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   Table of Contents - Current issue
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May-June 2021
Volume 11 | Issue 3
Page Nos. 231-356

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REVIEW ARTICLES  

Oral health system in Myanmar: A review p. 231
Tin Htet Oo, Sukanya Tianviwat, Songchai Thitasomakul
DOI:10.4103/jispcd.JISPCD_438_20  
Objectives: The study aims at reviewing Myanmar’s current situation to consider an improved oral health system and at promoting the oral health status of the Myanmar population. Materials and Methods: This review was conducted using the World Health Organization’s (WHO’s) six building blocks of the health system: oral health-care service delivery, dental workforce, oral health information system, essential medicine, health financing, and leadership and governance. The review was established on scientific articles and documents and information from reliable government and nongovernment organizations’ websites. Results: According to the National Oral Health Survey (2016–2017), the prevalence rate of untreated caries in six-year-old Myanmar children (84.1%), and in the 35–44 and 65–74 age group (above 40%) is high, which reflects a low utilization of oral health-care services. The dentist to population ratio is approximately 1:16,000: There are around 5,000 dentists and 400 trained dental nurses in Myanmar, and only about 1,000 dentists serve in government sectors. The inequalities in dental health care are compounded by a limited dental workforce and inequality of dentists between the public and private sectors in Myanmar. In the last National Health Plan (NHP, 2006–2011), the Myanmar government’s funding for required dental equipment and materials in each dental unit (around 5726 USD) has been considered inadequate. The current expenditure is not transparent. The other challenges are an insufficient supply of dental materials and instruments to all public dental sectors and a lack of oral health-care infrastructure. Conclusions: Such findings suggest a pressing need to address the effective oral health-care system and decree the specific goals for the Myanmar population’s oral health.
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Future challenges of Covid-19 and oral manifestations in daily dental practice: A literature review p. 242
Grecia Riofrio, Stephanny Castillo, Gabriela Salcedo, Daniel Alvitez-Temoche, Romel Watanabe, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_21_21  
Objective: Some patients reportedly present with oral manifestations of coronavirus disease 2019 (Covid-19). It is unknown if this is due to the virus itself or a side effect of treatment; however, severe acute respiratory syndrome coronavirus 2 has been shown to have a predilection for angiotensin-converting enzyme receptors that are present in the respiratory tract, oral mucosa, tongue, and salivary glands, causing alterations in taste and smell. Therefore, the objective of this review was to present the future challenges of Covid-19 and oral manifestations in daily dental practice through a literature review. Materials and Methods: Scientific evidence in the databases Scopus and PubMed was searched using the Boolean operators. Articles published in Spanish and English between January and December 2020 were included. Results: Of the 89 articles found in Scopus, 69 were of the open access type and 20 were in the “others” category; only 22 scientific articles were found in PubMed. Conclusion: It is important to take into account these clinical manifestations such as loss of taste and smell in order to detect the disease. Good oral hygiene is also recommended as a preventive measure to reduce viral load, which considerably reduces the probability of infecting other people who are in contact with the infected patient.
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Historical evolution and filtering characteristics of masks and respirators in dentistry in the context of COVID-19: A literature review p. 248
Angela Ramírez, Dagny Ochoa, Ginna Llanque, Briggitte Trelles, Romel Watanabe, Daniel Alvitez-Temoche, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_22_21  
Objectives: At present, it is very important to identify the available literature regarding the use of masks and respirators by analyzing their historical evolution in the medical field. In addition, consideration should be given to the major filtering characteristics of those most used due to the current SARS-CoV-2 pandemic. Therefore, the purpose of this literature review is to describe the qualitative evolution that facemasks and respirators have undergone along with their different characteristics. Materials and Methods: This literature review was conducted between September and December 2020. Articles were identified from PubMed Central, Scopus, and Web of Science. The following keywords were used: “COVID-19,” “dentistry,” and “masks.” These MeSH terms were combined with the Boolean operators “AND” and “OR.”Results: We found 36 articles in PubMed Central, 21 in Scopus, and 17 in Web of Science, which included reviews, clinical, descriptive, and experimental trials. Conclusion: The emergence of new pathogens leads to continuous improvement in masks and respirators. It was determined that for the dental field, respirators with filtration characteristics greater than 95%, such as FFP3, N100, N95, and KN95, are indicated in addition to their decontamination and reuse processes.
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Prevalence of dental caries in the Indian population: A systematic review and meta-analysis p. 256
Pragya Pandey, Tanya Nandkeoliar, AP Tikku, Diksha Singh, Manish Kumar Singh
DOI:10.4103/jispcd.JISPCD_42_21  
Objectives: To evaluate the pooled prevalence of dental caries among Indian population through systematic review and meta-analysis. Materials and Methods: A keyword search was conducted in PubMed, Science Direct, Google Scholar, Cochrane, and Scopus databases using relevant key words to extract the data pertaining to dental caries in Indian population. The search criteria included manuscripts published in English language from March 2009 to March 2019 and employed standard Boolean operators. The studies which met the inclusion criteria were independently reviewed by two researchers and their quality was assessed by the Newcastle–Ottawa Scale. The overall prevalence was deduced using the random effects model with prime focus given to the site of anatomical origin. R software version 3.5.2. was used for statistical analysis. Results: Post screening, out of the 253 articles identified, 70 met the inclusion criteria and were used to generate the meta-analysis. Among them, only few studies investigated the prevalence of root caries (n = 1). Overall prevalence of dental caries was 54.16% (CI: 0.4966–0.5866), whereas age-specific prevalence was 62% in patients above 18 years and 52% among 3–18 years of age (P < 0.0001). Maximum overall prevalence was noted in mixed dentition (58%). Region wise prevalence was more in western India (72%). Use of decayed, missed, and filled teeth as diagnostic criteria for early childhood caries was only 29%. Conclusions: Besides an overall prevalence of 54.16%, there exists a remarkable variation in dental caries prevalence rates as per age, diagnostic criteria, dentition, and geographical region. Furthermore, research should be focused on the prevalence of anatomical site specific caries as well.
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Application of adipose tissue stem cells in regenerative dentistry: A systematic review p. 266
Sumit Gaur, Rupali Agnihotri
DOI:10.4103/jispcd.JISPCD_43_21  
Aim: The aim of this study was to systematically review the applications of adipose tissue stem cells (ADSCs) in regenerative dentistry. Materials and Methods: An electronic search was conducted in Medline (PubMed) and Scopus databases. The original research associated with the role of ADSCs in regeneration of alveolar bone, periodontal ligament (PDL), cementum as well as the dental pulp was evaluated. Among the included studies, three animal studies and one human study had low risk of bias. Results: A total of 33 relevant studies were included in the review. The animal models, in vivo human, and in vitro studies revealed that ADSCs had a significant osteogenic differentiation potential. Besides, they had potential to differentiate into PDL, cementum, and dental pulp tissue. Conclusion: The ADSCs may be specifically applied for bone tissue engineering in the management of alveolar bone defects, specifically in dental implants and periodontal disease. However, their role in regeneration of PDL, cementum, and dental pulp requires further investigations. Overall, their applications in regenerative dentistry needs further verification through human clinical trials.
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ORIGINAL ARTICLES Top

Palatal inflammation and the presence of Candida in denture-wearing patients p. 272
Patrayu Taebunpakul, Pimporn Jirawechwongsakul
DOI:10.4103/jispcd.JISPCD_368_20  
Aim: Denture stomatitis (DS) is a common inflammatory reaction in denture wearers. The severity of palatal inflammation in DS is believed to be related to Candida colonization. The present study evaluated the presence of Candida at the palatal and the denture surface. The factors associated with DS were also investigated. Materials and Methods: Eighty-two denture wearers were evaluated for DS based on Newton’s classification. The samples were collected from palatal mucosa and the denture surface for Candida culture. The predisposing factors associated with DS were also assessed by questionnaire and by oral and dental prosthesis examination. Results: Thirty patients showed no signs of DS (36.59%), while 52 patients (63.41%) had DS. Candida was detected in 81.71% of all patients and specifically in 26.83% and 54.88% of non-DS and DS patients, respectively. The proportion of patients with a large amount of Candida at the palatal mucosa in the DS group (40.38%) was higher than in the non-DS group (26.67%) but not significantly different (P > 0.05). The amounts of Candida among the different Newton types also showed no statistically significant differences (P > 0.05). Candida was also detected on the denture surface of the non-DS (34.15%) and DS patients (57.32%). The amounts of Candida on the denture surface between the two groups showed no statistically significant difference (P > 0.05). The predisposing factors related to DS included the absence of occlusal rest and poor denture stability (P < 0.05). Conclusions: In this study, no association between the amount of Candida and DS was found. Mycological examination may be useful for the detection of Candida-induced DS and management. However, further study is required to establish a protocol for antifungal drugs prescription in the treatment of Candida-induced DS among the Newton type.
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Determining association between cognitive function and oral health status among rural community dwelling geriatrics p. 281
Arthi Balasubramaniam, Madan Kumar Parangimalai Diwakar, Sridhar Vaitheswaran, MP Santhosh Kumar, S Sushanthi, Indumathy Pandiyan
DOI:10.4103/jispcd.JISPCD_394_20  
Objective: Numerous prospective studies worldwide investigated the association between oral health status and dementia or cognitive decline. No clear agreement has emerged on the association. This study aimed to determine the association of cognitive function and oral health status among community dwelling geriatrics in rural South India. Materials and Methods: A cross-sectional study was conducted among community dwelling geriatrics in rural South India by recruiting 211 individuals aged above 60 years. Their cognitive function was assessed using pre-validated community screening instrument for dementia (CSI-D) which has informant and cognitive scale. The data on cognitive function was collected by community health workers in electronic version (Web app). Their oral health status was assessed by World Health Organization (WHO) oral health assessment form in electronic version (Web app). Results: From the logistic regression analysis, it was observed that cognitive impairment showed an association with 1.6- and 1.9-times risk for root caries and a greater number of missing teeth (P ≤ 0.05). No association of other oral health parameters such as gingivitis, periodontitis, dental erosion, and dental trauma with cognitive impairment exhibited. Conclusion: From the results, it can be concluded that cognitive impairment has an association with root caries and number of missing teeth which increases the risk for the same and vice versa.
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“Modified Schirmer test in assessment of salivary flow rate among patients on antidepressants”: A comparative study p. 287
Manipal Shruthi, Vathsala Naik, Pooja Naik, Raghavendra Kini, Ashwini Avanti, Supriya Bharti
DOI:10.4103/jispcd.JISPCD_416_20  
Aims: The objective of this study was to assess salivary flow rate (SFR) among healthy subjects or patients on antidepressant drugs such as tricyclic antidepressants (TCAs) and selective serotinin reuptake inhibitors (SSRIs) by using the “Modified Schirmer Test” (MST). To evaluate and correlate salivary flow rate by using MST and comparing it with the spitting method in patients on antidepressants and healthy control subjects. Materials and Methods: Data were collected from the patients visiting the dental college and the psychiatry department. A total of 105 subjects were included in the present study, dividing Group I as control, Group II as SSRIs, and Group III as TCAs. In all subjects, a screening questionnaire was recorded, SFR was determined by the spitting method, and MST was carried out in the morning. The MST was performed by placing a modified Schirmer tear strip (STS) on the floor of the mouth for all subjects, and readings were taken for 3 min. Results: The SFR value obtained among Group I by the spitting method was 0.83 ml at 5 min, and by the MST method was 34.97 mm at 3 min, with a P value of 0.860. The SFR value obtained among Group II by the spitting method was 0.47 ml at 5 min, and by the MST method was 26.25 mm at 3 min, with a P value of 0.001, which was highly significant. The SFR value obtained among Group III by the spitting method was 0.394 ml at 5 min, and by the MST method was 10.71 mm at 3 min, with a P value of 0.041, which was significant. Conclusions: A significant positive correlation was observed between the SFR value obtained by both the spitting method and MST. From our study, we can conclude that the MST can be used as an effective noninvasive tool to estimate SFR.
