Comparative clinical and radiographic evaluation of demineralized freeze-dried bone allograft with and without decortication in the treatment of periodontal intrabony defects: a randomized controlled clinical study.

OBJECTIVES: Regeneration of intrabony defects is a challenging target of periodontal therapy. The biologic rationale for regeneration not only is based on incorporating the regenerative material, but also takes into consideration the defect's inherent healing capacity. The present study was carried out to evaluate the efficacy of decortication or intramarrow penetration performed with demineralized freeze-dried bone allograft (DFDBA) in the management of intrabony defects. METHOD AND MATERIALS: Forty chronic periodontitis (stage II and III periodontitis) patients having 40 intrabony defects were randomly assigned into test group (intrabony defect filled with DFDBA after intramarrow penetration along with open flap debridement [OFD+IMP+ DFDBA]) and control group (DFDBA along with open flap debridement [OFD+DFDBA]). Primary outcome measures included probing pocket depth, clinical attachment level, and percentage bone fill (%BF). All parameters were recorded at baseline, 6 months, and 9 months postsurgical follow-up. RESULTS: Mean reduction in probing depth and gain in clinical attachment level was statistically significantly higher at the interdental defect site in the test group compared to the control group at 9 months follow-up (P = .02 and .04, respectively). In radiographic parameters, statistically significant improvements in defect depth and gain in defect area were found in the test group (P = .00 and .03, respectively). Statistically significant improvements in %BF and linear bone growth (P = .02 and .00, respectively) were also observed in the experimental group (39.47 ± 13.92% and 1.41 ± 0.54 mm) in comparison with the control group (19.29 ± 14.24%, 0.62 ± 0.49 mm). CONCLUSION: Addition of intramarrow penetration with DFDBA in surgical periodontal therapy may enhance the healing potential of periodontal intrabony defects, as observed by greater improvement in clinical and radiographic outcomes.

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial.

PURPOSE: The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects. METHODS: This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery. RESULTS: Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up. CONCLUSIONS: M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03169920.

Use of modified vertical internal mattress suture versus simple loop interrupted suture in modified Widman flap surgery: a randomized clinical study.

OBJECTIVES: Close approximation and stabilization of gingival flaps, vital for optimum outcome of surgical procedures, may be difficult to achieve in deep periodontal pockets by routinely used suturing techniques. Modified vertical internal mattress sutures have been reported to be useful in reducing dead space along with achievement of wound stability. The present study compares the outcome of flap closure by use of modified vertical internal mattress sutures and simple loop interrupted sutures in the surgical management of chronic periodontitis. METHOD AND MATERIALS: In total, 83 participants with chronic periodontitis received scaling and root planing. After 8 weeks, modified Widman flap surgery was performed in 48 patients at sites with probing pocket depth ≥ 4 mm. Modified vertical internal mattress sutures were placed in the test group (n = 24) and simple loop interrupted sutures were used in the control group (n = 24). Plaque Index (Silness and Loe), Gingival Index (Loe and Silness), bleeding on probing, probing pocket depth, clinical attachment level, and gingival recession were recorded on the day of surgery, and at 3 and 6 months of follow-up. RESULTS: Statistically significant improvement was noted in all the clinical parameters of both groups. The test group showed significantly greater improvement in probing pocket depth, clinical attachment level, bleeding on probing, and Gingival Index, although Plaque Index scores were similar. This improvement was confined to nonmolars only. CONCLUSION: Flap closure by modified vertical internal mattress suturing technique results in better improvement in periodontal clinical parameters than the use of simple loop interrupted sutures, especially in nonmolars.

Influence of mouth breathing on outcome of scaling and root planing in chronic periodontitis.

