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Aim: The aim of the study was to evaluate and compare the periodontal treatment outcomes in patients with periodontitis treated using conventional and microsurgical access flap procedure. Materials and Methods: Fifty chronic periodontitis patients were randomly assigned to conventional (Group I) and microsurgical (Group II) open flap debridement procedure. The parameters measured were probing pocket depth, clinical attachment loss (CAL), gingival recession (GR), bleeding on probing (BOP), wound healing, and postoperative pain. PD, CAL, GR, and BOP were assessed at pretreatment (baseline) and 3 months postoperatively. Wound healing was assessed using Landrey et al. healing index at 7th day and 3 months postoperatively and postoperative pain was assessed using number of analgesics taken for 7 days following surgery. Results: Healing Index score of 4 (very good healing) was found in 40% of sites of Group I and 95% of sites of Group II. Comparison of number of analgesics taken between groups on day 7 showed a statistically significant difference (P < 0.01), indicating that pain was significantly reduced in Group II compared to Group I. At 3 months postoperatively, there was no significant reduction in PD, CAL, GR, and BOP between the groups. Conclusions: In open flap debridement procedure, a microsurgical approach can substantially improve the early healing and induce less postoperative pain when compared to a conventional macroscopic approach.

Background: Chronic periodontitis is a prevalent oral health issue, affecting a substantial portion of the population. Infrabony defects, characterized by bone loss around teeth, are a hallmark of this condition and require surgical intervention to prevent further damage and tooth loss. Two commonly used surgical approaches are open flap debridement (OFD) and guided tissue regeneration (GTR). Materials and Methods: This prospective cohort study included 60 patients with chronic periodontitis and infrabony defects. Patients were randomly assigned to either the OFD or GTR group. Clinical parameters, including probing depth (PD) and clinical attachment level (CAL), were recorded at baseline and at 6-month and 12-month follow-up appointments. Radiographic assessments were conducted using periapical radiographs. The primary outcome measures were changes in PD and CAL, while secondary outcomes included radiographic evidence of bone regeneration. Results: At the 6-month follow-up, the OFD group demonstrated an average reduction in PD of 2.4 mm (SD = 0.8) and an increase in CAL of 1.6 mm (SD = 0.5). In contrast, the GTR group showed a reduction in PD of 2.1 mm (SD = 0.7) and an increase in CAL of 1.9 mm (SD = 0.6). These differences were not statistically significant (P > 0.05). Radiographic analysis indicated a mean bone fill of 1.2 mm (SD = 0.4) in the OFD group and 1.4 mm (SD = 0.3) in the GTR group at 12 months, with no significant difference observed between the two groups (P > 0.05). Conclusion: In this study, both OFD and GTR approaches demonstrated comparable clinical and radiographic outcomes in the treatment of infrabony defects in chronic periodontitis patients.

Background: The study aims to assess the clinical efficacy of periosteal pedicle graft (PPG) as a barrier membrane in guided tissue regeneration (GTR) for gingival recession, intrabony, and furcation defects. Materials and Methods: Electronic and hand searches were performed to identify randomized controlled/clinical trials investigating GTR using PPG, with 6-month follow-up. Primary outcomes recorded: probing depth (PD), clinical attachment level (CAL), bone fill, recession depth (RD) reduction, percentage of mean root coverage, keratinized tissue width (KTW), and bone defect area (BDA). Results: Thirteen articles were selected; 6 for recession, 2 for furcation, and 5 for intrabony. Meta-analysis was performed whenever possible, results expressed as pooled standardized mean differences (SMDs). In recession defects, the RD pooled SMD is 0.47 (95% confidence interval (CI) = [−0.50–1.44]), KTW pooled SMD is 1.30 (95% CI = [−0.30–2.91]), favoring PPG over the comparator. In furcation defects, PD pooled SMD is 1.12 (95% CI = [−2.77–0.52]), CAL pooled SMD is 0.71 (95% CI = [−1.09–2.50]), and bone fill pooled SMD is 0.67 (95% CI = [−3.34–4.69]) favoring PPG. In intrabony defects, PD pooled SMD is 0.54 (95% CI = [−2.12–1.04]), CAL pooled SMD is 0.23 (95% CI = [−1.13–0.68]), and BDA pooled SMD is 0.37 (95% CI = [−1.58–2.31]) favoring PPG. The results were not statistically significant. Conclusion: The current evidence indicates that PPG constitutes a valid and reliable alternative to collagen barrier membranes for successful GTR.

