Effect of Nonsurgical Periodontal Therapy on Metabolic Control and Systemic Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with Stage III Periodontitis.

Background: A reciprocal relationship is understood to exist between periodontal disease and type 2 diabetes mellitus (T2DM), and this intervention study aimed to evaluate the effects of nonsurgical periodontal therapy (NSPT) on metabolic control, systemic inflammation, and cytokines in patients of T2DM with Stage III periodontitis. Materials and Methods: Sixty patients of T2DM with Stage III periodontitis were divided equally into two groups: intervention group (IG) and control group. Clinical parameters such as bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months, and the serum samples were collected and processed at baseline and 6 months following NSPT to evaluate fasting plasma glucose, Glycosylated hemoglobin (HbA1c), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and high-sensitivity capsule-reactive protein (hs-CRP). Results: The results indicated a significant improvement in clinical parameters of PPD and CAL 6 months after NSPT (P = 0.005) in both the groups. However, a significant decrease (P < 0.0001) in the TNF-α, hs-CRP, blood glucose, and HbA1c levels was seen after NSPT. On the other hand, an increase in anti-inflammatory cytokine IL-10 was observed after NSPT in the IG. The changes in the pretreatment and posttreatment levels of all clinical, biochemical, and metabolic parameters, were found to be significant in both the groups except BOP. Conclusion: NSPT effectively improves periodontal condition, systemic inflammatory status, and glycemic control in patients of T2DM with Stage III periodontitis and decreases hs-CRP levels.

Efficacy of simultaneous placement of dental implants in osteotome-mediated sinus floor elevation with and without bone augmentation: A systematic review and meta-analysis.

Background: The aim of the present systematic review was to assess the effectiveness of simultaneous placement of implant in osteotome-mediated sinus floor elevation (OMSFE) procedure with and without bone augmentation. Materials and Methods: An exploration of randomized clinical trials (RCTs) was systematically done in three databases comprising PubMed, Cochrane, and Google Scholar complemented by a thorough manual search of periodontology/implantology-related journals. A final inclusion of 6 RCTs (2010-2020) was done to investigate the efficiency of simultaneous implant placement with OMSFE in conjunction with bone augmentation. A meta-analysis was further conducted with comparable studies which assisted in attaining a final conclusion regarding the survival rate, endosinus bone gain (ESBG), and marginal bone loss (MBL). Results: Data synthesis was performed on the basis of 6 trials and further meta-analysis was performed to statistically validate the clinical and radiographic outcomes. Meta-analysis on the parameters indicated greater ESBG (mean difference [MD]: 0.82; [95% confidence interval [CI]: 0.72-0.91, P ≤ 0.0001]), which was also associated with minimal MBL (MD: -1.11; [95% CI: -1.53-0.68, P ≤ 0.0001)] in the bone augmentation group. However, the parameter of implant survival rate (risk ratio: 1.04; [95% CI: 0.83-1.31, P = 0.6849)] failed to reveal significant difference between the two groups. Conclusions: In the restoration of masticatory apparatus, simultaneous placement of implant in OMSFE with bone augmentation can be considered as successful and predictable treatment approach in deficient posterior maxillary ridges. It contributes toward bone neoformation resulting in greater ESBG as well as a substantial decrease in MBL.

Patient-centered outcome measures comparing the autogenous and allogenic bone blocks in the augmentation of deficient alveolar ridges: A pilot study.

