Effect of non-surgical periodontal therapy on hemoglobin A1c in periodontitis patients without diabetes mellitus: A systematic review and meta-analysis

OBJECTIVES

This systematic review was aimed to evaluate the effect of non-surgical periodontal therapy (NSPT) on hemoglobin A1c (HbA1c) in periodontitis patients without diabetes mellitus (DM).

DATA/SOURCES

The present systematic review and meta-analysis were performed through searching the following electronic databases: EMBASE, MEDLINE, Web of Science, Cochrane Library and Open GREY. Interventional studies of periodontitis patients without DM were investigated. HbA1c changes in these patients before and after NSPT were analyzed. Subgroup analysis and sensitivity analysis were employed to identify sources of heterogeneity.

STUDY SELECTION

Three reviewers independently selected the eligible studies by screening the titles and abstract. Then, a full-text analysis was performed. The reasons for excluding studies were recorded. Any disagreements were settled by discussion with a fourth reviewer. All the four reviewers extracted and crosschecked the data, and disagreements were resolved by discussion. There are 21 case-series studies (self-controlled studies) and 1 non-randomized interventional studies (NRIs) were included.

RESULTS

For periodontitis patients without DM, a total of 469 individuals from 22 studies were enrolled. The pooled analysis demonstrated that it was significantly changed in HbA1c levels at 3-month follow-up (0.16 with 95% CI 0.04, 0.27; P=0.008), and 6-month follow-up (0.17% with 95% CI 0.08, 0.27; P<0.001) compared with baseline. Smoking, gender, experience of periodontal therapy and HbA1c value at baseline could be the sources of heterogeneity.

CONCLUSIONS

NSPT is potentially beneficial for the management of HbA1c in periodontitis patients with high risks of DM. However, high-quality randomized controlled trials are still necessary to confirm these conclusions.

CLINICAL SIGNIFICANCE

The systemic review evaluated the effect of NSPT on HbA1c in periodontitis patients without DM. The analysis may be beneficial to the management and control of the high risks of DM in periodontitis patients.

Randomized Trial to Test a Chemo-Mechanical Antiplaque Regimen as Adjunct to Periodontal Therapy

BACKGROUND

The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP).

OBJECTIVES

This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics.

METHODS

This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969.

RESULTS

In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75).

CONCLUSION

Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy.

KNOWLEDGE TRANSFER STATEMENT

This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes.

Periodontal Pocket Therapy Using a Class IV Dental Diode Laser in Dogs: A Retrospective Analysis

Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, P < .0001). No statistically significant results were observed for pocket type, as P values were greater than .05.

Impact of subgingival instrumentation on systemic inflammation and serum bone resorption marker in premenopausal women with periodontitis: a prospective interventional study

OBJECTIVES

Inflammatory disorders including periodontitis have been investigated for their impact on systemic inflammation and bone health. The present study was conducted with an aim to evaluate impact of control of periodontal inflammation through subgingival instrumentation on serum interleukin 6 and serum C-terminal telopeptide of type I collagen (CTX) in premenopausal females with stage II and III periodontitis.

METHOD AND MATERIALS

In this single-arm prospective study, periodontal parameters, serum interleukin 6, serum CTX, and hematologic parameters (total leukocyte count, differential leukocyte count, platelet count, mean platelet volume, and platelet distribution width) were assessed at baseline. Subgingival instrumentation was done, and oral hygiene instructions were given. At week 4, professional plaque control was performed, and oral hygiene instructions were reinforced. Serum and hematologic parameters were reassessed at 8 weeks after subgingival instrumentation, in individuals meeting the clinical endpoints (ie, bleeding on probing < 10%).

RESULTS

There was significant reduction in serum interleukin 6 of 0.168 ± 0.164 pg/mL (P = .000), and serum CTX of 17.459 ± 4.363 pg/mL (P = .000) at 8 weeks after subgingival instrumentation. There was significant decrease in eosinophil count (P = .018) and mean platelet volume (P = .016) at 8 weeks after subgingival instrumentation; however, no significant change was found in other hematologic parameters.

CONCLUSION

Following subgingival instrumentation, biomarkers of both systemic inflammation (interleukin 6) and bone turnover (CTX) were observed to reduce significantly. This finding hints towards a positive impact of periodontal intervention on bone health.

Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial

BACKGROUND

Diabetes mellitus (DM)-associated hyperinflammatory host response significantly provokes periodontal tissue destruction. In this context, the support of nonsurgical periodontal therapy in diabetics with host modulation agents is a current field of study. This clinical study aims to investigate the clinical efficacy of melatonin supplementation and discuss its possible biological mechanisms in nonsurgical periodontal treatment in patients with DM and periodontitis through some fundamental markers.

METHODS

In this randomized controlled and single-blind study, 27 of 55 diabetic patients with periodontitis (stage III/IV and grade C) underwent full-mouth scaling and root planing (fmSRP) alone and 28 patients underwent melatonin administration (6 mg daily, 30 days) in addition to fmSRP (full-mouth scaling and root planing plus melatonin, fmSRP-mel). The potential therapeutic contribution of melatonin was evaluated clinically and biochemically (gingival crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels) at 3rd and 6th months.

RESULTS

Melatonin (tablet, 6 mg daily, 30 days) did not cause any local or systemic side effects. fmSRP alone resulted in significant reduction in serum IL-1β levels, pocket depths, gingival inflammation, and gingival crevicular fluid RANKL and MMP-8 levels (p < 0.05). Moreover, melatonin supplementation resulted in a more significant decrease in bleeding and pocket depth scores at probing, especially at 3 months (p < 0.05). Furthermore, RANKL and MMP-8 levels were significantly lower at 3 months and IL-1β levels at 6 months compared to the control group (p < 0.05). However, OPG levels were not affected significantly by the treatments (p > 0.05).

CONCLUSION

Melatonin, as a host modulation agent, significantly increases the clinical efficacy of fmSRP. The reduction in periodontal inflammation and pocket depths may be a result of marked suppression of RANKL-associated osteoclastogenesis and extracellular matrix damage by melatonin.

Bacteremia Prevention during Periodontal Treatment-An In Vivo Feasibility Study

The link between periodontitis and systemic diseases has increasingly become a focus of research in recent years. In this context, it is reasonable-especially in vulnerable patient groups-to minimize bacteremia during periodontal treatment. The aim of the present in vivo feasibility study was to investigate the possibility of laser-based bacteremia prevention. Patients with stage III, grade B generalized periodontitis were therefore treated in a split-mouth design either with prior 445 nm laser irradiation before nonsurgical periodontal therapy or without. During the treatments, clinical (periodontal measures, pain sensation, and body temperature), microbiological (sulcus samples and blood cultures before, 25 min after the start, and 10 min after the end of treatment), and immunological parameters (CRP, IL-6, and TNF-α) were obtained. It was shown that periodontal treatment-related bacteremia was detectable in both patients with the study design used. The species isolated were Schaalia georgiae, Granulicatella adiacens, and Parvimonas micra. The immunological parameters increased only slightly and occasionally. In the laser-assisted treatments, all blood cultures remained negative, demonstrating treatment-related bacteremia prevention. Within the limitations of this feasibility study, it can be concluded that prior laser disinfection can reduce bacteremia risk during periodontal therapy. Follow-up studies with larger patient numbers are needed to further investigate this effect, using the study design presented here.

Different doses of vitamin D supplementation to nonsurgical treatment for vitamin-D-insufficient patients with diabetic periodontitis and the effect on gingival BMP-2 levels

Epidemiological data show people with diabetes mellitus (DM) have three-fold increase in risk of periodontitis. A vitamin D insufficiency can affect the progression of DM and periodontitis. This study evaluated the effects of different-dose vitamin D supplementation to nonsurgical periodontal therapy for vitamin-D-insufficient diabetic patients coexisting with periodontitis and changes of gingival bone morphogenetic protein-2 (BMP-2) levels. The study included 30 vitamin-D-insufficient patients receiving nonsurgical treatment followed by administration of 25,000 international units (IU) vitamin D3 per week (the low-VD group) and 30 patients receiving 50,000 UI vitamin D per week (the high-VD group). The decreases of probing pocket depth, clinical attachment loss, bleeding index, and periodontal plaque index values of patients after the six-month supplementation of 50,000 UI vitamin D3 per week to nonsurgical treatment were more significant than those after the six-month supplementation of 25,000 UI vitamin D3 per week to nonsurgical treatment. It was found that 50,000 IU per week vitamin D supplementation for 6 months could lead to a better glycemic control for vitamin-D-insufficient diabetic patients coexisting with periodontitis after nonsurgical periodontal therapy. Increased levels of serum 25(OH) vitamin D3 and gingival BMP-2 were found in both low- and high-dose VD groups, and the high-dose VD group exhibited higher levels than the low-dose VD group. Vitamin D supplementation in large doses for 6 months tended to improve the treatment of periodontitis and increase gingival BMP-2 levels in diabetic patients coexisting with periodontitis who were vitamin D deficient.

