Efficacy of root coverage with the use of the conventional versus laser-assisted flap technique with platelet-rich fibrin in class I and class II gingival recession: A randomized clinical trial.

BACKGROUND: The coronally advanced flap (CAF) technique is the preferred option in treating recession defects, especially when the attached gingiva is adequate. A laser-assisted vestibular releasing incision after surgery could enhance the outcome. Platelets, when used as adjunctive treatment, have shown good results. However, laser biostimulation post-surgery has not been studied. OBJECTIVES: The present study compared the benefits of using the conventional and laser-assisted flap technique with platelet-rich fibrin (PRF) in the treatment of class I and class II gingival recession. MATERIAL AND METHODS: The study included 24 subjects, both males and females. The participants, diagnosed with Miller's class I and II gingival recession, were categorized into 2 groups: group A (n = 12) treated with CAF and PRF; and group B (n = 12) treated with laser-assisted CAF and PRF. Root coverage (RC), the probing depth (PD), the clinical attachment loss (CAL), and the keratinized tissue width (KTW) were assessed preand 6 months postoperatively. The wound healing index (WHI) and the visual analog scale (VAS) scores were assessed 1 week post-surgery. RESULTS: Most clinical parameters improved significantly within the groups at 6 months postoperatively as compared to baseline (p < 0.05), except for PD and percentage root coverage (PRC). However, when intergroup comparisons were made, it was observed that both groups performed equally well and the differences between them were not significant. CONCLUSIONS: Both treatment modalities improved the clinical parameters post-surgery. However, further trials are warranted to affirm the benefits of the laser-assisted CAF technique.

Maresins: The Mainstay in Periodontal Resolution.

Not much was known about the resolution of inflammation until the recent past when significant breakthroughs led to the unveiling of the exact mechanism of this. It is now known that the resolution of inflammation involves specific mediators of resolution such as lipoxins, protectins, resolvins, and maresins, making it an active process. Of these mediators, maresins are the latest discovery. Maresins are macrophage-derived mediators that are involved in the resolution of inflammation. Various studies on what maresins do to resolve periodontitis are ongoing. Reportedly, maresins help in periodontal regeneration and wound healing. Having known the numerous roles of these mediators, our current focus is shifting from anti-inflammatory pharmacotherapy to resolution pharmacotherapy.

Efficacy of an herbal antioxidant as an adjunct to nonsurgical periodontal therapy on procalcitonin levels in smokers with chronic periodontitis.

CONTEXT: Smokers are at a higher risk of contracting periodontitis. This association is established and reported in many studies. Periodontitis is a polymicrobial disease, wherein smoking is an environmental factor which aggravates the damage caused to the tissues. Procalcitonin (ProCT) is a well-known marker for inflammatory and other infectious diseases and has been assessed in this study. It has been observed that the release of reactive oxygen species (ROS) is exaggerated in smokers. Antioxidants are administered to combat the harmful effects caused by the ROS, and Oxitard™ is a powerful herbal antioxidant that can counteract the action of free radicals. AIMS: As smokers are more prone to tissue injury due to excessive release of ROS, this study aimed to understand the benefits of systemic administration of Oxitard after scaling and root planing (SRP) on serum ProCT levels in smokers with chronic periodontitis (CP). SETTINGS AND DESIGN: This was a randomized interventional study, wherein forty patients participated. MATERIALS AND METHODS: Forty smokers with CP aged, between 35 and 60 years, were equally divided into Group A (SRP + Oxitard) and Group B (SRP only), selected from an outpatient ward of a referral care hospital in Hyderabad. A written informed consent was obtained from all the patients, and the study was approved by the institutional ethical committee (DN0026-15). STATISTICAL ANALYSIS USED: Data were analyzed by GraphPad Prism software version 6.01 (GraphPad software incorporation, California, USA). Comparison within the groups was made by paired t-test and between the groups by unpaired t-test. P < 0.05 was considered of statistical significance. RESULTS: Intragroup assessment showed an improvement in all the variables from baseline to 3 months, which was statistically significant (P < 0.0001). A comparison between the groups, however, yielded better results in Group A (Oxitard + SRP) over Group B. CONCLUSIONS: Oxitard administered systemically for 3 months after SRP was beneficial in improving both clinical and biochemical parameters.

Efficacy of Low-level Laser Therapy, Hyaluronic Acid Gel, and Herbal Gel as Adjunctive Tools in Gingivectomy Wound Healing: A Randomized Comparative Clinical and Histological Study.

Introduction Gingival overgrowth is usually an inflammatory response to plaque present on tooth surfaces. The other causes could be drugs and other systemic conditions. When the local factors are responsible and subgingival scaling does not help, gingivectomy is performed. The gingivectomy wound is raw and heals slowly. Low-level laser therapy (LLLT), hyaluronic acid, and herbal gels aid in healing after a gingivectomy. This study compared the efficacy of LLLT, hyaluronic acid, and herbal gel when used topically after a gingivectomy. This was a single-arm, interventional trial wherein 30 patients aged between 18 and 40 years with moderate gingival overgrowth participated. The study was approved by the institutional ethical committee. (DN/0109-16). The participants signed the consent form and the study was also registered (NCT03569683). Materials and methods The samples were equally divided into three groups. Group A received LLLT immediately postop, and on the first, third, and seventh days after surgery. Group B received hyaluronic acid (Gengigel) while Group C received an herbal gel (Hiora SG) for the same time periods after surgery, respectively. Analysis of variance (ANOVA) followed by a post-hoc Bonferroni test was used to evaluate differences within groups. Intergroup comparison was performed using the independent t-test. A p-value of <0.05 was considered statistically significant. Results The plaque index (PI), gingival index (GI), and gingival enlargement index (GEI) showed good improvement postoperatively within the groups, which was statistically significant. However, on an intergroup comparison, the GEI pertaining only to the laser group showed significant changes. Also, the pain perception analyzed by the visual analog score (VAS) was the least, and histologically, the amount of mature collagen fibers laid down were more in the laser group. Conclusion Patients irradiated with laser after gingivectomy (Group A) showed superior results in the clinical, histological variables as compared to Groups B and C.