Background: The aim of the present study was to evaluate and compare the patient-reported experience and outcome measures (PREMS and PROMS) and three-dimensional augmentation efficacy of the autogenous and allogenic bone block grafts in deficient alveolar ridges through cone beam computed tomography (CBCT). Materials and Methods: Twenty patients were equally divided into Groups I and II treated with autogenous and allogenic bone block grafts for ridge augmentation, respectively. The radiographic parameters including the apico-coronal defect height (DH) as well as buccolingual defect depth (DD) and mesiodistal defect width (DW) at apical, middle, and cervical zone were measured using CBCT at baseline, 6 months and 1 year. The PREMS and PROMS were evaluated using Visual analogue scale (VAS) scale and questionnaire method. Results: The mean DH, apical DD and DW, middle and cervical zone DW were significantly different between two study groups (P < 0.05). The mean apical 11.6 ± 1.91 and middle zone 9.43 ± 0.89 DD were significantly higher (in Group I as compared to Group II, with P values 0.016 and 0.004, respectively). The mean bone gains in apico-coronal DH and mesio-distal DW dimension in the apical and middle zone was significantly higher in Group I (P < 0.0001). The comparison of PROM revealed better patient satisfaction in Group II as depicted by significantly higher VAS score (P < 0.0001). Conclusion: Superior bone gain and reduced graft resorption was observed in Group I when compared to Group II. On the contrary, better PROMs and PREMs were obtained with the allogenic bone block augmentation.

Assessment and correlation of the influence of non-surgical periodontal therapy on serum lipid profile and cytokines in patients with stage III periodontitis.

BACKGROUND: Interleukins are the markers of inflammation and the lipid profile reveals the likelihood of arising cardiovascular disease (CVD). The present study aimed to assess and correlate the influence of non-surgical periodontal therapy (NSPT) on serum lipid profile and Interleukin-6 (IL-6) and Interleukin-8 (IL-8) in patients with Stage III periodontitis. METHODS: Sixty patients with the age range of 35-60 years with Stage III periodontitis were included by evaluating for periodontal parameters such as Probing pocket depth (PPD) and clinical attachment levels (CAL). NSPT was performed at baseline, 3 and 6 months. Biochemical parameters like serum lipid parameters of total cholesterol (TC), triglycerides (TG), low-density lipopolysaccharide (LDL), high-density lipopolysaccharide (HDL), and IL-6 and IL-8 serum levels were assessed at baseline and 6 months' post-NSPT. RESULTS: The results indicated a significant reduction (p < 0.0001) in the PPD (2.75 ± 0.41), CAL (3.23 ± 0.56), lipid profile, and serum cytokine levels 6 months' post-NSPT as compared to baseline. A highly significant (p < 0.0001) percentage reduction was observed in the IL-6 (35.3%), IL-8 (41.6%), TC (7.5%), TG (1.78%), LDL (6.2%), and HDL (-21.8%) clinical and biochemical parameters at 6 months' recall post-NSPT. CONCLUSION: Non-surgical periodontal therapy caused a significant reduction in the levels of serum pro-inflammatory cytokines IL-6 and IL-8 as well as the lipid biomarkers TC, TG, LDL, and increase values of HDL. These findings imply a considerable reduction in the risk of developing CVD in patients with Stage III periodontitis.

Efficacy of bone graft as monotherapy and in combination with platelet concentrates in grade II furcation defect - A systematic review and meta-analysis.

Background: The use of autologous platelet concentrates (PC) in addition to bone graft (BG) in open flap debridement (OFD) has been investigated to improve the efficacy and outcomes of regenerative therapy for furcation defects. This systematic review evaluated efficacy of added benefits of PC to bone grafts in treatment of grade II furcation defects. Methods: A thorough literature search on PubMed, Cochrane Library and Google Scholar databases was conducted. Data on outcomes were extracted only from randomized controlled clinical trials on humans with a minimum follow up of 6 months comparing BG alone and BG + PC in treatment of mandibular grade II furcation defect. Results: 36 of the 518 screened articles and abstracts were read in full-text, nine of which have been included in the meta-analysis. The addition of PC to BG has resulted in improvement in PD, GR (with smaller effect); V-DBD and H-DBD showed smaller change in experimental group whereas VCAL and HCAL exhibited overall larger changes with smaller effect. Conclusion: Bone regeneration in terms of defect fill with the addition of platelet concentrates to bone graft remains debatable considering the minimal benefits in the treatment of grade II mandibular furcation defect.

Proportions in papilla, crestal papilla, and proximal contact area in maxillary anterior teeth: A cross-sectional study.

