Split-mouth Randomized Clinical Trial Research Articles

Direct versus fully digital indirect bracket bonding: a split-mouth randomized clinical trial on accuracy

ObjectivesThe primary aim is to assess differences in accuracy of orthodontic bracket positioning between fully digital indirect bracket bonding (IDB) and conventional direct bracket bonding (DBB). The secondary aims are to assess differences in bracket bonding failures, bracket repositioning need, clinician experience and patient satisfaction.Materials and methodsThis prospective study was designed as a split-mouth randomized clinical trial. In total, 35 patients were analyzed with a six month follow-up period. Translational and orientational deviations from the planned bracket position were determined. Clinician experience and patient satisfaction were evaluated by means of a survey.ResultsThe difference in translation was 0.34 mm (95% CI: 0.238–0.352, p = 0.017), the difference in orientation was 4.80˚ (95% CI: 3.858–5.727, p < 0.001), both in favour of IDB. IDB showed significantly more immediate (IDB: 3.9%, DBB: 0%) and late (IDB: 5.4%, DBB: 2.5%, p = 0.008) bonding failures. Clinicians and patients experienced a shorter clinical chair time with indirect bonding over direct bonding.ConclusionsIDB bracket positioning leads to significant smaller translation and orientation deviations from digital IDB planning, than DBB bracket positioning. However, IDB leads to more immediate bonding failures than DBB. The majority of patients preferred IDB over DBB, due to a shorter clinical chair time.Clinical relevanceThis study adds to the knowledge of IDB in orthodontics and contributes to evidence on this technique. This evidence is applicable in everyday orthodontics, with respect to patient satisfaction and technical limits of IDB. The trial was registered in the Dutch Trial Register and the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization (WHO), number NL9411.

Clinical Comparison of Stain Removal Efficacy between Glycine Powder Air Polishing System and Ultrasonic Scaling in Removing Dental Plaque and Stains: A Split-mouth Randomized Clinical Trial

Abstract Introduction: Glycine powder air polishing (GPAP) has emerged as a less invasive option for periodontal maintenance therapy. This study aims at comparing the efficacy of GPAP in removing plaque and stains as compared to conventional ultrasonic scaling (USS). Materials and Methods: The present split-mouth randomised clinical trial recruited 20 adults with healthy gingiva or mild gingivitis. Removal of plaque and stains was performed by USS in one maxillary quadrant and by GPAP in the other. Clinical parameters assessed included stain scores by Lobene Stain Index, plaque level by Silness-Loe plaque Index, and pain scores using the Visual Analog Scale. The assessments were performed before and after the treatment and at a 15-day follow-up visit. Results: Significantly lower (P &lt; 0.05) levels of plaque and stains were achieved by both interventions as compared to those before the treatment. While immediate postoperative plaque levels were significantly (P &lt; 0.05) lower following USS, the difference failed to reach statistical significance (P &gt; 0.05) 1 week after the treatment. On the contrary, the stain scores were significantly lower after treatment and at the 7th-day follow-up after GPAP as compared to USS. A significantly greater number of patients (P &lt; 0.05) reported pain to be absent or only mild following GPAP, while those treated with USS experienced pain of severe intensity. Conclusion: Both GPAP and USS are effective in stain and plaque removal. However, GPAP achieved superior stain removal outcomes and was associated with significantly lower pain scores, suggesting it was more comfortable for patients compared to USS.

Flowable bulk-fill versus layering restorative material on Class II restorations: A randomized clinical trial

ObjectiveThis study evaluated the clinical performance of Class II restorations made with flowable bulk-fill base versus conventional layering ORMOCER-based restorative material in a split-mouth randomized clinical trial. MethodsThirty patients received two class II restorations (n = 60) performed with different strategies. All preparations received the application of the universal self-etching adhesive system according to the manufacturer's recommendation, followed by the placement of a sectional matrix, wooden wedge, and separation ring. The first restoration was performed using 4 mm of flowable bulk-fill material covered by 2 mm of conventional viscosity restorative material (Bulk-fill technique). The second restoration was performed only with the conventional viscosity material, with a maximum of 2 mm thick increments, up to fill the cavity (Layering technique). After occlusal adjustment, the same polishing system was used for all restorations. Evaluations using the FDI criteria were conducted after 7 days, 12, and 24 months. Data were analyzed with the Fisher's Exact test (α=0.05). ResultsFrom 30 participants, 24 attended the 24-month recall, and 48 restorations were evaluated. All restorations received acceptable overall scores for esthetic and biological properties after this period, while only 6.66 % of the restorations exhibited unacceptable overall scores for the functional properties in both groups. No significant differences between the tested restorative materials and techniques were found for each FDI criterion assessed. The success rate after 2 years was 93.33 % for both groups. ConclusionBoth restorative materials exhibited good clinical performance for the parameters analyzed with no differences between them after 24-month follow-up. Clinical relevanceFlowable bulk-fill ORMOCER-based material is a suitable alternative for direct Class II restorations, providing good clinical outcomes and simplifying the restorative procedure. Clinical trial registration numberRBR-6mvp9w

