Effect of periodontal disease on electromyographic activity of muscles of mastication: A cross-sectional study.

AIM: This study aims to compare surface electromyographic activities (EMG) of four muscles, that is anterior temporalis (AT), masseter (MST), sternocleidomastoid (SCM) and anterior belly of digastric (ABD), between chronic periodontitis patients and periodontally healthy individuals as well as to correlate these EMG findings with periodontal parameters. METHODS: Thirty chronic periodontitis patients were recruited in Group I and 30 periodontally healthy individuals in Group II. Clenching and resting EMG for 4 muscles (AT, MST, SCM and ABD) were recorded for each participant. These EMG values were compared between the groups and correlated with periodontal parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment loss). RESULTS: Resting EMG (rEMG) showed no significant difference between the groups for any muscle. Clenching EMG (cEMG) values were significantly lower in Group I than Group II for AT and MST (P = .001), but not so for SCM and ABD. Within Group I, AT and MST showed a significant negative correlation of cEMG with probing depth and clinical attachment loss (P < .05). CONCLUSION: Electrical muscle activities of AT and MST are lower in chronic periodontitis than periodontally healthy individuals.

Clinical efficacy of subgingivally-delivered 0.75% boric acid gel as an adjunct to mechanotherapy in chronic periodontitis: A randomized, controlled clinical trial.

AIM: Borinic acid quinoline esters are a recently-identified class of new antibacterial and anti-inflammatory compounds known to inhibit osteoclastic bone resorption. They have proposed to have osteostimulative properties by causing osteoblast differentiation in vivo and in vitro. The purpose of this double-masked, randomized, controlled clinical trial was to evaluate the effects of the subgingival delivery of boric acid gel as an adjunct to scaling and root planing (SRP) on clinical and radiographic parameters, and compare this method with SRP plus placebo gel alone in chronic periodontitis (CP) patients. METHODS: Thirty-nine systemically-healthy patients with CP were included in the present study. They were divided into two groups: (a) SRP + 0.75% boric acid gel (BA group); and (b) SRP + placebo gel (placebo group). At baseline, 3 and 6 months after treatment, clinical measurements, including plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage change in radiographic defect depth reduction (DDR%) as radiographic parameters were assessed. RESULTS: The mean PD reduction and mean CAL gain were greater in the BA group than the placebo group at 3 and 6 months. A significantly greater mean percentage of radiographic DDR% was found in the BA group (36.97±3.47%) compared to the placebo group (2.88±0.89%) after 6 months. CONCLUSION: BA as an adjunct to SRP can provide a new insight into therapeutic strategies for the management of CP, but further clinical evaluations are needed.

Boric acid gel as local drug delivery in the treatment of class II furcation defects in chronic periodontitis: a randomized, controlled clinical trial.

AIM: Boric acid (BA) exhibits antibacterial, anti-inflammatory, as well as osteoblastic, activity. The aim of the present study was to explore the efficacy of 0.75% BA gel as a local drug-delivery system in adjunct to scaling and root planing (SRP) for the treatment of class II furcation defects in comparison with placebo gel. METHODS: A total of 48 mandibular class II furcation defects were randomized and treated with either 0.75% BA gel or placebo gel. Clinical parameters were recorded at baseline, 3 months, and 6 months, while radiographic parameters were recorded at baseline and 6 months. RESULTS: Greater mean probing depth reduction and mean relative vertical and horizontal clinical attachment level gain were shown to be greater in group 1 than in group 2 at 3 and 6 months. Furthermore, a significantly greater mean percentage of bone fill was found in group 1 (16.98%±1.03%) than in the placebo (2.86%±0.92%) at 6 months. CONCLUSION: The .75% BA group showed significant improvement in clinical parameters compared to placebo gel as an adjunct to SRP. This implies an alternative for treatment of class II furcation.

Treatment of periodontal intrabony defects using autologous platelet-rich fibrin and titanium platelet-rich fibrin: a randomized, clinical, comparative study.

