UNASSIGNED: Scaling and root planing (SRP) is an inevitable primary step in non-surgical periodontal therapy. Debridement carried out with manual instruments and ultrasonics results in the removal of tooth structure. Current research revolves around laser as an efficient adjunct to SRP. This study evaluated and compared the effectiveness of root surface calculus removal between ultrasonics and Er,Cr:YSGG laser.
UNASSIGNED: Twenty-eight single-rooted teeth extracted due to periodontal disease were selected for the study. The specimens were randomly assigned to two groups (n=14). Group I underwent ultrasonic instrumentation using a piezo ultrasonic scaler, and group II was subjected to laser instrumentation using Er,Cr:YSGG laser (Waterlase). The specimens were processed, fixed, viewed under a field emission scanning electron microscope and evaluated using the remaining calculus index (RCI) and loss of tooth substance index (LTSI).
UNASSIGNED: Ultrasonics-treated specimens revealed more remaining calculus (1.57±0.65) and lost tooth substance (1.71±0.61) compared to the Er,Cr:YSGG laser-treated specimens, with significantly lower RCI (0.71±0.61) and LTSI (1.00±0.56). There was a statistically significant difference (P<0.05) in the efficacy of root surface calculus removal between the two groups.
UNASSIGNED: Compared to ultrasonics, Er,Cr:YSGG laser demonstrated superior results by causing precise removal of root surface calculus without significantly affecting tooth structure and aiding in new attachment.

Aim: The study aims to assess the efficacy of rose bengal (RB)-mediated antimicrobial photodynamic therapy (a-PDT) as an adjunct to scaling and root planing in the management of chronic periodontitis patients in terms of clinical parameters like gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and microbiological parameters like total microbial count, total red complex organism count, Porphyromonas gingivalis count, Treponema denticola count, and Tannerella forsythia count. Materials and Methods: In this randomized controlled clinical trial, a total of 30 patients were recruited who met the inclusion criteria. The participants were randomly allocated into group A with scaling and root planning (SRP) alone and group B with SRP + a-PDT. The clinical and microbiological parameters were measured at baseline and at 3-month follow-up. Intergroup and intragroup comparisons were performed using independent t test and paired t test, respectively. Value of p < 0.05 was considered as statistically significant. Results: At 3-month follow-up, group B treated with SRP + a-PDT showed statistically significant reduction in GI (0.58 ± 0.20) and PPD (1.81 ± 0.32 mm), gain in CAL (0.73 ± 0.04 mm), and reduction in total microbial count [2.80 ± 0.08 × 104 colony forming unit (CFU)], total red complex count (0.29 ± 0.14 × 102 CFU), P. gingivalis count (0.43 ± 0.13 × 102 CFU), T. denticola count (0.61 ± 0.04 × 102 CFU), and T. forsythia count (0.59 ± 0.04 × 102 CFU) as compared with group A (p < 0.05). Conclusion: RB-mediated a-PDT as an adjunct to SRP was significantly more effective in improving GI, PPD, and CAL and in reducing microbial count as compared with SRP alone in the management of chronic periodontitis.

OBJECTIVE: To evaluate the efficacy of platelet-rich fibrin (PRF) as an adjunct to scaling and root planing (ScRp) for healing shallow periodontal pockets.
METHODS: Twelve patients with periodontitis were enrolled in this split-mouth, randomized clinical trial. A total of 24 shallow periodontal pockets (4-6 mm) were treated by either ScRp alone (control) or PRF (test). Clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PLI), as well as platelet-derived growth factor-BB (PDGF-BB) by enzyme-linked immunosorbent assay (ELISA) in gingival crevicular fluid (GCF) were measured at baseline and at 1- and 3-month follow-up visits.
RESULTS: At 1- and 3-month follow-up visits, greater CAL gains (2.6 ± 0.25 mm and 3.26 ± 0.31 mm, respectively) and PPD reductions (2.58 ± 0.38 and 3.31 ± 0.39 mm, respectively) were observed in the test group compared to those in controls (CAL gain of 1.01 ± 0.49 mm and 1.43 ± 0.48 mm; PPD reduction of 1.1 ± 0.55 and 1.37 ± 0.49 mm, respectively). In addition, the increase in PDGF-BB in GCF in the test group (724.5 ± 186.09 pg/μl and 1957.5 ± 472.9 pg/μl) was significantly greater than that in controls (109.3 ± 24.07 and 614.64 ± 209.3 pg/μl) at 1- and 3-month follow-up visits, respectively.
CONCLUSIONS: The noninvasive use of PRF as an adjunct to ScRp successfully improved clinical periodontal parameters and might contribute to increased PDGF-BB in GCF.

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.
CONCLUSIONS: 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.
BACKGROUND: This clinical trial was registered on Clinical Trials.gov (Registration ID: NCT06209554) and released on 08/01/2024.