Assessment of Changes in the Outcome of Autogenous Tooth Grafts Over Time: A Clinical Study Evaluating Periodontal Healing in Bone Defects After Lower Third Molar Removal

BackgroundThe removal of impacted lower third molars (ILTM) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects. PurposeThe primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM. Study design, setting, sampleThis split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases. Predictor/exposure/independent variableThe predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted. Main outcome variablePD on the distobuccal, distomedial and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2) and 36 months (T3) postoperatively. CovariatesSex, age, surgical time, ILTM situation and position between groups were assessed. AnalysesANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval (CI) of 95% (p<0.05). ResultsThe sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68±2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (p<0.001, 95% CI) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3) and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74±0.28 (p<0.001) and 0.54 ± 0.3 (p=0.43) were observed in test and control groups, respectively. Conclusions and relevanceATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.

Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

ObjectivesTo evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up. MethodsForty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used. ResultsNo significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05). ConclusionThe clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations. Clinical significanceThe level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations.

Comparative evaluation of oxygenating agent “blue m gel” and traditional periodontal dressing “Coe-Pak” on patient preference parameters (Pain and wound healing) after surgical depigmentation – A split mouth study

Individuals with high lip line and gummy smile when accompanied withdark colored gingiva have an esthetic concern while smiling. For the management of gingival hyperpigmentation surgical technique with scalpel is still considered the gold standard, although healing may occur by secondary intension and oxygen is one of the essential nutrients for cellular metabolism and production of energy through ATP. It is also involved in collagen synthesis, oxygenative killing of bacteria and angiogenesis. To clinically evaluate and compare the effectiveness of oxygenating agent (Blue M Gel) and traditional periodontal dressing COE-PAK on patient preference parameters (pain and wound healing) after surgical depigmentation. This split-mouth randomized clinical trial was conducted on 5 non-smoking individuals aged 20–40 years irrespective of gender with maxillary or mandibular physiologic gingival pigmentation class (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (10 treated sites) who had requested an esthetic treatment for gingival hyperpigmentation of the maxillary or mandibular gingiva. The maxilla or the mandible was randomly divided into two symmetrical parts i.e. from the right second premolar to the midline and from the midline to the left second premolar—to receive either Blue M gel or Coe-Pak as a periodontal dressing after surgical depigmentation with a scalpel. Patient preference parameters such as pain was assessed after 24 hours and 7 days of intervention and re-epithelisation index with toluidine blue was assessed after 1 week and 1 month of intervention. The result of the study demonstrated that pain score and re-epithelisation score was less in Test group (Blue M Gel) as compared to control group (COE-PAK) and was found to be statistically significant. :It can be concluded that Blue M gel can also be a better alternative as a periodontal dressing compared to COE-PAK due to its properties of better healing and decreasing post-operative pain.

The Effects of a Cool Saline Solution Irrigation on Mandibular Third Molar Extraction Site: A Postoperative Split-Mouth Evaluation.

This study aimed to evaluate the effects of sterile saline solution irrigation (lavage) performed after mandibular third molar extraction on postoperative complications, utilizing a split-mouth randomized clinical trial design. Seventeen healthy participants requiring bilateral mandibular third molar extraction were enrolled in this single-center study. In each participant, one impacted third molar was designated as the experimental group and subjected to saline lavage at 4 °C. In contrast, the control group was the other impacted third molar, undergoing saline lavage at 25 °C. Various parameters, including postoperative pain, mouth opening, and facial swelling, were assessed using standardized measures and three-dimensional facial scanning at multiple time points. The average age of participants was 26.66 ± 4.1 years, with no postoperative complications observed in either group. The duration of surgery did not significantly differ between groups. Postoperative pain was significantly reduced in the experimental group during the immediate postoperative period compared with the control group, but this difference diminished over time. No significant differences were observed in mouth opening or facial swelling between groups at any time. In site 4 °C, sterile saline solution irrigation after mandibular third molar extraction may effectively reduce early postoperative complications, particularly pain, without prolonging surgical duration.

