Significant Reduction In Gingival Index Research Articles

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

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

Punicagranatum as a local drug delivery system: A Clinico microbiological study

The use of herbal/ natural compounds can be comparatively safer alternative to those of synthetic compounds for periodontal therapy. The present study aims to investigate the effect of pomegranate extracts in form of chip for treating adult patients affected with periodontitis followed with scaling and root planing. The study was conducted in two parts: Invitro and Invivo. The study was a randomized controlled study and was addressed by clinical and microbiological parameters at base line and subsequent intervals.
 Material and methods:In vitro release was performed by using Keshary-chien diffusion cell for randomly selected strip. In vivo30patients with adult periodontitis having initial pocket depth ≥4 mm were enrolled into this research. For each subject two experimental sites were chosen located in symmetrical quadrants. Sites were randomly assigned to control group or test group. Then subgingival application of medicated chips was done in both groups. The clinical parameters were recorded at baseline, 30 days and 90 days. Descriptive statistical analysis has been carried out in present study.
 Results: The in vivo study confirmed significant improvements of plaque index ratings with significant reduction in gingival index, plaque index and relative attachment level scores at 90 days as compared to control group. While Porphyromonasgingivalis ,Prevotellaintermedia , Fusobacteriumintermedia and Aggregatibacteractinomycetemcomitans showed a more significant reduction at 90 days as compared to control group. In vitro results showed complete drug release in – 72- 80 hours .Matrix degrades between 3 to 4 days. Pomegranate extracts in chip may provide additional advantages to scaling and root planing for improving periodontal status.
 KEYWORDS: Chip, gingiva, periodontal, pomegranate, punicagranatum

Efficacy of Nanocrystalline Calcium Sulphate Bone Graft (Nanogen®) and Platelet Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Split Mouth Randomised Clinical Study

Introduction: Periodontal disease leads to the loss of supporting structures of the tooth. Recent years have witnessed the evolution of many regenerating materials that have shown to be effective in regenerating the loss structures. Aim: To evaluate and compare clinically and radiographically the efficacy of Platelet Rich Fibrin (PRF) and Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) in the treatment of intrabony defects. Materials and Methods: A split mouth randomised clinical study was done in the Department of Periodontology D.A.P.M.R.V. Dental College Bangalore from November 2018 to May 2020. In this study, 30 surgical sites were selected from 15 chronic periodontitis patients American Academy of Periodontology (AAP, 1999) of age between 35-65 years and with interproximal probing depth ≥5 mm following phase I therapy and radiographic evidence of intrabony defects ≥3 mm deep. They were divided into two groups: Group I (n=15) received open flap debridement with Nanocrystalline Calcium Sulphate (nCS) and Group II (n=15) open flap debridement with PRF. Clinical parameters assessed were Gingival Index (GI), Plaque Index (PI), Gingival Recession (GR), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Intragroup was compared using Repeated Measures of ANOVA followed by Bonferroni's Post hoc Test and intergroup was compared using Independent Student Test. Results: Total 15 patients were selected in each group of which 10 were male and 5 were female patients. Mean age of the patients was 39.3 years. There was significant reduction in GI (p-value=0.04,PPD (p-value=0.04) and gain in CAL (p-value=0.04) in group I. The mean difference in CAL was also statistically significant in group II (p-value=0.01).The mean difference PI was not statistically significant between baseline and three months and baseline and six months in both groups. GR increased from baseline to three months and remained same at six months (p-value for group I and group II=0.36) in both groups. On intergroup comparison, group I (nCS) showed better improvement in clinical parameters like PPD (p-value=0.01), CAL (p-value=0.01) and BF (p-value=0.002) at all time intervals compared to group II (PRF). Conclusion: There was improvement in all clinical parameters except GR in both groups. So both can be used as regenerative materials. But based on this study nanocrystalline calcium sulphate bone graft can be preferred over PRF as a regenerative material.

Comparative evaluation of locally delivered probiotic paste and chlorhexidine gel as an adjunct to scaling and root planing in treating chronic periodontitis: A split-mouth randomized clinical trial.

