Autologous Platelet-Rich Fibrin in the Treatment of 3-Wall Intrabony Defects in Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Platelet-rich fibrin (PRF) has recently been applied in osseous regeneration. The aim of the present study is to explore the efficacy of PRF in treatment of intrabony defects (IBDs) in aggressive periodontitis. METHODS: Fifty-four IBDs in 17 patients were treated either with autologous PRF with open flap debridement (OFD) or OFD alone. Clinical and radiologic parameters such as probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect change were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction and mean CAL gain were significantly greater in PRF compared with the control group. Furthermore, a significantly greater percentage of mean bone defect change was found in the PRF group. CONCLUSION: Within the limits of the present study, there is greater bone fill at sites treated with PRF with conventional OFD than conventional OFD alone.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

Clinical and microbiological efficacy of 3% satranidazole gel as a local drug delivery system in the treatment of chronic periodontitis: A randomized, controlled clinical trial.

AIM: The present clinical trial was designed to investigate the effectiveness of subgingivally delivered satranidazole (SZ) gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS: Seventy subjects with probing depth (PD) ≥5 mm were selected. Thirty-five subjects each were randomly assigned to SRP + placebo (Group 1) and SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index, gingival index, clinical attachment level (CAL), and PD at baseline; 1 month, 3 months, and 6 months interval. Furthermore, microbial analysis using polymerase chain reaction was done to estimate the number of sites harboring periodontopathogens. RESULTS: Sixty four subjects were evaluated up to 6 months. At 6 months, the Group 2 resulted in greater mean reduction (4.10 mm) in PD as compared to Group 1 (1.49 mm), and also a greater mean CAL gain (4.20 mm) in Group 2 as compared to Group 1 (1.13 mm). These subjects also showed a significant reduction in the number of sites harboring periodontopathogens. CONCLUSION: The use of 3% SZ gel, when used as an adjunct to nonsurgical periodontal therapy in subjects with periodontitis, achieved better results than initial periodontal treatment alone.

Efficacy of Subgingivally Delivered Satranidazole in the Treatment of Type 2 Diabetes Subjects with Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: The present clinical trial was designed to investigate the effectiveness of subgingivally delivered satranidazole (SZ) gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS: Sixty-four subjects with probing depth (PD) ≥ 5 mm and who were diagnosed with type 2 diabetes were selected. Thirty-two subjects each were randomly assigned to SRP + placebo (Group 1) and SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index (PI), gingival index (GI), clinical attachment level (CAL) and PD at baseline, 1 month, 3-months and 6 months. RESULTS: At 6 months, Group 2 had greater mean reduction (4.73 mm) in PD as compared to Group 1 (2.09 mm; p < 0.05) and also a greater mean CAL gain (3.92 mm versus 1.64 mm; p < 0.05). CONCLUSION: The use of 3% SZ gel, when used as an adjunct to non-surgical periodontal therapy in subjects with periodontitis, achieves significantly better clinical results than initial periodontal treatment alone.

Clinical and microbiological effects of levofloxacin in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial.

AIM: The aim of the present study was to evaluate the clinical and microbiological effect of systemic levofloxacin (LFX) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis (CP). METHODS: Sixty-five patients with CP were randomly divided into a test (n = 33, SRP and LFX 500 mg, once daily [o.d.]) and a control group (n = 32, SRP and placebo, o.d.). Plaque index (PI), gingival index (GI), percentage of sites with bleeding on probing (%BoP), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, 10 days, and 1-, 3-, and 6-month intervals. The percentage of sites positive for Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia were recorded at baseline and at 3 and 6 months. RESULTS: Patients receiving LFX showed statistically-significant improvements in mean PD and CAL. The intergroup difference in PI, GI, and%BoP was not significant at any interval. There was a reduction in the percentage of sites positive for periodontopathic bacteria over the duration of the study in both groups, and a statistically-significant reduction in the number of sites positive for A. actinomycetemcomitans in the LFX group (P < 0.001). CONCLUSION: Levofloxacin was found to significantly improve the clinical and microbiological parameters in CP individuals.

