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.

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.

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.