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Objectives: In order to enhance clinical improvement of periodontal defects, the addition of enamel matrix derivatives (EMD) to open flap debridement (OFD) has been investigated. The aim of this systematic review is to figure out whether such a combination, in comparison to the treatment with OFD alone has some effects on the following outcomes: clinical attachment level gain, probing depth reduction, and gingival recessions increase. Methods: Electronic databases (PubMed, Embase, Web of Science, and Cochrane) were searched for randomized controlled trials in humans addressing the use of a combination of OFD and EMD versus a control group with OFD alone for the treatment of periodontal defects, with a minimum of 6 months of follow‐up; meta‐analysis and trial sequential analysis were then performed. Results: From a total of 204 records screened by title and abstract, 13 studies were read full‐text and eight out of them included in the meta‐analysis. Some significant differences have been demonstrated both for clinical attachment level gain and probing depth reduction between test and control groups. Conclusions: In the treatment of periodontal defects, the addition of EMD to OFD seems to be beneficial in terms of clinical attachment level gain, probing depth reduction, promoting periodontal regeneration. However, such results should be considered with caution because of the small number of studies included in the meta‐analysis and their heterogeneity. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this randomized, controlled, splitmouth trial was to clarify the clinical efficacy of using low-level laser therapy (LLLT) as an adjunct to open flap debridement in the treatment of periodontitis. Method and materials: The study was conducted on 10 patients with stage III periodontitis. Clinical parameters were recorded for 70 sites of periodontal pockets at baseline and after 3 months and included Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), and relative attachment level (RAL), and evaluated postoperative pain and dental hypersensitivity. After open flap debridement, the sites were randomly divided into test sites receiving the low-level diode laser (wavelength 808 nm) and control sites treated with laser-off. The Wilcoxon test and Mann--Whitney U-test were used for intra- and inter-group comparisons, respectively, and the Friedman test to test between different periods. Results: Both treatments produced a reduction in GI, BOP, and PD, an increased RGR, and a gain in RAL between baseline and 3 months after surgery. There were significant improvements in GI, PD, and RAL after 3 months; postoperative pain after 24 hours and after 3 days; and dental hypersensitivity after 1 week and 1 month of the surgery, which significantly decreased in the test group. Conclusion: Both groups were clinically effective in treating stage III periodontitis, with a significant preference in reduction of GI and PD and gain of RAL, and decreased postoperative pain (after 24 hours and 3 days) and dentinal hypersensitivity (after 1 week and 1 month) for open flap debridement+LLLT. Clinical relevance: The use of LLLT as an adjunct to open flap debridement improved the clinical indices, postoperative pain, and dentinal hypersensitivity better than open flap debridement alone in the treatment of stage III periodontitis. [ABSTRACT FROM AUTHOR]

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: 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). I n 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

Aim: This randomized split mouth study evaluated the effect of hyaluronic acid HA gel in a collagen sponge in the treatment of intra-bony periodontal defects. Materials and Methods: Twenty sites of intrabony defects in 10 systemically healthy patients with chronic moderate periodontitis were randomly distributed into two groups, 10 sites each. Group I treated with open flap debridement and collagen sponge soaked in placebo gel. Group II treated with open flap debridement and HA gel-soaked collagen sponge. Plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were measured at baseline, three months after surgery, and six months after that. Cone beam computed tomography was used to assess bone density, defect depth (DD), defect width (DW), and defect area (DA) at baseline and six months after surgery (BD). Results: Group II showed statistically significant improvement in plaque index, BOP, PPD and CAL at 3- and 6-month intervals, while group I showed statistically significant improvement regarding all clinical parameters except for CAL at 6 months, showed statistically insignificant increase approximating the baseline value. Intergroup comparison showed statistically significant differences in favour of group II at 3 and 6 months for PPD and CAL while for BOP at 6 months only. At six months, both groups had statistically significant improvements in the radiographic parameters, and intergroup comparison revealed statistically significant differences favouring group II. Conclusion: Hyaluronic acid resulted in clinical improvement and radiographic evidence of bone regeneration in the treatment of intra-bony defects in chronic periodontitis patients. [ABSTRACT FROM AUTHOR]