Crevicular and serum levels of monocyte chemoattractant protein-4 and high-sensitivity C-reactive protein in periodontal health and disease.

OBJECTIVES: Chemokines are chemotactic cytokines that are involved in destruction of the periodontal structures. The aim of this study is to determine the presence of MCP-4 and high sensitivity C reactive protein (hsCRP) levels in gingival crevicular fluid (GCF) and serum in periodontal health and disease and to find a correlation between MCP-4 and hsCRP in GCF and serum. METHODS: 40 subjects (20 males and 20 females) were selected and divided into three groups based on clinical parameters and radiologic parameters: Group 1 (10 healthy); Group 2 (15 gingivitis subjects) and Group 3 (15 chronic periodontitis subjects). The levels of serum and GCF MCP-4 were determined by ELISA and hsCRP levels were determined by immunoturbidimetry method. RESULTS: The mean GCF and serum concentration of MCP-4 were the highest for group 3 followed by group 2 and least in group 1. Similarly, the mean hsCRP concentrations were highest for group 3 and least in group 1. Moreover, a significant positive correlation was found between serum and GCF MCP-4 and hsCRP levels and periodontal parameters. CONCLUSION: The levels of MCP-4 and hsCRP increased from healthy to periodontitis. It can be proposed that MCP-4 and hsCRP are the potential biomarkers of inflammation in periodontal health and disease.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial.

AIM: To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP). MATERIALS AND METHODS: Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals. RESULTS: Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy. CONCLUSION: Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

Association of metabolic syndrome and periodontal disease in an Indian population.

BACKGROUND: Metabolic syndrome, the whole of interconnected factors, presents with local manifestation, such as periodontitis, related by a common factor known as oxidative stress. The aim of the present study was to assess the association between metabolic syndrome and periodontal disease in an Indian population. METHODS: Clinical criteria for metabolic syndrome included 1) abdominal obesity; 2) increased triglycerides; 3) decreased high-density lipoprotein cholesterol; 4) hypertension or current use of hypertension medication; and 5) high fasting plasma glucose. Serum C-reactive protein (CRP) levels were also measured. Periodontal parameters including gingival index (GI) average and deepest probing depth (PD) and clinical attachment level (CAL) were recorded on randomly selected quadrants, one maxillary and one mandibular. Based on the presence or absence of metabolic syndrome, individuals were divided into two groups. RESULTS: The periodontal parameters PD, CAL and GI differed significantly between the two groups. The GI values in Group 1 (2.06 ± 0.57) were greater than in Group 2 (1.79 ± 0.66; p = 0.0025). Similarly PD and CAL values in Group 1 (4.58 ± 1.69 and 2.63 ± 1.61 mm) were significantly greater (p < 0.001) than in Group 2 (3.59 ± 1.61 and 1.61 ± 1.40 mm, respectively). Also, three metabolic components and serum CRP correlated with average PD, and the strength of the correlation was medium in Group 1 as compared to Group 2, in which it was weak. CONCLUSION: The association between metabolic syndrome and periodontal disease was significant, and abdominal obesity appeared to be the most important contributing metabolic factor to periodontal disease.

Crevicular fluid and serum concentrations of progranulin and high sensitivity CRP in chronic periodontitis and type 2 diabetes.

INTRODUCTION: This study was designed to correlate the serum and gingival crevicular fluid (GCF) levels of progranulin (PGRN) and high sensitivity C-reactive protein (hs CRP) in chronic periodontitis and type 2 diabetes mellitus (DM). DESIGN: PGRN and hs CRP levels were estimated in 3 groups: healthy, chronic periodontitis, and type 2 DM with chronic periodontitis. RESULTS: The mean PGRN and hs CRP concentrations in serum and GCF were the highest for group 3 followed by group 2 and the least in group 1. CONCLUSION: PGRN and hs CRP may be biomarkers of the inflammatory response in type 2 DM and chronic periodontitis.

A randomized controlled clinical trial on the clinical and microbiological efficacy of systemic satranidazole in the treatment of chronic periodontitis.

