Effect of Nonsurgical Periodontal Therapy on Metabolic Control and Systemic Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with Stage III Periodontitis.

Background: A reciprocal relationship is understood to exist between periodontal disease and type 2 diabetes mellitus (T2DM), and this intervention study aimed to evaluate the effects of nonsurgical periodontal therapy (NSPT) on metabolic control, systemic inflammation, and cytokines in patients of T2DM with Stage III periodontitis. Materials and Methods: Sixty patients of T2DM with Stage III periodontitis were divided equally into two groups: intervention group (IG) and control group. Clinical parameters such as bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months, and the serum samples were collected and processed at baseline and 6 months following NSPT to evaluate fasting plasma glucose, Glycosylated hemoglobin (HbA1c), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and high-sensitivity capsule-reactive protein (hs-CRP). Results: The results indicated a significant improvement in clinical parameters of PPD and CAL 6 months after NSPT (P = 0.005) in both the groups. However, a significant decrease (P < 0.0001) in the TNF-α, hs-CRP, blood glucose, and HbA1c levels was seen after NSPT. On the other hand, an increase in anti-inflammatory cytokine IL-10 was observed after NSPT in the IG. The changes in the pretreatment and posttreatment levels of all clinical, biochemical, and metabolic parameters, were found to be significant in both the groups except BOP. Conclusion: NSPT effectively improves periodontal condition, systemic inflammatory status, and glycemic control in patients of T2DM with Stage III periodontitis and decreases hs-CRP levels.

Patient-centered outcome measures comparing the autogenous and allogenic bone blocks in the augmentation of deficient alveolar ridges: A pilot study.

Background: The aim of the present study was to evaluate and compare the patient-reported experience and outcome measures (PREMS and PROMS) and three-dimensional augmentation efficacy of the autogenous and allogenic bone block grafts in deficient alveolar ridges through cone beam computed tomography (CBCT). Materials and Methods: Twenty patients were equally divided into Groups I and II treated with autogenous and allogenic bone block grafts for ridge augmentation, respectively. The radiographic parameters including the apico-coronal defect height (DH) as well as buccolingual defect depth (DD) and mesiodistal defect width (DW) at apical, middle, and cervical zone were measured using CBCT at baseline, 6 months and 1 year. The PREMS and PROMS were evaluated using Visual analogue scale (VAS) scale and questionnaire method. Results: The mean DH, apical DD and DW, middle and cervical zone DW were significantly different between two study groups (P < 0.05). The mean apical 11.6 ± 1.91 and middle zone 9.43 ± 0.89 DD were significantly higher (in Group I as compared to Group II, with P values 0.016 and 0.004, respectively). The mean bone gains in apico-coronal DH and mesio-distal DW dimension in the apical and middle zone was significantly higher in Group I (P < 0.0001). The comparison of PROM revealed better patient satisfaction in Group II as depicted by significantly higher VAS score (P < 0.0001). Conclusion: Superior bone gain and reduced graft resorption was observed in Group I when compared to Group II. On the contrary, better PROMs and PREMs were obtained with the allogenic bone block augmentation.

Assessment and correlation of the influence of non-surgical periodontal therapy on serum lipid profile and cytokines in patients with stage III periodontitis.

BACKGROUND: Interleukins are the markers of inflammation and the lipid profile reveals the likelihood of arising cardiovascular disease (CVD). The present study aimed to assess and correlate the influence of non-surgical periodontal therapy (NSPT) on serum lipid profile and Interleukin-6 (IL-6) and Interleukin-8 (IL-8) in patients with Stage III periodontitis. METHODS: Sixty patients with the age range of 35-60 years with Stage III periodontitis were included by evaluating for periodontal parameters such as Probing pocket depth (PPD) and clinical attachment levels (CAL). NSPT was performed at baseline, 3 and 6 months. Biochemical parameters like serum lipid parameters of total cholesterol (TC), triglycerides (TG), low-density lipopolysaccharide (LDL), high-density lipopolysaccharide (HDL), and IL-6 and IL-8 serum levels were assessed at baseline and 6 months' post-NSPT. RESULTS: The results indicated a significant reduction (p < 0.0001) in the PPD (2.75 ± 0.41), CAL (3.23 ± 0.56), lipid profile, and serum cytokine levels 6 months' post-NSPT as compared to baseline. A highly significant (p < 0.0001) percentage reduction was observed in the IL-6 (35.3%), IL-8 (41.6%), TC (7.5%), TG (1.78%), LDL (6.2%), and HDL (-21.8%) clinical and biochemical parameters at 6 months' recall post-NSPT. CONCLUSION: Non-surgical periodontal therapy caused a significant reduction in the levels of serum pro-inflammatory cytokines IL-6 and IL-8 as well as the lipid biomarkers TC, TG, LDL, and increase values of HDL. These findings imply a considerable reduction in the risk of developing CVD in patients with Stage III periodontitis.

