Photodynamic therapy adjuvant to non-surgical periodontal therapy: Systematic review of randomized clinical trials.

OBJECTIVES: To systematically evaluate randomised controlled trials (RCTs) on whether adjuvant application of antimicrobial photodynamic therapy (aPDT) through the technique of irradiation in the external region of the periodontal pocket with optic-fibre tip offers benefits to scaling and root planning (SRP). METHODS: Five databases were searched by two independent reviewers according to pre-specified eligibility criteria up to April 2023. No restrictions regarding date of publication, language and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and Grading of Recommendations, Assessment, Development and Evaluation for assessing the certainty of evidence. RESULTS: A total of 1388 publications were identified and reviewed for eligibility. Four of them fulfilled the inclusion criteria. The sample consisted of a total of 83 patients with periodontitis. In these, 330 periodontal sites were evaluated. The clinical findings of the majority of the included studies demonstrated that patients who received the association of aPDT + RAR with the protocol evaluated here, obtained clinical results similar to patients who received only the SRP alone. In none of the evaluated RCTs, clinical advantages were observed that would categorise this aPDT protocol as superior to conventional treatment. CONCLUSION: Applying aPDT after SRP with external irradiation of the periodontal pocket does not seem to result in any clinical benefit compared to the use of SRP alone in patients with periodontitis.

Adjuvant effects of Saccharomyces cerevisiae in the treatment of experimental periodontitis in rats undergoing chemotherapy.

Surgical procedures, radiotherapy, and chemotherapy, individually or in association, are current oncological treatments. Among the most used chemotherapy drugs, 5-fluorouracil (5FU) is an antimetabolite with a broad spectrum of action. This study evaluated the effects of probiotics (PRO) as an adjuvant to the treatment of experimental periodontitis (EP) in rats immunosuppressed with 5FU.108 rats were randomly allocated to six different groups: EP; SS - systemic treatment with saline solution (SS); 5FU - systemic treatment with 5FU; 5FU+PRO - systemic treatment with 5FU, followed by the local administration of Saccharomyces cerevisiae ; 5FU+SRP - systemic treatment with 5-FU, followed by scaling and root planing (SRP); and 5FU+SRP+PRO - systemic treatment with 5FU followed by local treatments with SRP and PRO. Immunosuppression was obtained at two points: at the time of ligature installation and after 48 h. Six animals from each group were euthanized at seven, 15, and 30 d and hemimandibles were collected and processed for histopathological, histometric, and immunohistochemical analysis. Data were subjected to statistical analysis (α=5%). At 7 d, the 5FU+PRO group showed less bone resorption and better structured connective tissue compared with the EP, SS, 5FU+SRP, and 5FU+SRP+PRO groups. At 15 d, the 5FU+SRP group showed a greater intensity of the inflammatory response (p<0.05). At 30 d, the 5FU+SRP+PRO group showed better structured bone tissue and a higher percentage of bone tissue (PBT) than the EP, SS, 5FU, and 5FU+PRO groups (p<0.05). The use of Saccharomyces cerevisiae as monotherapy or as an adjuvant to periodontal therapy may have a positive effect on bone repair in immunosuppressed conditions.

Clinical and microbiological outcomes of subgingival instrumentation supplemented with high-dose omega-3 polyunsaturated fatty acids in periodontal treatment - a randomized clinical trial.

PURPOSE: This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV. METHODS: Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months. RESULTS: Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome "change of mean PD," no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group. CONCLUSION: High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits. The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020.

Low-level laser therapy has an additional effect with open flap debridement on the treatment of stage III periodontitis: a split-mouth randomized clinical trial.

