Clinico-microbiological Efficacy of Indocyanine Green as a Novel Photosensitizer for Photodynamic Therapy among Patients with Chronic Periodontitis: A Split-mouth Randomized Controlled Clinical Trial.

OBJECTIVE: Conventional nonsurgical periodontal therapy, i.e., scaling and root planing (SRP), is not sufficient to completely eradicate the microorganisms present in dental plaque biofilm due to the incapability of instruments to reach the inaccessible areas of a tooth with anatomical variations. Hence, to increase the effectiveness of SRP, many adjunctive treatment strategies are proposed, including photodynamic therapy (PDT). Therefore, the purpose of this study was to determine the clinical and microbiological efficacy of PDT using Indocyanine green (ICG) as a novel photosensitizer for the treatment of chronic periodontitis. MATERIALS AND METHODS: Twenty individuals who fulfilled the eligibility criteria were enrolled for this randomized controlled clinical trial using split-mouth design. Treatment sites from each individual were randomly allocated into two groups: SRP was done for the sites of the control group and an additional session of PDT using ICG was performed for the sites of the test group. Subgingival plaque samples were collected from both the sites and sent for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, and Tannerella forsythia using real-time polymerase chain reaction (RT-PCR) technique. Probing pocket depth (PD), clinical attachment loss (CAL), and count of all the three microorganisms were assessed at baseline and after 3 months. RESULTS: After 3 months, PD and CAL showed statistically significant improvement in the test sites (P < 0.001) compared to the control sites. However, the differences in the microbiological parameters were statistically nonsignificant between the groups. CONCLUSION: ICG as a photosensitizer may enhance the outcomes of SRP and can be used for PDT for the nonsurgical management of periodontal diseases.

To detect the minimum inhibitory concentration and time-kill curve of shiitake mushroom on periodontal pathogens: An in vitro study.

INTRODUCTION: Shiitake (Lentinula edodes) is an Asian edible mushroom with the second-largest cultivation percentages among edible mushrooms in the world. Previous studies have shown its nutritional richness such as high quantities of proteins, minerals, and vitamins. Moreover, in vitro and animal studies have displayed the medical importance of shiitake extracts including antitumor, antiviral, antibiotic, and hypocholesterolemic actions and also shown to have antibacterial efficacy and has been used for the elimination of oral biofilms and as a substitute of current chemical-based treatments. This study aims to analyze the inhibitory and antibacterial efficacy of shiitake mushroom extracts on periodontal pathogens. MATERIALS AND METHODS: Double extract, i.e., hot water and ethanol extract of shiitake were used for the assessments of minimum inhibitory concentrations on Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, and Prevotella intermedia using the tube-dilution method, and the time-kill curve was assessed for the above bacteria. RESULTS: Shiitake has shown potent antibacterial effects at a concentration of 3.12 µg/ml and has shown no growth after 2 h of culture. CONCLUSION: Shiitake mushroom extract has shown the potential antimicrobial effect on the certain periodontal pathogens.

Knowledge, attitude, and practice of dental implants among dental postgraduates and practitioners in Davangere City, Karnataka: A cross-sectional study.

BACKGROUND: Implant therapy has become an important part of treatment to restore function and esthetics in partially/completely edentulous patients. Inspite of the progress made in implant dentistry since its inception, there have been some loopholes in scientific based knowledge and established clinical experience amongst dental professionals and postgraduates.So,an analysis was performed of the real picture. OBJECTIVES: A study was conducted to assess and compare the knowledge, attitude and practice of dental implants among dental postgraduate students and dental practitioners (General and institutional)in Davangere City, Karnataka and to identify the variations in their knowledge, attitude and practice with respect to dentist's factors (years of experience, implant training and their specialization). MATERIALS AND METHODS: A cross sectional questionnaire based survey was conducted using census approach with informed consent. A pretested, self administered questionnaire containing demographic details and knowledge ,attitude and practice based questions was distributed and collected back from the respondents. Responses were coded before and decoded after the analysis. Statistical analysis was performed using SPSS SoftwareV17.0. RESULTS: The results were determined after the statistically analyzed and concluded that the knowledge was widespread among postgraduates and dental practitioners and variations existed amongst the subjects with respect to age, gender, years of experience, practice type, implant training and their specialization. It was also found that the attitude and practice towards implants and their evidence based knowledge about the same was variable.

