Significant Probing Depth Reduction Research Articles

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

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

Eficácia do laser de diodo de alta potência como coadjuvante à instrumentação mecânica de bolsa profunda em paciente com periodontite estádio III, grau C e generalizada

ABSTRACT Periodontitis is an inflammatory clinical condition caused by dysbiotic biofilm that results in progressive destruction of periodontal attachment and can lead to tooth loss if left untreated. Objective: To evaluate the clinical efficacy of high-power diode laser as an adjunct to mechanical instrumentation in periodontal pockets of a patient with generalized, stage III, grade C periodontitis. Methods: 126 sites of a patient were examined at the Clinical Research Laboratory (LabClin) of the Federal University of Campina Grande (UFCG), where the parameters of probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BoP) were evaluated at the beginning of the study and after 3 and 6 months of basic therapy. All sites received non-surgical periodontal treatment which corresponds to scaling and root planing (SRP) and coronary polishing. The deep periodontal pockets with PD ≥ 5 mm, received the adjuvant therapy with diode laser light. Results: There was a significant improvement of periodontal parameters of PD, CAL and BoP in all treated sites. In those with PD ≥ 5 mm, the results were similar, with statistically significant reduction of PD, CAL and BoP before and after treatment. After 6 months, all periodontal pockets with PD ≥ 5mm were reduced to values lower than 3. Conclusion: The irradiation of deep pockets with high-power diode laser proved to be effective as adjuvant therapy to SRP in patients with generalized, stage III, degree C periodontitis.

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

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

Use of Curcumin-Loaded Polyvinylpyrrolidone in Conjunction With Surgical Treatment of Intrabony Periodontal Defects ‘Controlled Clinical and Biochemical Study’

IntroductionOne of the major problems with curcumin topical therapy is its bioavailability in the gingival crevicular fluid in order to induce predictable effects. This study was conducted in order to evaluate the release pattern of curcumin in the gingival crevicular fluid from polyvinylpyrrolidone (PVP) as a sustained release vehicle. Clinical impact of curcumin-loaded (PVP) in conjunction with surgical treatment of intrabony periodontal defects was also evaluated. MethodsTwenty-four patients having stage II or stage III, grade A periodontitis, were included in the study. Patients were divided into two groups: group I: periodontal defects were treated by open flap debridement alone; group II: defects were treated by open flap debridement followed by application of curcumin-loaded (PVP) (2%curcumin). Clinical parameters were recorded 3 and 6 months postoperatively. Radiographic measurements were recorded 6 months postsurgically. The release profile of curcumin was performed using high-performance liquid chromatography. Curcumin availability was reported for up to 30 days. ResultsClinical results demonstrated statistically significant reduction in probing depth and gain in clinical attachment level for group II sites compared to group I. Gradual release of curcumin was detected in a descending manner over 14 days. Radiographic examination from baseline to 6 months showed a statistically significant bone fill in group II compared to that of group I. ConclusionsThe use of curcumin-loaded PVP in association with open flap debridement of intrabony periodontal defects leads to prolonged curcumin availability associated with a significant reduction in probing depth, gain in clinical attachment level, and bone fill compared to open flap debridement alone.

Clinical and radiographic peri-implant outcomes with riboflavin loaded Poly-L-glycolic acid nanoparticles incorporated in aloe-vera gel treating peri-implantitis in chronic hyperglycemic patients

AimThe objective of the current study was to compare the effectiveness of antimicrobial photodynamic therapy (PDT) versus Poly-L-glycolic acid nanoparticles loaded riboflavin incorporated in aloe vera gel (PGA/RF/AV) on periimplant parameters and bacterial counts in chronic hyperglycemic patients having periimplantitis. MethodsOne hundred and two diabetic patients undergoing mechanical debridement (MD) were equally divided into three groups: Group 1: PGA/RF/AV+ MD, Group 2: PDT + MD, and Group 3: MD alone. Periimplant parameters [Bleeding on probing (BoP), probing depth (PD), plaque index (PI), marginal bone level (MBL)] were recorded in all three groups. Periimplant plaque samples were studied to record the levels of Tannerella forsythia (Tf) and Porphyromonas gingivalis (Pg). The recordings were taken at baseline, 3 months and 6 months post treatment. ResultsAll three groups showed a reduction in severity of periimplantitis measured in terms of PD, PI, MBL and BoP. A statistically significant reduction in PD, PI and MBL was found in patients in Group 2 whereas participants of Group 1 were found to have a significant decrease in BoP. A statistically significant decline in the numbers of both the bacterial species was seen in Group 2 at the three-month follow-up whereas at the six-month follow-up, a statistically significant reduction was observed in treatment Group 2 in the levels of Tf species only. ConclusionRiboflavin-loaded nanocarrier incorporated in aloe vera gel showed greater clinical efficacy than PDT alone in the treatment of periimplantitis in chronic hyperglycemic individuals.