Background and Objectives: This randomized, double-arm, multicentric clinical trial aims to compare the clinical outcomes following the treatment of suprabony periodontal defects using open flap debridement (OFD) with or without the application of hyaluronic acid (HA). Materials and Methods: Sixty systemically healthy patients with at least two teeth presenting suprabony periodontal defects were randomly assigned with a 1:1 allocation ratio using computer-generated tables into a test (OFD + HA) or control group (OFD). The main outcome variable was clinical attachment level (CAL). The secondary outcome variables were changes in mean probing pocket depth (PPD), gingival recession (GR), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS). All clinical measurements were carried out at baseline and 12 months. Results: Sixty patients, thirty in each group, were available for statistical analysis. The mean CAL gain was statistically significantly different (p < 0.001) in the test group compared with the control group (3.06 ± 1.13 mm vs. 1.44 ± 1.07 mm). PPD reduction of test group measurements (3.28 ± 1.14 mm) versus the control group measurements (2.61 ± 1.22 mm) were statistically significant (p = 0.032). GR changes were statistically significant only in the test group 0.74 ± 1.03 mm (p < 0.001). FMBS and FMPS revealed a statistically significant improvement mostly in the test group. Conclusions: Suprabony periodontal defects could benefit from the additional application of HA in conjunction with OFD in terms of improvement of the clinical parameters compared with OFD alone.

Background: Soft-tissue intervention over bony defects may impede periodontal regeneration, the sole purpose of periodontal therapy. Human chorion membrane (CM) enhances guided tissue regeneration (GTR) and restores lost tissue. Consequently, calcium sulfate may represent a promising class of bone graft substitutes that helps in significant attachment gain without GTR membrane in deep narrow defects. Hence, this study was conducted to evaluate the efficacy of calcium sulfate graft in periodontal regeneration and to weigh the rationale of using CM for GTR in deep narrow defects. Methods: Thirteen patients with bilateral deep narrow defects clinically and radiographically (26 sites, ≥7 mm pocket depth [PD]) were selected and randomly allocated to Group I (open flap debridement and calcium sulfate placement) and Group II (open flap debridement and calcium sulfate with CM placement). Clinical parameters such as PD, clinical attachment level, and radiographical intrabony defect were recorded at baseline and 6 months postsurgery. Results: Significant attachment gain was found in both groups with nonsignificant intergroup differences. Conclusion: Calcium sulfate with or without CM is able to restore deep narrow bony defects efficiently. Deep narrow defects itself able to prevent soft-tissue collapse and ascertain excellent periodontal regeneration.

Background: Clinical outcomes of regenerative periodontal therapy has been traditionally assessed using surrogate markers, primarily clinical attachment level (CAL) gain and probing pocket depth (PPD) reduction. This study tried to assess newer clinical endpoints namely pocket closure and composite outcome measure (COM) apart from CAL gain, PPD reduction and gingival recession in patients who underwent guided tissue regeneration (GTR) and compared the same with open flap debridement (OFD) six months post treatment. Materials and Methods: Records of 58 sites in 48 patients who had undergone GTR (28 sites) and OFD (30 sites) for infrabony defects were evaluated for CAL gain, PPD reduction, change in GR, FMBS, and FMPS at baseline and 6 months after surgery. Pocket closure and COM were used to assess the efficacy of both treatments. Results: Statistically significant improvements were seen in both the groups except GR from baseline to 6 months. GTR-treated sites showed better improvements with a statistically significant difference in CAL gain after 6 months. Pocket closure and percentage of treatment success and failure in both the groups assessed using a COM were similar and did not differ statistically. Conclusion: Treatment of infrabony defects with GTR combined with a xenograft offers better CAL gain after 6 months compared to OFD alone and also found that baseline PPD and FMBS were the factors determining pocket closure.

Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and β-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and β-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and β-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and β-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and β-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

Background: Ibuprofen is one of the generally prescribed Non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain after periodontal surgery, but are contraindicated in certain patients. Ginger, which is the rhizome of Zingiber officinale, being a common herbal drug having anti-inflammatory as well as analgesic activities can be an efficient substitute for synthetic agents like Ibuprofen. Objectives: To compare the effectiveness of ibuprofen and dried ginger powder on pain and gingival inflammation following open flap debridement. Materials and methods: Ten systemically healthy individuals with chronic generalized periodontitis were selected for this single-blinded randomized cross-over clinical trial and underwent open flap debridement in at least two quadrants. Each quadrant was randomly allocated to receive either Ibuprofen (400 mg) or Ginger powder capsules (400 mg) thrice daily for three days. Subjects were requested to note down the pain score on the Visual Analogue Scale (VAS) provided in a printed format, for the first eight hours after surgery and on the following two days, and gingival inflammation was assessed after one week, using Modified Gingival Index (MGI). Result: The difference in the VAS score and MGI between the two groups was not of statistical significance. Conclusion: Effectiveness of ginger powder for the management of pain and gingival inflammation following open flap debridement is comparable to that of ibuprofen.

