Significant Reduction In Plaque Index Research Articles

Combined Efficacy of Advanced Oral Hygiene 
Aids and Active Reminders in Maintaining 
the Oral Hygiene of Patients with Fixed Orthodontic Appliances: A Randomized 
Clinical Trial

Objectives: To evaluate the efficacy of water irrigating devices, powered toothbrushes, and active repeated oral hygiene reminders on oral hygiene of fixed orthodontic patients. Materials and Methods: This was a randomized, examiner-blind clinical trial involving fixed orthodontic appliance patients. Patients were recruited within six months of bonding on both the arches. Eighty patients were randomly assigned to four groups; groups 1 and 3 subjects received standard oral hygiene procedures and used manual orthodontic toothbrushes, and subjects in groups 2 and 4 used powered toothbrushes and water irrigators for oral hygiene maintenance during the study period. In addition, repeated oral hygiene reminders via SMS were sent to subjects in groups 1 and 2, whereas groups 3 and 4 subjects received only oral motivation. The principal investigator assessed the plaque index (PI) and gingival index (GI) at baseline (T0) and after 2, 4, 8, and 12 weeks, that is, T1, T2, T3, and T4, respectively. Results: Group 2 and group 4 subjects showed statistically significant reduction in PI ( p < .001) and GI ( p < .001) scores at the end of study interval; however, the magnitude of decrease was less in group 4 in comparison to group 2. Intergroup comparisons between group 1 versus group 3 and group 2 versus group 4 were made to evaluate the efficacy of reminders. Statistically significant reduction was observed in group 2 as compared to group 4 at T4 ( p < .001) when compared to T1 ( p < .87). Conclusion: Using powered toothbrushes and oral irrigators resulted in a statistically more significant reduction in plaque and gingivitis scores than conventional procedures. Active reminders had a catalytic effect in improving the oral hygiene.

Efficacy of Ozonated Olive Oil Gel in the Management of Peri-Implant Mucositis.

Peri-implant mucosistis is similar to gingivitis, the former affects the mucosa around implants without bone loss. The aim of this study was to determine the effectiveness of ozonated olive oil gel in the management of peri-implant mucositis. A randomized controlled clinical trial was conducted among 50 patients with peri-implant mucositis within the age group of 25-50 years. They were randomly divided into two groups with 25 participants in each group based on the intervention [Group A (Ozonated olive oil gel), Group B (Chlorhexidine gel)]. Silness and Loe plaque index (PI) and Loe and Silness gingival index (GI) were recorded at baseline and after 4 weeks. Paired t-test and independent t-test was used to test the significance. Within the groups, there was a statistically significant reduction in PI and GI from baseline (P < 0.05). However, the difference in PI and GI between both the groups was statistically insignificant (P > 0.05). Ozonated olive oil gel was equally effective to chlorhexidine gel in the management of peri-implant mucositis.

Comparative evaluation of plaque removal efficacy and quantitative analysis of &lt;em&gt;Streptococcus mutans&lt;/em&gt; in saliva after using nylon and charcoal bristles toothbrushes in children: A clinico-microbiological study

Background: Dental biofilms are the primary aetiologic factors in the 2 most prevalent oral diseases, dental caries and periodontal disease. Among all oral hygiene methods available, mechanical plaque removal with a toothbrush is the primary mode of maintaining good oral hygiene.Objectives: Comparative evaluation of plaque removal efficacy and quantitative analysis of Streptococcus mutans in saliva after using nylon and charcoal bristles toothbrushes in children.Method: Forty healthy children aged 8-10 years having decayed-missing-filled-tooth (DMFT) score less than 5 were randomly allocated into two groups, one using charcoal bristles and the other using nylon bristles toothbrush. Loe &amp; Silness Plaque Index was recorded along with saliva sample collection for Streptococcus mutans count before and after using the respective toothbrushes for 1 week.Results: A significant reduction in plaque index was observed in each group with a non-significant reduction in Streptococcus mutans CFU. However, the comparison between the two groups was not statistically significant.Conclusions: This randomised, parallel, singleblinded clinical study demonstrated that both nylon and charcoal bristles toothbrushes significantly enhanced plaque control but there was no significant difference in the two methods. There was no significant reduction in Streptococcus mutans CFU.