OBJECTIVE: The purpose of this randomized, controlled, split-mouth trial was to clarify the clinical efficacy of using low-level laser therapy (LLLT) as an adjunct to open flap debridement in the treatment of periodontitis. METHOD AND MATERIALS: The study was conducted on 10 patients with stage III periodontitis. Clinical parameters were recorded for 70 sites of periodontal pockets at baseline and after 3 months and included Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), and relative attachment level (RAL), and evaluated postoperative pain and dental hypersensitivity. After open flap debridement, the sites were randomly divided into test sites receiving the low-level diode laser (wavelength 808 nm) and control sites treated with laser-off. The Wilcoxon test and Mann-Whitney U-test were used for intra- and inter-group comparisons, respectively, and the Friedman test to test between different periods. RESULTS: Both treatments produced a reduction in GI, BOP, and PD, an increased RGR, and a gain in RAL between baseline and 3 months after surgery. There were significant improvements in GI, PD, and RAL after 3 months; postoperative pain after 24 hours and after 3 days; and dental hypersensitivity after 1 week and 1 month of the surgery, which significantly decreased in the test group. CONCLUSION: Both groups were clinically effective in treating stage III periodontitis, with a significant preference in reduction of GI and PD and gain of RAL, and decreased postoperative pain (after 24 hours and 3 days) and dentinal hypersensitivity (after 1 week and 1 month) for open flap debridement+LLLT. CLINICAL RELEVANCE: The use of LLLT as an adjunct to open flap debridement improved the clinical indices, postoperative pain, and dentinal hypersensitivity better than open flap debridement alone in the treatment of stage III periodontitis.

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

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

Periodontal disease progression in the second half of life and following a single episode of scaling and root planing: A clinical study in the Sri Lankan tea plantation cohort with documented clinical parameters for more than 40 years.

BACKGROUND: To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se-SRP) in subjects lacking professional dental care and oral hygiene practices for >40 years. METHODS: In 2013, se-SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow-up) similarly to the previous surveys (1970 to 2010). RESULTS: Subjects' mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow-up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22 mm (± 1.70) in the test group was significantly higher compared with the control group (0.08 mm ± 1.30) (P <0.0001) demonstrating unaffected PDP. Computed estimates of further PDP revealed CAL and PD reductions in subjects aged ≥40 years. Specifically, the latter was positively correlated with tooth loss in subjects aged ≥40 years (P = 0.69, P = 0.0012) and ≥50 years (r = 0.62, P <0.0001). CONCLUSION: se-SRP in previously untreated periodontitis subjects aged ≥50 years may be ineffective in reducing PDP thus demanding advanced preventive measures, treatment in the first half of life, and sustained access to supportive care.

Clinical and Immunological Effects of Er,Cr:YSGG Laser in Nonsurgical Periodontal Treatment: A Randomized Clinical Trial.

Objective: The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Background data: As lasers have begun to be used in dentistry, the Er,Cr:YSGG laser has started to attract attention in the field of periodontology. Materials and methods: Fifty-nine nonsmoking patients with advanced chronic periodontitis were randomly allocated to a test group (full-mouth ultrasonic supra- and subgingival debridement+Er,Cr:YSGG laser application) and a control group (full-mouth ultrasonic supra- and subgingival debridement+root planing with Gracey curettes). The laser parameters were set as follows: 1.5 W output power, pulse mode H (pulse duration of 140 µs), pulse frequency of 20 Hz, and an air-water spray ratio of 10% air and 15% water. The instrumentation was performed until the operator felt that the root surfaces were adequately debrided. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index, interleukin-1 beta (IL-1ß), matrix metalloproteinase-8 (MMP-8), tissue inhibitor metalloproteinase-1 (TIMP-1), and MMP-8/TIMP-1 levels in gingival crevicular fluid were evaluated at baseline, 6 weeks, and 3 months postoperatively. Results: There were statistically significant differences in PD, which was our primary outcome, and BOP between the groups at both examinations [p < 0.001 and p < 0.001 (for PD) and p = 0.048 and p < 0.001 (for BOP), respectively], in favor of the laser group. However, there were no significant differences among groups at any time for CAL gain (p = 563 and p = 369, respectively). No significant differences in MMP-8, TIMP-1, and MMP-8/TIMP-1 levels were detected among groups. There was a statistically significant difference for IL-1ß levels among groups at 3-month evaluations in favor of the laser group. Conclusions: Using the Er,Cr:YSGG laser instead of hand instruments in nonsurgical periodontal treatment has shown additional improvements in terms of pocket reduction and gingival bleeding compared with traditional nonsurgical therapy.

