OBJECTIVE: To evaluate the effect of entrapment of curcumin within liposomal formulation and the sustained release attitude of the formulated liposomal gel on periodontal defects in diabetic patients in clinical and biochemical terms.
METHODS: Thirty diabetic patients with periodontitis were randomly assigned to three equal groups and ten healthy participants were assigned as the control group. Group I was subjected to scaling and root planing (SRP) with application of sustained release liposomal curcumin gel. Group II was subjected to scaling and root planning with application of curcumin gel. Group III was subjected to scaling and root planning with application of placebo gel. Group IV (control group), no intervention was done. The following parameters were evaluated before treatment and after 6 and 12 weeks: plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), tumour necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β) and total antioxidant capacity (TAC).
RESULTS: All study groups showed improvement in clinical and biochemical parameters that are statistically significant. Upon comparing the results of treatment modalities, the highest improvement was achieved in group I followed by group II then group III.
CONCLUSIONS: Sustained release liposomal curcumin gel enhanced the antioxidant capacity, decreased the inflammatory mediators and showed more improvement in clinical outcome for treatment of periodontitis in diabetic patients.

BACKGROUND: Recent studies suggest a role for microscopic crystalline particles of residual dental calculus in the pathogenesis of periodontitis. The purpose of this ex vivo study was to compare the effectiveness of scaling and root planing (SRP) alone versus SRP combined with 24% ethylenediamine-tetra acetic acid (EDTA) gel in removing calculus from extracted teeth and to determine the optimal length of time for application of the EDTA.
METHODS: Specimens consisted of 32 extracted teeth with heavy root calculus. A 4-mm diameter site was prepared on the root surface of each tooth which then underwent SRP. EDTA was applied to four timed groups: 30 s; 60 s; 120 s; and 180 s. Photomicrographs were taken at 40× magnification using white light (WL) and laser fluorescence (LF). Photomicrographs were analyzed using ImageJ. Specimens were also evaluated with scanning electron microscopy (SEM).
RESULTS: The mean area of residual calculus after SRP was 45%-53% (45.6% ± 19.6% WL, 53.8% ± 19.7% LF). Burnishing with EDTA for one minute following SRP reduced calculus to only 14%-18% (13.9% ± 12.5% LF, 18.2% ± 11.1% WL). Use of EDTA for greater than 1 min showed no further calculus removal. SEM revealed the surface of remaining calculus was altered by burnishing with EDTA.
CONCLUSIONS: SRP alone or SRP + 24% EDTA gel failed to remove all calculus. SRP alone removed >60% of calculus from root surfaces. Adjunctive use of 24% EDTA gel burnished on the root surface removed most of the calculus residual after SRP. Calculus remaining after EDTA burnishing exhibited a significantly altered morphologic appearance.

OBJECTIVE: This study aimed to compare the efficacy of subgingivally applied probiotics as an adjunct to scaling and root planing (SRP) vs SRP alone in patients with periodontitis.
METHODS: Patients diagnosed with periodontitis, with probing pocket depth (PPD) of 5-7 mm on at least two teeth on contralateral sites, were selected for the study and randomly allocated to the test group (n = 31) who underwent SRP along with subgingival application of probiotic paste and the control group (n = 31) who underwent only SRP. Clinical parameters were evaluated in both groups at baseline and after 12 weeks. The viability of probiotic bacteria was evaluated in the test group at baseline, day 4 and day 8.
RESULTS: All clinical parameters showed a statistically significant difference between baseline and 12 weeks on intragroup and intergroup comparison, with a greater improvement in the test group. Microbiological evaluation showed that the mean colony-forming units (CFUs) in the test group were 38.39 ± 7.76, 7.25 ± 2.72 and 1.57 ± 1.29 at baseline, day 4 and day 8, respectively. The mean CFUs significantly reduced with an increase in time from baseline to 8-day time interval.
CONCLUSIONS: It was seen that the probiotic bacteria remained viable in the periodontal pocket for up to 8 days after placement, but stable improvements were seen in all clinical parameters even at 12 weeks, indicating its prolonged efficacy. Thus, commercially available probiotics can prove to be an inexpensive method to treat periodontitis when combined with SRP.

BACKGROUND: High occlusal forces in patients with untreated periodontitis may reflect occlusal trauma-associated periodontal conditions. Occlusal analysis using T-scan might provide the distribution of occlusal loading forces in periodontitis patients. The study aimed to evaluate the effect of occlusal trauma in periodontitis patients and occlusal calibration using a T-scan.
METHODS: A total of 30 periodontitis patients were recruited for the study. Patients were categorized into two groups: Group I: scaling and root planing followed by T-scan recording and no occlusal calibration; Group II: scaling and root planing followed by occlusal calibration using T-scan. Clinical parameters, orthopantomogram (OPG) and T-scan evaluation were evaluated at baseline, 3-month and 6-month intervals.
RESULTS: Significant improvements in clinical parameters were noted at different time intervals after occlusal calibration using T-scan. At 3-month intervals, mean pocket depth showed statistically significant difference among the test group in the right (upper and lower) and left lower quadrant at P = 0.01, 0.002 and 0.005, respectively. Mean clinical attachment level (CAL) showed statistically significant difference among the test group in the right upper, right lower and left lower quadrants at P = 0.02, 0.001 and 0.009, respectively, at 3 months. The comparison of the mean gingival index (GI) at 6 months showed statistically significant difference among test and control groups at 6 months in different study quadrants (P = 1 in right upper, 0.009 in right lower, <0.001 in left upper and <0.001 in left lower). Mean pocket depth at the 6-month follow-up showed statistically significant difference among the test group in all the study quadrants (P = <0.001 in right upper, <0.001 in right lower, 0.003 in left upper and 0.005 in left lower). Mean CAL showed statistically significant difference among the test group in all the study quadrants at 6-month intervals (P = 0.02 in right upper, <0.001 in right lower, 0.01 in left upper and 0.04 in left lower). The bone defect height showed a statistically significant difference only in the right upper quadrant among both the test groups at the 6-month follow-up (P = 0.02). Comparing the mean percentage of force on both sides of the jaw showed a statistically significant difference among the test group at 6 months (P = 0.001 on the left side and 0.001 on the right side).
CONCLUSIONS: The occlusal correction using T-scan showed a positive association between probing pocket depth (PPD) and CAL at different time intervals from baseline to 6 months when these parameters were compared after occlusal adjustments.

