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Aim: Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters., Materials and Methods: Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models., Results: Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category 'interdental cleaning' was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation r s  = -.2349, p = .022) and periodontal inflamed surface area (PISA) (r s  = -.2099, p = .042)., Conclusions: Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy., (© 2024 The Author(s). Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objectives: To demonstrate the potential application of mixed reality (MR) holographic imaging technology in subgingival scaling and root planing (SRP) for patient with advanced periodontitis., Methods: This case series comprised the analysis of 1566 sites from 261 teeth of 10 patients with advanced periodontitis. Digital CBCT scans and intraoral scans of the patients were digitally acquired preoperatively and aligned to create a three-dimensional periodontal visualization model. Through rendering, interactive holographic images were displayed using MR. The surgeon first used MR images to communicate with the patients, and then facilitated SRP under their guidance. Probing pocket depth (PPD), clinical attachment loss (CAL), Plaque index (PI), and bleeding on probing (BOP) parameters were recorded at baseline and at 8-week postoperatively. Patient-reported outcome indicator questionnaires on self-efficacy were also collected., Results: PPD, CAL, PI, and BOP significantly decreased at 8-week following MR hologram-assisted SRP (p<0.001). For sites with PPD≥4 mm, PPD and CAL declined by 2.33±1.23 mm and 0.69±1.07 mm, respectively. PI significantly decreased from 1.94±0.61 to 0.82±0.58 (p < 0.001) and BOP sites decreased significantly from 84.11% to 40.25%. After receiving MR holograms for condition communication, most patients had a better perception of the effectiveness of SRP treatment and the benefits it brings. 80% of the subjects expressed their willingness to undergo MR-assisted periodontal treatment in the future., Conclusion: These results provide preliminary support for MR hologram-assisted digital SRP. With this technology, images of the gingiva and alveolar bone can be displayed in real time, accurately and three-dimensionally. This improves SRP effectiveness, diminishes complications, and enhances patients' confidence in the treatment., Clinical Significance: MR holographic imaging-based digital SRP is a clinically feasible and promising adjunctive periodontal treatment option. It may contribute to improved non-surgical treatment efficacy in patients with severe periodontitis., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols., Methods: Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q-SI (n = 21). The outcomes assessed were serum CRP and Lp-PLA 2 , and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment., Results: At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere-Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI., Conclusion: Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA 2 gained more benefits from the MINST approach at 1-year follow-up., (© 2024 The Author(s). Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Background: Diabetes mellitus (DM)-associated hyperinflammatory host response significantly provokes periodontal tissue destruction. In this context, the support of nonsurgical periodontal therapy in diabetics with host modulation agents is a current field of study. This clinical study aims to investigate the clinical efficacy of melatonin supplementation and discuss its possible biological mechanisms in nonsurgical periodontal treatment in patients with DM and periodontitis through some fundamental markers., Methods: In this randomized controlled and single-blind study, 27 of 55 diabetic patients with periodontitis (stage III/IV and grade C) underwent full-mouth scaling and root planing (fmSRP) alone and 28 patients underwent melatonin administration (6 mg daily, 30 days) in addition to fmSRP (full-mouth scaling and root planing plus melatonin, fmSRP-mel). The potential therapeutic contribution of melatonin was evaluated clinically and biochemically (gingival crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels) at 3rd and 6th months., Results: Melatonin (tablet, 6 mg daily, 30 days) did not cause any local or systemic side effects. fmSRP alone resulted in significant reduction in serum IL-1β levels, pocket depths, gingival inflammation, and gingival crevicular fluid RANKL and MMP-8 levels (p < 0.05). Moreover, melatonin supplementation resulted in a more significant decrease in bleeding and pocket depth scores at probing, especially at 3 months (p < 0.05). Furthermore, RANKL and MMP-8 levels were significantly lower at 3 months and IL-1β levels at 6 months compared to the control group (p < 0.05). However, OPG levels were not affected significantly by the treatments (p > 0.05)., Conclusion: Melatonin, as a host modulation agent, significantly increases the clinical efficacy of fmSRP. The reduction in periodontal inflammation and pocket depths may be a result of marked suppression of RANKL-associated osteoclastogenesis and extracellular matrix damage by melatonin., (© 2023 American Academy of Periodontology.)

Objective: To evaluate the efficacy of newly introduced ozonated gels compared with conventional chlorhexidine gel in the home management of periodontal patients., Materials and Methods: 30 patients with bilateral periodontal disease (severity I, complexity II) were enrolled (split-mouth study design). After nonsurgical mechanical periodontal debridement, the teeth were randomly divided into two groups: teeth in the Control group were treated with a chlorhexidine-based gel to aid oral hygiene maneuvers for 2 weeks after the first visit, while teeth in the Test group were treated in the same way with ozone-based gels. After the baseline assessment, the follow-up included assessments at 1, 2, and 6 months. The variables evaluated were clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BoP), plaque control record (PCR), recession (R), and tooth mobility (TM)., Results: For CAL, PPD, BoP, and PCR, significant intragroup differences were found for both groups (p < 0.05), in contrast to intergroup differences (p > 0.05). No significant differences were found for R and TM., Conclusion: Nonsurgical mechanical periodontal debridement with adjunctive use of ozone and chlorhexidine was found to be effective in periodontal treatment. Ozone could be suggested as an alternative to chlorhexidine., (© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Background: There is insufficient clinical and microbiological evidence to support the use of diode laser and air-polishing with erythritol as supplements to scaling and root planning(SRP). The aim of the current study is to evaluate the clinical and microbiologic efficacy of erythritol subgingival air polishing and diode laser in treatment of periodontitis., Methods: The study encompassed twenty-four individuals seeking periodontal therapy and diagnosed with stage I and stage II periodontitis. Eight patients simply underwent SRP. Eight more patients had SRP followed by erythritol subgingival air polishing, and eight patients had SRP followed by diode laser application. At baseline and six weeks, clinical periodontal parameters were measured, including Plaque Index (PI), Gingival Index (GI), periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL). The bacterial count of Aggregatibacter actinomycetemcomitans(A.A), Porphyromonas gingivalis (P.G) was evaluated at different points of time., Results: The microbiological assessment revealed significant differences in the count of A.A. between the laser and erythritol groups immediately after treatment, indicating a potential impact on microbial levels. However, the microbial levels showed fluctuations over the subsequent weeks, without statistically significant differences. Plaque indices significantly decreased post-treatment in all groups, with no significant inter-group differences. Gingival indices decreased, and the laser group showed lower values than erythritol and control groups. PPD and CAL decreased significantly across all groups, with the laser group exhibiting the lowest values., Conclusion: The supplementary use of diode laser and erythritol air polishing, alongside SRP, represents an expedited periodontal treatment modality. This approach leads to a reduction in bacteria and improvement in periodontal health., Trial Registration: This clinical trial was registered on Clinical Trials.gov (Registration ID: NCT06209554) and released on 08/01/2024., (© 2024. The Author(s).)