Comparing the Effectiveness of Conventional and Microsurgical Access Flap Techniques in Managing Horizontal Bony Defects in Chronic Periodontitis Patients: A Clinical and Radiographic Study

Abstract Objective Periodontal microsurgery is descendant of conventional periodontal surgery to reduce surgical trauma, improve wound healing, and enhance patient compliance. This study compared the efficacy of conventional and microsurgical access flap in the management of horizontal bony defects in chronic periodontitis patients. Materials and Methods Eight pairs of contralateral horizontal bone defects in chronic periodontitis patients were randomly allocated to control group and test group. Microsurgical access flap was carried out in test group under magnification, while control group received conventional access flap. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), relative attachment level (RAL), and relative gingival marginal level (RGML) were recorded at baseline, 3 months, and 6 months. Wound healing index (WHI) was evaluated after 1 week, 2 weeks, and 4 weeks. Pain perception was evaluated using visual analog scale (VAS) post-surgery and after 24 hours. Radiographic defect depth was measured at baseline and after 6 months. Statistical Analysis The statistical analysis was done by SPSS statistical software. The intragroup comparison was done by repeated measures analysis of variance. The intergroup difference between both groups was done by Student's t-test. The descriptive statistics for VAS and WHI was done by Wilcoxon signed rank test. The mean difference between clinical parameters from baseline to follow-up intervals was calculated by post-hoc least significance difference analysis. Results There was significant reduction in PI, GI, PPD, and RAL within both the groups (p &lt; 0.05). There was increase in RGML within both the groups from baseline to 6 months (p &lt; 0.05). In the intergroup comparison, test group showed better WHI and better pain perception (VAS) compared to control group (p &lt; 0.05). No difference was found between both the groups in terms of radiographic defect depth (p &gt; 0.5). Conclusion Both the procedures were effective in improving the clinical parameters but the microsurgical group showed better results in terms of wound healing and less postoperative pain. Both procedures showed no significant effect on radiographic defect depth.

Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial.

This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM). A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis +DM). A total of 60 sites in each group were randomized to receive treatment with SRP+placebo gel (control) or SRP+0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. Group-1 showed significant reduction in PI (0.56±0.15 and 0.52±0.19 from 0.67±0.17), mSBI (0.7± 0.60 and 0.47± 0.57 from 0.9±0.48), PPD (4.6± 0.85 and 3.43 ± 0.63 from 6.5±1.04) and gain in RAL (7.03±0.85 and 5.93 ± 0.69 from 8.9±1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups. ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

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

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

Clinical efficacy of green tea, aloe vera and chlorhexidine mouthwashes in the treatment of dental biofilm induced gingivitis: A multi-arm, double-blinded, randomized controlled clinical trial.

This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients. Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n=15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day. PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day. Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases.

Role of Chlorhexidine and Herbal Oral Rinses in Managing Periodontitis

The aim of this research was to assess the effect of 0.12% chlorhexidine (CHX) and a Salvadora persica-based mouthwash on whole salivary tumour necrosis factor-alpha (TNF-α) levels and periodontal inflammation in patients with type 2 diabetes mellitus (T2DM). Patients with and without medically diagnosed T2DM were included. Patients' medical records were evaluated to confirm the diagnosis of T2DM. All patients underwent nonsurgical periodontal therapy (NSPT). Patients were divided into 2 subgroups. In the test and control group, patients were advised to rinse with an S persica-based mouthwash and a non-alcoholic 0.12% CHX after NSPT twice daily for 2 weeks, respectively. Demographic data were collected. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were measured, and whole salivary TNF-α levels were gauged at baseline and at 3-month follow-up. Haemoglobin A1c (HbA1c) levels were measured in all patients at baseline and at 3-month follow-up. Sample size estimation was done, and group comparison was performed. Level of significance was set at P < .01. Twenty-one nondiabetic individuals and 21 patients with T2DM were included. At baseline, there was no significant difference in clinical and radiographic periodontal parameters amongst in patients with and without T2DM. At 3-month follow-up, HbA1c, TNF-α, PI, PD, and clinical AL were comparable with their respective baseline values in the test and control groups amongst patients with T2DM. In nondiabetic individuals, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01), and TNF-α (P < .01) at 3-month follow-up in the test and control groups compared with their respective baseline scores. In the short term, NSPT with 0.12% CHX or S persica-based mouthwashes is more effective in reducing periodontal inflammation and whole salivary TNF-α levels in nondiabetic individuals than in patients with T2DM with periodontal inflammation.