Antibacterial and anti-inflammatory properties of Plantago ovata Forssk. leaves and seeds against periodontal pathogens: An in vitro study.

BACKGROUND: Plantago commonly called as Isabgol (Plantago ovata Forssk.) is a perennial herb that belongs to the family Plantaginaceae. A range of biological activities has been found from plant extracts, including wound healing activity, anti-inflammatory, analgesic, antioxidant, weak antibiotic, immunomodulating and anti-ulcerogenic activity. Periodontal disease is a complex condition as a result of interaction between microorganisms and host inflammatory mediators. Hence, the extract of Isabgol is tested for its antibacterial and anti-inflammatory properties against periodontal disease. AIM: The aim of this in vitro study is to evaluate the antibacterial property of Isabgol leaves and seeds against periodontal pathogens, namely Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum and anti-inflammatory property against matrix metalloproteinase-2 (MMP-2) and MMP-9. MATERIALS AND METHODS: In this in vitro study, aqueous extract of Isabgol is tested for its antibacterial property against the stock cultures of specified periodontal pathogens using the tube dilution method and anti-inflammatory property against MMP-2 and MMP-9 using zymogen gel electrography. RESULTS: Minimum concentration at which the sensitivity of A. actinomycetemcomitans, P. gingivalis, P. intermedia, and F. nucleatum for the extract observed was 50 µl/ml, 0.8 µl/ml, 0.4 µl/ml and 12.5 µl/ml, respectively, concentrations below these showed no effect on the microorganisms. Zymogen electrographic test for anti-inflammatory activity showed percentage inhibition of 30% and 40% against MMP-2 and MMP-9, respectively. CONCLUSION: Isabgol is effective against the periodontal pathogens and inflammatory mediators which are responsible for periodontal disease.

Detection and comparison of Selenomonas sputigena in subgingival biofilms in chronic and aggressive periodontitis patients.

BACKGROUND: With the advent of DNA-based culture-independent techniques, a constantly growing number of Selenomonas phylotypes have been detected in patients with destructive periodontal diseases. However, the prevalence levels that have been determined in different studies vary considerably. AIM: The present study was undertaken to detect and compare the presence of Selenomonas sputigena in the subgingival plaque samples from generalized aggressive periodontitis (GAP), chronic generalized periodontitis, and periodontally healthy patients using conventional polymerase chain reaction (PCR) technique. MATERIALS AND METHODS: A total of 90 patients were categorized as periodontally healthy individuals (Group I, n = 30), chronic generalized periodontitis (Group II, n = 30), and GAP (Group III, n = 30). The clinical parameters were recorded and subgingival plaque samples were collected. These were then subjected to conventional PCR analysis. STATISTICAL ANALYSIS USED: Kruskal-Wallis ANOVA test was used for multiple group comparisons followed by Mann-Whitney U-test for pairwise comparison. RESULTS: On comparison between three groups, all the clinical parameters were found to be statistically highly significant. Comparing Groups I-II and I-III, the difference in detection was found to be statistically highly significant whereas in Groups II-III, it was statistically nonsignificant. On comparison of S. sputigena detected and undetected patients to clinical parameters in various study groups, the difference was found to be nonsignificant. CONCLUSION: S. sputigena was found to be significantly associated with chronic and aggressive periodontitis. Although the difference in its detection frequency in both groups was statistically nonsignificant when compared clinically, S. sputigena was more closely associated with the GAP.

Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful.

Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF and Type I Collagen Membrane). Surgical re-entry at nine months revealed bone formation in the apical third of the tooth. At one year, 87% radiographic bone gain was accomplished. The improvement in the clinical and radiographic parameters reinforced by the re-entry surgery findings strongly suggest that intentional replantation may be a cost-effective substitute to implants and tooth supported prosthesis in situations where conventional periodontal therapy would yield compromised outcomes.

Knowledge and Attitude about HIV/AIDS among HIV-Positive Individuals in Davangere.

A cross-sectional study was carried out on 100 HIV patients (55 male and 45 female) age 21 years and older registered at the Antiretroviral Therapy Centre of Chigateri General Hospital, Davangere, Karnataka, India, to evaluate their knowledge and attitude toward HIV. Overall, the source of knowledge about AIDS was through newspaper or television, 38% were aware of their AIDS status, 61% disclosed their status to family, 86% had incorrect knowledge about transmission, 57% experienced no moral support, 62% felt stigmatized, 52% discriminated against, 44% were denied treatment, 57% felt isolated, 54% experienced difficulty in carrying out daily activity, 52% of patients' social and personal life was affected, and 41% felt shy when disclosing their disease. This data reveals the need to consider the basic knowledge of the HIV patients about HIV/AIDS.

