Laser Therapy Effects on Periodontal Status: A Randomized Study Using Gaussian Network Analysis and Structural Equation Modeling Approach.

Background and Objectives: This paper aims to assess the role of laser therapy in periodontitis through an innovative approach involving computational prediction and advanced modeling performed through network analysis (Gaussian graphical models-GGMs) and structural equations (SEM). Materials and Methods: Forty patients, exhibiting periodontal pockets with a minimum depth of 5 mm, were randomly divided into two groups: a control group and a laser group. Four specific indicators were measured for each tooth, namely periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), and the mean of six measured values was recorded at five time markers (baseline, 6 months, 1 year, 2 years, and 4 years). The assessment algorithm included enrollment, measurements, and differential non-surgical periodontal treatment, according to the group allocation. Scaling, root planing, and chlorhexidine 1% were conducted for the control group, and scaling, root planing and erbium, chromium:yttrium-scandium-gallium-garnet (Er,CR:YSGG) laser therapy were conducted for the laser group. Results: The main results highlight that the addition of laser treatment to scaling and root planing led to notable clinical improvements, decreasing the PPD values, reducing the BOP scores, and increasing the CAL. Conclusions: Notable relationships between the specific indicators considered were highlighted by both the GGMs and by SEM, thus confirming their suitability as proxies for the success of periodontal treatment.

Clinical and microbiological efficacy of intra-pocket application of diode laser in grade C periodontitis: a randomized controlled clinical trial.

BACKGROUND: Periodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis. METHODS: A randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis. RESULTS: Compared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration. CONCLUSION: Laser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage. TRIAL REGISTRATION: NCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov.

Periodontal Pocket Therapy Using a Class IV Dental Diode Laser in Dogs: A Retrospective Analysis.

Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, P < .0001). No statistically significant results were observed for pocket type, as P values were greater than .05.

Comparative Evaluation of the Effectiveness of Triphala and Chlorhexidine in Full-mouth Disinfection Treatment of Periodontitis in Type 2 Diabetes Patients.

AIM: To evaluate and compare the efficacy of triphala and chlorhexidine (CHX) in the treatment of stages II and III periodontitis with one-stage complete mouth disinfection in type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS: A total of 24 type 2 diabetic subjects with either stage II or stage III periodontitis were randomly divided into test and control groups with 12 patients in each group. For control group, full-mouth disinfection (FMD) was done using CHX and for test group, FMD was done using triphala. Clinical parameters were evaluated at baseline and at 6 months which comprised of probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), papillary bleeding index (PBI). The primary outcomes considered were a reduction in PPD and a gain in CAL. The data were recorded, tabulated, and statistically analyzed. RESULTS: The PPD reduction for the test group was 3.38 ± 0.75 mm and for the control group was 3.39 ± 0.76 mm. The CAL gain for the test group was 3.39 ± 0.76 mm and for the control group was 3.18 ± 0.74 mm. Although there was a statistically significant PPD reduction, statistically not significant CAL gain was observed. CONCLUSION: Both the groups with the FMD protocol showed beneficial results in terms of PPD reduction and CAL gain but the test group showed slightly better results. CLINICAL RELEVANCE: Clinically, there is more PPD reduction and CAL gain from baseline to 6 months in the test group compared to the control group. Clinically, the test group has more favorable results compared to the control group.

Efficacy of Sub-Gingivally Delivered Propolis Nanoparticle in Non-Surgical Management of Periodontal Pocket: A Randomized Clinical Trial.

Naturally sourced products like propolis are commonly employed for the non-surgical treatment of periodontal pockets. The use of nanoparticle formulations of these natural remedies has the potential to improve treatment outcomes. The aim of the present study was to evaluate the efficacy of sub-gingivally delivered propolis nanoparticles in the non-surgical management of periodontal pockets. Forty patients diagnosed with periodontitis presenting at least one periodontal pocket with a probing pocket depth between 4 and 6 mm were selected. Patients were randomly assigned into the control group (n = 20), which received scaling and root planing (SRP) and saline (SRP + Saline), and the test group (n = 20), which received SRP and sub-gingivally delivered propolis nanoparticles (PRO) into the periodontal pocket (SRP + PRO). The clinical parameters recorded were plaque index (PI), gingival index (GI), relative attachment loss (RAL), probing pocket depth (PPD), and bleeding on probing (BOP). They were assessed at baseline, one month, and three months post therapy. The results indicated that there was a significant improvement in clinical parameters (p < 0.05) in the test sites compared with the control sites at the end of the study. The gingival index at one month and three months was found to be significantly better in the SRP + PRO group than the SRP + Saline group, with a p value of <0.001. The BOP, PPD, and RAL showed significant improvement with the SRP + PRO group at the end of the 3-month follow-up with p values of 0.0001, 0.001, and 0.05, respectively. The subgingival delivery of propolis nanoparticles showed promising results as an adjunct to SRP in patients with periodontitis presenting periodontal pockets.

Adjuvant effects of Saccharomyces cerevisiae in the treatment of experimental periodontitis in rats undergoing chemotherapy.

Surgical procedures, radiotherapy, and chemotherapy, individually or in association, are current oncological treatments. Among the most used chemotherapy drugs, 5-fluorouracil (5FU) is an antimetabolite with a broad spectrum of action. This study evaluated the effects of probiotics (PRO) as an adjuvant to the treatment of experimental periodontitis (EP) in rats immunosuppressed with 5FU.108 rats were randomly allocated to six different groups: EP; SS - systemic treatment with saline solution (SS); 5FU - systemic treatment with 5FU; 5FU+PRO - systemic treatment with 5FU, followed by the local administration of Saccharomyces cerevisiae ; 5FU+SRP - systemic treatment with 5-FU, followed by scaling and root planing (SRP); and 5FU+SRP+PRO - systemic treatment with 5FU followed by local treatments with SRP and PRO. Immunosuppression was obtained at two points: at the time of ligature installation and after 48 h. Six animals from each group were euthanized at seven, 15, and 30 d and hemimandibles were collected and processed for histopathological, histometric, and immunohistochemical analysis. Data were subjected to statistical analysis (α=5%). At 7 d, the 5FU+PRO group showed less bone resorption and better structured connective tissue compared with the EP, SS, 5FU+SRP, and 5FU+SRP+PRO groups. At 15 d, the 5FU+SRP group showed a greater intensity of the inflammatory response (p<0.05). At 30 d, the 5FU+SRP+PRO group showed better structured bone tissue and a higher percentage of bone tissue (PBT) than the EP, SS, 5FU, and 5FU+PRO groups (p<0.05). The use of Saccharomyces cerevisiae as monotherapy or as an adjuvant to periodontal therapy may have a positive effect on bone repair in immunosuppressed conditions.

Clinical evaluation of sodium hypochlorite/amino acids and cross-linked hyaluronic acid adjunctive to non-surgical periodontal treatment: a randomized controlled clinical trial.

OBJECTIVES: To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with mechanical debridement alone. MATERIALS AND METHODS: Fourty-eight patients diagnosed with stages II-III (Grades A/B) generalised periodontitis were randomly treated with either scaling and root planing (SRP) (control) or SRP plus adjunctive sodium hypochlorite/amino acid and xHyA gels (test). The primary outcome variable was reduction of probing depth (PD), while changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were secondary outcomes. The outcomes were assessed at baseline, at 3 and 6 months following therapy. RESULTS: All patients completed the 6 months evaluation. At 6 months, the test group showed statistically significantly better results in terms of mean PD reduction (2.9 ± 0.4 vs 1.8 ± 0.6 mm, p < 0.001). Similarly, mean CAL gain was statistically higher in the test group compared to the control one (test: 2.6 ± 0.5 vs control: 1.6 ± 0.6 mm, p < 0.001). Mean BOP decreased from 81.8 ± 16.2% to 48.9 ± 14.5% in control (p < 0.001) and from 83.2 ± 15.5% to 17.6 ± 11.5% in test (p < 0.001) groups with a statistically significant difference favouring the test group (p < 0.001). Mean PI scores were reduced statistically significantly in both groups (from 38.8 ± 26% to 26.5 ± 20.5% in control (p = 0.039) and from 60.6 ± 10.9% to 12.7 ± 8.9% in test group (p < 0.001)), with a statistically significant difference between the groups (p < 0.001). The number of moderate pockets (4-6 mm) were reduced from 1518 (41.2%) to 803 (22.6%) in the control and from 1803 (48.6%) to 234 (7.7%) in the test group with a statistically significant difference between the groups (p < 0.001), while the number of deep pockets (≥ 7 mm) changed from 277 (7.6%) to 35 (1.0%) in the control and from 298 (8.7%) to 4 (0.1%) in test group (p = 0.003). CONCLUSION: Within their limits the present data indicate that: a) both treatments resulted in statistically significant improvements in all evaluated clinical parameters, and b) the adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA to SRP yielded statistically significantly higher improvements compared to SRP alone. CLINICAL RELEVANCE: The combination of sodium hypochlorite/amino acid and xHyA gels to subgingival mechanical debridement appears to represent a valuable approach to additionally improve the outcomes of non-surgical periodontal treatment. Clinical Trial Registration Number NCT04662216 (ClinicalTrials.gov).

Photodynamic therapy as adjunctive treatment of single-rooted teeth in patients with grade C periodontitis: A randomized controlled clinical trial.

BACKGROUND: The present study aimed to evaluate the adjunctive effect of an antimicrobial photodynamic therapy (aPDT) protocol on single-rooted teeth of patients with grade C periodontitis. METHODS: Sixty-four single-rooted teeth (14 patients) were included in each group of this double-blinded split-mouth randomized clinical trial. The teeth were randomly divided into scaling and root planing + aPDT (test group) and scaling and root planing+sham aPDT (control group). The aPDT protocol consisted of incubation with 1% methylene blue for 5 min, rinsing, and application of a diode laser (wavelength of 660 nm, power of 100 mW) for 10 s. aPDT was repeated after 7 days. Bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) were recorded before and 3 months after treatment. A 5% significance level was adopted for statistical analysis. RESULTS: Final PD was significantly (P = 0.02) lower in the test group (2.87 ± 1.40 mm) compared to control (3.12 ± 1.69 mm). The test group showed a significantly higher percentage of sites with PD≤4 mm and concomitant BoP compared to control (91%x86%;P < 0.001). At sites with baseline PD>4 mm, final PD and CAL were significantly (P = 0.01) lower in the test group (4.11 ± 1.66 and 4.89 ± 2.49 mm, respectively) compared to control (4.88 ± 1.99 and 5.89 ± 2.74 mm, respectively). CONCLUSIONS: aPDT combined with scaling and root planning provided slightly better periodontal clinical results than the latter procedure alone, exerting a superior effect at sites with greater baseline PD. aPDT might be used as adjunctive treatment in grade C periodontitis affecting single-rooted teeth since it improves the response to conventional periodontal treatment.

Clinical efficacy of ozonated water and photodynamic therapy in non-surgical management of chronic periodontitis: A clinico- microbial study.

BACKGROUND: Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Treatment of the periodontitis is a key challenge since the disease occurs due to microbial biofilm which is extremely resistant to host response and antimicrobials. Among non-surgical methods, scaling and root planning (SRP) is considered as the fundamental method and results in the utmost improvements. However, complete elimination of subgingival calculus is difficult. A substitute treatment in inhibition of subgingival microbiota can be attained by ozonated water at a concentration of 0.5-4 mg/L. Lately, laser light therapy has been proposed in periodontal therapy in an endeavor to improve the efficiency and effectiveness of bacterial elimination and root surface debridement. MATERIALS AND METHODS: 26 patients with chronic periodontitis were selected. The selected arches were randomly divided into two groups: Group-A was subjected to SRP + Ozone-Therapy and Group-B to SRP + Photodynamic-Therapy. Clinical parameters were recorded at baseline, 1&2months. Microbial parameters were recorded at baseline and 2-months. RESULTS: For both the groups significant decrease in clinical parameters were seen from baseline to 1 month and further in 2 months. On intergroup comparison of clinical parameters no significant result was found. Both the groups showed significant decrease in microbial parameters was seen from baseline to 2 months. On intergroup comparison of microbial parameters no significant result was found. CONCLUSION: Clinically and microbiologically, there was significant difference in both the groups between all time periods (P < 0.001), however there was no significant difference between the two groups at all periods (P > 0.05).

