Comparative evaluation of efficacy of topical and intra-sulcular application of Co-enzyme Q10 in the non-surgical treatment of periodontal diseases.

Background: Periodontitis is a ubiquitous and irreversible inflammatory condition that affects the supporting structures of teeth, which could lead to tooth loss as well as contribute to systemic inflammation. During the inflammatory phase, there is a release of superoxide ions and reactive oxygen species, which causes an increase in the oxidative stress. To combat this stress, the use of certain antioxidants has been proposed, which will help in maintaining the harmonious equilibrium. Aim: The aim of the present systematic review is to investigate the efficacy of topical and intrasulcular application of coenzyme Q10 in nonsurgical treatment of periodontal disease. Materials and Methods: We conducted a systematic review on the clinical studies which compared the use of coenzyme Q10 as an adjunct to nonsurgical periodontal therapy. The studies mentioned in this review were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and met our inclusion criteria - only randomized control trials in humans and literature published between 2000 and 2020 were included. Results: Therapies with coenzyme Q10 as an adjunct to scaling and root planing (SRP) proved to show superior improvement by reduction in the clinical parameters (plaque index, gingival index, bleeding on probing, and clinical attachment loss) when compared to SRP alone. Conclusions: Adjunctive therapy with coenzyme Q10 provides longer-lasting therapeutic effects and better results when compared with SRP alone. The possibility to use the gel as a sole agent to support standard treatment procedures in periodontitis is also suggested.

Can procedure time for paracentesis be optimized based on bottle selection?

PURPOSE: The purpose of our study was to assess if plastic containers could decrease the overall procedure time for paracentesis relative to more commonly used glass containers. METHODS: In this IRB exempt study, initial pilot data comparing filling time of glass and plastic containers in an ex vivo setting under identical conditions revealed power calculations that n = 37 patients per group would be needed to achieve standard deviation (SD) = 60 s, difference (diff) = 40 s, two-tailed alpha-level 0.05, and power 80%. Total of 43 patients (93 containers) were enrolled and randomized to glass or plastic bottles at enrollment. Timing of bottle filling was assessed using standardized sonographic screen captures. RESULTS: An interim look at statistics at n = 20 patients indicated that original conjectures from pilot data were conservative and smaller sample size was sufficient to stop the study and conduct the analyses. Specifically, SD = 54 s, diff = 49 s, two-tailed alpha-level 0.05, and power 80% required n = 21 patients per group. Plastic containers had a statistically significantly lower average filling time per bottle (162.7 ± 53.3 s) compared to glass (212.2 ± 50.4 s) (p = 0.003). Viscosity was calculated for each specimen and did not affect the statistical significance of the results (p = 0.32). CONCLUSION: Plastic containers have 50 s time savings of per bottle filling time as compared to glass bottles as theorized based on their faster flow rate. This holds true in both an ex vivo setting and in patients and can have important downstream impacts on patient throughput, provider efficiency and system wide cost savings.

A comparative evaluation of biphasic calcium phosphate material and bioglass in the treatment of periodontal osseous defects: a clinical and radiological study.

AIM: The aim of this study was to evaluate the efficacy of biphasic calcium phosphate (ossifi) and bioactive glass in the treatment of periodontal osseous defects clinically and radiographically and compare them with open-flap debridement. METHODS AND MATERIALS: A total of 45 sites in two test groups (test 1, ossifi; test 2, bioactive glass) and a control group (open-flap debridement), in 35 patients, were selected in this study conducted at the department of Periodontics and Oral Implantology, D.A.V.(C) Dental College, Yamuna Nagar, India. Clinical parameters like plaque index, gingival index, pocket depth, and clinical attachment level were recorded at the baseline and at three months and six months postoperatively. Radiological parameters like the amount of defect resolution and the percentage of defect resolution were recorded at the baseline and at three months and six months postoperatively. RESULTS: Statistically significant difference in mean values of the plaque index, gingival index, pocket depth reduction, clinical attachment level, gain amount of defect resolution, and percentage of defect resolution were observed in all the groups at subsequent time periods. CONCLUSION: Both test groups showed significant improvement over the control in both the clinical and radiological parameters. CLINICAL SIGNIFICANCE: A greater percentage of defect resolution was noticed in test 1 as compared to test 2, followed by the control.