Randomized, controlled clinical trial to evaluate efficacy of sticky bone and concentrated growth factor in the management of intrabony defects: 12 months follow-up study.

Background: Platelet derivatives are enriched growth factors that ameliorate various cellular processes in regeneration. The present clinical trial aimed to evaluate and compare the effects of sticky bone and concentrated growth factors (CGFs) in the treatment of intrabony osseous defects by cone-beam computed tomography (CBCT). Materials and Methods: The study included 20 patients having 40 intrabony defects. 20 sites each were included in both test group (Sticky bone) and Control group (CGF alone). The clinical parameters including probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline and 6 and 12 months posttherapy. The radiographic parameters including the depth, mesiodistal (MD), and the buccolingual (BL) width of the defect to assess the amount of bone fill were examined at baseline and after 12 months using CBCT. Results: Twelve months posttherapy clinical results indicated a significant reduction of PPD and gain in CAL in both the study groups. Similar observations were recorded with CBCT radiographic parameters where the intrabony defect depth and MD defect width for the test group and control group significantly reduced after 12 months' posttherapy (P < 0.0001). However, no significant reduction in BL defect width was observed in control group (P = 0.577) in contrast to the test group (P = 0.028) after 12 months' posttherapy. Conclusion: Intrabony defects treated with sticky bone showed improved clinical and radiographic parameters indicative of enhanced periodontal regeneration as compared to CGF alone treated sites.

Peri-implant soft tissue stability through vestibular extension procedure: a retrospective study.

OBJECTIVES: The present retrospective study assessed the width of keratinized mucosa (WKM) and vestibular depth (VD) adjacent to dental implants subsequent to vestibular extension procedure in patients exhibiting inadequate WKM. A correlation between these two parameters with peri-implant soft tissue stability and the incidence of peri-implant soft tissue dehiscence (PSTD) was also examined. METHOD AND MATERIALS: The study included 36 patients (age range 30 to 50 years) with implant restoration. The patients with an inadequate WKM and VD underwent vestibular extension procedure in areas of implant placement. The Modified Plaque Index, Gingival Index, Sulcus Bleeding Index, WKM, VD, and the peri-implant probing depth were measured and compared at baseline, 3 months, and after 1 and 2 years post vestibular extension procedure. RESULTS: A significant enhancement was observed in VD dimensions for both men and women from baseline (1.73 ± 1.10 mm and 1.57 ± 0.98 mm, respectively) to 2 years posttherapy (6.93 ± 0.88 mm and 7.95 ± 1.12 mm, respectively). Similarly, there was an increase in WKM of 4.14 ± 0.24 mm in men and 4.84 ± 0.14 mm in women. However, a weak and insignificant negative correlation was observed between WKM, VD, and PSTD after 2 years. CONCLUSION: The results of the present study indicate that the vestibular extension procedures around dental implants enable the clinician to achieve greater WKM and VD posttherapy, which is maintainable for a considerable time. The peri-implant soft tissue stability achieved thereafter ensures proper oral hygiene at the site and also negatively correlates with the PSTD.

Influence of Adjunctive Photodynamic Therapy on Interleukin-6, Interleukin-8, and Interleukin-10 Gingival Crevicular Fluid Levels in Chronic Periodontitis - A Randomized Controlled Trial.