Pain Assessment and Need for Analgesics after Scaling and Root Planing in Patients with Stage II and Stage III Periodontitis.

Background and Objectives: The most common treatment procedure for periodontitis and gingivitis is scaling and root planing, which is perceived as a painful dental treatment. The current study aimed to assess pain perception and analgesics consumption after scaling and root planing (SRP) in patients with stage II and stage III periodontitis. Materials and Methods: Before starting the SRP, all the periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL), were measured. The anxiety level of the patients was also assessed using the modified dental anxiety scale (MDAS) questionnaire. Pain perception of the patients was recorded with the visual analog scale (VAS) after performing the SRP. Patients were asked to mark their pain level on the VAS sheet after two hours, four hours, eight hours, 24 h, and 48 h after the periodontal treatment. The following cut-off points were used for the pain intensity in the VAS: 0 = no pain, 1-4 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain. Patients were advised to take analgesics if the pain was intolerable. Multivariate logistic regression was performed to conduct the association of all dependent variables and the pain perception of patients. A nonparametric Friedman test was conducted to assess pain perception at different times. Results: A total of 52 patients including 32 males and 20 females participated in the current study, with a mean age of 43.10 ± 12.33 years. Multivariate analyses showed that MDAS and analgesic consumption is significantly associated with pain perception. Other clinical variables are not associated with pain perception. The Friedman test exhibited that pain perception is significantly associated (p < 0.05) with time. Conclusions: Analgesic consumption and anxiety level are significantly associated with pain perception after SRP treatment.

Effectiveness of photodynamic therapy on clinical and biomarker related periodontal parameters and oral health related quality of life (OHRQoL) in Parkinson's disease patients with stage III periodontitis.

AIMS: To evaluate the clinical, radiographic, immune modulatory biomarkers and quality of life with the application of photodynamic therapy (PDT) as an adjunctive treatment to dental scaling and root planing (SRP) in patients with chronic periodontitis and Parkinson's disease. METHODOLOGY: Individuals who had a confirmed diagnosis of stage III periodontitis and stage 4 Parkinson's disease according to Hoehn and Yahr scale were involved in this study. The participants were divided into two groups: Group SRP (n = 25) received traditional dental scaling procedure including full-mouth debridement and disinfection, and Group PDT + SRP (n = 25) received both traditional cleaning procedures along with adjunctive chloro­aluminum phthalocyanine (CAPC) gel (0.005% concentration) mediated PDT. CAPC photosensitizer was activated using a diode laser (wavelength=640 nm, energy=4 J, 150 mW power, and overall power density of 300 J/cm2) for 60 s. The study measured clinical parameters such as plaque score (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and radiographic alveolar bone loss (ABL). Proinflammatory cytokine levels such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) and oral health related quality of life were also assessed. RESULTS: The mean age of patients in Group SRP was 73.3 years, while the mean age in Group PDT + SRP was 71.6 years. The PDT + SRP group showed a significant reduction in all clinical parameters at 6 and 12 months compared to the SRP group alone (p < 0.05). IL-6 and TNF-α levels were significantly reduced in the PDT + SRP group at 6 months compared to the SRP group alone (p < 0.05). However, at 12 months, both groups showed comparable TNF-α levels. The results showed that Group PDT + SRP had significantly lower OHIP scores compared to Group SRP, with a mean difference of 4.55 (95% confidence interval [CI]: 1.98 to 7.12) (p < 0.01). CONCLUSION: Combined SRP with PDT showed significant improvement compared to SRP alone in terms of clinical parameters, cytokine levels, and oral health-related quality of life in individuals diagnosed with stage III periodontitis associated with Parkinson's disease.

