Clinical Effect of Subgingivally Delivered Simvastatin in the Treatment of Patients With Chronic Periodontitis: A Randomized Clinical Trial
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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.Keywords:
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The relationship between cigarette smoking and periodontal disease has been examined extensively. Local delivery of antimicrobials into periodontal pockets improves periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered 0.5% clarithromycin (CLM) as an adjunct to scaling and root planing for treating chronic periodontitis in smokers.Sixty-one patients were randomized and categorized into two treatment groups: group 1, in which 31 individuals received scaling and root planing plus 0.5% CLM, and group 2, in which 30 individuals received scaling and root planing plus placebo gel. Clinical parameters were recorded at baseline and at 1, 3, and 6 months; they included plaque index (PI), modified sulcus bleeding index (mSBI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL). The mean concentration of 0.5% CLM in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography.Both therapies resulted in significant improvements. At the end of 6 months, the mean GI, PI, mSBI, PD, and CAL for the CLM group were 1.06 ± 0.28, 2.82 ± 0.64, 1.36 ± 0.24, 4.64 ± 0.63, and 4.90 ± 0.46, respectively, versus 1.38 ± 0.41, 3.22 ± 0.57, 1.44 ± 0.27, 6.07 ± 0.88, and 5.69 ± 0.46, respectively, for the placebo group. Using an individual-based analysis, individuals in group 1 showed enhanced clinical outcome (P <0.05) over a period of 6 months compared with those in group 2. CLM was detected in GCF until a period of 7 weeks after the local drug delivery.Although both treatment strategies seemed to benefit the individuals, the adjunctive use of 0.5% CLM as a controlled drug delivery system enhanced the clinical outcome.
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This study aimed to compare the effects of subgingival delivery of 2% curcumin gel and 0.2% chlorhexidine gel as an adjunct to scaling and root planing (SRP) on clinical and microbiological parameters in the management of patients with chronic periodontitis.In total, 25 systemically healthy individuals with age group ≥30 years diagnosed with chronic periodontitis were included in the study. The study was a double-blind split-mouth randomized control clinical trial. Two sites were selected in each patient and were randomly allocated to experimental and control sites. At baseline, measurements of site-specific periodontal parameters and collection of subgingival plaque sample were done. After full-mouth SRP, subgingival delivery of 2% curcumin gel in experimental sites and 0.2% chlorhexidine gel in control sites was done. At 1 and 3 months, subgingival plaque samples were collected again and site-specific periodontal parameters were measured.The experimental group (2% curcumin gel) showed statistically significant improvements in periodontal [i.e., sulcus bleeding index (SBI), probing pocket depth (PPD), and relative attachment level (RAL)] and microbiologic parameters in the form of colony-forming units (CFUs) in comparison with control group (0.2% chlorhexidine gel).Subgingival delivery of curcumin has shown effective anti-inflammatory and antibacterial properties. Since it is biologically accepted by the patients and its delivery in periodontal pockets can be recommended as an adjunct to SRP therapy for the treatment of patients with localized, moderate chronic periodontitis and in patients under the periodontal maintenance phase.Curcumin being a herbal agent may be excellent alternative to chlorhexidine. It is biologically accepted by the patients and can be recommended as an adjunct to SRP in the treatment of localized moderate chronic periodontitis and periodontal maintenance patients.