BACKGROUND: Numerous studies have assessed the effect of photodynamic therapy (PDT) both as a primary mode of treatment and as an adjunct to scaling and root planing in the treatment of periodontitis. Some results were nondefinitive and, in part, inconsistent with respect to the clinical and biochemical effects. Hence, the aim of this study was to evaluate the effect of PDT as an adjunct to nonsurgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) interleukin-6 (IL-6), IL-8, and IL-10 levels in the treatment of chronic periodontitis (CP). MATERIALS AND METHODS: In 21 patients with CP, two contralateral sites (premolar and molar) were randomly divided into: control sites (treated with NSPT only) and test sites (treated with NSPT + PDT). Clinical parameters including bleeding on probing (BOP), probing pocket depth, clinical attachment level were evaluated at baseline, 1- and 3 months and biochemical parameters of GCF levels of IL-6, IL-8, and IL-10 were evaluated at baseline and 3-month post-therapy through enzyme-linked immunosorbant assay. RESULTS: A greater improvement in BOP score at 1 month (41.10% ± 3.58%) and 3-months (38.00% ± 3.62%) posttherapy was found in the test site as compared to control site. Regarding cytokines, test sites exhibited significant reductions in IL-6 (4.29 ± 0.67 pg/ml) and IL-8 (308.16 ± 36.04 pg/ml) levels and increase in IL-10 (14.25 ± 0.83 pg/ml) level at 3 months (P < 0.0001). CONCLUSION: Additional application of PDT, adjunctive to NSPT, resulted in a significant reduction in BOP score as well as GCF pro-inflammatory cytokine levels along with an increase in anti-inflammatory cytokine levels, compared to NSPT alone.

Effect of Aloe vera as a local drug delivery agent in the management of periodontal diseases: A systematic review and meta-analysis.

BACKGROUND: Aim of the present meta-analysis was to evaluate the effect of Aloe vera in various forms such as gel, mouthwash, and dentifrice on gingival and plaque index (PI) in comparison to various allopathic products such as chlorhexidine, metformin, chlorine dioxide, fluoridated toothpaste, and alendronate. MATERIALS AND METHODS: A comprehensive electronic search was conducted on PubMed/MEDLINE, GOOGLE SCHOLAR, and HAND SEARCH of reference list of archived articles published till January 2020. Randomized controlled trials were searched comparing the Aloe vera product with other products which used PI and gingival index (GI) to evaluate the outcomes. Finally, nine studies assessing PI and four studies evaluating GI were considered for the meta-analysis. After extracting the information, a risk of bias was estimated. The standardized mean differences (SMDs) and fixed and random effect models were obtained from the mean treatment differences. RESULTS: The estimates of SMD of PI from fixed effects (SMD = 0.271, 95% confidence interval [CI] = 0.00134-0.407, P < 0.001) and random effects (SMD = 0.288, 95% CI = 0.048-0.529, P = 0.019) were found slightly different, the models showed consistent results yielding positive and significant treatment effects. For GI fixed effects (SMD = 0.27, 95% CI = -0.035-0.575, P = 0.0803, not significant) and random effects (SMD = 0.259, 95% CI = 0.049-0.469, P = 0.016, significant) were found slightly different and positive. However, one model showed significant and another model showed nonsignificant treatment effects. CONCLUSION: Results from our meta-analyses confirmed the beneficial effects of A. vera in improving the periodontal parameters and hence may be considered as a safe alternative drug delivery agent for the management of periodontal diseases in future.

Assessment of knowledge, awareness, and attitude among patients with cardiovascular disease about its association with chronic periodontitis.

BACKGROUND: A strong bilateral relationship between cardiovascular disease (CVD) and chronic periodontitis has been established for decades. However, a knowledge gap regarding this association still persists among patients. The main objective of the present study was to assess the knowledge, awareness, and attitude among patients with CVD about its association with chronic periodontitis (CP). MATERIALS AND METHODS: This observational cross-sectional survey consisted of 500 patients with CVD. Along with information on demographic characteristics, data were collected on knowledge, awareness, and attitude of the interrelationships between periodontal disease and CVD, using a 5-point Likert scale, with 4 and 5 representing "agree" and "strongly agree," respectively. RESULTS: A significant number of the study population had no knowledge regarding the bilateral association CVD and CP. Other questions revealed limited awareness and ignorant attitude of the patients. CONCLUSION: Within the limitations of the study, it can be concluded that there is a lack of awareness and an ignorant attitude about the bidirectional relationship between CVD and periodontitis among the CVD patients. Special efforts should be taken by dental as well as medical professionals to increase the awareness in this regard and thereby deliver quality health-care services at earlier stages.

Peri-implant tissue stability in premolar and molar sites: a retrospective clinical and radiographic analysis.

OBJECTIVES: The retrospective study was undertaken to assess the peri-implant tissue stability in premolar and molar sites clinically and radiographically for implants 7 years after loading. METHOD AND MATERIALS: 408 implants placed in 275 patients from 2012 to 2020 and following a regular recall protocol were assessed for Modified Plaque Index (MPI), Sulcus Bleeding Index (SBI), pocket probing depth (PPD), and the peri-implant soft tissue dehiscence (PSTD) clinically and mesial bone loss (MBL) and distal bone loss (DBL) radiographically. RESULTS: Significant differences were found in MPI, SBI, and PPD amongst both men and women in the premolar and molar regions. The mean MBL and DBL were substantially greater in women than in men and marginally more in the maxilla than in the mandible. Maximum mean bone loss on either aspect of the premolar and molar implants was 2.80 ± 1.54 mm and 2.97 ± 0.96 mm for women. Implant success of 96.82% at 7 years was achieved and the patient satisfaction levels of 94.55% and 95.50% in the mandibular and maxillary arches, respectively, implied that patients were satisfied with the treatment. CONCLUSION: Women exhibited greater marginal bone loss on the mesial and distal aspects than men, with premolar implant sites demonstrating greater propensity for marginal bone loss than molar implant sites.

Association of location and diameter of alveolar antral artery to crest of alveolar bone in dentate and partially edentulous patients - A cone-beam computed tomography study.

BACKGROUND: One of the most challenging anatomical conditions to manage during sinus augmentation using lateral window approach is the alveolar antral artery (AAA) when it is unusually wide in diameter and passes through the area of the osteotomy with a complete intraosseous course. The purpose of this study was to investigate the association of location and diameter of AAA to the crest of alveolar bone in dentate and partially edentulous patients using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Totally 100 CBCT scans of patients (50 dentate and 50 edentulous) were selected and analyzed. The location and diameter of AAA in the lateral wall of the maxillary sinus were evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar (P1), second premolar (P2), and first molar (M1). RESULTS: The diameter of AAA in dentate patients was higher in M1 region (1.32 ± 0.34 mm) than P1 (0.91 ± 0.20 mm) and P2 (1.07 ± 0.24 mm) regions as compared to edentulous patients. It was found that the location of AAA for P1 in the dentate group (22.35 ± 4.17 mm) was significantly higher than that of the edentulous group (20.37 ± 2.48 mm). A negative relationship has been found between age and the distance between the AAA canal and crest of the alveolar ridge in both dentate (P = 0.001) and edentulous (P = 0.003). CONCLUSION: A significantly negative relationship existed between age, diameter, and location of AAA in both the dentate and edentulous groups.

Quantitative analysis of gingival phenotype in different types of malocclusion in the anterior esthetic zone.

BACKGROUND: For any esthetic treatment planning, the shape and form of gingiva should be a prime factor of concern. The correct identification of gingival phenotype (GP) ensures a firm foundation for future health and prognosis of the treatment indicated. Hence, the aim of the present study was to evaluate the correlation between the GP in the anterior esthetic zone with different types of maloclussion and severity of crowding. MATERIALS AND METHODS: A total of 110 periodontally healthy controls were equally divided into two groups depending on the type of malocclusion. They were further divided according to the levels of dental crowding as mild, moderate, and severe. GP was measured on the anterior esthetic teeth using transgingival probing, and width of the attached gingiva (WAG) was measured using histochemical staining method. RESULTS: In severe crowding group, the GP in 12 and 22 region was found to be thick (P = 0.035) while, in 32 and 42 region was thin (P = 0.042). The WAG shows a significant difference between WAG with 23 in severe crowding group with P = 0.042, whereas there was no significant relationship found between the GP with Angle's classification. CONCLUSION: Within the limitations of the study, it can be concluded that the teeth in the maxillary and mandibular anterior esthetic region showed the thin phenotype. When the severity of crowding increases, the GP and WAG vary depending on the position of the tooth. There is no association between the Angle's classification and the mean GP of the maxillary and mandibular anterior region teeth.

Influence of facial index, facial profile, lip size, and angulations of teeth on gingival characteristics of anterior teeth: A gender-based evaluation.