Introduction:The etiological factors of periodontal diseases are the habitation of dysbiotic bacteria, absence of beneficial bacteria, and susceptibility of the host. Irresolute pattern in the periodontal diseases pathogenesis leads to the evolution of novel antimicrobial therapy.Objective:The objective of the study is to assess and compare the competency of locally delivered probiotic paste with chlorhexidine gel as a supplement to scaling and root planing (SRP) in chronic periodontitis patients.Materials and Methods:A split-mouth randomized controlled trial was designed on 10 systemically healthy participants having chronic periodontitis at three distinct quadrants with 5–6-mm pocket depth. The sites in each participant were randomly selected for Group A (negative control), Group B (positive control), and Group C (test). In Group A, only SRP, Group B – SRP + chlorhexidine local drug delivery (LDD), Group C – SRP + probiotic LDD were done, respectively. Gingival index (GI) and bleeding index (BI) were determined at baseline, 3rd, 6th, and 9th weeks, whereas probing pocket depth (PPD), Russell's periodontal index, and clinical attachment level were checked at baseline and after 9 weeks.Results:It shows a significant reduction in GI, BI, PPD, and gain of CAL in probiotic LDD group.Conclusion:Nowadays, since microbes are rapidly developing resistance to antibiotics, the development of probiotics is a boon for the treatment of periodontal diseases. Diseases of the periodontium are not restricted to the oral cavity alone but also have strong systemic effects. Hence, probiotics give a natural and promising choice of therapy to establish both good oral and systemic health.

Are adjunctive therapies effective in reducing gingivitis and plaque?

Data sources PubMed, CENTRAL, Scopus and Cochrane electronic databases were used as the data sources for the systematic review. All randomised control trials that reviewed antiseptics published up to and including 26 February 2019 were included. A manual search of reference lists of the selected studies was conducted, including information from previous systematic reviews conducted by the same authors.Study selection Two trained and calibrated reviewers screened titles and abstracts that investigated the efficacy of adjuncts to mechanical plaque control, in systematically healthy patients aged 18 years or older with dental plaque biofilm-induced gingivitis, in an intact periodontium (GP) or in patients previously treated for periodontitis with gingival inflammation (PP_GI). Studies with at least one test group and a control group were included, where changes from baseline up to six months in gingival or bleeding indices was the primary outcome.Data extraction and synthesis Data was extracted by three reviewers and reported outcomes extracted at baseline, six months and the longest to follow-up visit. Meta-analysis was conducted for six-month data on antiseptics investigating gingival indices, bleeding indices and plaque indices. Studies were compared via mean treatment effect, calculated for baseline to six months, and analysed using weighted mean differences (WMD) or standardised mean differences (SMD). Statistical heterogeneity was assessed using Cochran's Q and I squared statistic. Study-specific estimates were pooled using the random-effect model and meta-regression analysis performed. Sensitivity analysis was performed to assess the contribution of each study to the evidence and Begg's rank correlation test utilised to assess publication bias.Results Following screening of 1,101 articles, 70 were included in quantitative synthesis. Adjuncts yielded statistically significant reductions in gingival index, plaque index and plaque. Meta-regression analysis showed use of mouth rinses resulted in greater reductions in plaque when compared with dentifrices, whereas antiseptic agents were similarly effective in reducing gingivitis in plaque in patients with GP and PP_GI.Conclusions Based on the present evidence, adjunctive antiseptics in mouth rinses and dentifrices demonstrate statistically significant reductions in gingival, bleeding and plaque indices, when used in adjunct to mechanical plaque control. Clinical significance must be interpreted with caution due to the heterogeneity among studies included and significant publication bias.

Clinical Efficacy of a Novel Lipid-based Thymoquinone Gel: A Two-arm, Single-blinded, and Randomized Study.

