A Comparative Evaluation between the Efficacy of Scaling & Root Planing (SRP) with Local Delivery of Chlorhexidine Gluconate and SRP Alone in Periodontal Pocket Reduction Therapy

Aim: The aim of the present study was to compare the efficacy of locally delivered chlorhexidine as an adjunct to scaling and root planning (SRP) & SRP alone in bringing reduction of pocket depth in the treatment of moderate to severe periodontitis patients. Materials and Methods: A total number of 15 patients both males and females in the age group of 30-55 years were selected with total number of 30 sites with periodontal probing pocket depth measuring 5-8mm in different quadrant of the mouth. A randomized, double blind, controlled clinical trial design was followed for the study. On one side scaling and root planning was done and on the other side scaling and root planning was done along with local delivery of chlorhexidine glugocate then the patient was examined after 0, 45, and 60 days using The clinical parameters the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Statistical Analysis: Student paired T-test has been carried out for this present study. Results: The mean reduction of Plaque Index score between 0-45 day between control site and test site was 1.58±0.11 and the mean reduction of Plaque Index score between 0-60 day between control site and test site was 2.42±0.34 which is found not significant. At the Control site the mean plaque index score on 0 day was 2.2, on 45th day was 1.88 and on 60th day was 1.82. At the test site the mean plaque index score on 0 day was 2.6, on 45th day was 1.82 and on 60thday was 1.59. There was change from the base line values of mean plaque index between the control sites and test sites but was not significant. Conclusion: There was improvement in all the clinical parameters of the test sites in comparison to the control sites from base line to 60 days, but the adjunctive use of chlorhexidine showed a significant improvement only on the clinical attachment level.

Unusual Findings in Trials Evaluating Adjuncts to Scaling and Root Planing: Meta-analysis (Part 1)

Background: A number of studies in patients with periodontitis have compared scaling and root planning (SRP) combined with an adjunctive treatment to SRP alone. Within that literature, an array of studies with overlapping investigators has consistently yielded substantially greater effects of adjunctive treatments than had been previously noted. This report investigates discrepancies between that cluster of research and the most recent American Dental Association (ADA) systematic review. Methods: This review was preregistered at https://osf.io/4meyd/ . A search using the Scopus platform identified 32 articles published from 2010 to 2017 by investigators affiliated with the Government Dental College and Research Institute (GDCRI) in Bangalore, India. The primary outcome used in this meta-analysis was the change in clinical attachment level (CAL) after 6 mo. Effect sizes were estimated using Comprehensive Meta-Analysis software after categorizing agents into groups based on pharmacologic similarity. Results: The search identified 32 studies encompassing 5 sets of adjunctive agents. Across the GDCRI studies, the CAL averaged 1.67 mm (95% confidence interval [CI]: 1.43–1.91 mm), substantially exceeding values reported in the ADA review (mean: 0.39 mm, 95% CI: 0.27–0.51 mm). For categories of studies in which comparable subgroup estimates were available, the evaluations yielded overlapping estimates of SRP alone, but CAL estimates were discrepant for both locally delivered antimicrobials (GDCRI studies: mean: 1.45 mm, 95% CI: 0.63–2.27 mm; ADA review: mean: 0.38 mm, 95% CI: 0.16 –0.60 mm) and systemic antibiotics (GDCRI studies: mean: 1.35 mm, 95% CI: 0.97–1.73 mm; ADA review: mean: 0.39 mm, 95% CI: 0.21–0.57 mm). Conclusion: In the literature on adjunctive agents supplementing SRP, findings from investigators linked to GDCRI stand out as having significantly more favorable estimated effects. Meanwhile, some agents studied by GDCRI-linked investigators have not been investigated by other researchers. In the absence of a clear explanation for discrepant results, it is recommended that unusually favorable reported effects of adjunctive agents be viewed with caution. Knowledge Transfer Statement: The present meta-analysis observed an unusually large effect size of adjunctive agents to scaling and root planning in studies conducted by the same research group. These results were not consistent with trials on adjunctive agents and previous reports. As this research group has exclusively tested most of the agents, their results must be viewed with caution until other independent groups replicate the studies and reproduce the effect size.