Utilization of a periodontal endoscope in nonsurgical periodontal therapy: A randomized, split-mouth clinical trial

BACKGROUND

The removal of subgingival calculus to obtain gingival health is an integral part of nonsurgical periodontal therapy. The periodontal endoscope is used by some clinicians to help enhance access to effectively remove subgingival calculus; however, longer-term studies on this subject are still lacking. The purpose of this randomized, controlled clinical trial was to compare the clinical outcomes of scaling and root planing (SRP) using a periodontal endoscope versus conventional SRP using loupes for up to 12 months, utilizing a split-mouth design.

METHODS

Twenty-five patients were recruited who exhibited generalized stage II or stage III periodontitis. SRP was rendered by the same experienced hygienist using either a periodontal endoscope or conventional SRP using loupes, following random assignment of the left and right halves of the mouth. All periodontal evaluations were done by the same periodontal resident at baseline, and at 1, 3, 6, and 12 months after therapy.

RESULTS

Single-rooted teeth interproximal sites displayed a significantly lower percentage of improved sites (P < 0.05) than multirooted teeth for probing depth and clinical attachment level (CAL). Maxillary multirooted interproximal sites favored the use of the periodontal endoscope at the 3- and 6-month time periods (P = 0.017 and 0.019, respectively) in terms of the percentage of sites with improved CAL. Mandibular multirooted interproximal sites showed more sites with improved CAL using conventional SRP than with the periodontal endoscope (P < 0.05).

CONCLUSION

Overall, the use of a periodontal endoscope was more beneficial in multirooted sites compared to single-rooted sites, specifically in maxillary multirooted sites.

Reporting characteristics of nonsurgical periodontal therapy trials registered in ClinicalTrials.gov: an observational study

Aim: To evaluate the completeness of the description of nonsurgical periodontal therapy interventions in clinical trials registered in ClinicalTrials.gov and correspondence of registered information for trial participants and outcome measures with published articles. Materials & methods: We retrieved data from ClinicalTrials.gov and corresponding publications. The completeness of intervention reporting was assessed using the Template for Intervention Description and Replication (TIDieR) checklist for oral hygiene instructions (OHI), professional mechanical plaque removal (PMPR), and subgingival instrumentation, antiseptics and antibiotics. The completeness of registration of trial protocol information was assessed according to the WHO Trial Registration DataSet for participant information (enrollment, sample size calculation, age, gender, condition) and primary/secondary outcome measures. Results: 79 included trials involved OHI (n = 38 trials, 48.1%), PMPR (n = 19, 24.1%), antiseptics (n = 11, 12.7%), or antibiotics (n = 11, 12.7%). There was a great variety in the terms used to describe these interventions. Most of the analyzed trials (93.7%) were completed and did not provide any data on study phase (74.7%). The description of intervention in the registry in ClinicalTrials.gov was inadequate for all analyzed interventions, with description inconsistencies in matching publications. There were also discrepancies in registered and published outcomes: for 39 trials with published results, 18 had different registered and reported primary outcomes, and 29 different registered and reported secondary outcomes. Conclusion: The completeness of the description of nonsurgical therapy of periodontitis in clinical trials is unsatisfactory, reducing the quality of translation of the new evidence and procedures into clinical practice. Significant discrepancy in registered and reported trial outcomes calls into question the validity of reported results and relevance for practice.

IgA Levels among Type 2 Diabetic and Non-Diabetic Patients with Periodontitis: A Prospective Clinical Study

OBJECTIVES

 To estimate gingival crevicular immunoglobulin A(IgA) using enzyme-linked immunosorbent assay (ELISA) among type II diabetic patients with periodontitis.

MATERIALS AND METHODS

 A non-randomized study was done of 40 periodontitis subjects with a mean age of 50 years and were recruited into two groups, Group A (Type II controlled diabetics with HbA1c < 7%) and Group B (non-diabetics with HbA1c between 4 and 6%). Both the groups underwent nonsurgical periodontal therapy (NSPT). The clinical parameters were recorded at baseline, 1, and 3 months. GCF sample was collected for the estimation of crevicular IgA at baseline and at 3 months.

STATISTICAL ANALYSIS

 Results were analyzed using parametric tests paired t-test and Student's t-test for every assessment point. The level of significance was set at p < 0.05.

RESULTS

 Difference in IgA levels and clinical parameters was seen between diabetic and non-diabetic groups, which was statistically significant.

CONCLUSION

 Changes in crevicular IgA levels in patients with diabetic periodontitis can be used as a novel biomarker in assessing the inflammatory status.

Complications and treatment errors in nonsurgical periodontal therapy

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Controlled release devices as adjuvants in nonsurgical periodontal therapy: A systematic review

Controlled release devices (CRD) have been widely studied regarding their application in periodontal therapy. Therefore, the present study aims to evaluate the use and effectiveness of controlled-release devices in nonsurgical periodontal therapy through a systematic review. The research was carried out in six different databases, namely: Online Medical Literature Search and Analysis System (Medline-PubMed), Web of Science, Science Direct, Scopus, Scielo, and Google Scholar. The descriptors "Delayed-Action Preparation," "Therapeutics," and "Periodontitis," were used with their EntryTerms and connected through the Boolean operators AND and OR. A total of 2847 studies were found, and after applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist flowchart, 34 were selected using the eligibility criteria. After that, the qualitative results were tabulated and the risk of bias in each of them was evaluated. It can be observed that the use of CRD presents itself as a successful alternative for adjuvant treatment to periodontal therapy, a fact due to its availability and local concentration in the crevicular fluid. However, further clinical research is still needed to develop devices that are effective, with an easy and quick application, as well as available at a good cost-benefit ratio.

Effects of nonsurgical periodontal therapy on serum creatinine level in systemically healthy individuals with periodontitis: An interventional study

Background

Several studies have suggested a relationship between periodontitis and serum creatinine levels. Both low and high serum creatinine levels have been reported in individuals with periodontitis. The impact of periodontal therapy on serum creatinine levels has not been fully investigated yet. The aim of the study is to estimate the influence of nonsurgical periodontal therapy (NSPT) on serum creatinine levels in systemically healthy individuals with periodontitis at stage II and stage III with grade A and grade B.

Materials and Methods

Sixty-eight systemically healthy individuals included in the study were divided into Group A (GA) (Periodontally healthy) and Group B (GB) (Periodontitis: stage II and III with grade A and grade B). Gingival index, sulcular bleeding index, probing pocket depth, clinical attachment level, body mass index, and serum creatinine levels were recorded at baseline for both GA and GB, 90 days after NSPT for GB only. Collected data were analyzed statistically.

Results

Serum creatinine levels in GB were significantly higher when compared with GA and serum creatinine levels in GB before and 90 days after NSPT were statistically insignificant.

Conclusions

Serum creatinine levels were higher in individuals with periodontitis when compared with periodontally healthy individuals and NSPT has no considerable influence on the serum creatinine levels in individuals with periodontitis. Further studies are required to confirm these findings.

Therapeutic Manuka Honey as an Adjunct to Non-Surgical Periodontal Therapy: A 12-Month Follow-Up, Split-Mouth Pilot Study

Periodontitis is recognized as one of the most common diseases worldwide. Non-surgical periodontal treatment (NSPT) is the initial approach in periodontal treatment. Recently, interest has shifted to various adjunctive treatments to which the bacteria cannot develop resistance, including Manuka honey. This study was designed as a split-mouth clinical trial and included 15 participants with stage III periodontitis. The participants were subjected to non-surgical full-mouth therapy, followed by applying Manuka honey to two quadrants. The benefit of adjunctive use of Manuka honey was assessed at the recall appointment after 3, 6, and 12 months, when periodontal probing depth (PPD), split-mouth plaque score (FMPS), split-mouth bleeding score (FMBS), and clinical attachment level (CAL) were reassessed. Statistically significant differences between NSPT + Manuka and NSPT alone were found in PPD improvement for all follow-up time points and CAL improvement after 3 and 6 months. These statistically significant improvements due to the adjunctive use of Manuka amounted to (mm): 0.21, 0.30, and 0.19 for delta CAL and 0.18, 0.28, and 0.16 for delta PPD values measured after 3, 6, and 12 months, respectively. No significant improvements in FMPS and FMBS were observed. This pilot study demonstrated the promising potential of Manuka honey for use as an adjunct therapy to nonsurgical treatment.

