Clinical and radiographic evaluation of platelet-rich fibrin and bone graft material (ß-tricalcium phosphate + hydroxyapatite) in the treatment of intrabony defects of periodontitis patients: a randomized controlled trial.

OBJECTIVE: The present study aimed to assess the clinical and radiographic effect of a bone graft material (ß-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet-rich fibrin in intrabony defects of periodontitis patients. METHOD AND MATERIALS: This 6-month randomized controlled clinical trial was carried out in 42 intrabony periodontal defects (average age 40 years). Intrabony defects ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase 1 periodontal therapy were treated either with open flap debridement with bone graft (ß-tricalcium phosphate + hydroxyapatite; control group) or open flap debridement with bone graft plus platelet-rich fibrin membrane (test group). Individual customized acrylic stents with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative clinical attachment level (RCAL), gingival marginal level (GML), vertical bone defect fill (VHD), and area of intrabony defects (AOD) on intraoral periapical radiographs. Clinical attachment level (CAL) gain was considered as primary outcome and PPD reduction and radiographic bone fill as secondary outcomes. RESULTS: The preoperative Plaque Index, RCAL, GML, PPD, VHD, and AOD in the control group were 1.06 ± 0.08, 11.57 ± 2.29 mm, 5.24 ± 1.89 mm, 6.29 ± 1.52 mm, 14.36 ± 2.65 mm, and 7.79 ± 4.39 mm2, respectively. After 6 months these were 1.08 ± 0.14, 9.34 ± 2.54 mm, 5.81 ± 2.20 mm, 3.52 ± 0.93 mm, 12.64 ± 2.34 mm, and 5.34 ± 3.2 mm2, respectively. The preoperative PI, RCAL, GML, PPD, VHD, and AOD in the experimental group were 1.14 ± 0.05, 12.19 ± 2.86 mm, 4.38 ± 1.63 mm, 7.81 ± 2.6 mm, 13.46 ± 3.42 mm, and 10.31 ± 8.71 mm2, respectively. After 6 months these were 1.09 ± 0.12, 8.62 ± 2.62 mm, 4.90 ± 1.79 mm, 3.71 ± 1.68 mm, 10.10 ± 2.07 mm, and 4.38 ± 2.67 mm2, respectively. After 6 months of evaluation both the groups showed a significant reduction in PPD (P < .001) and a significant gain in CAL (P < .001), as well as significant improvement in radiographic VHD fill and AOD changes. Again, the test group showed significant changes (P < .001) over the control group considering the same outcomes. CONCLUSION: With the study limitations in mind, it can be concluded that for the treatment of intrabony defects with the bone graft material (ß-tricalcium phosphate + hydroxyapatite; Biograft, IFGL Bio Ceramics) or the same bone graft with platelet-rich fibrin membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters, the latter having highly significant benefits. However, the bone graft material requires improvement.

Adjunctive Effect of Autologous Platelet-Rich Fibrin in the Treatment of Intrabony Defects in Localized Aggressive Periodontitis Patients: A Randomized Controlled Split-Mouth Clinical Trial.

The aim of this study was to investigate the clinical and radiologic efficacy of autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects associated with localized aggressive periodontitis (LAP). A total of 30 sites, 2 sites per individual in 15 LAP patients, were treated with modified flap operation (MFO; Kirkland flap) alone or combined with autologous PRF. The study variables included plaque index, sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level at baseline and 12 months postoperatively. The radiographic bone fill (RBF) on standardized radiographs was assessed after a year using image analysis software. The improvements in PD, CAL, and RBF in test sites compared to control sites were statistically significant (P < .05). Mean CAL gain and bone fill in the test sites were 4.0 ± 0.63 mm and 3.09 mm, respectively. Almost 80% of the PRF-treated sites showed ≥ 50% bone fill with minimal marginal tissue recession. Use of PRF significantly enhances the clinical and radiographic outcomes of open flap debridement in the treatment of periodontal intraosseous defects in patients affected by LAP.

Prevalence of dental erosion among young competitive swimmers: a pilot study.