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis.

BACKGROUND: Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice. METHODS: We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias. RESULTS: Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11). CONCLUSION: The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.

Antimicrobial photodynamic therapy (aPDT) with curcumin and LED, as an enhancement to scaling and root planing in the treatment of residual pockets in diabetic patients: A randomized and controlled split-mouth clinical trial.

INTRODUCTION: Residual pockets represent a risk factor for periodontal disease progression. Diabetes Mellitus (DM) may impair prognosis after cause-related therapy, mainly due to the chronic hyperglycemia that negatively influences tissue repair. This study evaluated the clinical efficacy of antimicrobial photodynamic therapy (aPDT) with curcumin (CUR) solution (100 mg/L) and LED irradiation (465-485 nm), as an adjunctive therapy to scaling and root planing (SRP), in the treatment of residual pockets in type 2 diabetic patients. METHODS: Individuals with type 2 DM and chronic periodontitis presenting at least one residual pocket per quadrant were selected (n = 25). In each patient, all residual pockets with probing depth (PD) ≥5 mm and bleeding on probing (BOP) were allocated to receive, according to quadrant: 1) SRP (SRP group); 2) SRP and irrigation with CUR solution (100 mg/L) (CUR group); 3) SRP and LED irradiation (InGaN, 465-485 nm, 0.78 cm², 78 mW, 100 mW/cm², 60 s) (LED group); 4) SRP, irrigation with CUR solution (100 mg/L), one minute of pre-irradiation, and LED irradiation (InGaN, 465-485 nm, 60 s) (aPDT group). Clinical parameters of PD, gingival recession (GR), clinical attachment level (CAL), BOP and visible plaque index (PI) were evaluated at baseline, three and six months post-therapies. Differences between the examination periods in each group were analyzed by Friedman's test for non-parametric data, while parametric data were submitted to analysis of variance (One-way ANOVA), followed by Tukey's test. Intergroup comparisons were performed by Kruskal-Wallis test. RESULTS: In an intergroup comparison, the mean values for PD, GR, CAL, BOP and PI were not different at baseline, three and six months (p > 0.05). The intragroup comparison evidenced reduction in PD and BOP in all treatment groups at three and six months (p < 0.05). Significant CAL gain was notable only for the aPDT and LED groups at three months in comparison to baseline data (p < 0.05). CONCLUSION: Treatment of residual pockets in patients with type 2 DM through association of SRP with aPDT (CUR solution 100 mg/L and LED irradiation) or LED irradiation may yield short-term (three months) clinical benefits regarding CAL gain.

Comparative evaluation of chlorhexidine and cinnamon extract used in dental unit waterlines to reduce bacterial load in aerosols during ultrasonic scaling.

BACKGROUND: Dental unit waterlines (DUWL) are believed to be a source of infection. Ultrasonic instruments generate aerosols with significantly greater numbers of bacteria. Chlorhexidine (CHX) exhibits significant antiseptic effect. Recently, cinnamon (CIN) has been displayed to have antibacterial and anti-inflammatory properties in vivo. AIM: The aim of this study is to compare and evaluate the efficacy of CHX versus CIN extract in the reduction of bacterial count in dental aerosols when used as an irrigant through DUWL during ultrasonic scaling. MATERIALS AND METHODS: Sixty patients with moderate-to-severe gingivitis were randomly divided into 3 groups of 20 patients each undergoing ultrasonic scaling. For experimental group I, CHX was added in dental unit reservoir before ultrasonic scaling. Similarly, in group II, CIN extract was used and group III served as control where distilled water (DW) was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. One plate from each position was incubated aerobically for 48 h and other plate anaerobically for 72 h. The total number of colony forming units (CFUs) was then calculated and statistically interpreted. RESULTS: CHX and CIN both were equally effective (P > 0.05) in reducing the bacterial count in aerosols as compared to DW (P < 0.05) when used through DUWL. Maximum contamination was seen on the agar plate placed at the chest of the patient. CONCLUSION: Both CIN and CHX used as an irrigant through DUWL effectively helped in the reduction of bacterial count in dental aerosols.