Effect of Nonsurgical Periodontal Therapy on Metabolic Control and Systemic Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with Stage III Periodontitis

Background

A reciprocal relationship is understood to exist between periodontal disease and type 2 diabetes mellitus (T2DM), and this intervention study aimed to evaluate the effects of nonsurgical periodontal therapy (NSPT) on metabolic control, systemic inflammation, and cytokines in patients of T2DM with Stage III periodontitis.

Materials and Methods

Sixty patients of T2DM with Stage III periodontitis were divided equally into two groups: intervention group (IG) and control group. Clinical parameters such as bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months, and the serum samples were collected and processed at baseline and 6 months following NSPT to evaluate fasting plasma glucose, Glycosylated hemoglobin (HbA1c), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and high-sensitivity capsule-reactive protein (hs-CRP).

Results

The results indicated a significant improvement in clinical parameters of PPD and CAL 6 months after NSPT (P = 0.005) in both the groups. However, a significant decrease (P < 0.0001) in the TNF-α, hs-CRP, blood glucose, and HbA1c levels was seen after NSPT. On the other hand, an increase in anti-inflammatory cytokine IL-10 was observed after NSPT in the IG. The changes in the pretreatment and posttreatment levels of all clinical, biochemical, and metabolic parameters, were found to be significant in both the groups except BOP.

Conclusion

NSPT effectively improves periodontal condition, systemic inflammatory status, and glycemic control in patients of T2DM with Stage III periodontitis and decreases hs-CRP levels.

Efficacy of nonsurgical periodontal therapy for treatment of periodontitis: practical application of current knowledge

This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.

Minimal periodontal basic care - no surgery, no antibiotics, low adherence. What can be expected? A retrospective data analysis

OBJECTIVE

This retrospective study aimed to evaluate tooth loss and the evolution of periodontal inflammatory parameters within a strict nonsurgically treated patient cohort with < 2 supportive periodontal care visits per year, defined as minimal periodontal basic care, of 2.5 to 10.7 years.

METHOD AND MATERIALS

Data for nonsurgically treated patients were checked for: complete periodontal examination data at baseline (T0), after active periodontal therapy (T1), and after ≥ 2.5 years of supportive periodontal care (T2); smoking, diabetes mellitus, age (at least 18 years), plaque and gingival indices, bleeding on probing, percentage of residual pockets, supportive periodontal care adherence, and number of supportive periodontal care visits were assessed as risk factors for tooth loss.

RESULTS

In total, 132 patients were included (76 female, mean age 56.7 ± 10.3 years), mean T1-T2: 4.5 ± 1.6 years. 26.5% of all patients lost 118 teeth (0.5 teeth/patient, 0.12 teeth/patient/year). Plaque and bleeding parameters were: mean plaque control record, 59.77 ± 28.07%; mean Papilla Bleeding Index, 47.46 ± 34.12%; mean bleeding on probing, 33.46 ± 21.52%. Supportive periodontal care duration (P = .013) and T2 bleeding on probing (P = .048) were identified as patient-related risk factors for tooth loss.

CONCLUSION

Minimal periodontal basic care was characterized by elevated bleeding on probing, Papilla Bleeding Index, and plaque control record scores. This possibly highlights a lack of consequent applied surgical intervention (if needed) transitioning into regular supportive periodontal care, including insufficient patient behavioral changes regarding domestic oral hygiene procedures and possibly nonaddressed proinflammatory dietary habits as a negative effect. An apparently low tooth loss rate could be observed. The duration of supportive periodontal care was identified as a risk factor for tooth loss.

Periodontal treatment of patients with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is a rare condition in which fragile vascular walls lead to increased risks of bleeding, cerebral abscesses, arteriovenous malformations, anemia, and thrombosis. To date, no protocol has been established for optimizing the clinical outcomes of periodontal treatment in patients with this condition. The aim of this case report is to describe a safe clinical approach to periodontal treatment in a patient with HHT. A 39-year-old woman had a history of multiple macules on the oral mucosa, and a diagnosis of HHT was made based on the Curaçao diagnostic criteria (epistaxis, telangiectases, visceral lesions, and family history). Evaluation of the patient's periodontal clinical parameters and radiographs led to a diagnosis of generalized periodontitis, stage IV, grade C. The patient underwent nonsurgical periodontal therapy consisting of supragingival and subgingival scaling and root planing under a careful and specific protocol that included antibiotic prophylaxis before each session. Two months after therapy, the periodontal reevaluation showed improvement in the clinical parameters at most sites. Sites with remaining periodontal pockets were re-treated according to the same protocol, including the antibiotic prophylaxis. The patient was enrolled in a periodontal maintenance program, and her HHT was routinely monitored by her physician. Periodontal treatment may promote secondary complications in patients with HHT if appropriate systemic care is not provided, and the periodontal treatment plan should be designed individually for each patient. Establishing the correct HHT diagnosis and coordinating care with the patient's physician are essential to safe, effective treatment.

Ozone in Patients with Periodontitis: A Clinical and Microbiological Study

The purpose of this article was to assess the effectiveness of ozone therapy as an adjunct to mechanical therapy in periodontitis patients. Thirty-two patients diagnosed with generalized periodontitis were selected, with a total of 655 teeth examined. Each patient’s mouth was divided into four quadrants (the split-mouth model) to be randomly treated with four sessions of gaseous ozone or air. The following clinical variables were recorded: the gingival index, the periodontal clinical attachment loss, the Miller’s mobility index and the clinical improvements, as assessed through the visual analog scale (VAS). In addition, the microorganisms were qualitatively compared. After four weeks of treatment, the teeth of the ozone-treated quadrants showed statistically significant reductions in the gingival index and an improvement in the clinical attachment (p < 0.0001). The same treatment also significantly improved mobility by between 70% and 86% compared to the control group (p < 0.0001). Statistically significant differences were also recorded for the VAS (p < 0.0001). In the qualitative study of the subgingival flora, significant differences were observed (p < 0.0001). The overall results of this trial support the view that ozone treatment is effective and well tolerated in cases of generalized chronic periodontitis.

The efficacy of adjunctive periodontal therapies during supportive periodontal care in patients with residual pockets. A systematic review and meta-analysis

While it is well-established that patients that develop signs of relapsing periodontitis in supportive periodontal care (SPC) will need to repeat subgingival instrumentation of the residual pockets, less certainty is available in terms of which protocol should be followed and whether the use of adjunctive therapies or physical agents might provide additional benefits to repeated instrumentation alone. The aim of this systematic review was therefore to assess whether repeating subgingival instrumentation in combination with adjunctive therapies (other than antimicrobials) might provide a significant benefit in terms of pocket closure, probing pocket depth (PPD) reduction or clinical attachment level (CAL) gain in patients during SPC with residual/relapsing pockets. Four databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with a minimum follow-up of 3 months that investigated the use of adjunctive therapies (other than antimicrobials) in case of residual/relapsing pockets in patients in SPC since at least 3 months. Data extraction and risk of bias assessment were performed in the studies meeting the inclusion criteria and meta-analysis was performed when ≥3 studies assessing the same adjunctive therapy were identified. 12 studies (2 CCTs and 10 RCTs) were included for qualitative analysis. Meta-analysis was performed only for 3 studies on the adjunctive use of photodynamic therapy (PDT) and it indicated a nonsignificant benefit compared to the placebo in terms of PPD reduction and CAL gain at 3 months (weighted mean difference 0.07 and -0.03, respectively) and at 6 months of follow-up (weighted mean difference -0.09 and -0.18, respectively). While antiseptics did not provide significant benefits, one study on probiotics and one on the use of vitamin D and calcium supplementation showed significant improvements in periodontal parameters. There is currently insufficient/poor evidence to determine the efficacy of adjunctive strategies (other than antimicrobials) to improve the outcomes of SPC in case of residual/relapsing pockets.