INTRODUCTION: Dryness is known to be associated with inflammatory diseases such as dry eye disease and atopic dermatitis. There is significant water loss from the oral cavity during mouth breathing. This study is conducted to estimate the influence of mouth breathing on the outcome of scaling and root planing (SRP) in chronic periodontitis (CP). MATERIALS AND METHODS: CP patients comprising of 33 mouth breathers (MBs) and 33 nose breathers (NBs) were recruited. Thirty patients in each group completed the study. At baseline, plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. SRP was done in both groups. At the 4th, 8th, and 12th week, PI, GI, and BOP were recorded. PD and CAL were also assessed at the 12th week. RESULTS: At the 12th week, there was significantly less improvement in GI at palatal sites of maxillary anterior and maxillary posterior teeth in MB group. Sixty-nine percent of BOP positive sites with PD >4 mm were converted into BOP negative sites with PD ≤4 mm in maxillary posterior palatal sites in NB. This success was 38% in MB. CONCLUSION: Control of periodontal inflammation by SRP in CP patients is affected at palatal sites of mouth breathers.

Periodontal status in chronic periodontitis depressed patients on desvenlafaxine: An observational study.

BACKGROUND: A wide variety of drugs have the potential to affect immune and inflammatory responses of periodontium. A class of antidepressant drug, selective serotonin and norepinephrine reuptake inhibitors, has shown anti-inflammatory function. The aim of the present study is to explore the effect of desvenlafaxine on clinical periodontal parameters in patients with chronic periodontitis. MATERIALS AND METHODS: The patients were divided into two groups as follows: test group (n = 63) comprised of participants on 50 mg once-daily dose of desvenlafaxine for ≥2 months and control group (n = 72) included participants who were yet to be prescribed medication for depression. Periodontal parameters of both the groups were analyzed and compared statistically. RESULTS: Participants taking desvenlafaxine revealed lower values of periodontal parameters as compared to those in control group. The number of pockets with greater depth and clinical attachment loss was greater in control group. CONCLUSION: In our study, patients on desvenlafaxine were associated with less pocket depth and bleeding on probing.

Effect of Non-Surgical Periodontal Therapy Along With Myo-Inositol on High-Sensitivity C-Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study is to evaluate the effect of non-surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high-sensitivity C-reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP). METHODS: Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo-inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re-evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A). RESULTS: Periodontal parameters were significantly improved in the test group compared with the control group at 3- and 6-month follow-up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3- and 6-month follow-up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3- and 6-month follow-up, which was further comparable to group A. CONCLUSION: SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.

Association of periodontal disease with glycemic control in patients with type 2 diabetes in Indian population.

This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis (CP) were divided according to tertiles of mean PISA (periodontal inflamed surface area) scores as low, middle and high PISA groups. Simultaneously a group of 67 periodontally healthy individuals (PH) was recruited. Periodontal examinations, including full-mouth assessment of probing depths (PPD), bleeding on probing, clinical attachment level and plaque scores were determined. Blood analyses were carried out for glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2 h post parandial glucose (PPG). Individuals in PH group had significantly better glycemic control than CP group. Upon one-way analysis of variance, subjects with increased PISA had significantly higher HbA1c levels, retinopathy and nephropathy (P < 0.05). After controlling for age, gender, body mass index (BMI), socioeconomic status (SES), family history of diabetes and periodontitis, duration of diabetes, the mean PISA in mm2, PPD 4-6 mm (%) and PPD ≥ 7 mm (%) emerged as significant predictors for elevated HbA1c in regression model (P < 0.05). Logistic regression analysis revealed that PISA was associated with higher risk of having retinopathy and neuropathy (odds ratio). In our study, the association between glycemic control and diabetic complications with periodontitis was observed.

Effect of periodontitis on bone mineral density in postmenopausal women: A non-randomized interventional study.

OBJECTIVE: Chronic periodontitis (CP) is associated with increased systemic inflammation and osteoporosis. Pro-inflammatory cytokines, implicated in systemic bone loss, are also associated with periodontitis. The impact of control of systemic inflammation by scaling and root planing (SRP) on bone mineral density (BMD) in postmenopausal (PM) osteopenic women with CP was investigated in this study. METHOD AND MATERIALS: Sixty-eight PM osteopenic women with CP were included. The test group (n = 34) received SRP along with calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months, while the control group (n = 34) received calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months. BMD, serum high sensitivity C-reactive protein (hsCRP), and periodontal parameters were recorded at baseline and 6 months. RESULTS: Improvement in BMD and serum hsCRP showed a statistically significant difference between groups at 6 months (P < .001). Binomial logistic regression analysis revealed that the test group was 4.82 (ORadjusted = 4.82; 95% CI = 1.17-19.71; P = .029) times more likely to exhibit normal BMD at 6 months. The results suggest there is an association of control of systemic inflammation by SRP with improved BMD in PM osteopenic women with generalized severe CP.