Non-surgical periodontal therapy with adjunct photodynamic therapy for the management of periodontal inflammation in adults using nicotine-free electronic-cigarette: A randomized control trial

ObjectiveThe aim was to assess the effect of non-surgical periodontal therapy (NSPT) with adjunct photodynamic treatment (PDT) for the management of periodontal inflammation in young electronic cigarette (E-cig) users. MethodsPatients with periodontal inflammation were included. Patient demographics and information related to E-Cig usage were recorded. Scores of plaque index (PI), bleeding index (BI), clinical attachment loss (AL) and probing depth (PD) recorded at baseline and at 3-months’ follow-up. Patients were randomly divided into test (NSPT + PDT) and control groups (NSPT) alone. Sample-size estimation was done using data from a pilot investigation and group comparisons were done. Correlation between periodontal parameters and duration of E-cig use was assessed using regression analysis models. Group-comparisons were done using the Mann Whitney U test; and logistic regression was done to correlate periodontal parameters with age, gender, frequency of vaping, number of puffs inhaled and oral hygiene maintenance protocols. Level of significance was set at P<0.01. ResultsTwenty-three and 23 individuals were randomly allocated to the test- and control-group, respectively. At baseline, PI, BI and PD were comparable in all patients. There was a significant reduction in PI (P<0.01), BI (P<0.01) and PD (P<0.01) in the test and control groups at 3-months’ follow-up when compared with their respective baseline scores. At 3-months’ follow-up, there was no significant difference in PI, BI and PD among patients in the test and control groups. There was no clinical evidence of clinical AL among patients in the test- and control groups at baseline and at 3-months’ follow-up. ConclusionIn the short-term, PDT is as effective as NSPT for the management of periodontal inflammation in young E-Cig users.

Efficacy of 0.2% chlorhexidine gluconate and 0.1% octenidine dihydrochloride mouth rinses in patients with plaque induced gingivitis: Double blinded randomised case control study.

Aims: The study aims at making a comparative study of two commercially available mouth rinses, 0.2% chlorhexidine gluconate and 0.1% octenidine dihydrochloride for assessing their efficacy as an antiplaque agent in patient with plaque induced gingivitis.&#x0D; Methods and Material:&#x0D; In double-blinded experimental study forty-five patients with dental plaque induced gingivitis, divided into 3 groups of 15 patients each, were advised 0.2% chlorhexidine gluconate (CHX) and 0.1% octenidine dihydrochloride (OCT) and distilled water as a mouth rinses respectively. Clinical parameters viz, Plaque Index, Modified Gingival Index and Gingival Bleeding Index were assessed (day 0, 5,10 and15). Microbial count was also assessed from the collected plaque samples (at day 0 and on day 15). Antimicrobial susceptibility test was also done.&#x0D; Statistical analysis used: One- way ANOVA with post hoc test using Tukey, Paired- t test, Mann-Whitney U test, The Kruskal-Wallis test, Wilcoxon signed-rank test&#x0D; Results:&#x0D; There was significant difference in mean plaque index between the different groups. There was a significant reduction in plaque index for 0.2% CHX The mean modified gingival index was higher in group belonging to 0.1% OCT compared to 0.2% CHX that was statistically significant (p = 0.005).  Similarly, the mean gingival bleeding index was significantly higher in group belonging to 0.1% OCT compared to 0.2% CHX (p = 0.005). On day 15 change in the microbial count was statistically significant for 0.2% CHX (p = 0.026).and 0.1% OCT (p = 0.001).&#x0D; Conclusions:&#x0D; The antimicrobial and antiplaque efficacy (in vivo and in vitro) of 0.1% octenidine dihydrochloride containing mouth rinse was comparatively higher than that containing 0.2% chlorhexidine gluconate thereby demonstrating the former's potential usefulness in controlling plaque and gingivitis.

Determination of efficacy of curcumin and Tulsi extracts as local drugs in periodontal pocket reduction: A clinical and microbiological study.

Background:The aim of our study is to assess the effectiveness of Curcumin and Tulsi in the control of periodontal parameters when delivered in the form of local drug delivery (LDD) agents.Methods:Curenext gel® and Tulsi gel were used as the two LDD agent. A split mouth randomized clinical trial was carried out in 15 patients. Three sites in different quadrants were assigned treatment modality of scaling and root planing (SRP) alone, SRP with LDD of curcumin and SRP with LDD of Tulsi extract, respectively. Clinical parameters Probing Pocket Depth, Clinical Attachment Level, Plaque Index, Gingival Index, and modified Sulcus Bleeding Index were recorded and subgingival plaque sample collected for N-benzoyl-L-arginine-p-nitroanilide (BAPNA) assay on baseline followed by LDD with extracts in the assigned group. The parameters were recorded at baseline and on 30th day postoperatively. Unpaired and Paired-'t' test were used for intergroup and intragroup comparison of recorded clinical and microbiological parameters.Results:All the treatment modalities showed statistically significant reduction in clinical and microbiological parameters on intragroup comparison. Intergroup comparison showed statistically significant reduction in Plaque Index in curcumin group and BAPNA assay in Tulsi group when compared to SRP.Conclusion:Both the herbs were effective in improving periodontal parameters and may develop as an alternative to currently used LDD agents in near future.