Efficacy of MMP-8 Level in Gingival Crevicular Fluid to Predict the Outcome of Nonsurgical Periodontal Treatment: A Systematic Review

Purpose: To explore whether baseline matrix metalloproteinase (MMP)-8 level in gingival crevicular fluid (GCF) (exposure) can predict the outcome (reduction in probing pocket depth (PPD) (outcome)) of nonsurgical periodontal therapy (NSPT) (manual or ultrasonic or both) in patients with periodontitis (population/problem) after 3 months. Methods: Six databases (PubMed, Cochrane library, ProQuest, Ovid, Scopus, EBSCO) were searched for relevant articles published until 30 July 2021. Retrieved articles were passed through a three-phase filtration process on the basis of the eligibility criteria. The primary outcome was the change in PPD after 3 months. Quality of the selected articles was assessed using Cochrane Risk of Bias tool (RoB2) and Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tools. Results: From 1306 articles, five were selected for analysis. The results showed high variations in the level of GCF MMP-8 level at baseline. The average amount of reduction in PPD was 1.20 and 2.30 mm for pockets with initial depth of 4−6 mm and >6 mm, respectively. Conclusion: On the basis of available evidence, it was not possible to reach a consensus on the ability of baseline GCF MMP-8 to forecast the outcome of NSPT. This could have been due to variation in clinical and laboratory techniques used. However, consistency in mean PPD reduction after 3 months was shown.

Evaluation of the reactive oxygen metabolite levels in plasma, gingival crevicular fluid, and saliva in generalized chronic periodontitis patients before and after nonsurgical periodontal therapy: A case-control and interventional study

Background

Reactive oxygen metabolites (ROMs) produced in periodontitis could contribute to excessive tissue damage. Thus, treatment of chronic periodontitis may decrease the ROM levels. The aim of this study is to evaluate the ROM levels in plasma, saliva, and gingival crevicular fluid (GCF) in generalized chronic periodontitis (GCP) patients before and after nonsurgical periodontal treatment.

Materials and Methods

Two groups were included in this study. Group I consisted of 30 healthy controls (C) and Group II consisted of 30 subjects with GCP. Plaque index (PI), papillary bleeding index, Probing Depth (PD), and clinical attachment level were recorded. GCF, saliva, and plasma samples were collected from both groups. ROM levels were assessed. A baseline comparison was made between the two groups. Nonsurgical periodontal treatment was carried out for Group II subjects. Two months posttreatment, the clinical parameters and ROM levels in GCF, saliva, and plasma were reassessed in Group II, and the data were compared with their baseline values. Statistical analysis was done using SPSS 20 software and results were derived.

Results

Two months posttreatment, Group II exhibited significant reduction in ROM levels in plasma, saliva, and GCF with significant decrease in PI, bleeding on probing, probing depth, and attachment loss.

Conclusion

Thus, significant oxidative stress may occur in chronic periodontitis and nonsurgical periodontal therapy may be regarded as an effective treatment modality to treat the diseased periodontium, thereby preventing possible systemic diseases in future.

Comparative Evaluation of Sclerostin Levels in Gingival Crevicular Fluid in the Treatment of Chronic Periodontitis Patients Using Diode Laser as an Adjunct to Scaling and Root Planing: A Clinico-biochemical Study

Aims:

Sclerostin is an inhibitor of bone formation, and laser irradiation enhances osteoblast proliferation. The objective of this study was to assess and compare the gingival crevicular fluid (GCF) sclerostin level and clinical parameters of chronic periodontitis patients following the application of diode laser (810 nm) as an adjunct to scaling and root planing (SRP).

Subjects and Methods:

Fifteen systemically healthy chronic periodontitis patients (age 35–55 years) with probing pocket depth ≥5mm were included in this split-mouth study. SRP and pocket irradiation with diode laser were done in the test group and SRP alone in the control group at baseline. Low-level laser therapy application and saline irrigation were done in both the groups, respectively, in the 2^nd and 3^rd visits. Two microliters of GCF samples was collected from both the groups at baseline before treatment and on the 90^th day for the assessment of sclerostin concentration.

Results:

This study showed a statistically significant reduction of clinical parameters in the test and control groups at the end of 3 months. Both the groups showed a statistically significant reduction of sclerostin levels in GCF after 3 months, in which the test group (125.80 ± 28.21 to 82.80 ± 9.31) showed a highly significant reduction (P = 0.000).

Conclusions:

The adjunctive use of laser had shown a beneficial effect in terms of clinical parameters and osteoblast proliferation by the reduction in the levels of sclerostin in GCF. From the observations of this study, it can be concluded that the therapeutic effectiveness of diode laser as an adjunct to SRP is having a beneficial effect and sclerostin can be used as a potent biomarker.

Effect of Conventional Periodontal Treatment (Scaling and Root Planing) on Type-2 Diabetic Patient with Moderate Generalized Chronic Periodontitis: A Clinical Study

Background:

The aim is to assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in Type 2 diabetes mellitus (DM) patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c).

Materials and Methods:

A prospective, comparative, clinical study was performed on 50 patients suffering from Type 2 DM with moderate, generalized chronic periodontitis. Type 2 moderately controlled diabetic patients with HbA1c values within the range of 6%–8% were selected. The parameters recorded were gingival index, plaque index, sulcus bleeding index, probing pocket depth, clinical attachment level, and HbA1c. The recordings were done at baseline and 6 months after SRP procedures.

Results:

Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.05).

Conclusion:

SRP resulted in a statistically significant reduction in the clinical parameters and HbA1c. Hence, periodontal treatment should be included in the management of diabetic patients.

Clinical effectiveness of a topical subgingival application of injectable platelet-rich fibrin as adjunctive therapy to scaling and root planing: a double-blind, split-mouth, randomized, prospective, comparative controlled trial

OBJECTIVE

The purpose of this randomized, controlled, split-mouth clinical trial was to clarify the clinical efficacy of using injectable platelet-rich fibrin (i-PRF) as an adjunctive subgingival irrigation to scaling and root planing (SRP) in the treatment of periodontitis.

METHOD AND MATERIALS

The study was conducted in 15 patients suffering from stage II to III with grade B to C periodontitis with bilateral periodontal pockets (≥ 5 mm) on a minimum of two teeth without degree II or III of furcation involvement or tooth mobility. The evaluated clinical parameters were: Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession at baseline and after 3 months. After full-mouth supra- and subgingival SRP, the sites were randomly divided into test sites receiving the subgingival application of i-PRF and controls treated with saline. The Wilcoxon test and Mann-Whitney U test were used for intra- and inter-group comparisons, respectively.

RESULTS

In total, 726 sites were treated (388 test group and 338 control group) with no uneventful healing effects. Statistically significant decreases in PI (P = .001), BOP (P = .001 for both groups), PPD (P = .001 and P = .000 for test and control groups, respectively), CAL (P = .015 and P = .001 for test and control groups, respectively) between pretreatment and 3 months posttreatment were noted in both test and control groups. For inter-group comparisons, there was no statistically significant difference in all clinical indices (P > .05).

CONCLUSION

In this study, both groups were clinically effective as nonsurgical periodontal treatments, without any clinical benefits of using i-PRF.

Influence of a Low-Carbohydrate and Rich in Omega-3 Fatty Acids, Ascorbic Acid, Antioxidants, and Fiber Diet on Clinical Outcomes in Patients with Chronic Gingivitis: A Randomized Controlled Trial

Background

Nutrition has a significant impact on the pathophysiology of periodontal disease. Both micro- and macronutrients have an impact on periodontal health. This study aimed at the evaluation of the effects of a diet low in carbohydrate and rich in omega-3 fatty acids, ascorbic acid, antioxidants, and fiber on clinical outcomes in patients with gingival inflammation for four weeks.

Materials and Methods

Overall, 54 systemically healthy subjects were enrolled in this study. The clinical trial consisted of two groups: Group A (test group) (n = 27) was instructed to consume a diet comprising low carbohydrates, rich in omega-3 fatty acids, ascorbic acid, antioxidants, and fibers for the next four weeks; in Group B (control group) (n = 27), no alteration in dietary behavior was done, and these subjects were instructed to have their daily routine diet. Clinical parameters measured were plaque index (PI), gingival bleeding index (GI), probing depths (PD), clinical attachment level (CAL), and bleeding on probing (BOP) at one week without any dietary changes (baseline) for both the groups, followed by a one-week adaptation period; then, the parameters were checked on a weekly basis for the next four weeks.

Results

Primary clinical outcome BOP and secondary outcome GI showed significant changes in the test group compared with the control group (P < 0.05). However, no significant changes were seen in the plaque scores in the test group (P > 0.05). The degree of diet compliance on the clinical parameters (PI, GI, and BOP) was assessed by using regression analysis.

Conclusion

Dietary recommendations can be beneficial in managing gingival and periodontal inflammation. Nutritional interventional studies as monotherapy are required to evaluate the clinical significance of diet in periodontal therapy.

Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review

Background: On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation. Methods: A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT). Results: Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters. Conclusions: The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.

