Untreated Chronic Periodontitis Research Articles

An evaluation of the long-term wear of a distal extension-removable partial denture on abutment teeth that have undergone periodontal therapy

Although the evidence is clear on the long-term effects of removable partial dentures (RPDs) on the periodontal health of abutment and non-abutment teeth, little work has been done on the periodontal outcomes of the remaining teeth previously treated with periodontal therapy. The aim of this study was to evaluate the effect of denture loading on teeth previously exposed to periodontal treatment with additional photo-disinfection. Twelve partially edentulous patients classified as having mandibular Kennedy Class I arches were included. In each quadrant of the mandibular arch, the terminal abutment was diagnosed to have untreated chronic periodontitis. Initially, all the affected abutments received a conservative periodontal treatment in form of scaling and conventional root debridement. Patients were randomly received additional treatment with photodynamic therapy in one of the mandibular quadrants (test group). After the periodontal treatment, a 4-week load-free period was planned. Mandibular distal extension RPDs was fabricated to restore the missing teeth. The clinical periodontal parameters including plaque index (PI), gingival index (GI), gingival recession (GR), probing pocket depth (PD), clinical attachment level (CAL) and tooth mobility (TM) were assessed at baseline, and then for two additional 6-month recall appointments over a period of twelve months after prosthetic treatment. In addition, the mean annual vertical bone loss was also assessed. Except for the PI, GR, and PD, values for the mean GI, CAL, and TM scores at the test group were significantly lower than those in the control group. Better annual vertical bone loss results were observed on the proximal sides of abutments treated with additional photodynamic therapy. The results of this study suggest that RPD abutments affected by chronic periodontitis may perform better as abutments for distal extension RPDs when treated with both conventional root debridement and additional antimicrobial photodynamic therapy.

Comparative evaluation of effects of subgingival application of ozonated olive oil versus chlorhexidine in patients with chronic periodontitis: A clinico- microbiological randomised trial

Comparative evaluation of effects of subgingival application of ozonated olive oil versus chlorhexidine in patients with chronic periodontitis: A clinico- microbiological randomised trial - JDS- Print ISSN No: - 2320-7302 Online ISSN No:- 2393-9834 Article DOI No:- 10.18231/j.jds.2019.023, Journal of Dental Specialitie

Comparative Effect of Topical Local Anaesthetic Spray & Gel in the Reduction of Pain on Periodontal Probing in Individuals with Untreated Chronic Periodontitis

INTRODUCTION: The experience of pain during dental procedures is a concern to many individuals. In periodontal practice, the first meet between the patient and the periodontist is usually a periodontal examination.
 AIM: The present study aims to compare the efficacy of local anaesthetic gel & spray in the reduction of pain on periodontal probing in a group of individuals with untreated chronic periodontitis.
 MATERIALS AND METHODS: Thirty participants meeting the inclusion criteria were included in the study and had full-mouth periodontal probing done at six sites per tooth. The participants were divided into 2 groups: Group I;15 patients with LOX 2% gel and Group II;15 patients were assessed with lignocaine spray. Intragroup comparison was done using paired t-test and Analysis of Variance was done for inter group comparison.
 RESULTS: The pre and post VAS score of the two groups over the periods were recorded of 2 minutes & 5 minutes. In Group I, the mean VAS at 2 min decreases comparatively from the base-line & remained lower significantly at 5 min as compared to the baseline. In contrast, in Group II, it decreased comparatively at 2 minutes but increases at 5 minutes and reaches almost the baseline value.
 CONCLUSION: For early pain relief, study found LOX 2% gel more effective than lignocaine spray in the of untreated chronic periodontitis.

