Comparative analysis of platelet-rich fibrin membrane and 0.2% hyaluronic acid gel on healing following gingival depigmentation procedure.

Introduction: Platelet-rich fibrin (PRF) accelerates wound healing by promoting faster cicatricial tissue remodeling and excellent neovascularization. Hyaluronic acid (HA) being biocompatible, anti-inflammatory, and proangiogenic leads to improvement in the rate of wound healing. Aim: The aim of this study was to compare the effect of PRF membrane and 0.2% HA gel on wounds after gingival depigmentation surgery. Materials and Methods: This study was carried out on 30 systemically healthy individuals recruited from the pool of patients who visited the department of periodontology. After depigmentation procedure in every patient, the sites were divided into three even groups. Group A received PRF membrane and periodontal dressing, Group B received 0.2% HA gel application and periodontal dressing, and Group C served as a control group in which only periodontal dressing was placed. The individuals were evaluated for the healing index (HI) and Numerical Rating Scale (NRS) on the 3rd and 5th day. Epithelialization test (ET) was performed on the 5th day. Gingival biotype was reassessed and compared to preoperative value after 3 months. The clinical trial was expressed in terms of mean and standard deviation. Intra-group comparison and inter-group comparison were done through the Kruskal-Wallis ANOVA test. All statistical tests were performed through SPSS version 25.0 (IBM). Results: The inter-group statistical analysis concerning NRS, HI, and ET showed statistically significant results in Groups A and B compared to Group C (P < 0.05), while gingival biotype showed statistically significant results in Group A compared to Groups B and C. Conclusion: The use of PRF membrane and HA gel to protect the raw wound site of depigmented gingiva proved to be an effective approach, resulting in faster healing.

Clinical and radiographic evaluation of 0.8% hyaluronic acid as an adjunct to open flap debridement in the treatment of periodontal intrabony defects: randomized controlled clinical trial.

OBJECTIVES: Present study aimed to evaluate and compare the clinical and radiographic efficacy of 0.8% hyaluronic acid (HA) gel as an adjunct to open flap debridement (OFD) versus open flap debridement (OFD) alone in the treatment of periodontal intrabony defects. MATERIALS AND METHODS: This randomized, controlled, split-mouth, clinical trial included 20 chronic periodontitis (stage II or III (grades A to B)) patients, having at least two contralateral intrabony defects. Forty bilateral intrabony defects (20 in each group) were randomly divided into test (0.8% HA gel + OFD) and control (OFD + placebo) groups. Clinical parameters evaluated at baseline, 6-months, and 12-months were plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and gingival recession (GR). Using cone beam computed tomography (CBCT), radiographic parameters were evaluated at baseline and 12 months. This included bone defect fill (DF), alveolar crest changes (ACC), and defect resolution (DR). CAL served as the primary outcome variable. RESULTS: After 12 months, the test group showed significantly greater CAL gain (5.1 ± 1.2 versus 4.05 ± 1.19 mm) and bone defect fill (DF) (5.67 ± 2.01 versus 4.49 ± 1.78 mm) compared to the control group. Mean PD reduction in the test group (5.3 ± 1.2 versus 4.35 ± 0.81 mm) was statistically significant compared to the control group at 12-month period. The control group showed statistically significant increase in GR (1.2 ± 0.76 versus 0.7 ± 0.73 mm) compared to the test group after 12 months. CONCLUSION: Application of hyaluronic acid gel in conjunction with open flap debridement resulted in enhanced clinical and radiographic outcomes compared to open flap debridement alone. CLINICAL RELEVANCE: Adjunctive application of HA gel in open flap debridement may improve clinical and radiographic outcomes. CLINICAL TRIAL REGISTERED NUMBER: CTRI/2018/03/012334.

Impact of different platelet-rich fibrin (PRF) procurement methods on the platelet count, antimicrobial efficacy, and fibrin network pattern in different age groups: an in vitro study.