Estimation of Pentraxin 3 and Porphyromonas Gingivalis Levels in Patients with Rheumatoid Arthritis and Periodontitis- An Observational Study.

INTRODUCTION: Periodontal diseases are inflammatory in nature involving interplay between the bacterial plaque and the micro-organisms, with the response of the host playing a pivotal role in either attenuating or eliminating the disease. Rheumatoid Arthritis (RA) is also a chronic inflammatory disease which shares common risk factors with periodontitis. Porphyromonas Gingivalis and Pentraxin 3 (an acute inflammatory protein) have been observed to be associated with both the diseases. AIM: This study was done to determine if there was any association between Pophyromonas Gingivalis and Pentraxin 3 levels in patients with RA and Chronic Periodontitis in comparison with Healthy controls. MATERIALS AND METHODS: This observational study was conducted on 90 subjects (42 Males and 48 Females) aged between 30-60 years. The subjects were selected from the out patient ward of a tertiary referral care hospital. The selected subjects were equally divided into three groups. Group I: Comprising of 30 patients with RA and chronic periodontitis who were in turn, subdivided into Group I- A (n=15) -Patients just diagnosed with RA and Group I- B (n=15) Patients under medications for more than three months. Group II: Patients with Chronic Periodontitis (n=30) and Group III: Healthy Controls (n=30) Intergroup comparison for continuous data was done by One-way analysis of variance test followed by Bonferroni's post-hoc test. Intragroup comparison for continuous data was done by paired t-test. RESULTS: Intergroup comparison between Group I and Group II did not show any statistical difference pertaining to the clinical parameters except for the Gingival Index (GI) which was found to be higher in Group II (Mean= 2.07) when compared to Group I (Mean=1.59). Intragroup comparison between Group IA and Group IB was statistically significant for GI, Plaque Index (PI), and Clinical Attachment Levels (CAL). Intragroup comparison between Group I-A and Group I-B showed that both Porphyromonas gingivalis and Pentraxin 3 Levels were higher in Group I- A. CONCLUSION: In this study, it was observed that there was a positive association between Porphyromonas gingivalis and Pentraxin 3 levels in patients with rheumatoid arthritis and periodontitis.

Evaluation of oxidative stress in chronic periodontitis patients following systemic antioxidant supplementation: A clinical and biochemical study.

CONTEXT: Oxidative stress is associated with the pathogenesis of many systemic diseases including chronic periodontitis. Periodontal pathogen activated neutrophils liberate the reactive oxygen species (ROS), which causes the destruction of periodontal tissues. Antioxidants modulate the ROS production and inhibit the tissue destruction. AIM: We aimed to evaluate the oxidative stress marker malondialdehyde (MDA) in chronic periodontitis patients following scaling and root planing (SRP) after systemic lycopene supplementation. MATERIALS AND METHODS: This was an interventional single arm study. Twenty systemically healthy patients with chronic periodontitis were recruited. Clinical parameters modified gingival index, probing depth, clinical attachment loss were recorded, and serum MDA levels were assessed by thiobarbituric acid reactive substances assay. Patients were supplemented with 8 mg lycopene daily for 2 months following SRP treatment. All the parameters were assessed at pretreatment and 2 months and 6 months posttreatment. RESULTS: From pretreatment to posttreatment at 2 months, the mean values of all parameters were reduced. While from 2 to 6 months when lycopene was not administered, an increase in the mean values of all the parameters was observed; however, these values were still below baseline values. CONCLUSION: There was a reduction in oxidative stress and improvement in clinical parameters following systemic antioxidant therapy along with SRP, which was maintained up to 4 months after discontinuation of lycopene treatment.

Systemic lycopene as an adjunct to scaling and root planing in chronic periodontitis patients with type 2 diabetes mellitus.

BACKGROUND: Patients with type 2 diabetes have an increased prevalence of periodontitis and, in turn, periodontitis adversely affects the diabetic status. Oxidative stress plays a key role in affecting the pathophysiology of both the diseases and adjunctive systemic antioxidant therapy may have beneficial effect on the treatment outcome. This study was planned to compare the efficacy of systemic antioxidant therapy with lycopene as an adjunct to scaling and root planing versus scaling and root planing alone in chronic periodontitis patients with type 2 diabetes mellitus. MATERIALS AND METHODS: 40 diabetic subjects with periodontitis, attending the OP wing of the Department of Periodontics of a tertiary referral care hospital were randomized and equally divided into group A and group B. Diabetes status was recorded as per ADA guidelines and the periodontitis status as per American Academy of Periodontology (AAP) guidelines. Group A patients underwent scaling and root planing with administration of lycopene 8 mg and group B patients were treated with scaling and root planing alone. Clinical parameters like gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were recorded. Serum markers, i.e. malondialdehyde (MDA) (TBARS assay) and C reactive protein (CRP) (ELISA), and glycated hemoglobin (HbA1c) levels were assessed at baseline and at 2 months and 6 months post-therapy. RESULTS: Inter-group comparison showed group A giving statistically significant results in reducing mean serum MDA levels at 2 months and 6 months, and in reducing mean PD (mm) and mean HbA1c (%) levels at 2 months (P < 0.005). CONCLUSION: Lycopene as an adjunctive treatment was effective in reducing oxidative stress and restoring altered glycemic levels. Further longitudinal studies with a larger sample size are required to establish the role of lycopene in the management of chronic periodontitis.