ABSTRACTObjective:To evaluate the clinical efficacy of topical 0.1% lipid-based Thymoquinone (TQ) gel, as an antiplaque and antigingivitis agent.Materials and Methods:A randomized clinical trial was carried out in the Outpatient Department of Pediatric and Preventive Dentistry, Dr. Z.A. Dental College, India with a purposive sample of 60 healthy children of 12–18 years of age, having a gingival and plaque index ≥1; the children were divided into two groups by simple randomization. Group A (30 subjects) was advised to apply peanut amount of Chlorhexidine (CHX) gel, twice a day for 2min. Group B (30 subjects) was advised the same but with a peanut amount of 0.1% lipid-based TQ gel. The clinical parameters were the recording of plaque and gingival indices, prior to the treatment (baseline) and at the 14th and 28th day, respectively (post-treatment). The total duration of the study was 28 days with follow-up.Results:Data analysis was done by employing IBM Statistical Package for Social Sciences Windows software, version 20 (IBM Corp, Armonk, NY, USA). The 0.1% lipid-based TQ gel had a statistically significant reduction (P < 0.001) in plaque index as compared with CHX gel during the 0–14th day and 0–28th day, respectively. Similarly, 0.1% lipid-based TQ gel showed a statistically significant reduction in gingival index (P = 0.005) during the 0–14th day and a statistically significant reduction during the 0–28th day (P < 0.001), as compared with CHX gel.Conclusions:Statistically significant reduction in plaque (P < 0.001) and gingival index (P < 0.001) with the usage of 0.1% lipid-based TQ gel.

Efficacy of Xanthan-Based Chlorhexidine Gel on the Levels of Interleukin-1β in Chronic Periodontitis: An Interventional Study.

ABSTRACTAims and Objectives:Xanthan-based chlorhexidine gel (Chlosite®) is a local drug delivery system that exposes the sub-gingival bacteria to the effects of chlorhexidine (CHX) for a prolonged time. Hence, the study aimed at evaluating the clinical efficacy of the subgingival application of Chlosite gel as an adjunctive to mechanical scaling and root planing (SRP) and at evaluating the salivary interleukin (IL)-1β level to substantiate the clinical efficacy of xanthan-based CHX gel.Materials and Methods:A total number of 40 patients with chronic periodontitis in the age group of 30–50 years were enrolled in this interventional study. The patients were assigned to group A, in which only SRP was done, and group B, in which SRP along with the subgingival application of Chlosite gel was done. Periodontal parameters and salivary IL-1β level were evaluated, and the data obtained were statistically analyzed by using paired and unpaired “t” tests.Results:The results obtained showed a statistically significant reduction in the mean gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and salivary IL-1β values in both the groups from baseline to 30 days. There was a statistically significant reduction in GI, in group B when compared with group A, after the treatment. Salivary IL-1β value in group B was slightly lower when compared with group A after the treatment, but it was not statistically significant.Conclusions:The xanthan-based CHX gel is therapeutically effective when used as an adjunct to SRP. The study also indicated that salivary IL-1β can be used as a reliable biomarker.

A pilot study to evaluate the effectiveness of adjunctive use of two antimicrobial topical gels in chronic gingivitis

BackgroundGingivitis is one of the most prevalent oral disease in humans. The most important etiological factor of gingivitis is dental plaque. Plaque control procedures comprises of several mechanical and chemical methods. Many studies have advocated that chemical plaque control methods can be used successfully as an adjunct to mechanical plaque control procedures. Thus, the aim of this pilot study is to evaluate the effectiveness of two topical antimicrobial gels as an adjunct to mechanical plaque control over a period of 2 weeks in treatment of chronic gingivitis patients. Material and MethodsThis is a single blind, two arm parallel design pilot clinical study including 60 systemically healthy patients with 1) chronic generalized gingivitis (MGI>1), 2) probing depth ≤ 3mm and 3) zero clinical attachment loss. The study participants were randomly assigned into two groups i.e., Group I- Chlorhexidine Gluconate (CHX) gel, Group II- combination gel of Chlorhexidine gluconate and Metronidazole (CHX-MTZ) gel. Clinical parameters viz. Gingival Index (GI) and Modified Sulcus bleeding index (MSBI) were recorded firstly at baseline after Scaling and Root Planing(SRP), and secondly at the end of the study period of two weeks. Intra and inter-group comparisons of clinical parameters were done using appropriate statistical tests. ResultsThere was high significant reduction in GI and MSBI scores at the end of 2 weeks period in both the groups. Further, combination gel of Group II (CHX+MTZ) was found to be statistically more effective as compared to Group I (CHX) used alone. ConclusionsOur study suggests that Chemotherapeutic agents like CHX and combination CHX-MTZ Gel are clinically effective as adjunct to Scaling and Root Planning(SRP) in treatment of Chronic Gingivitis. Further, post statistical comparative analysis has proved CHX-MTZ combination gel regime to be more clinically effective than CHX gel used alone in treatment of Chronic Gingivitis as adjunct to SRP. Key words:Scaling and Root Planning (SRP), Chronic Gingivitis, Chlorhexidine Gluconate (CHX) gel, Combination (CHX+MTZ) Gel, Metronidazole (MTZ).