Introduction: Regenerative treatment with open flap debridement (OFD) and bone graft material containing growth factors is developed to repair alveolar bone defects due to periodontitis. Freeze-dried human platelet-rich plasma (FD-hPRP) is platelet-rich plasma which is freeze-dried to prolong storage time, simplify application, and increase growth factors number that promote osteoblast proliferation to accelerate bone regeneration. This study examined the effect of FD-hPRP application as a bone graft on the alveolar bone height and density radiographically in periodontitis treatment of Oryctolagus cuniculus rabbits. Methods: Twelve-male rabbits were periodontitis induced by ligation technique and Porphyromonas gingivalis lipopolysaccharide injection randomly divided into three groups: 1) OFD, 2) OFD+demineralized freeze-dried bone allograft (DFDBA), 3) OFD+FD-hPRP. OFD was performed in all groups with DFDBA applied in group 2 and FD-hPRP applied in group 3, then subjected to radiographic examination. The alveolar bone height data from Vet-Exam Plus and bone density data from ImageJ then analyzed with a two-way analysis of variance followed by Post Hoc Least Significant Difference test. Results: Significant difference (p<0.05) between the group 1 and group 2 and 3, and an insignificant difference (p>0.05) between the group 2 and 3. Conclusion: FD-hPRP application increased alveolar bone height and density radiographically in periodontitis rabbits. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the adjunctive effects of the diode laser in open flap debridement as compared with the conventional mechanical debridement evaluated by clinical and microbiological parameters and also limited literatures were available on such studies. Twenty patients with bilateral periodontal pockets in the quadrant of either maxilla or mandible at least 6 teeth in quadrant diagnosed with chronic periodontitis with probing pocket depths = 5mm after phase I therapy. Group-A (Control Group) Open flap Debridement (OFD) were done and Group-B (Test Group) Open flap Debridement (OFD) with Diode Laser were done under local anesthesia. In the present study there were a statistically significant difference in Plaque index, Gingival index, pocket probing depth and relative attachment level at baseline and at 3 months in the control and the test group and also there was a statistically significant reduction in the number of CFUs of anaerobes in the laser-treated group as compared with the control group. Colony-forming units were statistically insignificant at baseline and 3 months as the P-value was 0.06 and 0.7 respectively and statistically significant at 3 months as the pvalue was <0.001.Colony-forming units were statistically significant in Group B (Test group) Laser treated group at 3 months as the p-value was <0.001. Therefore, lasers can be used as an adjunctive treatment with open flap debridement as a part of periodontal therapy in the future. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Patient satisfaction is the primary focus of the healthcare system. Patient-reported outcome measures (PROMs) are standardized and valid measures obtained directly from the patients and are used to assess and compare the efficacy of healthcare services. This can help improve the service provided by the healthcare system. Therefore, this study aimed to assess PROMs during the first week post-surgery across different periodontal surgical procedures and explore their correlation with surgical duration. Furthermore, the study sought to evaluate the occurrence of postoperative complications. Methodology A total of 30 healthy patients with no systemic history, requiring periodontal surgical procedures such as crown lengthening (CLP), open flap debridement (OFD), and soft tissue grafting (STG) were included in the study. The Visual Analog Scale (VAS) was utilized for gathering PROMs concerning bleeding, swelling, bruising, and pain at intervals of days zero, three, five, and seven after the surgical procedure. Results On the surgical day and over seven days, VAS scores were the lowest for CLP and highest for STG procedures. This result is in accordance with the duration required for surgery. VAS scores for OFD were intermediate. Prevalence of 20% soft tissue graft dehiscence and 40% tenderness on palpation was observed. Swelling and bleeding were noticed in 10% and 20% of OFD cases. Conclusions One week post-surgically, the mean VAS scores were minimum for CLP, whereas maximum for STG procedures. As CLP and OFD require less duration compared to STG, duration plays a significant role in post-surgical outcomes. Prevalence of the post-surgical complications is also related to the duration of the surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Late Shri Yashwantrao Chavan Memorial Medical & Rural Development Foundation’s Dental College and Hospital, Ahmednagar issued approval YCMM&RDF's/IERB/10. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Newaskar et al.)