Effects of diode laser application on inflammation and mpo in periodontal tissues in a rat model.

OBJECTIVE: In this study, we aimed to histologically and immunologically evaluate the effect of diode laser treatment when applied adjunctive to scaling and root planing (SRP) in an experimental periodontitis model. MATERIALS AND METHODS: We used Wistar-Albino rats (n=60) with average weight of 230 g. Experimental periodontitis was induced by ligature at the right and left first mandibular molar teeth in all rats. After 11 days, the ligature was removed and rats were divided into two groups. The control group (n=30) received only SRP treatment, while the laser group (n=30) received a diode laser (GaAlAs, 810 nm, 1 W, 10 J, 20 s) treatment adjunctive to SRP. Ten rats in each group were sacrificed after 7, 15, and 30 days. Histopathological examination was performed in the left mandible of rats. Myeloperoxidase (MPO) was evaluated by western blot in the gingival specimens from the right mandible. RESULTS: MPO levels in the laser group were statistically significantly lower compared with the control group (p≤0.05). There was no statistically significance at any time between MPO levels in the control group (p>0.05). MPO levels in the laser group at the 7th day were statistically significantly higher compared to the 15th (p≤0.05) and the 30th day (p≤0.05). Inflammatory cell infiltration decreased over time in both groups and was statistically significantly lower in the laser group than in the control group at all times (p≤0.01). CONCLUSIONS: Within the limits of this study, we suggest that diode laser application is an adjunctive treatment because it reduced inflammation and MPO when applied in addition to SRP. On the other hand, more studies are needed for the assessment of the effects of diode laser application to periodontal tissues.

aPDT for periodontitis treatment in ovariectomized rats under systemic nicotine.

BACKGROUND: This study evaluated the antimicrobial photodynamic therapy (aPDT) as an adjunctive therapy to scaling and root planning (SRP) for the treatment of experimental periodontitis (EP) in ovariectomized rats under systemic nicotine. METHODS: Female ovariectomized rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were inserted in the rats 30 days before the induction of EP, which was induced by placing a ligature around the left mandibular first molar. The rats were randomly divided into three treatment subgroups: SRP, SRP plus low-level laser therapy (LLLT), and SRP plus aPDT. aPDT consisted of the application of a phenothiazine photosensitizer followed by LLLT. Ten animals from each group were euthanized at days 7, 15, and 30 after periodontal treatment. The furcation region was evaluated using histological, histometric analyses and immunolabelling for PCNA, TRAP, RANKL, and OPG. RESULTS: Nicotine administration resulted in greater bone loss (BL). aPDT resulted in lower BL compared to SRP. aPDT showed higher quantities of PCNA-positive cells compared to SRP, regardless of the nicotine status. aPDT resulted in less recruitment of osteoclasts and lower RANKL immunolabelling compared to LLLT and SRP. CONCLUSION: aPDT was effective in animals treated with nicotine.

