Split-mouth Clinical Trial Research Articles

Photodynamic antimicrobial chemotherapy and ultraconservative caries removal linked for management of deep caries lesions

BackgroundUltraconservative removal of carious tissue is becoming increasingly highlighted for management of deep caries lesions, and combined with an antimicrobial photochemistry-based treatment modality (PACT), this approach can be enhanced favoring dental tissue repair and preservation. The aim was to investigate the effectiveness of PACT using a light emitting diode (LED) associated with a photosensitizer toluidine blue ortho (TBO) on deep caries lesions. MethodsFor that, a single blind, randomized, controlled, split-mouth clinical trial where 45 patients with at least two deep carious lesions on permanent posterior teeth was performed. The primary intervention was deep caries lesion management with disinfection of remaining dentin tissue using PACT. Bacterial counts were measured following treatments as the main outcome. The remaining dentinal samples of each lesion were treated with either non-PACT-control or PACT. The PACT procedure were characterized by 100μgmL−1 TBO followed by 94Jcm−2 LED irradiation. Samples of dentin were collected before and immediately after treatments for microbiological analysis of total viable bacteria, mutans streptococci and Lactobacillus spp. counts. Microbial reduction was data were submitted to unpaired t test (α=5%). ResultsPACT led to statistically significant reductions in mutans streptococci (1.08±1.20log), Lactobacillus spp. (1.69±1.37log), and total viable bacteria (1.07±1.01log) compared to the control, which showed log reductions respectively of 0.05±0.49, 0.52±0.89, and 0.47±0.77 for the same microorganisms. ConclusionDentin from deep carious lesions treated with PACT showed a decrease in cariogenic microbial load.

A randomized clinical trial of an adjunct diode laser application for the nonsurgical treatment of peri-implantitis.

In this radiographic and microbiologic split-mouth clinical trial, efficacy of a diode laser as an adjunct to conventional scaling in the nonsurgical treatment of peri-implantitis was investigated. Eradication of pathogenic bacteria and infected sulcular epithelium presents a significant challenge in the nonsurgical treatment of peri-implantitis. Ten patients (mean age, 55.1 years; SD, 11.4) with 48 two piece, rough-surface implants and diagnosed with peri-implantitis were recruited (NCT02362854). In addition to conventional scaling and debridement (control group), crevicular sulci and the corresponding surfaces of 24 random implants were lased by a diode laser running at 1.0 W power at the pulsed mode (λ, 810 nm; energy density, 3 J/cm(2); time, 1 min; power density, 400 mW/cm2; energy, 1.5 J; and spot diameter, 1 mm); (laser group). Healing was assessed via periodontal indexes (baseline and after 1 and 6 months after the intervention), microbiologic specimens (baseline and after 1 month), and radiographs (baseline and after 6 months). Baseline mean pocket depths (4.71, SD, 0.67; and 4.38, SD 0.42 mm) and marginal bone loss (2.71, SD 0.11; and 2.88, SD 0.18 mm) were similar (p = 0.09 and p = 0.12) between the control and laser groups, respectively. After 6 months, the laser group revealed higher marginal bone loss (2.79, SD 0.48) than the control groups (2.63, SD 0.53) (p < 0.0001). However, in both groups, the microbiota of the implants was found unchanged after 1 month. In this clinical trial, adjunct use of diode laser did not yield any additional positive influence on the peri-implant healing compared with conventional scaling alone.

Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial.

To evaluate the effect of using low-level laser therapy (LLLT) to control pain and discomfort during orthodontic treatment. A randomized, split-mouth clinical trial was conducted with 30 volunteers in need of orthodontic treatment, of both genders, aged between 18 and 40 years, who were randomly divided into two groups. One hemiarch was considered the exposed group (EG) and the other, the placebo group (PG). Both groups had elastic separators placed mesially and distally to the first molars of the two hemiarches at different times. The EG received an AIGaAs diode LLLT (810 nm, 100 mW, 2J/cm(2)) application for 15 seconds per point (interdental papilla at the mesial, distal, and near the root apex) immediately after separator placement on the maxillary right side. The PG also had elastics placed around the maxillary right molars, but received only simulated LLLT application. The elastics were left in place for 5 days, and after a waiting period of 1 week, they were inserted on the left side in both groups; however, the order of laser application was changed. While the separator remained in place, the patient marked his degree of perceived discomfort on a Visual Analog Scale (VAS) at 5 minutes (T0), 24 hours (T1), and 120 hours (T2), after LLLT application. A statistically significant difference was observed (P < .005) in reducing discomfort in the exposed group compared with the placebo group. This reduction of discomfort in the EG was observed at all time intervals. A sincle AIGaAs diode LLLT application may be indicated for the control or reduction of pain in the early stages of orthodontic treatment.

