A Comparative Evaluation of Subgingivally Delivered 2% Curcumin and 0.2% Chlorhexidine Gel Adjunctive to Scaling and Root Planing in Chronic Periodontitis.

AIM: This study aimed to compare the effects of subgingival delivery of 2% curcumin gel and 0.2% chlorhexidine gel as an adjunct to scaling and root planing (SRP) on clinical and microbiological parameters in the management of patients with chronic periodontitis. MATERIALS AND METHODS: In total, 25 systemically healthy individuals with age group ≥30 years diagnosed with chronic periodontitis were included in the study. The study was a double-blind split-mouth randomized control clinical trial. Two sites were selected in each patient and were randomly allocated to experimental and control sites. At baseline, measurements of site-specific periodontal parameters and collection of subgingival plaque sample were done. After full-mouth SRP, subgingival delivery of 2% curcumin gel in experimental sites and 0.2% chlorhexidine gel in control sites was done. At 1 and 3 months, subgingival plaque samples were collected again and site-specific periodontal parameters were measured. RESULTS: The experimental group (2% curcumin gel) showed statistically significant improvements in periodontal [i.e., sulcus bleeding index (SBI), probing pocket depth (PPD), and relative attachment level (RAL)] and microbiologic parameters in the form of colony-forming units (CFUs) in comparison with control group (0.2% chlorhexidine gel). CONCLUSION: Subgingival delivery of curcumin has shown effective anti-inflammatory and antibacterial properties. Since it is biologically accepted by the patients and its delivery in periodontal pockets can be recommended as an adjunct to SRP therapy for the treatment of patients with localized, moderate chronic periodontitis and in patients under the periodontal maintenance phase. CLINICAL SIGNIFICANCE: Curcumin being a herbal agent may be excellent alternative to chlorhexidine. It is biologically accepted by the patients and can be recommended as an adjunct to SRP in the treatment of localized moderate chronic periodontitis and periodontal maintenance patients.

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

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

Associations between nonnutritive sucking habits, developing malocclusion, and various feeding practices in 3-6-year-old Indian urban children: A case-control study.

BACKGROUND: Nutritive sucking and nonnutritive sucking (NNS) may affect the craniofacial development, differently. AIM AND OBJECTIVES: We investigated associations between NNS habits (NNSHs), developing malocclusion, and various feeding practices in 3-6-year-old children. METHODOLOGY: A sample of 350 children 3-6-year-old from various preschools were selected for this case-control study (94 with NNSH and 256 without NNSH). NNSH (outcome) and feeding practices and developing malocclusions (exposures) were assessed using a structured study tool. RESULTS: The prevalence of NNSH in 3-6-year-old children was 26.8%. The odds (95% [confidence interval (CI)]) of boys compared to girls having NNSH were 0.66 (0.4121-1.706) (P = 0.0290). The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57% followed by spacing 8.5%, increased overjet 6.8%, crowding 2.2%, posterior crossbite and rotation 1.4%, and overbite 1.14%. Breastfeeding was found to be the most commonly used mode of feeding reported by 53.42% of mothers. It was found that the odds (95% [CI]) of subjects having NNSH were 0.66 (0.4694-0.9460) (P < 0.0001) who were not breastfed as compared to those who were breastfed. Among developing malocclusions, increased overjet with P = 0.0019, open bite with P = 0.0416, and spacing with P = 0.0243 were found to be associated with feeding practices. CONCLUSION: The prevalence of NNSH and developing malocclusions (increased overjet, open bite, and spacing) was 26.8% and 34.01%, respectively. Breastfeeding played a protective role against developing NNSH.

pH-sensitive semi-interpenetrating network of microcrystalline cellulose and methacrylic acid hydrogel for the oral delivery of insulin.