Photo-activated disinfection with light-emitting diode reduces some key periodontal pathogens in chronic periodontitis

The aim of the present study was to evaluate the potential of minimally invasive periodontal treatment using repeated photo-activated oral disinfection (PAD) with red light emitting diodes as an adjunct to ultrasonic scaling (US) in the treatment of chronic periodontitis. In a single-centred, randomized clinical trial involved 40 patients with untreated chronic periodontitis received US with repeated 3 episodes of PAD (test group) or US alone (control group). Clinical parameters (plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL)) were recorded for 12 months and subgingival biofilm analyses for five periodontal pathogens (A. actinomycetemcomitans (Aa), P. gingivalis (Pg), P. intermedia (Pi), T. forsythia (Tf), T. denticola (Td)) were performed for 6 months. Supportive periodontal treatment (SPT) was repeated every 3 months during the clinical trial, additional one episode of PAD was also applied in the test group. Both treatment modalities improved clinical parameters after 3 months and SPT maintained favourable clinical outcomes during 12 months. There were no statistical significant differences between the treatment groups. Statistical significant reduction of Aa, Pg, Tf, Td (p<0.05) was observed in the test group. In moderate pockets significant reduction of Pg, Tf, Td (p<0.05) and in deep periodontal pockets reduction of Pg, Pi, Td (p<0.05) was observed. Within the limits of the present study it may be concluded that the addition of PAD to US significantly reduced some key periodontal pathogens, however, patients with a history of periodontitis should be on SPT every 3-4 months.

Clinical and Radiographic Assessment of Periodontal Infrabony Defect Depth and Width and Their Correlation

Brief Background There is preliminary evidence of periodontal defect depth, number of walls and the width of infrabony defects exerting influence on the regenerative potential of particular therapeutic modality. Aim: To assess defect width and defect depth and their influence on pretreatment defect angle in patients affected with periodontal disease. Materials and Methods 60 untreated severe chronic or aggressive periodontitis patients were selected for the study. Digital intraoral periapical radiograph of defects in all patients were taken using RVG. First auxiliary line was drawn to represent tooth axis (AUX1). Perpendicular to this, a second auxiliary line (AUX2) was drawn that ran through most coronal margin of defect (M3). The depth of defect was measured as the distance between the base of bony defect and AUX2. The width of defect was the distance from coronal margin of bony defect to the root surface perpendicular to AUX1. Results In a total of 67 defects, the radiographic defect depth, defect width and defect angle for maxillary arch was 3.19 ± 1.19 mm , 2.82 ± 0.63 mm and 37.34 ± 9.47 ° respectively while these values for mandibular sites were 3.69 ± 0.92 mm, 2.87 ± 0.76 mm and 35.62 ± 7.08 ° respectively. Multilevel regression analysis revealed narrow defect angles to be related to deep infrabony defects, whereas the width of the interdental space to wide defects. Summary and Conclusion Defect dimensions are determined by the radius of action of microbial biofilm and the baseline defect angle of an infrabony defect would be a function of defect depth. Key Words: Periodontitis, periodontal therapy, vertical defects, radiography

Loss of periodontal ligament fibroblasts by RIPK3-MLKL-mediated necroptosis in the progress of chronic periodontitis

Periodontal homeostasis is maintained by the dynamic equilibrium between cell death, differentiation and proliferation of resident cells in the periodontal microenvironment. Loss of resident periodontal ligament fibroblasts (PDLFs) has been a major challenge in the periodontal treatment. This study aimed to investigate the exact role of necroptotic cell death in periodontal diseases. Elevated levels of receptor-interacting protein serine-threonine kinases -1 (RIPK1), phosphorylated RIPK3, mixed lineage kinase domain-like protein (MLKL), phosphorylated MLKL and FLIPL were observed in gingival tissues collected from patients with untreated chronic periodontitis; whereas no difference in caspase 8 was observed between the periodontitis and healthy control group. In contrast to the high incidence of necroptotic cell death in monocytes during live P. gingivalis infection with a low multiplicity of infection (MOI), necroptosis was only observed in PDLFs with a high MOI. Priming PDLFs with frozen thawed monocytes enhanced proinflammatory responses to P. gingivalis infection; moreover, frozen thawed monocytes stimulation triggered RIPK1, RIPK3 and MLKL-mediated-necroptotic cell death in PDLFs. These results indicated that RIPK3 and MLKL-mediated-necroptotic cell death participated in the pathogenesis of periodontitis, and DAMPs released from monocytes after P. gingivalis stimulation by necroptosis triggered not only inflammatory responses, but also necroptosis of PDLFs.