OBJECTIVE: The present clinical trial was designed to investigate the effectiveness of systemic satranidazole (SZ) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS: Sixty-six subjects presenting with at least twelve teeth with probing depth (PD) > or = 4 mm were selected. Thirty-three subjects were randomly assigned to full-mouth SRP + placebo (Group 1) and 33 subjects were assigned to full-mouth SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index (PI), gingival index (GI), clinical attachment level (CAL) and PD at baseline, 1 month, 3 months and 6 months. Also, microbial analysis of dental plaque using polymerase chain reaction was done at baseline, 3 and 6 months to estimate the number of sites harboring periodontopathogens. RESULTS: Sixty subjects were evaluated up to 6 months. At 6 months, Group 2 showed greater mean reduction (3.84 +/- 1.31 mm) in PD as compared to Group 1 (1.42 +/- 1.01 mm; p < 0.05) and there was a greater mean CAL gain (3.22 +/- 1.01 mm) in Group 2 as compared to Group 1 (1.15 +/- 1.49 mm; p < 0.05). These subjects also showed significant reductions in the number of certain periodontopathogens, such as Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. CONCLUSION: The systemic use of SZ, when used as an adjunct to non-surgical periodontal therapy in subjects with periodontitis, achieves significantly better clinical and microbiological results than scaling and root planing alone.

Association of stem cell factor and high-sensitivity C reactive protein concentrations in crevicular fluid and serum in patients with chronic periodontitis with and without type 2 diabetes.

The aim of the present study was to clarify whether there is any correlation between the levels of high-sensitivity C reactive protein (hs-CRP) and stem cell factor (SCF) in serum and gingival crevicular fluid (GCF) of patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (DM). A total of 40 subjects were divided into 3 groups: 10 periodontally healthy subjects (Group 1), 15 CP patients (Group 2), and 15 type 2 DM patients with CP (Group 3). Levels of hs-CRP and SCF in GCF and serum were quantified using different techniques. The clinical outcomes evaluated were gingival index (GI), probing depth (PD) and clinical attachment level (CAL), and the correlations of the two inflammatory mediators with clinical parameters were evaluated. The levels of these inflammatory mediators increased continuously from group 1 to group 2, and to group 3. The serum levels of both hs-CRP and SCF were correlated with PD in patients with CP (P < 0.05). SCF levels were correlated with PD in Group 3 (P < 0.05). The fact that the levels of hs-CRP and SCF were highest in DM patients with CP suggests that the presence of a systemic condition has a profound effect on the levels of inflammatory mediators, both locally at sites of periodontal disease, and elsewhere.

Correlation of MCP-4 and high-sensitivity C-reactive protein as a marker of inflammation in obesity and chronic periodontitis.

OBJECTIVES: Obesity is increasing in prevalence worldwide and has emerged as a strong risk factor for periodontal disease. Conversely, the remote effects of periodontal disease on various systemic diseases have been proposed. The aim of this study is to determine the presence of MCP-4 and high sensitivity C reactive protein (hsCRP) levels in gingival crevicular fluid (GCF) and serum in obese and non-obese subjects with chronic periodontitis and to find a correlation between MCP-4 and hsCRP in GCF and serum. MATERIALS AND METHODS: Forty subjects (20 males and 20 females) were selected and divided into four groups (10 subjects in each group), based on clinical parameters: group NOH (non-obese healthy), group OH (obese healthy), Group NOCP (non-obese with chronic periodontitis) and group OCP (obese with chronic periodontitis). The levels of serum and GCF MCP-4 were determined by ELISA and hsCRP levels were determined by immunoturbidimetry method. RESULTS: The mean GCF and serum concentration of MCP-4 was highest for group OCP followed by group NOCP, group OH (in GCF); group OH, group NOCP(in serum) and least in group NOH. The mean hsCRP concentration was highest for group OCP followed by group OH, group NOCP and group NOH. A significant positive correlation was found between serum and GCF MCP-4 and hsCRP levels. CONCLUSION: GCF MCP-4 concentrations increased in periodontal disease compared to health and correlated positively with the severity of disease indicating it as a novel marker of periodontal disease. The serum concentration of MCP-4 was found to be more in obese group as compared to nonobese group indicating it as a marker of obesity. Furthermore, based on the positive correlation of MCP-4 and hsCRP found in this study, it can be proposed that MCP-4 and hsCRP may be the markers linking chronic inflammation in obesity and periodontal disease.

Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial.

BACKGROUND: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The identification of clinical measurements influential to treatment outcomes is critical to optimize the results of surgical periodontal therapy. The present study aimed to explore the clinical and radiographical effectiveness of autologous platelet-rich fibrin (PRF) and autologous platelet-rich plasma (PRP) in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. MATERIAL AND METHODS: Seventy-two mandibular degree II furcation defects were treated with either autologous PRF with open flap debridement (OFD; 24 defects) or autologous PRP with OFD (25), or OFD alone (23). Clinical and radiological parameters such as probing depth, relative vertical clinical attachment level and horizontal clinical attachment level along with gingival marginal level were recorded at baseline and 9 mo postoperatively. RESULTS: All clinical and radiographic parameters showed statistically significant improvement at both the test sites (PRF with OFD and PRP with OFD) compared to those with OFD alone. Relative vertical clinical attachment level gain was also greater in PRF (2.87 ± 0.85 mm) and PRP (2.71 ± 1.04 mm) sites as compared to control site (1.37 ± 0.58 mm), and relative horizontal clinical attachment level gain was statistically significantly greater in both PRF and PRP than in the control group. CONCLUSIONS: The use of autologous PRF or PRP were both effective in the treatment of furcation defects with uneventful healing of sites.

Post-treatment levels of stem cell factor and hs-CRP in serum and crevicular fluid of chronic periodontitis subjects with type 2 diabetes.

OBJECTIVE: The purpose of this study is to evaluate the stem cell factor (SCF) and high sensitive C reactive protein (hs-CRP) concentration in gingival crevicular fluid (GCF) and serum of chronic periodontitis subjects with type 2 diabetes, and to evaluate the effect of nonsurgical periodontal therapy on their GCF and serum concentrations. MATERIALS AND METHODS: A total of (age and gender matched) 22 subjects were evaluated. Pre- and post-treatment levels of SCF and hs-CRP in GCF and serum were measured and compared using enzyme linked immunosorbant assay. Clinical parameters including probing depth and clinical attachment level were also measured. Paired t-test was used to compare the before- and after-treatment levels of the two molecules. RESULTS: A highly significant difference (P < 0.001) was found in the GCF and serum concentrations of SCF and hs-CRP before and after treatment. CONCLUSION: Our observations indicated that short-term nonsurgical therapy resulted in a significant improvement in periodontal indices and in a marked decrease of SCF and hs-CRP serum and GCF levels.

Association of progranulin and high sensitivity CRP concentrations in gingival crevicular fluid and serum in chronic periodontitis subjects with and without obesity.

BACKGROUND: Obesity is considered as a strong risk factor of inflammatory periodontal tissue destruction. The purpose of this study is to determine presence of progranulin (PGRN) and high sensitivity C reactive protein (hs CRP) levels in serum and gingival crevicular fluid (GCF) in obese subjects with chronic periodontitis and to find an association, if any. MATERIAL AND METHODS: 40 subjects (20 males and 20 females) were selected based on their clinical parameters into four groups (10 subjects in each group): group 1 (healthy non obese), group 2 (healthy obese), group 3 (non obese with chronic periodontitis) and group 4 (obese with chronic periodontitis). Serum and GCF PGRN levels were estimated by enzyme linked immunosorbant assay (ELISA) and hs CRP levels were estimated by immunoturbidimetry method. RESULTS: The mean PGRN and hs CRP concentration both in serum and GCF were highest for group 4 followed by group 3, group 2 and least in Group 1. CONCLUSION: PGRN and hs CRP may be novel biomarkers of the chronic inflammatory response in obesity and chronic periodontitis.

Microbiological outcomes of systemic ornidazole use in chronic periodontitis. Part II.