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Golden standard and golden proportion of maxillary anterior teeth among Saudi population in Makkah p. 294
Mohamed Fattouh Abdallah, Omer H Alamoudi, Abdullah Muneer Ali, Raian A Marzogi, Mohammed A Bafaraj, Wahdan Mohammed Abdelghany Elkwatehy
DOI:10.4103/jispcd.JISPCD_432_20  
Background: Maxillary anterior teeth are important in achieving optimum aesthetics, Different methods are used to calculate their dimension: as golden standard (GS) to measure Width/Height (W/H) of anterior teeth and Golden Proportion (GP) to measure their perceived widths. Researchers had reported on GS and GP in different populations. Objectives: The aim of the present study is to evaluate the occurrence of GS and GP of maxillary anterior teeth among the Saudi population in Makkah. Materials and Methods: A total of 384 participants (2304 teeth) were included in this study; photographs were taken by using a digital camera at a fixed distance and saved on a personal computer; the perceived mesio-distal widths and occluso-gingival heights of the maxillary anterior teeth were measured; GS was calculated from W/H of upper central incisors (W11/H11 and W21/H21); and GP was calculated from width of canines/laterals (W13/W12 and W23/W22) and laterals/centrals (W12/W11 and W22/W21). The normal range of GS was considered between 75% and 85%, whereas the normal range of GP was considered between 55% and 65%. Data were analyzed by using suitable statistical tests, and p-value ≤ 0.05 was considered statistically significant. Both GS and GP were compared in relation to gender, race, and shape of the face. Results: There were 43% of GS ratios, 14% of GP of canines/laterals, and 34% of GP ratios of laterals/centrals that were within the normal range. There were no significant differences between GS of males and females (p=0.512) as well as among different races (0.137), whereas there were significant differences among different face shapes (p=0.001). For GP of canines/laterals, there were significant differences between males and females (p=0.000), different races (p=0.000), and different face shapes (p=0.001). For GP of laterals/centrals; there were no significant differences between males and females (p=0.216) whereas there were significant differences among different races (p=0.000) and different face shapes (p=0.007). Conclusion: The GS was 85% among the Saudi population in Makkah and it was more prevalent than other golden measures. The GP was 77.5 for canines/laterals and 65.8 for laterals/centrals, and their frequencies were very low. Personal characteristics and dento–facial specifications should be considered to obtain maximum aesthetics.
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Cleaning of endodontic files with and without enzymatic detergent by means of the manual method versus the ultrasonic method: An experimental study p. 307
César F Cayo-Rojas, Estefany Brito-Ávila, Ana S Aliaga-Mariñas, Karen K Hernández-Caba, Emylain D Saenz-Cazorla, Marysela I Ladera-Castañeda, Luis A Cervantes-Ganoza
DOI:10.4103/jispcd.JISPCD_8_21  
Aim: The aim of this article is to evaluate the cleanliness level achieved with and without the application of enzymatic detergent for the manual method versus the ultrasonic method, applied to Flexoreamer K-type files No. 25, No. 30, and No. 35. Materials and Methods: 192 K-type Flexoreamer files were divided into four categories: A1 (ultrasonic method with enzymatic detergent), A2 (ultrasonic method without enzymatic detergent), B1 (manual method with enzymatic detergent), and B2 (manual method without enzymatic detergent). Each category was randomly distributed in three groups of 16 files each (No. 25, No. 30, and No. 35). The files were used for biomechanical instrumentation of the root canal in premolars. The active part of the files was examined under a stereomicroscope, considering four cleaning levels: 4 (100% cleanliness), 3 (95–99% cleanliness), 2 (85–94% cleanliness), 1 (75–84% cleanliness), and 0 (less than 75% cleanliness). For hypothesis testing, the Mann–Whitney U-test was used to differentiate between techniques, and the Kruskal–Wallis multiple comparison test was used to compare pairs of files within each cleaning method. Results: When using enzymatic detergents, the manual and ultrasonic methods did not show significant differences when comparing each group of the files analyzed (P > 0.05). However, when comparing the cleaning level without enzymatic detergent between the manual and ultrasonic methods, we observed that it obtained a superior result when compared with the manual method for each type of file: No. 25 (P = 0.021), No. 30 (P < 0.001), and No. 35 (P < 0.001). Both methods achieved a significantly higher level of cleaning with the application of the enzymatic detergent (P < 0.05) than without applying it. Conclusion: The ultrasonic cleaning method proved to be the most effective method for the removal of biologic waste when compared with the manual method using a nylon brush. However, there was no significant difference between these two methods when enzymatic detergent was used.