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 hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis.

This systematic review aimed to evaluate the effects of hyaluronic acid (HA) alone or in combination with any bone substitute for the treatment of intrabony defects (IBDs). Six databases were searched up to April 2022 to find randomized clinical trials comparing the clinical effects of open flap debridement (OFD) + HA versus OFD alone (first group) or OFD + HA + bone substitutes versus OFD + bone substitutes (second group) in the treatment of IBDs with a follow-up of at least 3months. Random effects models of mean differences were used to determine the clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill (RBF). Of the 276 studies identified, 6 were included in the qualitative synthesis, and 5 in the meta-analyses. The meta-analyses in the first group showed a statistically significant differences for CAL gain (mean difference [MD]:1.00; 95% confidence interval [CI]:0.65 - 1.35; n = 2) and PD reduction (MD: 0.76; 95%CI: 0.34 - 1.17; n = 2) favoring HA + OFD at 6months. However, in the second group, the meta-analyses did no show additional effect of HA in association with bone substitute was demonstrated for either CAL gain (MD: 0.57; 95%CI: - 0.30 - 1.43; n = 2) or PD reduction (MD: 1.05; 95%CI: - 0.38 - 2.47; n = 2) but did show significant differences for RBF (MD: 0.57; 95%CI: 0.15 - 0.99; n = 2) at 12months. Compared with OFD alone, local application of HA in the treatment of IBDs provided a significant CAL gain and PD reduction at 6months. However, its combination with bone substitutes showed no statistically significant differences at 12months. The use of OFD + HA improves the CAL and PD in the treatment of IBDs compared to OFD only after 6months of follow-up. These results are not maintained after 12months.

Efficacy of subgingival minocycline hydrochloride delivery as an adjunct to non-surgical mechanical debridement for the treatment of peri-implantitis in patients with type-2 diabetes mellitus.

The aim was to assess the efficacy of subgingival minocycline hydrochloride (MH) delivery with non-surgical mechanical debridement (NSMD) for treating peri-implantitis in patients with type-2 diabetes mellitus (DM). Type-2 diabetic and non-diabetic patients with peri-implantitis were included. In the test-group, patients underwent NSMD with a single session of MH delivery. In the control-group, patients underwent NSMD alone. Hemoglobin A1c (HbA1c), modified plaque-index (mPI), modified gingival index (mGI), probing-depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6-month follow-up. Level of significance was set at p<0.01. Thirty type-2 diabetic and 30 healthy individuals with peri-implantitis were included. There was a significant reduction in mPI (p<0.01), PD (p<0.01) and mGI (p<0.01) at 6 months among patients with and without type-2 DM in the test and control groups. There was no significant difference in peri-implant parameters in all patients at the 6-month follow-up. There was no significant difference in HbA1c and CBL among patients with and without type-2 DM in the test and control groups when baseline values were compared with those at 6 months of follow-up. A single application of subgingival MH delivery is as effective as NSMD alone for the treatment of peri-implantitis in type-2 diabetic patients.

The Tunnel Wall Approach and Enamel Matrix Derivative to Cover Exposed Roots and Improve Clinical Attachment Levels in Cairo Class III Defects Associated with an Intrabony Lesion in the Anterior Area: Three Cases.

These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area.