Background: The regeneration and maintenance of the interdental papilla presents a great challenge to the clinician while smile designing. Proportions of papilla height (PH), crestal PH (CPH), and proximal contact areas (PCA) are more stable parameters. Aim: The purpose of the present study was to evaluate and correlate the papilla proportion (PP), crestal PP (CPP), and PCA proportion (PCAP) in periodontally healthy males and females. Materials and Methods: One hundred and twenty patients in an age group of 20-40 years, divided equally based on gender, were assessed for PH, CPH, and PCA of maxillary anterior teeth. The findings were recorded on study models and radiographs to obtain the PP, CPP, and PCAP on the mesial and distal aspects of respective tooth. Statistical Analysis: The overall comparison of parameters was performed using paired t-test. Results: The mean mesial PP (43.51% ± 3.10% for male and 45.23% ± 2.23% for female) and CPP values (48.36% ± 3.35% for male and 51.16% ± 2.96% for female) were found to be greater of each tooth type and were more pronounced for females. The PCAP values were greater for distal aspects (36.76% ± 7.00% for males and 33.30% ± 6.93% for females). Conclusion: The results of the study indicate that PP and CPP are more pronounced in females, while the PCAP is more marked in males. Furthermore, it appears that the PP and CPP are inversely related to the PCAP in both males and females.

Gender-based evaluation of positional variations of gingival papilla and its proportions: A clinicoradiographic study.

Background: The proportionate presence of natural teeth, gingival tissues along with the interdental papilla (IDP) is critical components of an esthetic smile. Hence, the present study examined the IDP height (PH), its position clinically and radiographically as papilla proportion (PP) and crestal PP (CPP). Materials and Methods: The study included 120 patients with healthy periodontium with an age group of 20-40 years, equally divided as males and females. The maxillary anterior interdental sites from canine to contralateral canine were examined for PH, PP, crestal PH (CPH), and CPP. Results: The mean values of PH, PP, CPH, and CPP were found to be greater on the mesial aspects of all the teeth as compared to the distal aspects. The females exhibited overall higher values than males for all the parameters. Majority of the teeth exhibited statistically significant differences for PP on mesial aspect when compared based on gender with mean values of 44.58% ±3.35% (males) and 47.17% ±3.23% (females) (P < 0.0001) for central incisor (CI). The CPP on mesial aspect for CI was 50.57% ±3.51% (males) and 54.21% ±3.76% (females) with P < 0.0001. A similar trend was followed in other teeth. Conclusion: The maxillary anterior teeth exhibit greater values on mesial aspects for parameters such as PH, PP, and CPP in both the gender thereby indicating an apical positioning of the IDP tip on distal aspect when compared to mesial. Furthermore, the values and differences were more pronounced in females than the males.

Comparative evaluation of peri-implant tissues in definitive and repeated abutment replacements: A randomized clinical trial.

BACKGROUND: Repeated abutment replacements may insults the soft tissue (mucosal) barrier mechanically, that might initiate other toxic irritants and bacteria into the mucosal-implant barrier that may affect the strength of the tissues around implants. The development of the "definitive abutment," might minimize the chances of peri-implant soft and hard tissue loss. Therefore, the study was designed to assess peri-implant tissue dimensions in dental implants with definitive abutment (Test group) and repeated abutment replacements (Control group). MATERIALS AND METHODS: Twenty edentulous sites from systemically healthy participants were selected for the study. Parameters registered were bleeding on probing, Sulcus probing depth, peri-implant marginal bone loss (PMBL) and additionally, two parameters were measured both clinically and radiographically, which included distance of cement enamel junction to alveolar crest (CEJ-AC) and distance of CEJ to gingival margin (CEJ-GM). At the time of surgery, sites were allocated randomly to either test group or control group. All the measurements were recorded at baseline, 3 and 6 months. RESULTS: The PMBL increased from baseline to 3 months in control (1.05 ± 0.28 mm) and test groups (0.65 ± 0.41 mm). When the clinical values of CEJ-AC and CEJ-GM were compared with their respective radiographic values, no substantial differences were noticed between both the groups. The soft-tissue margins in both the groups remained comparatively stable across all the time points. CONCLUSION: The findings of this study point toward the use of implants with definitive abutment are more beneficial in achieving better maintenance in terms of marginal peri-implant tissue health.