Masticatory satisfaction, ability, and performance in partially dentate patients after periodontal therapy

Abstract Introduction Understanding the effects of periodontal therapy is essential in performance and satisfaction of partially dentate patients. Objective To assess the effect of subgingival periodontal treatment in performance and masticatory satisfaction and ability as reported by partially dentate patients with untreated chronic periodontitis. Materials and method Patients were given nonsurgical periodontal treatment and masticatory satisfaction, ability, and performance were evaluated before and after treatment. Performance was assessed based on sieving chewed standardized chewable material, while satisfaction and ability were analyzed using a questionnaire based on OHIP-EDENT. Result Mean numbers of functional tooth units were 10.36 ± 1.43 anterior and 6.73 ± 0.79 posterior teeth. Masticatory performance did not vary significantly (p = 0.075), and mean particle sizes before and after treatment were 4.23 ± 1.84 mm and 3.90 ± 0.75 mm, respectively. Overall satisfaction and ability scores after treatment were higher (p &gt; 0.05) compared with scores prior to the periodontal intervention. Conclusion Periodontal treatment improves masticatory satisfaction and ability with no effect on performance.

Elevated Salivary Il-1β, Pge2 And Mmp-3 Levels And Their Significant Reduction Post Therapy In Patients With Chronic Periodontitis Compared To Healthy Individuals

Background: The role of IL-1β, PGE2 and MMP-3 in the pathogenesis of periodontal disease is well researched. This study aimed to asses and compared the salivary IL-1β, PGE2 and MMP-3 levels in patients with untreated chronic severe periodontitis and those treated with periodontal phase I therapy and periodontally healthy individuals as controls, in relationship to the presence of salivary anti-β1 IgA. Methods: A total of 30 subjects participate in the study: 15 subjects had chronic severe periodontitis and 15 were healthy individuals used as a control. After saliva collection and its purification, we quantify by enzyme-linked immunosorbent assay (ELISA) procedure using as coating antigen a synthetic β1 peptide with an amino acid sequence identical to the second extracellular loop of the human β1 adrenoceptor (β1 AR), the presence of anti β1 AR antibody (IgA) in the saliva of patients and healthy individuals. Also, IL-1β, PGE2, nitrites and metalloproteinase 3 (MMP-3) were assessed using ELISA) assay. Results: Our data indicated that IL-1β, PGE2, nitrites and MMP-3 levels are elevated in the saliva of patients with untreated chronic severe periodontitis and were significantly higher than in healthy subjects. Also, the amounts of anti- β1 IgA in the saliva was significantly higher compared with that of healthy individuals. After periodontal phase I therapy these levels of inflammatory biomarkers are significantly reduced but the titres of the antibody did not change, suggesting a close association between salivary IL-1β, PGE2, nitrites and MMP-3 and periodontitis without any changes in the levels of anti β1 IgA. Conclusions: These results suggest that the abnormal amount of these cytokines and enzymes in saliva has potential monitoring applications as a risk marker of the disease progression but the raised levels of anti β1 IgA present in the saliva of chronic severe periodontitis patient, are not directly associated with the course of the disease. Additional studies are needed to validate this assumption.

Subgingival glycine powder air-polishing as an additional approach to nonsurgical periodontal therapy in subjects with untreated chronic periodontitis.

Glycine powder air-polishing (GPAP) is an alternative approach to removing subgingival plaque biofilms for effective periodontal therapy. This study aimed to investigate the effect of subgingival GPAP as an additional approach to nonsurgical periodontal treatment in subjects with chronic periodontitis. Twenty-seven nonsmoking subjects were recruited. Two quadrants in each subject were randomly assigned, according to a split-mouth design, to receive scaling and root planing (SRP) and GPAP (Test group) or SRP and air flushing with water (Control group) at sites with probing depth ≥5mm. Clinical parameters, gingival crevicular fluid volumes and the concentrations of interleukin-1β and interleukin-1ra in gingival crevicular fluid were measured at baseline and 1, 3 and 6months after the treatments. At baseline, no statistically significant difference in periodontal and gingival crevicular fluid parameters was found between the Test and Control groups. Overall, the periodontal conditions of all subjects showed significant improvement after the treatments. Notably, the Test group showed greater reduction in gingival crevicular fluid volume (0.37±0.26μL) than the Control group (0.23±0.30μL) at 3months (P<.05). The gingival crevicular fluid levels of interleukin-1β and interleukin-1ra showed a significant decrease in both groups at 6months, and no significant difference was found between the groups. These preliminary results suggest that GPAP, as an additional approach to nonsurgical periodontal treatment, may be beneficial for the short-term improvement of subclinical inflammation when measured by gingival crevicular fluid volume. Further longitudinal studies with larger sample sizes are required to clarify the exact benefits of GPAP treatment for controlling inflammation and maintaining long-term periodontal health.

