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.

Platelet-Rich Fibrin Combined With a Porous Hydroxyapatite Graft for the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis. METHODS: Ninety IBDs were treated with autologous PRF with open-flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%). CONCLUSIONS: Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3-wall IBDs.

4-Hydroxy-2-nonenal, an oxidative stress marker in crevicular fluid and serum in type 2 diabetes with chronic periodontitis.

OBJECTIVE: Chronic periodontitis (CP) is a common, chronic inflammatory disease initiated by bacteria, which has an increased prevalence and severity in patients with type 2 diabetes mellitus (t2 DM). A variety of reactive oxygen species are able to cause direct damage to proteins, deoxyribonucleic acid, carbohydrates and lipids. Lipid peroxidation is always combined with the formation of reactive aldehydes like 4-Hydroxy-2-nonenal (HNE). The purpose of this study was to determine the presence of the HNE-His adducts levels in serum and gingival crevicular fluid (GCF) in t2 DM among CP subjects and to find an association, if any. MATERIALS AND METHODS: A total of 40 subjects (20 males and 20 females) were selected based on their clinical parameters into three groups: Group 1 (10 healthy), Group 2 (15 subjects, CP without t2 DM), Group 3 (15 subjects, CP with t2 DM). Serum and GCF samples were collected to estimate the levels of the HNE-His adducts by the enzyme linked immunosorbent assay. RESULTS: The mean HNE-His adducts concentration both in serum and GCF was highest for Group 3 followed by Group 2 and least in Group 1. CONCLUSIONS: All samples in each group tested positive for HNE-His adducts assay. Serum and GCF HNE-His adducts concentration both in t2 DM with CP and non-diabetic CP subjects were higher than the healthy controls. Further large scale longitudinal studies should be carried out to confirm positive correlations.

Protein carbonyl: An oxidative stress marker in gingival crevicular fluid in healthy, gingivitis, and chronic periodontitis subjects.

BACKGROUND: A defined role for reactive oxygen species (ROS) in the tissue destruction that characterizes periodontitis has been described. Protein carbonyl (PC) is the most widely used biomarker for oxidative damage to proteins, and reflects cellular damage induced by multiple forms of ROS. The purpose of this study is to determine the presence of PC in gingival crevicular fluid (GCF) in healthy, gingivitis, and chronic periodontitis (CP) subjects and to find an association, if any. MATERIALS AND METHODS: A total number of 75 subjects (38 males and 37 females) were selected based on their clinical parameters into three groups: Group 1 (25 healthy subjects), Group 2 (25 gingivitis subjects), and Group 3 (25 CP subjects). GCF samples were collected to estimate the levels of PC. RESULTS: The PC concentration in GCF was highest in subjects with CP as compared to gingivitis and healthy subjects and a significant association was observed between GCF PC levels and all periodontal parameters. CONCLUSION: There was an increase in PC levels in GCF as the disease process progressed from healthy to gingivitis and CP, suggesting a role for increased oxidative stress in CP.

8-Isoprostane: a lipid peroxidation product in gingival crevicular fluid in healthy, gingivitis and chronic periodontitis subjects.

OBJECTIVE: The idea that reactive oxygen species (ROS) are associated with the pathogenesis of inflammatory periodontal diseases and have a role (direct or indirect) in tissue damage has become a major area of research over the last decade. The purpose of this study is to determine, presence of 8-isoprostane in gingival crevicular fluid (GCF) in healthy, gingivitis and chronic periodontitis (CP) subjects and to find an association, if any between GCF 8-isoprostane levels and clinical periodontal parameters. MATERIALS AND METHODS: 78 subjects (40 males and 38 females) were selected based on their clinical parameters into three groups: Group 1 (26 healthy), Group 2 (26 gingivitis subjects) and Group 3 (26 CP subjects). GCF 8-isoprostane levels were estimated by ELISA. RESULTS: The 8-isoprostane concentration in GCF was highest in subjects with chronic periodontitis as compared to gingivitis and healthy subjects and a significant association was observed between GCF 8-isoprostane levels and all periodontal parameters. CONCLUSIONS: There was increase in 8-isoprostane levels in GCF as the disease process progressed from health to gingivitis and chronic periodontitis, suggesting a role for increased oxidative stress in CP.

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.