Efect of Anaheal (Bromelain) Drug on the Periodontal Clinical Indices in Nonsurgical Periodontal Treatment of Patients with Chronic Periodontitis

Objective: To evaluate the effect of Anaheal (Bromelain) drug on the periodontal clinical indices in nonsurgical periodontal treatment of patients with chronic periodontitis. Material and Methods: In this double blind clinical trial, 80 patients with chronic moderate periodontitis and a healthy systemic status were chosen, and divided into two 40-subject groups. Thereafter, the standard treatment of periodontitis including scaling and root planning in one session by the unit operator was performed for all patients. Eventually, one group of the patients was administered Bromelain medication (500-mg capsule twice a day) one hour before food, while the other group was given placebo. Four and eight weeks after the treatment, the clinical periodontal indicators were measured and recorded in both groups. The data were assessed using descriptive statistics and analytical test methods (Mann-U-Whitney and Chi-square). P value less than 0.05 was considered statistically significant. Results: Gingival index, probing depth and plaque index before the treatment were similar in both groups (Anaheal and placebo). However, four and eight weeks after the treatment, the three studied indices were significantly lower in the Anaheal group as compared to the placebo (p<0.05). The index of bleeding on probing was also similar before the treatment and four weeks after the treatment in both groups. However, eight weeks after the treatment, this index was significantly lower in the Anaheal group as compared to the placebo group (p<0.05). Conclusion: Administration of oral Anaheal medication after nonsurgical periodontal treatments reduced all the clinical periodontal indices among patients with chronic periodontitis as compared to the control group. Therefore, it can be a suitable substitute for the common oral industrial antibiotics.

Effects of diode laser application on inflammation and mpo in periodontal tissues in a rat model

Abstract Objective In this study, we aimed to histologically and immunologically evaluate the effect of diode laser treatment when applied adjunctive to scaling and root planing (SRP) in an experimental periodontitis model. Materials and methods We used Wistar-Albino rats (n=60) with average weight of 230 g. Experimental periodontitis was induced by ligature at the right and left first mandibular molar teeth in all rats. After 11 days, the ligature was removed and rats were divided into two groups. The control group (n=30) received only SRP treatment, while the laser group (n=30) received a diode laser (GaAlAs, 810 nm, 1 W, 10 J, 20 s) treatment adjunctive to SRP. Ten rats in each group were sacrificed after 7, 15, and 30 days. Histopathological examination was performed in the left mandible of rats. Myeloperoxidase (MPO) was evaluated by western blot in the gingival specimens from the right mandible. Results MPO levels in the laser group were statistically significantly lower compared with the control group (p≤0.05). There was no statistically significance at any time between MPO levels in the control group (p>0.05). MPO levels in the laser group at the 7th day were statistically significantly higher compared to the 15th (p≤0.05) and the 30th day (p≤0.05). Inflammatory cell infiltration decreased over time in both groups and was statistically significantly lower in the laser group than in the control group at all times (p≤0.01). Conclusions Within the limits of this study, we suggest that diode laser application is an adjunctive treatment because it reduced inflammation and MPO when applied in addition to SRP. On the other hand, more studies are needed for the assessment of the effects of diode laser application to periodontal tissues.

Treatment of experimental periodontal disease by laser therapy in simvastatin-modified rats.

OBJECTIVE: The aim of this study was to evaluate low-level laser therapy (LLLT) as an adjuvant treatment for scaling and root planing (SRP) for the treatment of induced periodontitis in simvastatin-modified rats. MATERIAL AND METHODS: A total of 180 rats were evenly divided into two groups: Veh - receiving oral administration of polyethylene glycol (vehicle); S - receiving oral administration of Simvastatin. Periodontal disease was induced in both groups at the first mandibular molar. After seven days, the ligature was removed and the animals were divided into subgroups according to the following local treatments: NT - no treatment; SRP - scaling and root planing and irrigation with saline solution; and LLLT ¬- SRP and laser irradiation (660 nm; 0.03 W; 4 J). Ten animals in each subgroup/local treatment were euthanized at 7, 15 and 30 days. Samples of gingival tissue were processed to analyze the tissue oxidative damage and radiographic analysis. Levels of oxidative stress were analyzed by the expressions of Tripeptideglutathione (TG), Malondialdehyde (MDA) and Carbonylated Proteins (CP). RESULTS: The animals in S group had higher levels of TG and lower levels of MDA and CP compared with Veh group (p<0.05). Radiographically, in the intragroup analysis Veh and S, LLLT showed lower bone loss (BL) compared with NT and SRP, in all experimental periods (p<0.01). In addition, a lower BL was observed for the animals of Veh group treated with LLLT compared with treatment SRP in the S group, in all experimental periods. CONCLUSION: Within the limits of this study, we can conclude that LLLT was effective as adjuvant treatment for SRP protecting against the occurrence of oxidative tissue damages as well as for reducing alveolar bone loss in experimentally induced periodontitis simvastatin-modified rats.