Clinical and Radiographic Evaluation of Piezocision Corticotomy with Bone Graft Guided By 3D-Surgical Template in Maxillary Protrusion (comparative study)

Purpose: The intent of the study was to compare the periodontal and bony changes of piezocision corticotomy with bone graft guided by 3D-surgical template in maxillary protrusion versus non grafted one. Patients and Methods: Prospective study included 20 maxillary protrusive female patients with age group ranging between 20 and 50 years. Patients were divided in to group I: treated with piezocision corticotomy without bone graft guided by 3D surgical template. Group II: treated with piezocision corticotomy with bone graft guided by 3D surgical template. CBCT scan was performed of all the patients. Gingival index (GI), probing depth (PD) and CBCT images were performed at baseline and 6months then collected data were analyzed using SPSS statistical analysis program. Results: There were significant reductions in GI, and PD of Group I and Group II from baseline to 3 months. Radiographic analysis of group II showed a statistically significant increase of labial bone thickness (LBT) after 6 months. Conclusion: The uses of guided bone regeneration during cortioctomy improve the clinical parameter and augment the labial bone with minimal loss of bone thickness during en-mass movement.

The Effects of Salvia officinalis Gel as an Adjunct to Scaling and Root Planning in Patients with Periodontitis (Clinical and Immunological Study)

Background: Phytotherapy is the usage of herbal species with medicinal properties for the management of various diseases. Gingivitis and periodontitis are diseases that involve the role of both the bacteria and the host immune response. Over the years, various researches have shown the importance of herbal products in the management of periodontal diseases. Aims of the study: To evaluate the efficacy of locally applied Salvia officinalis gel as adjunctive in the treatment of chronic periodontitis. Subjects and methods: Fourteen patients (10 males and 4 females) with chronic periodontitis were enrolled in the present study with total number of twenty-eight periodontal pockets utilizing a split mouth design, the pockets were divided into two groups, the test group which was treated with scaling and root planning procedure and the application of the S. officinalis gel, and the control group that treated with scaling and root planning only. Plaque index (PI) and gingival index (GI) were recorded for each site. Gingival crevicular fluid (GCF) was collected from each site by using PerioCol paper strips. The concentration of the transforming growth factor beta-1 in the gingival crevicular fluid was quantified by a high sensitivity enzyme-linked immunosorbent assay. Results: The test group demonstrated a significant reduction in GI at 1-week and 1-month after the treatment comparing to baseline (1.14 vs. 1.64, p = 0.003, and 1.21 vs. 1.64, p = 0.028, respectively), while no significant reduction in the PI at recall visits comparing to baseline. The control group demonstrated no significant reduction in PI and GI at recall visits, comparing to baseline. Both the test and control groups demonstrated no significant reduction in the transforming growth factor-beta 1 concentration in the gingival crevicular fluid at one week after the treatment comparing to baseline, while at one month after the treatment only the test group demonstrated a significant reduction comparing to baseline (3.91 vs. 9.62, p = 0.044). Conclusion: The findings of the present study indicated that the S. officinalis gel has a potential anti-inflammatory role in the treatment of chronic periodontitis by monitoring both the clinical and immunological parameters.

Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial.

Context:Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets.Materials and Methods:Forty-five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day.Results:The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria.Conclusion:The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

Recovery of Clinical Periodontal Parameters After Orthodontic Appliance Removal: A Prospective Study