Ceramic soft tissue trimming bur: A new tool for gingival depigmentation.

OBJECTIVE: Pigmentation of the gingiva plays a negative role in an otherwise acceptable "smile window". In the present world, people are more concerned about their aesthetics. Several techniques have been employed such as scalpel surgery, electrosurgery, cryosurgery, chemical agents, abrasion and LASER method for the removal of melanin hyper-pigmentation. The present study is aimed at comparing the efficacy of LASER and soft tissue trimmer for gingival depigmentation. METHODS: A randomized split-mouth study was conducted for twenty patients with gingival pigmentation. Dummet Oral Pigmentation Index (DOPI), Gingival Pigmentation Index (GPI) for pigmentation, bleeding factor, wound healing factor, gingival colour and visual analogue scale (VAS) score for pain were evaluated for both the groups at baseline, 7th day, 1st month and 6th month. RESULTS: Intra-group comparison between baseline and 6th month showed highly significant difference for both LASER and bur groups. There was no statistically significant difference found between both the groups at 6th month using gingival pigmentation index. CONCLUSION: It can be concluded that LASER and soft tissue trimmer both are comparable in achieving aesthetic satisfaction. Hence, the soft tissue trimmer could also be used for depigmentation as it is very cost effective, readily available and acceptable by the patients.

A clinico-microbiologic study comparing the efficacy of locally delivered chlorhexidine chip and diode LASER as an adjunct to non-surgical periodontal therapy.

BACKGROUND: Considering the microbial etiology of the periodontal disease, the periodontal therapy aims to control or abolish the pathogenic microbes. The gold standard scaling and root planing procedure has been used since time immemorial but the drawbacks associated with it have led to the development of various adjunctive means. The current study was therefore, performed to comparatively assess the efficacy of local delivery of chlorhexidine and 808-nm diode LASER as an appurtenance to scaling and root planing in patients with chronic periodontitis. METHODS: In a randomized split mouth evaluation, 30 patients having probing depth of ≥5 mm which bled on probing at least at 3 different sites were included. At baseline, the evaluation of plaque index, bleeding index, probing pocket depth and clinical attachment level was done and the microbial samples were collected for the assessment of spirochetes, motile rods and coccoid cells. The 3 selected sites of each subject were allocated to 3 different groups A, B, C viz; Scaling and root planing (SRP) + chlorhexidine chip, SRP + diode LASER and SRP respectively. The patients were recalled after 4 weeks to re-evaluate the clinical and microbiological parameters. RESULTS: All the parameters significantly reduced from baseline to 4 weeks in all the 3 groups. Intergroup comparisons revealed remarkable difference between group A and C and group B and C, respectively; no notably significant difference was found between group A and B. CONCLUSION: The additional use of LASER and chlorhexidine chip assures anti-inflammatory effect and anti-microbial effect that allows reduction in bacterial counts and promotes healing. The use of adjuncts have been found to be efficacious in controlling disease and promoting periodontal health and thereby reducing the need for surgical procedures to be undertaken.

Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis.