Eeficiency of conventional technique and surgical operating microscope in crown lengthening: An original research

Background: The success of any periodontal therapy always depends on better visual access and, magnification is an important component which provides good hand eye coordination with a better treatment outcome. The aim of our study is to assess the effectiveness of magnification over conventional method while performing surgical crown lengthening and to evaluate the patient comfort level and pain perception over a period of 3 months. Methods -The study was conducted amongst 20 patients, 10 in each group requiring crown lengthening for restorative purpose and was evaluated ever a period of 3 months. Results - During 3months follow up, significant differences were found between the groups for probing depth with mean difference of 1.22±0.6, position of gingival margin as with mean 2.7±1.15 and biologic width with mean difference 2.8±0.42.Regarding patient comfort and patients pain perception it was found low for microscope group with mean difference of 2±0.67 Conclusion – A good visual access is a primary requisite behind the success of any periodontal therapy and it was concluded from our study that there was significant reduction in probing depth and improvement in biologic width, gingival margin.

Efficacy of Er:YAG laser for the peri-implantitis treatment and microbiological changes: a randomized controlled trial.

The aims of this study were to identify the microbiological changes in the periodontal pockets following an Er:YAG laser (ERL) irradiation and mechanical debridement to compare the effectiveness of ERL irradiation to mechanical debridement for peri-implantitis treatment through randomized controlled trials. Twenty-three patients with peri-implantitis lesions were treated in either a test group, ERL set at energy level of 100mJ/pulse, frequency of 10Hz, pulse duration was 100µs, and irradiated by three passages, or a control group, with mechanical debridement using an ultrasonic scaler. An examiner measured the following clinical parameters at different stages (a baseline and at 3- and 6-month post-treatment): probing depth (PD), bleeding on probing (BOP), marginal bone loss (MBL), and anaerobic bacteria counts. Linear regression, with generalized estimation equations, was used to compare the clinical parameters and anaerobic bacterial counts at different stages and between groups. The anaerobic bacterial counts significantly decreased within the control group during the follow-ups. At the 6-month follow-up, both groups showed a significant reduction in PD (test group: mean difference of 0.84mm; control group: mean difference of 0.41mm), and the test group showed a significantly higher PD reduction on the buccal site (1.31mm) compared to that of the control group (0.25mm). Both ERL and mechanical debridement treatments led to significant improvements in PD. When mechanical debridement therapy was used, significant anaerobic bacterial count reductions were observed. Future treatment of peri-implantitis should involve a combination of both of these therapies.

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.

Non-submerged reconstructive approach for peri-implantitis osseous defect with removal of implant crowns: One-year outcomes of a prospective case series study.

The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap readaptation around the replaced healing abutments, without obtaining a primary wound closure. Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months. At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 and 1.63mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51mm) and BOP (65%) reduction were also noted. Considering its limitations, the use of a non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes.

Evaluation of biphasic hydroxapatite and β-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study.

The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and β-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and β-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Overall, by the end of 6 months, biphasic hydroxyapatite and β-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and β-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. In the present study, biphasic hydroxyapatite and β-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

Azithromycin as an adjunct to subgingival professional mechanical plaque removal in the treatment of grade C periodontitis: a systematic review and meta-analysis.

The aim of this systematic review was to evaluate clinical and microbiological outcomes with the use of azithromycin as an adjunct to non-surgical subgingival professional mechanical plaque removal (PMPR) in the treatment of grade C periodontitis. Online database searches using high-level MeSH terms in a PICO structure were conducted along with hand-searching of relevant periodontal journals. Titles and abstracts of identified studies were independently reviewed by both authors and the full texts of studies meeting the inclusion criteria were independently reviewed. In total, 122 studies were identified through searches, of which 6 were included in the qualitative analysis and 4 in the meta-analysis. Three studies included in the meta-analysis were deemed at low risk of bias and 1 at serious risk. There were conflicting results on whether azithromycin reduced the number of subgingival pathogens or detectable subgingival Aggregatibacter actinomycetemcomitans between the included studies. The meta-analysis revealed a statistically significant probing depth reduction difference in favour of azithromycin compared to the control at 3 months (weighted mean difference [WMD]=-0.39 mm; 95% confidence interval [CI], -0.66 to -0.13 mm; I²=0%) and 12 months (WMD=-1.32 mm; 95% CI, -1.71 to -0.93 mm; I²=0%). The clinical attachment level change was also statistically significant in favour of azithromycin compared to the control at 3 months (WMD=-0.61 mm; 95% CI, -1.13 to -0.10 mm; I²=71%) and 12 months (WMD=-0.88 mm; 95% CI, -1.32 to -0.44 mm; I²=0%). Based upon these results, azithromycin offers additional improvements in some clinical parameters when used in conjunction with subgingival PMPR in patients with aggressive periodontitis over control groups. These improvements appear to be maintained for up to 12 months after treatment completion. However, due to a lack of well-designed studies, the conclusions that can be drawn from the available evidence are limited. Trial Registration: International Prospective Register of Systematic Reviews Identifier: CRD42020168195.

Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.

Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial

ObjectivesThis parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue.Material and methodsTwenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post‐surgery, and supra‐alveolar attachment gain (SUPRA-AG) was recorded at 1 year post‐surgery.ResultsAt 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05).ConclusionsNIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue.Clinical relevanceNIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain.Clinical trial registrationClinicaltrials.gov: NCT04712630.

Clinical evaluation of excisional new attachment procedure versus laser assisted new attachment procedure in the treatment of periodontal pockets

TheLaser Assisted New Attachment Procedure (LANAP) protocol is a laser based periodontal regenerative procedure and was patterned, conceptually, after the Excisional New Attachment Procedure (ENAP) to separate the diseased epithelium from the underlying connective tissue and to selectively vaporize and disrupt inflamed and necrotic tissue from connective tissue.: The present study was designed to compare and evaluate the clinical efficacy of LANAP versus ENAP in the treatment of chronic periodontitis.: Twenty periodontal pocket sites of ≥5mm in systemically healthy patients were selected and randomly allocated to either (ENAP) Excisional New Attachment Procedure (Group I) or (LANAP) Laser Assisted New Attachment Procedure (Group II). Patients were evaluated for Plaque Index, Gingival Index, Gingival Bleeding Index, Probing Depth, Loss of attachment, recession and VAS scores. Patients were recalled for follow up at 1 week, 1 month and 3 months at which clinical parameters were recorded.: The results of the present study revealed statistically insignificant difference in both groups however clinically significant reduction in probing depth was seen with ENAP as compared to LANAP but laser procedure had less VAS scores as compared to ENAP.Although probing depth reduction was more for ENAP, patient discomfort with less bleeding was observed with LANAP.

EVALUATION OF EFFICACY OF DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT WITH AND WITHOUT PLATELET-RICH FIBRIN IN THE TREATMENT OF INTRABONY DEFECTS BY CONE BEAM COMPUTED TOMOGRAPHY: A CLINICAL AND RADIOGRAPHIC STUDY

Background: Eventhough the combination of DFDBA (demineralized freeze dried bone allograft) with PRF (platelet-rich fibrin) has been attempted in periodontal practice with significant results, assessment of the intrabony defect and defect bone fill largely done with two-dimensional imaging modalities. Three dimentional analysis of the intrabony defect and defect bone fill has not been attempted with cone beam computer tomography (CBCT). The present study evaluated the efficacy of DFDBA with and without PRF in the treatment ofintrabony defects by CBCT. Methods: 60 defects in systemically healthy patients ranging from 18 to 50 years of age will be included in the study.30 defects were treated with PRF+DFDBA and 30 defects were treated with DFDBA alone. The study will include the assessment of clinical parameters involving probing depth (PD), relative attachment level(RAL), full mouth bleeding scores(FMBS),plaque index and gingival index from baseline to 3 , 6, 9 months. Hard tissue changes will be assessed radiographically by evaluating defect fill and defect resolution by CBCT at baseline&amp; 9 months. Results: The results of the present study are statistically significant in both groups in terms of clinical and radiographical parameters (P &lt; 0.001). In inter-group comparison, there was a statistically significant greater PD reduction and attachment gain while there was not significant reduction in terms of PI, GI, FMBS, defect fill and defect resolution in DFDBA+ PRF group. Conclusion: DFDBA along with PRF failed to provide additional value in terms of defect fill and defect resolution over DFDBA alone.