Functionally graded membrane: A novel approach in the treatment of gingival recession defects.

Background:Guided tissue regeneration has recently been advocated in re-constructing soft-tissue dimensions in recession defects. Advancement in nanotechnology has led to increased zest for approaches such as electrospinning of biologically active; nanofibrous functionally graded regenerative membranes for periodontal tissue engineering. A functionally graded membrane (FGM) had been tailored by incorporating chitosan and nano-hydroxyapatite over Amnion membrane and used in gingival recession defects.Study Design:It was single-blind, randomized controlled study. Split-mouth study was conducted in nine patients and 22 sites with recession defects were selected. Sites were divided into Group A (Amnion membrane with coronal advanced flap) and Group B (FGM with coronal advanced flap).Materials and Methods:Sites were assessed clinically by recording plaque index (PI), gingival index (GI), vertical recession defect depth (VRDD), relative clinical attachment level (CAL), and width of keratinized tissue at baseline, 3–6 months; and radiographically by recording linear bone growth by dentascan at baseline and 6 months.Result:Both groups showed statistically significant reduction in PI, GI and VRDD, and CAL and nonsignificant reduction in width of keratinized tissue at 3 and 6 months postoperatively. Group A showed statistically significant linear bone growth at 6 months. Group B also showed gain in linear bone growth at 6 months; however, result was statistically nonsignificant.Conclusion:FGM had shown favorable results by enhancing bone growth while preventing the gingival tissue downgrowth.

The Effects of Curcumin in the Treatment of Gingivitis: A Systematic Review of Clinical Trials.

Different modalities of treatments are available for management of gingival disease but most have adverse effects. Curcumin has anti-inflammatory properties and can be used for management of various inflammatory processes. This systematic review evaluates the effects of curcumin as an adjuvant to oral hygiene on plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and inflammation in patients with gingivitis. A comprehensive search was conducted using PubMed/MEDLINE, Cochrane, SCOPUS, and Google Scholar. Based on the Population, Intervention, Control, and Outcome (PICO) model, clinical trials which tested the effects of curcumin as an adjunctive product or alone in control of gingival inflammation up until 21 February 2020 with language restrictions were selected. From the 422 papers found, 14 met the eligibility criteria. In most of these studies, curcumin treatment achieved significant reductions in PI, GI, GBI, and microbial colony count and was as effective as chlorhexidine mouthwash, with no serious adverse effects. We conclude that treatment with curcumin for gingivitis is safe as a natural herbal compound and is as effective as chlorhexidine mouthwash.

Role of Probiotics for the Treatment of Peri-Implant Mucositis in Patients With and Without Type 2 Diabetes Mellitus.

This study hypothesized that probiotic therapy (PT) does not offer additional benefits to mechanical debridement (MD) for the treatment of diabetic subjects with peri-implant mucositis (PM). This study compared the influence of PT as an adjunct to MD for the treatment of PM in type 2 diabetic and nondiabetic patients over a 12-month follow-up period. Patients with and without type 2 diabetes were included. PM patients were categorized into 2 groups based on the treatment procedure: (1) nonsurgical + PT and (2) nonsurgical MD alone. Demographics and education statuses were recorded. Gingival index (GI) and plaque index (PI), crestal bone loss (CBL), and probing depth (PD) were measured at baseline and after 6 and 12 months. Significant differences were detected with P < .01. The hemoglobin A1c level was significantly higher in patients with diabetes at all time durations than in patients without type 2 diabetes (P < .001). Baseline GI, PI, PD, and CBL were comparable in all groups. In patients with type 2 diabetes, there was no difference in PI, GI, PD, and CBL at 6- and 12-month follow-up. In patients without type 2 diabetes, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01) at 6-month and 1-year follow-up as compared with baseline. In patients without type 2 diabetes, MD with or without adjunct PT reduced soft-tissue inflammatory parameters in patients with PM.

Assessment of Antiplaque and Anti-Gingivitis Efficacy of Mouthwashes Prepared from Neem and Mango Extracts.

