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ObjectivesThe aim of the present randomized clinical trial (RCT) with a parallel arm design was to evaluate the clinical and microbiological efficacy of repeated ICG-aPDT as an adjunct to full-mouth subgingival debridement in the treatment of periodontitis.Materials and methodsTwenty-four periodontitis patients were treated with full-mouth ultrasonic subgingival debridement (FMUD). Initial sites with probing depth (PD) > 4 mm were randomly assigned to receive the test (ICG-aPDT with an 810 nm diode laser) or the control treatment (off-mode aPDT) one and four weeks after FMUD. Clinical parameters were registered after 3 and 6 months. The presence of the main periodontal pathogens in subgingival samples was assessed with real-time PCR.ResultsBoth treatment modalities resulted in significant clinical improvements at 3 and 6 months. The only significant differences in favour of the test group were found at 6 months for a higher PD reduction in initial deep pockets (PD ≥ 6 mm) and a higher percentage of closed pockets (PD ≤ 4 mm/no bleeding on probing). Limited microbiological changes were observed in both groups after treatment with no inter-group difference, except for a more significant reduction in Aggregatibacter actinomycetemcomitans and Parvimonas micra levels in the test group at 3 months.ConclusionThe combination of repeated ICG-aPDT and FMUD provided no benefits except for selective clinical and microbiological improvements compared to FMUD alone.Clinical relevanceBased on the obtained results, only limited adjunctive effects could be found for the combined use of ICG-aPDT and FMUD. Further, well-designed RCT with larger sample sizes are required to confirm these findings.Trial registrationClinicalTrials.gov NCT04671394.

The gold standard in the non-surgical treatment of periodontitis is scaling and root planing (SRP). In recent years, the use of autogenous platelet concentrates has spread over many specialties in dentistry and, thus, has also been gaining popularity in periodontal treatment. Its two main fractions are platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), which, since 2014, can also be used via injection as injectable platelet-rich fibrin (i-PRF). The authors conducted a comprehensive systematic review in accordance with the PRISMA 2020 guidelines. It involved searching PubMed, Embase, Scopus, and Google Scholar databases using the phrases (“Root Planing” OR “Subgingival Curettage” OR “Periodontal Debridement”) AND (“Platelet-Rich Plasma”). Based on the authors’ inclusion and exclusion criteria, 12 results were included in the review, out of 1170 total results. The objective of this review was to ascertain the impact of utilizing PRP and i-PRF in SRP. The results revealed that both the incorporation of PRP and i-PRF were found to be significantly associated with are duction in gingival pocket depth and again in clinical attachment level; however, i-PRF demonstrated superiority in improving clinical parameters. Furthermore, i-PRF demonstrated notable bactericidal efficacy against Porphyromonas gingivalis. On the other hand, PRP proved inferior to an Nd:YAG laser in clinical parameter improvement; however, it demonstrated significant efficiency as well. This literature review led the authors to the conclusion that autologous platelet concentrates might be competent agents for improving the therapeutic outcomes of SRP.

Background The current study aimed to assess the clinical and radiographic outcomes of the effect of subgingival application of ozonated gel as an adjunct to scaling and root planing (SRP) in diabetic patients with stage III periodontitis. Methods Twenty-four patients with type II diabetes mellitus (DM) were randomized into two groups, with 12 patients in each group. Group I served as the intervention group, receiving both SRP and ozone gel application (SRP + Ozone), while Group II served as the control group, undergoing SRP alone. Clinical attachment level was evaluated as primary outcome, with secondary outcomes including probing pocket depth, full mouth plaque score, full mouth bleeding score, dentinal hypersensitivity, radiographic linear defect depth, radiographic defect angle, and periodontal ligament widening space assessed at 3 and 6 months. Results The results revealed statistically significant intragroup differences between the two groups ( p  < 0.05). In contrast, intergroup differences revealed no statistically significant difference across the various time intervals ( p  > 0.05). The reduction in PD in the SRP + Ozone group at three months was statistically significant ( p  = 0.04). The SRP + Ozone group showed a significant radiographic improvement compared to the SRP group. The Visual Analogue Scale (VAS) also demonstrated statistically significant differences between the two groups. Glycated hemoglobin (HbA1c) significantly decreased after 6 months, with no significant signifcant differences between groups ( p  > 0.05). Conclusions Ozone gel is suggested to be a promising potential natural adjunctive therapy for diabetic patients to enhance periodontal health, with no reported adverse effects. Trial registration ID: NCT05538078, Date of Registration: 09/09/2022. ( https://register.clinicaltrials.gov/prs/app/action/DownloadReceipt?uid=U0006D54&ts=3&sid=S000CGX4&cx=g1wreh ).

