Esha Agarwal

Comparative Evaluation of Autologous Platelet-Rich Fibrin and Platelet-Rich Plasma in the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

BACKGROUND The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. METHODS Ninety intrabony defects were treated with either autologous PRF with open-flap debridement or autologous PRP with open-flap debridement or open-flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. RESULTS Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. CONCLUSIONS Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open-flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long-term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.

Platelet-Rich Fibrin Combined With a Porous Hydroxyapatite Graft for the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

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.

Clinical and microbiologic effects of commercially available dentifrice containing aloe vera: a randomized controlled clinical trial.

BACKGROUND Certain plants used in folk medicine serve as a source of therapeutic agents that have antimicrobial and other multipotential effects. This prospective, randomized, placebo, and positively controlled clinical trial was designed to evaluate the clinical and microbiologic effects of a commercially available dentifrice containing aloe vera on the reduction of plaque and gingival inflammation in patients with gingivitis. METHODS Ninety patients diagnosed with chronic generalized gingivitis were selected and randomly divided into three groups: group 1, placebo toothpaste; group 2, toothpaste containing aloe vera; and group 3, toothpaste with polymer and fluoride containing triclosan. Clinical evaluation was undertaken using a gingival index, plaque was assessed using a modification of the Quigley-Hein index, and microbiologic counts were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks. A subjective evaluation was also undertaken by questionnaire. RESULTS Toothpaste containing aloe vera showed significant improvement in gingival and plaque index scores as well as microbiologic counts compared with placebo dentifrice. These improvements were comparable to those achieved with toothpaste containing triclosan. CONCLUSION Toothpaste containing aloe vera may be a useful herbal formulation for chemical plaque control agents and improvement in plaque and gingival status.

8-Isoprostane: A lipid peroxidation product in gingival crevicular fluid in healthy, gingivitis and chronic periodontitis subjects

OBJECTIVE The idea that reactive oxygen species (ROS) are associated with the pathogenesis of inflammatory periodontal diseases and have a role (direct or indirect) in tissue damage has become a major area of research over the last decade. The purpose of this study is to determine, presence of 8-isoprostane in gingival crevicular fluid (GCF) in healthy, gingivitis and chronic periodontitis (CP) subjects and to find an association, if any between GCF 8-isoprostane levels and clinical periodontal parameters. MATERIALS AND METHODS 78 subjects (40 males and 38 females) were selected based on their clinical parameters into three groups: Group 1 (26 healthy), Group 2 (26 gingivitis subjects) and Group 3 (26 CP subjects). GCF 8-isoprostane levels were estimated by ELISA. RESULTS The 8-isoprostane concentration in GCF was highest in subjects with chronic periodontitis as compared to gingivitis and healthy subjects and a significant association was observed between GCF 8-isoprostane levels and all periodontal parameters. CONCLUSIONS There was increase in 8-isoprostane levels in GCF as the disease process progressed from health to gingivitis and chronic periodontitis, suggesting a role for increased oxidative stress in CP.

Protein carbonyl: An oxidative stress marker in gingival crevicular fluid in healthy, gingivitis, and chronic periodontitis subjects

Background: A defined role for reactive oxygen species (ROS) in the tissue destruction that characterizes periodontitis has been described. Protein carbonyl (PC) is the most widely used biomarker for oxidative damage to proteins, and reflects cellular damage induced by multiple forms of ROS. The purpose of this study is to determine the presence of PC in gingival crevicular fluid (GCF) in healthy, gingivitis, and chronic periodontitis (CP) subjects and to find an association, if any. Materials and Methods: A total number of 75 subjects (38 males and 37 females) were selected based on their clinical parameters into three groups: Group 1 (25 healthy subjects), Group 2 (25 gingivitis subjects), and Group 3 (25 CP subjects). GCF samples were collected to estimate the levels of PC. Results: The PC concentration in GCF was highest in subjects with CP as compared to gingivitis and healthy subjects and a significant association was observed between GCF PC levels and all periodontal parameters. Conclusion: There was an increase in PC levels in GCF as the disease process progressed from healthy to gingivitis and CP, suggesting a role for increased oxidative stress in CP.

Efficacy of Local Drug Delivery of 0.5% Clarithromycin Gel as an Adjunct to Non‐Surgical Periodontal Therapy in the Treatment of Current Smokers With Chronic Periodontitis: A Randomized Controlled Clinical Trial

BACKGROUND The relationship between cigarette smoking and periodontal disease has been examined extensively. Local delivery of antimicrobials into periodontal pockets improves periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered 0.5% clarithromycin (CLM) as an adjunct to scaling and root planing for treating chronic periodontitis in smokers. METHODS Sixty-one patients were randomized and categorized into two treatment groups: group 1, in which 31 individuals received scaling and root planing plus 0.5% CLM, and group 2, in which 30 individuals received scaling and root planing plus placebo gel. Clinical parameters were recorded at baseline and at 1, 3, and 6 months; they included plaque index (PI), modified sulcus bleeding index (mSBI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL). The mean concentration of 0.5% CLM in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography. RESULTS Both therapies resulted in significant improvements. At the end of 6 months, the mean GI, PI, mSBI, PD, and CAL for the CLM group were 1.06 ± 0.28, 2.82 ± 0.64, 1.36 ± 0.24, 4.64 ± 0.63, and 4.90 ± 0.46, respectively, versus 1.38 ± 0.41, 3.22 ± 0.57, 1.44 ± 0.27, 6.07 ± 0.88, and 5.69 ± 0.46, respectively, for the placebo group. Using an individual-based analysis, individuals in group 1 showed enhanced clinical outcome (P <0.05) over a period of 6 months compared with those in group 2. CLM was detected in GCF until a period of 7 weeks after the local drug delivery. CONCLUSION Although both treatment strategies seemed to benefit the individuals, the adjunctive use of 0.5% CLM as a controlled drug delivery system enhanced the clinical outcome.