Insulin is commonly administered to diabetic patients subcutaneously and has shown poor patient compliance. Due to this, research has been carried out extensively to find molecules that could deliver insulin orally. In this context, a new type of pH-responsive hydrogel, composed of microcrystalline cellulose and methacrylic acid-based hydrogels, has been developed and studied for the oral delivery of insulin. These hydrogels were prepared by free radical polymerization using potassium persulphate as initiator and N, N'-methylenebisacrylamide as a cross-linker. These pH-sensitive hydrogels showed swelling in distilled water as high as 5800 %. The hydrogels were investigated for swelling in saline and glucose solutions, and pH sensitivity was confirmed by swelling in solutions of different pH. The morphological shape was established by SEM, and the structure was analyzed by FTIR. Thermal degradation was investigated by TGA. In vitro release studies have confirmed pH sensitivity, showing lower insulin release at pH 1.2 than at pH 6.8. The encapsulation efficiency was determined to be 56.00 ± 0.04 %. It was further validated by in-vivo investigations for which insulin was loaded into hydrogels and administered orally to healthy and diabetic Wistar rats at 40 IU/kg, showing maximum hypoglycemic effect at 6 h, which was sustained for 24 h. In the stomach's acidic environment, the gels remained unaffected due to the formation of intermolecular polymer complexes. Insulin remained in the gel and was protected from proteolytic degradation. Thus, pH-responsive methacrylic acid-based hydrogels are promising for biomedical applications, especially oral drug delivery.

Rewiring metabolism of Clostridium thermocellum for consolidated bioprocessing of lignocellulosic biomass poplar to produce short-chain esters.

Consolidated bioprocessing (CBP) of lignocellulosic biomass uses cellulolytic microorganisms to enable enzyme production, saccharification, and fermentation to produce biofuels, biochemicals, and biomaterials in a single step. However, understanding and redirecting metabolisms of these microorganisms compatible with CBP are limited. Here, a cellulolytic thermophile Clostridium thermocellum was engineered and demonstrated to be compatible with CBP integrated with a Co-solvent Enhanced Lignocellulosic Fractionation (CELF) pretreatment for conversion of hardwood poplar into short-chain esters with industrial use as solvents, flavors, fragrances, and biofuels. The recombinant C. thermocellum engineered with deletion of carbohydrate esterases and stable overexpression of alcohol acetyltransferases improved ester production without compromised deacetylation activities. These esterases were discovered to exhibit promiscuous thioesterase activities and their deletion enhanced ester production by rerouting the electron and carbon metabolism. Ester production was further improved up to 80-fold and ester composition could be modulated by deleting lactate biosynthesis and using poplar with different pretreatment severity.

Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer.

BACKGROUND: Oral squamous cell carcinoma (SCC) is associated with oral microbial dysbiosis. In this unique study, we compared pre- to post-treatment salivary microbiome in patients with SCC by 16S rRNA gene sequencing and examined how microbiome changes correlated with the expression of an anti-microbial protein. RESULTS: Treatment of SCC was associated with a reduction in overall bacterial richness and diversity. There were significant changes in the microbial community structure, including a decrease in the abundance of Porphyromonaceae and Prevotellaceae and an increase in Lactobacillaceae. There were also significant changes in the microbial community structure before and after treatment with chemoradiotherapy, but not with surgery alone. In patients treated with chemoradiotherapy alone, several bacterial populations were differentially abundant between responders and non-responders before and after therapy. Microbiome changes were associated with a change in the expression of DMBT1, an anti-microbial protein in human saliva. Additionally, we found that salivary DMBT1, which increases after treatment, could serve as a post-treatment salivary biomarker that links to microbial changes. Specifically, post-treatment increases in human salivary DMBT1 correlated with increased abundance of Gemella spp., Pasteurellaceae spp., Lactobacillus spp., and Oribacterium spp. This is the first longitudinal study to investigate treatment-associated changes (chemoradiotherapy and surgery) in the oral microbiome in patients with SCC along with changes in expression of an anti-microbial protein in saliva. CONCLUSIONS: The composition of the oral microbiota may predict treatment responses; salivary DMBT1 may have a role in modulating the oral microbiome in patients with SCC. After completion of treatment, 6 months after diagnosis, patients had a less diverse and less rich oral microbiome. Leptotrichia was a highly prevalent bacteria genus associated with disease. Expression of DMBT1 was higher after treatment and associated with microbiome changes, the most prominent genus being Gemella Video Abstract.

A rare osteolytic lesion in the mandible: A diagnostic dilemma.