Esthetic demands for correction of irregularities of dentition are becoming a prime concern even in patients above the age of 40 years. Severe periodontitis, being insidious, if present simultaneously, complicates the situation. Periodontally compromised adult patients requiring the treatment for malaligned teeth are encountered very frequently in daily practice, and the correction of these requires a combined perio-ortho interdisciplinary approach. The present case report deals with a 5-year follow-up of a case whose prime concern was rotated anterior teeth in the maxillary arch. However, along with this, severe periodontitis was also present. Open flap debridement along with osseous grafting was done wherever required, followed by fixed adjunctive orthodontic treatment. After the completion of orthodontic treatment, a fixed retainer in the form of splinting was given and the entire treatment met the esthetic along with functional demands of the patient. Early 6 months followed by yearly follow-ups reflected clinical and radiographic improvements in the dentition.

Clot formation is the first step of the healing process, and clinical procedures always find ways to stabilize this clot better. Platelets play a significant role in clot formation, and Platelet Concentrates (Pc) are an abundant reservoir of platelets. This article aims to review the in vitro research and systematic reviews on PCs that are currently available. Broadly, PCs mainly include Platelet-rich plasma and platelet-rich fibrin. PCs are an excellent source for growth factors such as PDGF-AA, TGF β1, VEGF, EGF, and IGF. Numerous systematic reviews and meta-analyses have analyzed the clinical application of PCs in various periodontal procedures. In alveolar ridge preservation, PCs are known to reduce postoperative pain, edema, trismus, and inflammation. PRF had shown significant improvement in achieving root coverage and recession depth reduction. PCs exhibited a positive influence on CAL gain when used as an adjunct to OFD in treating infra-bony defects. Pcs have a positive effect on bone maturation in the short term. Besides, PCs can be used in regenerative endodontics, treatment of medication-related osteoradionecrosis of Jaw (MRONJ), and accelerating tooth movement. In conclusion, PCs positively affect soft tissue healing, while their role in hard tissue healing is still unclear.

Context: Different techniques are used for periodontal therapy, viz. scaling and root planing, subgingival curettage, gingivectomy, and full- or split-thickness flap procedures with or without osseous recontouring. Most of the said periodontal surgeries are invasive and associated with pain and secondary discomfort, thus leading to a quest for newer techniques such as laser-assisted closed pocket debridement techniques for periodontal therapy. The present study was designed to compare the efficacy of closed pocket debridement with diode laser and periodontal open flap debridement as assessed by clinical and microbiological parameters. Materials and Methods: Twenty patients in an age range of 20–54 years and with pocket depth of ≥5 mm and ≤7 mm were included in the study. The plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and colony forming units (CFUs) of the periodontal pathogens namely Porphyromonas gingivalis, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and streptococci were compared in patients undergoing closed pocket debridement with diode laser (Group I) against open flap debridement (Group II) at baseline and after 3 months of the procedure. Results: There was a statistically significant difference between the PD reduction in Group I and Group II (P = 0.02), with Group II showing greater reduction in PD. Furthermore, the mean value of CFUs after 3 months of the procedures in Group I was significantly less as compared to Group II. Conclusion: The laser-treated group (Group I) was found to be better in terms of decrease in clinical PD as compared to Group II. The bactericidal effect of the diode laser was, also, clearly evident by a greater reduction of CFUs of periodontal pathogens in Group I as compared to Group II.

Background: Among treatment modalities, grafting of biomaterials/bone substitutes has been used with varying success to accomplish the reconstruction of the lost periodontal attachment apparatus. Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), are playing an increasingly important role in bone reconstructive procedures. The aim of this study was to evaluate the clinical outcome of reconstructive surgery in human deep intrabony defects with the use of fisiograft (polylactic and PGA copolymer) with open flap debridement (OFD) versus OFD alone in the treatment of periodontal intrabony defects. Materials and Methods: Thirty 2- or 3-walled intrabony defects were treated in 15 (ten male and five female) patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The study used a split-mouth design where two intrabony defects were randomly chosen to receive fisiograft (polylactic and PGA copolymer) with OFD (Group 1) on 15 sites and remaining 15 sites were chosen only for OFD alone (Group 2). Statistical Analysis: Wilcoxon's signed-rank test as an alternative to paired t-test and Mann–Whitney U-test as an alternative to unpaired t-test were used for statistical analysis. Results: There was a decrease in probing pocket depth of 3.93 ± 0.08 mm for PGA/PLA with OFD and 3.14 ± 0.41 mm for OFD alone with a mean gain of relative clinical attachment level of 3.81 ± 0.30 and 2.46 ± 0.03 for PGA/PLA with OFD and OFD alone, respectively. Gingival margin position was 0.667 ± 0.51 mm and 3.626 mm for the PGA/PLA with OFD and OFD alone. The mean amount of defect fill for PGA/PLA with OFD and OFD alone was 1.80 ± 0.86 mm and 1.20 ± 0.94 mm, with a mean change in the level of alveolar crest after 6 months being 0.267 ± 0.46 and − 0.86 ± 0.74 for the two groups, respectively. The mean difference in percentage of original defect resolved when compared between the test and control groups 6 months postoperatively was found to be 31.85% which was statistically significant (P = 0.001). Conclusion: In the present study, fisiograft (polylactic and PGA copolymer) with OFD group showed better results than where OFD alone was used in the treatment of periodontal intrabony defects in terms of both clinical as well as radiographic assessment. Although Fisiograft® has shown promising results on clinical and radiological evaluation in the present study, it would be inappropriate to draw definite conclusions regarding the nature of the defect fill.