1% alendronate gel as local drug delivery in the treatment of Class II furcation defects: a randomized controlled clinical trial.

BACKGROUND: Alendronate (ALN), an aminobisphosphonate, is known to stimulate the formation of osteoblast precursors to promote osteoblastogenesis. The present study aims to explore the efficacy of 1% ALN 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 69 mandibular Class II furcation defects were randomized and treated with either 1% ALN gel or placebo gel. Clinical parameters were recorded at baseline, 3 months, 6 months, and 12 months, and radiographic parameters were recorded at baseline, 6 months, and 12 months. Defect fill at baseline, 6 months, and 12 months was calculated on standardized radiographs using image analysis software. RESULTS: Mean probing depth (PD) reduction and mean relative vertical (RVCAL) and horizontal (RHCAL) clinical attachment level gain were shown to be greater in the ALN group than the placebo group at 3, 6, and 12 months. Furthermore, a significantly greater mean percentage of bone fill was found in the ALN group (32.11% ± 6.18%, 32.66% ± 5.86%), compared with the placebo group (2.71% ± 0.61%, 1.83% ± 1.51%), at 6 and 12 months, respectively. CONCLUSIONS: The results of the present study show that local delivery of 1% ALN into a Class II furcation defect stimulates a significant PD reduction, RVCAL and RHCAL gains, and improved bone fill compared with placebo gel as an adjunct to SRP. ALN can provide a new direction in management of furcation defects.

Efficacy of subgingivally delivered simvastatin in the treatment of patients with type 2 diabetes and chronic periodontitis: a randomized double-masked controlled clinical trial.

BACKGROUND: Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Recently, it has been reported that statins promote bone formation. The present study is designed to investigate the effectiveness of 1.2% SMV in an indigenously prepared, biodegradable, controlled-release gel as an adjunct to scaling and root planing (SRP) in the treatment of patients with type 2 diabetes and chronic periodontitis (CP). METHODS: Thirty-eight patients were categorized into two treatment groups: SRP plus 1.2% SMV and SRP plus placebo. Clinical parameters were recorded at baseline before SRP and at 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 and 9 months, radiologic assessment of intrabony defect (IBD) fill was done using computer-aided software. RESULTS: Mean PD reduction and mean CAL gain were found to be greater in the SMV group than the placebo group at 3, 6, and 9 months. Furthermore, significantly greater mean percentage of bone fill was found in the SMV group (32.64% ± 12.90%) compared to the placebo group (4.22% ± 9.75%) after 9 months. CONCLUSION: There was a greater decrease in mSBI and PD and more CAL gain with significant IBD fill at sites treated with SRP plus locally delivered SMV in patients with type 2 diabetes and CP.

Locally delivered 1% metformin gel in the treatment of smokers with chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: Metformin (MF) (1,1-dimethylbiguanide HCl) is one of the most commonly used oral antihyperglycemic agents for the treatment of type 2 diabetes mellitus. Recently, MF has been shown to have bone-sparing properties. The present study is designed to investigate the effectiveness of MF 1% in an indigenously prepared, biodegradable, controlled-release gel, as an adjunct to scaling and root planing (SRP) in treatment of vertical defects in smokers with generalized chronic periodontitis (CP). METHODS: Fifty patients were categorized into two treatment groups: SRP plus 1% MF and SRP plus placebo. Clinical parameters were recorded at baseline and at 3 and 6 months; they included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, intrabony defect (IBD) fill was radiologically assessed using computer software. RESULTS: Mean PD reduction and mean CAL gain were found to be greater in the MF group than the placebo group at all visits. Furthermore, a significantly greater mean percentage of bone fill was found in the MF group (26.17% ± 6.66%) than the placebo sites (3.75% ± 8.06%) (P <0.001). CONCLUSION: There was greater decrease in mSBI and PD and more CAL gain with significant IBD fill at vertical defect sites treated with SRP plus locally delivered MF, versus SRP plus placebo, in smokers with generalized CP.

Efficacy of varying concentrations of subgingivally delivered metformin in the treatment of chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: Metformin (MF), a second-generation biguanide, is a commonly used oral antidiabetic drug that has been shown recently to stimulate osteoblasts and reduce alveolar bone loss. The present study aims to explore the efficacy of 0.5%, 1%, and 1.5% MF gel as a local drug delivery system in adjunct to scaling and root planing (SRP) for treatment of intrabony defects (IBDs) in patients with chronic periodontitis. METHODS: A total of 118 IBDs were treated with 0.5%, 1%, or 1.5% MF gel or placebo gel. Clinical parameters (modified sulcus bleeding index, plaque index, probing depth [PD], and clinical attachment level [CAL]) were recorded at baseline, 3 months, and 6 months, whereas radiographic parameters were recorded at baseline and 6 months. IBD depth at baseline and 6 months was calculated on standardized radiographs by using the image analysis software. The mean concentration of MF in gingival crevicular fluid was estimated by reverse-phase high-performance liquid chromatography. RESULTS: Mean PD reduction and mean CAL gain was found to be greater in MF groups than the placebo group at both 3 and 6 months. Furthermore, significantly greater reduction of IBD depth was found in the MF groups compared to the placebo group, with greatest reduction in 1% MF. CONCLUSIONS: The results of the present study show that local delivery of MF into the periodontal pocket stimulated significant increase in the PD reduction, CAL gain, and improved IBD depth reduction compared to placebo in adjunct to SRP. This can provide a new direction in the field of periodontal healing.

Clinical efficacy of subgingivally delivered 1.2% atorvastatin in chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: Atorvastatin (ATV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Recently, statins have shown pleiotropic effects such as anti-inflammation and bone stimulation. The aim of the present study is to investigate the effectiveness of 1.2% ATV as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBDs). METHODS: Sixty individuals were randomized into two treatment groups: SRP plus 1.2% ATV and SRP plus placebo gel. At baseline and 3, 6, and 9 months, clinical parameters, which included modified sulcus bleeding index, plaque index, probing depth (PD), and clinical attachment level (CAL), were recorded at baseline. Radiologic assessment of IBD fill was done using computer-aided software at baseline and 6 and 9 months. RESULTS: Mean PD reduction and mean CAL gain were greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic bone fill was found in the ATV group (35.49% ± 5.50%) compared to the placebo group (1.82% ± 1.32%) after 9 months. CONCLUSION: ATV as an adjunct to SRP can provide a new direction in the management of IBDs.

Effect of non surgical periodontal therapy on gingival crevicular fluid and serum visfatin concentration in periodontal health and disease.

Visfatin is a pleiotropic mediator which acts as growth factor, cytokine, enzyme involved in energy including nicotinamide adenine dinucleotide metabolism and has been recently demonstrated to exert several pro-inflammatory functions. The purpose of this study is to evaluate the Visfatin concentration in gingival crevicular fluid (GCF) and serum in patients with chronic periodontitis, and to evaluate the effect of non-surgical periodontal therapy on the GCF and serum visfatin concentration. 30 subjects (age range: 25 to 52 years) were selected and divided into two groups based on the gingival index, probing depth, periodontal attachment level, and radiologic parameters (bone loss): group 1 (15 subjects with healthy periodontium), group 2 (15 subjects with chronic periodontitis), while, Group 2 patients after 8 weeks of the treatment (scaling and root planning, SRP) constituted group 3. GCF samples (by microcapillary pipettes) and serum samples (by venipuncture) were collected to estimate the levels of Visfatin using enzyme linked immunosorbent assay kit. The mean Visfatin concentration in GCF and serum was observed to be the highest in group 2 and lowest in group 1. While concentration in group 3 was similar to group 1. The concentration of Visfatin in GCF and serum decreased after SRP. The Visfatin concentration in GCF and serum found to be highest in chronic periodontitis group and decreases after treatment. Hence Visfatin values can be considered as an "inflammatory marker" can be explored in future as a potential therapeutic target in the treatment of periodontal disease.

Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. METHODS: Ninety intrabony defects were treated with either autologous PRF with open-flap debridement or autologous PRP with open-flap debridement or open-flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. CONCLUSIONS: Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open-flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long-term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.

Effect of nonsurgical periodontal therapy on crevicular fluid and serum glutathione peroxidase levels.

BACKGROUND: Plasma glutathione peroxidase (eGPx) is an important selenium containing antioxidant in human defense against oxidative stress. While crevicular fluid (GCF) eGPx levels and its association with periodontal disease is well documented, there is no data on correlation of GCF and serum eGPx levels in chronic periodontitis. Hence this study was undertaken to further probe into the role of oxidative stress in periodontal diseases and effect of nonsurgical periodontal therapy (NSPT) by correlating GCF and serum levels of eGPx. MATERIALS AND METHODS: Thirty subjects (16-Males and 14-Females; age: 30-38 years) participated in the study. The subjects were divided, based on gingival index, probing pocket depth and clinical attachment level into: Healthy (group-1, n=10), Gingivitis (group-2, n=10) and Periodontitis (group-3, n=10). Chronic periodontitis patients after NSPT constituted group 4. GCF and serum samples collected from each subject were quantified for eGPx levels using Enzyme linked Immunosorbent Assay. RESULTS: The mean eGPx concentrations increased from health (14.01 ng/µl and 78.26 ng/ml) to gingivitis (22.86 ng/µl and 90.44 ng/ml) and then to periodontitis (29.89 ng/µl and 103.43 ng/ml), in GCF and serum respectively. After NSPT, there was statistically significant reduction in eGPx concentration in GCF and serum (19.41 ng/µl and 85.21 ng/ml). Further, all the GCF eGPx values showed a positive correlation to that of serum eGPx level. CONCLUSION: Thus, increased eGPx concentration in GCF can be considered as an indicator of local increase in oxidative stress. While, increase in serum eGPx levels indicates that periodontal disease can also lead to increased oxidative stress at the systemic level.

Local drug delivery of alendronate gel for the treatment of patients with chronic periodontitis with diabetes mellitus: a double-masked controlled clinical trial.

BACKGROUND: Alendronate (ALN) increases alveolar bone density with systemic use and, has been found to increase bone formation on local delivery into the periodontal pocket. The purpose of the present study is to explore the efficacy of 1% ALN gel as a local drug delivery system in adjunct to scaling and root planing (SRP) for the treatment of intrabony defects in patients with chronic periodontitis (CP) with type 2 diabetes (DM) compared to a placebo gel. METHODS: Seventy intrabony defects were treated with either 1% ALN or placebo gel. Clinical parameters were recorded at baseline, 2 months, and 6 months. Radiographic parameters were recorded at baseline and 6 months. Defect fill at baseline and 6 months was calculated on standardized radiographs using image analysis software. RESULTS: Mean probing depth (PD) reduction and mean clinical attachment level (CAL) gain was greater in the ALN group than the placebo group at both 2 and 6 months. Furthermore, significantly greater mean percentage of bone fill was found in the ALN group (44.2% ± 11.78%) compared to the placebo group (2.8% ± 1.61%). CONCLUSIONS: In patients with type 2 DM and CP, local delivery of 1% ALN into periodontal pockets resulted in a significant increase in the PD reduction, CAL gain, and improved bone fill compared to placebo gel as an adjunct to SRP. Thus, ALN can be used as an adjunct to SRP to provide a new dimension in the periodontal therapy in the near future.

Association of serum and crevicular visfatin levels in periodontal health and disease with type 2 diabetes mellitus.

BACKGROUND: Levels of visfatin in serum and gingival crevicular fluid (GCF) were explored in patients with periodontal health, periodontal disease with and without type 2 diabetes mellitus (t2 DM) and were found to be elevated with periodontal disease, and were correlated with periodontal clinical parameters. DM and chronic periodontitis (CP) are associated with each other. Adipokines, specifically visfatin, are secreted from adipocytes and are thought to cause insulin resistance. The purpose of this study is to determine the presence of visfatin in serum and GCF in t2 DM among individuals with CP and to find an association, if any. METHODS: Thirty individuals (15 males and 15 females) were selected based on their clinical parameters into three groups: group 1 (10 healthy), group 2 (10 well-controlled t2 DM among individuals with CP), and group 3 (10 individuals with CP and without diabetes). Serum and GCF samples were collected to estimate the levels of visfatin using enzyme linked immunosorbent assay. RESULTS: The mean visfatin concentration increased in both serum and GCF in individuals with t2 DM with CP. Also, it was observed that visfatin in both serum and GCF correlated positively with all the periodontal parameters. CONCLUSIONS: All the samples in each group tested positive for visfatin assay. Serum and GCF visfatin concentration in both t2 DM with CP and individuals with CP and without diabetes correlated positively with all the clinical parameters. Additional large-scale longitudinal studies should be performed to confirm positive correlations.