Background: The aim of this study was to assess the efficacy of photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) on clinical parameters and microbial composition in subgingival plaque of periodontitis patients., Methods: Seventeen patients were included in this split-mouth randomized clinical trial. Sites with probing pocket depth (PPD) ≥5 mm in combination with bleeding on probing in different quadrants were randomized into the control group, the group with a single PDT application right after SRP, and the group with three repeated PDT applications 1 week after SRP. The subgingival plaque was collected for 16S rRNA gene sequencing at baseline, Week 2, and Week 8., Results: Seventeen patients with 60 sites completed this 8-week follow-up, and 157 subgingival plaques were successfully analyzed by sequencing. Significant improvements were observed in two primary outcomes: PPD at Week 8 and subgingival microbial composition. Compared to the control group, the repeated-PDT group showed a notable improvement in PPD, substantial alterations in the microbial profile, including a reduction in α-diversity and anaerobic bacteria, and an increase in aerobic bacteria at Week 2. Secondary outcomes, such as clinical attachment level and sulcus bleeding index, also showed improvement at Week 8. Furthermore, both the single- and repeated-PDT groups exhibited a decrease in periodontopathogens and an increase in beneficial bacteria compared with baseline., Conclusion: PDT promotes changes in the microbial composition of periodontitis patients' subgingival plaque in a direction favorable to periodontal health, and repeated PDT is a promising adjunctive therapy for periodontal treatment., (© 2024 American Academy of Periodontology.)

Aim: To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis., Materials and Methods: PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC., Results: This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD., Conclusions: Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets., (© 2024 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: This study was designed to assess the influence of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) levels of semaphorin-4D (SEMA-4D), peptidylarginine deiminase-2 (PAD-2), and matrix metalloproteinase-8 (MMP-8) levels in periodontally healthy, Stage III periodontitis non-smoker and smoker patients., Methods: Sixty patients were equally divided into three groups, Group I: Periodontally healthy, Group II: Non-smokers with Stage III periodontitis, and Group III: Smokers with Stage III periodontitis. The patients underwent NSPT with clinical and biochemical parameters examined at baseline and 3 months post therapy. GCF was collected for levels of SEMA-4D, PAD-2, and MMP-8 through enzyme-linked immunosorbent assay (ELISA)., Results: Greater values of PPD (8.06 ± 0.19 mm), CAL (8.94 ± 0.19 mm), PI (2.58 ± 0.19) while lower PBI (1.39 ± 0.19%) and GI (1.72 ± 0.19) scores were seen in Group III as compared to Group II, which reduced significantly from baseline to 3 months in both the groups after NSPT. Minimum values of SEMA-4D, PAD-2, and MMP-8 levels in GCF were seen for Group I, which increased incrementally to Group II and III. Also, among Group II and III the SEMA-4D, PAD-2, and MMP-8 levels in GCF reduced from baseline to 3 months indicating a favorable response within the tissues., Conclusion: Greater levels in GCF of Levels of SEMA-4D, PAD-2, and MMP-8 in Group II and III, which reduced significantly post NSPT, implied that these biomarkers play a pivotal role in the inflammatory process and can be utilized for early diagnosis., (© 2023 American Academy of Periodontology.)

Aim: The study aims is to evaluate the antibacterial effect of vitamin D3 against the red complex bacteria , Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia in chronic periodontitis patients., Materials and Methods: The study comprised 98 participants with chronic periodontitis. All clinical parameters including plaque index (PI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and a microbiological assay of P. gingivalis, T. denticola, T. forsythia were assessed at the baseline. All study participants who underwent scaling and root planning were divided into two groups, A and B, each with 49 patients and only group B patients were advised to take vitamin D supplementation of 60,000 IU granules, once daily for 2 months. All the patients of both the groups were recalled at the end of 2nd month and all the clinical and microbiological parameters were reassessed., Results: After two months, there was a reduction in all the clinical markers in both groups, but the group B patients showed more improvement following non-surgical treatment vitamin D intake. There was also a statistical reduction in P. gingivalis, T. denticola, and T. forsythia following administration of vitamin D in group B patients compared to group A., Conclusion: These discoveries proposed that vitamin D has a superb antimicrobial impact against red complex periodontal microbes and might be considered a promising compound in the counteraction of periodontal disease., Clinical Significance: Vitamin D is considered to possess anti-inflammatory and antimicrobial activity, which may help to delay the progression of periodontitis. So, vitamin D3 can be used as a potential supplement that could be employed to stop the advancement of periodontal disease. How to cite this article: Govindharajulu R, Syed NK, Sukumaran B, et al . Assessment of the Antibacterial Effect of Vitamin D3 against Red Complex Periodontal Pathogens: A Microbiological Assay. J Contemp Dent Pract 2024;25(2):114-117.

Aim: This split-mouth randomized trial (RCT) aimed to assess the effect of diode laser on the clinical parameters in patients with periodontitis, compare the results with scaling and root planing (SRP) alone, and assess the implications of diode laser (DL) on plaque bacteria., Materials and Methods: Seventeen periodontitis patients were randomly assigned into two equal groups based on the therapy delivered. Group I (control site) received just SRP at baseline, while group II (test site) received both SRP and DL irradiation. For both groups, the clinical periodontal parameters probing pocket depth (PPD), and clinical attachment level (CAL) were measured at baseline, 30 days, and 90 days. Microbiological amount was also measured at baseline, 30, and 90 days after periodontal treatment. The amounts of Aggregatibacter actinomycetemcomitans ( A.a ), Prevotella intermedia ( Pr. intermedia ), and Porphyromonas gingivalis ( P. gingivalis ) were determined using real-time PCR probing with specific bacterial primers., Results: In both groups, PPD and CAL showed statistically significant reductions at different time intervals ( p < 0.05). No significant difference were observed in CAL values after 1 and 3 months in both test and control groups ( p > 0.05). The mean values of the concentration of A.a, Pr. intermedia and P. gingivalis were lower in the case group as compared to the control group and the difference was statistically significant after 1 month (* p = 0.001)., Clinical Significance: According to this study, non-invasive laser treatment has the potential to improve clinical outcomes by lowering the quantity of A.a, Pr. intermedia and P. gingivalis ., Conclusion: In both groups, a considerable decrease in the periodontal pathogens A.a, Pr. intermedia and P. gingivalis were discovered; however, the intergroup comparison was insignificant in relation to PD and CAL. The adjunctive treatment with diode laser showed better efficacy in ensuring a better periodontal treatment than SRP alone. How to cite this article: Abdullah LA, Hashim N, Rehman MM, et al . Effectiveness of Diode (810 nm) Laser in Periodontal Parameters and Reduction of Subgingival Bacterial Load in Periodontitis Patients. J Contemp Dent Pract 2023;24(12):1008-1015.

Background: The removal of subgingival calculus to obtain gingival health is an integral part of nonsurgical periodontal therapy. The periodontal endoscope is used by some clinicians to help enhance access to effectively remove subgingival calculus; however, longer-term studies on this subject are still lacking. The purpose of this randomized, controlled clinical trial was to compare the clinical outcomes of scaling and root planing (SRP) using a periodontal endoscope versus conventional SRP using loupes for up to 12 months, utilizing a split-mouth design., Methods: Twenty-five patients were recruited who exhibited generalized stage II or stage III periodontitis. SRP was rendered by the same experienced hygienist using either a periodontal endoscope or conventional SRP using loupes, following random assignment of the left and right halves of the mouth. All periodontal evaluations were done by the same periodontal resident at baseline, and at 1, 3, 6, and 12 months after therapy., Results: Single-rooted teeth interproximal sites displayed a significantly lower percentage of improved sites (P < 0.05) than multirooted teeth for probing depth and clinical attachment level (CAL). Maxillary multirooted interproximal sites favored the use of the periodontal endoscope at the 3- and 6-month time periods (P = 0.017 and 0.019, respectively) in terms of the percentage of sites with improved CAL. Mandibular multirooted interproximal sites showed more sites with improved CAL using conventional SRP than with the periodontal endoscope (P < 0.05)., Conclusion: Overall, the use of a periodontal endoscope was more beneficial in multirooted sites compared to single-rooted sites, specifically in maxillary multirooted sites., (© 2023 American Academy of Periodontology.)