OBJECTIVES: Platelet-rich fibrin (PRF) procuring protocols have been suggested, differing in speed and time duration. Since different derivation protocols may alter PRF characteristics, the present study was conducted to evaluate the variations in the fibrin network pattern, platelet count, and antimicrobial efficacy of PRF procured using variable centrifugation speeds and time durations in different age groups. MATERIALS AND METHODS: Sixty healthy subjects participated in the study and were equally divided into three age groups (20-34 years, 35-49 years, 50-65 years). From each age group, total of 6 PRF membranes were fabricated from 10 ml tubes. Three PRF membranes were obtained at 1400, 2800, and 3500 rpm for 8 min while other 3 membranes were obtained after 15 min of centrifugation respectively. The relative centrifugal force (RCF) values were within the spectrum of 228-1425 g. PRF membranes were then subjected to platelet count estimation, antimicrobial activity against oral bacteria, and changes in fibrin network pattern with respect to different age groups and different centrifugation protocols. RESULTS: Highest platelet concentration, antimicrobial activity, and dense fibrin network were obtained in 20-34 years age group. Intragroup analysis within each group revealed highest platelet count and antimicrobial activity in PRF membranes, obtained at 1400 rpm for 8 min. Denser fibrin network pattern was demonstrated by PRF membranes procured at 3500 rpm for 15 min. CONCLUSIONS: PRF properties, i.e., platelet count, antimicrobial efficacy, and fibrin network, are influenced by technical aspects of PRF preparation (RCF value, centrifugation speed, and time) and patient age. CLINICAL RELEVANCE: Based on the finding of present study, it can be implied that lower centrifugation speed and time can increase the platelet concentration and antimicrobial activity of the PRF membrane. Contrarily, lowering the speed and time leads to lesser density fibrin network pattern. Centrifugation protocols thus need to be adapted accordingly.

Subgingivally delivered coenzyme Q10 in the treatment of chronic periodontitis among smokers: A randomized, controlled clinical study.

BACKGROUND: Coenzyme Q10 is an antioxidant whose efficacy in periodontal diseases is well known. However studies regarding its efficacy in smokers with periodontitis are few. Coenzyme Q10 serves as an endogenous antioxidant and its increased concentration in the diseased gingiva effectively suppresses advanced periodontal inflammation. OBJECTIVES: The aim of this study is to evaluate the efficacy of coenzyme Q10 as an adjunct to scaling and root planing in smokers with chronic periodontitis. METHODS: Total of 40 patients were enrolled for the study. The subjects were divided into control (Scaling and root planing only) and test group (Coenzyme Q10 plus Scaling and root planing). Clinical parameters such as plaque index, modified sulcular bleeding index, probing pocket depth and clinical attachment level. These were assessed at baseline, at 1 month and 3 month. The results were subjected to appropriate statistical analysis. RESULTS: There was a significant improvement in all clinical parameters in the test sites seen at the end of the 1 month and 3 month period. CONCLUSIONS: Coenzyme Q10 can be said to have a beneficial effect on smokers with periodontitis when used as an adjunct to scaling and root planing.

Comparative evaluation of two antibacterial-coated resorbable sutures versus noncoated resorbable sutures in periodontal flap surgery: A clinico-microbiological study.

BACKGROUND: Sutures at the surgical site can act as a reservoir for microbes, leading to surgical site infection. This mainly occurs in braided sutures due to wicking action. The use of triclosan-coated suture (TCS) or chlorhexidine-coated suture (CCS) could be one of the possible alternatives to reduce the microbial load. OBJECTIVES: The study was designed to assess the antibacterial efficacy of resorbable TCS and CCS along with its effect on healing after periodontal flap surgery in comparison to noncoated sutures (NCSs). MATERIALS AND METHODS: Thirty patients with chronic periodontitis indicated for periodontal flap surgery satisfying inclusion criteria were randomly assigned in the three groups: (1) NCS-polyglycolic acid sutures (control group), (2) TCS-polyglycolic acid sutures (experimental Group A), and (3) CCS-polyglycolic acid sutures (experimental Group B). All the patients were evaluated at day 0 (baseline), day 8, day 15, and day 30 for healing index (HI), postoperative pain (POP), and visible plaque index (VPI). Aerobic and anaerobic bacterial growth around each suture was evaluated after day 8. Two randomly chosen samples from each group were examined using confocal laser scanning microscopy (CLSM) for the presence of biofilm. RESULTS: Although intergroup HI and POP were statistically insignificant (P > 0.05), intragroup evaluation showed statistically significant improvement. VPI was more in NCS compared to antibacterial sutures. There was significantly less concentration of anaerobic bacteria as compared to aerobic bacteria (P < 0.05). CLSM showed the presence of more viable bacteria on NCS as compared to antibacterial sutures. CONCLUSION: TCS or CCS sutures can be used in periodontal surgeries to reduce the bacterial load at the surgical sites.