Objectives Considering the changes in periodontal parameters after orthodontic treatment and lack of adequate evidence on the return of these parameters to normal, the aim of this study was to evaluate the time needed for recovery of periodontal parameters to normal after debonding. Methods In this prospective study, 24 patients (21 females and 3 males) with a mean age of 18.86 ± 4.64 years were included, who were in the final stage of their orthodontic treatment and ready for debonding of orthodontic brackets. The most important inclusion criteria were: No history of periodontal problems, no extensive restorations and caries, no smoking, no systemic disorders and no calculus. In each session, the patients were given oral health instructions and then probing depth (PD), plaque index (PI), gingival index (GI) and bleeding on probing (BOP) of the first molars and central incisors of each quadrant were evaluated at the time of debonding (T1), and one (T2), two (T3) and three (T4) months later; in patients who did not return to normal status (GI ≤ 0.5, negative BOP, PD ≤ 3 mm) after 3 months, the measurements were repeated in subsequent months (up to 6 months). ANOVA followed by pairwise Tukey comparisons were used for determining differences in PD, GI, BOP and PI between the time intervals. Results In general, all the parameters were decreased from T1 to T4. Furthermore, comparisons between different intervals using post hoc Tukey test showed that decreases in PD of the buccal surface and proximal surface in comparison to debonding time were significant during the first and second months, respectively (P < 0.05). Interpretation of statistical data showed a significant reduction in GI after two months. BOP became negative and significantly different after one month in half of the teeth and two months in the other teeth. PI generally decreased from T1 to T4. Conclusions Based on the results of this study, periodontal parameters returned to normal one to two months after debonding.

An evaluation of the efficacy of ethanolic extract of Nigella sativa L. (Kalonji) on the clinical parameters of moderate‑to‑severe gingivitis: A split‑mouth clinical study.

Introduction:Gingivitis is a relatively innocuous and reversible inflammation of gingiva. If left untreated, it might progress involving the deeper supporting periodontal tissues of the tooth with consequent mobility and tooth loss. Compelling literature has suggested the role of local antibacterial and anti‑inflammatory agents as an adjunct to scaling and root planing (gold standard) for treating periodontal diseases. Various herbs such as Nimba (Azadirachta indica A. Juss), Babbula (Vachellia nilotica (L.) P.J.H. Hurter & Mabb.) and turmeric (Curcuma longa L.) have been used for gingivitis since ancient times. Nigella sativa L. (Kalonji) is one such herb known for its remarkable anti‑inflammatory, antioxidant and antimicrobial properties and thus has been utilized in the present study.Aim:The aim of the study was to explore the clinical efficacy of different ethanolic solutions of N. sativa in moderate‑to‑severe gingivitis patients.Materials and Methods:It is a split‑mouth clinical study with 24 patients of moderate‑to‑severe gingivitis from the age group of 25–45 years. Recruited individuals were divided in to group I1, group II1 and group III1 (scaling and root planning i.e., control) and group I2, group II2 and group III2 (experimental). Three doses of solution 1 (1:3), solution 2 (1:1) and solution 3 (3:1) were administered to the experimental groups for 3 consecutive days. The clinical parameters, i.e., gingival index (GI) and plaque index (PI) were recorded at baseline, 14 days and 28 days in all the individuals. ANOVA test was used in the study for statistical analysis.Results:Intergroup comparison in terms of GI showed statistically significant difference at 14th and 28th day from baseline between I1 &I2, at only 28th day between II1 & II2 and insignificant difference between III1 & III2 at all time intervals from baseline. On intragroup comparison, statistically significant reduction in GI in all groups from baseline till 28 days was found, but among experimental groups best result was seen in group III2 (P < 0.001; F value 153.75). As far as PI is concerned, intergroup comparison between different groups displayed statistically significant difference from baseline to 14th and 28th day between all groups i.e I1& I2, II1& II2 and III1& III2. On intragroup comparison, statistically significant reduction in PI in all control groups i.e I1, II1 & III1 was found, but among experimental groups only group III2 provided statistically significant reduction (P < 0.001, F value 30.40).Conclusion:The results of this study indicate that, the ethanolic extract of N. sativa is effective in the treatment of moderate to severe gingivitis.

Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis.