AIM: The aim of the present study was to compare the effectiveness of open flap debridement (OFD) alone and OFD with either autologous platelet-rich fibrin (PRF) or titanium PRF (TPRF) in the treatment of intrabony defects (IBD). METHODS: The study was conducted on patients reporting to the Department of Periodontics, The Oxford Dental College and Hospital, Bangalore, India. Thirty-eight patients with 90 periodontal IBD of moderate-severe periodontitis were selected and assigned to the OFD alone group (group I), the OFD with autologous PRF group (group II), or the OFD with TPRF group (group III). In each patient, a minimum number of two sextants were present, with probing pocket depths (PPD) ≥5 mm in at least three teeth. RESULTS: At 9 months' postoperatively, upon comparing the PPD reduction, defect depth reduction, and clinical attachment level gains, it was noted that groups II and III showed statistically-significant improvements compared with group I, but no statistically-significant difference was noted between groups II and III. CONCLUSION: The present study demonstrated that marked improvements in the clinical parameters and radiographic outcomes were noted with both autologous PRF and TPRF in the treatment of IBD.

Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis: a randomized placebo-controlled clinical trial.

AIM: Alendronate (ALN) and atorvastatin (ATV) are known to inhibit osteoclastic bone resorption and were proposed to have osteostimulative properties. The aim of the study was to evaluate and compare the efficacy of 1% ALN and 1.2% ATV gel as a local drug-delivery system in adjunct to scaling and root planning (SRP) for the treatment of intrabony defects in chronic periodontitis patients. METHODS: A total of 90 intrabony defects were treated with either 1% ALN, 1.2% ATV, or placebo gel. Clinical parameters (plaque index, modified sulcus bleeding index, probing depth (PD), and clinical attachment level (CAL)) were recorded at baseline, 3, 6, and 9 months. Intrabony defect depth (IBD) and defect depth reduction (DDR%) was calculated on standardized radiographs at 6 and 9 months. RESULTS: The mean PD reduction, CAL gain, and DDR% were greater in the ALN and ATV group than in the placebo group at 3, 6, and 9 months. Furthermore, a significantly greater DDR% was found in the ALN group at 6 and 9 months than in the ATV and placebo groups. CONCLUSION: Local delivery of 1% ALN results in significantly greater improvement in PD, CAL, IBD depth, and DDR% as compared to 1.2% ATV gel.

Correlation of crevicular fluid and serum levels of retinol-binding protein 4 and leptin in chronic periodontitis and obesity.

OBJECTIVE: Retinol-binding protein 4 (RBP4) and leptin are both adipokines and involved in the pathophysiology of different vascular and inflammatory diseases and selectively elevated in patients with obesity. The aim of the present study was to determine and correlate the levels of RBP4 and leptin in gingival crevicular fluid (GCF) and serum in patients with chronic periodontitis (CP) and obesity. MATERIALS AND METHODS: A total of 70 patients with age group 25 to 45 years were divided into four groups based on gingival index (GI), probing depth (PD), clinical attachment level (CAL), body mass index (BMI) and radiographic evidence of bone loss. The groups were (1) group I (non-obese periodontally healthy), (2) group II (obese periodontally healthy), (3) group III (non-obese with chronic periodontitis) and (4) group IV (obese with chronic periodontitis). The GCF and serum levels of human RBP4 and leptin were quantified using ELISA. RESULTS: An increase in RBP4 levels from group I to group IV was found in both GCF and serum. However, GCF leptin levels was found to be greatest in group II, then group I, group IV and group III showing the least while an increase in serum levels from group I to group IV was found. The GCF and serum values of the inflammatory mediator correlated with the evaluated periodontal parameters and with each other (p < 0.05). CONCLUSION: RBP4 and leptin can be considered as possible GCF and serum markers of inflammatory activity in CP and obesity, which further longitudinal studies are needed.

Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial.