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Dental-craniofacial characteristics of Southern Vietnamese people with well-balanced face on cephalometric films and its comparison with Caucasians and Northern Vietnamese population p. 316
ThuyTrang Thi Ho, QuynhTam Thi Luong
DOI:10.4103/jispcd.JISPCD_13_21  
Objectives: The objective of this study was to evaluate the dental-craniofacial measurements of the Southern Vietnamese people aged 18 to 25 with well-balanced face on cephalometric films. Materials and Methods: This cross-sectional study included 60 cephalometric tracings of students (30 males, 30 females). The cephalometric measurements were made on 34 angles, 26 distances, and 4 ratios of skeletal, dental, and soft tissue cephalometric analysis. The mean and standard deviation (SD) of the dental-craniofacial measurements were calculated and compared among male and female subjects and with Caucasian and the Northern Vietnamese population. Results: Among the Southern Vietnamese cephalometric tracing samples, the majority of the linear measurements were smaller in female than in male, while the angular and ratio measurements showed no significant difference. When compared with Caucasians, the cranial fossa lengths, the vertical facial heights, the lengths of maxilla and mandible, and the facial convexity of the Southern Vietnamese people were significantly smaller (P < 0.01), while the upper and lower incisors protrusion, and lip protrusion were larger (P < 0.01). The maxillary and mandibular protrusions, and mandibular rotational patterns were similar between these two groups. When compared with the Northern Vietnamese population, the mandibular plane angle and the upper and lower incisor protrusion of the Southern Vietnamese people were significantly larger (P < 0.05). Conclusions: The dental-craniofacial measurements of the Southern Vietnamese people were different among male and female, and different than those of Caucasians and Northern Vietnamese population. Such differences should be taken into account when considering orthodontic and orthognathic treatment strategies.
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The impact of pregnancy and menopause on the correlation between salivary calcium levels, calcium intake, and bleeding on probing (BOP) p. 324
Sri Tjahajawati, Anggun Rafisa, Kintan Nurpratiwi Gumilar, Fitri Nurzanah, Rasmi Rikmasari
DOI:10.4103/jispcd.JISPCD_14_21  
Aims: Evaluate the impact of pregnancy and menopause on the correlation between salivary calcium levels, calcium intake, and bleeding on probing (BOP), so it can be used as indicators to determine the oral health status of pregnant and menopausal women. Materials and Methods: This was a descriptive study using a cross-sectional approach. Participants included 26 menopausal women, 24 pregnant women, and 35 control subjects. Salivary calcium levels were measured using an atomic absorption spectrophotometer, and calcium intake was assessed using a semi-quantitative food frequency questionnaire. Other supporting data included height, weight, blood pressure, blood glucose level, salivary pH, and volume. Results: The mean salivary calcium levels of pregnant women (0.72 ± 0.61 mmol/L) were lower than those of control subjects (1.69 ± 0.81 mmol/L), but the mean salivary calcium levels of menopausal women were higher (1.99 ± 1.24 mmol/L). Most of the subjects in all three groups had inadequate calcium intake. The mean BOP values of pregnant and menopausal women were higher than those of the control subjects. This study found the only variable that correlated with the salivary calcium level was the menopausal group’s blood glucose level (P = 0.009). Conclusions: Pregnancy and menopause did not have an impact on the relationship between salivary calcium levels and BOP but had an impact on the relationship between salivary calcium levels and calcium intake. Calcium intake did not affect salivary calcium levels in both conditions when compared with the control group.