Diode Laser Has an Additional Benefit When Used with Conventional Scaling and Root Planning for Chronic Periodontitis Treatment - Comparative Analysis

BACKGROUND Almost 47 % of the population over the age group of 30 is affected by chronic periodontitis. Although the first and gold standard therapy in periodontal treatment is scaling and root planing (SRP), which is a non-surgical approach towards treatment, yet another therapy for the treatment of chronic periodontitis is to irradiate the periodontal pockets with laser. The purpose of this study was to confirm as to whether the use of diode laser (800 – 980 nm) as adjunct to scaling and root planning (SRP) improved the results of conventional mechanotherapy in the treatment of chronic periodontitis patients. METHODS In this study we designed our groups in such a way that 40 patients (20 males and 20 females) with two deepest nonadjacent pockets ≥ 5mm in two different quadrants were selected. In this study each treatment group belonged to a separate quadrant of the mouth. One group was allotted to SRP group while the second one was allotted to SRP + Diode Laser group. Clinical parameters like (Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) in chronic periodontitis patients were measured and evaluated at baseline, after 1 month and after 3 months of the treatment. Statistical analysis was also done intra group and inter group. RESULTS From this we infer that PPD was significantly reduced in SRP and SRP + Diode laser groups from baseline and post 1 month (P < 0.001), between baseline and post 3 months (P < 0.001) and between 1 month and 3 months (P < 0.001). There was also significant improvement in CAL in SRP and SRP + Diode Laser groups from baseline and post 1 month (P < 0.0001), between baseline and post 3 months (P < 0.0001) and between 1 month and 3 months (P < 0.0001). BOP also reduced in SRP and SRP + Diode Laser group from baseline. When SRP and SRP + Diode laser groups were compared they showed non statistically significant results but individually both the groups showed statistically significant results. CONCLUSIONS The results of the present study indicate that, comparison of SRP alone group which is a conventional method with SRP as adjunct to Diode laser group i.e., a non-surgical approach showed improvement of CAL and also reduction in PPD and BOP for the treatment of chronic periodontitis patients. KEY WORDS Periodontitis, Laser, Scaling and Root Planing, Adjunct Therapy, Diode Laser

EFFECTIVENESS OF PROBIOTICS AS AN ADJUNCT IN PERIODONTAL CARE

Relevance of the problem. Periodontitis is a multifactorial inflammatory disease related with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Treatment of periodontitis aims to prevent further disease progression, to minimize symptoms and perception of the disease, possibly to restore lost tissues and to support patients in maintaining a healthy periodontium. Scaling and root planning (SRP) is the gold standard for the treatment of periodontitis. For the reduction in bacterial recolonization probiotics have been suggested as promising agents not only to retard recolonization, but also to increase the number of beneficial bacteria and to modulate immunological parameters in the prevention and treatment of periodontal disease. Aim of the work. To find out and assess the data of clinical trials that proposes clinical outcomes of the adjunctive use of probiotic for 3 months after SRP in comparison to SRP combined with a placebo. Tasks: 1) ascertain and assess the recolonization of bacteria after active treatment of periodontitis; 2) clarify and evaluate clinical variables improvement after the usage of local adjunctives; 3) find out and assess the distinction between different probiotics strains. Material and methods. This literature review has been carried out in accordance with the PRISMA Statement [23]. Electronic literature review was performed using MEDLINE and ELSEVIER databases and the selection of the articles, published in English between 2010 and 2020 year. The search for publications was based on keywords and their combinations: chronic periodontitis, scaling and root planning, adjunct care, probiotics, supplements. Results. This literature review includes eight suitable studies that met the inclusion criteria. Conclusions. The qualitative findings of the studies showed that major part of the included trials reported significant improvement in clinical periodontal parameters in periodontitis patients with the adjunctive use of probiotics compared with control group. 75 % of included studies made with L. reuteri found probiotic containing L. reuteri usage as an adjunct therapy to be significant in the improvement of clinical parameters. Probiotic therapy could be used for managing periodontal diseases. This review puts a stress on L. reuteri effectiveness. However, further studies are needed to substantiate its longitudinal effect.