Aim: To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy., Methods: A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] ≥4 mm with bleeding on probing, and no sites with PPD ≥ 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders., Results: Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p < .01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p < .05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p < .01). Subjects with a combination of 'unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD≥6 mm (MD = 1.51; 95% CI: 0.23-2.80; p < .05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p < .05) at re-evaluation., Conclusions: Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Purpose: This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV., Methods: Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months., Results: Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome "change of mean PD," no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group., Conclusion: High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits. The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020., (© 2023. The Author(s).)

Objective: To evaluated the relationship between serum vitamin D levels and periodontal healing outcomes in patients with mild or moderate periodontitis., Methods: Serum vitamin D levels and periodontal pockets and gingival bleeding were evaluated in 51 patients before and 6 months after non-surgical periodontal treatment. A t-test and chi-square test were used to analyse the data (p ≤ 0.05)., Results: The mean reduction of periodontal pocket depth was statistically significant higher in patients with vitamin D ≥30 ng/ml than those with <30 ng/ml (CI = -0.23-0.42, p = 0.05), but not clinically significant. Vitamin D level was not associated with the percentage of sites of gingival bleeding on probing at the final evaluation (OR = 0.58, 95% CI = 0.17-1.99, p = 0.39)., Conclusion: Lower serum vitamin D level was associated with a slightly reduced periodontal healing after non-surgical periodontal therapy, which should be further investigated in a larger population., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The systematic review and meta-analysis aimed to evaluate the efficacy of Metformin (MF) with Platelet Rich Fibrin (PRF) over PRF alone in the treatment of periodontal osseous defects., Materials and Methods: An extensive electronic search for articles published up to September 2021 was conducted on 'Embase', 'PubMed' and other library databases accompanied with manual searching. Randomized controlled trials (RCTs), comparing MF plus PRF Vs PRF alone in periodontal osseous defects were identified in which periodontal pocket depth (PPD), Clinical attachment level (CAL) and Intrabony defect depth (IBD Depth) were the outcome measures., Results: Four studies compared MF plus PRF vs .PRF alone in periodontal osseous defects. Meta-analysis was carried out for PPD reduction, CAL gain and IBD Depth changes. A standardized mean difference (SMD) of 1.86 for PPD reduction, 1.95 for CAL gain and 1.31 for IBD Depth reduction in all the studies was observed and the findings were statistically significant favouring test group., Conclusion: The systematic review indicates supplemental benefits of combination therapy of MF + PRF over monotherapy in resolving periodontal osseous defects. In our quest to achieve maximum regeneration in periodontal osseous defects, combination therapies such as MF + PRF have reported to be better treatment choices over other modalities.

Background: Periodontitis is one of the most common chronic inflammatory diseases in the world, which affects oral health. Resveratrol is a polyphenol with therapeutic effects on the inflammation caused by periodontal pathogens. This study aimed to evaluate the impact of resveratrol supplementation on clinical parameters and inflammatory markers in patients with chronic periodontitis., Methods: In this randomized, double-blind study, 40 chronic periodontitis patients underwent non-surgical therapy and were randomly assigned to two intervention and control groups, receiving either resveratrol supplements or a placebo for four weeks. Salivary levels of interleukin-8 (IL-8), interleukin-1β (IL-1β), and clinical parameters, including pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding index (BI), were measured before and after the intervention., Results: The results showed that in both the case and control groups, after four weeks of using resveratrol, only plaque index (PI) was significantly different compared to the control group (P = 0.0001). However, there were no significant differences in the mean pocket depth (PD), clinical attachment loss (CAL), bleeding index (BI), and salivary levels of IL-8 and IL-1β between the two groups after the intervention., Conclusion: Resveratrol complement was helpful as an anti-inflammatory food supplement, along with other non-surgical periodontal treatments in chronic periodontitis patients., (© 2023. The Author(s).)

This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters ( n  = 46), moderate smokers ( n  = 17), and heavy smokers ( n  = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.

Purpose: To investigate the effects of ultrasonic scaling and root planning(SRP) assisted by perioscope on gingival recession of maxillary lateral incisor., Methods: Thirty-six outpatients with moderate to advanced chronic periodontitis from the Department of Periodontology at Dental and Ophthalmic Clinic of Putuo District from June 2020 to December 2020 were collected as research objects. Periodontal treatment was carried out according to a single-blind split-mouth self-control design randomly with(experimental group, namely perioscope group) or without(control group, namely SRP group) periodontal endoscope．The labial periodontal probing depth (PD), labial attachment loss (AL) and gingival recession(GR) in the maxillary lateral incisors were recorded at baseline, 3 and 6 months, and compared among groups by SPSS 22.0 software package., Results: There was no significant difference between perioscope group and SRP group at baseline. ΔGR (the recession extent of gum within two observation time) in perioscope group was significantly smaller than that in SRP group at 3 months（P<0.05）. There was no significant difference in other periodontal indicators at 3 and 6 months between the 2 groups after treatment, but it can be found that the degree of PD reduction and AL improvement in perioscope group was more than those in SRP group, this trend was most obvious at 3 months. PD and AL were significantly different between baseline and 3 months or 6 months in the two groups. There were significant differences in ΔGR at 3 months and 6 months between the two groups., Conclusions: Compared with routine SRP, the extent of root surface debridement with perioscope-assisted SRP is thorough and less invasive, and the reduction of gingival recession of labial surface of maxillary lateral incisor at 3 months is significantly less; thus, the aesthetic effect is prominent.

Objectives: Dysbiosis of oral microbiome play an integral role in periodontitis. Bacterial balance is an important aspect of host defence. Mechanical debridement alone is insufficient to manage many cases. Probiotics are a novel adjunctive strategy, but the beneficial effects of probiotics in the management of moderate periodontitis have not been evaluated before. The objective of the present study was to assess the efficacy of probiotic mouth rinse of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii as an adjunct to mechanical debridement in grade II periodontitis. The study also evaluated change in salivary pH and IgA in both groups., Methods: The study was registered under Clinical Trial Registry of India (CTRI NO: CTRI/2019/10/021630). 60 patients with stage II periodontitis were randomized into probiotic and placebo group (n = 30 in each group) after mechanical debridement. Patients were instructed to use mouth rinse twice a day for 30 days. Periodontal parameters (Plaque index, Gingival index, Pocket depth and clinical attachment level) were recorded at baseline, after 1 and 3 months. Salivary pH was tested using a pH metre and IgA using enzyme linked immunosorbent assay., Results: Significant improvement in all clinical parameters were noted in both the groups after 1 and 3 months. Intergroup comparison revealed significant difference in gingival index, probing depth and clinical attachment gain. Significant elevation of salivary IgA and pH was noticed in probiotic group in contrast to placebo group., Conclusion: The present study supports the use of probiotic mouthwash as an adjunct to mechanical therapy for the management of stage II periodontitis., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This randomized, controlled clinical trial aimed to compare the differences in periodontal clinical outcomes, duration of the procedure, and patient's experience between conventional scaling and root planing and erbium-doped: yttrium-aluminum-garnet (Er:YAG) in the treatment of generalized moderate to severe chronic periodontitis or generalized Stages II or III, and Grade B periodontitis based on the Centers for Disease Control (CDC), American Academy of Periodontology (AAP), and European Federation of Periodontology (EFP) definitions., Methods: Thirty subjects were initially recruited. In a split-mouth fashion, right and left sides were randomly allocated into two treatment arms: conventional scaling and root planing (C-SRP) versus laser-assisted scaling and root planing (L-SRP). A blinded examiner recorded clinical measurements at baseline and 3 months. Duration of the procedure was also recorded for each visit, and the patient's experience was assessed with a questionnaire at baseline, 1, and 3 months., Results: The final sample consisted of 26 subjects. Both treatments resulted in overall improvement, but no significant differences were found between modalities for clinical attachment gain or probing depth reduction. The duration of the procedure was approximately half for L-SRP, and postoperative sensitivity was greater in C-SRP., Conclusions: The low-energy protocol with Er:YAG (50 mJ) used for the non-surgical treatment of moderate-severe chronic or Stage II-III, Grade B periodontitis performed in this study population was a treatment modality that yielded similar clinical improvements when compared to conventional scaling and root planing., (© 2021 American Academy of Periodontology.)