Odontogenic myxofibroma is a benign tumour that is rarely encountered in any bone other than jaws. It accounts for only 3-11% of all odontogenic tumours. The pathogenesis of these tumours is still controversial and may arise from myxomatous degeneration or fibrous stroma or from the mesenchymal portion of the tooth germ. Clinically, they are slow-growing and can cause gradual expansion of the cortical plates, loosening, displacement of teeth, and rarely root resorption. Biologically, the tumour is locally aggressive with a high recurrence rate, which warrants extensive surgical treatment. Here, we present a case of central odontogenic myxofibroma in a 45-year-old female resulting in the extensive involvement of the mandible within a month.

Cone-beam Computed Tomographic Analysis of Deciduous Root Canals after Instrumentation with Different Filing Systems: An In Vitro Study.

Aim and objective: To evaluate root canal transportation, centering ability ratio (CAR), remaining dentine thickness, dentinal cracks, and instrumentation time after instrumentation with different filing systems in root canals of primary teeth by cone beam computed tomography (CBCT) analysis. Materials and methods: Sixty prepared canals of primary teeth divided into 4 groups with 15 canals in each were prepared with NiTi K files, Proaper Next (PTN) files, OneShape (OS), and WaveOne (WO) files, respectively. Using CBCT scan, the pre- and postinstrumentation scan was done to obtain images at three levels (apical, middle, and cervical). The results obtained were statistically analyzed using SPSS 21 statistical software version. Result: Significant statistical difference was found between different filing systems. Conclusion: ProTaper Next files showed least canal transportation and the best centering ability was shown by OS file system. The NiTi K hand files preserved maximum remaining dentin thickness (RDT) and produced minimum dentin cracks. WO file system took least instrumentation time when compared to the other three filing systems. Clinical significance: The use of rotary instruments in the pulpectomy of primary teeth represents a promising technique being advantageous for the pediatric patients by maintaining the original canal curvatures, showing greater ability to maintain dentin thickness, causing lesser dentin cracks, and reducing chair time thus favoring preparation of more conical root canals and better obturation. How to cite this article: Singh P. Cone-beam Computed Tomographic Analysis of Deciduous Root Canals after Instrumentation with Different Filing Systems: An In Vitro Study. Int J Clin Pediatr Dent. 2022;15(S-1):S22-S29.

Oral Hygiene Practices and the Awareness of Perio-Systemic Interrelationship Among the Population of Ranchi City: A Hospital-Based Study.

BACKGROUND: The concept of the pathogenesis and etiology of periodontal disease, with their infectious and chronic natures, usually facilitates acknowledging the possibility of these infections influencing events elsewhere in the body. Concurrent awareness and recognition of the interaction between systemic and oral diseases are one of the enormous advances that require a periodontist to not only strictly direct their knowledge toward prevention and treatment but also spread awareness about the same among the unknown. Thus, the primary goal of our study was to assess public awareness of periodontal and systemic interrelationships with oral hygiene practices in Ranchi, Jharkhand. METHODOLOGY:  A total of 800 subjects between ages 18 and 60 years visiting the outpatient department of periodontology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), were randomly selected for inclusion in the study. After the oral hygiene checkup, the patients were presented with a self-constructed questionnaire form, where patients' awareness and knowledge about perio-systemic interrelationship and their patterns about oral hygiene practices were assessed. RESULTS: The data collected was analyzed using mean and standard deviation (SD), while the chi-square (χ2) test was to evaluate the mean difference. The results of our study showed a fair oral hygiene index, minimal oral hygiene practices, and a lack of awareness regarding the interrelationship between bad oral health and systemic diseases among the population of Ranchi. Out of 800 subjects, the majority (around 44.25%) visited a dentist only if and when needed, and around 80% of the population continued using their toothbrushes for more than six months. In fact, awareness regarding the perio-systemic interrelationship was only among 5.12% (3.25% ± 1.87%) of the total population. CONCLUSION: Within the limitations of our study, it can be concluded that there is a need to educate the general population about the pros and cons of maintaining oral hygiene. Dental awareness, along with periodontal health care and its impact on systemic health, should be intensified through various means.