AIM: The aim of this study was to evaluate and compare the efficacy of subgingivally delivered 10% doxycycline hyclate and xanthan based chlorhexidine gels when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS AND MATERIALS: A randomized, controlled, single center study was conducted involving 90 sites in 30 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of doxycycline gel [SRP+DH], SRP + insertion of chlorhexidine gel [SRP+CHX]), and SRP alone [SRP]. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 1 month, and 3 months post therapy. RESULTS: All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (p<0.001). At 3 months, sites treated with SRP+DH and SRP+CHX showed an additional reduction in PPD of 0.86 +/- 1.0 mm and 0.66 +/- 1.58 mm, respectively, significantly greater than SRP alone (p<0.02). Differences in mean PPD reduction between SRP+DH and SRP+CHX were not significant (p=0.46). At 3 months, differences in relative CAL between both SRP+DH (0.80 +/- 0.92) and SRP+CHX (0.63 +/- 1.47) and SRP alone were statistically significant (p<0.02). Differences in relative CAL between SRP+DH and SRP+CHX were not significant (p=0.54). CONCLUSION: The results suggest treatment with 10% doxycycline hyclate and xanthan based chlorhexidine gels as an adjunct to SRP improves PPD and CAL patients with periodontitis compared to SRP alone. CLINICAL SIGNIFICANCE: The use of local drug therapy may refocus the need for surgical periodontal therapy toward deeper pockets.

Clinical and radiological evaluation of an osseous xenograft for the treatment of infrabony defects.

OBJECTIVE: To evaluate the effectiveness of demineralized bone matrix (DMBM), an osteoconductive and osteoinductive graft material, as a bone graft for the treatment of osseous defects, both clinically and radiographically. MATERIALS AND METHODS: The effectiveness of DMBM was assessed at 40 sites in 30 patients who had infrabony defects. Grafted test sites were compared with control sites treated with open-flap debridement. RESULTS: Significant improvement in all variables was found, including reduction of probing depth, and gain in clinical attachment level and bone fill for test and control sites at 3 months and 6 months postoperatively. For test sites, reduction of probing depth was 2.80 mm at 3 months and 4.05 mm at 6 months, and for control sites, 1.75 mm at 3 months and 2.65 mm at 6 months. Gain in the level of clinical attachment for test sites was 2.80 mm at 3 months and 4.00 mm at 6 months; for control sites, this gain was 1.75 mm at 3 months and 2.60 mm at 6 months. The mean amount of defect resolution was 2.02 mm and 3.27 mm for test sites and 0.82 mm and 1.17 mm for control sites, at 3 months and 6 months, respectively. The mean percentage of defect resolution was 37.1% and 56.5% for test sites compared with 20.5% and 28.6% for control sites, at3 months and 6 months, respectively. CONCLUSIONS: DMBM improves healing outcomes, namely, reduction of probing depth, resolution of osseous defects and gain in clinical attachment, compared with open flap debridement.

Clinical evaluation of a bioresorbable membrane (polyglactin 910) in the treatment of Miller type II gingival recession.

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Comparative evaluation of coenzyme Q10-based gel and 0.8% hyaluronic acid gel in treatment of chronic periodontitis.

BACKGROUND: The anti-inflammatory and immune enhancing effects of coenzyme Q10 (CoQ10) and hyaluronic acid are well established in medical literature. The present study was undertaken to evaluate their role in chronic periodontitis. MATERIALS AND METHODS: One hundred twenty sites in 24 patients with clinically confirmed periodontitis were included in the study. A split-mouth design was used for intrasulcular application of CoQ10 as adjunct to scaling and root planing (SRP), 0.8% hyaluronic acid as adjunct to SRP and SRP alone. Clinical parameters such as plaque index (PI), gingival color change index (GCCI), Eastman interdental bleeding index (EIBI), pocket depth (PD), and clinical attachment level (CAL) were recorded. All the clinical parameters PI, EIBI, GCCI, PD, and CAL were recorded at baseline before SRP. Only PI, EIBI, and GCCI were recorded at 1st and 2nd week. Twenty-one days post 2nd week, i.e., 6th week all the clinical parameters were recorded again. RESULTS: Intragroup analysis of all the clinical parameters showed clinical significant results between baseline and 6th week. However, on intergroup analysis, the results were not significant. CONCLUSION: The local application of CoQ10 and hyaluronic acid gel in conjunction with SRP may have a beneficial effect on periodontal health in patients with chronic periodontitis.

Morphological study of proximal root grooves and their influence on periodontal attachment loss.