Effect of Nonsurgical Periodontal Treatment Combined With Diode Laser or Photodynamic Therapy on Chronic Periodontitis: A Randomized Controlled Split-Mouth Clinical Trial.

The optimum removal of bacteria and their toxins from periodontal pockets is not always obtained by conventional mechanical debridement. Adjunctive therapies may improve tissue healing through detoxification and bactericidal effects. The purpose of the present study was to evaluate the impact of adjunctive laser therapy (LT) and photodynamic therapy (PDT) on patients with chronic periodontitis. Twenty patients with at least three quadrants involved and each of them presenting pockets 4-8 mm deep were included in the study. Periodontal treatment comprising scaling and root planning (SRP) was accomplished for the whole mouth. Applying a split-mouth design, each quadrant was randomly treated with SRP alone (group A), SRP with LT (group B), and SRP with PDT (group C). The clinical indices were measured at baseline 6 weeks and 3 months after treatment. Microbiological samples were taken and evaluated at baseline and 3-month follow-up. All groups showed statistically significant improvements in terms of clinical attachment level (CAL) gain, periodontal pocket depth (PPD) reduction, papilla bleeding index and microbial count compared to baseline (P < .05). The results showed more significant improvement in the 6-week evaluation in terms of CAL in groups B and C than in group A (P < .05). Group B also revealed a greater reduction in PPD than the other treatment modalities (P < .05). The obtained data suggested that adjunctive LT and PDT have significant short-term benefits in the treatment of chronic periodontitis. Furthermore, LT showed minimal additional advantages compared to PDT.

Local infiltration of Vitamin D3does not accelerate orthodontic tooth movement in humans:A preliminary study

Objective: To determine the effect of Vitamin D3 on the rate and amount of orthodontic tooth movement in humans when injected locally at the site. Materials and Methods: A prospective, split-mouth clinical trial was carried out on 15 subjects who were referred for bilateral therapeutic extraction of the first premolars followed by canine retraction in the maxillary arch. Vitamin D3 in a vehicle of local anesthetic solution was injected into the buccal vestibule immediately distal to the canine to be retracted on the experimental side; on the contralateral side, only local anesthetic solution as control was injected into the correspnding site on the 7th, 21st, and 47th days of canine retraction. The amount of canine retraction was assessed using the palatal rugae as stable landmarks, and the values obtained were compared using preand postcanine retraction occlusograms. Results: The experimental teeth whose gingivae had received injections containing Vitamin D3 had moved considerably less than had the matched control teeth (P , .001). Conclusions: Localized injection of vitamin D3 produces a significantly decreased rate and amount of tooth movement in humans. (Angle Orthod. 0000;00:000–000.)

Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial.

The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children. The children's teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %. The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period. It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations. Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.

Comparison of the Pain Perception of Conventional and Computer-controlled Anesthesia Techniques for Extraction of Maxillary First Premolar

ABSTRACT Introduction Anterior middle superior alveolar (AMSA) block is a nerve block technique in conjunction with computer-controlled local anesthetic delivery (CCLAD) system. Anterior middle superior alveolar produces local anesthesia (LA) to the maxillary teeth from second premolar to the central incisor including the hard palate and corresponding soft-tissue of both buccal and palatal side, with single palatal injection. Aim To evaluate efficacy of AMSA block for extraction of maxillary first premolar. Study design In randomized single blind, split mouth clinical trial, the 14 patients received the conventional buccal-palatal (B-P) anesthesia on one side and CCLAD anesthesia AMSA for other side. The treatment consisted of bilateral extraction of maxillary first premolars for orthodontics. Pain perception ratings were obtained by using 10 point visual analog scale (VAS). Results A total of 100% cases had painless injection with CCLAD, whereas 28.57% patients had painless injection experience with conventional LA. In all cases, there was no pain during extraction on both sides. With CCLAD, buccal retraction was painful in four cases whereas palatal retraction was painful in one case. Conclusion Anterior middle superior alveolar block injected with CCLAD is better as LA technique for extraction of maxillary first premolar as compared to B-P approach. How to cite this article Manekar VS. Comparison of the Pain Perception of Conventional and Computer-controlled Anesthesia Techniques for Extraction of Maxillary First Premolar. World J Dent 2015;6(3):150-153.