The objective of the study presented was to determine the prevalence of oral problems--eg, dental erosion, rough surfaces, pain--among young competitive swimmers in India, because no such studies are reported. Its design was a cross-sectional study with a questionnaire and clinical examination protocols. It was conducted in a community setting on those who were involved in regular swimming in pools. Questionnaires were distributed to swimmers at the 25th State Level Swimming Competition, held at Thane Municipal Corporation's Swimming Pool, India. Those who returned completed questionnaires were also clinically examined. Questionnaires were analyzed and clinical examinations focused on either the presence or absence of dental erosions and rough surfaces. Reported results were on 100 swimmers who met the inclusion criteria. They included 75 males with a mean age of 18.6 ± 6.3 years and 25 females with a mean age of 15.3 ± 7.02 years. Among them, 90% showed dental erosion, 94% exhibited rough surfaces, and 88% were found to be having tooth pain of varying severity. Erosion and rough surfaces were found to be directly proportional to the duration of swimming. The authors concluded that the prevalence of dental erosion, rough surfaces, and pain is found to be very common among competitive swimmers. They recommend that swimmers practice good preventive measures and clinicians evaluate them for possible swimmer's erosion.

Clinical effect of autologous platelet-rich fibrin in the treatment of intra-bony defects: a controlled clinical trial.

AIM: Platelet-rich fibrin (PRF) may be considered as a second-generation platelet concentrate widely used to accelerate soft and hard tissue healing because of presence of many growth factors. The present study aimed to investigate the clinical and radiological effectiveness of autologous PRF in the treatment of intra-bony defects of chronic periodontitis patients. MATERIAL AND METHODS: Thirty-two intra-bony defects (one site/patient) were treated either with autologous PRF or a conventional open flap debridement alone. Clinical parameters such as plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL) and gingival marginal level (GML) were recorded at baseline and 9 months post-operatively. In both the groups, by using the image analysis software intra-bony defect fill was calculated on standardized radiographs (from the baseline and 9 months). RESULTS: For all clinical and radiographic parameters test group was performed better than control group, and the difference was found to be statistically significant. Furthermore, images analysis revealed significantly greater bone fill in the test group compared with control (46.92%versus 28.66 %). Mean PD reduction (4.56 ± 0.37>3.56 ± 0.27) and CAL gain (3.69 ± 0.44>2.13 ± 0.43) in test group was found to be more compared with that of control group. In the test group, PD of >4 mm has highest percentage of PD reduction (68.9%) and CAL gain (61.6%). On frequency distribution analysis, there was no more difference for PD reduction in both the groups but CAL gain was much more in the test group than the control group. CONCLUSIONS: Within the limit of the present study, there was greater reduction in PD, more CAL gain and greater intra-bony defect fill at sites treated with PRF than the open flap debridement alone.

Primary gingival pseudoepitheliomatous hyperplasia with periodontal findings: a rare case report.

BACKGROUND: This paper is the first-ever report, to our knowledge, of a case of generalized primary gingival pseudoepitheliomatous hyperplasia(PEH) with significant periodontal findings in a 23-year-old Indian female patient. It explains the need to differentiate PEH from squamous cell carcinoma in diagnosis and treatment planning. The present article also reviews current immunohistologic staining methods used to differentiate PEH from squamous cell carcinoma. METHODS: A two-stage surgical approach was used to eliminate the lesion by gingivectomy and gingivoplasty under local anesthesia. Histopathologic examination of excised tissue was done to differentiate it from squamous cell carcinoma. RESULTS: After 1-year follow-up, there was uneventful gingival healing and no recurrence of the lesion. CONCLUSIONS: Differentiation of PEH from squamous cell carcinoma of the gingiva is important for diagnosis and treatment. It is also important to consider PEH as a rare condition of gingival overgrowth.

Pemphigus vulgaris: effects on periodontal health.

Increasing evidence indicates that systemic conditions are risk factors of periodontitis. Pemphigus is a group of bullous diseases affecting the oral cavity. The aim of this study was to assess the periodontal status of pemphigus vulgaris (PV) patients. The periodontal status of 50 PV patients and 50 healthy subjects was assessed by a single examiner. PV patients were assessed based on the Clinical Severity Score (CSS). Periodontal clinical parameters such as plaque score, full mouth gingival bleeding score, probing depth (PD), clinical attachment level (CAL) and radiological bone loss were recorded. Effects of age, gender, daily tooth brushing habit, oral lesions and treatment duration on the periodontal status of PV patients were also determined. A statistically significant difference was found between the PV group and the healthy group with respect to the plaque score, PD and CAL (P < 0.05). Logistic regression analysis confirmed that age, gender, and treatment did not significantly influence clinical severity of the disease (P > 0.05). Increased PD and CAL were found with an increase in the CSS. The poor periodontal status in PV patients suggests that PV may be involved in the initiation or progression of periodontitis.