Role of Triphala in dentistry.

Ayurveda is considered as the "science of life," because the ancient Indian system of health care focused views of man and his illness. India has an age-old heritage of traditional herbal medicine. Conventional drugs usually provide effective antibiotic therapy for bacterial infections, but there is an increasing problem of antibiotic resistance and a continuing need for new solutions. Hence, now herbal drugs are being preferred to synthetic antibiotics. 'Triphala' is a well-known powdered preparation in the Indian system of medicine (ISM). It consists of equal parts of the Emblica officinalis, Terminalia chebula, and Terminalia belerica. Currently, Triphala is being extensively researched for its various therapeutic effects including its anti-caries, antioxidant, anti-collagenase, and anti-microbial activities. The present review will focus on the comprehensive appraisal of Triphala and its several applications in dentistry.

A comparative scanning electron microscopy study between hand instrument, ultrasonic scaling and erbium doped:Yttirum aluminum garnet laser on root surface: A morphological and thermal analysis.

BACKGROUND AND OBJECTIVES: Scaling and root planing is one of the most commonly used procedures for the treatment of periodontal diseases. Removal of calculus using conventional hand instruments is incomplete and rather time consuming. In search of more efficient and less difficult instrumentation, investigators have proposed lasers as an alternative or as adjuncts to scaling and root planing. Hence, the purpose of the present study was to evaluate the effectiveness of erbium doped: Yttirum aluminum garnet (Er:YAG) laser scaling and root planing alone or as an adjunct to hand and ultrasonic instrumentation. SUBJECTS AND METHODS: A total of 75 freshly extracted periodontally involved single rooted teeth were collected. Teeth were randomly divided into five treatment groups having 15 teeth each: Hand scaling only, ultrasonic scaling only, Er:YAG laser scaling only, hand scaling + Er:YAG laser scaling and ultrasonic scaling + Er:YAG laser scaling. Specimens were subjected to scanning electron microscopy and photographs were evaluated by three examiners who were blinded to the study. Parameters included were remaining calculus index, loss of tooth substance index, roughness loss of tooth substance index, presence or absence of smear layer, thermal damage and any other morphological damage. RESULTS: Er:YAG laser treated specimens showed similar effectiveness in calculus removal to the other test groups whereas tooth substance loss and tooth surface roughness was more on comparison with other groups. Ultrasonic treated specimens showed better results as compared to other groups with different parameters. However, smear layer presence was seen more with hand and ultrasonic groups. Very few laser treated specimens showed thermal damage and morphological change. INTERPRETATION AND CONCLUSION: In our study, ultrasonic scaling specimen have shown root surface clean and practically unaltered. On the other hand, hand instrument have produced a plane surface, but removed more tooth structure. The laser treated specimens showed rough surfaces without much residual deposit or any other sign of morphological change.

Clinical evaluation of topical application of perio-Q gel (Coenzyme Q(10)) in chronic periodontitis patients.

BACKGROUND AND OBJECTIVES: Coenzyme Q(10) is a well studied antioxidant in medical literature, but studies regarding its efficacy in periodontal diseases are few. Hence, the aim of this study was to test the efficacy of coenzyme Q(10) in the form of gel (Perio-Q) in patients with chronic gingivitis and periodontitis. MATERIALS AND METHODS: A total of 12 patients were enrolled. A split mouth design was used for topical (extrasulcular) application, intra-pocket application alone, intra-pocket application combined with scaling and root planing (SRP) and SRP only in each quadrant, respectively. Clinical parameters such as plaque index, gingival index, gingival bleeding index, probing pocket depth, clinical attachment level were assessed at baseline, 3rd week, and 6th week. The results were subjected to statistical analysis, which were expressed as mean±SD and proportions as percentages. Intra group comparisons were made by paired t-test and one way analysis of variance (ANOVA) for inter-group comparisons. Categorical data was analyzed by Fisher's exact test. RESULTS: The results showed on intra-group analysis significant reduction (P<0.01) of clinical parameters (plaque index (PI), gingival index (GI), gingival bleeding index (GBI), periodontal probing pocket depth (PPD), and clinical attachment level (CAL)) in all four treatment groups, whereas on inter-group analysis, intra-pocket gel application in combination with SRP showed significant reduction (P<0.05) for PI, GI, GBI, and CAL in comparison to intra-pocket gel alone. INTERPRETATION AND CONCLUSION: In the present study, in chronic periodontitis patients, sub-gingival mechanical debridement only and with Perio-Q gel showed almost similar clinical results without any statistically significant differences. Hence, it confirmed the primary role of basic mechanical approaches in periodontal therapy and did not provide enough clinical support for the superiority of adjunctive use of Perio-Q gel. However, it appears that Perio-Q gel in this study may have a potential additive effect. Further, long term clinical studies of Perio-Q gel with various doses and duration need to be conducted.