BACKGROUND: This study aimed to demonstrate the efficacy of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser-assisted nonsurgical periodontal therapy in periodontitis patients during 8 weeks of healing.
METHODS: A split-mouth, single-blinded, randomized controlled clinical trial was conducted on 12 patients diagnosed with stage III/IV periodontitis and had a minimum of two teeth with probing pocket depth (PPD) > 5 mm in at least two quadrants. Upon randomization, each quadrant was assigned for conventional scaling and root planing (SRP) procedure or laser-assisted therapy (SRP + laser) using radial firing tip (RFPT 5, Biolase). Clinical measurements and gingival crevicular fluid collection were performed for statistical analysis.
RESULTS: In the initial statistical analysis on the whole subject teeth, modified gingival index (MGI) reduction was greater in test group at 1(P = 0.0153), 4 (P = 0.0318), and 8 weeks (P = 0.0047) compared to the control in the same period. PPD reduction at 4 weeks in test group was -1.67 ± 0.59 showing significant difference compared to the control (-1.37 ± 0.63, P = 0.0253). When teeth with mean PPD ≥5 mm were sorted, MGI decrease was significantly greater in test group at 1 (P=0.003) and 8 week (P=0.0102) follow-ups. PPD reduction was also significantly greater in test group at 4 week period (-1.98 ± 0.55 vs -1.58 ± 0.56, test vs control, P=0.0224).
CONCLUSIONS: Er,Cr:YSGG-assisted periodontal therapy is beneficial in MGI and PPD reductions during early healing period.

Background and Objectives: This paper aims to assess the role of laser therapy in periodontitis through an innovative approach involving computational prediction and advanced modeling performed through network analysis (Gaussian graphical models-GGMs) and structural equations (SEM). Materials and Methods: Forty patients, exhibiting periodontal pockets with a minimum depth of 5 mm, were randomly divided into two groups: a control group and a laser group. Four specific indicators were measured for each tooth, namely periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), and the mean of six measured values was recorded at five time markers (baseline, 6 months, 1 year, 2 years, and 4 years). The assessment algorithm included enrollment, measurements, and differential non-surgical periodontal treatment, according to the group allocation. Scaling, root planing, and chlorhexidine 1% were conducted for the control group, and scaling, root planing and erbium, chromium:yttrium-scandium-gallium-garnet (Er,CR:YSGG) laser therapy were conducted for the laser group. Results: The main results highlight that the addition of laser treatment to scaling and root planing led to notable clinical improvements, decreasing the PPD values, reducing the BOP scores, and increasing the CAL. Conclusions: Notable relationships between the specific indicators considered were highlighted by both the GGMs and by SEM, thus confirming their suitability as proxies for the success of periodontal treatment.

OBJECTIVE: The purpose of the present study was to evaluate the smear layer removal efficacy of three various agents on periodontally compromised tooth.
METHODS: The current study included 75 molar teeth that were extracted due to periodontal disease. After that, 25 samples were randomly assigned using a simple random technique to the three different agent groups, group A: Scaling and root planing (SRP) and application of SofScale agent, group B: SRP and application of QMix agent, group C: SRP and application of MTAD agent. Using a diamond circular saw, the treated portions were divided into horizontal and vertical halves. All samples were viewed under Scanning Electron Microscope. Every tooth was focused at the coronal third, middle third, and apical third portion with a magnification of 1000×. Data were recorded and statistically analyzed.
RESULTS: The smear layer removal efficacy was more in the QMix agent (3.06 ± 0.04) group followed by MTAD agent (3.28 ± 0.09) and SofScale agent (4.14 ± 0.10) group on the root surface. On intra group comparison, there was a statistically significant difference found in all the intra group agents with all the three levels. On inter group evaluation, at coronal third, there was no significant difference found between the different agents. There was a significant difference found between the different agents at middle and coronal third.
CONCLUSIONS: On conclusion, the current investigation found that, the root surfaces treated with QMix shown a greater ability to remove smear layers compared to tooth surfaces treated with MTAD and SofScale agent.
CONCLUSIONS: Conventional therapies such as SRP effectively eliminate calculus, plaque, and necrosed cementum; nevertheless, they leave behind a smear layer that could impede normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. The traditional root conditioning agents such as citric acid have certain disadvantages, though, such as an acidic pH that could harm the root surface. As a result, researchers have been looking for biocompatible root conditioning treatments that are more effective. How to cite this article: Singh DK, BS Raj H, Soans CR, et al. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024;25(2):156-159.

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.
CONCLUSIONS: 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.

OBJECTIVE: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients.
METHODS: This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient\'s eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure.
RESULTS: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01).
CONCLUSIONS: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses.

BACKGROUND: Periodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis.
METHODS: A randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis.
RESULTS: Compared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration.
CONCLUSIONS: Laser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage.
BACKGROUND: NCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov.