EFFICACY OF PHOTODYNAMIC THERAPY AS AN ADJUNCT TO NON – SURGICAL PERIODONTAL THERAPY IN TYPE-2 DIABETES MELLITUS PATIENT
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Abstract:
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 trialKeywords:
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BACKGROUND: Periodontitis is a major cause of tooth loss among adults. Several
studies have shown a possible systemic impact of periodontal infection, including
poor glycemic control in patients with diabetes. Recently, photodynamic therapy
(PDT) was used to successfully treat periodontal infection. PDT provides a broad
spectrum antimicrobial efficacy with no local or systemic side effects. The
objective of this study was to examine the effect of the adjunctive use of PDT on
periodontal status and glycemic control of patients with diabetes and
periodontitis. METHODS: Forty-five patients with type 2 diabetes and moderate to
severe chronic periodontitis were selected and randomly assigned to one of the
following three treatment modalities (15 subjects each): scaling and root planing
(SRP) only, SRP plus systemic doxycycline, and SRP plus PDT. The plaque and
bleeding scores, probing depth, clinical attachment level, and glycosylated
hemoglobin (HbA1c) level were recorded at baseline and 3 months after periodontal
treatment. Descriptive statistics, the paired t test, and analysis of variance
(ANOVA) were used for data analysis. RESULTS: Statistically significant
differences in the mean probing depth, clinical attachment level, plaque deposit,
and bleeding on probing were found between baseline and 12 weeks post-treatment
for all groups. No significant differences in periodontal parameters and glucose
levels were detected among the three groups. Reduction in the mean HbA1c level
after treatment was observed in all groups but was only significant for the SRP
plus doxycycline group. CONCLUSION: The results of the present study indicate
that PDT does not benefit conventional non-surgical periodontal therapy in
patients with diabetes.
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Background and Objective Photodynamic therapy (PDT) has been used as a therapeutic alternative to treat periodontitis, especially in challenging sites that require additional periodontal therapy such as residual pockets. The aim of this split‐mouth randomized trial was to evaluate the microbiological and clinical effects of PDT on non‐surgical treatment of unresponsive pockets. Study Design/Materials and Methods A split‐mouth, randomized controlled clinical trial was conducted in 15 patients presenting at least two residual pockets (probing pocket depth [PPD] ≥5 mm with bleeding on probing [BoP]) in single‐rooted teeth in supportive periodontal therapy. The selected sites randomly received: (1) SRP + PDT: scaling and root planing combined with photodynamic therapy (methylene blue as a photosensitizer), or (2) SRP: scaling and root planing alone. The concentrations of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were evaluated using a Real‐time PCR technique at baseline and 3, 7, 14, and 90 days. Clinical parameters were assessed at baseline and 3 months post‐therapies. Results Both treatments promoted clinical improvements, with additional benefits to the SRP + PDT group in PPD reduction and clinical attachment level gain ( P < 0.05) after 3 months. Only the SRP + PDT group exhibited a statistically significant reduction in the levels of A. actinomycetemcomitans on the 3rd and 7th days after therapy ( P < 0.05), and a lower concentration of this pathogen was detected at 7 days in the SRP + PDT group when compared to the other therapy ( P < 0.05). Conclusion The combined therapeutic approach SRP + PDT may reduce A. actinomycetemcomitans levels for a short‐term period, associated with additional improvement in clinical parameters in treating residual pockets. Lasers Surg. Med. 48:944–950, 2016. © 2015 Wiley Periodicals, Inc.
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Background: Periodontitis is a major cause of tooth loss among adults. Several studies have shown a possible systemic impact of periodontal infection, including poor glycemic control in patients with diabetes. Recently, photodynamic therapy (PDT) was used to successfully treat periodontal infection. PDT provides a broad spectrum antimicrobial efficacy with no local or systemic side effects. The objective of this study was to examine the effect of the adjunctive use of PDT on periodontal status and glycemic control of patients with diabetes and periodontitis. Methods: Forty‐five patients with type 2 diabetes and moderate to severe chronic periodontitis were selected and randomly assigned to one of the following three treatment modalities (15 subjects each): scaling and root planing (SRP) only, SRP plus systemic doxycycline, and SRP plus PDT. The plaque and bleeding scores, probing depth, clinical attachment level, and glycosylated hemoglobin (HbA1c) level were recorded at baseline and 3 months after periodontal treatment. Descriptive statistics, the paired t test, and analysis of variance (ANOVA) were used for data analysis. Results: Statistically significant differences in the mean probing depth, clinical attachment level, plaque deposit, and bleeding on probing were found between baseline and 12 weeks post‐treatment for all groups. No significant differences in periodontal parameters and glucose levels were detected among the three groups. Reduction in the mean HbA1c level after treatment was observed in all groups but was only significant for the SRP plus doxycycline group. Conclusion: The results of the present study indicate that PDT does not benefit conventional non‐surgical periodontal therapy in patients with diabetes.
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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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A pilot study comparing the outcome of scaling/root planing with and without Perioscope™ technology.