Serum levels of oncostatin M (a gp 130 cytokine): an inflammatory biomarker in periodontal disease.

OBJECTIVE: Periodontitis is considered to be a risk factor for systemic diseases such as atherosclerosis, diabetes, etc., and cytokines play a key role. The present study was carried out to measure the level of serum oncostatin M (OSM) in patients with chronic periodontitis, and to evaluate the effect of non-surgical periodontal therapy on the serum OSM concentration. MATERIALS AND METHODS: Sixty subjects were divided into three groups (each group n = 20) based on the gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL): group I healthy; group II gingivitis; and group III chronic periodontitis. Group III patients were followed for 8 weeks after non-surgical periodontal therapy as the after-treatment group (group IV). Estimation of serum OSM was done using an enzyme-linked immunosorbent assay. RESULTS: The mean OSM concentrations in serum were highest in the chronic periodontitis group (mean 68.05 pg ml(-1)) and decreased following treatment (39.65 pg ml(-1)) while OSM was undetectable in healthy subjects or in patients with gingivitis. CONCLUSION: Increased serum OSM concentration in patients with chronic periodontitis and its positive correlation with PPD and CAL, suggest its role as an inflammatory biomarker in periodontal disease and it may exaggerate other systemic conditions such as atherosclerosis and rheumatoid arthritis.

Gingival crevicular fluid levels of oncostatin M in periodontal conditions.

OBJECTIVE: The initial study has reported the increased level of oncostatin M (OSM) in gingival crevicular fluid (GCF) of chronic periodontitis patients, and no study has reported its level in gingivitis patients. Therefore, the present study has been carried out to measure the level of OSM in gingival crevicular fluid of gingivitis and chronic periodontitis patients and effect of periodontal therapy on OSM concentration in GCF of chronic periodontitis patients. DESIGN: A total of 60 subjects were divided into three groups (n=20) based on gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL): healthy (group I), gingivitis (group II) and chronic periodontitis (group III). A fourth group (group IV) consisted of 20 subjects from group III, 8 weeks after treatment i.e. scaling and root planning (SRP). GCF samples were collected from all the groups to estimate the levels of OSM using Enzyme-Linked ImmunoSorbentAssay (ELISA). RESULT: The mean OSM concentrations in GCF was found to be the highest in group III i.e. 0.81+/-0.33 pg/microl. The mean OSM concentration in group I was 0.0689+/-0.022 pg/microl in GCF and in group IV it was 0.0943+/-0.037 g/microl). For group II the mean OSM concentration in GCF 0.125+/-0.023 pg/microl, was fell in between the concentrations obtained in groups I and III. CONCLUSIONS: The greater the amount of periodontal tissue destruction there is substantial increase in GCF OSM concentrations. Since, OSM levels are positively correlated with PPD and CAL, it can be considered as an inflammatory biomarker in periodontal diseases.

Clinical effect of subgingivally delivered simvastatin in the treatment of patients with chronic periodontitis: a randomized clinical trial.

BACKGROUND: Periodontitis is an inflammatory disease that results in bone resorption creating bony defects, which may cause tooth loss. Various drugs have been studied using local delivery to improve the periodontal health and to achieve periodontal regeneration. Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. The present study was designed to investigate the effectiveness of SMV, 1.2 mg, in an indigenously prepared biodegradable controlled-release gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS: Sixty patients were categorized into two treatment groups: SRP plus placebo (group 1) and SRP plus SMV, 1.2 mg (group 2). Clinical parameters were recorded at baseline before SRP and at 1, 2, 4, and 6 months; they included modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of intrabony defect (IBD) fill was done using computer-aided software. The mean concentration of SMV in gingival crevicular fluid was estimated by reverse-phase high-performance liquid chromatography. RESULTS: All subjects tolerated the drug, without any postapplication inflammation. Both therapies resulted in significant improvements. The decrease in mSBI score at 6 months was greater in group 2 (2.3267 +/- 0.8017) compared to group 1 (0.5033 +/- 0.6815). The mean decrease in PD from baseline to 6 months was 1.20 +/- 1.24 mm and 4.26 +/- 1.59 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 1.63 +/- 1.99 mm and 4.36 +/- 1.92 mm in groups 1 and 2, respectively. In group 2, there was greater decrease in mean IBD (1.41 +/- 0.74 mm or 32.54%) compared to group 1 (0.09 +/- 0.58 mm or 2.16%). CONCLUSION: There was a greater decrease in gingival index and PD and more CAL gain with significant IBD fill at sites treated with SRP plus locally delivered SMV in patients with chronic periodontitis.