Treatment of experimental periodontal disease by laser therapy in simvastatin-modified rats

Abstract Low intensity laser can be used as a promising alternative in the treatment of periodontal disease. Objective The aim of this study was to evaluate low-level laser therapy (LLLT) as an adjuvant treatment for scaling and root planing (SRP) for the treatment of induced periodontitis in simvastatin-modified rats. Material and Methods A total of 180 rats were evenly divided into two groups: Veh - receiving oral administration of polyethylene glycol (vehicle); S - receiving oral administration of Simvastatin. Periodontal disease was induced in both groups at the first mandibular molar. After seven days, the ligature was removed and the animals were divided into subgroups according to the following local treatments: NT - no treatment; SRP - scaling and root planing and irrigation with saline solution; and LLLT ¬- SRP and laser irradiation (660 nm; 0.03 W; 4 J). Ten animals in each subgroup/local treatment were euthanized at 7, 15 and 30 days. Samples of gingival tissue were processed to analyze the tissue oxidative damage and radiographic analysis. Levels of oxidative stress were analyzed by the expressions of Tripeptideglutathione (TG), Malondialdehyde (MDA) and Carbonylated Proteins (CP). Results The animals in S group had higher levels of TG and lower levels of MDA and CP compared with Veh group (p<0.05). Radiographically, in the intragroup analysis Veh and S, LLLT showed lower bone loss (BL) compared with NT and SRP, in all experimental periods (p<0.01). In addition, a lower BL was observed for the animals of Veh group treated with LLLT compared with treatment SRP in the S group, in all experimental periods. Conclusion Within the limits of this study, we can conclude that LLLT was effective as adjuvant treatment for SRP protecting against the occurrence of oxidative tissue damages as well as for reducing alveolar bone loss in experimentally induced periodontitis simvastatin-modified rats.

The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment on gingival crevicular fluid levels of transforming growth factor-beta 1, tissue plasminogen activator and plasminogen activator inhibitor 1 in smoking and non-smoking chronic periodontitis patients: A split-mouth, randomized control study.

BACKGROUND AND OBJECTIVE: This study aimed to investigate the effects of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) on smoking and non-smoking patients with chronic periodontitis. MATERIAL AND METHODS: The study was conducted using a split-mouth design with 30 patients with chronic periodontitis (15 smokers, 15 non-smokers) and 30 healthy individuals matched for age, sex and smoking status as controls. Groups were constituted as follows: Cp+SRP+Sham: non-smokers with chronic periodontitis treated with SRP; Cp+SRP+LLLT: non-smokers with chronic periodontitis treated with SRP+LLLT; SCp+SRP+Sham: smokers with chronic periodontitis treated with SRP; SCp+SRP+LLLT: smokers with chronic periodontitis treated with SRP+LLLT; C: control group comprised of periodontally healthy non-smokers; SC: control group comprised of periodontally healthy smokers. LLLT was first applied on the same day as SRP and again on days 2 and 7 after SRP treatment. Clinical parameters were recorded before non-surgical periodontal treatment (baseline) and on day 30. Gingival crevicular fluid samples were collected before periodontal treatment (baseline) and during follow-up visits on days 7, 14 and 30. Gingival crevicular fluid transforming growth factor (TGF)-ß1, tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) levels were measured using enzyme-linked immunosorbent assay. RESULTS: All clinical parameters showed significant reductions between baseline and day 30 following SRP treatment in both the LLLT and sham groups (P<.001). No significant differences were observed between the LLLT and sham groups of either the smokers or non-smokers (P>.05). Gingival crevicular fluid PAI-1 levels decreased significantly in the SCp+SRP+sham and SCp+SRP+LLLT groups (P<.05), and gingival crevicular fluid tPA levels decreased significantly in the Cp+SRP+sham, Cp+SRP+LLLT and SCp+SRP+LLLT groups (P<.05). Gingival crevicular fluid TGF-ß1 levels decreased significantly in all treatment groups (P<.05). Although no significant differences were found between the gingival crevicular fluid PAI-1, tPA and TGF-ß1 levels of the LLLT versus sham groups (P>.05) at any of the time points measured, both LLLT groups showed significant reductions in tPA/PAI-1 ratios over time. CONCLUSION: Within the limits of this study, LLLT may be understood to play a role in the modulation of periodontal tissue tPA and PAI-1 gingival crevicular fluid levels, particularly in smoking patients with chronic periodontitis, and may thus be recommended as an adjunct to non-surgical periodontal treatment.