OBJECTIVE: A prime component in an esthetic and pleasing appearance of face is the proportionate presence of different compositions of the face. The present study aimed to evaluate the association between facial index, facial form, lip size, and angulation of anterior teeth with periodontal phenotype in males and females. MATERIALS AND METHODS: This cross-sectional study included 100 consecutive periodontally healthy orthodontic patients equally divided based on gender in two groups. The facial parameters including the Facial index (FI), lip size, and Gingival thickness (GT) for maxillary and mandibular incisors were measured using a digital vernier calliper. Maxillary and mandibular incisors inclination was measured using cephalometric analysis. RESULTS: Significant differences were observed among both the genders in terms of FI and facial forms, upper lip size, and angulations of mandibular anterior teeth and the periodontal phenotype. The GT was found to be strongly associated with the FI and mandibular anterior teeth angulation. CONCLUSION: The FI, and teeth inclinations are associated with the GT and shows sexual dimorphism. The evaluation of the periodontal phenotype and anthropometric parameters is essential during diagnosis and treatment planning for potential orthodontic patients and prediction of its influence on the periodontal tissues. CLINICAL SIGNIFICANCE: The gingival thickness varies with the facial index, facial form, teeth inclination, and lip size and thereby can be used to predict the pros and cons of orthodontic treatment and the need for prior periodontal therapy.

Proximal contact areas of maxillary anterior teeth and their influence on interdental papilla.

OBJECTIVES: Open gingival embrasures leading to appearance of black triangles which apart from being unesthetic contribute towards food retention, adversely affecting the health of the periodontium. Correction of such papillary deformities is extremely challenging, which requires an in depth knowledge about the interproximal geometry for the appropriate management of interdental papilla. So, the present study was aimed to determine the proximal contact areas of maxillary anterior teeth and their influence on the interdental papilla. MATERIALS AND METHODS: In 200 periodontally healthy patients equally divided into 21-40 years (Group I) and 41-60 years (Group II) of age group amounting to a total of 1400 interdental papillae in maxillary anterior teeth were examined to compute the apicocoronal Proximal contact area (PCA), Proximal contact area proportion (PCAP), and dimensions between alveolar crest and apical contact point (D1) to assess their influence on presence or absence of interdental papilla. RESULTS: The PCA dimensions were maximum for Central incisor-Central incisor measuring about 3.90 ±â€¯0.93 mm and 3.97 ±â€¯0.90 mm for Group I males and females respectively and 3.86 ±â€¯1.22 mm and 3.63 ±â€¯1.14 mm for males and female patients in Group II respectively. There was a gradual reduction till Canine-Premolar. Similar trend was followed in PCAP and D1. Consistently more dimensions of D1 were observed in Group II as compared to Group I which influenced the presence of papilla which was predominantly found in Group I patients amongst both the sexes. CONCLUSION: There was a gradual decrease in the PCA and PCAP in the distal direction anteroposteriorly from maxillary central incisors to first premolars on either sides. The younger age group of both the sexes exhibit greater presence of interdental papilla owing to the lesser D1 dimensions as compared to the older patients.

Evaluation of stress, serum and salivary cortisol, and interleukin-1ß levels in smokers and non-smokers with chronic periodontitis.

BACKGROUND: Existing literature indicates a positive relationship between stress and chronic periodontitis (CP) but there is limited information on the combined influence of stress and smoking on the progression of periodontal disease. So, the objective of this study was to evaluate the effects of stress, salivary and serum, cortisol and interleukin-1ß levels in smokers with CP. METHODS: Seventy-five patients equally divided into three groups of healthy controls (Group I), smokers and non-smokers with CP (Group 2 and Group 3) respectively were evaluated for clinical parameters, biochemical parameters of salivary and serum cortisol and IL-1ß levels via enzyme linked immunosorbent assay (ELISA). Zung's self-rating depression scale questionnaire was used to determine the stress levels amongst the patients. RESULTS: Smokers with CP exihibited higher values of probing pocket depth, clinical attachment level, plaque index while lower papillary bleeding index, and gingival index scores as compared to non-smokers with CP. The salivary cortisol and IL-1 ß were relatively higher as compared to serum values in Group 2 than Group 3. The Group 2 patients revealed higher depression scores as compared to Group 3 patients. The depression scores positively and significantly correlated with the salivary cortisol in Group 2 patients. CONCLUSION: The results indicate that smokers with CP exhibit a significantly higher serum and salivary cortisol, IL-1ß, and stress levels and thus they may show an increased risk and periodontal disease severity. Further exploration of relationships between periodontitis and stress is required.