Disorder under stress: Role of polyol osmolytes in modulating fibrillation and aggregation of intrinsically disordered proteins.

Intrinsically disordered proteins (IDPs) comprise ~30-40% of the proteome, have key roles in cellular processes, and have been reported to be involved in stress regulation working in synergy with osmolytes. Osmolytes are known to accumulate against various stresses in living systems and are known to stabilize the native conformation of globular proteins. However, little is known of their effect on IDPs and their mechanism of action is unclear. We have investigated the effect of a series of polyol osmolytes on the conformation, aggregation and fibrillation properties of the IDPs α and ß-synuclein, involved in Parkinson's disease, using fluorescence, CD, light scattering and TEM. We observe inhibition of fibril and aggregate formation with increasing concentration as well as the number of hydroxyl groups in polyols as observed by light scattering measurements which correlates well with the increase in viscosity of solution with increasing number of OH groups in them. However, ThT assay, while indicating suppression of fibril formation at various concentrations of polyols, shows enhanced fibrillation at some other concentrations which could be due to the heterogeneity of the species formed that are ThT insensitive. Fibril formation was, thus, probed by using Nile red fluorescence which showed sensitivity towards the species formed. ANS binding fluorescence also indicates a decrease in the hydrophobicity of the fibrils with increasing number of OH groups in polyols. Polyols do not have any effect on the fibrillation of ß-syn but lead to enhanced amorphous aggregate formation in presence of Ethylene Glycol and Glycerol and a reduction in the presence of Sorbitol. The net free energy of transfer of the proteins from water to Sorbitol is large and positive while it is relatively negligible in the case of Glycerol suggestive of greater preferential exclusion effect of Sorbitol in comparison with Glycerol in the case of IDPs as well. The results overall show differential and complex effect of osmolytes towards the fibrillation/aggregation properties of the two IDPs and suggest that an appropriate balance between the concentration and type of polyol or osmolyte would be required for the survival of organisms rich in IDPs under various stress conditions.

PEGylated Lipova E120 liposomes loaded with celecoxib: in-vitro characterization and enhanced in-vivo anti-inflammatory effects in rat models.

The goal of the current investigation was to prepare PEGylated Lipova E120 liposomes loaded with celecoxib for the effective treatment of rheumatoid arthritis (RA). PEGylated liposomes were prepared and were characterized using techniques such as particle size distribution, polydispersity index (PDI), zeta potential, encapsulation efficiency and in-vitro release, in-vivo and stability studies. The morphological study was characterized by scanning electron microscopy and transmission electron microscopy. To determine the interaction between drug and polymer Fourier transform infrared, Raman, thermogravimetric analysis and differential scanning calorimetry studies were performed. Results show that formulation F6 was optimized with a particle size of 92.12 +/- 1.7 nm, a PDI of 0.278 +/- 0.22, a zeta potential of - 40.8 +/- 1.7 mV with a maximum encapsulation of 96.6 +/- 0.05% of drug in the PEGylated liposomes. The optimized formulation shows a maximum release of drug i.e. 94.45 +/- 1.13% in 72 h. Tail immersion assay shows that the optimized formulation F6 significantly increases the reaction time and carrageenan-induced assay shows that the optimized formulation inhibits the increase in paw edema thus providing a pain relief treatment in RA. These results suggest that the PEGylated liposomes provide a sustained release of celecoxib and helps in effective treatment of RA.

Oral tuberculosis - Current concepts.

Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.

One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial.

AIM: Alendronate (ALN) has antiresorptive and osteostimulative properties. The major component of aloe vera (AV) gel is acemannan, which has been found to have osteogenic properties. The aim of the present study is to explore the effectiveness of 1% ALN and AV gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with class II furcation defects. METHODS: Ninety volunteers were randomly assigned to three treatment groups: (a) SRP plus placebo gel; (b) SRP plus 1% ALN gel; and (c) SRP plus AV gel. Clinical and radiographic parameters were recorded at baseline and at 6 and 12 months. RESULTS: The mean probing depth reduction and relative horizontal clinical attachment level (CAL) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12 months. Furthermore, a significantly greater mean percentage of defect depth reduction (DDR) was found in the ALN group (38.09 ± 9.53, 44.86 ± 6.29) than the AV groups (11.94 ± 15.10, 14.59 ± 25.49) at 6 and 12 months, respectively. CONCLUSION: ALN showed significant improvement in all clinical parameters, along with greater DDR, compared to AV in the treatment of class II furcation defects as an adjunct to SRP.