Comparing the Effect of Combination of 1% Ornidazole and 0.25% Chlorhexidine Gluconate (Ornigreat™) Gel and Aloe vera Gel in the Treatment of Chronic Periodontitis: A Randomized, Single-Blind, Split-Mouth Study

Aim and Objective:

The aim of this study is to compare the efficiency of subgingivally delivered 1% ornidazole and 0.25% chlorhexidine (CHX) gluconate (Ornigreat™ gel) and Aloe vera (AV) gel in the treatment of chronic periodontitis.

Materials and Methods:

Twenty chronic periodontitis patients with pocket depths ranging from 4 to 6 mm bilaterally at least in one site were included in the study. After a thorough nonsurgical periodontal therapy, 1% ornidazole and 0.25% CHX gluconate (Ornigreat™ gel) and AV gel were subgingivally delivered into the pocket sites, and the clinical parameters such as plaque index (PI), gingival index (GI), bleeding index (BI), and clinical attachment level (CAL) were evaluated at baseline and after 4 weeks.

Results:

In both the groups, a reduction in PI, GI, and probing depth readings was evidenced after 4 weeks. A significant improvement was noticed in the BI in the AV group when compared with that of Ornigreat™ group. Taking CAL into consideration, though improvement was there in both the groups, it was not appreciable.

Conclusion:

AV which is an herbal derivative when subgingivally delivered in the pocket site could be an equally effective and affordable substitute for Ornigreat™ gel.

Clinical and microbiological evaluation of the synergistic effects of diode laser with nonsurgical periodontal therapy: A randomized clinical trial

Context:

Nonsurgical and surgical therapies along with local and systemic antibiotic regimens have been advocated in the treatment of periodontitis. Due to increasing risk of developing antibiotic resistance and inability of nonsurgical periodontal therapy to completely eradicate the pathogenic microorganisms, lasers have been used as an adjunct to conventional therapy.

Aim:

The aim of the present study is to evaluate the effectiveness of the use of diode lasers as adjunct to scaling and root planing (SRP) compared to SRP alone on various clinical and microbiologic parameters in chronic periodontitis patients.

Settings and Design:

Patients were taken from the department of periodontology and implantology, who were having chronic periodontitis.

Materials and Methods:

A total of forty patients participated in the study and they were divided into Group I – the test group (SRP + diode laser) and Group II – the control group (SRP alone). The following clinical parameters were assessed: oral hygiene index simplified; clinical attachment level (CAL); probing pocket depth (PPD); bleeding on probing (BOP) at baseline, 4 weeks, and 12 weeks after the treatment; and colony-forming units (CFUs) 1 week postoperatively.

Statistical Analysis Used:

The statistical analysis was performed using paired t-test, unpaired t-test, Wilcoxon signed-rank test, and Mann–Whitney test.

Results:

There was reduction in BOP, PPD, and gain in CAL from baseline to 3 months and also a reduction in CFU 1 week postoperatively.

Conclusion:

There was a significant improvement in clinical parameters in test group (SRP + laser) as compared to the control group (SRP alone).

Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review

Objective: The purpose of this literature review was to evaluate the effectiveness of using Er:YAG (erbium-doped yttrium/aluminum/garnet) laser or Er,Cr:YSGG (erbium, chromium-doped yttrium/scandium/gallium/garnet) laser on calculus removal and their effect on the topography and roughness of root surface in comparison with the conventional instruments in the nonsurgical periodontal therapy. Background data: One of the most challenging problems in treatment of periodontal disease is the elimination of plaque and calculus, leaving a clean and smooth root surface to decrease plaque and calculus retention, and for good gingival reattachment. Materials and methods: PubMed and Google Scholar were searched for available literature. The electronic search was limited to articles published in the period between January 2007 and April 2017, in the English language. Results: A total of 47 publications fulfilled the inclusion criteria of this systematic review and screened according to the research questions. Calculus removal using the ultrasonic instrument showed remaining calculus compared with the hand instrument, whereas, on the contrary, erbium lasers revealed no remaining calculus or smaller amounts compared with the conventional instruments when used in appropriate settings. The results of this review showed that ultrasonic instrumentation produced effects on the root surface almost similar to that of hand instrumentation. Er:YAG laser and Er,Cr:YSGG laser clarify a little more surface roughness when compared with conventional instruments. Conclusions: The present systematic review indicates that a combination of scaling and root planing (SRP) using the erbium lasers as an adjunctive therapy at certain parameters can be appropriate to remove residual debris from the root surface and at the same time have little or no negative thermal effect on the root surface. The Er:YAG laser also seems to be the most suitable for nonsurgical periodontal therapy. Additional new good-designed studies are needed to evaluate the effectiveness of erbium lasers with SRP in nonsurgical periodontal therapy.

Clinical and microbiological effects of 1% Matricaria chamomilla mouth rinse on chronic periodontitis: A double-blind randomized placebo controlled trial

BACKGROUND

Several herbal mouth rinses are assessed in the literature as an adjunct to scaling and root planning (SRP) for the treatment of periodontal diseases. The objective of this study was to evaluate and compare the clinical and microbiological effects of Matricaria chamomilla (MTC) mouth rinse with chlorhexidine (CHX) and placebo mouth rinse for the management of chronic periodontitis.

MATERIALS AND METHODS

This double-blind, randomized, placebo controlled, clinical trial involved seventy five patients, suffering from chronic periodontitis, which were randomly divided into three groups: negative control (SRP + placebo), positive control (SRP + 0.12% CHX), and test group (SRP + 1% MTC mouth rinse). Mouth rinsing (adjunctive therapy) was continued for 1 month while clinical parameters (plaque index, gingival index, sulcus bleeding index, probing pocket depth [PPD], clinical attachment level, gingival recession [GR], stain index) and microbial colony forming units were evaluated at base line, 6 weeks, and 3 months.

RESULTS

All groups showed a significant change in parameters (except GR for placebo group) between base line and 3 months. MTC mouth rinse suggested added significant benefits over placebo group over the study period. However, it determined more but nonsignificant improvement in PPD (3.68 mm vs. 3.36 mm) and CAL (3.00 mm vs. 2.72 mm) as compared to CHX rinse at 3 months' period as compared to baseline.

CONCLUSION

Advantages of using test group were comparable to CHX associated group; therefore, MTC mouth rinse can be used as an effective adjunct during nonsurgical periodontal therapy for chronic periodontitis.

Netrin-1 and its receptor Unc5b as markers of periodontal disease

OBJECTIVES

The aim of this present study was to evaluate the levels of Netrin-1 and Unc5b in periodontal health and disease.

BACKGROUND

Netrin-1, acting via its receptor UNC5b, regulates the inflammatory response and takes apart in bone destructive diseases.

METHODS

Samples of gingival crevicular fluid (GCF), whole saliva, and serum were taken from systemically healthy, nonsmoking 20 periodontitis , 20 gingivitis patients, and 20 periodontally healthy subjects at baseline and 4 weeks after nonsurgical periodontal treatment (NSPT). Whole-mouth and site-specific clinical periodontal parameters were recorded. Netrin-1 and Unc5b levels were measured by enzyme-linked immunosorbent assay. Data were analyzed by nonparametric tests.

RESULTS

Total amount of Netrin-1 in GCF was significantly higher in periodontitis than the others, and the levels were significantly reduced after NSPT. Salivary and serum concentrations of Netrin-1 were significantly different among the study groups (P = .000), and NSPT significantly increased the concentration levels of both salivary and serum Netrin-1 (P < .05). Healthy subjects had significantly lower GCF (P = .001) and conversely, higher salivary and serum levels of Unc5b than the other groups (P = .002). The GCF levels of Unc5b were significantly reduced (P < .01), and conversely, serum concentrations were significantly increased after NSPT (P < .05). GCF Netrin-1 and Unc5b total amounts were positively correlated with clinical parameters (P < .01 and P < .05) whereas salivary Netrin-1 and Unc5b concentrations were negatively correlated with clinical parameters (P < .01 and P < .05).

CONCLUSIONS

The results of this study indicate that Netrin-1 and its receptor Unc5b may have essential roles in periodontal inflammation and those can be assumed as useful therapeutic agent to control inflammation and periodontal breakdown.

Adjunctive use of InGaAsP and Er,Cr:YSGG lasers in nonsurgical periodontal therapy: a randomized controlled clinical study

OBJECTIVE

To evaluate clinically and microbiologically the outcomes following the combined application of InGaAsP diode laser and Er,Cr:YSGG laser for nonsurgical treatment of chronic periodontitis (ChP).

METHOD AND MATERIALS

Forty-two patients (age 45.31 ± 9.78 years, 22 female, 23 smokers) with ChP were randomly treated with subgingival debridement (SD) by means of ultrasonic and hand instruments (control group, n = 21) or with InGaAsP followed 1 week later by InGaAsP + SD + Er,Cr:YSGG (test group, n = 21). In the test group, a second laser treatment was performed for all residual sites (bleeding sites with probing depth [PD] ≥ 4 mm) 2 months after the first laser therapy. At baseline and 6 months after therapy, periodontal clinical and microbiologic parameters were evaluated.