Fissure Sealants or Fluoride Varnish? A Randomized Pragmatic Split-Mouth Trial

This study aimed to compare the clinical effectiveness of resin-based fissure sealants (FS) and fluoride varnish (FV) in children at high caries risk. A practice-based split-mouth randomized clinical trial was conducted at 9 Public Dental Service (PDS) clinics in Norway. In total, 409 children age 6 to 10 y at high caries risk (d3mft > 0) meeting inclusion criteria were recruited by dentists and dental hygienists during routine examination. Eligibility criteria were 2 fully erupted first permanent molars (FPMs) in the same jaw, with sound occlusal surfaces or with initial caries. Participation was voluntary, caregivers and eligible children were informed about the study, and written parental consent was obtained. FS and FV were randomly applied on contralateral FPMs in the same jaw, with each participant serving as their own control. FS was applied at baseline and thereafter maintained according to clinicians’ conventional procedures, whereas FV was applied at baseline, 6 mo, and 12 mo. The study outcome was success, with no need for invasive treatment (caries control), while failure was defined as dentin carious lesion or restoration. Two-level mixed-effects logistic regression analysis was used to compare FS and FV groups. Of 409 recruited children, 369 (90%) children/tooth pairs were examined after 36 mo. Intention-to-treat analysis showed 94.1% adjusted predicted probability (aPP) of success (95% confidence interval [CI] 91.7 to 96.4) in the FS group and 89.6% aPP (95% CI 86.5 to 92.7) in the FV group. In the adjusted analysis, the FV group had a lower OR for success compared with the FS group (OR 0.54, 95% CI 0.24 to 0.87). In the population studied, the clinical effectiveness of FS was statistically significantly higher compared with FV but below the estimated minimal clinically important difference of 10%.

The effect of autologous demineralized dentin matrix on postoperative complications and wound healing following lower third molar surgery: A split-mouth randomized clinical trial

Background/purposeAutologous dentin materials are among the most promising bone substitutes for preventing osseous defects on the distal side of the lower second molar. This study aimed to investigate the effects of autologous demineralized dentin matrix on postoperative complications and wound healing after lower third molar surgery. Materials and methodsThirteen patients with bilateral symmetrical lower third molars participated in this split-mouth randomized clinical trial. After removal surgery, one socket of the lower third molar was grafted with dentin material (demineralized dentin matrix side), and a piece of collagen sponge was used for the tooth socket of the remaining side (control side). The upper third molar on the same lateral side was extracted immediately before lower third molar surgery and used to create a demineralized dentin matrix according to the manufacturer's protocol (KometaBio). After lower third molar surgery, pain, swelling, trismus, and Inflammatory Proliferative Remodeling Scale scores were used to evaluate postoperative complications and wound healing. ResultsPain, swelling, and trismus of the demineralized dentin matrix and control sides were not significantly different at any assessment time (P > 0.05). The wound-healing scores of the demineralized dentin matrix side were better than those of the control side; however, the differences were only significant at 7th and 30th days (P < 0.05). ConclusionGrafting autologous demineralized dentin matrix into the tooth socket did not increase the postoperative complications after lower third molar surgery. However, wound healing on the graft side was comparatively better than that on the control side. Clinicaltrials.gov identifierNCT06073639, date 10 October, 2023. This is a retrospectively registered trial.

Effect of laser corticotomy on canine retraction rate: a split-mouth randomized clinical trial

BackgroundThis study assessed the effect of corticotomy with Er: YAG (erbium-doped yttrium aluminium garnet) laser on the rate of canine retraction.MethodsThis randomized split-mouth controlled clinical trial was conducted on 12 patients undergoing orthodontic treatment with extraction of maxillary first premolars. Following initial leveling and alignment, an alginate impression was made from the maxillary arch, and Er: YAG laser corticotomy was performed in one of the maxillary quadrants of each patient. Canine retraction was started immediately after corticotomy by placement of nickel-titanium (NiTi) closed coil springs at both sides. At the end of each month, alginate records were repeated for 4 months. Study models were scanned, and the anteroposterior movement of canine was quantified bilaterally. Pain was also measured by a visual analog scale (VAS). Probing depth (PPD) of canines and two adjacent teeth was also evaluated and pulp vitality was assessed by performing the cold test. Data were analyzed by paired and independent t-test and one-way ANOVA (alpha = 0.05).ResultsThe rate of canine retraction was significantly greater in the laser-assisted corticotomy quadrant than the control (P < 0.05). No significant difference existed in posterior anchorage loss, canine rotation angle, PPD, pulp vitality, or pain score between two groups (P > 0.05).ConclusionsFlapless Er: YAG laser corticotomy significantly enhanced canine retraction rate with no adverse effect on other parameters.