Clinical efficacy of low-level laser therapy as an adjunct to nonsurgical treatment of chronic periodontitis

Aims and Objective : In recent years, there has been a growing interest in the use of dental lasers for the treatment of periodontal diseases. The purpose of this randomized, split-mouth clinical trial was to evaluate the clinical efficacy of low-level laser therapy (LLLT) as an adjunct to conventional scaling and root planning (SRP). Materials and Methods: A total of 10 patients with untreated chronic periodontitis were randomly assigned in a split-mouth design to receive SRP with or without adjunctive LLLT. Clinical parameters including plaque index, gingival index, probing pocket depth were recorded at baseline, 1 st month and 3 rd month after the treatment. Gingival crevicular fluid (GCF) was collected for the assay of interleukin-1b (IL-1b) levels at baseline, 1 st week and 1 st month. Results: Both laser and control sides showed a significant reduction in IL-1b levels in GCF at 1 st week and 1 st month (P < 0.001). On comparing, laser sides showed a significant reduction in IL-1b levels at 1 st week (P = 0.041). No significant difference in IL-1b levels were found between laser and control sides at 3 rd month (P = 0.450). All the clinical parameters showed a significant difference (P < 0.05) at 1 st and 3 rd month after the treatment between laser and control sides. Conclusion: The present study suggests that LLLT could be a beneficial adjunct to nonsurgical treatment of chronic periodontitis on a short-term basis.

The clinical efficacy of laser assisted modified Widman flap: A randomized split mouth clinical trial.

The objective of the study was to compare the clinical efficacy of use of a diode laser (DL) (810 nm) as an adjunct to modified Widman flap (MWF) surgery to that of MWF alone. Twenty-five patients between the ages of 20 and 50 years with generalized chronic periodontitis were selected for the study. Control sites (Group A) were randomly selected to receive an MWF, and the contralateral test sites (Group B) received MWF in conjunction with low-level laser therapy. The energy density of 4 J/cm² was applied to the gingival surface after periodontal treatment. The study tooth/site was treated along with any additional teeth in the quadrant in which the site was located if needed. Randomization was done using a coin flip. The DL was used to de-epithelialize the inner part of the periodontal flap and photo-biostimulate the surgical area. Plaque index (PI), papillary bleeding index (PBI), probing depth (PD), and clinical attachment level (CAL) scores were recorded at baseline and at 6 and 9 months. Data were expressed as the mean ± standard deviation. Statistical analyzes were performed using paired Student's t-testfor intragroup comparisons and unpaired Student's t-test for intergroup comparisons. No significant difference was observed in PI scores between the two groups at baseline, 6 and 9 months. PBI scores were significantly lower in Group B versus Group A at 6 months (P < 0.01). However, no significant difference was observed between the two groups in PBI scores at the end of 9 months. PD reduction in Group B versus Group A was statistically significant at the end of 9 months (P < 0.01). Gains in CAL were significantly greater in Group B versus Group A at 6 and 9 months. The use of an 810 nm DL provided additional benefits to MWF surgery in terms of clinical parameters.

Does Implant Design Affect Implant Primary Stability? A Resonance Frequency Analysis-Based Randomized Split-Mouth Clinical Trial.

The purpose of this study was to assess implant stability in relation to implant design (conical vs. semiconical and wide-pitch vs narrow-pitch) using resonance frequency analysis. Twenty patients with bilateral edentulous maxillary premolar region were selected. In one hemiarch, conical implants with wide pitch (group 1) were installed; in the other hemiarch, semiconical implants with narrow pitch were installed (group 2). The implant allocation was randomized. The implant stability quotient (ISQ) was measured by resonance frequency analysis immediately following implant placement to assess primary stability (time 1) and at 90 days after placement (time 2). In group 1, the mean and standard deviation ISQ for time 1 was 65.8 ± 6.22 (95% confidence interval [CI], 55 to 80), and for time 2, it was 68.0 ± 5.52 (95% CI, 57 to 77). In group 2, the mean and standard deviation ISQ was 63.6 ± 5.95 (95% CI, 52 to 78) for time 1 and 67.0 ± 5.71 (95% CI, 58 to 78) for time 2. The statistical analysis demonstrated significant difference in the ISQ values between groups at time 1 (P = .007) and no statistical difference at time 2 (P = .54). The greater primary stability of conical implants with wide pitch compared with semiconical implants with narrow pitch might suggest a preference for the former in case of the adoption of immediate or early loading protocols.