RESULTS

Six months after therapy, statistically significant clinical and microbiologic improvements (PD reduction, clinical attachment level [CAL] gain, quantitative reduction of periopathogens) were observed in both groups compared to baseline. However, the use of InGaAsP followed by SD and the adjunctive use of an Er,Cr:YSGG laser, yielded statistically significantly higher clinical (PD, CAL, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) and microbiologic (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum) improvements (P < .05) compared to SD alone.

CONCLUSIONS

In patients with ChP, the adjunctive use of InGaAsP and Er,Cr:YSGG to SD may additionally improve the clinical and microbiologic parameters obtained with SD alone, thus representing a valuable approach in nonsurgical periodontal therapy.

The effect of miniaturized manual versus mechanical instruments on calculus removal and root surface characteristics: An in vitro light microscopic study

Objectives

The aim of this study was to evaluate by light microscopy analysis the effect of the use of miniaturised piezoelectric tips versus mini‐five area specific curets on calculus removal and postoperative root surface alterations.

Methods

A total of 20 extracted teeth were used. Two square surfaces (5×5 mm) were marked on each root surface with a diamond bur mounted on a high‐speed handpiece. Before and after instrumentation, a series of magnified images (4.2×) of each experimental surface were taken with a standardized approach. According to a randomization list, the two surfaces on each sample were instrumented in a standardised fashion either with a mine‐five curet or a slim piezoelectric tip. The images were processed using an imaging software. Data were summarised as means and standard deviations for the two outcomes (calculus and alterations.) at each time (pre and post) for both of the groups (manual and mechanical).

Results

Both manual and mechanical instrumentation significantly reduced the calculus deposits (p < .001) without significant differences between the two groups. Both manual and mechanical treatments significantly increased alterations (p < .01). There was a statistically significant evidence of a greater increase in alterations from mechanical treatment.

Conclusions

Slim mechanical piezoelectric tips and manual mini‐five area‐specific curets have similar effects on calculus removal. Manual instrumentation results in a more homogeneous postoperative root surface with less root alterations.

Impact of Er:YAG laser on wound healing following nonsurgical therapy: A pilot study

The purpose is to examine early wound healing through histological analysis by characterizing connective tissue distribution and organization in the treated periodontium following nonsurgical therapy. Periodontal disease is a multifactorial pathological process that leads to the loss of the surrounding periodontium. Traditional periodontal therapies have proven beneficial in halting the progression of disease. The aim of this study is to investigate early wound healing in periodontal patients following hand/ultrasonic instrumentation alone, erbium-doped yttrium aluminum garnet laser instrumentation alone, or a combination of hand/ultrasonic instrumentation and Er:YAG laser instrumentation for the nonsurgical treatment of periodontitis by histologic evaluation. Twenty-one patients were randomized to receive nonsurgical therapy for the treatment of chronic periodontitis with three modalities prior to surgical therapy. Baseline clinical measurements were obtained prior to treatment. Wound healing was assessed by obtaining an otherwise discarded tissue sample following nonsurgical therapy of the selected study site. Samples were obtained at 2 or 6 weeks following initial therapy with a step-back incision and fixated for histological and immunohistochemical analysis. There were minimal between-group differences in the amount of collagen distribution when analyzing the Mallory-Heidenhain Azan trichrome, Picrosirus Red stain, and proliferating cell nuclear antigen at both time points. Descriptive analysis of baseline measurements showed no differences in probing depth change, bleeding on probing, and clinical attachment level following initial therapy between the three treatment groups at 2 or 6 weeks. Each treatment modality was effective in treating moderate to severe chronic periodontitis; however, the results of this study are inconclusive regarding superiority of any one treatment approach from a histologic and immunohistochemical perspective. Based on this assessment, there was increased fibroblast proliferation and collagen maturation between the 2- and 6-week time point after treatment in all treatment groups, with few apparent differences between treatment groups. This pilot study qualitatively evaluated early wound healing in periodontal patients following non surgical therapy with various treatment modalities. When comparing descriptive outcomes of Er:YAG laser therapy and hand/ultrasonic instrumentation there were minimal differences in collagen distribution and density between groups. The evaluated modalities were each effective treating periodontal patients with non surgical therapy.

No differences in microbiome changes between anti-adhesive and antibacterial ingredients in toothpastes during periodontal therapy

Aim

This subgroup analysis of a 12‐week randomized, double‐blind, and two‐center trial aimed to evaluate whether two different toothpaste formulations can differentially modulate the dental microbiome.

Material and Methods

Forty one mild to moderate periodontitis patients used as an adjunct to periodontal treatment either a toothpaste with anti‐adhesive zinc‐substituted carbonated hydroxyapatite (HA) or with antimicrobial and anti‐adhesive amine fluoride/stannous fluoride (AmF/SnF₂) during a 12‐week period. Plaque samples from buccal/lingual, interproximal, and subgingival sites were taken at baseline, 4 weeks after oral hygiene phase, and 8 weeks after periodontal therapy. Samples were analyzed with paired‐end Illumina Miseq 16S rDNA sequencing. The differences and changes on community level (alpha and beta diversity) and on the level of single agglomerated ribosomal sequence variants (aRSV) were calculated with analysis of covariance (ANCOVA) and likelihood ratio test (LRT).

Results

Interproximal and subgingival sites harbored predominately Fusobacterium and Prevotella species associated with periodontitis, whereas buccal/lingual sites harbored mainly Streptococcus and Veillonella species associated with periodontal health. Alpha and beta diversity did not change noticeably differently between both toothpaste groups (P > 0.05, ANCOVA). Furthermore, none of the aRSVs showed a noticeably different change between the tested toothpastes during periodontal therapy (P_adj .> 0.05, LRT).

Conclusion

The use of a toothpaste containing anti‐adhesive HA did not induce statistically noticeably different changes on microbial composition compared to an antimicrobial and anti‐adhesive AmF/SnF₂ formulation.

Five-year results of nonsurgical treatment to manage severe generalized aggressive periodontitis

It is challenging for clinicians to carry out successful periodontal therapy and maintain a full dentition in young patients with generalized bone loss of 90%. Due to advanced attachment loss and the young age of patients, fixed or removable prosthetic treatment options are compromised. Implant therapy would be complex and expensive. The presented case shows the successful conservative periodontal therapy of advanced generalized aggressive periodontitis in a 29-year-old female. A conservative approach was applied and maintained all teeth with patient satisfaction both functionally and esthetically. This case was followed over 5 years.

Nonsurgical periodontal therapy based on the principles of cause-related therapy: rationale and case series

Cause-related therapy is key in the management and resolution of the two most common oral diseases: dental caries and periodontal disease. This is the first phase of treatment for those diseases. The aim is to remove, reduce, or eliminate the main causes of the disease. When referring to caries and periodontal disease, the primary etiology is bacterial plaque so the cause-related therapy phase should include plaque control as a major component. This can be achieved by constantly and continuously educating patients about the pathophysiology of the diseases and by helping them develop proper daily plaque removal techniques. Furthermore, various professional therapeutic interventions are delivered as necessary to eliminate or suppress other etiologic or risk factors. In this case series, the principles of proper cause-related therapy are demonstrated through three cases that were successfully managed by nonsurgical periodontal therapy. Biologic and clinical rationales are also discussed.

Comparison of effectiveness of low-dose aspirin versus omega-3 fatty acids as adjuvants to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis

Context:

Periodontitis and diabetes are universally prevalent diseases which are interlinked with each other. Inflammatory products released both by the microorganisms, and the host plays a pivotal role in causing both the diseases. Pentraxins are acute-phase proteins which are often found to be elevated in inflammatory states. Anti-inflammatory agents have a very important role to play in curbing infection of which, aspirin and omega-3 fatty acids (O3FAs) are being administered often nowadays. Nonsurgical periodontal therapy (NSPT) remains the gold standard of treatment, and other agents have been used as adjuvants only, to increase the efficacy of treatment.

Aims:

This study compares the effects of low-dose aspirin versus O3FAs when used as adjuvants to NSPT in patients with diabetes and chronic periodontitis.

Settings and Design:

A total of 42 patients (mean age of 30–65 years) from a diabetic center who were diagnosed with Type II diabetes and chronic periodontitis were included in the study.

Materials and Methods:

This study was done in the department of periodontics of a tertiary referral care hospital in Hyderabad, in collaboration with a reputed diabetic center.