Papillary Height and its Relation with Interproximal Distances and Cementoenamel Junction in Subjects with Chronic Periodontitis. A Cross-Sectional Study.

INTRODUCTION: Presence of intact interdental papilla is considered as an essential component of aesthetic dentistry. Loss or absence of interdental papilla creates black triangles which are unpleasing. AIM: The purpose of the present study was to determine relation of interproximal distances and cementoenamel junction with the classification of interdental papilla recession after surgical exposure in chronic periodontitis patients. MATERIALS AND METHODS: This cross-sectional, single masked study group involved 198 interdental papillae in 50 chronic periodontitis patients subjected to open flap debridement. The subjects were divided into three groups according to loss of height of interdental papillae: Class I papilla, Class II papilla, Class III papilla. The interproximal distances included vertical and horizontal distance. The vertical distance was measured from apical point of the contact area to alveolar crest; horizontal distance was measured between roots at the alveolar crest. Distance from mid buccal cementoenamel junction to apical point of the contact area was also measured. RESULTS: The vertical distance was found to be significantly affecting all the classes of loss of papillary height (p<0.05). Significantly positive correlation was found between vertical distance and buccal cementoenamel junction (p<0.05). On applying multiple linear regressions vertical distance was found to be strongest determinant of loss of papillary height. CONCLUSION: Although interproximal distances and cementoenamel junction affect the height of interdental papilla, other factors influencing the existence of interdental papilla should also be taken into consideration for treatment planning to achieve better aesthetics.

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 (ß = -0.358, P < 0.001) while mean change in GI was positively associated with HDL-C (ß = 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.

Micronutrients and superoxide dismutase in postmenopausal women with chronic periodontitis: a pilot interventional study.

PURPOSE: The study was aimed at investigating changes in periodontal parameters and superoxide dismutase activity triggered by root surface debridement with and without micronutrient supplementation in postmenopausal women. METHODS: Forty-three postmenopausal chronic periodontitis patients were divided into two groups: group 1 (n=22) were provided periodontal treatment in the form of scaling and root planing (SRP) and group 2 (n=21) patients received SRP along with systemic administration of micronutrient antioxidants. Patients in both groups were subjected to root surface debridement. Group 2 patients also received adjunctive micronutrient antioxidant supplementation. Serum and salivary superoxide dismutase (SOD) activity along with periodontal parameters were recorded at baseline and 3 months after therapy. RESULTS: Salivary and serum SOD values significantly (P<0.05) improved with periodontal treatment. Improvement in systemic enzymatic antioxidant status along with reduction in gingival inflammation and bleeding on probing (%) sites was significantly greater in group 2 as compared to group 1. CONCLUSIONS: Adjunctive micronutrient supplements reduce periodontal inflammation and improve the status of systemic enzymatic antioxidants in postmenopausal women.

Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: a cross-sectional study.