Severe periodontitis is challenging to treat. The aim of this study was to evaluate the efficacy of a combined Er:YAG laser (ERL) and Nd:YAG laser (NDL) in non-surgical treatment for severe periodontitis. One week after supragingival scaling, 32 systemically healthy patients with stage III or IV periodontitis were randomly divided into a control group (16 subjects) and a test group (16 subjects). The control group was treated by scaling and root planning (SRP) with ultrasonic equipment and manual instruments, and the test group was treated by SRP as well as ERL and NDL. Before treatment, the following clinical parameters were recorded at baseline: debris index (DI), probing depth (PD), clinical attachment level (CAL), and percentage of bleeding on probing (BOP %). Two months after therapy, the clinical parameters were recorded again, and the results between the groups were compared. All clinical parameters were significantly improved in both groups after therapy. For moderately deep periodontal pockets (4 mm ≤ PD ≤ 6 mm), the gains in CAL were greater in the test group (1.17 ± 1.47 mm) than in the control group (0.46 ± 2.78 mm), while no significant difference was found for PD reductions after therapy between the two groups. For deep periodontal pockets (PD > 6 mm), the differences in all of the clinical parameters were similar between the test group and the control group. In this short-term study, ERL and NDL radiation exhibited potential advantages in improving the clinical attachment level compared to conventional SRP in the non-surgical treatment of severe periodontitis., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Periodontitis and chronic kidney disease are both chronic inflammatory diseases and share some common risk factors. This 3-month pilot study aimed to clarify whether non-surgical periodontal therapy is beneficial in clinical, biochemical, and microbiological conditions in patients with periodontitis and kidney failure. Kidney failure patients with moderate to severe periodontitis were recruited from two hospitals. Treatment group received non-surgical periodontal therapy, and control group received oral hygiene instruction only. Outcome assessments were conducted 1 and 3 months after treatment. Non-parametric tests were used to analyze the patient-level data. Periodontal site-level assessments were analyzed by Student t -test and paired t -test. Statistical significance was set at p -value < 0.05. A total of 11 subjects completed the study. There was no significant difference between groups in all-cause mortality, cardiovascular events, infection events, systemic parameters, and serum biomarkers. Comparing to control group, clinical periodontal parameters, gingival crevicular fluid interleukin-1β (IL-1β) level and periodontal pathogens showed significant improvement in the treatment group. Non-surgical periodontal treatment did not change systemic outcomes in kidney failure patients, but changed the local micro-environment.

Introduction: Moderate chronic periodontitis is the most common periodontal disease. The treatment of this condition should aim at achieving a biocompatible root surface and decontamination of the pocket, thereby restoring the health status., Aim: In the present study, the aim was to examine the clinical effectiveness of fibreless Er:YAG laser used for scaling and root planing and to compare it with a conventional treatment with Gracey curettes., Materials and Methods: The study included 909 periodontal pockets which were treated in a split-mouth design with either Gracey curettes or with Er:YAG laser (1.5 W). Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing (BoP), and plaque index were recorded., Results: There was a considerable decrease of PPD, CAL, BoP, and plaque presence values at 1 and 3 months after therapy in both treatment groups. Sites treated with Er:YAG laser demonstrated mean CAL gain of about 1.00 mm and 0.44 mm at the first and third month, respectively. In the control group, there was also significant gain of CAL of about 1.33 mm at the first and 0.30 mm at the third month. Significant difference was observed in all parameters between both groups in favour of the laser treatment., Conclusions: The results of the present study suggest that the Er:YAG laser shows clinical effectiveness in the treatment of moderate chronic periodontitis. It can be used as a single treatment modality for subgingival scaling and root planing resulting in greater improvements in all recorded data in contrast to conventional treatment., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Backgrounds: To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients., Methods: We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I 2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method., Results: Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs., Conclusions: SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice., (© 2021. The Author(s).)

Background: (-)-Epigallocatechin Gallate (EGCG) as green tea catechins possessed antibacterial and anti-inflammatory effects on periodontal disease. This study was designed to evaluate the clinical and microbiological efficacy of scaling and root planing (SRP) using EGCG aqueous solution as coolants through a new-type ultrasonic scaler tip on chronic periodontitis., Methods: This split-mouth, randomized clinical trial included 20 patients (2 drop-outs) with chronic periodontitis and the maxillary contra-lateral sides were allocated into test and control groups randomly. Through the new-type scaler tip, 762 sites with probing depth (PD) ≥ 4 mm were treated by SRP using EGCG solution or distilled water as coolants respectively. Clinical parameters and red complex pathogens in subgingival microbiome were evaluated at baseline, 3 and 6 months after treatments., Results: During 6 months, the SRP plus EGCG medication contributed to additional PD reduction as 0.33 mm and gain of clinical attachment level as 0.3 mm compared with SRP alone, and approximate 8% more sites obtained PD reduction ≥ 2 mm (p < 0.05). Meanwhile, the mean relative abundance of Tannerella forsythia was significantly lower in the combined treatment group (p < 0.05)., Conclusion: The purified EGCG showed the potential to improve the outcome of periodontal non-surgical treatment and the new-type scaler tip provided an alternative vehicle for subgingival medication. Trial registration The trial was registered in Chinese Clinical Trial Registry on 15 February 2020 (No.: ChiCTR2000029831, retrospectively registered). http://www.chictr.org.cn/showprojen.aspx?proj=49441 .