BACKGROUND: Different materials have been investigated for renewal of lost supporting periodontal structures and tested for furcation defect treatment. Platelet-rich fibrin (PRF) is a pool of growth-promoting factors and cytokines that promote bone regeneration and maturation of soft tissue. Alendronate (ALN), an influential member of the bisphosphonate group, is known to enhance osteoblastogenesis and inhibit osteoclastic bone resorption, thus promoting tissue regeneration. This randomized trial was done to assess effectiveness of PRF and 1% ALN gel combination in mandibular degree II furcation defect treatment in comparison with PRF and access therapy alone. METHODS: Seventy-two mandibular molar furcation defects were treated with either access therapy alone (group 1), access therapy with PRF (group 2), or access therapy with PRF and 1% ALN (group 3). Plaque index, modified sulcus bleeding index, probing depth (PD), relative vertical attachment level (RVAL) and relative horizontal attachment level (RHAL), and intrabony defect depth were recorded at baseline and 9 months postoperatively. Radiographically, defect fill, assessed in percentage, was evaluated at baseline, before surgery, and 9 months post-therapy. RESULTS: Group 3 showed greater PD reduction and RVAL and RHAL gain when compared with groups 1 and 2 postoperatively. Moreover, group 3 sites showed a significantly greater percentage of radiographic defect fill (56.01% ± 2.64%) when compared with group 2 (49.43% ± 3.70%) and group 1 (10.25% ± 3.66%) at 9 months. CONCLUSIONS: Furcation defect treatment with autologous PRF combined with 1% ALN gel results in significant therapeutic outcomes when compared with PRF and access therapy alone. Combining ALN with PRF has potential for regeneration of furcation defects without any adverse effect on healing process.

Human soluble receptor for advanced glycation end products and tumor necrosis factor-α as gingival crevicular fluid and serum markers of inflammation in chronic periodontitis and type 2 diabetes.

The present study aimed to evaluate the levels of soluble receptor for advanced glycation end products (sRAGE) and tumor necrosis factor-α (TNF-α) in serum and gingival crevicular fluid (GCF) in chronic periodontitis (CP) patients with and without type 2 diabetes mellitus (T2DM). A total of 70 subjects were divided into four groups: group 1 (n = 15; subjects with healthy periodontium); group 2 (n = 20; CP patients); group 3 (n = 20; CP patients with T2DM); and group 4 (n = 15; CP patients without T2DM). The serum and GCF levels of human sRAGE and TNF-α were assessed using enzyme-linked immunosorbent assay and correlated with clinical parameters, including probing depth, gingival index and clinical attachment level. Both sRAGE and TNF-α levels varied with the inflammatory state of the patient; the highest levels of sRAGE were seen in group 1, whereas the lowest levels in group 3 (P < 0.05). Conversely, TNF-α levels were found to be the highest in group 3 and lowest in group 1 (P < 0.05). Thus, human sRAGE and TNF-α can be considered as possible GCF and serum markers of inflammatory activity in CP and T2DM.(J Oral Sci 58, 547-553, 2016).

Synergistic Approach Using Platelet-Rich Fibrin and 1% Alendronate for Intrabony Defect Treatment in Chronic Periodontitis: A Randomized Clinical Trial.

BACKGROUND: Platelet-rich fibrin (PRF) is a reservoir of concentrated platelets that provides a pool of biologic growth-promoting factors and cytokines, which help in mediating regeneration of lost bone and soft tissue maturation. Alendronate (ALN), a member of the amino-bisphosphonate group, is known to enhance periodontal tissue regeneration by inhibiting osteoclast-mediated bone resorption and promoting osteoblast-mediated osteogenesis. The current intervention aims to assess combined effectiveness of PRF and 1% ALN with access therapy in intrabony defect (IBD) treatment in patients with chronic periodontitis (CP). METHODS: Single IBDs in 90 patients were categorized into three groups: 1) group 1 had access therapy alone; 2) group 2 had access therapy with PRF; and 3) group 3 had access therapy with PRF + 1% ALN. Site-specific plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level, included as parameters for clinical assessment, were evaluated before surgery at baseline and 9 months postoperatively. Percentage IBD depth reduction, assessed using radiographs, was evaluated at baseline and postoperatively. RESULTS: Compared with groups 1 and 2, group 3 exhibited significantly greater reduction in PD and gain in CAL postoperatively. Significantly greater IBD depth reduction was shown in group 3 (54.05% ± 2.88%) compared with group 2 (46% ± 1.89%) and group 1 (7.33% ± 4.86%) postoperatively. CONCLUSION: Combined approach therapy of PRF + 1% ALN for IBD treatment in patients with CP showed better clinical parameter outcomes with greater IBD depth reduction compared with PRF and access therapy alone.