BACKGROUND: The etiology of periodontal diseases is multifactorial including both systemic and local causes. Local factors such as grooves on root surfaces contribute a great deal to the causation of periodontal diseases. MATERIALS AND METHODS: Proximal radicular grooves were studied in 150 extracted maxillary and mandibular anterior teeth. Periodontal attachment loss was measured after staining the root surfaces with 0.1% toluidine blue stain. The relationship of the presence and absence of grooves with periodontal attachment loss was also studied. RESULTS: The prevalence of proximal root grooves was found to be 86.67%. The prevalence of grooves on maxillary teeth was 43.42% and on mandibular teeth was 56.67%. A greater loss of attachment was present on grooved surfaces than on nongrooved surfaces. CONCLUSION: The proximal radicular grooves present as one of the major etiological factors in periodontal diseases.

2% sodium fluoride-iontophoresis compared to a commercially available desensitizing agent.

BACKGROUND: Dentin hypersensitivity is a common clinical condition and age-old complaint, presenting problems to both the patient and the dentist. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. The failure to practice satisfactory plaque control has well-established consequences on gingival and periodontal health. Thus, a cycle of sensitive teeth leading to reduced plaque control, more periodontal disease, and more recession may be established. METHODS: The hypersensitive teeth were identified by the patient and verified by the light stroke of a dental explorer along the cervical area of all teeth present. Subjects fulfilling the inclusion and exclusion criteria were evaluated using tactile, 1-second air blast, and cold water stimuli, and the subject's response was recorded on the verbal rating scale. A total of 425 teeth from 50 patients included in this study were randomly divided into two groups: group 1, who received 2% sodium fluoride-iontophoresis (NaF) and group 2, who received an aqueous solution of hydroxy-ethyl-methacrylate and glutaraldehyde (HEMA-G). The teeth were evaluated immediately after treatment and at 2 weeks, 1 month, and 3 months. In case of failure at the 2-week interval, the affected tooth was retreated with the same drug as before and evaluated further. RESULTS: The results were statistically analyzed, and it was found that group 1 treatment was more effective than group 2 at 1- and 3-month intervals. There was a comparatively greater recurrence of hypersensitivity in group 2. A comparable number of teeth required repeat dosage in both groups. Teeth which required repeat dosage had greater mean discomfort scores at baseline for all three tests than the teeth which did not require a repeat dose. CONCLUSIONS: Both agents showed significant reduction in sensitivity at all time intervals compared to baseline; however, NaF had a comparatively greater effect than HEMA-G at both the 1- and 3-month intervals; an almost equal number of teeth in both groups required repeat doses. Teeth with a higher initial sensitivity score required a repeat dose. Both agents were found to be equally effective immediately after application; the 2% NaF was comparatively better than HEMA-G in providing long-term relief.

Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft.

OBJECTIVE: Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. The search for the appropriate root coverage techniques has resulted in many different approaches. The goal of this study was to evaluate the degree of patient acceptance with acellular dermal matrix (ADM) allograft in the treatment of buccal gingival recession and to compare it with subepithelial connective tissue graft. MATERIALS AND METHODS: Thirty patients with Miller's class II recessions were treated and randomly assigned to the test group (ADM) and control group (subepithelial connective tissue graft). All patients underwent full periodontal evaluation and pre-surgical preparation, including oral hygiene instructions and scaling and root planing. The exposed roots were thoroughly planed and covered by a graft without any further root treatment. Results were evaluated based on the parameters measuring patient satisfaction and clinical outcome after 6 months of the surgical procedure. RESULTS: Postoperatively, significant root coverage, reduction in probing depth, gain in clinical attachment level, and increase in widths of keratinized tissue and attached gingiva were observed on intra-group comparison. There was no significant difference in any of the parameters between test and control groups. CONCLUSION: The subepithelial connective tissue graft and ADM graft were able to successfully treat gingival recession defects; however, the ADM showed better patient acceptance than the connective tissue graft.

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis.