A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: an in vitro study using scanning electron microscopy.

BACKGROUND: The commonly accepted idea concerning root planing is that excessive removal of cementum is not necessary for removal of endotoxins. The ideal instrument should enable the removal of all extraneous substances from the root surfaces, without causing any iatrogenic effects. AIM: To compare the remaining calculus, loss of tooth substance, and roughness of root surface after root planing with Gracey curette, ultrasonic instrument (Slimline insert FSI-SLI-10S), and DesmoClean rotary bur. MATERIALS AND METHODS: The efficiency of calculus removal, the amount of lost tooth substance, and root surface roughness resulting from the use of hand curette, ultrasonic instrument, and rotary bur on 36 extracted mandibular incisors were examined by SEM. We used three indices to measure the changes: Remaining calculus index (RCI), Loss of tooth substance index (LTSI), and Roughness loss of tooth substance index (RLTSI). Twelve samples were treated with each instrument. The time required for instrumentation was also noted. STATISTICAL ANALYSIS: Kruskal-Wallis ANOVA was used for multiple group comparisons and the Mann-Whitney test for group-wise comparisons. Analysis was carried out with SPSS software (version 13). RESULTS AND CONCLUSION: The RCI and LTSI showed nonsignificant differences between the three groups. RLTSI showed a significant difference between Slimline and hand curette as well as Slimline and Desmo-Clean. Slimline showed the least mean scores for RCI, LTSI, and RLTSI. Thus, even though the difference was not statistically significant, Slimline insert was shown to be better than the other methods as assessed by the indices scores and the instrumentation time.

Similar hematological and biochemical parameters among periodontitis and control group subjects.

OBJECTIVE: There are conflicting reports in the past literature documenting the tendency of anemia in patients with periodontitis. Hence, this study was undertaken to assess whether periodontitis may cause an anemic state, by evaluating and comparing the red blood cell count, levels of hemoglobin, hematocrit, erythrocyte sedimentation rate (ESR), serum iron and serum ferritin between subjects with and without periodontitis. METHODS: In this cross-sectional study, 140 systemically healthy subjects of both sexes (mean age 46 years) were recruited as control group (50 subjects without periodontitis) and study groups comprising 30 patients each with mild, moderate and severe chronic generalized periodontitis. Periodontal parameters and orthopantamographs were taken for all the groups and then 5 mL venous blood samples were sent for complete blood count and biochemical analysis. Inter-group and intra-group comparisons were performed for all the assessed parameters. RESULTS: The periodontal parameters were significantly higher (P⩽.05) in periodontitis patients. Except for the ESR, which was significantly higher (P=.03) in the mild periodontitis group than the control group, hematological and biochemical parameters were not significantly different (P>.05) among the study groups or between the control and study groups. This difference was not evident even among the male and female subjects of both control and study groups (P>.05). CONCLUSIONS: Within the limits of this cross-sectional study, it can be concluded that the presence and severity of periodontitis may not affect the hematological and biochemical parameters of an individual. Further long term studies are however encouraged to validate these findings.

Impaired neutrophil and monocyte chemotaxis in chronic and aggressive periodontitis and effects of periodontal therapy.