Comparative evaluation of the chlorhexidine and cinnamon extract as ultrasonic coolant for reduction of bacterial load in dental aerosols.

BACKGROUND: Ultrasonic instruments generate aerosols with significantly greater number of bacteria. Preprocedural mouthrinses or chemotherapeutic coolants are used for the reduction of bacterial load in dental aerosols. The use of chlorhexidine as an ultrasonic coolant has been well established. However, this application has not yet been investigated for cinnamon extract which is known to have antibacterial and anti-inflammatory properties in vivo. AIM: The aim of this study is to compare and evaluate the efficacy of chlorhexidine and cinnamon extract as an ultrasonic coolant in reduction of aerosol contamination and biofilm formation during ultrasonic scaling in comparison with the distilled water (DW). MATERIALS AND METHODS: Sixty patients diagnosed with moderate-to-severe gingivitis were randomly divided into three groups of twenty patients each undergoing ultrasonic scaling. For Group I, chlorhexidine was used as an ultrasonic coolant; for Group II, cinnamon extract was used; and Group III was served as control where DW was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. Both the plates from each position were incubated aerobically for 48 h. The total number of colony-forming units were counted as mean ± standard deviation and statistically analyzed. In addition, biofilm sampling of dental unit waterlines (DUWLs) was also done to evaluate the effect of these antimicrobials. Apart from microbial examination, clinical parameters such as plaque index and gingival index were also evaluated at baseline and 1-month follow-up. RESULTS: Chlorhexidine and cinnamon both were equally effective (P > 0.05) in reducing the bacterial count in aerosols and biofilm in DUWL as compared to DW when used as ultrasonic cooling agent. CONCLUSION: Both cinnamon and chlorhexidine used as an ultrasonic device coolant through DUWLs effectively helped in the reduction of bacterial count in dental aerosols.

Comparative Evaluation of Boric Acid Gel versus Chlorhexidine Gel in the Treatment of Chronic Periodontitis: Randomized, Placebo-Controlled Clinical Study.

BACKGROUND: Over the years, various antimicrobials have been tried and tested in the treatment of periodontitis. Chlorhexidine (CHX) has emerged as the gold standard. In recent years, trend has shifted toward the use of agents with antibacterial, anti-inflammatory, and osteoblastic activity. Boric acid (BA) is one such agent which possess all such properties and thus been evaluated in the treatment of periodontitis. AIM AND OBJECTIVE: The aim of the study is to compare and evaluate the efficacy of 0.75% BA gel versus 1% CHX gel as an adjunct to scaling and root planing in patients with chronic periodontitis both clinically and microbiologically. MATERIALS AND METHODS: The present study was a randomized, placebo-controlled clinical trial where 45 systemically healthy patients with chronic periodontitis were included in the study. About 15 patients each were divided into three groups, that is, Group I received BA gel, Group II received CHX gel, and Group III received placebo gel as a local drug delivery agent. Clinical parameters such as gingival index, plaque index, modified sulcus bleeding index, probing pocket depth, and clinical attachment level were evaluated at baseline and 6-month follow-up. Microbiological analysis to check for mixed anaerobic flora was done using subgingival plaque samples at baseline and 3 months after treatment. RESULTS: Significant reduction was seen in all clinical parameters in both BA and CHX gel groups as compared to control group (P < 0.05). However, on comparing BA gel group with CHX gel, the results were statistically insignificant (P > 0.05). CONCLUSION: BA gel and CHX gel both were equally effective in improving the clinical and microbiologic parameters in patients with chronic periodontitis when used as a local drug delivery agent.

Antimicrobial photodynamic therapy using indocyanine green as a photosensitizer in treatment of chronic periodontitis: A clinico-microbial study.