Objectives:This study aimed to determine the minimum inhibitory concentration (MIC) of mouthwashes prepared from neem and mango extracts against Streptococcus mutans (S. mutans) in vitro. Their taste acceptability and effects on plaque index (PI), gingival index (GI) and salivary pH were also evaluated and compared with chlorhexidine (CHX) in children.Materials and Methods:Dry extracts of neem and mango twigs were prepared and their MIC against S. mutans was determined. The effective MIC was used to prepare mouthwashes from the two extracts. Three parallel groups of children (n=30) used either neem, mango or 0.2% CHX mouthwash for 21 days. The PI and GI were recorded at baseline and at 7 and 21 days. The salivary pH and taste acceptability were also assessed.Results:The MIC of both extracts was achieved at 25% concentration. There was a significant difference between the GI score of mango group compared with neem and CHX at the three time points (P<0.001). There was no significant difference between the neem and mango groups in PI (P=0.674). There was no significant difference among the three groups in salivary pH either (P=0.817). Intragroup comparison showed significant reductions in PI, GI and salivary pH in all the three groups after 21 days (P<0.001).Conclusion:Neem and mango mouthwashes can be used as effective alternatives to CHX in children.

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.

Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: A randomized controlled clinical trial.

Although studies have been done that evaluated the effect of photodynamic therapy (PDT) in cigarette smokers and vapers, however, literature on the impact of these types of smoking on peri-implant parameters lack. The present clinical trial assessed the effectiveness of PDT as an adjunctive therapeutic modality in the treatment of peri-implant mucositis (p-iM) in individuals vaping e-cigs and cigarette smokers. Individuals with p-iM were divided into three groups. (a) Group 1: Cigarette smokers with p-iM (b) Group 2: Vapers (e-cigarette smokers) with p-iM, (c) Group 3: Non-smokers with p-iM. Plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were calculated. Pro-inflammatory biomarkers including matrix metalloproteinase (MMP)-8 and tumor necrosis factor-alpha (TNF-α) were quantified using enzyme linked immunosorbent assay. All assessments were performed at baseline (before treatment) and 12 weeks post treatment. Full mouth disinfection (FMD) was done with the ultrasonic scaler and copious irrigation. The photodynamic therapy (PDT) was done with a diode laser (wavelength: 670 nm, power: 150 mW, density: 1.1 W/cm2). Methylene blue photosensitizer (0.005% concentration) was incorporated inside the periimplant pockets (10 seconds at a depth of 3 mm), and the pockets were irradiated a flexible tip for one minute on the buccal and lingual surfaces. The session of PDT was performed only once at baseline. Twenty-five cigarette-smokers (Group 1), 21 electronic cigarette smokers (Group 2) and 25 never-smokers (Group 3) participated in the study. The mean age of the selected participants in groups 1, 2 and 3 was 29.5, 27.8, and 30.2 years, respectively. Statistically significant reduction in PI and PD parameters was observed on baseline and at 12 weeks in all groups. BOP significantly increased in group 1 and 2 at 12 weeks. A statistically significant reduction from baseline to 12 weeks was reported in the biomarker levels for all the study groups. PDT with adjunctive mechanical debridement reduced the plaque index and probing depth, while increased bleeding on probing, in addition to reducing pro-inflammatory biomarkers in tobacco smokers.

Plaque Inhibitory Effect of Hyaluronan-Containing Mouthwash in a 4-Day Non-Brushing Model.

Despite being the gold standard antiplaque agent, chlorhexidine (CHX) has many adverse effects that make scientists search for new agents to combat biofilms as effective as CHX. Hyaluronan, also known as hyaluronic acid (HA), is a natural polysaccharide with anti-inflammatory, antioxidant and bacteriostatic properties. The objectives were to evaluate the plaque inhibitory, and anti-inflammatory effects of HA mouthwash compared to CHX and distilled water (DW) in a 4-day non-brushing model together with the participants' preference to the used products. Thirty-three systemically and periodontally healthy subjects were included in this randomised, double-blinded, crossover clinical study. Subjects were randomly assigned into three treatment-sequence groups to use three mouthwashes one after another, in three different time periods. After professional prophylaxis at day 1, subjects refrained from all oral hygiene measures and used mouthwashes that were individually allocated to them. On day 5, scoring of plaque index (PI) according to Turetsky modification of Quigley Hein Index system, modified gingival index (MGI) and measurement of gingival crevice fluid (GCF) volume were performed. Treatment satisfaction questionnaire form was given at the end of each experimental period. CHX showed statistically significant reduction in PI followed by HA (p = 0.048). No statistically significant differences were detected between HA and CHX in terms of MGI and GCF volume. For HA, subjects reported significantly better taste, less sensitivity, burning sensation, mouth dryness and numbness perception compared to CHX and DW. CHX revealed the best plaque inhibition closely followed by HA. Early gingival inflammatory changes were found similar for CHX and HA. Furthermore, HA was well accepted with better perceptions than CHX and DW.