Although powered toothbrushes have been reported to reduce gingivitis more than manual toothbrushes in the general population, the evidence regarding orthodontic patients has been inconclusive. Thus, we aimed to compare their effectiveness in relation to any available parameter regarding oral health in orthodontic patients with fixed appliances. Searches without restrictions for published and unpublished literature and hand searching took place up to August 2017. Oral-health relevant data from randomized controlled trials of at least 4-weeks duration comparing powered and manual tooth brushing without supervision were reviewed. Data were classified as short term (assessments at 1-3months) and long term (assessments at>3months), and the random-effects method was used to combine treatment effects. Individual study risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of evidence was evaluated according to the Grades of Recommendation, Assessment, Development and Evaluation approach. The initially identified articles were finally reduced to 9 randomized controlled trials investigating the periodontal health in 434 patients. Eight studies followed patients up to 3months, and 1 up to 12months during treatment. One study was at low and the rest at unclear risk of bias. Overall, in the short term, there was low-quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual brushing with regard to the gingival index (weighted mean difference, -0.079; 95% confidence interval, -0.146 to -0.012; P=0.021) and indexes assessing gingival bleeding (standardized mean difference, -0.637; 95% confidence interval, -1.092 to -0.183; P=0.006). In the long term, only 1 available studyshowed a statistically significant benefit of powered over manual toothbrushes with regard to gingival index and bleeding. No differences were observed in probing pocket depth and relative attachment loss. For the rotation-oscillation brushes that involved the greatest body of evidence, statistically significant reductions in gingival index and bleeding were demonstrated only in the long-term study. No included study provided quantified measurements regarding caries activity. Overall, powered toothbrushes may promote gingival health better than manual toothbrushes in orthodontic patients. However, no type demonstrated clear superiority. Better study standardization and reporting in longer follow-up studies are necessary to elucidate the clinical relevance of these results.

Comparative Evaluation of Antiplaque Efficacy between Essential Oils with Alcohol-Based and Chlorhexidine with Nonalcohol-Based Mouthrinses.

Aim and Objectives:The aim of this study is to compare the antiplaque efficacy of alcohol-based mouthwash with essential oils and nonalcohol-based chlorhexidine mouthrinse in 4 days plaque re-formation study.Materials and Methods:The current research paper is double-blinded, parallel designed clinical trial that was conducted in the Department of Periodontics and Oral Implantology, Kalinga Institute of Dental Sciences, Bhubaneswar. This included ninety dental students of Bachelor of Dental Surgery curriculum (in the age range from 20 to 24 years) Professional cleaning with scaling and polishing was carried out to acquire a zero plaque and gingival index (GI) for all ninety patients at baseline. Ninety patients were randomly divided into three groups with thirty patients in each group named as Group A, B, and C, respectively. Two commercially available mouthrinses, one containing alcohol (labeled as Solution (A) and one without alcohol (labeled as Solution (B) were placed in identical bottles and distributed to Group A and Group B patients. Whereas, the Group C patientswere instructed to use warm saline mouth rinse. The statistical analysis was performed using the Statistical Package for the Social Sciences software (Version 18).Results:Essential oils with an alcohol-based and chlorhexidine (CHX) alcohol-free mouthrinse (0.2%) groups compared to normal saline showed significant reductions in GI and PI scores.(P < 0.0001).Conclusion:The antiplaque efficacy of both alcohol-based mouthwash with essential oils and nonalcohol based CHX mouthwash were found to be equally effective in 4 days of plaque re-formation.

Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral.

Anorganic bovine bone mineral (ABBM) is extensively used in the treatment of intra-bony defects. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with a simplified technique. Although certain studies have reported the use of PRF in the treatment of intra-bony defects, to date, none of them have evaluated its additive effects with ABBM. Therefore, a randomised, split-mouth clinical trial was conducted to compare healing of intra-bony defects treated with an ABBM-PRF combination with healing of those treated with ABBM alone. By using a split-mouth design, 15 paired intra-bony defects were randomly treated with either ABBM alone (control group) or ABBM-PRF combination (test group). Following clinical parameters and radiographical measurements were recorded at baseline and 6 months after treatment: plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), clinical attachment level (CAL), vertical bone loss, depth of defect and defect angle. Preoperative clinical and radiographical measurements were similar for the test and control groups. Statistically significant reductions in GI, PD, CAL, vertical bone loss, depth of intra-bony defect and widening of defect angle were detected after treatment in both groups. With respect to inter-group analysis, gain in CAL was significantly greater in the test group than in the control group, whereas no inter-group differences were observed in any other parameter. The results of this study indicate that both therapies are effective in the treatment of intra-bony defects.

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

IntroductionDuring critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically...

A randomised clinical study to evaluate the efficacy of alcohol-free or alcohol-containing mouthrinses with chlorhexidine on gingival bleeding.