THE EFFECT OF DIODE LASER AS AN ADJUNCT TO PERIODONTAL TREATMENT ON CLINICAL PERIODONTAL PARAMETERS AND HALITOSIS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Aim: The aim of this study is to examine the clinical efficiency of diode laser periodontal pocket irradiation as an adjunct to conventional scaling and root planning (SRP) on periodontal parameters and halitosis. Material and Methods: In our randomized, controlled clinical trial, 40 patients with untreated chronic periodontitis were randomly separated into two group to receive SRP with laser (laser group n=20) or SRP solely (control group n=20). Plaque index (PI), gingival index (GI), probing pocket depth (PD), clinic attachment loss (CAL), bleeding on probing (BOP) and halitosis were recorded at baseline and 1st ,3rd and6th months after treatment by a periodontist. Results: Both treatment methods showed significant reductions in clinical parameters and halitosis levels compared to baseline. Conclusion: The present study indicates that compared to SRP solely, adjunctive applications of a 940-nm diode laser with SRP showed lower bleeding on probing and halitosis levels.

Clinical efficacy of photodynamic therapy adjunctive to scaling and root planing in the treatment of chronic periodontitis: A systematic review and meta-analysis

PurposeTo evaluate the clinical efficacy of photodynamic therapy (PDT) adjunctive to scaling and root planing (SRP) in patients with untreated chronic periodontitis based on up-to-date evidence. MethodsMEDLINE and the Cochrane Library were systematically searched to identify eligible randomized controlled trials (RCTs), supplemented by a manual literature search. Mean differences (MD) and the corresponding 95% confidence intervals (CI) of probing depth (PD) reduction and clinical attachment level (CAL) gain were synthesized. The I2 test and Q statistics were used to determine the inter-study heterogeneity. Subgroup analysis based on smoking status was performed. ResultsEleven RCTs with a total of 243 subjects were included. Significant improvement in PD reduction (MD=0.13, CI:0.02–0.24, p=0.02) and marginal significant improvement in CAL gain (MD=0.18, CI:−0.005–0.363, p=0.056) were observed in favor of SRP+PDT at 3months. When evaluated at 6months after baseline, the association of PDT with SRP resulted in a significant benefit in PD reduction (MD=0.40, CI:0.05–0.74, p=0.03), but not in CAL gain (MD=0.37, CI:−0.18–0.93, p=0.18). Subgroup analysis revealed that the combined therapy produced no significant improvements in PD and CAL at neither 3months nor 6months for studies with smokers. No treatment-related adverse events or side effects had been reported by the included studies. ConclusionsPooled analysis suggests a short-term benefit of PDT as an adjunct to SRP in clinical outcome variables. However, evidence regarding its long-term efficacy is still insufficient and no significant effect has been confirmed in terms of CAL gain at 6months. Future clinical trials of high methodological quality are needed to establish the optimal combination of photosensitizer and laser configuration.

Teeth under High Occlusal Force may Reflect Occlusal Trauma-associated Periodontal Conditions in Subjects with Untreated Chronic Periodontitis.

To determine the association of high occlusal force (HOF) with the signs of occlusal trauma and periodontal conditions in periodontitis patients, and elaborate the relevant clinical implications. Periodontal parameters and signs of occlusal trauma were recorded for 807 teeth in 30 subjects with untreated chronic periodontitis. The T-scan II occlusal analysis system determined the HOF during maximum intercuspation, lateral excursion and protrusive excursion. The correlation of HOF with periodontal parameters and signs of occlusal trauma was analysed. Overall, the teeth with HOF existed mainly in molars and presented with deeper probing depth (PD) and higher frequency of bleeding on probing (BOP) than those without HOF. The fixed-effect analysis showed that HOF was positively correlated with PD and BOP (P < 0.05) in posterior teeth; widened periodontal ligament space on radiographs in upper (r = 0.179, P < 0.01) and lower posterior teeth (r = 0.205; P < 0.05); as well as functional mobility in upper posterior teeth (r = 0.168; P < 0.05). This study suggests that the posterior teeth with HOF in subjects with chronic periodontitis may reflect occlusal trauma-associated periodontal conditions that could probably increase the risk of further periodontal destruction. These findings may improve the clinical assessment of occlusal trauma and related periodontal conditions for better patient management and treatment outcomes.