Objective Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical agent as an adjunct to Scaling and root planing (SRP) versus SRP alone for the treatment of periodontitis. Materials and methods Sixty-six patients with moderate periodontitis were enrolled. Through a randomized design, the patients were randomly assigned to SRP + nutraceutical agent (test group) or SRP alone (control group). Patients were regularly examined the clinical, inflammatory mediators and visual analogue scale (VAS) changes over a 6-month period. Clinical attachment level (CAL) was the primary outcome variable chosen. Gingival crevicular fluid (GCF) inflammatory mediator change and the impact of treatment on VAS were evaluated through a linear regression model. Results Both treatments demonstrated an improvement in periodontal parameters compared with baseline. After 6 months of treatment, compared with the control group, the test group determined a significant probing depth (PD) ( p  = 0.003) and bleeding on probing (BOP) reduction ( p  < 0.001), while CAL gain was significantly obtained at 30 and 60 days after treatment ( p  < 0.05). In the test group, the level of inflammatory mediators was significantly reduced compared with the control group ( p  < 0.05). The linear regression analysis demonstrated that the nutraceutical agent exerted, in the test group, a significant influence on VAS at 6, 12, 24, and 48 h after treatment ( p  < 0.05). Conclusions Nutraceutical agent resulted in a more significant reduction in clinical, inflammatory mediators and short-term pain compared with SRP alone. Clinical relevance Nutraceutical agent, when combined with SRP, was demonstrated to be effective in reducing periodontal parameters and controlling the levels of inflammatory mediators and pain in patients with periodontitis.

ObjectivesTo determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects.Materials and methodsIn a split-mouth randomised controlled trial, 20 patients’ dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model.ResultsAfter 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group’s deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP.ConclusionsMINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects.Clinical relevanceMINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects.Trial registrationClinicaltrials.gov (NCT04036513) on June 29, 2019.

Mechanical removal of microbial biofilm dental plaque from tooth surfaces is important for treatment of periodontal diseases. However, the effectiveness of conventional scaling and root planing (SRP) is affected by the local conditions and residual bacteria which may affect the healing process. We performed a randomized clinical trial to test our hypothesis that adjunctive antimicrobial photodynamic therapy (aPDT) plus SRP has significant effect compared with SRP alone, which can last for 1 year. The study included 136 sites in 16 patients with previously untreated chronic periodontitis, at least one premolar and one molar in every quadrant (minimum, four teeth/quadrant) and at least one tooth with attachment loss of ≥4 mm in every quadrant. In all patients, two randomly assigned quadrants were treated with SRP and the other two were treated with SRP + aPDT. The clinical parameters of probing pocket depth (PPD), bleeding on probing (BOP), and clinical attachment level (CAL) were evaluated at baseline and after 3, 6, and 12 months. There were no significant differences between the two groups at baseline. PPD and BOP showed significant reduction, and CAL showed significant gain from baseline for all three time points in both groups. In addition, there were significantly greater reduction and gain for SRP + aPDT than for SRP at all three time points. No adverse effects of aPDT were observed. These data demonstrate significant improvement in all evaluated clinical parameters for at least 1 year and suggest that aPDT as an adjunctive therapy to SRP represents a promising therapeutic concept for persistent periodontitis.