The purpose of this study was to determine if the use of a periodontal endoscope improves periodontal outcomes of scaling/root planing when compared to scaling/root planing alone.Thirty subjects with moderate periodontitis were recruited from the University of Minnesota School of Dentistry. Of these, 26 completed the study. A randomized split mouth design was used to evaluate periodontal outcomes at 6 to 8 weeks and 3 month intervals after sites within 2 quadrants of each subject were scaled and root planed with or without the use of the Perioscope™. Paired t-tests were used to test whether there were within-patient differences in improvement between Perioscope™ and non-Perioscope™ sites as measured by periodontal measurements (probing depth, clinical attachment level) and indices of gingival inflammation, including bleeding on probing (BOP) and gingival inflammation (GI). P-values less than 0.05 were declared to be statistically significant.Less BOP and GI were found in the Perioscope™ sites at visit 1 and visit 2. Reduction in pocket depth and clinical attachment loss was achieved for all sites but probing depth and clinical attachment level changes were found to be unrelated to the use of the Perioscope™. Mean probing depth (SD) was reduced from 5.29 mm (0.4) to 3.55 mm (0.8) in the Perioscope™ sites and 5.39 mm (0.5) to 3.83 mm (1.2) in non-Perioscope™ sites from baseline measurements to visit 2.The adjunctive use of the periodontal endoscope improved periodontal outcomes with respect to gingival inflammation and bleeding upon probing. The adjunctive use of the Perioscope™ was not found to be superior to traditional scaling and root planing with regard to pocket depth reduction and clinical attachment loss.
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To determine the preventive effect of a periodontal dressing containing colophony, zinc oxide and magnesium oxide applied after scaling and root planing on clinical variables, subgingival bacteria and local immune response in patients with chronic periodontitis.In this randomised prospective clinical study, 28 volunteers with generalised moderate chronic periodontitis were treated with full-mouth scaling in a split-mouth design. In the test quadrants, the periodontal dressing was applied during the first three days. At baseline and after 6 and 12 weeks, probing pocket depth (PD), attachment level (AL) and bleeding on probing (BOP) were recorded, and subgingival plaque samples were taken for laboratory analysis.In both groups, PD, AL and BOP were significantly reduced (p=0.001). BOP was significantly lower in the control than the test group after 6 weeks (p=0.046). Significantly reduced bacterial counts of Porphyromonas gingivalis were found in the control group after 12 weeks (p=0.013). No differences were found for the microbiological results between the groups. After 12 weeks, interleukin (IL)-8 and matrix metalloproteinase (MMP)-8 were significantly higher in the test group (p=0.023 and p=0.003, respectively).The adjunctive application of a periodontal dressing had no additional preventive effect on clinical data 12 weeks after scaling and root planing.
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To observe the non-surgical treatment response on diabetic patients with chronic periodontitis.Moderate to advanced chronic periodontitis was studied in 36 Diabetes Mellitus (DM) patients classified as 20 cases with high and fluctuating blood glucose level (DM-H) and 16 cases with relatively low and stable blood glucose level (DM-L). 28 non-DM patients with chronic periodontitis served as control (Non-DM). Plaque Index (PlI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Depth (PD) and Clinical Attachment Loss (AL) of all patients were recorded at 6 sites on each tooth at the baseline and in the first, the third, the sixth month after oral hygiene instrument (OHI), scaling and root planing.It was found that the short-term effect of non-surgical periodontal procedure had resulted in significant resolution of gingival inflammation and pronounced reduction in pocket depth and gain of attachment loss in all patients. The treatment response was similar in both DM and Non-DM patients with chronic periodontitis.Non-surgical periodontal treatment allowed for favorable treatment responses in a group of diabetic patients with chronic periodontitis and that their various profiles of blood glucose did not influence the short-term healing response to the treatment.
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Introduction This study was performed to evaluate the clinical efficacy of using the Perio-Flow device (Electro Medical Systems, Nyon, Switzerland) adjunctively with mechanical instrumentation on periodontal parameters and halitosis. Materials and Methods Sixty patients who presented with a 4- to 6-mm probing pocket depth were recruited for the study. Patients were randomly assigned to scaling and root planing (SRP) or SRP + glycine powder air-polishing (GPAP). For both groups, the plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level scores were recorded at baseline and 1 month. Volatile sulphur compounds (VSCs) were measured by a Halimeter (Interscan Corp., Chatsworth, CA, USA) at baseline, immediately after treatment, and at 7, 14, and 30 days. Results Both groups showed significantly lower plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level gain scores at 1 month than at baseline. No significant differences were found between the groups at any time point. The VSCs were significantly different at 1 month compared with baseline in both groups. However, the intergroup comparisons of VSCs were not statistically significant at any time point. Conclusion Within the limits of this study, SRP is effective for treatment of periodontitis and halitosis. However, using GPAP adjunctively with mechanical instrumentation has no beneficial effects on halitosis or periodontal parameters.
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