Comparative Assessment of the Effect of Three Various Local Drug Delivery Medicaments in the Management of Chronic Periodontitis.

AIM: The aim of this study was to evaluate the efficacy of three different local drug delivery medications in the treatment of chronic periodontitis. MATERIALS AND METHODS: Sixty participants, aged 30-55 years, were involved in the current research. Participants who fulfilled the inclusion criteria entered the study and were allocated at random to one of the three groups, each comprising 20 patients as: group A: Scaling and root planing (SRP) with local application of doxycycline gel, group B: SRP with local application of tetracycline fibers, and group C: SRP with local application of chlorhexidine gel. The plaque index (PI), the gingival index (GI), and periodontal pocket depth (PPD) were documented at baseline visit (prior to local drug delivery), and these indices were again documented 30 and 90 days post-local drug delivery. RESULTS: At baseline, GI score for doxycycline gel use decreased from 1.38 ± 0.05 to 0.94 ± 0.02, 1.36 ± 0.11 to 0.76 ± 0.19 for tetracycline fibers use, as well as from 1.38 ± 0.10 to 0.84 ± 0.21 for chlorhexidine gel use post 90 days. The PI value at baseline for doxycycline gel use lessened from 1.26 ± 0.01 to 1.02 ± 0.06, 1.30 ± 0.14 to 0.82 ± 0.16 for tetracycline fibers use, as well as 1.30 ± 0.22 to 0.98 ± 0.11 for chlorhexidine gel use post 90 days. At baseline, PPD values for doxycycline gel use decreased from 5.88 ± 0.24 to 3.72 ± 0.11, tetracycline fibers use lessened from 5.90 ± 0.09 to 3.02 ± 0.06, as well as for chlorhexidine gel group from 5.82 ± 0.18 to 3.44 ± 0.16 post 90 days. CONCLUSION: Within the limitations of the current research, it may be inferred that tetracycline fibers exhibited somewhat superior enhancement to chlorhexidine as well as doxycycline gel. CLINICAL SIGNIFICANCE: Local administration of antibacterial agents in continued or regulated delivery arrangement is employed to augment the actions of nonsurgical periodontal management, and it may be likely to attain gingival well-being by eliminating the requirement for invasive methods with the aid of local drug delivery arrangements. Chosen elimination or prohibition of microbial pathogens with locally administered antibacterial agents coupled with SRP is an efficient move toward treatment of chronic periodontitis.

Impact of supragingival scaling on the outcomes of subgingival instrumentation completed after 1 week: a split-mouth randomized clinical trial.

OBJECTIVE: To investigate the impact of supragingival scaling on the clinical outcomes of subgingival instrumentation completed after 1 week. METHOD AND MATERIALS: In 27 patients with Stage II and Stage III periodontitis, pairs of contralateral quadrants were randomly assigned into test group 1 (single sitting scaling and root planing) and test group 2 (supragingival scaling followed by subgingival instrumentation after 1 week). Periodontal parameters were recorded at baseline, 2, 4, and 6 months; Gingival crevicular fluid vascular endothelial growth factor (VEGF) estimation was done at baseline in both groups and 7 days after supragingival scaling in test group 2. RESULTS: At 6 months, significantly better improvement in test group 1 at sites with periodontal probing depth (PPD) > 5 mm; (∆PPD = 2.32 mm vs 1.41 mm, P = .001; ∆clinical attachmen level [CAL] = 2.34 mm vs 1.39 mm, P = .001) was observed. Supragingival scaling resulted in significant reduction in gingival crevicular fluid VEGF (42.46 to 27.88 pg/site) after 1 week. Regression analysis explained 14% variance in VEGF to baseline PPD at sites with PPD > 4 mm; and 21% variance in CAL improvement to VEGF at sites with PPD > 5 mm. The percentage of sites with PPD = 5 to 8 mm reaching the clinical endpoint was 52% and 40% for test group 1 and test group 2, respectively. Better results were noticed in bleeding on pocket probing-positive sites in both groups. CONCLUSION: The sites with PPD > 5 mm where supragingival scaling was followed by subgingival instrumentation after 1 week resulted in less favourable treatment outcomes. (Clinical trial registry NCT05449964).