Space Closure with Different Appointment Intervals: A Split-mouth Randomized Controlled Trial.

Canine retraction has been successful with various force systems and retraction techniques. The appointment interval for force reactivation in canine retraction along the archwire is 4-8 weeks. The aim was to evaluate the effect of different reactivation intervals on the rate of space closure. This split-mouth randomized clinical trial recruited 38 patients indicated for the first premolar extraction. Monthly digital models were acquired for 6 months. The first premolars were extracted, and temporary anchorage devices were placed for maximum anchorage control. The canines were retracted using elastomeric chains which were replaced every 2, 4, 6, or 8 weeks. The monthly rate of canine retraction was measured. The time to space closure was calculated. The secondary outcome was the mesial drift of the first molars. The Kaplan-Meier survival analysis and the Friedman test evaluated and compared the groups. There was no significant difference between the monthly canine retraction rate or the first molar mesial drift between the groups. The mean time to space closure was 5.74 months in the 2-week reactivation group, which was statistically less than the other groups. The 2-week reactivation interval may reduce time to space closure. Direct anchorage control with miniscrews limited anchorage loss significantly.

Efficacy of photodynamic therapy as an adjunct to scaling and root planing on clinical parameters and microbial composition in subgingival plaque of periodontitis patients: A split-mouth randomized clinical trial.

The aim of this study was to assess the efficacy of photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) on clinical parameters and microbial composition in subgingival plaque of periodontitis patients. Seventeen patients were included in this split-mouth randomized clinical trial. Sites with probing pocket depth (PPD) ≥5mm in combination with bleeding on probing in different quadrants were randomized into the control group, the group with a single PDT application right after SRP, and the group with three repeated PDT applications 1week after SRP. The subgingival plaque was collected for 16S rRNA gene sequencing at baseline, Week 2, and Week 8. Seventeen patients with 60 sites completed this 8-week follow-up, and 157 subgingival plaques were successfully analyzed by sequencing. Significant improvements were observed in two primary outcomes: PPD at Week 8 and subgingival microbial composition. Compared to the control group, the repeated-PDT group showed a notable improvement in PPD, substantial alterations in the microbial profile, including a reduction in α-diversity and anaerobic bacteria, and an increase in aerobic bacteria at Week 2. Secondary outcomes, such as clinical attachment level and sulcus bleeding index, also showed improvement at Week 8. Furthermore, both the single- and repeated-PDT groups exhibited a decrease in periodontopathogens and an increase in beneficial bacteria compared with baseline. PDT promotes changes in the microbial composition of periodontitis patients' subgingival plaque in a direction favorable to periodontal health, and repeated PDT is a promising adjunctive therapy for periodontal treatment.

Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial

ObjectivesThis 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs). MethodsA total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan–Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05). ResultsAfter 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5–99.9) for PHT group and 90.8 % (81.1–96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable. ConclusionsBoth composites showed high rates of retention rates after 24 months. Clinical significanceThe clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions. Registration of clinical trialsRBR-6d6gxxz

Quality of obturation and the behavior of children treated under nitrous oxide conscious sedation: A double-blinded split-mouth randomized clinical trial

Abstract Aim: Our aim is to assess the quality of obturation and behavior of the children treated with and without nitrous oxide sedation and also to investigate the association between the quality of obturation and the behavior of children. Materials and Methods: A double-blinded split-mouth randomized clinical trial was conducted in 60 teeth. A total of 30 children aged 4–8 years in need of pulpectomy in bilateral mandibular molars were selected. On the first appointment, the children were assigned to protocol A, where the pulpectomy was performed without nitrous oxide inhalation sedation (NOIS). In the second visit, the children were allocated to protocol B, where pulpectomy was done in the contralateral molar under NOIS. The obturation quality and behavior of the children were graded according Coll and Sadrian criteria and Ohio State University Behavior Rating Scale, respectively. The data were assessed with descriptive statistics, Chi-square test, and Wilcoxin signed-rank test. Results: The quality of obturation and the behavior of the children were significantly better under conscious sedation (P = 0.000). Also, there was a significant association noted between the behavior of the children and quality of obturation (P = 0.0.012). Children exhibiting quiet behavior favored optimal fill, while in children showing cry alone or struggle , it was more of under-fill. In children showing both struggle and cry, more of over-fill pattern of obturation was noticed. Conclusion: Nitrous oxide sedation enhances the obturation quality and children’s behavior. Furthermore, there is a clear association between children’s behavior and obturation quality, regardless of whether nitrous oxide sedation is used or not.