Comparison of Scalpel and Diode Laser in Management of Gingival Enlargement: A Case Report

Inflammatory gingival enlargement is an excessive growth of gingival tissue due to inflammation in response to plaque accumulation. Enlargement of gingiva hampers the efficiency of daily oral hygiene practices which in turn accumulates more plaque, thus causing inflammation. Phase I therapy, consisting of scaling and root planning only reduces the inflammatory component of the enlarged gingival tissues but the fibrotic gingival enlargement remaining thereafter is then removed surgically by gingivectomy. Apart from the conventional scalpel gingivectomy, many other treatment modalities such as gingivectomy by lasers and electrocautery are now being widely used in the field of surgical periodontal therapy. This case report describes the management of gingival enlargement in relation with gingivae of maxillary teeth by administering separate treatment modalities i.e. diode laser and conventional scalpel gingivectomy.

Determining Relative Percentage Change as a New Metrics in Scaling and Root Planning Therapy Outcome in Patients with Chronic Periodontitis

Aims: To quantify the relative percentage change in the patients with periodontitis after employing the scaling and root planning (SRP) therapy and determine the association in the improvements in clinical parameters of biochemical oxidative stress (OS) markers, total antioxidant capacity (TAOC), and malondialdehyde (MDA). Study Design: In this cross sectional study, two groups of patients were clinically evaluated and their biochemical parameters were quantified and statistically compared. Place and Duration of Study: Departments of Biochemistry and Periodontology, M. A. Rangoonwala Dental College, Pune and Department of Biochemistry, Grant Govt. Medical College, Mumbai. The study was carried out between May 2010 and July 2012. Methodology: Individuals with generalized chronic periodontitis (n = 86; CAL ≥ 3mm American Academy of Periodontology 1999 criteria) were clinically (Gingival index, plaque index, probing depth, clinical attachment level) and biochemically (TAOC, MDA) evaluated. The SRP therapy was performed and a follow-up was done after 3 months. The mean values of clinical and biochemical study parameters and their relative percentage change were evaluated thoroughly. Results: Individuals with chronic periodontitis showed improved clinical and biochemical oxidative stress (OS) markers. After the SRP therapy, significant improvement (p ˂ 0.05) was found in both clinical and biochemical parameters from their corresponding pre-treatment values. The relative percentage change in clinical parameters ranged between 14.5% to 38.7%, and those of TAOC and MDA were -10.3% and 34.71% respectively. Further, the relative % change in TAOC and MDA showed significant correlation (p ˂ 0.05) to those of PI, PD, and CAL. Conclusion: On conducting the SRP therapy, improvement in clinical parameters and biochemical OS parameters is noticed in the individuals with periodontitis. The relative percentage change can be used as a tool for therapy outcome assessment.

Image Processing Techniques in Periapical Dental X-Ray Image Detection and Classification

An Image procedure method is a method that is beneficial in involving direct observation of the patient diagnosis of determination. These are the ideas to ploy the format of the splitting of various tush forms available inside the X-radiation of dental images that would be applied for the enamel splinter, scaling, and root planning, and so on that presupposes a lead job inside the detectable evidence of infirmity. The splitting and assembling of x-radiation images of teeth for detecting, among the huge directory in clinical regular procedure, is phenomenal satisfactory in magnificence and time overwhelming programme. This challenge is split into 5 extraordinary modules initiate with fetching x-radiation figures of teeth as the data to perform operations over it accompanied via preprocessing and segmentation. The capabilities are extricated for research and examining digital images and execute a class of affected teeth. In the paper, an alternative approach for the splitting and representation of grandiose tooth head.