = 0.001). However, no statistically significant differences were found in clinical parameters (GI, SBI, PD, CAL) between the test and control groups at any time point. Intragroup analysis showed significant improvements in these parameters over time within both groups, indicating the effectiveness of SRP in managing clinical symptoms of periodontitis. Conclusion: Hesperidin significantly reduced serum CRP levels, indicating an anti-inflammatory effect, but did not result in significant improvements in clinical parameters compared to placebo.