Objective: To evaluate the efficacy of oily calcium hydroxide suspension (OCHS) in the of treatment of infrabony defects. Method and Materials: Thirty patients with advanced chronic periodontitis, with one deep infrabony defect, were randomly treated with open flap debridement (OFD) (control) or OFD + OCHS (test). Clinical measurements were performed at baseline and 9 months after treatment. Surgical reentry was performed after 9 months. The primary outcome variables were reduction in probing pocket depth (PPD) and gain in relative attachment level (RAL). The secondary outcome was the reduction in depth of defect (DOD) measured intrasurgically. Results: A statistically significant reduction in PPD was observed at the end of 9 months, with the control group showing a mean reduction of 2.06 ± 0.59 mm from baseline to 9 months and the test 1.06 ± 1.22 mm (P ⩾ .05). There was no statistically significant gain in RAL at the end of 9 months, with a mean of 0.60 ± 0.50 mm in the control group and 0.60 ± 0.91 mm in the test (P ⩾ .05). No statistically significant difference was observed in DOD at 9 months, with a mean difference of 0.80 ± 0.77 mm in the control group and 0.66 ± 0.97 mm in the test (P ⩾ .05). Conclusion: Within the limitations of the study, OCHS failed to demonstrate any superior clinical outcomes in comparison with OFD. [ABSTRACT FROM AUTHOR]

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.

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Contemporary Clinical Dentistry.)

Background: Surgical treatments such as guided tissue regeneration (GTR) and access flap surgery are widely employed for the treatment of intrabony defects. However, little is known regarding the postoperative expression of gingival crevicular fluid (GCF) markers. Objective: The aim of this systematic review was to compare the expression of GCF markers following treatment of periodontal intrabony defects with guided tissue regeneration or access surgery. The association of the markers' expression with the clinical outcome was also assessed. Methods: An electronic literature search was conducted in MEDLINE, EMBASE, OpenGrey, LILACS and Cochrane Library up to December 2018 complemented by a manual search. Human, prospective clinical studies were identified. The changes from baseline up to 30 days (early healing) and 3 months (late healing) were assessed. Results: A total of 164 publications were identified and reviewed for eligibility. Of these, 10 publications fulfilled the inclusion criteria. The included studies evaluated 15 different GCF markers with a follow-up time between 21 and 360 days postoperatively. PDGF, VEGF and TIMP-1 changes were often investigated in the included studies; however, contrasting results were reported. Two studies agreed that both GTR and OFD lead to similar OPG level changes. TGF-β1 is increased early postoperatively, irrespective of the surgical technique employed. Conclusion: There is limited evidence available on the expression of GCF markers after surgical interventions of intrabony periodontal defects. However, OPG and TGF-β1 tend to increase early post-operatively, irrespective of the surgical technique employed, irrespective of the surgical technique employed. Clinical relevance: More well-designed, powered studies with sampling periods reflecting the regenerative process are needed, and future research should focus on employing standardised protocols for collecting, storing and analysing GCF markers. [ABSTRACT FROM AUTHOR]