Influence of Adjunctive Photodynamic Therapy on Interleukin-6, Interleukin-8, and Interleukin-10 Gingival Crevicular Fluid Levels in Chronic Periodontitis - A Randomized Controlled Trial.

BACKGROUND: Numerous studies have assessed the effect of photodynamic therapy (PDT) both as a primary mode of treatment and as an adjunct to scaling and root planing in the treatment of periodontitis. Some results were nondefinitive and, in part, inconsistent with respect to the clinical and biochemical effects. Hence, the aim of this study was to evaluate the effect of PDT as an adjunct to nonsurgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) interleukin-6 (IL-6), IL-8, and IL-10 levels in the treatment of chronic periodontitis (CP). MATERIALS AND METHODS: In 21 patients with CP, two contralateral sites (premolar and molar) were randomly divided into: control sites (treated with NSPT only) and test sites (treated with NSPT + PDT). Clinical parameters including bleeding on probing (BOP), probing pocket depth, clinical attachment level were evaluated at baseline, 1- and 3 months and biochemical parameters of GCF levels of IL-6, IL-8, and IL-10 were evaluated at baseline and 3-month post-therapy through enzyme-linked immunosorbant assay. RESULTS: A greater improvement in BOP score at 1 month (41.10% ± 3.58%) and 3-months (38.00% ± 3.62%) posttherapy was found in the test site as compared to control site. Regarding cytokines, test sites exhibited significant reductions in IL-6 (4.29 ± 0.67 pg/ml) and IL-8 (308.16 ± 36.04 pg/ml) levels and increase in IL-10 (14.25 ± 0.83 pg/ml) level at 3 months (P < 0.0001). CONCLUSION: Additional application of PDT, adjunctive to NSPT, resulted in a significant reduction in BOP score as well as GCF pro-inflammatory cytokine levels along with an increase in anti-inflammatory cytokine levels, compared to NSPT alone.

Evaluation and association of periodontal status with levels of Porphyromonas gingivalis in chronic periodontitis with and without Type 2 diabetes mellitus following nonsurgical periodontal therapy using quantitative polymerase chain reaction: An interventional study.

BACKGROUND: The aim of the present study was to detect and correlate the levels of Porphyromonas gingivalis with clinical parameters after nonsurgical periodontal therapy (NSPT) in chronic periodontitis patients with or without Type 2 diabetes mellitus (T2DM), using quantitative polymerase chain reaction (Q-PCR) method. MATERIALS AND METHODS: Sixty patients equally divided into three groups, i.e., periodontally healthy (Group I), chronic periodontitis (CP) (Group II), and CP with T2DM patients (Group III) were assessed through clinical parameters of probing pocket depth (PPD) and clinical attachment level (CAL) and were correlated for the presence of P. gingivalis in the respective groups. PPD, CAL, and saliva samples for microbiological evaluation were assessed at baseline, 1-, and 3-month post-NSPT. RESULTS: Significant reduction of PPD was found 1.26 ± 0.22 versus 0.43 ± 0.33 mm in Group I, 4.62 ± 0.78 versus 2.58 ± 0.60 mm in Group II, and 6.28 ± 1.52 versus 4.01 ± 1.38 mm in Group III post-NSPT at 3 months. Similarly, a notable reduction of CAL was exhibited in both Group II (5.28 ± 0.80 vs. 3.12 ± 0.77 mm) and Group III (7.14 ± 1.59 vs. 4.51 ± 1.38 mm) patients after NSPT at 3 months. A greater reduction of P. gingivalis concentrations was observed in both Group II and Group III at 3-month post-NSPT. CONCLUSION: The substantial improvement of clinical parameters was found to be in correlation with the load of P. gingivalis, which was reduced more in Group II than in Group III, emphasizing the applicability and sensitivity of Q-PCR method for its assessment.