Clinical and microbiological outcomes of subgingival instrumentation supplemented with high-dose omega-3 polyunsaturated fatty acids in periodontal treatment - a randomized clinical trial.

PURPOSE: This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV. METHODS: Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months. RESULTS: Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome "change of mean PD," no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group. CONCLUSION: High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits. The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020.

Minimally invasive non-surgical therapy (MINST) in stage III periodontitis patients: 6-month results of a split-mouth, randomised controlled clinical trial.

OBJECTIVES: To determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects. MATERIALS AND METHODS: In a split-mouth randomised controlled trial, 20 patients' dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model. RESULTS: After 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group's deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP. CONCLUSIONS: MINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects. CLINICAL RELEVANCE: MINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04036513) on June 29, 2019.

Er:YAG laser-assisted comprehensive periodontal pocket therapy for residual periodontal pocket treatment: A randomized controlled clinical trial.

BACKGROUND: This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial. METHODS: Two sites in 18 patients having residual periodontal pockets of ≥5 mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12 months. RESULTS: Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12 months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78 mm vs. 1.89 mm on average; p = 0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67 mm vs. 1.06 mm; p = 0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p = 0.031), compared with SRP alone. CONCLUSION: The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone.

The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: A systematic review and meta-analysis.

BACKGROUND: The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. RESULTS: Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias. CONCLUSION: Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.

Adjunctive effects of photodynamic therapy using indocyanine green in residual pockets during periodontal maintenance therapy: A split-mouth randomized controlled trial.

BACKGROUND: Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone. METHODS: A split-mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real-time polymerase chain reaction. RESULTS: Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls. CONCLUSIONS: Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels.

Photodynamic therapy as an adjunctive treatment for Grade C periodontitis in molar teeth: a preliminary trial.

OBJECTIVE: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for Grade C periodontitis in molars teeth. METHOD AND MATERIALS: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis. RESULTS: Both groups exhibited improvement in the clinical parameters (P < .001). However, the reductions in bleeding on probing and probing depth were greater in the test group (P < .001). There were no significant differences in the other clinical parameters between groups (P ≥ .130). CONCLUSIONS: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planing. aPDT may be used as adjunctive treatment for Grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement.

Probiotic adjuvant treatment in combination with scaling and root planing in chronic periodontitis: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the impact of probiotic supplementation on treating chronic periodontal (CP) disease based on clinical and microbiological findings. Four databases were searched: Medline, Embase, Cochrane Library, and the Web of Science databases. The references to relevant studies were also manually searched. Analyses were conducted using the Review Manager 5.2 software, while the quality of randomised controlled trials was assessed with the Cochrane Risk of Bias tool. In total, 19 studies were included in the meta-analysis. Pooled results revealed that the adjuvant use of probiotics in the treatment of patients with periodontal disease was largely associated with good clinical efficacy. Resulting in statistically significant improvements in plaque index (P<0.05), periodontal probing depth (P<0.05), clinical attachment level (P<0.05), gingival index (P<0.05), bleeding on probing (P<0.05), deep probing depth (P<0.05), and levels of subgingival microbes (P<0.05) following probiotic supplementation. In summary, the results of this meta-analysis suggest that the administration of probiotics together with scaling and root planing can somewhat improve CP patient clinical outcomes and reduce levels of periodontal pathogens. However, more comprehensive experiments are needed to standardise probiotics and maximise their adjuvant therapy.