Platelet-Rich Fibrin With 1.2% Rosuvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Regenerative periodontal therapy encompasses use of various bioactive agents that are not only inflammomodulatory but also osteoclast-inhibitory or, rather, osteostimulative. Hypolipidemic statin drugs, particularly rosuvastatin (RSV), are known to be associated with alveolar bone formation and periodontal improvements. Platelet analogs such as platelet-rich fibrin (PRF), being rich sources of growth factors, have also come into widespread periodontal regenerative use. The aim of this study is to evaluate and compare efficacy of open flap debridement (OFD) with or without PRF or PRF + 1.2% RSV gel in treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). METHODS: Ninety individuals with a total of 90 IBDs were randomly assigned to one of three treatment groups: 1) OFD alone; 2) OFD + PRF; and 3) OFD + PRF + 1.2% RSV gel placement. Measurements recorded at baseline and 9 months after surgery were: 1) plaque index (PI); 2) modified sulcus bleeding index (mSBI); 3) probing depth (PD); 4) clinical attachment level (CAL); and 5) IBD depth. RESULTS: Significant PI and mSBI reductions were observed in all three groups. PRF placement significantly enhanced improvements in periodontal parameters compared with OFD alone. Addition of 1.2% RSV gel to PRF resulted in significantly greater CAL gain and PD and IBD depth reductions over 9 months compared with other groups. CONCLUSION: OFD with RSV (1.2%) and PRF results in significantly greater periodontal benefits compared with OFD alone or with PRF.

1.2% Rosuvastatin Versus 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are an important group of hypolipidemic drugs that are able to modulate inflammation and alveolar bone loss. Rosuvastatin (RSV) and atorvastatin (ATV) are known to inhibit osteoclastic bone resorption and have been proposed to have osteostimulative properties. The aim of this study is to evaluate and compare the efficacy of 1.2% RSV and 1.2% ATV gel local drug delivery (LDD) and redelivery systems, in addition to scaling and root planing (SRP), for the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). METHODS: A total of 90 individuals with 90 IBDs was randomly allocated to treatment with SRP followed by LDD of 1.2% RSV, 1.2% ATV, or placebo gel. Clinical and radiographic parameters, including plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), and IBD depth, were recorded at baseline and 6 and 9 months. RESULTS: All three groups showed significant reduction in PI and mSBI at all intervals. Mean mSBI and PD reductions, CAL gain, and IBD depth reduction with statin drugs were significantly greater than with placebo gel LDD. Improvements in these parameters were significantly greater with RSV LDD than ATV or placebo gels at 6 and 9 months. CONCLUSION: LDD of 1.2% RSV results in significantly greater clinico-radiographic improvement than 1.2% ATV or placebo gels as adjunct to mechanical periodontal therapy.

Adjunctive Local Delivery of Aloe Vera Gel in Patients With Type 2 Diabetes and Chronic Periodontitis: A Randomized, Controlled Clinical Trial.

BACKGROUND: Herbal agents such as Aloe vera (AV) have been used in medical and dental therapy for thousands of years. AV has anti-inflammatory, antioxidant, antimicrobial, hypoglycemic, healing-promoting, and immune-boosting properties. This study aims to investigate the clinical effectiveness of locally delivered AV gel used as an adjunct to scaling and root planing (SRP) in the treatment of patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP). METHODS: Sixty patients with probing depth (PD) ≥ 5 mm and clinical attachment level (CAL) ≥ 3 mm were randomly divided into two groups. All patients underwent SRP. Placebo gel was locally delivered to group 1 and AV gel to group 2. Full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), PD, and CAL were recorded at baseline and 3 and 6 months. RESULTS: Patients in group 2 showed significantly greater mean reductions in PI, mSBI, and PD and mean gain in CAL compared with those in group 1 from baseline to 3 months. Gain in CAL was significantly greater in group 2 at all time intervals versus group 1. CONCLUSION: Adjunctive use of locally delivered AV gel, in comparison to locally delivered placebo gel, is associated with greater reduction in PI, mSBI, and PD as well as more gain in CAL in patients with T2DM and CP.