BACKGROUND: Photodynamic therapy (PDT) has gained much attention in recent years in the treatment of periodontitis. Number of photosensitizer have been developed and has been used in various clinical studies. However, the use of recently developed photosensitizer has been limited. AIM: The present study aims at comparing and evaluating the effects of photodynamic therapy using Indocyanine green in the treatment of chronic periodontitis. MATERIALS AND METHODS: In present randomized clinical trial, 30 subjects were equally divided into two groups i.e. test group (SRP + Photodynamic therapy) & control group (SRP). Clinical parameters evaluated at baseline and 3 month follow up were, Plaque index, Sulcus Bleeding Index, Probing Pocket Depth, Clinical Attachment Level, Gingival Recession. Microbiological analysis of plaque sample was also done to check for anaerobic mixed flora. RESULTS: Significant reduction was seen in all the clinical parameters in the test group. Anaerobic culture of plaque samples of test group also revealed significant reduction of microorganisms in comparison with control group. CONCLUSION: Indocyanine Green can act as an alternative to other photosensitizers in photodynamic therapy as an adjunct to SRP in the treatment of chronic periodontitis.

Comparative evaluation of chlorhexidine and cinnamon extract used in dental unit waterlines to reduce bacterial load in aerosols during ultrasonic scaling.

BACKGROUND: Dental unit waterlines (DUWL) are believed to be a source of infection. Ultrasonic instruments generate aerosols with significantly greater numbers of bacteria. Chlorhexidine (CHX) exhibits significant antiseptic effect. Recently, cinnamon (CIN) has been displayed to have antibacterial and anti-inflammatory properties in vivo. AIM: The aim of this study is to compare and evaluate the efficacy of CHX versus CIN extract in the reduction of bacterial count in dental aerosols when used as an irrigant through DUWL during ultrasonic scaling. MATERIALS AND METHODS: Sixty patients with moderate-to-severe gingivitis were randomly divided into 3 groups of 20 patients each undergoing ultrasonic scaling. For experimental group I, CHX was added in dental unit reservoir before ultrasonic scaling. Similarly, in group II, CIN extract was used and group III served as control where distilled water (DW) was used. The aerosols from ultrasonic units were collected on two blood agar plates at three different positions. One plate from each position was incubated aerobically for 48 h and other plate anaerobically for 72 h. The total number of colony forming units (CFUs) was then calculated and statistically interpreted. RESULTS: CHX and CIN both were equally effective (P > 0.05) in reducing the bacterial count in aerosols as compared to DW (P < 0.05) when used through DUWL. Maximum contamination was seen on the agar plate placed at the chest of the patient. CONCLUSION: Both CIN and CHX used as an irrigant through DUWL effectively helped in the reduction of bacterial count in dental aerosols.

Indocyanine green-mediated photothermal therapy in treatment of chronic periodontitis: A clinico-microbiological study.

BACKGROUND: Photodynamic therapy (PDT) has developed as an alternative treatment modality in periodontitis patients. Different photosensitizers used over the years have shown contradictory results. Thus, recently indocyanine green (ICG)-mediated photothermal therapy has emerged for the treatment of chronic periodontitis. AIM: The present study aimed at comparing and evaluating the effects of photothermal therapy using ICG in the treatment of chronic periodontitis with scaling and root planing (SRP). MATERIALS AND METHODS: This was a randomized, controlled, clinical trial where fifty participants were equally divided into two groups, i.e., control group (SRP) and test group (SRP + photothermal therapy). Clinical parameters were evaluated at baseline and 6-month follow-up. These were plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Microbiological analysis of plaque sample was also done to check for anaerobic mixed flora. RESULTS: Significant reduction was seen in PD, CAL, and BOP in the test group as compared to control group after 6 months (P < 0.05). However, intergroup comparison of PI showed nonsignificant results (P > 0.05). Anaerobic culture of plaque samples of test group also revealed a significant reduction of microorganisms in comparison with control group. CONCLUSION: ICG-mediated photothermal therapy can act as an alternative to antimicrobial PDT as an adjunct to SRP in the treatment of chronic periodontitis.