Aim: Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non-surgical periodontal therapy., Materials and Methods: Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non-smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non-surgical periodontal therapy. Meta-regressions were conducted to evaluate correlations between outcomes and other contributing factors., Results: Seventeen studies were included. The post-treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: -0.33 mm, 95% confidence interval (CI): [-0.49, -0.17], p < .01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: -0.20 mm, CI: [-0.39, -0.02], p < .01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups., Conclusions: Smoking negatively impacts clinical responses to non-surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non-smokers., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To explore the application of the combined use of baseline salivary biomarkers and clinical parameters in predicting the outcome of scaling and root planing (SRP)., Materials and Methods: Forty patients with advanced periodontitis were included. Baseline saliva samples were analysed for interleukin-1β (IL-1β), matrix metalloproteinase-8 and the loads of Porphyromonas gingivalis, Prevotella intermedia, Aggregatibacter actinomycetemcomitans and Tannerella forsythia. After SRP, pocket closure and further attachment loss at 6 months post-treatment were chosen as outcome variables. Models to predict the outcomes were established by generalized estimating equations., Results: The combined use of baseline clinical attachment level (CAL), site location and IL-1β (area under the curve [AUC] = 0.764) better predicted pocket closure than probing depth (AUC = 0.672), CAL (AUC = 0.679), site location (AUC = 0.654) or IL-1β (AUC = 0.579) alone. The combination of site location, tooth loss, percentage of deep pockets, detection of A. actinomycetemcomitans and T. forsythia load (AUC = 0.842) better predicted further clinical attachment loss than site location (AUC = 0.715), tooth loss (AUC = 0.530), percentage of deep pockets (AUC = 0.659) or T. forsythia load (AUC = 0.647) alone., Conclusion: The combination of baseline salivary biomarkers and clinical parameters better predicted SRP outcomes than each alone. The current study indicates the possible usefulness of salivary biomarkers in addition to tooth-related parameters in predicting SRP outcomes., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Effectiveness of scaling and root planing (SRP) with/without adjunct probiotic (Lactobacillus reuteri) treatment towards the reduction in periodontal inflammatory parameters (clinical attachment loss [AL], marginal bone loss [MBL], plaque index [PI], and bleeding on probing [BOP] in shamma users and non-users [controls] with chronic periodontitis [CP]) remains uninvestigated. The aim of the present randomized controlled trial was to compare the efficacy of SRP with and without adjunct probiotic therapy (PT) in the treatment of CP among shamma users and controls (individuals not using tobacco in any form)., Methods: The study was conducted in accordance with the Consolidated Standards of Reporting Trials guidelines. Patient demographics were recorded using a questionnaire. Therapeutically, patients were allotted into four groups as follows: 1) group 1: Shamma chewers that underwent SRP alone; 2) group 2: Shamma-chewers that underwent SRP + PT; 3) group 3: Non-chewers that underwent SRP alone; and 4) group 4: Non-chewers that underwent SRP + PT. Periodontal parameters (PI, BOP, PD, clinical AL and mesial and distal MBL) were measured on all teeth except third molars at baseline and at 3- and 6-month follow-ups. Level of significance was set at P < 0.05., Results: In total, 31, 32, 31, and 33 individuals were included in groups 1, 2, 3, and 4, respectively. Among shamma users, there was no significant difference in the scores of PI, BOP, PD, clinical AL and MBL when SRP was performed with/without adjunct PT. Amongst controls, SRP with adjunct PT was more effective in reducing PI (P < 0.05), BOP (P < 0.05) and PD (P < 0.05) at 3-month follow-up. There was no significant difference in periodontal parameters at 3- and 6-month follow-ups in patients that underwent SRP with and without adjunct PT., Conclusions: Habitual shamma use compromises the outcome of SRP in patients with CP. Among patients that do not use any form of ST product, SRP is an effective treatment modality for the treatment of CP, and this relationship is independent of use of adjunct PT., (© 2020 American Academy of Periodontology.)

Aim: The study aim was to investigate the predictive role of obesity on clinical response following non-surgical periodontal therapy in individuals with severe periodontitis., Methods: A total of 57 BMI obese and 58 BMI normal non-smoker adults with periodontitis (defined as probing pocket depths (PPD) of ≥5 mm and alveolar bone loss of >30% with >50% of the teeth affected) received non-surgical periodontal therapy. Periodontal status was based upon PPD, clinical attachment level (CAL) and full-mouth bleeding score (FMBS). Mean PPD, percentage sites PPD >4 mm, percentage sites PPD >5 mm and FMBS at 2 and 6 months were outcome variables. Propensity score analysis was used to assess the effect of obesity on outcome variables after adjusting for confounders., Results: Statistically significant higher clinical measures (mean PPD, mean percentage of sites with PPD >4 mm, mean percentage of sites with PPD >5 mm and FMBS) were observed in the obese group than the normal group at baseline, 2 and 6 months after therapy (p < .01). At 2 and 6 months, obesity was associated with worse mean PPD (p < .05), percentage sites with PPD >4 mm (p < .05), percentage sites with PPD > 5mm (p < .05) and FMBS (p < .01), independent of age, gender, ethnicity or plaque levels., Conclusions: Obesity compared to normal BMI status was an independent predictor of poorer response following non-surgical periodontal therapy., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective of this study was to evaluate the clinical attachment level (CAL) gain of Er:YAG, Er,Cr; YSGG, Nd:YAG; and diode laser (DL) as monotherapy or adjunctive to scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) about lasers applied in SRP of chronic periodontitis were searched from PubMed, Cochrane Library, Web of Science, Ovid, Science Direct, Wan Fang, and China National Knowledge Infrastructure (CNKI) databases up to September 2018 and from references of selected full-texts and related reviews. Standard mean differences and 95% confidence intervals were counted for CAL gain. The random effects NMA were performed in STATA software. There were 25 RCTs about CAL gain at 3 and/or 6 months after lasers were applied in SRP. No inconsistency was detected. Er:YAG as monotherapy gained significantly more CAL at 3 months than did SRP; no significant differences were detected among other comparisons. In terms of CAL gain at 3 months, the ranking result from best to worst was as follows: Er:YAG as monotherapy, DL adjunctive to SRP, Er:YAG adjunctive to SRP, Er,Cr;YSGG as monotherapy, Nd:YAG adjunctive to SRP, and SRP. In terms of CAL gain at 6 months, the ranking result from best to worst was as follows: DL adjunctive to SRP, Nd:YAG adjunctive to SRP, SRP, Er:YAG adjunctive to SRP, and Er:YAG as monotherapy. Laser-assisted periodontal treatment could be superior to SRP alone and could serve as a good adjunctive treatment tool.

This study investigated the local effect of photobiomodulation (PBM) for the treatment of periodontal pockets in patients with periodontitis and type 2 diabetes. Thirty-eight periodontal pockets presenting probing depth (PD) and clinical attachment level (CAL) ≥ 5 mm were selected from 19 patients (two pockets/patient). The selected periodontal pockets were randomly assigned to receive mechanical debridement only (control group) or mechanical debridement with PBM (PBM group). Clinical measures, such as PD, CAL, bleeding on probing (BoP), and presence of supragingival biofilm (PI), were collected and compared at baseline, 3, 6, and 12 months. After 12 months, no statistically difference was observed for mean PD and mean CAL when control and PBM groups were compared. The frequency of pockets with PD 5-6 mm was significantly lower for the PBM group at 6 months when compared to the control group. Pockets with PD ≥ 7 mm changed significantly between baseline and 3, 6, and 12 months for the PBM group, while for the control group, statistical significance was only observed between baseline and 6 months. The PBM protocol used in this study did not provide significant changes for PD and CAL in periodontal pockets when compared to mechanical therapy only. However, PBM was more effective in reducing the percentage of moderate periodontal pockets at 6 months in patients with type 2 DM.

