Download PDF
CC BY 4.0 · Eur J Dent 2024; 18(02): 526-533
DOI: 10.1055/s-0043-1772567
Original Article

Anti-infective Efficacy of Mechanical Debridement with Adjunctive Modalities on Clinical and Cytokine Parameters in Treatment of Chronic Periodontitis: Randomized Controlled Clinical Trial

Anjale Rajagopal
1   Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Jothi Varghese 
1   Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Vinutha Bhat
2   Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Vibha Acharya
2   Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Vinayak Kamath
3   Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objectives Periodontal debridement involves conventional scaling and root planing (SRP) along with variant forms of adjunctive therapies. In the present clinical trial, we investigated if the adjunctive use of HybenX gel or diode laser along with SRP could provide a favorable outcome for the treatment of chronic periodontitis.

Materials and Methods The present study involved 60 subjects diagnosed with chronic periodontitis who were randomly assigned as test groups (laser or HybenX) or control group (SRP alone). The primary outcomes of the clinical trial were pocket probing depth (PPD) and clinical attachment level (CAL), which was evaluated at baseline and at third-month time interval. Additionally, secondary outcomes included estimation of reduction in inflammatory mediators interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) in gingival crevicular fluid using enzyme-linked immunosorbent assay at baseline and third-month intervals.

Statistical Analysis Normality determination was checked using Shapiro–Wilk test. Since the data was not normally distributed, nonparametric tests were applied. The comparison of clinical parameters between the groups was analyzed with Kruskal–Wallis test. Wilcoxon sign rank test was used to compare the pairwise comparison of clinical parameters among the groups from baseline to third-month follow-up. The inflammatory mediators at various time points were compared using a One-way analysis of variance test, and the inflammatory mediators in each study group were compared using a paired t-test.

Results Both the test groups demonstrated a decrease in PPD and CAL. However, the HybenX group exhibited statistically significant reduction at the end of the third-month study interval compared to the laser group and SRP alone. Further, the secondary outcome IL-1β and TNF-α analysis exhibited statistically significant reduction in all the groups posttherapy.

Conclusion The adjunctive application of HybenX gel yielded an advantage compared to laser and SRP for the treatment of chronic periodontitis.

Clinical Relevance Adjunctive use of the oral tissue desiccant (HybenX gel) combined with SRP improved the periodontal pocket disinfection process and enhanced tissue healing devoid of adverse effects.

Keywords

lasers - tissue desiccant - inflammatory mediators - mechanical debridement - chronic periodontitis

Ethical Approval Statement

The study was approved by the institutional ethical review board that was conducted in accordance with the Helsinki Declaration of 1975 further revised in 2013 and prospectively registered in the Clinical Trials Registry.


Authors' Contribution

J.V.: conceptualization, methodology, study design, analysis/interpretation of data and critical revision, manuscript editing, reviewing, and final draft. A.R.: study design, data acquisition, data analysis and interpretation, and drafted the manuscript. V.B., V.A., V.K.: study design and analysis/interpretation of data. All authors gave final approval and agreed to be accountable for all aspects of the work.