Statistical Analysis Used:

Intragroup comparison was done using the paired t-test for continuous data and Wilcoxon signed-rank test for score data. Intergroup comparison was compiled using independent t-test. All P < 0.05 were considered statistically significant.

Results:

Intragroup comparison at baseline and 3 months after NSPT showed statistically significant results (P < 0.001) in all the three groups pertaining to the clinical (gingival index, probing pocket depth, and clinical attachment level) and biochemical (glycosylated hemoglobin and pentraxin) parameters. However, the intergroup comparison showed a significant improvement in Group II related to pentraxin levels only (P < 0.001).

Conclusions:

O3FAs proved to be better than low-dose aspirin and placebo after NSPT.

Comparative evaluation of subgingivally delivered 1.2% rosuvastatin and 1% metformin gel in treatment of intrabony defects in chronic periodontitis: A randomized controlled clinical trial

BACKGROUND

The aim of this study is to explore and compare the clinical efficacy of locally delivered 1.2% Rosuvastatin (RSV) and 1% Metformin (MF) gel as an adjunct to scaling and root planning (SRP) in the treatment of intrabony defects in chronic periodontitis patients.

METHODS

A total of 90 volunteers were randomly assigned to three treatment groups; 1) SRP plus placebo gel; 2) SRP plus 1.2% RSV gel; 3) SRP plus 1% MF gel. Clinical parameters like modified sulcus bleeding index (mSBI), plaque index (PI), pocket probing depth (PD) and clinical attachment level (CAL) were recorded at baseline, 6 and 12 months and the radiologic assessment of bone defect fill was performed at 6 and 12 months.

RESULTS

mSBI, BP, PD, and CAL were improved in all the groups, however mean reductions in PD, CAL gain, and percentage of bone fill was found to be higher in RSV and MF groups than placebo group at all visits.

CONCLUSION

Adjunctive use of locally delivered 1.2% RSV and 1% MF gel stimulates a significant PD reduction, CAL gains and improved bone fill when compared with placebo gel. Results were significantly better with the use of 1.2% RSV gel than 1% MF gel.

C-Reactive Protein Levels and Periodontal Diseases During Pregnancy in Malaysian Women

PURPOSE

To investigate the association between plasma CRP levels and periodontal disease during pregnancy.

MATERIALS AND METHODS

Fifty-six pregnant women attending the Antenatal Clinic, UMMC for their first antenatal check-up consented and were recruited for this study: 28 subjects with diseased periodontium (test group) and 28 subjects with healthy periodontium (control). The test group underwent nonsurgical periodontal therapy and the control group was given oral hygiene education. Periodontal parameters and CRP levels were evaluated at baseline and 6 weeks. Pregnancy outcome data were recorded from the Antenatal Clinic, UMMC.

RESULTS

Plasma CRP levels in the test group were statistically significantly elevated compared to the control group (8.55 ± 5.28 mg/l vs 5.66 ± 2.91 mg/l). After nonsurgical periodontal therapy, a statistically significant reduction in the CRP level in the test group (2.06 mg/l) along with statistically significant improvement in periodontal status in both groups was observed. The mean birth weight for infants of both groups showed no statistically significant difference.

CONCLUSIONS

Plasma CRP levels in pregnant women with diseased periodontium were statistically significantly reduced after nonsurgical periodontal therapy. However, no association between CRP levels and adverse pregnancy outcome was observed.

High-throughput proteomic analysis of candidate biomarker changes in gingival crevicular fluid after treatment of chronic periodontitis

BACKGROUND AND OBJECTIVE

Untargeted, high-throughput proteomics methodologies have great potential to aid in identifying biomarkers for the diagnosis of periodontal disease. The application of such methods to the discovery of candidate biomarkers for the resolution of periodontal inflammation after periodontal therapy has been investigated.

MATERIAL AND METHODS

Gingival crevicular fluid samples were collected from 10 patients diagnosed with chronic periodontitis at baseline and 1, 5, 9 and 13 weeks after completion of mechanical periodontal treatment. Clinical indices of periodontal disease, including probing depth, recession, clinical attachment level and bleeding on probing, were recorded at baseline and 13 weeks. Samples were analyzed using an online liquid chromatography-nanoelectrospray-hybrid ion trap-Orbitrap mass spectrometer. Spectra were processed with the PILOT_PROTEIN proteomics software suite.

RESULTS

Clinical parameters were significantly improved 13 weeks after treatment (Wilcoxon signed ranks test, P < .05). From the substantial number of identified proteins, a small subset was extracted by filter methods that included temporal pattern matching, logistic function fitting and mixed-integer linear optimization. This subset includes azurocidin, lysozyme C and myosin-9 as candidate biomarkers prominent at baseline and alpha-smooth muscle actin as prominent 13 weeks after treatment. Cross-validation studies yielded average predictive accuracy and area under the curve of 0.900 and 0.930, respectively.

CONCLUSION

High-throughput proteomic analysis can contribute to identifying endpoints of periodontal therapy. These candidate biomarkers should be evaluated for clinical efficacy.

Anesthetic efficacy of 4% articaine and 2% lignocaine in achieving palatal anesthesia following a single buccal infiltration during periodontal therapy: A randomized double-blind split-mouth study

Background

The aim of this randomized split-mouth double-blind study was to evaluate whether 4% articaine hydrochloride with 1:100,000 epinephrine administered as a single buccal infiltration in the maxillary posterior sextant can provide palatal anesthesia when compared with 2% lignocaine with 1:100,000 epinephrine during scaling and root planing and access flap surgery (AFS).

Material and Methods

A total of 40 patients with chronic generalized periodontitis requiring periodontal therapy in the maxillary posterior sextants were recruited in this study. About 4% articaine and 2% lignocaine were administered as buccal infiltration in a split-mouth design randomly. The pain scores in the palatal aspect were recorded during scaling and root planing and open flap debridement using Heft-Parker visual analog scale. The onset of anesthesia was also recorded and compared.

Results

The success rate for maxillary buccal infiltration to induce palatal anesthesia using articaine was 90% during scaling and root planing and 82.5% during AFS and for lignocaine solution was 20% and 15%, respectively. The difference between the two agents was statistically significant (P < 0.05). The onset of anesthesia between articaine and lignocaine was also found to be statistically significant (P < 0.05).

Conclusion

In this study, we observed that the efficacy of 4% articaine was superior to 2% lignocaine to induce palatal anesthesia following maxillary buccal infiltration in maxillary posterior sextants.

Correlative analysis of plasma and urine neopterin levels in the pre- and post-menopausal women with periodontitis, following nonsurgical periodontal therapy

Context:

Periodontitis is an inflammatory condition which is distinguished by the devastation of the supported tooth structures. In such inflammatory conditions, some biomarkers such as neopterin will be secreted and elevated in the body fluids, which can be used as a diagnostic marker for the present and future disease activity.

Aims:

Assessment of the neopterin as a biomarker in inflammatory conditions such as menopause and periodontitis.

Settings and Design:

A cross-sectional interventional study.

Materials and Methods:

Sixty female individuals with a mean age of 40–60 years with chronic periodontitis were included in this study. All were categorized into two groups of thirty each, depending on their menstrual history: Group I – thirty premenopausal women and Group II – thirty postmenopausal women. Urine and plasma were collected from both groups to estimate neopterin levels. ELISA kit was used to assess the neopterin levels at baseline and after 3 months of nonsurgical periodontal therapy (NSPT).

Statistical Analysis Used:

IBM SPSS version 21 software.

Results:

A significant depreciation in the mean values of all the parameters from baseline to 3 months (P < 0.001), in the intragroup analysis, was observed. Plasma (0.006) and urine (0.004) reduction was seen.

Conclusions:

In both the groups, in 3 months after NSPT, decreased neopterin levels were found, suggesting that the NSPT is the definitive therapy. Further, suggesting that, neopterin levels in the plasma and urine can be used as an index to identify the periodontal inflammation and destruction.

Association of Human Interleukin-35 Level in Gingival Crevicular Fluid and Serum in Periodontal Health, Disease, and after Nonsurgical Therapy: A Comparative Study

Background:

Innovating newer methods to diagnose a multifactorial disease such as periodontitis is always challenging for a clinician. Gingival crevicular fluid (GCF) which is closely associated with the periodontal tissue environment has been used a viable alternative to saliva for the diagnosis of periodontitis.

Aim:

The aim of the present study was to estimate and compare the interleukin-35 (IL-35) levels in GCF and serum among healthy, gingivitis, and chronic periodontitis (CP) individuals as well as to evaluate the effect of nonsurgical periodontal treatment (NSPT) on IL-35 level among patients with CP.