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.

OBJECTIVE: To evaluate the efficacy of the adjunctive use of tea tree oil (TTO) for dental plaque control and nonsurgical periodontal treatment (NSPT).
METHODS: Three electronic databases were searched from 2003. The reference lists of the included articles and relevant reviews were also manually searched. Randomised controlled trials reporting the clinical outcomes of the topical use of TTO as an adjunct to daily oral hygiene or scaling and root planing (SRP) were included. Regarding the use of TTO as an adjunctive to daily oral hygiene, the primary outcome was plaque index (PI) reduction. Regarding the use of TTO as an adjunctive to SRP, probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were the primary outcomes. The secondary outcomes were adverse events.
RESULTS: Eleven studies were included for qualitative analysis, 9 studies were included for quantitative analysis, and 6 studies were included to examine the application of TTO mouthwash as an adjunctive to daily oral hygiene. In addition, three studies were included to analyse the subgingival use of TTO adjunctive to SRP at selected sites. The results indicated a nonsignificant improvement in PI reduction in the TTO mouthwash group compared with placebo. The incidence of adverse events was statistically significantly greater in the CHX group than in the TTO group. For subgingival use of TTO adjunctive to SRP, beneficial effects were observed in the TTO group compared with SRP alone in terms of PPD and CAL at both three and six months post-treatment. However, an unpleasant taste was reported in three out of four studies.
CONCLUSIONS: There is a lack of strong evidence to support the beneficial effects of TTO. Studies with larger sample sizes and standardised evaluation criteria are needed to further demonstrate the clinical relevance of TTO.

BACKGROUND: This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.
METHODS: Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.
RESULTS: At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period.
CONCLUSIONS: The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.
CONCLUSIONS: Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

BACKGROUND: Idiopathic gingival enlargement is associated with plaque, but other contributing factors are unclear. The prognosis of idiopathic gingival enlargement is closely related to the patient\'s oral hygiene habits and regular follow-up.
METHODS: This article reports a case of a 32-year-old male patient with idiopathic gingival enlargement. The patient presented to the department of stomatology with a 2-month history of gingival swelling and pain on the right upper posterior teeth. During the treatment, oral hygiene instruction, supragingival cleaning, subgingival scaling, and root planning were carried out, and part of the hyperplastic gingiva was taken and sent for pathology. Pathological examination showed gingival enlargement with chronic suppurative inflammation. At 4-month follow-up, the patient\'s periodontal condition remained basically stable, and the gingival enlargement did not recur.
CONCLUSIONS: The treatment of this case resulted in significant reduction of gingival swelling and patient\'s pain reduction through non-surgical treatment and good plaque control, indicating that patients with idiopathic gingival enlargement can also achieve ideal results through non-surgical treatment. Through oral hygiene instruction, the patient mastered the method of self-plaque control, which is conducive to the long-term stabilization of the periodontal situation.

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.

OBJECTIVE: To evaluate periodontal wound healing following scaling and root planing (SRP) in conjunction with the application of sodium hypochlorite/amino acids and cross-linked hyaluronic acid (xHyA) gels in dogs.
METHODS: In four beagle dogs, 2-wall intrabony defects were created and metal strips were placed around the teeth. Clinical parameters were measured 4 weeks after plaque accumulation. The experimental root surfaces were subjected to SRP with either the subgingival application of a sodium hypochlorite/amino acid gel and a xHyA gel (test group) or SRP alone (control group) using a split-mouth design. Clinical parameters were re-evaluated at 6 weeks. The animals were sacrificed at 8 weeks for histological analysis.
RESULTS: The test group showed significant improvements in all clinical parameters compared to the control group. Histologically, the test group exhibited statistically significantly greater new bone formation [i.e., length of newly formed bone, new bone area] compared with the control group (p < 0.05). Furthermore, statistically significantly greater formation of new attachment [i.e., linear length of new cementum adjacently to newly formed bone with inserting collagen fibers] and new cementum was detected in the test group compared with the control group at 8 weeks (p < 0.05 and p < 0.01, respectively).
CONCLUSIONS: The adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA gels to SRP offers an innovative novel approach to enhance periodontal wound healing/regeneration.
CONCLUSIONS: The present findings have for the first-time shown histologic evidence for periodontal regeneration in support of this novel treatment modality.