BACKGROUND AND OBJECTIVES: Depressed chemotactic activity of polymorphoneutrophil (PMN) and monocyte (MN) appears to be one of the significant risk factors in the development of periodontal disease. Although bacteria are the primary etiologic factor in periodontal disease, the patient's host response is a determinant of disease susceptibility. Depressed chemotaxis of PMN and MN could lead to periodontal destruction by altering the host response i.e. impairment of the normal host response in neutralizing infection and alterations that result in destruction of the surrounding periodontal tissues. MATERIALS AND METHODS: Thirty patients (10 healthy subjects, 10 chronic periodontitis, and 10 with aggressive periodontitis) participated in this study. Clinical parameters like plaque index, gingival index, probing pocket depth, and radiographic assessment were done. The peripheral blood PMNs and MNs were isolated from the patient and the chemotactic response was studied. Statistical analysis was performed using post-hoc Newman-Keul range test. RESULTS: PMN and MN chemotaxis was found to be statistically significant (P<0.05) at baseline and three months after periodontal therapy in chronic and aggressive periodontitis group compared to healthy subjects. However on comparison between chronic and aggressive periodontitis group statistical significance was not found (P>0.05).Comparision between chronic periodontitis, aggressive periodontitis with healthy subjects, PMN and MN chemotaxis showed statistical significance (P<0.05) at baseline and three months after periodontal therapy, Whereas statistically there was no difference when chronic periodontitis was compared with aggressive periodontitis. INTERPRETATION AND CONCLUSION: Depressed chemotaxis of PMN and MN results in increased periodontal destruction. In this study, depressed PMN and MN chemotaxis is seen in both aggressive periodontitis group and chronic periodontitis group and the response was altered although to a lesser degree after periodontal therapy in both groups indicating that effect of treatment does exist.

Accuracy of probing attachment levels using a new computerized cemento-enamel junction probe.

BACKGROUND AND OBJECTIVES: The assessment of clinical attachment level (CAL) represents the gold standard for diagnosing and monitoring periodontal disease. The aim of the present study was to evaluate the performance of the newly introduced cemento-enamel junction (CEJ) probe in detecting CAL, using CEJ as a fixed reference point, and to compare the CEJ probe with the Florida stent probe (FSP) as well as with a standard manual probe, University of North Carolina-15 (UNC-15). MATERIALS AND METHODS: Three examiners recorded the probing attachment level in 384 sites in case group (chronic periodontitis), and in 176 sites, in control group (healthy periodontal status), using the three probes. Subjects included both the sexes and ranged from 35 to 45 years. The experimental design was structured to balance the intra- and inter-examiner consistency at the same site during the two visits. RESULTS: CEJ probe showed higher intra-and inter-examiner consistency over both FSP and UNC-15 in both the case and control groups. Frequency distribution of differences of various magnitudes of repeated measurements ≤1 mm was in the higher range of 86.8% to 87.5% for CEJ probe. The FSP was more reproducible than UNC-15 in detecting relative attachment level (RAL). INTERPRETATION AND CONCLUSION: CEJ automated probe was found to have greatest potential for accuracy and consistency in detecting CAL than FSP and UNC-15. The automated probes appeared to be more reproducible than manual probes.

Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report.

BACKGROUND: Drug-influenced gingival overgrowth is an unaesthetic overgrowth of gingiva principally associated with intake of drugs like phenytoin, cyclosporin A and nifedipine. Its occurrence in both dentate and edentulous regions of oral cavity is poorly understood. OBJECTIVES: This report highlights clinical and histological description, aetiology and management of gingival overgrowth in a partially edentulous (non-denture wearer) 60-year-old female patient with epilepsy on phenytoin and phenobarbital drugs from past 7 years. MATERIALS AND METHODS: Patient's intraoral examination revealed lobulated and fibrotic consistency gingival overgrowth around teeth and on partially edentulous ridges of upper and lower arches along with generalised tooth mobility. Under medical consultation, full mouth extraction, surgical excision of overgrowth followed by complete denture rehabilitation and replacement of combination drugs with sodium valproate were accomplished. RESULTS: Histologically, the lesion showed fibro-epithelial hyperplasia. Clinical results after 6 months demonstrated almost complete resolution of gingival overgrowth. CONCLUSION: The findings of present case suggest that gingival overgrowth can occur even in partially edentulous ridges (not exposed to denture wear) that could be due to persistence of gingival overgrowth, which may not resolve completely following tooth extraction or occurs because of incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa.

Third molars: a threat to periodontal health??