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The recent decades, considerable attention has focused on using of different typesof laser irradiation in treatment of periodontal diseases. The aim of the present studywas the assessment of efficacy of low-level and high-level diode laser treatment incombination with scaling and root planing (SRP) in patients with chronicperiodontitis. The total sample of the present study consisted of twelve patients hadmoderate to severe chronic periodontitis in at least (3) vital single-rooted teeth indifferent quadrants of each patient.These teeth of the twelve patients were allocated into three groups according to thetype of the received treatment (12 teeth from 12 patients for each group).1- Group A (GA) treated with scaling & root planing ( SRP).2- Group B (GB) (SRP + low-level laser).3- Group C (GC) (SRP + high-level laser).Clinical measurements were performed by a single well trained and calibratedexaminer, and they included, plaque index (PI), gingival index (GI), bleeding onprobing (BOP), clinical attachment level (CAL) and probing pocket depth (PPD). Theresults of the present study were positive and predictable in both lasers irradiationmodes. The differences between the changes of the SRP group (GA), and two laserslow and high density lasers combined with SRP groups (GB & GC) at baseline werenot significant. All of the clinical parameters that were investigated in this study haveshowed a significant improvement at 6 months from the baseline for the three groupsof the study. These findings reported that low & high-level diode laser can have abeneficial effect in treatment of chronic periodontitis in combination with traditionalmechanical treatment
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Objective: This study compared the effect of 980 Diode laser + scaling and root planing (SRP) versus SRP alone in the treatment of chronic periodontitis. Method: 21 healthy patients with moderate periodontitis with a probing depth of at least 5mm were included in the study. A total of 42 sites were treated during 6weeks with a combination of 980 Diode laser and SRP (21 sites) or SRP alone (21 sites). The gingival index (GI), probing pocket depth (PPD) and bleeding on probing (BOP) were examined at the baseline and after 6 weeks after the start of treatment. Results: Both groups showed statistically significant improvements in GI, BOP and PPD after treatment. The results also showed significant improvement from laser+ SRP group to SRP alone group. Conclusion: The present data suggest that treatment of chronic periodontitis with either 980 Diode laser + SRP or SRP alone results in statistically significant improvements in the clinical parameters. The combination of 980 Diode laser irradiation in the gingival sulcus and SRP, was significantly better as compared to SRP alone.
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Abstract Objective: This paper reports a meta‐analysis of studies that have investigated the effect of scaling and root planing on periodontal probing depth and attachment loss. Material and methods: The criteria used for inclusion of studies were as follows: root planing and scaling alone was one of the primary treatment arms; patients or quadrants of each patient were randomly assigned to study groups; 80% of patients enrolled were included in first year follow‐up examinations; periodontal probing depth and attachment loss were reported in mm; the sample size of each study and substudy was reported. Sample size was used to weight the relative contribution of each study since standard errors were not reported by many studies and sample size is highly correlated with standard error and therefore statistically able to explain a substantial portion of the standard error on studies that use similar measures. Results: The meta‐analysis results show that periodontal probing depth and gain of attachment level do not improve significantly following root planing and scaling for patients with shallow initial periodontal probing depths. However, there was about a 1‐mm reduction for medium initial periodontal probing depths and a 2‐mm reduction for deep initial periodontal probing depths. Similarly, there was about a 0.50‐mm gain in attachment for medium initial periodontal probing depth measurements and slightly more than a l‐mm gain in attachment for deep initial periodontal probing depth measurements. Surgical therapy for patients with deep initial probing depths showed better results than scaling and root planing in reducing probing depths. When patients were followed up over 3 years or more, these differences were reduced to less than 0.4 mm. Antibiotic therapy showed similar results to scaling and root planing. However, a consistent improvement in periodontal probing depth and gain of attachment is demonstrated when local antibiotic therapy is combined with root planing and scaling.