Effect of scaling and root planing with and without adjunctive use of an essential-oil-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic patients.

AIM: The aim was to assess the effect of scaling and root planing (SRP) with and without adjunctive use of an essential-oil (EO)-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic (T2D) patients. METHODS: Sixty T2D patients were included. In Group 1 (n = 30), SRP was performed and patients were instructed to rinse twice daily with EO-based oral rinse for 30 days. In Group 2 (n = 30), SRP was performed and participants were instructed to rinse twice daily with water for 30 days. Periodontal parameters (plaque index (PI), bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 4 mm) and hemoglobin A1c (HbA1c) levels were assessed at baseline and after 90 days. RESULTS: In both groups, periodontal parameters were similar at baseline. After 90 days of follow-up, there was a significant reduction in the severity of periodontal parameters in patients in Group 1 compared with Group 2. After 90 days of follow-up, there was also a significant reduction in HbA1c among patients in Group 1 compared with Group 2. CONCLUSIONS: Scaling and root planing with adjunct use of an EO-based oral rinse is more effective in the treatment of periodontal inflammation in T2D patients than SRP alone. This approach also helps reduce hyperglycemia in T2D patients as compared with when SRP is performed alone.

The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis.

BACKGROUND AND OBJECTIVES: Although low-level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its effectiveness as an adjunct to non-surgical periodontal treatment. This study aimed to evaluate whether an additional benefit exists for the application of LLLT compared with scaling and root planing (SRP) alone. MATERIAL AND METHODS: An extensive search was conducted in the Cochrane Library (Issue 8, 2015), PubMed (1997) and EMBASE (1947) before August 2015 for randomized controlled trials (RCTs). The bias risk was assessed with the Cochrane tool for risk of bias evaluation. A meta-analysis was performed using REVMAN 5.3. RESULTS: After independent screening of 354 initial records, eight publications (seven RCTs) were included. However, six were rated as 'having a high risk of bias' as a result of major methodological weakness in 'allocation concealment' and 'blinding of key personnel'. Meta-analysis showed that LLLT-mediated SRP demonstrated significant short-term benefits over SRP monotherapy in the improvement of the probing pocket depth (p = 0.0009 at 1 mo; p = 0.03 at 2 mo) and the level of interleukin-1ß in the gingival crevicular fluid (p = 0.01 at 1 mo). Nevertheless, LLLT failed to show significant additional intermediate-term (3 and 6 mo) effects in terms of clinical parameters and alveolar bone density. CONCLUSION: These findings indicated that LLLT showed only short-term additional benefits after conventional SRP. Its long-term effects remain unclear due to substantial methodological weaknesses and an insufficient number of current studies. Future RCTs with better designs and longer follow-up periods are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.

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.