Evaluation of diode laser and stannous fluoride in the treatment of root sensitivity after access flap surgery: Randomized controlled clinical trial.

BACKGROUND: Postsurgical root sensitivity has always been an enigma to the periodontists. There is a plethora of evidence suggesting the presence of root sensitivity following periodontal flap surgical procedures. Thus, the aim of the present study was to compare and evaluate the effect of low-power diode lasers with and without topical application of stannous fluoride (SnF2) gel in the treatment of root sensitivity and also evaluate whether laser creates any placebo effect in the control group or not. MATERIALS AND METHODS: Thirty patients participated in this study and 99 teeth were included. Root sensitivity was assessed for all groups with a Verbal Rating Scale (VRS). For each patient, the teeth were randomized into three groups. In the test Group I, sensitive teeth were treated with SnF2 and diode laser. In the test Group II, sensitive teeth were irradiated with laser only. In the control group, no treatment was performed. RESULTS: The mean ± standard deviation (SD) score for VRS and Visual Analog Scale at baseline was not statistically significant (P > 0.05) between the three groups. After 15 min, statistical significant difference was seen in test Group I and test Group II, although no difference was found in the control group. At 15th day and 30th day, the mean ± SD scores were statistically significant (P < 0.05). CONCLUSION: Within the limitations of the study, it can be concluded that diode lasers alone and in combination with 0.4% SnF2 was effective in the treatment of root sensitivity after access flap surgery.

Comparative evaluation of platelet count and antimicrobial efficacy of injectable platelet-rich fibrin with other platelet concentrates: An in vitro study.

BACKGROUND: Platelet concentrates are used in various medical procedures to promote soft- and hard-tissue regeneration. In recent times, their antimicrobial efficacy is also explored. However, various platelet concentrates have evolved which differ in the centrifugation protocols. One such recently introduced platelet concentrate is injectable platelet-rich fibrin (i-PRF) concentrate. Hence, the aim was to evaluate the antimicrobial property, and platelet count of i-PRF in comparison to other platelet concentrates, i.e., PRF, platelet-rich plasma (PRP), and control (whole blood). MATERIALS AND METHODS: Blood samples were obtained from 10 chronic generalized marginal gingivitis patients. Platelet concentrates were prepared using standardized centrifugation protocol. Platelet count was evaluated by manual counting method using smear preparation of each sample. Subsequently, antimicrobial activity against oral bacteria was examined on blood agar using disc diffusion method to quantify the inhibitory effects. RESULTS: Statistical significance was analyzed by one-way analysis of variance (ANOVA). P <0.05 was considered statistically significant. Mean zone of inhibition around i-PRF (P < 0.01) and PRF (P < 0.05) showed statistical significance. Although a distinct zone of inhibition was seen with PRP, it was not statistically significant (P > 0.05). i-PRF showed statistically significant difference (P < 0.001) in platelet count when compared to control. It was also significant when compared to PRP (P < 0.01), PRF (P < 0.001). CONCLUSION: i-PRF has maximum antimicrobial efficacy and higher platelet count in comparison to other platelet concentrates, thereby indicating to have a better regenerative potential then others.

Comparative evaluation of sutures coated with triclosan and chlorhexidine for oral biofilm inhibition potential and antimicrobial activity against periodontal pathogens: An in vitro study.

BACKGROUND: Surgical site plaque accumulation is one of the challenging problems leading to unfavorable healing. The antibacterial sutures can be used to reduce or inhibit plaque formation. Presently there is no study comparing efficacy of sutures coated with triclosan and chlorhexidine in terms of oral biofilm inhibition and antimicrobial property against periodontal pathogens. AIM: The aim of present study was to evaluate the antibacterial efficacy and oral biofilm inhibition around chlorhexidine and triclosan coated polyglactin sutures in comparison to uncoated sutures. MATERIALS AND METHOD: Equal segments of chlorhexidine and triclosan coated polyglactin sutures (3-0) were incubated at 370°C in saliva collected from 10 chronic periodontitis patients for 7 days. Plain uncoated suture served as control. Biofilm formation was analyzed with Confocal Laser-Scanning Microscopy (CLSM) and Scanning Electron Microscopy (SEM). Quantitative assessment was done using Colony Forming Units (CFU/mL).The antibacterial efficacy of the sutures was tested against specific periodontal pathogens (S.mutans, F.nucleatum, A.actinomycetomcomitans, P.intermedia, P.gingivalis) using agar diffusion method. CLSM and SEM were not subjected to statistical analysis. ANOVA test was used for colony forming units and agar diffusion test. (P < 0.05) Results: CLSM and SEM showed substantial biofilm inhibition around chlorhexidine-coated sutures followed by triclosan-coated when compared to plain uncoated suture. The antibacterial coated sutures showed statistically significant difference in CFUs/ml and zone of inhibition compared to plain uncoated sutures. Among coated sutures, chlorhexidine-coated sutures showed better results. CONCLUSION: The antibacterial coated sutures have a promising potential in preventing the colonization of periodontal pathogens around it thereby inhibiting biofilm formation.