4-Hydroxy-2-nonenal, an oxidative stress marker in crevicular fluid and serum in type 2 diabetes with chronic periodontitis

Objective: Chronic periodontitis (CP) is a common, chronic inflammatory disease initiated by bacteria, which has an increased prevalence and severity in patients with type 2 diabetes mellitus (t2 DM). A variety of reactive oxygen species are able to cause direct damage to proteins, deoxyribonucleic acid, carbohydrates and lipids. Lipid peroxidation is always combined with the formation of reactive aldehydes like 4-Hydroxy-2-nonenal (HNE). The purpose of this study was to determine the presence of the HNE-His adducts levels in serum and gingival crevicular fluid (GCF) in t2 DM among CP subjects and to find an association, if any. Materials and Methods: A total of 40 subjects (20 males and 20 females) were selected based on their clinical parameters into three groups: Group 1 (10 healthy), Group 2 (15 subjects, CP without t2 DM), Group 3 (15 subjects, CP with t2 DM). Serum and GCF samples were collected to estimate the levels of the HNE-His adducts by the enzyme linked immunosorbent assay. Results: The mean HNE-His adducts concentration both in serum and GCF was highest for Group 3 followed by Group 2 and least in Group 1. Conclusions: All samples in each group tested positive for HNE-His adducts assay. Serum and GCF HNE-His adducts concentration both in t2 DM with CP and non-diabetic CP subjects were higher than the healthy controls. Further large scale longitudinal studies should be carried out to confirm positive correlations.

Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial

BACKGROUND Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. METHODS A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). RESULTS Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. CONCLUSION Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.

Clinical and microbiological effects of commercially available dentifrice containing amine fluoride: A randomized controlled clinical trial

Background: The inability of the normal adult population to perform adequate tooth brushing has led to the search for chemotherapeutic agents in order to improve plaque control. This 6 month, single center, randomized controlled clinical trial was conducted to assess the clinical and microbiological effects of a dentifrice containing only amine fluoride (AF) as the active ingredient on gingivitis. Materials and Methods: Ninety subjects diagnosed with chronic generalized gingivitis were selected and randomly divided in three groups: Group 1 – placebo toothpaste, Group 2 – AF containing toothpaste, and Group 3 – triclosan containing toothpaste with polymer and fluoride. Clinical evaluation was undertaken using the gingival index of Loe and Silness and the plaque index and microbiological counts were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks. A subjective evaluation was also undertaken by a questionnaire. Results: AF containing toothpaste showed significant improvement in gingival and plaque index scores as well as microbiologic counts compared with placebo dentifrice. These improvements were comparable to triclosan containing toothpaste. Conclusions: AF containing toothpaste may be a useful formulation for chemical plaque control agent and improvement in plaque and gingival status and add to the list of various therapeutic agents used for maintenance of gingival health.

Study of Orthophosphate, Pyrophosphate, and Pyrophosphatase in Saliva With Reference to Calculus Formation and Inhibition

BACKGROUND A large amount of calculus may hamper the efficacy of daily oral hygiene and thereby accelerate plaque formation. Salivary concentrations of orthophosphate and pyrophosphate are important in preventing calculus formation. Activity of orthophosphate, pyrophosphate, and pyrophosphatase was studied in whole saliva in calculus-forming groups and plaque-forming groups. METHODS The material for this study consists of 60 healthy individuals (age range: 15 to 30 years; mean age: 22 years). Depending on calculus index score, individuals were divided into four groups, each of 15 patients: Group 1, calculus index score 0 to 0.6; Group 2, calculus index score 0.7 to 1.8; Group 3, calculus index score 1.9 to 3; and Group 4, plaque group where index varied from 0 to 3. The saliva was collected and biochemically analyzed for concentration of orthophosphate, pyrophosphate, and pyrophosphatase. RESULTS The mean values of orthophosphate in Groups 1, 2, 3, and 4 were 0.2559, 1.3639, 1.7311, and 0.1868 mM, respectively. The mean values of pyrophosphate in Groups 1, 2, 3, and 4 were 0.3258, 0.1091, 0.0314, and 0.3860 mM, respectively. The mean values of pyrophosphatase in Groups 1, 2, 3, and 4 were 10.7937, 15.4249, 27.2900, and 7.5427 units/ml, respectively. CONCLUSIONS A holistic approach toward the control of periodontal disease should include antiplaque and anticalculus agents. The results are conclusive that the components orthophosphate, pyrophosphate, and pyrophosphatase present in saliva have a very significant role to play in formation and inhibition of calculus. This study reinforces the idea of using pyrophosphate and newer bisphosphonates as potential anticalculus agents.