OBJECTIVE: The aim of this study was to evaluate and compare the efficacy of subgingivally delivered Minocycline microspheres and 25% Metronidazole gel when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A randomized, controlled, single center study was conducted involving 60 sites in 20 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of Minocycline microspheres at day 1 (Group A), SRP + insertion of Metronidazole gel at day 1 and at day 7 (Group B), and SRP alone (Group C). Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at day 1, 1 month, and 3 months post therapy. RESULTS: All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (P < 0.001). At 3 months, sites treated with minocycline showed an additional reduction in PPD of 0.85 ± 0.03 mm, significantly greater than SRP alone. Differences in mean PPD reduction between Group B and Group C and between Group A and Group B were not significant. At 3 months, difference in CAL gain between Group A and C was 0.50 ± 0.45, which was statistically significant and between Group B and C was 0.35 ± 0.11, which was not found to be statistically significant (P = 0.20). Differences in relative CAL between Group A and Group B were also not found to be statistically significant (P = 0.53). CONCLUSION: The results concluded that treatment with Minocycline microspheres and Metronidazole gel improve PPD and CAL in patients with periodontitis compared to SRP alone.

Burning mouth syndrome and menopause.

Menopause is a physiological process typically occurring in the fifth decade of life. One of the most annoying oral symptoms in this age group is the burning mouth syndrome (BMS), which may be defined as an intraoral burning sensation occurring in the absence of identifiable oral lesion or laboratory findings. Pain in burning mouth syndrome may be described as burning, tender, tingling, hot, scalding, and numb sensation in the oral mucosa. Multiple oral sites may be involved, but the anterior two-third part and the tip of tongue are most commonly affected site. There is no definite etiology for BMS other than the precipitating causative factors, and it is still considered idiopathic. Various treatment options like use of benzodiazepine, anti-depressants, analgesics, capsaicin, alpha lipoic acids, and cognitive behavioral therapy are found to be effective, but definite treatment is still unknown. The present article discusses some of the recent concepts of etiopathogenesis of BMS as well as the role of pharmacotherapeutic management in this disorder.

Recurrent gingival swelling in pregnant women.

The aim of this case report is to present a rare case which has been reported with the history of small nodule like growth on mandibular buccal and lingual area. Thirty year old pregnant women reported a nodule on left mandibular buccal and lingual region. The lesion was surgically excised and sent for biopsy to differentiate from kimura's disease, pyogenic granuloma, epithelioid angiosarcoma (EH). Histologically lesion shows proliferation of endothelial cells along blood vessels suggesting epithelioid hemangioma. The purpose of this report is to discuss and differentiate EH and other vascular rare entities occurring in the oral cavity.

Reactive oxygen species in periodontitis.

Recent epidemiological studies reveal that more than two-third of the world's population suffers from one of the chronic forms of periodontal disease. The primary etiological agent of this inflammatory disease is a polymicrobial complex, predominantly Gram negative anaerobic or facultative bacteria within the sub-gingival biofilm. These bacterial species initiate the production of various cytokines such as interleukin-8 and TNF-α, further causing an increase in number and activity of polymorphonucleocytes (PMN) along with these cytokines, PMNs also produce reactive oxygen species (ROS) superoxide via the respiratory burst mechanism as the part of the defence response to infection. ROS just like the interleukins have deleterious effects on tissue cells when produced in excess. To counter the harmful effects of ROS, human body has its own defence mechanisms to eliminate them as soon as they are formed. The aim of this review is to focus on the role of different free radicals, ROS, and antioxidants in the pathophysiology of periodontal tissue destruction.

Comparative evaluation of two commercially available desensitizing agents for the treatment of dentinal hypersensitivity.