Peripheral blood neutrophil extracellular trap production and degradation in chronic periodontitis.

To investigate exvivo peripheral neutrophil extracellular trap (NET) production and their subsequent degradation by plasma in chronic periodontitis patients, and periodontally and systemically healthy-matched controls. Chronic periodontitis patient and control (n=40 pairs) peripheral blood neutrophils (PBN) were stimulated for NET quantification. A subset of patients received non-surgical periodontal therapy (n=19) and NETs were quantified 3 months later alongside controls. Blood plasma was collected from patients and controls to quantify plasma-induced NET degradation (n=19 pairs). Subsequent experiments quantified plasma concentrations of DNase-1, immunoglobulin G (IgG), free light chains (FLCs), and cystatin C. No differences were observed in NET production between patients and controls. However, NET production decreased significantly in patients post-treatment. Plasma NET degradation was significantly lower in patients than controls, which may be due to significantly reduced DNase-1 levels as demonstrated, or potentially due to elevated IgG/FLC concentrations in patients. NET degradation post-periodontal treatment was comparable between patients and controls. NET production was comparable between patients and controls; however, non-surgical therapy causes attenuated NETs. NET degradation by plasma is impaired in untreated chronic periodontitis, potentially increasing the chronic NET burden, which may enhance antimicrobial function, or conversely, increase the risk of autoimmune/inflammatory responses.

Adjunctive use of modified Yunu-Jian in the non-surgical treatment of male smokers with chronic periodontitis: a randomized double-blind, placebo-controlled clinical trial.

BackgroundYunu-Jian (YJ) is a Chinese medicine (CM) heat purging formula, which is used to reduce wei huo (stomach-heat, SH) and enrich shen yin (kidney-yin, KY). This formula is also commonly used to manage diabetes mellitus and gum/oral inflammation. The activity of YJ can be modified or refined by the addition of other CM herbs and/or minor changes to one of its five key ingredients. The aim of this study was to evaluate the adjunctive use of modified YJ (mYJ) or YJ containing additional osteoblast-stimulating and inflammation-modulating CM herbs in the non-surgical periodontal treatment of smokers with chronic periodontitis in a randomized, double-blind, prospective, placebo-controlled study.MethodsHealthy adult male smokers with untreated chronic periodontitis who showed CM syndrome of SH and KY deficiency (KYD) whilst attending a dental teaching hospital from October to December, 2005, were invited to participate in a randomized double-blind, placebo-controlled clinical trial. The trial itself involved the once-daily oral administration of a placebo or mYJ for 3 months as an adjunct to non-surgical periodontal therapy. Several periodontal parameters, including radiographic alveolar bone density, were measured by computer-assisted densitometric image analysis (CADIA) on selected sites, and CM signs of SH and KYD were followed from their baseline values to various time points up to 12 months or the end of study.ResultsTwenty-five smokers (consumed 25.0 ± 15.3 smoking-pack years, ranged 7.5–80; aged 46.3 ± 6.8 years) with periodontitis and SH and KYD were recruited (Placebo, n = 14; mYJ, n = 11). All of the participants showed good tolerance towards the CM recipe. All of the periodontal parameters had improved after 12-month follow-up, and no statistically significant differences were detected between the control group and test group, except for the higher CADIA values observed compared with the baseline at 12 months for test sites (P = 0.025). 4/3/3 test vs 14/13/13 control participants had persisting SH and KYD at 6, 9 and 12 months (P < 0.001), respectively.ConclusionsThe adjunctive use of mYJ preserved the post-treatment increases in the radiographic alveolar bone density at the study sites and led to an overall improvement in SH and KYD compared with the controls.Trial registration HKU Clinical Trial Register, HKCTR-1848 (www.hkuctr.com/Study/Show/3acbf983831244d29d50b543540bf6e9)Electronic supplementary materialThe online version of this article (doi:10.1186/s13020-016-0111-z) contains supplementary material, which is available to authorized users.