It has been earlier proposed a novel graft on basis of bioactive glass-ceramics for infected bony defects, where silver and copper ions are represented as antibacterial agents. The objective was to investigate clinical and radiological efficacy of the bioactive glass-ceramic composition (BGCC) as bone substitute material for periodontal intrabony defects surgery. In a group of 47 patients with periodontitis was conducted controlled clinical study of the proposed composition. As a control in 24 patients it has been used deproteinized bovine bone mineral (DBBM) with collagen membrane. Such parameters as pocket probing depth (PPD), clinical attachment level (CAL), gingival recession, the early wound-healing index (EHI), hygienic and gingival indices, radiological bone density were used for evaluation surgical outcomes. Guided tissue regeneration was carried out in 56 intrabony defects. A year after surgery it has been determined almost the same significant (p<0.05) decrease PPD to 53.5% in the BGCC group and to 45.7% in the DBBM group, CAL gain to 30.4% in the BGCC group and to 28.0% in the DBBM group. Intrabony defects were bone filled to 27.5% and to 30.1% respectively with no significant differences for comparison groups. However, it was noted the advantage of significant increasing bone density in treated sites with BGCC (p<0.05). It also has shown a tendency to decrease discomfort for patients and to improve wound healing in postsurgical period according to the EHI in the same group. The using of BGCC with collagen membrane leads to significant reduction in probing depth, clinical attachment level gain, raises bone density profile. However, further long-term clinical studies with histological evaluation are necessary.

Background: To compare the effectiveness of systemic doxycycline as an adjunct to scaling and root planing (SRP) with SRP alone in improving periodontal clinical attachment level and glycemic control in diabetic patients with periodontitis., Methods: Two independent reviewers (KY and SJ) screened two electronic databases, PubMed and Scopus, for randomized clinical trials on the use of systemic doxycycline as an adjunct to scaling and root planing in improving periodontal status and glycemic control in diabetic patients with periodontitis using predetermined selection criteria within a 3-month period. The reviewers independently did data screening, data selection, data extraction and risk of bias. Quality of studies involved was analysed using the revised Cochrane Risk of Bias 2.0. Weighted standard mean differences (SMD) and 95% confidence intervals were calculated using a random effects meta-analysis model. Publication bias was evaluated using funnel plot. Quality of evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Results: Electronic searches provided 1358 records and six studies were selected. The meta-analyses indicated that there was no statistically significant difference in the improvement of periodontal status with the use of systemic doxycycline as an adjunct for scaling and root planing (SRP). SMD of clinical attachment levels (- 0.22 [- 0.52, 0.08]) and HbA1c levels (- 0.13 [- 0.41, 0.15]) were calculated. Overall risk of bias is high in 2 out of 6 studies involved., Conclusion: Systemic doxycycline when used in addition to scaling and root planing yields no significant improvement of clinical attachment levels for periodontal status and reduction of HbA1c levels in treatment of diabetic patients with periodontitis when comparing the test group to the control group.

Aim: Aim of this review was to present a comprehensive outline of the use of hard tissue lasers in Periodontics with respect to non-surgical periodontal treatment. Materials and method: Electronic databases of PubMed and Cochrane Library were searched from 1992 to 2018. 18 clinical studies were evaluated after the inclusion, exclusion criteria. Results: It was deduced that Er:YAG laser is a feasible option for non-surgical periodontal therapy if proper parameters are followed i.e. the energy in the range of 140-160 mJ and frequency of 10 Hz. None of the studies favoured the use of Nd:YAG and CO 2 laser because of their prospective adverse effects. Conclusion: It can be concluded that Er:YAG laser application in non-surgical periodontal therapy is valuable. In combination with mechanical debridement, the results are similar or better with significant gains in clinical attachment level as compared to other various lasers. It is an excellent alternative to control the proliferation of micro-organisms. Nd:YAP, diode and other low power lasers can be used but with caution since they offer no additional advantage over conventional treatment modalities.

Aim: The present study aims to assess the efficacy of different periodontal dressing materials on wound healing clinically., Materials and Methods: A total of 45 patients between the age group of 30-45 years, with chronic generalized periodontitis with loss of attachment of 3-6 mm, who require periodontal flap surgery, were screened to include in the study. Out of 45 subjects, 24 were males and 21 were females. The subjects were randomized into 3 groups as 15 in each. Group I: a collagen dressing, group II: light-cure dressing, and group III: non-eugenol-based dressing. The clinical parameters such as plaque index, vertical probing depth, pain, gingival index, and patient satisfaction were documented for all the three groups on the 7th and the 14th day. Visual analog scale (VAS) was used to score the pain severity. The SPSS 20 software was used to analyze the data. The significance level was set at 5%., Results: The mean gingival index score reduced from 1.40 ± 0.14 to 1.10 ± 0.30 in group I, from 1.48 ± 0.01 to 1.26 ± 0.22 in group II, and from 1.58 ± 0.16 to 1.33 ± 0.10 in group III. The mean plaque index score reduced from 1.48 ± 0.56 to 1.18 ± 0.40 in group I, from 1.46 ± 0.01 to 1.24 ± 0.48 in group II, and from 1.42 ± 0.12 to 1.20 ± 0.20 in group III. There was a statistical difference found in all the three groups and between the groups from the plaque and gingival index scores. The probing depth comparison shows a significant difference in group I. Patient satisfaction was almost similar in all the groups. The pain index showed the reduction in the pain severity from the 7th day to the 14th day in all the subjects from all the three groups., Conclusion: It can be concluded that the periodontal wound covered with a collagen dressing material showed significant evidence to provide symptomatic relief and better healing to the patients compared to that of light-cure and non-eugenol periodontal dressing material.

Purpose: To evaluate the effect of basic periodontal treatment on clinical periodontal parameters associated with abutment teeth of patients with mandibular Kennedy class I removable partial dentures (RPD) 18 months after treatment., Materials and Methods: Thirty patients with periodontal disease were treated and evaluated according to the following periodontal parameters: visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), clinical attachment loss (CAL), and keratinized mucosa (KM). These parameters were compared between abutment teeth with direct and indirect retainers at baseline, and after 6 and 18 months. Data were analyzed by Friedman Test and Wilcoxon Test for all variables., Results: Most patients (n = 26; 86.7%) included in the study were female and had a mean age of 61 years (±7.54). Results showed that VPI and BOP decreased over time, and that VPI values were higher in abutment teeth with direct retainers (p = 0.001). There was a reduction in PD after 6 months, which was maintained up to 18 months. In general, abutment teeth with direct retainers had significantly higher values for PD, GR, and CAL (p = 0.029). Data also indicated that the parameters for VPI, BOP, and PD improved; however, abutment teeth with direct retainers presented smaller improvements, compared with abutment teeth with indirect retainers, which presented significant improvements for almost all variables., Conclusion: Periodontal treatment and oral hygiene care of patients were adequate for maintenance of adequate periodontal conditions, regardless of the use of prostheses., (© 2018 by the American College of Prosthodontists.)