The third molars have received the fair amount of interest in literature. It has been blamed for problems such as-lower incisor crowding, atypical facial pain, caries etc. They are considered as 'waste bins' in dental practices as they are regarded as functionally non-essential. While making the clinical decision, they are given less importance and often extraction is considered to be the treatment option. Despite periodontal problems that can arise with extracted third molars, retention of third molars can also lead to periodontal problems with the adjacent teeth in addition to teeth farther to third molars. Of late, it is very important to consider the periodontal problems while making the clinical decision. This review paper has been discussed keeping this as prime objective.

Evaluation of the polyactide-polyglycolide copolymer Fisiograft® in the treatment of intrabony defects: clinical and radiographic results of a pilot study

To evaluate the efficacy of the polylactide-polyglycolide copolymer Fisiograft® as a bone graft material in the treatment of interproximal intrabony defects clinically and radiographically. Methods: A total of 22 intrabony defects in 8 patients with chronic periodontitis (4 males and 4 females) aged 20 to 55 years were recruited and divided equally into two groups: control (open flap debridementalone) and experimental (open flap debridement with Fisiograft®). Recordings of probing pocket depth (PPD), clinical attachment level (CAL), gingival margin position (GMP) and radiovisiographic assessment was done at baseline and 6 months. Results: Statistical analysis was done by Wilcoxon Signed Rank test for intra-group comparisons and Mann-Whitney U-test for inter-group comparisons. The clinical parameters PPD, CAL and GMP were found to be statistically significant(p<0.05) within each group. Inter-group comparison showed only the CAL gain to be statistically significant (p<0.01). In relation to hard tissue changes, statistically significant (p=0.05) result was seen for the percent filling of the original defect, comparing the experimental and control groups 6 months postoperatively. Conclusions: Placement of Fisiograft® resulted in better healing of intrabony defects as assessed clinically and radiographically when compared to open flap debridement alone.

Platelet concentrates: past, present and future.

Platelets play a crucial role in hemostasis and wound healing, platelet growth factors are well known source of healing cytokines. Numerous techniques of autologous platelet concentrates have been developed and applied in oral and maxillofacial surgery. This review describes the evolution of the first and second generation of platelet concentrates (platelet rich plasma and platelet rich fibrin respectively) from their fore runner-fibrin sealants.

Effect of local drug delivery in chronic periodontitis patients: A meta-analysis.

Periodontal diseases are multi-factorial in etiology, and bacteria are one among these etiologic agents. Thus, an essential component of therapy is to eliminate or control these pathogens. This has been traditionally accomplished through mechanical means (scaling and root planing (SRP)), which is time-consuming, difficult, and, sometimes, ineffective. From about the past 30 years, locally delivered, anti-infective pharmacological agents, most recently employing sustained-release vehicles, have been introduced to achieve this goal. This systematic review is an effort to determine the efficacy of the currently available anti-infective agents, with and without concurrent SRP, in controlling chronic periodontitis. Four studies were included, which were all randomized controlled trials, incorporating a total patient population of 80, with 97 control sites and 111 test sites. A meta-analysis completed on these four studies including SRP and local sustained-release agents compared with SRP alone indicated significant adjunctive probing depth (PD) reduction for 10% Doxycycline hycylate (ATRIDOX), minocycline hydrochloride (ARESTIN), tetracycline hydrochloride (PERIODONTAL PLUS AB), and chlorhexidine gluconate (PERIOCHIP). Essentially, all studies reported substantial reductions in gingival inflammation, plaque scores, and bleeding indices, which were similar in both the control and the experimental groups. Use of antimicrobial sustained-release systems as an adjunct to SRP does not result in significant patient-centered adverse events. Local drug delivery combined with SRP appears to provide additional benefits in PD reduction compared with SRP alone.

Role of coenzyme Q(10) as an antioxidant and bioenergizer in periodontal diseases.

Periodontal disease is an inflammatory disease process resulting from the interaction of a bacterial attack and host inflammatory response. Arrays of molecules are considered to mediate the inflammatory response at one time or another, among these are free radicals and reactive oxygen species (ROS). Periodontal pathogens can induce ROS overproduction and thus may cause collagen and periodontal cell breakdown. When ROS are scavenged by antioxidants, there can be a reduction of collagen degradation. Ubiquinol (reduced form coenzyme Q(10)) serves as an endogenous antioxidant which increases the concentration of CoQ(10) in the diseased gingiva and effectively suppresses advanced periodontal inflammation.