Association of clinical parameters with periodontal bacterial haemolytic activity.

To determine whether haemolytic activity of subgingival bacteria is associated with periodontitis clinical parameters and to identify which bacteria produce the haemolysins. Subgingival plaque samples from 22 untreated chronic periodontitis patients were investigated by culture and identified with matrix assisted laser desorption/ionisation time-of-flight mass spectrometry. Total aerobic and anaerobic bacterial viable counts, percentage distribution of α- and β-haemolytic bacteria were significantly elevated in diseased sites in relation to healthy sites (p<0.001). Periodontal pathogens were more frequently detected at diseased sites: Porphyromonas gingivalis, Tannerella forsythia, Treponema sp., Prevotella sp., Parvimonas micra, Fusobacterium sp., Campylobacter sp., Capnocytophaga sp., and Selenomonas sp. Haemolytic unidentifiable species and Gram-positive anaerobes such as Slackia exigua, Solobacterium moorei, and Bulledia extructa were also more frequently detected at diseased sites. In diseased sites, the presence of different haemolytic characteristics was more strongly correlated with clinical measures of disease than the mere absence or presence of specific species. The strongest correlation with probing pocket depth was observed for overall β-haemolytic toxicity (r=0.73, p<0.001). A strong association was observed between subgingival bacterial haemolytic activity and clinical parameters in patients with chronic periodontitis. Further investigations are warranted to delineate the role of haemolysins in the pathogenesis of periodontitis.

Patients’ perceptions of antimicrobial photodynamic therapy in the management of chronic periodontitis

The aim of this study is to evaluate patients’ perception of antimicrobial photodynamic therapy (aPDT) in the management of chronic periodontitis. 90 patients (51 females and 39 males) with untreated localized chronic periodontitis were randomly assigned to receive SRP with aPDT (test group) or SRP alone (control group) in a single-centered double-blinded randomized and controlled clinical trial. Patients’ perception in terms of changes in bleeding gums, pain in gums while chewing, bad breath and sensitive gums along with pain during the procedure and patient acceptance were recorded for 6 months after treatment by a periodontist who was blinded to the procedure. Inter-group and intra-group statistical analyses were performed. Significant difference between the frequencies of two groups with respect to each variable was assessed using non-parametric test. Patients’ report of bleeding gums and pain in the gums while chewing showed statistically significant reduction in the test group at 2 weeks and 1 month (p<0.05). Also, a significant difference was detected at 1 month between SRP and SRP+aPDT in terms of halitosis (p<0.05). No statistically significant change was observed between two groups in terms of sensitive gums, pain during procedure and patient acceptance. Patients perceived short-term benefits of single session of aPDT therapy due to the reduction in bleeding gums, halitosis and pain while chewing following treatment. Further studies are required to assess the effectiveness of aPDT for a longer-term and following multiple sessions.

A randomized placebo-controlled trial to evaluate a novel noninjectable anesthetic gel with thermosetting agent during scaling and root planing in chronic periodontitis patients.

Aim:To study the efficacy of a noninjectable anesthetic gel with a thermosetting agent in the reduction of pain during scaling and root planing (SRP) in untreated chronic periodontitis patients.Materials and Methods:This study is a randomized, double-masked, split-mouth, placebo-controlled trial. Thirty patients were enrolled who underwent SRP in a split-mouth (right side/left side) manner. Before commencement of SRP, both quadrants on each side were isolated and had a randomized gel (either placebo or test gel) placed in the periodontal pockets for 30 s. The pain was measured using numerical rating scale (NRS) and verbal rating scale (VRS).Results:The median NRS pain score for the patients treated with the anesthetic test gel was 1 (range: 0-4) as opposed to 5 (range: 3-7) in the placebo treated patients. The mean rank of pain score using NRS in test gel was 16.18 as compared to 44.82 in placebo treated sites. Hence, significant reduction in pain was found in test gel as compared to placebo using NRS (P < 0.001). The VRS showed that the majority of patients reported no pain or mild pain with a median of 1 as compared to placebo treated sites with a median of 2 suggestive of moderate pain.Conclusions:The NRS and VRS pain scores showed that the side treated with anesthetic gel was statistically more effective than the placebo in reducing pain during SRP.