Publication History

Article published online:
17 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. J Clin Periodontol 2004; 31 (03) 193-199
    CrossrefPubMedSearch in Google Scholar
  • 2 Tunkel J, Heinecke A, Flemmig TF. A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol 2002; 29 (Suppl. 03) 72-81 , discussion 90–91
    CrossrefPubMedSearch in Google Scholar
  • 3 Bartold PM, Van Dyke TE. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000 2013; 62 (01) 203-217
    CrossrefPubMedSearch in Google Scholar
  • 4 Aoki A, Sasaki KM, Watanabe H, Ishikawa I. Lasers in nonsurgical periodontal therapy. Periodontol 2000 2004; 36 (01) 59-97
    CrossrefPubMedSearch in Google Scholar
  • 5 Raffetto N. Lasers for initial periodontal therapy. Dent Clin North Am 2004; 48 (04) 923-936 , vii
    CrossrefPubMedSearch in Google Scholar
  • 6 Raghavendra M, Koregol A, Bhola S. Photodynamic therapy: a targeted therapy in periodontics. Aust Dent J 2009; 54 (Suppl. 01) S102-S109
    PubMedSearch in Google Scholar
  • 7 Qadri T, Javed F, Johannsen G, Gustafsson A. Role of diode lasers (800-980 nm) as adjuncts to scaling and root planing in the treatment of chronic periodontitis: a systematic review. Photomed Laser Surg 2015; 33 (11) 568-575
    CrossrefPubMedSearch in Google Scholar
  • 8 Mills MP, Rosen PS, Chambrone L. et al. American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases. J Periodontol 2018; 89 (07) 737-742
    CrossrefPubMedSearch in Google Scholar
  • 9 Antonelli A, Giovannini L, Baccani I, Giuliani V, Pace R, Rossolini GM. In vitro antimicrobial activity of the decontaminant HybenX® compared to chlorhexidine and sodium hypochlorite against common bacterial and yeast pathogens. Antibiotics (Basel) 2019; 8 (04) 188
    CrossrefPubMedSearch in Google Scholar
  • 10 Porter SR, Al-Johani K, Fedele S, Moles DR. Randomised controlled trial of the efficacy of HybenX in the symptomatic treatment of recurrent aphthous stomatitis. Oral Dis 2009; 15 (02) 155-161
    CrossrefPubMedSearch in Google Scholar
  • 11 Lombardo G, Signoretto C, Corrocher G. et al. A topical desiccant agent in association with ultrasonic debridement in the initial treatment of chronic periodontitis: a clinical and microbiological study. New Microbiol 2015; 38 (03) 393-407
    PubMedSearch in Google Scholar
  • 12 Pan W, Wang Q, Chen Q. The cytokine network involved in the host immune response to periodontitis. Int J Oral Sci 2019; 11 (03) 30
    CrossrefPubMedSearch in Google Scholar
  • 13 Genco RJ. Host responses in periodontal diseases: current concepts. J Periodontol 1992; 63: 338-355
    CrossrefPubMedSearch in Google Scholar
  • 14 Vahabi S, Sattari M, Taheraslani M, Bagheban AA. Correlation between interleukin- 1β, interleukin-6 and tumor necrosis factor-α and clinical parameters in chronic and aggressive periodontal disease. J Adv Periodontol Implant Dent 2011; 3 (02) 51-56
    Search in Google Scholar
  • 15 Isola G, Matarese G, Williams RC. et al. The effects of a desiccant agent in the treatment of chronic periodontitis: a randomized, controlled clinical trial. Clin Oral Investig 2018; 22 (02) 791-800
    CrossrefPubMedSearch in Google Scholar
  • 16 Khalil B, Abou Sulaiman A, Al Hajjar B. The effects of adjunctive use of a desiccant agent in the treatment of stage III periodontitis (randomized controlled clinical trial). Saudi Dent J 2023; 35 (02) 172-177
    CrossrefPubMedSearch in Google Scholar
  • 17 Schulz KF, Altman DG, Moher D. CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152 (11) 726-732
    CrossrefPubMedSearch in Google Scholar
  • 18 Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol 2018; 89 (Suppl. 01) S159-S172
    CrossrefPubMedSearch in Google Scholar