The goal of this review is to summarize the results of randomized trials reported since 2010 that assessed the effect of periodontal interventions on at least one systemic outcome in human subjects of any age, gender or ethnicity. Oral outcome measures included gingivitis, pocket depth, clinical attachment loss and/or radiographic bone loss and oral hygiene indices. Studies were excluded if the trial was not completed or if treatment was not randomized. The results suggest that nonsurgical periodontal intervention provided to pregnant women is safe and improves periodontal status without preventing adverse pregnancy outcomes. Nonsurgical periodontal intervention was also found to provide modest improvement in glycemic control in individuals with type 2 diabetes mellitus and periodontitis. Also, improving oral care through mechanical or chemical control of dental-plaque biofilm formation can contribute to the prevention of respiratory infections in differing clinical settings, including hospitals and nursing homes, and in patients with chronic obstructive pulmonary disease. No clinical trials were reported that tested the effect of periodontal interventions on medical outcomes of atherosclerosis, cardiovascular diseases, stroke, rheumatoid arthritis, Alzheimer's disease, chronic kidney disease or malignant neoplasia., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Laser technology in periodontal therapy could help in reducing total bacterial count., Objectives: The aim of this study was to evaluate the effects of pocket debridement using an erbium-doped yttrium aluminium garnet laser (Er:YAG laser - ERL), scaling and root planing (SRP) with photodynamic therapy (PDT), or SRP alone. Teeth vitality and soft tissue carbonization were also assessed., Material and Methods: This study included 1,169 single-rooted teeth from 84 patients divided into 3 groups (n = 28). The G1 group had ERL with 40 mJ of energy, a frequency of 40 Hz and a fluence of 63.66 J/cm2. The G2 group had SRP + PDT (635 nm diode laser, 12 J of energy and irradiation time of 30 s) and a Toluidine Blue photosensitizer (PS) (application time of 60 s). The G3 group was administered SRP alone. In the 42 subjects (G1: n = 11, G2: n = 14 and G3: n = 17) with high amounts of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf), additional 1-week antibiotic treatments with clindamycin or amoxicillin + clavulanic acid - in doses of 600 mg/day or 1000 mg/day, respectively - were prescribed 3 months after the therapy. Microbiological and clinical analyses of the probing depth (PD), recession (RC), plaque index (PI), bleeding on probing (BOP), and attachment loss (AT) were performed at baseline and at the follow-up of 3 months, 3 months and 1 week, and 6 months., Results: Plaque index decreased in G1 after 3 months, 3 months and 1 week, and 6 months (p < 0.05) and was lower in G1 vs G2 after 3 months (p < 0.05). The reduction in BOP in G1 after 3 months and 1 week was higher in comparison with G2 or G3 (p < 0.02). Probing depth decreased in all groups (p < 0.05). We found a reduction in the percentage of sites with some bacteria after 3 months - Prevotella intermedia (Pi) (G1 and G2), Capnocytophaga gingivalis (Cg) and Eubacterium nucleatum (En) (G3), and after 3 months and 1 week with En, Td, Tf (G1, G2 and G3), Pi (G1 and G2), Aa, Peptostreptococcus micros (Pm), and Cg (G3), and with Pi (G1 and G2), Tf (G2), Pg, En (G2 and G3), and Pm (G3) after 6 months (p < 0.05). We observed no signs of carbonization or teeth injury., Conclusions: Scaling and root planing + PDT and ERL may be an alternative therapy for chronic periodontitis.

Purpose: The purpose of this study was to evaluate the effects of repeated scaling and root planing (SRP), with or without locally-delivered minocycline microspheres (MM) on residual pockets in patients undergoing periodontal maintenance (PMT). Methods: Patients on PMT were randomized into two groups for treatment of one posterior interproximal inflamed pocket (≥5 mm) with a history of bleeding on probing every 6 months: SRP plus MM (n=30) or exclusively SRP (n=30). Baseline and 24-month measurements included radiographic interproximal alveolar bone height, probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival crevicular fluid (GCF), and salivary interleukin (IL) - 1β, (24 month only). Results were analyzed for baseline data or change in measurements after 24 months of treatment between different treatment groups, as well as whether significant changes occurred after 24 months of treatment for each treatment group individually. Results: Alveolar bone height and GCF IL-1β remained stable over the 24 months. The SRP + MM and SRP groups each demonstrated reduced PD (0.8 ± 0.9 mm and 1.1 ±0.6 mm, respectively, p < 0.001 each), CAL (0.8 ± 0.9 mm and 1.0 ± 0.6 mm, respectively, p < 0.001 each) and BOP (55% and 48%, respectively, p = 0.001 each). However, there were no differences between groups over the 24-month study period. Conclusion: Scaling and root planning alone, of moderately inflamed periodontal pockets at 6-month intervals, produced stable interproximal alveolar bone height as well as sustained improvements in probing depths, clinical attachment level, bleeding on probing over 24 months; minocycline microspheres were not shown to enhance these results., (Copyright © 2018 The American Dental Hygienists’ Association.)

The present study was performed to evaluate the impact of smoking status on 6-month clinical outcomes of a regenerative procedure based on enamel matrix derivative and deproteinized bovine bone mineral in the treatment of intraosseous defects accessed with buccal single flap approach. A total of 22 defects were selected in smoking (n = 11) and nonsmoking (n = 11) patients. Regenerative treatment resulted in similar clinical attachment level (CAL) gain in both smokers and nonsmokers. A trend toward lower 6-month CAL gain and probing depth reduction was observed in patients smoking 11 to 20 cigarettes per day compared to those smoking 1 to 10 cigarettes per day.

Objectives: Lots of bioactive materials have been additionally applied for the treatment of periodontal intrabony defect. However, there is dearth of studies to systematically evaluate the supplementary role of them in periodontal regeneration. The goal of this meta-analysis is to evaluate the adjunctive effects of bioactive materials such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and amnion membrane (AM) on the outcomes of bone grafting treatment for periodontal intrabony defects., Methods: Articles published before December 2017 were searched electronically in three databases (PubMed, Embase, and Cochrane Central), with no date or language limits. Randomized controlled trials (RCTs) on the assessment of effectiveness of the four biomaterials in conjunction with demineralized freeze-dried bone allografts (DFDBA) in the treatment of periodontal intrabony defects were enrolled in this meta-analysis. Data were analyzed with STATA 12., Results: Nine studies were included. PRF and PRP significantly improved pocket depth (PD) reduction and clinical attachment loss (CAL) gain. Only PRF exhibited a positive result in recession reduction (RecRed). Only PRP showed a statistically significant increase in bone fill. AM merely gained more CAL. EMD did not improve any clinical outcome., Conclusion: Our data suggest that PRF/PRP could be taken as a preferred adjunct to facilitate periodontal regeneration of intrabony defects.

In the search for the ideal treatment of periodontal disease various non-surgical techniques should be considered. The objective of this study was to evaluate the efficacy of full-mouth scaling (FMS) by clinical and microbiological parameters. 670 individuals were evaluated with 230 subjects meeting the selection criteria and were divided into two groups; 115 subjects treated with FMS and 115 treated with weekly sessions of scaling and root planning (SRP). The patient population had a mean age of 51.67 years, with moderate chronic periodontitis. Subjects were evaluated prior to treatment (T1) and 90 days after execution of therapy (T2), with regards to: probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and microbial detection for the presence of Porphyromonas gingivalis (P.g.) and Prevotella intermedia (P.i.) by culture method and confirmed by biochemical tests. Subjects treated in the FMS group also rinsed with 0.12% chlorhexidine mouthwash for seven days following treatment. The results were analyzed using statistical Student's t-test and chi-square test. No statistically significant differences were observed for PD and CAL between T1 and T2 in both groups. For GI and PI significant difference was observed between the groups. For the evaluated microbial parameters was observed reduction of P.g. and P.i., but only for P.g. with a significant reduction in both groups. The full mouth scaling technique with the methodology used in this study provided improved clinical conditions and reduction of P.g. in subjects with moderate periodontitis, optimizing the time spent in the therapeutic execution.

