Antibacterial and anti-inflammatory effects of a novel herb-mediated nanocomposite mouthwash in plaque-induced gingivitis: A randomized controlled trial.

BACKGROUND: Gingivitis is frequently painless, rarely causes spontaneous bleeding and is manifested by minor clinical changes. Therefore, most patients are unaware of the disease or do not seek treatment, as it is asymptomatic. Several methods for removing microbial plaque have been proposed, including mechanical and chemical ones. Amla or Indian gooseberry is a medicinal herb; its secondary metabolites, such as phenolic acid, flavonoids and terpenoids, can be used to preferentially reduce metal ions and form nanoparticles (NPs). Green synthesis with the use of the amla seed extract is a unique approach for the production of graphene oxide (GO)-silver (Ag) nanocomposite mouthwash. OBJECTIVES: The aim of the present study was to prepare an amla seed-mediated GO-Ag nanocomposite mouthwash, and to assess its antibacterial and anti-inflammatory efficacy in plaque-induced gingivitis. MATERIAL AND METHODS: The present double-blind randomized controlled trial was conducted among 30 gingivitis patients. The patients were randomly allocated into 2 groups based on the intervention: group A (n = 15; nanocomposite mouthwash); and group B - control (n = 15; 0.2% chlorhexidine (CHX) mouthwash). Clinical parameters, including the plaque index (PI), the gingival index (GI), a microbiological parameter - colony forming units (CFUs), and a biochemical parameter - the C-reactive protein (CRP) level in gingival crevicular fluid (GCF), were assessed at baseline and at 15 days. RESULTS: The study results showed statistically significant differences in the mean PI and GI scores, and the CRP levels in the post-intervention period as compared to baseline in both groups. After the intervention period of 15 days, there were statistically significant differences between the 2 study groups in terms of mean PI and GI scores, and CRP levels. CONCLUSIONS: The amla seed-mediated GO-Ag nanocomposite mouthwash efficiently reduced plaque, gingival inflammation and CFUs among patients with plaque-induced gingivitis, but was not equivalent to the CHX mouthwash.

Evaluation of alveolar antral anastomosis in south Indian population using cone beam computed tomography: a prospective study.

OBJECTIVES: The posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA), both of which are ultimate branches of the maxillary artery, are connected by a horizontal anastomosis. PSAA anastomoses intraosseously and extraosseously with IOA. Profuse bleeding from the lateral wall while performing the direct sinus augmentation is a significant intraoperative complication.Thus the present study focused to assess the location of an alveolar antral anastomosis (AAA) in relation to the crest of the alveolar bone using cone beam computed tomography (CBCT). METHODS: A total of 200 CBCT scans of patients who were indicated for implant surgery were chosen and assessed. Group 1 includes 100 dentate patients and Group 2 includes 100 partially edentulous patients. The location of anastomosis along the lateral wall of the maxillary sinus was evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar, second premolar, and first molar. RESULTS: The mean distance for P1, P2, and M1 was 21.94 ± 1.02 mm, 19.41 ± 0.40 mm, and 17.36 ± 0.51 mm, respectively, in the dentate group, whereas in the edentulous group, it was 20.07 ± 0.46 mm, 18.95 ± 0.32 mm, and 16.08 ± 0.16 mm. In 80% of participants, the distance of an AAA from the alveolar crest was between 16 and 23 mm, whereas in 12% of the participants the distance of an AAA from the alveolar crest was less than 16 mm. CONCLUSION: The present study concludes that the first premolar region is safe for preparing the lateral window but for the second premolar and first molar additional care should be taken prior to surgery.

Minimally Invasive Surgery Periodontal Therapy for the Treatment of Intrabony Periodontal Defects: A Systematic Review.

Background: Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects. Materials and Methods: An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted. Results: The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA. Conclusion: Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.

Comparative evaluation of combined efficacy of methylene blue mediated antimicrobial photodynamic therapy (a-PDT) using 660 nm diode laser versus Erbium-chromium-yttrium-scandium-gallium-garnet (Er, Cr: YSGG) laser as an adjunct to scaling and root planing on clinical parameters in supportive periodontal therapy: A randomized split-mouth trial.

AIM: The aim of this study was to evaluate combined efficacy of methylene blue mediated antimicrobial photodynamic therapy (a-PDT) using 660 nm diode laser versus Er, Cr: YSGG laser as an adjunct to scaling and root planing on improving the Probing depth (PD), Clinical attachment level (CAL), Plaque Index (PI) and Gingival Index (GI).clinical parameters in Supportive periodontal therapy. MATERIALS AND METHOD: In this split-mouth, double-blind, randomized controlled trial, we compared a-PDT versus Er,Cr:YSGG as an adjunct to scaling and root planning (SRP) with SRP alone in Supportive periodontal therapy. A total of 36 subjected were enrolled. In each patient, two quadrants constituted the control group (Group I - Scaling and root planing SRP alone), one site in other quadrant constituted the test group 1 (Group II - SRP followed by application of Er, Cr: YSGG laser), and another site in different quadrant constituted the test group 2 (Group III - SRP followed by antimicrobial Photodynamic therapy using diode laser). The diode laser was operated at a peak power of 70 mW using a 0.6 mm diameter fiber-optic tip. Each site was irradiated with a power density of 28 mW/cm2, for 10 s, thus delivering a total energy of 16.72 J/cm2 per tooth. Whereas, the Er,Cr:YSGG laser's parameters were set to 1 W of power, 10% air, and 15% water. The same procedure was repeated at 1st, 2nd and 3rd week for both the laser therapies. Plaque index (PI), Gingival index (GI), Probing depth (PD,) and Clinical attachment level (CAL) were measured by a single examiner at baseline and 3 months follow up. Inter group analysis of the parameters were done using One-way ANOVA and pairwise comparison was carried out by Tukey's post hoc test. Intra group analysis was performed using Students's paired t test. Statistical significance was set to p < 0.05. RESULTS: There were no significant differences between participants for clinical parameters at baseline. PI, GI PD, and CAL significantly improved at 3 months follow up compared to baseline in both the study groups (Group II - SRP + Er,Cr:YSGG, Group III - SRP + a-PDT) with P < 0.05. Adjunctive use of Er,Cr:YSGG laser with SRP showed better clinical outcomes than a-PDT with SRP. CONCLUSION: Nonsurgical periodontal therapy of chronic periodontitis using Er, Cr: YSGG, and a-PDT as an adjunct to SRP was significantly more effective than SRP alone in reducing PD, CAL, GI, and PI at 3 months follow up. Adjunctive use of Er,Cr:YSGG laser with SRP showed better clinical outcomes than a-PDT with SRP. However, the long-term positive benefits of the laser therapies are yet unknown and more research with longer follow-ups are required.