  • 19 Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967; 38 (6, 6 Part II): 610-616
    CrossrefPubMedSearch in Google Scholar
  • 20 Mühlemann HR, Son S. Gingival sulcus bleeding–a leading symptom in initial gingivitis. Helv Odontol Acta 1971; 15 (02) 107-113
    PubMedSearch in Google Scholar
  • 21 Lowenguth RA, Greenstein G. Clinical and microbiological response to nonsurgical mechanical periodontal therapy. Periodontol 2000 1995; 9 (01) 14-22
    CrossrefPubMedSearch in Google Scholar
  • 22 Proye M, Caton J, Polson A. Initial healing of periodontal pockets after a single episode of root planing monitored by controlled probing forces. J Periodontol 1982; 53 (05) 296-301
    CrossrefPubMedSearch in Google Scholar
  • 23 Guentsch A, Kramesberger M, Sroka A, Pfister W, Potempa J, Eick S. Comparison of gingival crevicular fluid sampling methods in patients with severe chronic periodontitis. J Periodontol 2011; 82 (07) 1051-1060
    CrossrefPubMedSearch in Google Scholar
  • 24 Konopka L, Pietrzak A, Brzezińska-Błaszczyk E. Effect of scaling and root planing on interleukin-1β, interleukin-8 and MMP-8 levels in gingival crevicular fluid from chronic periodontitis patients. J Periodontal Res 2012; 47 (06) 681-688
    CrossrefPubMedSearch in Google Scholar
  • 25 Apatzidou DA, Kinane DF. Quadrant root planing versus same-day full-mouth root planing. I. Clinical findings. J Clin Periodontol 2004; 31 (02) 132-140
    CrossrefPubMedSearch in Google Scholar
  • 26 Jia L, Jia J, Xie M. et al. Clinical attachment level gain of lasers in scaling and root planing of chronic periodontitis: a network meta-analysis of randomized controlled clinical trials. Lasers Med Sci 2020; 35 (02) 473-485
    CrossrefPubMedSearch in Google Scholar
  • 27 Pai BSJ, Krishnan NR, Walveker A. et al. Comparative evaluation of sclerostin levels in gingival crevicular fluid in the treatment of chronic periodontitis patients using diode laser as an adjunct to scaling and root planing: a clinico-biochemical study. Contemp Clin Dent 2021; 12 (03) 276-281
    CrossrefPubMedSearch in Google Scholar
  • 28 Yu S, Zhao X, Zhang Y, Liu Y, Li A, Pei D. Clinical effectiveness of adjunctive diode laser on scaling and root planing in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis. Lasers Med Sci 2022; 37 (02) 759-769
    CrossrefPubMedSearch in Google Scholar
  • 29 Hatipoğlu M, Aytekin Z, Daltaban Ö, Felek R, Firat MZ, Üstün K. The effect of diode laser as an adjunct to periodontal treatment on clinical periodontal parameters and halitosis: a randomized controlled clinical trial. Cumhur Dent J 2017; 20 (03) 152-160
    CrossrefSearch in Google Scholar
  • 30 Belibasakis GN, Bostanci N. The RANKL-OPG system in clinical periodontology. J Clin Periodontol 2012; 39 (03) 239-248
    CrossrefPubMedSearch in Google Scholar
  • 31 Hanna R, Dalvi S, Amaroli A, De Angelis N, Benedicenti S. Effects of photobiomodulation on bone defects grafted with bone substitutes: a systematic review of in vivo animal studies. J Biophotonics 2021; 14 (01) e202000267
    CrossrefPubMedSearch in Google Scholar
  • 32 Mastromatteo-Alberga P, Cárdenas LAE, Correnti M. Cytokines and MMPs levels in gingival crevicular fluid from patients with chronic periodontitis before and after non-surgical periodontal therapy. J Oral Res. 2018; 7 (03) 98-101
    CrossrefSearch in Google Scholar
  • 33 Pesevska S, Nakova M, Gjorgoski I. et al. Effect of laser on TNF-alpha expression in inflamed human gingival tissue. Lasers Med Sci 2012; 27 (02) 377-381
    CrossrefPubMedSearch in Google Scholar
  • 34 Graves DT, Cochran D. The contribution of interleukin-1 and tumor necrosis factor to periodontal tissue destruction. J Periodontol 2003; 74 (03) 391-401
    CrossrefPubMedSearch in Google Scholar