PURPOSE: Both chronic periodontitis (CP) and iron deficiency anemia (IDA) induce oxidative stress in the body and cause an imbalance between reactive oxygen species and antioxidants, such as superoxide dismutase (SOD). This study explored the SOD enzyme activity of saliva and serum in CP patients with and without IDA and analyzed the impact of IDA on CP. METHODS: A total of 82 patients were divided into four groups: control group (CG, 22), periodontally healthy IDA patients (IDA-PH, 20), CP patients (CP, 20), and IDA patients with CP (IDA-CP, 20). After clinical measurements and samplings, serum and salivary SOD levels were determined using an SOD assay kit. RESULTS: IDA-CP patients exhibited a higher gingival index, bleeding on probing, probing pocket depth, and percentage (%) of sites with a clinical attachment loss (CAL) of ≥6 mm (P<0.008) than CP patients. The mean salivary and serum SOD levels were significantly lower in the IDA-PH, CP, and IDA-CP patients than in the CG group (P<0.008). A significant positive correlation between salivary and serum SOD activity was observed in IDA (P<0.05). Furthermore, serum and salivary SOD levels were significantly and negatively correlated with all periodontal parameters including the percentage of sites with CAL of 4-5 and ≥6 mm (P<0.05) except the significant correlation between salivary SOD activity and mean CAL and the percentage of sites with CAL of 4-5 mm (P>0.05) in these patients. CONCLUSIONS: Within the limits of this study, it may be suggested that IDA patients with chronic periodontitis have more periodontal breakdowns than patients with chronic periodontitis. Serum and salivary SOD activity levels were lower in the IDA-PH, CP and IDA-CP groups than in the CG. Iron deficiency anemia influenced the serum SOD activity but did not seem to affect the salivary SOD activity in these patients.

Effect of non-surgical periodontal therapy on serum ferritin levels: an interventional study.

BACKGROUND: Ferritin, an acute-phase reactant, has been found to be elevated in many chronic inflammation-related diseases. The aim of the present study is to investigate differences in concentrations of serum ferritin in patients with and without periodontal disease before and after non-surgical periodontal therapy and correlate these values with clinical variables associated with periodontal disease. METHODS: Forty-two individuals were included in this study, 20 with chronic periodontitis (CP) and 22 classified as periodontally healthy. Serum ferritin concentrations, hemoglobin levels, and periodontal parameters (probing depth [PD], clinical attachment level, gingival index, bleeding on probing, and plaque index) were recorded at baseline and 3 months after non-surgical periodontal therapy. RESULTS: Patients with CP showed higher concentrations of serum ferritin than periodontally healthy controls (P <0.01). After adjustment for confounders, a positive and significant correlation was observed between serum ferritin levels and the number of sites with PD ≥ 6 mm at baseline (P <0.01). Regression analyses revealed association between deep pockets and serum ferritin levels at baseline (R(2) = 0.823). Significant reductions in serum ferritin levels were observed at the 3-month assessment after periodontal treatment (P <0.01), and the post-treatment serum ferritin values were comparable to those of controls (P >0.05). Furthermore, the post-treatment degree of change in the serum ferritin level was positively and significantly associated with improvement in PD (R(2) = 0.213, P <0.05). CONCLUSION: Serum ferritin levels are raised in patients with CP and decrease to control levels post-treatment.

Clinical evaluation of correction of pathologic migration with periodontal therapy.

OBJECTIVE: there is a paucity of clinical evidence regarding the amount and frequency of repositioning of pathologically migrated teeth after conventional periodontal treatment. The present study was carried out to find and relate these two parameters of periodontal success with severity of migration. METHOD AND MATERIALS: a total of 45 subjects with a history of recently formed diastema or noticeable increase in already existing diastema were selected. Twenty-nine patients with 76 diastema sites participated in the study (16 patients were lost to follow-up). Repositioning was assessed by measuring the sites on study models obtained at baseline, reevaluation at 6 weeks after nonsurgical periodontal therapy, and 4 months after surgery. RESULTS: after nonsurgical therapy, 65.78% of sites demonstrated some degree of repositioning, while 7.89% closed completely. Four months after surgical treatment, 32.30% of sites showed complete repositioning and 47.69% of sites showed an additional partial repositioning. This corresponds to a 79.99% rate of positive responses to therapy. When sites measuring ⋜ 1 mm were considered, 65.38% showed complete closure and 96.15% demonstrated positive response to therapy. CONCLUSION: the findings suggest that there is an inverse relationship between the severity of migration and amount (as well as frequency) of repositioning. The results emphasize the importance of early diagnosis in the successful treatment of pathologic migration to prevent more complex and time-consuming orthodontic and prosthodontic procedures.