Aim: Evaluation of 20‐year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. Materials and methods: In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra‐lateral defect (OFD) each (split‐mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. Results: Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split‐mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months. Conclusions: Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Outlines the management protocol that was utilised in OFD followed by aPDT in the treatment of chronic periodontitis. • Demonstrates the beneficial role of adjunctive aPDT in improving clinical parameters. • Demonstrates role of aPDT in providing a bactericidal effect after surgical periodontal therapy. • Indicates that the adjunctive use of aPDT can be achieved regardless of any post-operative complications. • Emphasizes on how aPDT can be beneficial in achieving uneventful and faster wound healing. Abstract Background Antimicrobial photodynamic therapy (aPDT) has proved to be an effective adjunctive modality with potential benefits in the management of chronic periodontitis. The combination of photothermal and photodynamic effects of Indocyanine green (ICG) dye, when it is photoactivated with a diode laser of 810 nm wavelength, has been well documented in literature. Aim This study was conducted to evaluate whether a single session of antimicrobial photodynamic therapy using ICG dye-810 nm diode laser combination can provide a substantial benefit when it is utilised as an adjunct to open flap debridement (OFD) in the management of chronic periodontitis. Materials and method Following thorough scaling and root planing, a comparative split mouth randomized controlled clinical trial was carried out on 20 recruited subjects who provided one test (OFD + aPDT) and one control site (OFD alone) each (total 40 treatment sites). The test group was subjected to a single episode of aPDT using ICG photosensitiser dye (1 mg/ml) activated with 810 nm diode laser. The laser was used in a continuous wave, non-contact mode at a power output of 100 mW applied for 30 s/spot (the total of 4 spots per tooth) and delivered by 400 μm fibre, to provide a fluence (energy density) value of 0.0125 J/cm² per spot and generate a total energy of 3 J. The following clinical parameters were assessed at baseline and 3 months: probing pocket depth (PPD), relative attachment level (RAL), relative gingival margin level (RGML), plaque index (PI), gingival index (GI), and gingival bleeding index (GBI). Intragroup and intergroup comparison was performed using paired t -test and independent samples t -test respectively. Results Intragroup comparison revealed a statistically significant improvement from baseline visit (p < 0.05). Intergroup comparison showed a statistically significant improvement in RAL, RGML and GI in the test group (p < 0.05). Conclusion Utilisation of ICG dye activated with 810 nm diode laser, which mediated aPDT, has demonstrated surplus clinical improvement following OFD in the management of chronic periodontitis. [ABSTRACT FROM AUTHOR]

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.

Background and Objectives: The periodontal regenerative techniques using growth factors and stem cells are gaining momentum in periodontics. However, relatively little is known about the biological process and the potential role of direct transplantation of autologous periodontal ligament stem cells (PDLSC) niche in promoting periodontal regeneration. Aim: The aim of this is to clinically and to radiographically evaluate the effects of direct transplantation of autologous PDLSC niche (A-PDLSc Ni) in intrabony defects. Materials and Methods: Among 28 patients, 14 sites in test group were treated with open flap debridement (OFD) followed by direct transplantation of A-PDLSc Ni and other 14 sites in control group were treated with OFD. Clinical and radiographic assessment was done for each site before surgical therapy and at intervals of 3, 6, 9, and 12 months using radiovisiography. For clinical and radiographic parameters, intragroup comparison was made by paired t-test and unpaired t-test for intergroup comparisons. Results: The result showed that significant reduction (P < 0.05) of clinical parameters in both the OFD and A-PDLSc Ni groups. Radiographic parameters such as alveolar crest changes, defect area resolution were not statistically significant in both the OFD and A-PDLSc Ni groups whereas improvement in defect density was statistically significant (P < 0.05) only in the autologous periodontal ligament stem cell niche group. Conclusion: In the present study, treatment of intrabony defect by direct transplantation of autologous periodontal ligament stem cells niche in comparison with OFD showed a significant reduction in probing pocket depth (PPD), gain in clinical attachment level, and there was no gingival recession seen owing to thick gingiva. Radiographically, there was alveolar crest improvement, decrease in defect area, and increase in defect density in A-PDLSC Ni group. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]