Comparative evaluation of co-enzyme Q10 and Melaleuca alternifolia as antioxidant gels in treatment of chronic periodontitis: A clinical study.

BACKGROUND: Conventional nonsurgical periodontal therapy has been proven to be an effective treatment for patients with chronic periodontitis. Coenzyme Q10 and tea tree oil (TTO) are known to have potential therapeutic benefits in chronic periodontitis. AIMS: The aim of the study is to compare the efficacy of Coenzyme Q10 (Perio Q(®)) and tea tree oil (Melaleuca alternifolia) gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis. MATERIALS AND METHODS: Patients were divided equally into three groups: Group I (Control group): those receiving placebo gel + SRP, Group II (Test group I): those receiving Perio Q(TM) gel + SRP, and Group III (Test group II): those receiving tea tree oil gel + SRP. A total of 15 patients with 45 sites were enrolled in the study. Clinical parameters evaluated were plaque index (PI), gingival bleeding index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). STATISTICAL ANALYSIS USED: Paired t-test was applied using SPSS software. RESULTS: Mean PPD reduction for Group I, Group II, and Group III was 0.50 ± 0.2, 2.95 ± 0.20, and 2.09 ± 0.15, respectively. Mean CAL reduction for Group I, Group II, and Group III was 0.45 ± 0.22, 2.33 ± 0.04, and 2.28 ± 0.09, respectively. Changes in mean PI scores for Group I, Group II, and Group III were 0.67 ± 017, 1.00 ± 0.11, and 1.08 ± 0.05 and GBI scores were 0.92 ± 0.29, 1.08 ± 0.13, and 0.88 ± 0.28, respectively. CONCLUSIONS: Coenzyme Q10 and tea tree oil gel proved to be effective in the treatment of chronic periodontitis.

Comparative evaluation of the effectiveness of audio and audiovisual distraction aids in the management of anxious pediatric dental patients.

OBJECTIVE: The aim of this study was to evaluate and compare audio and audiovisual distraction aids in management of anxious pediatric dental patients of different age groups and to study children's response to sequential dental visits with the use of distraction aids. STUDY DESIGN: This study was conducted on two age groups, that is, 4-6 years and 6-8 years with 30 patients in each age group on their first dental visit. The children of both the age groups were divided into 3 subgroups, the control group, audio distraction group, audiovisual distraction group with 10 patients in each subgroup. Each child in all the subgroups had gone through three dental visits. Child anxiety level at each visit was assessed by using a combination of anxiety measuring parameters. The data collected was tabulated and subjected to statistical analysis. RESULTS: Tukey honest significant difference post-hoc test at 0.05% level of significance revealed audiovisual group showed statistically highly significant difference from audio and control group, whereas audio group showed the statistically significant difference from the control group. CONCLUSION: Audiovisual distraction was found to be a more effective mode of distraction in the management of anxious children in both the age groups when compared to audio distraction. In both the age groups, a significant effect of the visit type was also observed.

Management of a large internal resorption lesion with metal reinforced glass ionomer cement.

Mineral trioxide aggregate is the mainstay of treatment of large internal resorption defects. But its cost may be a deterrent to its use in some patients. The present case report describes the successful endodontic management of an extensive internal resorptive lesion in a mandibular molar with metal reinforced glass ionomer cement.