Dialysis membrane-induced oxidative stress: role of heme oxygenase-1.

Dialysis membranes have been reported to induce monocyte apoptosis. We studied the role of oxidative stress in the induction of dialysis membrane-induced monocyte apoptosis. Superoxide dismutase, a superoxide scavenger, prevented dialysis membrane-induced monocyte apoptosis. Similarly, other antioxidants also inhibited dialysis membrane- induced apoptosis. In addition, the interaction of dialysis membranes with monocytes was associated with the generation of molecules leading to oxidative stress such as superoxide and TBARS. Interestingly, pre-induction of heme oxygenase (HO)-1 by hemin prevented dialysis membrane-induced monocyte apoptosis, whereas inhibition of HO-1 activity (treatment with tin protoporphyrin, SN-P) enhanced dialysis membrane-induced monocyte apoptosis. We suggest that oxidative injury associated with dialysis membrane and monocyte interaction plays a role in monocyte injury. Pre-induction of HO-1 may attenuate dialysis membrane-induced monocyte apoptosis.

Human chemerin correlation in gingival crevicular fluid and tear fluid as markers of inflammation in chronic periodontitis and type-2 diabetes mellitus.

AIM: The aim of the present study was to evaluate the levels and correlation of human chemerin in gingival crevicular fluid (GCF) and tear fluid in chronic periodontitis (CP) subjects with and without type-2 diabetes mellitus (DM). MATERIALS AND METHODS: A total of 40 subjects were divided into three groups: group 1 had 10 periodontally healthy subjects; group 2 consisted of 15 CP subjects and group 3 had 15 type-2 DM subjects with CP. The GCF and tear fluid levels of human chemerin were quantified using enzyme linked immunosorbent assay (ELISA). Systemic parameters such as body mass index, glycated hemoglobin levels and fasting plasma glucose levels were evaluated. The clinical outcomes evaluated were gingival index (GI), probing depth (PD), and clinical attachment level (CAL), and the correlations of the two inflammatory mediators with clinical parameters were evaluated. RESULTS: Human chemerin levels increased from group 1 to group 2 to group 3. The GCF and tear-fluid values of the inflammatory mediators correlated positively with each other and with the evaluated periodontal parameters (P < 0.05). CONCLUSION: Human chemerin can be considered as possible GCF and tear-fluid markers of inflammatory activity in CP and DM.

Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery.

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

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

Comparative efficacy of a herbal and a non-herbal dentifrice on dentinal hypersensitivity: a randomized, controlled clinical trial.

AIM: Dentinal hypersensitivity (DH) is a common painful condition of the teeth of adults. The present study was conducted to assess and compare the efficacy of a commercially-available novel herbal dentifrice with a non-herbal potassium nitrate in the reduction of DH. METHODS: A total of 145 individuals (73 males and 72 females; aged 25-60 years) were divided into three groups randomly: (a) group 1: a placebo dentifrice; (b) group 2: a commercially-available herbal dentifrice; and (c) group 3: 5% non-herbal potassium nitrate. The sensitivity scores for controlled air stimulus and cold water were recorded at baseline, 6 weeks, and 12 weeks. RESULTS: Both groups 2 and 3 were found to be significantly better, as compared to the placebo group at the end of 6 and 12 weeks in the reduction of DH. Group 2 also showed comparable results in the reduction of DH when compared to group 3. CONCLUSION: The herbal dentifrice showed comparable results to the non-herbal dentifrice and can be recommended for the treatment of DH.

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet-Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial.

BACKGROUND: A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second-generation, sulfur-containing, hydrophilic statin with potent anti-inflammatory and osseodifferentiation mechanisms of action. Platelet-rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double-masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open-flap debridement (OFD). METHODS: One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). CONCLUSIONS: Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.