Objective To assess the impact of injectable platelet-rich fibrin (i-PRF) as an adjunct to scaling and root planing (SRP) in patients with periodontitis. Materials and methods Twenty-four patients, with two pairs of contralateral teeth (probing depth [PD] ≥ 5 mm), were enrolled. The tooth pairs were randomly assigned to either the control group (SRP, n  = 149 sites) or the experimental group (SRP + i-PRF, n  = 135 sites). The clinical parameters PD, gingival recession (GR), clinical attachment level (CAL), plaque index (PI), and full mouth bleeding on probing (fBOP) were evaluated at baseline and 45 and 90 days. Radiographic analysis measured the distance from the cementoenamel junction to the alveolar bone crest (CEJ-BC) at baseline and 90 days. Results Both groups showed significant reductions in PD, CAL, fBOP, and PI from baseline to 45 days ( p  < 0.001), without significant differences between the groups ( p  > 0.05). The test group exhibited increased GR at 45 days ( p  < 0.05). CEJ-BC decreased in both groups at 90 days with no significant intergroup difference ( p  > 0.05). At 90 days, no significant intra- or intergroup differences were observed in any of the clinical parameters ( p  > 0.05). Conclusion SRP alone or combined with i-PRF resulted in comparable clinical and radiographic improvements in patients with periodontitis. Adjunctive i-PRF did not offer significant additional benefits. Clinical relevance This study shows SRP alone and SRP + i-PRF yield satisfactory periodontal outcomes. Moreover, this study introduces the injection of i-PRF around the periodontal pocket, which, to the best of our knowledge, has not been extensively explored in the existing literature. Trial registration https://ensaiosclinicos.gov.br/ : RBR-52h647m.

Background Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by 57.3% from 1990 to 2010. Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. Root planing, in order to eliminate the “infected cementum,” has been an important step in the treatment of periodontitis since the 1970s. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried. Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments. Hence, an increasing number of dentists prefer to do scaling with ultrasonic instruments only. However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment. Therefore, this study is devoted to compare the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing, which takes the implementation of root planing as the only variable and is more in line with the current clinical situation, thus hoping to provide some valuable reference to dentists. Methods/design Forty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology (Beijing, China). By means of randomization tables, one quadrant of the upper and lower teeth is the test group and the other is the control group. Test group: ultrasonic subgingival scaling combined with manual root planing. Control group: ultrasonic subgingival debridement. In a 24-week follow-up period, plaque index, probing depth, clinical attachment loss, bleeding index, furcation involvement, mobility, and patient-reported outcome (Visual Analog Scale for pain and sensitivity) will be observed and documented. Discussion This study evaluates the effectiveness of ultrasonic subgingival scaling combined with manual root planing and ultrasonic subgingival debridement alone in the nonsurgical treatment of periodontitis with a split-mouth design after 1, 3 and 6 months. The result of the trial should potentially contribute to an advanced treatment strategy for periodontitis with an ideal clinical outcome. Trial registration International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR1800017122 . Registered on 12 July 2018.

Laser technology has affected the field of Periodontology in many ways. They help to manage periodontal disease. This investigation aimed to compare the clinical results of diode laser in conjunction with scaling and root planing (SRP) and SRP alone in treating periodontal pockets in Periodontitis patients. This randomized controlled clinical research utilized a split-mouth approach. It included 25 patients (11 females and 14 males, aged 20 to 65) presenting a moderate periodontal pocket with depths of 4–7 mm on both the right and left sides of the mouth. Two groups were utilized: the control group (SRP alone) on the right side of the mouth and the experimental group (SRP in conjunction with diode laser) on the left side of the mouth. The intervention comprised a single session of scaling and root planing (SRP) accompanied by 10-second administrations of a dual-wavelength diode laser Working within the wavelength range 810–980 nm on the left side. In contrast, the contralateral side received SRP only. Probing Pocket Depth, clinical attachment loss, Plaque Index, and Bleeding on Probing Index were assessed at baseline, 1.5 months, and 3 months post-treatment. The results indicate that both therapies enhanced periodontal parameters at 1.5 and 3 months compared to the baseline. SRP + diode laser, on the other hand, demonstrated a substantial enhancement in probing depth.(PD;4.92 ± 0.65–3.82 ± 0.87–3.55 ± 0.80 vs. 4.95 ± 0.67–4.14 ± 0.93–3.90 ± 0.93, p  < 0.001) and BOP%(100.0%-43.2%-34.80% vs. 100.0%-54.8%-44.0%, P  < 0.05) in contrast to SRP alone. No substantial differences were detected in CAL and plaque percentages between treatment groups ( P  > 0.05) at 1.5 and 3 months post-treatment. Conclusions indicate that within the limit of this study, the integration of scaling and root planing (SRP) with diode laser therapy resulted in a significant reduction in moderate periodontal pocket depth and bleeding on probing over the 3-month trial period in patients with Periodontitis.