The Impacts of Synbiotic Supplementation on Periodontal Indices and Biomarkers of Oxidative Stress in Type 2 Diabetes Mellitus Patients with Chronic Periodontitis Under Non-Surgical Periodontal Therapy. A Double-Blind, Placebo-Controlled Trial.

AimThe aim of the current study was to investigate that combination of the synbiotic supplementation in adjunct with non-surgical periodontal therapy (NSPT) is useful in treating periodontitis and biomarkers of oxidative stress in type 2 diabetes mellitus (T2DM) patients.MethodsIn this study, 47 patients suffering from DM and CP were recruited and randomly assigned to two groups. The intervention (n= 23) and control (n=24) groups received either multispecies probiotic supplement plus 100 mg fructo-oligosaccharide (500 mg in each capsule) or placebo capsule containing 500 mg wheat flour, respectively, every day for 8 weeks. All subjects were treated with NSPT during the intervention period. Serum levels of interleukin-1β (IL-1β), malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and periodontal indices including clinical attachment loss (CAL), pocket depth (PD) (main outcome), BOP, and plaque index were measured before and after the intervention.ResultsSupplementation with the synbiotic with NSPT led to a significant decrease in the levels of IL-1β, MDA, plaque index, PD, and CAL in the intervention group post-intervention (p < 0.05). The serum levels of TAC, SOD, and GPx were significantly increased in the intervention group compared with the baseline (p < 0.05). Consumption of synbiotic with NSPT, compared to the control, resulted in a significant decrease in the mean changes of IL-1β, MDA, and CAL (p < 0.05). Also, the mean changes of TAC and GPx were significantly higher in the intervention group compared with the control group (p < 0.05). Also, in the intervention group was seen a significant reduction in plaque index (p = 0.035) and BOP (p = 0.04) compared with the control group.ConclusionIt was observed that synbiotic supplementation with NSPT may be beneficial in improving inflammatory, antioxidant, and periodontal status in T2DM patients with CP.

Efficacy of omega 3 fatty acid as an adjunct in the management of chronic periodontitis: A randomized controlled trial

: Periodontitis is conventionally treated with both surgical and nonsurgical methods. Various adjuncts have been used previously with compromised efficacy. Recently omega-3(ώ-3) polyunsaturated fatty acids (PUFA) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The purpose of the present study was to evaluate and compare the clinical efficacy of ώ-3 fatty acids as an adjunct to scaling and root planing in the treatment of periodontitis. 110 Patients were selected for the study out of which 20 were excluded (12 not meeting the inclusion criteria and 8 refused to participate). 90 patients (48 in test and 42 in the control group) after randomisation through a coin toss method were enrolled in a single-blind randomised controlled trial conducted in the Periodontics department of a dental college. Full mouth subgingival scaling and root planing and ώ-3 fatty acid 500 mg (EPA/DHA 180/120 mg), BD daily for 1 month was given to the test group and subgingival scaling and root planing only was given to the control group. Clinical parameters like probing pocket depth, clinical attachment level, plaque index and gingival index were recorded at baseline, 1 and 3 months and were compared. Statistical analyses demonstrated a significant reduction in probing pocket depth (t = 65.56, P = 0.000) and (t = 51.69, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. There was a significant gain in clinical attachment level (t = 63.29, P = 0.000) and (t = 31.03, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. The gingival index shows an appreciable reduction in both groups, and in test group, it is statistically significant at 3 months (t = 2.15, P = 0.03). There was no statistical significant reduction in plaque index at 3 months (t = 0, P = 0.997). The present study showed that adjunctive use of ώ-3 fatty acids proved to be beneficial over scaling and root planing alone in the treatment of chronic moderate periodontitis. The beneficial effects were in terms of significant improvements in clinical parameters, probing pocket depth, and clinical attachment level and gingival index. Dietary modulation is now emerging as an adjunct to periodontal therapy. Hence, omega-3 fatty acid may be used routinely in the management of chronic periodontitis.