Effect of upper lip compression on pain reduction during local anesthesia. A split-mouth randomized clinical trial.

Effect of upper lip compression on pain reduction during local anesthesia. A split-mouth randomized clinical trial.

Effects of laser and indocyanine-green mediated antimicrobial photodynamic therapy on the red complex bacteria and crevicular procalcitonin level in periodontitis patients: A split-mouth randomized clinical trial

Abstract Objective: To determine the effects of laser and photodynamic therapy (PDT) on crevicular procalcitonin (PCT) and red complex bacteria in patients with periodontitis stage II grade A. Methods: Sixty-six sites with periodontitis were selected. After scaling and root planing (SRP), participants were randomized to receive 810-nm diode laser and PDT using indocyanine green (ICG). The primary outcome was the change in crevicular PCT levels and red complex bacterial loads measured using the BAPNA assay. Secondary outcomes included probing depth (PPD), clinical attachment loss (CAL), relative attachment level (RAL), plaque index, and gingival index, assessed at baseline and 3 months post-intervention. Results: Significant improvements (P &lt; 0.001) were observed for all variables within each group at the 3-month follow-up compared to baseline. Among the treatment groups, SRP+ICG-PDT demonstrated a greater reduction in BAPNA and PCT levels compared to SRP+laser and SRP alone. Correlation analysis between BAPNA and PCT revealed a significant positive correlation (r = 0.64; p = 0.001). Conclusion: In patients with periodontitis stage II grade A, a single application of PDT using 810-nm laser and ICG provided enhanced benefits compared to SRP alone or SRP+laser in terms of reducing red complex bacterial load and gingival crevicular procalcitonin levels at the 3-month follow-up.

Impact of supragingival scaling on the outcomes of subgingival instrumentation completed after 1 week: a split-mouth randomized clinical trial.

To investigate the impact of supragingival scaling on the clinical outcomes of subgingival instrumentation completed after 1 week. In 27 patients with Stage II and Stage III periodontitis, pairs of contralateral quadrants were randomly assigned into test group 1 (single sitting scaling and root planing) and test group 2 (supragingival scaling followed by subgingival instrumentation after 1 week). Periodontal parameters were recorded at baseline, 2, 4, and 6 months; Gingival crevicular fluid vascular endothelial growth factor (VEGF) estimation was done at baseline in both groups and 7 days after supragingival scaling in test group 2. At 6 months, significantly better improvement in test group 1 at sites with periodontal probing depth (PPD) > 5 mm; (∆PPD = 2.32 mm vs 1.41 mm, P = .001; ∆clinical attachmen level [CAL] = 2.34 mm vs 1.39 mm, P = .001) was observed. Supragingival scaling resulted in significant reduction in gingival crevicular fluid VEGF (42.46 to 27.88 pg/site) after 1 week. Regression analysis explained 14% variance in VEGF to baseline PPD at sites with PPD > 4 mm; and 21% variance in CAL improvement to VEGF at sites with PPD > 5 mm. The percentage of sites with PPD = 5 to 8 mm reaching the clinical endpoint was 52% and 40% for test group 1 and test group 2, respectively. Better results were noticed in bleeding on pocket probing-positive sites in both groups. The sites with PPD > 5 mm where supragingival scaling was followed by subgingival instrumentation after 1 week resulted in less favourable treatment outcomes. (Clinical trial registry NCT05449964).