Postoperative pain after bupivacaine supplementation in mandibular third molar surgery: splint-mouth randomized double blind controlled clinical trial

Efficacy of anesthetic supplementation with bupivacaine to control both pain and the number of analgesics ingested after surgery has been proposed; however, no report was found in the literature regarding supplemental use of bupivacaine. Thus, the aim of this study was to evaluate the clinical efficacy of bupivacaine in appeasing postoperative pain, when used as supplemental anesthesia at the end of surgeries to extract mandibular third molars. Eighty surgeries were performed in 40 healthy ASA I patients of mandibular bilateral, semi-enclosed, and symmetrical third molars, in a randomized, double-blind, placebo-controlled, and split-mouth clinical trial. Two procedures were performed. In one case, a preoperative anesthetic block was performed with bupivacaine (0.5 %) and epinephrine (1:200,000). Supplementation with the same anesthetic composition was used at the end of the surgery (test group). In the second case (control group), the procedure was identical to that used in the test group, but was supplemented in a randomized double-blind trial with saline (placebo), using the split-mouth method. Postoperative pain (measured with a visual analog scale) was the primary variable studied, and analgesic consumption was the secondary variable. Nonparametric analysis of variance (Wilcoxon test) and a two-tailed test to determine the ratio was used. P value was set at 0.05. No statistically significant difference (P > 0.05) was found in the variables studied. An adverse effect related to the anesthetic under study was not observed. There is no appreciable value to the second injection regarding pain and analgesia use, but there was a difference regarding patient acceptance in surgeries of mandibular semi-enclosed and impacted third molars.

Clinical evaluation of submerged and non-submerged implants for posterior single-tooth replacements: a randomized split-mouth clinical trial

The aim of this study was to evaluate clinical and radiographic results of submerged and non-submerged implants for posterior single-tooth replacements and to assess patient-based outcomes. Twenty patients were included in the study. A split-mouth design was used; implants inserted using a submerged technique were compared to those inserted with a non-submerged technique. Implants were restored with metal–ceramic crowns after 3 months. Reconstructions were examined at baseline, 6, 12, and 24 months. Standardized radiographs were made. Radiographic crestal bone level changes were calculated, as well as soft tissue parameters, including pocket probing depth, bleeding on probing, plaque index, and gingival index. Results were analyzed by two-way repeated measures of variance (ANOVA). To evaluate patient-based outcomes, patients were asked to complete a questionnaire at the 6-month follow-up; the Wilcoxon paired signed rank test was used to compare scores. The data of 18 patients were reviewed. During 24 months, non-submerged implants (0.57±0.21mm) showed significantly lower bone loss than submerged implants (0.68±0.22mm) (P<0.01). Patient satisfaction with non-submerged implants (median 87.5) was significantly higher than with submerged implants (median 81.5) (P<0.01). Non-submerged implants showed comparable clinical results to submerged implants and resulted in higher patient satisfaction due to decreased surgical intervention.

Platelet-rich plasma combined with decalcified freeze-dried bone allograft for the treatment of noncontained human intrabony periodontal defects: a randomized controlled split-mouth study.

The aim of the present randomized split-mouth clinical trial was to compare plateletrich plasma (PRP) combined with a demineralized freeze-dried bone allograft (DFDBA) to DFDBA with a saline solution in the treatment of noncontained human periodontal intrabony defects. Forty-eight noncontained interproximal intrabony defects in 24 healthy nonsmoking patients diagnosed with chronic periodontitis were randomly assigned to the test group (PRP/DFDBA) or the control group (DFDBA/saline). Clinical (probing pocket depth, clinical attachment level [CAL], and gingival recession [REC]) and radiographic (bone fill, defect resolution, and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation. Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the test group exhibited statistically significantly greater changes compared with the control group in CAL (3.15 ± 0.50 versus 2.40 ± 0.61 mm), REC (0.54 ± 0.59 versus 1.23 ± 0.47 mm), bone fill (3.02 ± 0.50 versus 2.37 ± 0.47 mm), and defect resolution (3.29 ± 0.53 versus 2.69 ± 0.38 mm). Findings indicate that a combination of PRP and DFDBA is more effective than DFDBA with saline for the treatment of noncontained intrabony defects.