The effect of indocyanine green-mediated photodynamic therapy as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A comparative split-mouth randomized clinical trial.

The aim of this study was to assess the effect of adjunctive photodynamic therapy (PDT) (using 810 nm diode laser and Indocyanine green as photosensitizer) in chronic periodontitis. Patients with untreated chronic periodontitis were included. Treatment was done according to a split mouth design. All sites received periodontal treatment comprising scaling and root-planing (SRP). Test group were additionally treated with PDT. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD) and Relative Attachment Level (RAL) were evaluated at baseline, 1 month and 3 months. Mean baseline values for PI, GI, PPD and RAL were not different in the test group and control group. Statistical significant difference in PPD and RAL, 3 months after treatment was seen in test group as compared to the control group. In patients with chronic periodontitis, clinical outcomes of conventional SRP can be improved by adjunctive PDT.

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Introduction: periodontal disease affects more than 50% of the Colombian population being considered as one of the main causes of oral morbidity. Diagnostic tests that could evaluate its extension and severity are important since we can account then for reliable tools to quantify the disease severity. Objective: To estimate the interrater reliability for the detection of radiographic findings in chronic periodontitis patients using conventional periapical radiography. Methods: It was performed a diagnostic test study including patients diagnosed with untreated localized chronic periodontitis including the worst prognosis tooth and performing a single conventional radiography using parallelism technique. We assigned a code for each radiograph and two independent and blinded assessors performed radiographic measurements for the following findings: lamina dura, presence of bone defects and defect type. Agreement evaluation was performed through Cohen's Kappa statistic. Results: We evaluated 125 radiographs. Average age was 38,8±9,9 years from whose 61,6 % were female patients. Reproducibility for lamina dura was 0,08 (95% CI: -0,04 - 0,21); bone defects 1,00 (95% CI: 1,00 - 1,00) and type of bone defects 0,31 (95% CI: 0,29 - 0,38). Conclusions: reliability for lamina dura assessment was considered null, for bone defects almost perfect while for type of bone defect acceptable. For some findings it is necessary accurate assessments, which could reflect higher agreement due to the importance of diagnostic and treatment plan establishment.

Serum, saliva, and GCF concentration of RANKL and osteoprotegerin in smokers versus nonsmokers with chronic periodontitis.

Background:The role of host response in periodontitis pathogenesis is confirmed, and it is well established that immune response plays a major role in the alveolar bone destruction. In the investigation of these responses, the role of receptor activator of the nuclear factor-kB ligand (RANKL)-osteoprotegerin (OPG) system is the most promising. Smoking can affect the RANKL-OPG system in a manner that will further enhance bone loss in periodontitis. The aim of this study is to assess the serum, saliva, and gingival crevicular fluid (GCF) concentration of RANKL and OPG in smoker versus nonsmoker untreated chronic periodontitis (CP) patients.Materials and Methods:Thirty-nine subjects were included in the present cross-sectional study: 29 systemically healthy CP male patients (15 smokers, 14 nonsmokers) and 10 systemically and periodontally healthy nonsmoker male subjects. Serum, GCF, and whole saliva samples were obtained from the subjects. The enzyme-linked immunosorbent assay (ELISA) kits were used for assaying the concentrations of RANKL and OPG in the samples. The one-way analysis of variance (ANOVA) test and the least significant difference (LSD) post hoc test were utilized to compare differences between the groups.Results:RANKL and OPG concentrations in saliva, serum, and GCF did not show any significant difference among all groups (P > 0.05). Salivary RANKL/OPG ratios were significantly higher in the nonsmoker CP group than in the healthy control group (P > 0.05) but they were not statistically significant among smoker periodontitis patients.Conclusions:The salivary RANKL/OPG ratio was higher in nonsmokers with periodontitis in comparison with smoker periodontitis patients.