Background: To compare treatment modalities: Open flap debridement (OFD) alone (Group I), OFD in combination with PerioGlas® (Group II), and OFD in combination with autologous platelet-rich fibrin (PRF) (Group III) for periodontal intrabony defects (IBDs). Aim: To evaluate on clinical and radiographic basis, effectiveness of PerioGlas®, and PRF in treating IBDs. Settings and Design: IBDs selected on the basis of the inclusion criteria were randomly assigned to Groups I, II, and III by coin toss method. Materials and Methods: The study was conducted on patients reporting to the department of periodontology and oral implantology. Thirty-eight patients with ninety periodontal IBDs of moderate to severe periodontitis were selected and assigned to Groups I, II, and III. In each patient, a minimum number of two sextants were present with pocket depths ≥5 mm in at least three teeth. Statistical Analysis: Statistical analysis based on mean values, standard deviation, and P values. Results: Compared to baseline, 9 months postoperatively: (1) mean probing pocket depth reduction for Group I was 3.68 mm ± 0.72, for Group II was 5.57 mm ± 1.10, and for Group III was 6.11 mm ± 0.92. (2) The mean relative attachment level gain for Group I was 4.14 mm ± 0.76, for Group II was 6.57 mm ± 1.45, and for Group III was 6.74 mm ± 1.55. (3) Mean radiographic IBD fill for Group I was 69.29% mm ± 7.73, for Group II was 74.44% mm ± 8.57, and for Group III was 75.01% mm ± 7.85. Conclusion: This study shows marked improvements in the clinical parameters and radiographic outcomes with both PerioGlas® and autologous PRF to treat periodontal IBDs as compared to OFD alone.

Background: Management of furcation defects is challenging, and constantly newer therapeutic strategies are evolving. Platelet-rich fibrin (PRF) is successfully used alone and in combination with various agents in the furcation defects. Lately, metformin (MF), a second generation biguanide has gained popularity owing to its osteogenic potential. Aims and Objectives: The aim of the present study was to evaluate the clinical and radiographic effectiveness of open flap debridement (OFD) and PRF when compared to OFD + PRF + 1% MF gel in the management of mandibular Grade II furcation defects. Materials and Methods: Thirty mandibular grade II furcation defects were stratified into two groups; in one group OFD and PRF is used, and the other group had an additional MF gel with PRF in OFD. Clinical parameters such as plaque index, modified sulcus bleeding index, probing pocket depth (PD), relative vertical attachment level (RVAL), and relative horizontal attachment level (RHAL) were recorded at baseline and at 6 months. Radiovisiography and ImageJ software were used to evaluate the intrabony defect depth. Results: The OFD + PRF + MF group showed significantly higher probing PD reduction, RVAL and RHAL gain than the OFD + PRF group. Conclusions: PRF when combined with a potential osteogenic agent like MF can provide a better therapeutic benefit to a furcation involved tooth.

Aim: To evaluate the efficacy of Polylactic Acid/Polygycolic Acid (PLA/PGA -Fisiograft®) with Open Flap Debridement (OFD) and OFD alone in the treatment of intrabony defects over a period of 9 months. Material and Methods: Twenty Nine systemically healthy subjects with total of 30 defects were included in the present, randomized, controlled and two arm parallel study. Tests were treated with OFD along with Fisiograft® and controls with OFD alone. Results: On intra-group comparison, clinical parameters at 6 and 9 months showed statistically significant results. On comparing between the two groups, the reduction in Defect Specific Bleeding Score (DSBS), Defect Specific Plaque Score (DSPS), Probing Depth (PD) and gain in Clinical Attachment Level (CAL) revealed no statistical significances other than Recession Depth (REC) which was more in controls. The mean radiographic parameters at 9 months post-operatively in both the groups were statistically significant. However, the intergroup comparison revealed no statistically significant values. Conclusions: The overall results at the end study proved that the adjunctive use of Fisiograft® was not beneficial when compared with OFD alone. Clinical Significance: Synthetic bone replacement graft materials are commonly used for periodontal regeneration. The present study was conducted by using PLA/PGA reveals no additional benefit over OFD alone in treatment of intrabony defects.

Aim: 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 debridement alone) 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