Assessment of knowledge, awareness, and attitude among patients with cardiovascular disease about its association with chronic periodontitis.

BACKGROUND: A strong bilateral relationship between cardiovascular disease (CVD) and chronic periodontitis has been established for decades. However, a knowledge gap regarding this association still persists among patients. The main objective of the present study was to assess the knowledge, awareness, and attitude among patients with CVD about its association with chronic periodontitis (CP). MATERIALS AND METHODS: This observational cross-sectional survey consisted of 500 patients with CVD. Along with information on demographic characteristics, data were collected on knowledge, awareness, and attitude of the interrelationships between periodontal disease and CVD, using a 5-point Likert scale, with 4 and 5 representing "agree" and "strongly agree," respectively. RESULTS: A significant number of the study population had no knowledge regarding the bilateral association CVD and CP. Other questions revealed limited awareness and ignorant attitude of the patients. CONCLUSION: Within the limitations of the study, it can be concluded that there is a lack of awareness and an ignorant attitude about the bidirectional relationship between CVD and periodontitis among the CVD patients. Special efforts should be taken by dental as well as medical professionals to increase the awareness in this regard and thereby deliver quality health-care services at earlier stages.

Association of location and diameter of alveolar antral artery to crest of alveolar bone in dentate and partially edentulous patients - A cone-beam computed tomography study.

BACKGROUND: One of the most challenging anatomical conditions to manage during sinus augmentation using lateral window approach is the alveolar antral artery (AAA) when it is unusually wide in diameter and passes through the area of the osteotomy with a complete intraosseous course. The purpose of this study was to investigate the association of location and diameter of AAA to the crest of alveolar bone in dentate and partially edentulous patients using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Totally 100 CBCT scans of patients (50 dentate and 50 edentulous) were selected and analyzed. The location and diameter of AAA in the lateral wall of the maxillary sinus were evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar (P1), second premolar (P2), and first molar (M1). RESULTS: The diameter of AAA in dentate patients was higher in M1 region (1.32 ± 0.34 mm) than P1 (0.91 ± 0.20 mm) and P2 (1.07 ± 0.24 mm) regions as compared to edentulous patients. It was found that the location of AAA for P1 in the dentate group (22.35 ± 4.17 mm) was significantly higher than that of the edentulous group (20.37 ± 2.48 mm). A negative relationship has been found between age and the distance between the AAA canal and crest of the alveolar ridge in both dentate (P = 0.001) and edentulous (P = 0.003). CONCLUSION: A significantly negative relationship existed between age, diameter, and location of AAA in both the dentate and edentulous groups.

Assessment of buccal and lingual alveolar bone width in the posterior region at dentate and edentulous sites: A cone-beam computed tomography study.

BACKGROUND: Alveolar bone dimensions form an important prognostic factor in determining the success of implant treatment outcome. The present study evaluated the buccal and lingual bone width in posterior dentate and edentulous sites using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The study included 100 patients, divided equally into two groups, Group A (males) and Group B (females) indicated for implant therapy. CBCT scans were evaluated for the assessment of the thickness of buccal and lingual bone width at four levels, i.e., crestal bone width (CBW), mid root bone width, middle of alveolar bone housing bone width , and most apical portion bone width (APBW). Bone width was measured at three levels in the edentulous region as CBW, bone width 5 mm from crest (CBW-1), and 10 mm from crest (CBW-2). RESULTS: Gradual increase in bone width was observed from crestal bone at buccal and lingual level (CBW-B and CBW-L) from 1.10 ± 0.29 mm and 1.21 ± 0.34 mm to APBW at buccal and APBW lingual side from 2.82 ± 0.51 mm and 3.43 ± 0.42 mm, respectively. For both the groups, the differences in bone width at three levels were statistically significant, with CBW being significantly higher for Group A than Group B. CONCLUSION: At edentulous sites, CBW was lesser as compared to the apical levels. The bone width on buccal and lingual sides of dentate sites at the coronal level is minimal compared to the apical level, which has definite implications for implant therapeutics.

Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized controlled split-mouth trial.

BACKGROUND: The objective of our study was to evaluate and compare the effectiveness of coronally advanced flap (CAF) with or without the use of platelet-rich fibrin (PRF) membrane in the treatment of multiple adjacent recession defects (MARD) clinically and by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Twenty healthy patients having 75 MARD were allocated randomly to CAF with orthodontic button group (CAFB) or CAFB + PRF membrane group (CAFB + PRF). Clinical parameters such as gingival recession depth (GRD), probing depth (PD), and keratinized tissue width (KTW) were calculated at baseline, 3 months, and 6 months. The distance from the facial alveolar crest of bone to gingival margin bone and gingival thickness (GT) at three different points were assessed by CBCT at baseline and 6-month postsurgery. Esthetic outcome and postoperative discomfort were evaluated using root coverage esthetic score and visual analog scale, respectively. RESULTS: Percent root coverage achieved in CAFB category was 93.17% ± 13.23% and that in CAFB + PRF group was 95.68% ± 10.13% at 6 months, with no notable difference. Similarly, no difference was found in either group in GRD reduction, PD, and CAL postoperatively. Use of PRF resulted in statistically highly significant (P < 0.001) increased GT at 6 months' time point as compared to participants treated with CAF without PRF, which indicates clinical and esthetic benefits achieved through the procedure. CONCLUSIONS: CAFB can be used successfully to treat MARD with predictable outcome. Additional benefit in terms of gain in KTW and GT can be achieved when PRF membrane is used as an adjunct.

Relevance of single-nucleotide polymorphism to the expression of resistin gene affecting serum and gingival crevicular fluid resistin levels in chronic periodontitis and type 2 diabetes mellitus: A randomized control clinical trial.

AIM: The present study is aimed to investigate whether single-nucleotide polymorphism (SNP) of resistin gene (RETN) at -420 and +299 sites, is associated with resistin levels in serum and gingival crevicular fluid (GCF) in periodontally healthy, chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM) patients. MATERIALS AND METHODS: Serum and GCF samples were procured from all the 60 patients (twenty in each group) of the three study groups i.e., periodontally healthy (Group I), CP (Group II) and CP with T2DM patients (Group III) to analyze resistin levels using enzyme-linked immunosorbent assay test and clinical parameters were assessed at baseline and at 3 months after scaling and root planing (SRP). RETN polymorphism at -420 and +299 was genotyped by polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: Patients with SNP -420 and +299 were positively correlated with increased serum and GCF resistin levels in Group II and Group III patients. SRP led to substantial reduction in the serum and GCF resistin levels. CONCLUSION: These findings are suggestive of a biologic link between resistin, periodontal diseases, and periodontal diseases with T2DM and RETN SNP at -420 and +299 in imparting increased resistin levels in inflammatory and diabetic conditions.

Comparative evaluation of open flap debridement alone and in combination with anorganic bone matrix/cell-binding peptide in the treatment of human infrabony defects: A randomized clinical trial.

BACKGROUND: The synthetic anorganic bone matrix/cell-binding peptide (ABM/P-15) has displayed an increased fibroblast migration and attachment with bone graft material, thus enhancing periodontal regeneration. The objective of the present study was to evaluate and to correlate the efficacy of open flap debridement (OFD) with and without ABM/P-15 in the treatment of human infrabony periodontal defects. MATERIALS AND METHODS: A total of 20 chronic periodontitis patients with equal number infrabony defects were randomly selected and assigned into two groups depending on the treatment received: Control group (treated with OFD) and Test group (treated with OFD + ABM/P-15). Clinical parameters recorded included plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), gingival recession, and radiographic defect depth (RDD) which were evaluated at baseline and 6 months postsurgically. RESULTS: When compared to baseline, both the treatment groups demonstrated improvements in the clinical parameters at 6 months. Test group exhibited a mean PPD reduction of 4.15 ± 1.04 mm, CAL gain of 3.10 ± 1.42 mm, and reduction in RDD of 1.90 ± 0.72 mm postoperatively at 6 months. In contrast to Control group, the Test group showed greater reduction in PPD (P < 0.05) which was statistically significant, greater CAL gain and greater mean RDD reduction (P < 0.001) which was highly significant. CONCLUSION: In the surgical management of periodontal infrabony defects, Test group elicited in statistically significant PPD reduction, CAL gain, and better infrabony defect fill at 6 months' postoperatively.