Gingival bleeding following twice-daily use of 0.2% w/v chlorhexidine digluconate mouthrinse with and without alcohol (0.2% CHX-alcohol; 0.2% CHX-alcohol-free, respectively) and brushing with a standard fluoride toothpaste was compared to brushing alone. Three hundred and nineteen subjects with mild-to-moderate gingivitis (with ≥16 gradable permanent teeth including four molars, bleeding after brushing and ≥20 bleeding sites) completed this randomised, examiner-blinded, parallel-group study. A prophylaxis was performed at baseline. Gingival Severity Index (GSI; primary objective), Gingival Index (GI) and Plaque Index (PI) were assessed at baseline and after 6 weeks of treatment. Adverse events (AEs) were recorded throughout the study. Between treatment differences at week 6 demonstrated significantly lower GSI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (primary endpoint; treatment difference -0.061 [95% CI -0.081, -0.041] and -0.070 [95% CI -0.090, -0.050], respectively; both p <0.0001). There were also significant reductions in GI and PI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (all p <0.0001). The proportion of subjects reporting ≥1 treatment-related adverse events (TRAEs) was 27.8% (0.2% CHX-alcohol), 24.8% (0.2% CHX-alcohol-free) and 3.7% (brushing alone). Chlorhexidine mouthrinse with or without alcohol as an adjunct to brushing with regular fluoride toothpaste significantly reduces bleeding scores, plaque and gingival inflammation compared to brushing alone. TRAEs are characteristic of those associated with the use of chlorhexidine and are similar for both mouthrinses.

Periodontal evaluation of different toothbrushing techniques in patients with fixed orthodontic appliances

Plaque control is the major consensus during orthodontic treatment to prevent the occurrence of cavities and periodontal inflammation. The mechanic resource of greater effectiveness and frequent use in this control is the oral hygiene. The tooth brushing techniques most used in orthodontic patients are: Ramfjord's method, Modified Stillman technique and Bass method. Since control studies evaluating the effectiveness of usual tooth brushing techniques do not show clear advantage, the objective of this study was to evaluate the effectiveness of three brushing methods, through periodontal clinical parameters of patients with fixed orthodontic appliances. Thirty patients were selected, with ages between 14 and 22 years old, with fixed orthodontic appliances. After basic periodontal treatment the following factors were evaluated: 1--Plaque index and 2--Gingival index and each patient was randomly included in one of the three selected groups according to the brushing technique: Group 1--Scrubbing technique; Group 2--Modified Stillman technique and Group 3--Bass technique. Patients were evaluated for 9 months. The results showed a significant reduction of clinical parameters by the end of this period, however there was a very significant reduction of Gingival index on group 3 (13.6%) when compared to the other groups. Thus, it can be suggested that the Bass technique can be effective on the reduction of periodontal clinical parameters of Plaque index and Gingival index in patients with fixed orthodontic appliances.

Evaluation of the Safety and Efficacy of Complete Care Herbal Toothpaste in Controlling Dental Plaque, Gingival Bleeding and Periodontal Diseases

Aim: The aim of the study is evaluation of safety and efficacy of complete Care Herbal Toothpaste in controlling dental plaque, gingival bleeding and periodontal diseases. Materials and methods: A hundred subjects of both sex with dental plaque and other dental problems in the age group of 18-60 years, who willing gave informed written consent, were included in the study. All the subjects were given Complete Care Herbal Toothpaste and advised to brush the teeth twice daily for 6 weeks and to come for follow up visits at 2nd week, 4th week and 6th week. Improvement in plaque index, oral hygiene status and gingival index was evaluated in these patients. Results: Ninety-two out of hundred subjects who were included in the trial completed till the six weeks of followup, there was significance of p<0.05 reduction in gingival index, plaque index, bleeding index and overall response in individuals with plaque. No clinically significant adverse reactions, were reported or observed, during the entire study period and overall compliance to the treatment was excellent. Therefore, Complete Care Herbal Toothpaste is effective and safe against gingivitis, plaque, bleeding of gums and other oral problems. Conclusion: The effectiveness of Complete Care Herbal Toothpaste was evaluated in subjects with plaque. At the end of the study, Complete Care Herbal Toothpaste showed significant reduction in gingival index, plaque index, bleeding index and overall improvement towards the oral problems of the subjects included in the study. A significant symptomatic relief was seen after treatment for 6 weeks with Complete Care Herbal Toothpaste. No clinically significant adverse reactions, were reported or observed, during the entire study period and overall compliance to the treatment was good.