OBJECTIVE: Antimicrobials are increasingly being used as adjuncts to non-surgical or surgical periodontal therapy. The main purpose of the present analysis was to evaluate the effect of systemic ornidazole (ORN) on total anaerobic microbial counts of subjects with moderate to advanced chronic periodontitis (CP). METHODS: This was a single-center, double-blinded, placebo-controlled, randomized clinical trial of six months duration. Fifty-eight subjects presenting with at least 12 teeth with probing depth (PD) > or = 4 mm were selected. Thirty subjects received full-mouth scaling and root planing (SRP) + placebo (control group) and 28 subjects received full-mouth SRP + ORN (test group). The total anaerobic counts were analyzed by collecting subgingival plaque from deepest pockets at baseline (B/L), 1 week, 1 month, 3 months and 6 months. RESULTS: Paired and unpaired t-tests were used to determine the inter- and intra-group differences. Fifty subjects were evaluated up to six months. There was a significant difference in the number of anaerobes in the two groups at all the intervals except B/L (p<0.05). CONCLUSION: The systemic use of ORN very efficiently reduced the microbial load in the group that received antibiotics.

Clinical efficacy of subgingivally delivered 1.2-mg simvastatin in the treatment of individuals with Class II furcation defects: a randomized controlled clinical trial.

BACKGROUND: Simvastatin (SMV) assists in bone regeneration and has an anti-inflammatory effect when delivered or applied locally. The present clinical trial is designed to investigate the effectiveness of 1.2-mg SMV as a local drug delivery system as an adjunct to scaling and root planing (SRP) for the treatment of Class II furcation defects. METHODS: Seventy-two patients with mandibular buccal Class II furcation defects were randomized and categorized into two treatment groups: SRP plus placebo (group 1) and SRP plus 1.2-mg SMV (group 2). Clinical parameters were recorded at baseline before SRP and at 3 and 6 months; they included modified sulcus bleeding index (mSBI), probing depth (PD), and relative vertical (RVAL) and horizontal (RHAL) attachment levels. At baseline and after 6 months, radiologic assessment of bone defect fill was performed. RESULTS: Both therapies resulted in significant improvements. The decrease in mSBI score at 6 months was greater in group 2 (2.02 ± 0.23) compared with group 1 (1.80 ± 0.22). The mean decrease in PD at 6 months was 1.30 ± 1.0 and 4.05 ± 1.31 mm in groups 1 and 2, respectively. A significantly greater gain in mean RVAL and RHAL was found in group 2 than in group 1 (P <0.05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (25.16%) compared with group 1 (1.54%). CONCLUSION: Locally delivered SMV provides a comfortable and flexible method to improve clinical parameters and also to enhance bone formation.

Systemic ornidazole as an adjunct to non-surgical periodontal therapy in the treatment of chronic periodontitis: a randomized, double-masked, placebo-controlled clinical trial.

BACKGROUND: The purpose of this clinical trial is to evaluate the adjunctive clinical effects of the systemic administration of ornidazole (ORN) in the full-mouth scaling and root planing (SRP) of individuals with moderate-to-advanced chronic periodontitis. METHODS: Fifty-eight individuals presenting ≥12 teeth with probing depth (PD) ≥4 mm were selected. All participants were instructed on strict oral hygiene measures and were advised to use 0.2% chlorhexidine mouthwash for 1 week before being allocated to two groups. Thirty participants were randomly assigned to full-mouth SRP + placebo (control group), and 28 participants were assigned to full-mouth SRP + ORN (test group). The clinical outcomes evaluated were plaque index, gingival index, clinical attachment level (CAL), and PD. RESULTS: Fifty participants could be evaluated by ≤6 months. At 6 months, the test group had greater mean reduction (2.84 mm) in PD compared to the control group (0.84 mm) (P <0.05), and there was also a greater mean CAL reduction (2.92 mm) in the test group compared to the control group (0.92 mm) (P <0.05). CONCLUSION: The systemic use of ORN, when used in conjunction with initial periodontal treatment consisting of SRP in adults with periodontitis, achieves significantly better clinical results than initial periodontal treatment alone.