Is Erbium:Yttrium-Aluminum-Garnet Laser Versus Conventional Rotary Osteotomy Better in the Postoperative Period for Lower Third Molar Surgery? Randomized Split-Mouth Clinical Study

Lasers have been extensively used in dentistry for several applications. We investigated and compared the use of an erbium:yttrium-aluminum-garnet laser and conventional rotary instruments for bone removal in third molar surgery. We implemented a randomized, split-mouth clinical trial. Patients with bilateral and symmetrical third molar impaction referred to the Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, were enrolled in the study. Each patient was treated once with the erbium:yttrium-aluminum-garnet laser and once with conventional rotary instruments for bone removal during third molar surgery. Pain, swelling, and trismus were taken into account to match the 2 techniques.In addition, the times required to complete osteotomy and for the full operation were recorded. Descriptive and bivariate statistics were computed, and the P value was set at .05. The sample was composed of 15 patients (8 men and 7 women) ranging in age from 18 to 30 years. Pain perceived in the laser-treated group was significantly less than that in the conventional group(P = .0013). This also was true for trismus (P = .0002) and swelling. The operating time for osteotomy was longer in the laser group. The results of this study suggest that the laser could be an interesting alternative to conventional rotary instruments. Future studies with a larger number of patients are required to confirm the conclusions achieved from this work.

Split-mouth comparison of Physics forceps and extraction forceps in orthodontic extraction of upper premolars

We compared outcome variables (operative complications, inflammatory complications, and operating time) in patients being treated by orthodontic extraction of upper premolars with the Physics forceps or the universal extraction forceps. We organised a single blind, split-mouth clinical trial to compare the outcomes of the 2 groups (n=54 premolars). The Physics forceps group had lower mean (SD) visual analogue scores (VAS) for pain (0.59 (0.57)) on the first postoperative day than the other group (1.04 (0.85)) (p=0.03). There were no other significant differences between the 2 groups in any other variable studied.

Five-year clinical performance of the dentine Deproteinization Technique in non-carious cervical lesions

ObjectiveThe aim of this study was to evaluate the 5-year clinical performance of composite restorations of non-carious cervical lesions (NCCL) using a total-etch adhesive system with or without collagen removal with 10% sodium hypochlorite (NaOCl). MethodsIn this study randomized controlled split-mouth clinical trial, one-hundred and thirty-eight NCCL were restored into 30 patients. Each patient received at least one pair of composite restorations (Filtek A110/3M ESPE), bonded either with 2 techniques: Conventional Technique – acid etching with 37% phosphoric acid+Prime & Bond NT (Denstply DeTrey); Deproteinization Technique – acid etching with 37% phosphoric acid+10% NaOCl for 1min+Prime & Bond NT. The two techniques were evaluated using the United States Public Health Service (USPHS) criteria at baseline, 18 months, 3 and 5 years. After five years, one-hundred and six restorations were evaluated in 24 patients. Data were analyzed using the Chi-Square test (p<0.05). ResultsThere were no statistically significant differences between the two techniques regarding the evaluated parameters (p>0.05). ConclusionAfter 5 years, the application of 10% NaOCl deproteinization on etched dentine did not affect the clinical performance of composite restorations placed in NCCL when compared to the conventional total-etch technique. Clinical significanceClinical studies evaluating the performance of the Deproteinization Technique are scarce. In this study, this technique showed similar clinical performance at the end of 5 years when compared to a conventional total-etch technique.