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To compare the short-term clinical effects following non-surgical periodontal treatment with Er:YAG laser or with combination of ultrasonic subgingival scaling and root planing with hand instrument (SRP) for patients with chronic periodontitis.In the study, 17 patients with chronic periodontitis were randomly treated in a split-mouth design with Er:YAG laser (test group) or a combination of ultrasonic subgingival scaling and root planing with hand instrument (control group). The degree of discomfort experienced during the treatment was graded by the patient using visual analogue scale (VAS) immediately after the completion of test and control treatment procedures. The following clinical parameters were recorded by a calibrated and blinded examiner: plaque index (PLI), bleeding index (BI), probing depth (PD) and attachment loss (AL).The mean VAS score of Er:YAG laser treatment [3 (2, 4.5)] was significantly lower than that of control treatment [5 (4, 6), P=0.013]. Both the groups showed significant reduction of PLI, PD, AL and BI values 2 months and 4 months after treatment. For sites with PD≥4 mm at baseline, the sites treated with Er:YAG laser demonstrated mean PD change from (5.6±1.1) mm to (3.6±1.1) mm and to (3.4±1.0) mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from (5.1±1.5) mm to (3.9±1.6) mm and to (3.8±1.7) mm at the end of 2 months and 4 months respectively, meanwhile the BI value showed significant decrease, P=0.000; the sites treated with conventional SRP demonstrated mean PD change from (5.6±1.1) mm to (3.8±1.1) mm and (3.5± 1.0) mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from (4.8±1.6) mm to (3.8±1.6) mm and (3.6±1.8) mm at the end of 2 months and 4 months respectively, and the BI value also showed significant improvement. No statistical difference for all clinical parameters were found between the two treatment groups.The present results indicate that non-surgical periodontal therapy with Er:YAG laser is safe and effective, and Er:YAG laser therapy could be used for patients who was sensitive to pain.
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The aim of this study was to evaluate the clinical and microbiological effects of local application minocycline HCl 2% gel, used as an adjunct to scaling and root planing (SRP) for treatment of chronic periodontitis (CP). CP is an inflammation of periodontal tissue that is caused mainly by bacterial infection, where periodontal destruction such as loss of attachment and bone destruction occurred.A total of 81 subjects with moderate to severe periodontitis whose baseline clinical attachment loss (CAL) was ≥4 mm were randomly assigned to receive SRP alone (control group, N=39) or SRP followed by four times of local application of minocycline HCl gel (Periocline) once a week (test group, N=42). Pocket depth, CAL, and papilla bleeding index were examined at baseline, 21 days, 2, 3, and 6 months. Subgingival plaque samples were collected with sterile curettes and were analyzed by real-time polymerase chain reaction for the presence of three periodontal pathogens (Porphyromonas gingivalis [P.g.], Tannerella forsythia [T.f.], and Treponema denticola [T.d.]) at baseline, 2, 3, and 6 months.The number of bacteria was reduced in both groups at 2 months after baseline (SRP treatment). The changes (2-6 months) in T.d. and T.f. counts in the test group were significantly lower than those in the control group. In the control group, a significant regrowth of P.g., T.f., and T.d. was observed from 2 to 6 months and of P.g. and T.f. from 3 to 6 months. On the other hand, in the test group, the number of the three bacteria did not significantly increase during the 6-month period.The results showed that local application of minocycline, used as an adjunct to SRP, was effective for suppressing regrowth of periodontal pathogens, suggesting its risk reduction of recurrent periodontal pathogens in CP.
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Background: To Evaluate the additional benefit of Antimicrobial Photodynamic therapy, if any in the glycemic control of type 2 diabetes mellitus chronic periodontitis patients .
Methods: Fifty diabetic patients with chronic periodontitis were taken for the study who met the inclusion criteria of clinical attachment loss ?3 to 5 mm at ? 30% of sites and bleeding on probing present in two different quadrants . After SRP ( Scaling and root planing ) , one quadrant was selected for aPDT while other served as a control group. Clinical parameters i.e. Plaque index, Probing depth ,Relative attachment level and HBA1c were measured at baseline, 1 week , 1month and 3 months.
Results: Statistically significant differences in the mean probing depth, Relative attachment level, plaque deposit, and HBA1c were found between baseline and 12 weeks post-treatment for both groups. No significant differences in glucose levels were detected among the two groups in 1 week . Reduction in the mean HbA1c level after treatment was observed in both groups in 1 month and 3 months .
Conclusion: Antimicrobial Photodynamic Therapy when used in addition to scaling and root planing yields significant improvement of mean probing depth , Plaque deposit ,Relative attachment levels, periodontal status and reduction of HbA1c levels in treatment of diabetic patients with periodontitis when comparing the test group to the control group.
Keywords: photodynamic therapy , scaling and root planing, glycated haemoglobin ,Randomized controlled trial
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