AIMS: A randomized clinical trail was designed to compare the efficacy of two commercially available desensitizing agents (fluoride varnish containing 6% sodium fluoride and 6% calcium fluoride and a gel containing 6% potassium nitrate and 0.11% fluoride ions) in the treatment of dentinal hypersensitivity. SETTINGS AND DESIGN: Randomized clinical trial. MATERIALS AND METHODS: Twenty-one patients were selected. Subjects were evaluated using three different stimuli, i.e., tactile test, air blast test and cold water test. They were then randomly divided into two groups. Patients in group I were treated with fluoride varnish and group II patients were treated with gel containing 6% potassium nitrate and 0.11% fluoride ions. The patients were examined at baseline, immediately after application of the agent, at 1 week, 1 month and 3 months interval. STATISTICAL ANALYSIS: Statistical analysis was done using unpaired "t" test, paired "t" test and Chi-square test with Yate's correction. RESULTS: The results were analyzed; it was seen that patients treated in group I showed significantly better results compared to group II patients at 1 month and 3 months interval. Teeth which required repeat dose and those which did not require repeat dose were comparable in number. CONCLUSIONS: Both the agents showed significant reduction in sensitivity at all time intervals compared to baseline. A comparatively significant reduction in sensitivity score was seen in patients treated with fluoride varnish and it appeared to be more effective in providing long-term relief against all the three test stimuli. Teeth with initial high sensitivity score required repeat doses, which was comparable for both the groups.

Obesity, periodontal and general health: Relationship and management.

Obesity is a multifaceted subject. It has increased at an alarming rate in recent years. Being overweight increases the likelihood of a patient having associated health and social problems which may affect dental services and dental management. A review of the literature on obesity and periodontal disease suggested that they both confound each other and obesity itself has been recognized as a major risk factor for periodontal disease. It has been found that adverse effects of obesity on the periodontium may be mediated through pro-inflammatory cytokines and various other bioactive substances. This article tries to focus on the possible role of obesity and obesity-related diseases like diabetes and coronary heart diseases (CHD), as a potential contributor to periodontal disease and vice versa. The meanings of these associations can be useful for various diagnostic and treatment planning purposes.

Effect of insertion of xanthan-based chlorhexidine gel in the maintenance phase following the treatment of chronic periodontitis.

OBJECTIVES: The aim of this study was to evaluate the efficacy of subgingivally administered xanthan-based chlorhexidine gel when used in the maintenance phase following scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A randomized, controlled, single-center study was conducted involving 92 sites in 46 systemically healthy patients suffering from moderate to advanced chronic periodontitis with isolated pockets. The selected sites were randomized to two treatment arms: Group A (SRP alone) and Group B (SRP + insertion of chlorhexidine gel after 1 month). The gingival index, plaque index, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 month and 3 months. RESULTS: Both the groups showed significant reductions in PPD and CAL at both follow-up visits when compared with the baseline values (P<0.001). CONCLUSIONS: The results suggest that the application of xanthan based chlorhexidine gel following SRP in the maintenance phase might be beneficial in treatment of the chronic periodontitis in comparison to SRP alone. Greater improvements may be achieved when antimicrobial agents are used following SRP.

Comparative evaluation of hand and power-driven instruments on root surface characteristics: A scanning electron microscopy study.

AIM: The aim of this study was to compare root surface characteristics following root planing with various hand- and power-driven instruments. MATERIALS AND METHODS: A total of 20 single, rooted teeth were used in this study; two specimens were used as control (no instrumentation done) and the remaining 18 specimens were equally divided into three groups. Specimens from each group were then subjected to root planing by one of the following instruments: (1) a Gracey curette, (2) ultrasonic tip and (3) a Rotary bur. In each case, the time required for scaling and root planing and surface roughness using the Roughness and Loss of Tooth Substance Index (RLTSI) was measured. RESULT: The mean RLTSI scores for the Gracey curette, ultrasonic and rotary instrument groups were 2.5, 2.0 and 0.667, respectively. The mean scores of time spent for scaling and root planing by the Gracey curette, ultrasonic and rotary instrument groups in seconds were 42.50, 35.83 and 54.50, respectively. CONCLUSIONS: All the three instruments, namely Gracey curette, ultrasonic tip and rotary bur, were effective in mechanical debridement of the root surface. The results favored the use of rotary instruments for root planing to achieve a smooth, clean root surface; however, the use of rotary instrument was more time consuming, which might limit its use in clinical practice.