The Effect of Three Desensitizing Agents on Dentin Hypersensitivity: A Randomized, Split-mouth Clinical Trial

The aim of this study was to evaluate the efficacy of three desensitizing agents to provide relief to dentin hypersensitivity after one session in a four-week follow-up. Forty selected patients participated in a double-blind study following a split-mouth model. One application of the desensitizing agents (A, Admira Protect [Voco]; B, Bifluorid 12 [Voco]; and C, Colgate Pro-Relief in office [Colgate Palmolive]) was performed in three different quadrants for each patient. Each tooth was evaluated by tactile and evaporative stimuli, and the sensitivity response was measured using the Visual Analogue Scale. Evaluations were performed at baseline, immediately after treatment, and after one, two, three, and four weeks. The application of Kruskal-Wallis and Dunn multiple comparisons tests (5%) for both tactile and evaporative stimuli showed that all agents presented a significant desensitizing effect. In groups A and B this relief was maintained for four and three weeks, respectively, as measured by tactile stimulus and for four weeks with evaporative stimulus. The desensitizing effect for group C was maintained for two weeks for both tactile and evaporative stimuli. It is concluded that all desensitizing agents tested were effective in reducing sensitivity compared to baseline values. One application of Admira Protect and Bifluorid 12 presented a longer-lasting desensitizing effect than did Colgate Pro-Relief (applied in the office) on both tactile and evaporative stimuli.

Influence of intra‐pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial

Compare the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6weeks after treatment. Performed treatment procedures were scaling and root planing using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients' pain perception and anesthesia acceptance were recorded on questionnaires. No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (p>0.05). These findings are valid even for deeper pockets. Gel-group had significant higher intra-operative pain perception. In retrospect 69% of patients favored gel. Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Supragingival treatment as an aid to reduce subgingival needs: a 450-day investigation.

This study investigated the clinical effects of using a supragingival biofilm control regimen (SUPRA) as a step prior to scaling and root planing (SRP). A split-mouth clinical trial was performed in which 25 subjects with periodontitis (47.2 ± 6.5 years) underwent treatment (days 0–60) and monitoring (days 90–450) phases. At Day 0 (baseline) treatments were randomly assigned per quadrant: SUPRA, SRP and S30SRP (SUPRA 30 days before SRP). The full-mouth visible plaque index (VPI), gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) were examined on days 0, 30, 60, 90, 120, 270, and 450. Baseline data were similar among all groups. From days 0 to 60, the groups showed similar significant decreases in VPI and GBI. Reductions in PPD for the SRP (3.39 ± 0.17 to2.42 ± 0.16 mm) and S30SRP (3.31 ± 0.11 to 2.40 ± 0.07 mm) groups were greater (p < 0.05) than those for the SUPRA group. This pattern was also observed for BOP. Attachment gain was similar and greater for the SRP (3.34 ± 0.28 to 2.58 ± 0.26 mm) and S30SRP (3.25 ± 0.21 to 2.54 ± 0.19 mm) groups compared to the SUPRA group. Results were maintained from day 90 forward. Overall, the S30SRP treatment reduced the subgingival treatment needs in 48.16%. Performance of a SUPRA step before SRP decreased subgingival treatment needs and maintained the periodontal stability over time.

Clinical and Biochemical Effects of 810 nm Diode Laser as an Adjunct to Periodontal Therapy: A Randomized Split-Mouth Clinical Trial

The aim of this clinical trial was to determine the clinical and biochemical efficacy of an 810 nm diode laser as an adjunct to scaling and root planing (SRP). Lasers can achieve excellent tissue ablation with strong bactericidal and detoxification effects. The use of lasers is one of the most promising new technical modalities for nonsurgical periodontal treatment. However, the most effective wavelength and parameters for their use are still under investigation. This study was designed as a single-blinded, randomized-controlled, split-mouth clinical trial. Twenty-one patients (12 females and 9 males between 26 and 55 years of age), diagnosed with generalized chronic periodontitis, were included in the study. After initial periodontal therapy, which consisted of oral hygiene instructions and scaling, patients underwent two different treatment modalities. Test and control sites were chosen with coin toss randomization. At the test site, patients received SRP and laser treatment; at the contralateral control site, they received SRP treatment alone. Both treatment modalities resulted in significant improvements in all clinical and biochemical parameters. Sites irradiated with an 810 nm diode laser using the "hot tip" (∼ 760 °C) technique showed enhanced healing in all the registered periodontal variables and interleukin (IL)-1β levels, compared with SRP alone. Within the limitations of this study, the use of diode lasers as an adjunct to SRP produced significant improvements in clinical parameters as well as gingival crevicular fluid (GCF) IL-1β levels in the 6 month study period.