Aim: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis., Subjects and Methods: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients., Results: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal-orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4-6 mm healed after periodontal-orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p = .03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal-orthodontic treatment duration was significantly longer for the control group (p < .01)., Conclusions: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Borinic acid quinoline esters are a recently-identified class of new antibacterial and anti-inflammatory compounds known to inhibit osteoclastic bone resorption. They have proposed to have osteostimulative properties by causing osteoblast differentiation in vivo and in vitro. The purpose of this double-masked, randomized, controlled clinical trial was to evaluate the effects of the subgingival delivery of boric acid gel as an adjunct to scaling and root planing (SRP) on clinical and radiographic parameters, and compare this method with SRP plus placebo gel alone in chronic periodontitis (CP) patients., Methods: Thirty-nine systemically-healthy patients with CP were included in the present study. They were divided into two groups: (a) SRP + 0.75% boric acid gel (BA group); and (b) SRP + placebo gel (placebo group). At baseline, 3 and 6 months after treatment, clinical measurements, including plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage change in radiographic defect depth reduction (DDR%) as radiographic parameters were assessed., Results: The mean PD reduction and mean CAL gain were greater in the BA group than the placebo group at 3 and 6 months. A significantly greater mean percentage of radiographic DDR% was found in the BA group (36.97±3.47%) compared to the placebo group (2.88±0.89%) after 6 months., Conclusion: BA as an adjunct to SRP can provide a new insight into therapeutic strategies for the management of CP, but further clinical evaluations are needed., (© 2017 John Wiley & Sons Australia, Ltd.)

Background: Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis., Methods: Ninety IBDs were treated with autologous PRF with open-flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively., Results: Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%)., Conclusions: Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3-wall IBDs., (© 2017 American Academy of Periodontology.)

Objective: This review aims to systematically evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) combined with rich platelet derivatives on the treatment of human periodontal intrabony defects., Methods: A search in PubMed, Web of Science, Embase, Cochrane Library, CNKI, and other electronic databases was conducted to identify randomized controlled trials (RCT) of the use of DFDBA combined with rich platelet derivatives in the treatment of human periodontal intrabony defects, performed before May 2016. The quality of the RCTs was assessed. RevMan 5.3 software was applied for Meta-analysis., Results: A total of nine RCTs were included. A total of 194 patients and 303 defects were involved. Short-term (6 months) and long-term (12 to 18 months) groups were included. Meta-analysis results revealed that DFDBA combined with rich platelet derivatives was superior to DFDBA or rich platelet derivatives alone for probing depth reduction in the short-term [MD=0.75 mm, 95% confidence intervals (CI) (0.31 mm, 1.20 mm), P=0.001 0] and longterm groups [MD=0.87 mm, 95%CI (0.02 mm, 1.72 mm), P=0.04], clinical attachment level gain in the short-term [MD=
0.65 mm, 95%CI (0.08 mm, 1.22 mm), P=0.03] and long-term groups [MD=1.31 mm, 95%CI (0.60 mm, 2.01 mm), P<0.000 3], gingival recession reduction in the long-term group [MD=-0.58 mm, 95%CI (-0.78 mm, -0.38mm), P<0.000 01], bone fill gain in the short-term [MD=0.52 mm, 95%CI (0.03 mm, 1.00 mm), P=0.04] and long-term groups [MD=1.26 mm, 95%CI (0.65 mm, 1.86 mm), P<0.000 1]., Conclusions: DFDBA combined with platelet rich derivatives is probably effective in the treatment of human periodontal intrabony defects. It is probably superior to DFDBA or platelet rich derivatives alone. Considering the limitation of the included studies, high-quality and large-sample RCTs are required to evaluate the effect.

The purpose of this study was to evaluate the efficacy and safety of equine-derived bone matrix as a carrier for recombinant human platelet-derived growth factor BB (rhPDGF-BB) versus beta-tricalcium phosphate (β-TCP) for the treatment of intraosseous periodontal defects in adult patients. This study was performed on 32 adults with advanced periodontal disease. Eligible subjects were randomized in 1:1 ratio into a test (rhPDGF-BB-coated equine-derived bone matrix) or control group (rhPDGF-BB-coated β-TCP). Probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), and defect depth on radiographs were measured at 2 weeks before surgery, on the day of surgery (DOS), and 6 months postsurgery (6MPS). The clinical and radiographic data were analyzed over the test period. Statistically significant PD reductions and CAL gain between baseline and 6MPS and between ODS and 6MPS were seen in both groups (P < .01). No statistically significant differences in PD reduction were found between groups. However, the test group showed significant CAL gain between DOS and 6MPS. The radiographic bone level change was statistically significant compared to baseline (P < .01) in both groups. The results suggested that equine-derived bone matrix is a viable, effective, and safe carrier scaffold for rhPDGF in periodontal defects.

Objective: The aim of the study was to retrospectively assess the survival rate and stability of periodontally compromised and mobile anterior mandibular teeth after splinting in patients under supportive periodontal therapy (SPT)., Materials and Methods: Thirty-nine patients with splinted anterior mandibular teeth and SPT (≥1 visit/year) for 3-15 years were re-examined. Periodontal status, patient and tooth-related factors were assessed retrospectively before (baseline) and 3 years after splinting (n = 39 patients, 162 splinted teeth). For patients with splints inserted for more than 3 years, retrospective data after 5 (n = 30), 7 (n = 24), 10 (n = 16), 12 (n = 8) and 15 years (n = 4) was included, if available. At baseline, splinted teeth included at least one tooth with increased mobility combined with clinical attachment loss (CAL) ≥ 5 mm and ≥50% relative bone loss (RBL). Baseline RBL of splinted teeth was assessed for all patients. Change in RBL was assessed after 10 years, if available., Results: No splinted tooth was lost within the first 3 years after splinting. One splinted tooth was lost 7 years after baseline and one 12 years after baseline. After 3 years mean(SD) periodontal probing depth of splinted teeth decreased from 3.39(1.41) mm to 2.12(0.37) mm and mean(SD) CAL from 5.61(1.66) mm to 5.09(1.67) mm and remained stable over the observation period. No change in RBL was observed over a 10-year period (p = .213). The survival rate of the splints until fracture or debonding was 74.4% after 3 years., Conclusions: Periodontally compromised splinted teeth show a high survival-rate and periodontal stability during SPT.

Although periodontal diseases are caused by some of the specific pathogens, most of the tissue damage is caused by the host reaction to disease and not actually by the infections. Therefore, host modulatory therapy (HMT) has advanced benefit for the treatment of periodontitis, which works basically by reducing tissue destruction and regeneration in periodontium by altering the critical aspects of host response regulation and up regulating defensive regenerative responses. The present study was conducted with the goal to test an innovative therapeutic option using chemically modified tetracycline in patients affected with generalized, moderate and severe chronic periodontitis. We assumed that CMT might have the potential to provoke an assessable clinical result and pharmacologically impede the level inflammatory flow. CMT (incyclinide) treated group had significantly higher CAL (clinical attachment) values than Placebo Control suggesting an improved CAL in CMT treatment. Host modulation therapy width incyclinide can be as an adjunct to conventional nonsurgical therapies without antimicrobial resistance. Progress was noticed in the clinical parameters but not the serum CRP level in our study establishing the role of CMTs in controlling chronic periodontitis. Also CMT treatment indicates its role in anti-inflammatory process as it inhibited IL-12 and TNF alpha but IL-10 level was not affected. However, more randomized placebo-controlled clinical trials with large sample size are required in order to authenticate the usage of CMTs in chronic periodontitis treatment. Based on this understanding, exploration of the novel, low-cost synthetic inhibitors that can be used as potential therapeutic agents, has been tested., (Copyright © 2017 Elsevier Ltd. All rights reserved.)