Settings and Design:

The study was conducted at the Department of Periodontics, Srirama Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India. It is a comparative study.

Materials and Methods:

A total of 60 participants were divided into healthy (Group I; n = 20), gingivitis (Group II; n = 20), and CP (Group IIIA; n = 20). GCF samples collected from each individual at baseline and 6 weeks after NSPT for Group III individuals (Group IIIB; n = 20) were quantified for IL-35 levels using enzyme-linked immunosorbent assay.

Statistical Analysis:

All analyses were performed using Shapiro–Wilk test, analysis of variance, Tukey's honestly significant difference post hoc test, and multiple regression analysis.

Results:

The mean IL-35 concentration in GCF was significantly high (P < 0.05) for Group IIIA (70.26 ± 4.0 pg/ml), as compared to Group I (54.81 ± 22.3 pg/ml) and Group IIIB (55.72 ± 10.2 pg/ml).

Conclusion:

In the present study, GCF and serum IL-35 concentration among CP individuals was highest among all the groups. Individuals receiving NSPT showed a significant reduction in IL-35 levels as compared to CP individuals.

Effect of Nonsurgical Periodontal Therapy on Serum Highly Sensitive Capsule Reactive Protein and Homocysteine Levels in Chronic Periodontitis: A Pilot Study

Introduction:

The aim of the present study was to assess the effect of nonsurgical periodontal therapy on circulating serum high-sensitivity capsule reactive protein (hs-CRP) and homocysteine (Hcy) levels in patients with chronic periodontitis.

Materials and Methods:

The study involved fifty participants. The test group included 25 systemically healthy controls (mean age 38.44 ± 3.27 years) with severe chronic periodontitis and the control group (n = 25) included age- and sex-matched systemically and periodontally healthy controls. Clinical parameters were recorded, intraoral periapical radiographs were taken, hematological tests and assessment of serum hs-CRP levels and Hcy levels were performed at baseline and 3 months after completion of nonsurgical periodontal therapy.

Results:

Mean serum hs-CRP and Hcy concentration in patients with chronic periodontitis were 3.37 ± 0.54 mg/L and 21.47 ± 7.93 μmol/L, respectively, and was significantly higher than the controls (1.68 ± 0.71 mg/L and 13.93 ± 8.30 μmol/L, respectively) (P < 0.05). Posttreatment, the mean serum hs-CRP and Hcy concentration reduced significantly in both test and control groups (P < 0.05).

Conclusion:

Chronic periodontitis leads to an increase in circulating levels of hs-CRP and Hcy in plasma and nonsurgical periodontal therapy decreases periodontal inflammation, which in turn reduces systemic inflammation and consequently decreases serum levels of hs-CRP and Hcy.

Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals

Background and Objective:

Chronic low-level bacteremia and a systemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The objective of this study is to evaluate the effect of nonsurgical periodontal therapy on various hematological parameters in patients with periodontitis.

Materials and Methods:

A total of 30 periodontitis patients were selected for the study. Clinical parameters such as plaque index, gingival index, and probing pocket depth were assessed. For each patient, venous blood sample were collected, and the estimation of total leukocyte count (TLC), differential leukocyte count, platelet count, and erythrocyte sedimentation rate (ESR) was carried out. All the clinical and hematological parameters were measured at baseline, 1 week and 2 weeks after nonsurgical periodontal therapy.

Results:

The study results showed that there was a statistically significant decrease in TLC, ESR, and platelet count at 1 week and 2 weeks following nonsurgical periodontal therapy.

Conclusion:

In this study, it has been concluded that there is a decrease in the hematological parameters after nonsurgical periodontal therapy, which may also reduce the risk of atherosclerosis formation in the blood vessel and possibly prevent cardiovascular diseases.

Effect of hyperlipidemia on response to nonsurgical periodontal therapy: Statin users versus nonusers

Objective:

To evaluate the response to nonsurgical periodontal therapy among hyperlipidemic subjects and whether statin use by hyperlipidemic subjects influences the response.

Materials and Methods:

This study was conducted on 107 chronic periodontitis subjects (35 normolipidemic [NL] controls, 36 hyperlipidemics on nonpharmacological therapy and 36 hyperlipidemics on statins). Periodontal (plaque index, gingival index [GI], probing depth [PD], and clinical attachment level [CAL]) and biochemical (plasma triglyceride [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-DL-C [HDL-C] levels) examination was done at baseline and 3 months after nonsurgical periodontal treatment.

Results:

Both the NL and statin groups exhibited significantly greater improvement in GI as compared to the hyperlipidemic group on nonpharmacological therapy (P = 0.004 and 0.006, respectively). Mean change in PD correlated negatively with baseline TC (r = −0.306) and LDL-C (r = −0.360) while mean change in GI positively correlated with baseline HDL-C (r = 0.219). Regression analyses revealed that mean change in PD was negatively associated with LDL-C (β = −0.358, P < 0.001) while mean change in GI was positively associated with HDL-C (β = 0.219, P = 0.023).

Conclusions:

While higher baseline lipid levels were somewhat detrimental to the resolution of inflammation postperiodontal treatment, the inclusion of statin therapy among hyperlipidemic subjects seemed to improve clinical response as compared to those devoid of the drug. The findings of the study are suggestive of a possible adjunctive role of statins in periodontal treatment that warrants future studies.

Tetracycline as local drug delivery in treatment of chronic periodontitis: A systematic review and meta-analysis

Background:

The aim of the present meta-analysis is to determine the efficacy of tetracycline group of antibiotics as local drug delivery agents in the treatment of chronic periodontitis.

Materials and Methods:

MEDLINE, EBSCO, Cochrane database, and Google Scholar were used to identify studies in English published up to January 31, 2017. An additional hand search of relevant journals and of the bibliographies of the paper identified was also performed. Articles retrieved were screened using specific inclusion criteria by two independent reviewers. Randomized control trials investigating the effect of tetracycline group of antibiotics as local drug delivery agents in chronic periodontitis were included in the study.

Results:

Ten relevant articles were selected for the meta-analysis, of which five articles were retrieved after electronic search, three articles were included after hand search, and two unpublished articles were included. The number of patients in studies ranged from 13 to 140 sites with mean age ranging from 20 to 75. A total of 588 sites were treated using tetracycline group of antibiotics as local drug delivery agents in the treatment of chronic periodontitis. The meta-analysis showed standard difference in mean −1.02 mm (95% confidence interval [CI] 0.28, 1.75) for clinical gain in attachment in favor of tetracycline group. Standard difference in mean for probing depth (PD) was 1.20 mm (95% CI 0.57, 1.87) in tetracycline group.

Conclusion:

The results of this meta-analysis showed a significant improvement in periodontal parameters such as CAL, PD, and sulcular bleeding index in favor of tetracycline as local drug delivery compared to placebo.

Effect of nonsurgical periodontal therapy on salivary myeloperoxidase levels: A biochemical study

BACKGROUND

Myeloperoxidase (MPO), the most abundant protein in neutrophils, is the focus of inflammatory pathologies. MPO could participate in the initiation and progression of periodontal disease.

MATERIALS AND METHODS

A total of 60 patients with healthy gingiva, gingivitis, periodontitis between age group of 20-55 years were selected. Group I - 20 Patients with healthy gingiva, Group II - 20 Patients with generalized gingivitis, Group III - 20 Patients with generalized chronic periodontitis, Group IV - 20 Patients of Group III after 1-month of scaling and root planning. The following parameters were recorded: Gingival index, plaque index, bleeding on probing index, probing pocket depth, clinical attachment level, salivary MPO levels. All the parameters were then statistically analyzed.

RESULTS

The mean MPO levels in Group I recorded was - 0.320 + 0.06, Group II was - 0.183 + 0.04, Group III was - 0.814 + 0.08 and Group IV was - 0.386 + 0.08 respectively. All these values were statistically significant when compared between the four groups (P < 0.05). A significantly elevated salivary MPO levels were found in subjects with chronic periodontitis as compared to the gingivitis group and the healthy group (P < 0.05). However, moderate but statistically significant increase in the MPO levels were observed in the gingivitis group as compared to the healthy group (P < 0.05). Furthermore, significant reduction in MPO levels were observed in Group IV after 1-month of nonsurgical periodontal therapy.

CONCLUSION

The activities of MPO enzyme were significantly increased in the saliva of patients with periodontal disease in comparison to healthy individuals. Furthermore, nonsurgical periodontal therapy was found to be effective in improving clinical parameters and in reducing MPO levels. Salivary enzymes like MPO could be considered as a biochemical marker of periodontal disease activity.