Correlation of levels of oncostatin M cytokine in crevicular fluid and serum in periodontal disease.

AIM: The aim of this study was to measure the level of Oncostatin M (OSM) a gp130 cytokine in the gingival crevicular fluid (GCF) and serum of chronic periodontitis patients and to find any correlation between them before and after periodontal therapy (scaling and root planing, SRP). METHODOLOGY: 60 subjects (age 25-50 years) were enrolled into three groups (n=20 per group), group I (healthy), group II (gingivitis) and group III (chronic periodontitis). Group III subjects were followed for 6-8 weeks after the initial periodontal therapy (SRP) as the group IV (after periodontal therapy). Clinical parameters were assessed as gingival index (GI), probing depth (PD), clinical attachment level (CAL), and radiographic evidence of bone loss. GCF and serum levels of OSM were measured by using Enzyme Linked Immunosorbent Assay (ELISA). RESULTS: It was found that mean OSM levels had been elevated in both the GCF and serum of chronic periodontitis subjects (726.65 +/- 283.56 and 65.59 +/- 12.37 pg mL(-1), respectively) and these levels were decreased proportionally after the periodontal therapy (95.50 +/- 38.85 and 39.98 +/- 16.69 pg mL(-1) respectively). However, OSM was detected in GCF of healthy subjects (66.15 +/- 28.10 pg mL(-1)) and gingivitis-suffering subjects (128.33 +/- 22.96 pg mL(-1)) and was found as below the detectable limit (approximately equal 0.0 pg mL(-1)) in the serum of same subjects. Significant correlation has been found between clinical parameters and GCF-serum levels of OSM. CONCLUSION: Increased OSM level both in the GCF and serum, and the decreased levels after initial periodontal therapy (SRP) may suggest a use as an inflammatory biomarker in the periodontal disease.

Correlation of gingival crevicular fluid interleukin-18 and monocyte chemoattractant protein-1 levels in periodontal health and disease.

BACKGROUND: Interleukin (IL)-18 is a proinflammatory cytokine of the IL-1 superfamily and is unique, with the capacity to induce T-helper (Th)1 or Th2 differentiation depending on the immunologic context. Monocyte chemoattractant protein (MCP)-1 is a CC chemokine responsible for chemotaxis of monocytes. A previous study showed the induction of MCP-1 by IL-18 in mice macrophages. The present study was carried out to examine the gingival crevicular fluid (GCF) levels of IL-18 and MCP-1 in periodontal health and disease and to evaluate any correlation between IL-18 and MCP-1 GCF levels. METHODS: Sixty subjects (30 males and 30 females; age range: 26 to 49 years) participated in the study. The subjects were initially divided into three groups, consisting of 20 subjects in each group, based on the gingival index, probing depth (PD), clinical attachment loss (AL), and radiologic parameters (bone loss): healthy (group 1), gingivitis (group 2), and periodontitis (group 3), whereas patients in group 3 after treatment constituted group 4. GCF samples were collected from all of the groups to estimate the levels of IL-18 and MCP-1 using enzyme-linked immunosorbent assay. RESULTS: The mean IL-18 and MCP-1 concentrations in GCF were highest in group 3 (330.61 pg/microl and 73.3 pg/microl, respectively). The results suggest that IL-18 and MCP-1 levels increased in GCF from periodontal health to disease and decreased after periodontal therapy. Levels of IL-18 and MCP-1 positively correlated with PD and clinical AL in group 3. In addition, IL-18 and MCP-1 levels significantly correlated with each other in groups 2, 3, and 4. CONCLUSIONS: GCF IL-18 and MCP-1 concentrations increased in periodontal disease compared to health and correlated positively with the severity of disease. Further, based on the positive correlation of IL-18 and MCP-1 found in this study, it can be proposed that IL-18 may promote an inflammatory response by the induction of MCP-1 production and the subsequent recruitment and activation of circulating leukocytes at the inflammatory site.