Comparative evaluation of the efficacy of BlueM active oxygen gel and Coe-pak dressing on post-operative healing of gingival depigmentation: a study protocol

Introduction Dark colored gingiva is an esthetic concern that cannot be ignored, especially when accompanied by a high lip line or gummy smile. Gingival depigmentation is a periodontal plastic surgical procedure wherein the hyperpigmentation is removed or reduced by various techniques. Protecting the wound from mechanical trauma and stability of the surgical site during the healing process are among the most important advantages of periodontal dressing application after surgery. Aim This study is aimed to comparatively evaluate the effectiveness of reactive oxygen gel species (BlueM gel) and the traditional Coe-Pack dressing on gingival healing and pain after surgical depigmentation. Protocol This split-mouth randomized clinical trial will be conducted on 20 patients aged 18–45 years with maxillary physiologic gingival pigmentation classes (II) (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (40 treated sites). The maxilla will be randomly divided into two symmetrical parts—from the right second premolar to the midline and from the midline to the left second premolar—to receive either BlueM gel or Coe- Pack as a dressing after surgical depigmentation with a scalpel. Various indices will be assessed, such as plaque index, papillary bleeding index, pain index, healing index and reepithelization index with toluidine blue, and the follow-up period will be one month. Expected results- A total of 20 patients will be included in this study. Statistically significant differences are expected to show in the pain index and healing index after one, two, three, four, and five days. The BlueM gel group is expected to show a higher significant difference after one, two, three and four weeks in the reepithelization index.

Photodynamic therapy as adjunctive treatment of single-rooted teeth in patients with grade C periodontitis: A randomized controlled clinical trial

BackgroundThe present study aimed to evaluate the adjunctive effect of an antimicrobial photodynamic therapy (aPDT) protocol on single-rooted teeth of patients with grade C periodontitis. MethodsSixty-four single-rooted teeth (14 patients) were included in each group of this double-blinded split-mouth randomized clinical trial. The teeth were randomly divided into scaling and root planing + aPDT (test group) and scaling and root planing+sham aPDT (control group). The aPDT protocol consisted of incubation with 1% methylene blue for 5 min, rinsing, and application of a diode laser (wavelength of 660 nm, power of 100 mW) for 10 s. aPDT was repeated after 7 days. Bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) were recorded before and 3 months after treatment. A 5% significance level was adopted for statistical analysis. ResultsFinal PD was significantly (P = 0.02) lower in the test group (2.87 ± 1.40 mm) compared to control (3.12 ± 1.69 mm). The test group showed a significantly higher percentage of sites with PD≤4 mm and concomitant BoP compared to control (91%x86%;P < 0.001). At sites with baseline PD>4 mm, final PD and CAL were significantly (P = 0.01) lower in the test group (4.11 ± 1.66 and 4.89 ± 2.49 mm, respectively) compared to control (4.88 ± 1.99 and 5.89 ± 2.74 mm, respectively). ConclusionsaPDT combined with scaling and root planning provided slightly better periodontal clinical results than the latter procedure alone, exerting a superior effect at sites with greater baseline PD. aPDT might be used as adjunctive treatment in grade C periodontitis affecting single-rooted teeth since it improves the response to conventional periodontal treatment.

THREE-YEAR OUTCOME OF DIODE LASER PULPOTOMY OF PRIMARY MOLARS USING THREE PULP CAPPING AGENTS: A SPLIT-MOUTH RANDOMIZED CLINICAL TRIAL

ObjectivesPulpotomy is the most commonly performed treatment for asymptomatic primary molars with exposed dental pulp. This study aimed to assess the clinical /radiographic success of diode laser pulpotomy with mineral trioxide aggregate (MTA), calcium hydroxide (CH), and calcium-enriched mixture (CEM) cement as pulp capping agents. MethodsThis split-mouth randomized clinical trial was conducted initially on 34 children aged 3-8 years but 4 patients left the study before the first follow-up visit and the study was accomplished and analyzed with 30 cases. The patients had at least 3 first/second molars with deep caries that in radiographic evaluation revealed that they required pulpotomy. Following pulpotomy, the pulp stump was irradiated with diode laser (noncontact mode, 632 nm, 30 mW power) as photobiomodulation mode. Pulp tissue was then capped with MTA, CH, or CEM cement (n = 30 in each group). Reinforced zinc oxide eugenol was applied over the capping agent, and the teeth were restored with stainless steel crowns. Teeth were clinically/radiographically assessed at 6, 12, 18, and 36 months, after treatment. Data were analyzed by Cochran and McNemar tests. ResultsAll 30 patients showed up for clinical/radiographic follow-ups for up to 36 months. Regarding clinical outcomes, the 6-, 12-, 18-, and 36-month success rates of all experimental groups were nearly similar with no significant difference (p > .05). Regarding radiographic outcomes, the 6-month success rates were similar among the groups (p > .05); however, the 12-, 18-, and 36-month outcomes of CEM and MTA groups were similar but significantly superior to that of CH group (p < .05). ConclusionDiode laser irradiation and subsequent capping of pulp tissue with MTA or CEM cement can be employed for pulpotomy of primary molars.