Risk assessment of osteoporosis in pre- and postmenopausal periodontally healthy and chronic periodontitis women with digital panoramic radiographs.

BACKGROUND: Osteoporosis is particularly high in females, the early identification of which remains a challenge. Panoramic radiographs are routinely advised to detect periodontal diseases and can be used to predict low bone mineral density (BMD). Hence, this investigation was aimed to identify the risk of osteoporosis in pre- and postmenopausal periodontally healthy and chronic periodontitis women with digital panoramic radiographs. MATERIALS AND METHODS: The study population consisted of 120 patients equally divided as Group I - Premenopausal periodontally healthy, Group II - Premenopausal periodontitis, Group III - Postmenopausal periodontally healthy, and Group IV - Postmenopausal periodontitis. Clinical parameters were recorded, and digital panoramic radiographs were used to record the mental index (MI), panoramic mandibular index (PMI), and mandibular cortical index (MCI) scores. RESULTS: MI was found to be varied, and the differences were highly significant among Group III and IV (P = 0.0003) and Group II and IV (P = 0.0007), and significant difference was found between Group I and Group II (P = 0.0113). MCI evaluation showed a greater prevalence of C2 and C3 patterns among postmenopausal women. MCI correlation with MI (P < 0.0001), PMI (P < 0.0001) and age (P = 0.0029) indicated a highly significant variance. CONCLUSION: The positive association between MCI and chronic periodontitis in postmenopausal women confirms the high risk of osteoporosis in them. Furthermore, an increased percentage of patients with undetected decrease in BMD may be identified by screening with digital panoramic radiographs which are done on a routine basis for periodontal and other dental diseases and thus could be used as an effective aid to quantify bone density in future.

Influence of interventional nonsurgical periodontal treatment on levels of salivary and serum nitric oxide in smokers and nonsmokers with chronic periodontitis.

BACKGROUND AND OBJECTIVE: Nitric oxide (NO) is a widespread signaling molecule which is known to influence varied biological processes. However, an uncontrolled high level of NO accelerates tissue destruction. The pathogenesis of periodontal disease is also affected by smoking which alters the inflammatory response. The present study was thus performed to assess the effect of nonsurgical periodontal treatment on salivary and serum NO levels in smokers and nonsmokers with chronic periodontitis. MATERIALS AND METHODS: Forty patients with chronic periodontitis, including 20 nonsmokers and equal number of smokers participated in the present study. Probing depth, clinical attachment level, plaque index, gingival index were assessed, serum and saliva samples were obtained from the patients at baseline and after Phase I therapy at 6 weeks to estimate NO by Griess colorimetric reaction. RESULTS: Smokers showed higher serum and saliva NO levels 30.3 ± 3.28 and 50.4 ± 4.07 µM as compared to nonsmokers 20.05 ± 2.42 µM and 37.5 ± 2.95 µM, respectively, at baseline. After Phase I therapy, both the groups exhibited significant improvement in clinical parameters and reduction in serum and saliva NO levels; however, reduction was higher in nonsmokers. CONCLUSION: More destructive expression of periodontal disease in smokers causes an increase in the concentrations of NO and less reduction after Phase I therapy as compared to nonsmokers with chronic periodontitis. Hence, NO levels in saliva and serum could be used as indicators of periodontal inflammatory condition.