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Efficacy of desensitizers in reducing post-preparation sensitivity prior to a fixed dental prosthesis: A randomized controlled clinical trial p. 332
Mohammed E Sayed, Harisha Dewan, Neda Alomer, Shaa Alsubaie, Hitesh Chohan
DOI:10.4103/jispcd.JISPCD_31_21  
Aims: The aim of this article is to evaluate and compare the effectiveness of Gluma, Shield Force Plus, and Telio CS desensitizers, in reducing pre- and post-cementation sensitivity for complete coverage restorations. Materials and Methods: The study was a double-blind, randomized, controlled clinical trial in which 56 patients requiring posterior three-unit fixed partial dentures were randomly assigned to four groups, each group with 14 patients (n = 14): Group C (Control group), Group GL (Gluma group), Group SF (Shield Force Plus group), and Group TC (Telio CS group). In the desensitizer groups, desensitizer application was performed following the manufacturer’s directions immediately after tooth preparation (first visit), before metal restoration try-in (second visit, 2 weeks after the first visit), and before final cementation (third visit, 2 weeks after the second visit). Sensitivity levels were scored and evaluated using a visual analog scale (VAS), using cold test and electric pulp test (EPT) during the three visits before the cementation, and then over the phone 2 weeks after the final cementation. The data were statistically analyzed using one-way analysis of variance (ANOVA) followed by post-hoc Bonferroni and unpaired t-tests. Results: One-way ANOVA revealed significant differences between the four groups. The post-hoc Bonferroni tests showed a significant decrease in the mean cold test scores from the first to third visit, with a p-value <0.001 for the GL, SF, and TS groups. The mean EPT scores also decreased significantly from the first to third visit (p< 0.001) for the GL and SF groups, whereas p = 0.023 for the TS group. Most of the subjects did not complain of any sensitivity post-cementation, except for one patient in Group TS. Conclusion: All three desensitizers were found to be effective in reducing pre- and post-cementation dentin sensitivity, as indicated by the consistent reduction in VAS scores throughout the visits.
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How do schoolchildren view other children who have discolored teeth? p. 340
Moza Al Khayyal, Manal Al Halabi, Iyad Hussein, Anas Salami, Helen Rodd, Amar Hassan, Mawlood Kowash
DOI:10.4103/jispcd.JISPCD_46_21  
Objectives: Facial look and expression affect how people are viewed by others. This study aimed to evaluate how schoolchildren in the Emirate of Sharjah, United Arab Emirates view their peers who have discolored teeth. Materials and Methods: A cross-sectional study using randomized cluster sampling of Sharjah public schools was conducted. A previously developed and validated social attribute questionnaire was utilized to determine children’s dental appearance-related judgments. Children aged 11–14 years were given photographs of subjects either with discolored teeth or without, and they were asked to rate them using six positive and five negative signifiers. The total attribute score (TAS) ranged from 11 (most negative) to 44 (most positive). A linear regression analysis and t-tests were performed to determine the effects of gender and age in mean TAS. Results: TAS was significantly lower among discolored teeth photographs when compared with photographs without teeth discoloration (P = 0.004). TAS was found to be significantly higher with increased age (P = 0.035), but gender had no significant effect. Conclusion: Teeth discoloration resulted in more negative social judgment between Sharjah schoolchildren and their peers.
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Efficacy of complex phytoadaptogens as an adjunct to non-surgical treatment of chronic periodontitis: A randomized clinical trial p. 348
Zhanna Valerevna Dzampaeva, Fatima Sergeevna Datieva, Zaira Savelevna Esenova, Elena Astanovna Takoeva
DOI:10.4103/jispcd.JISPCD_56_21  
Background: Many herbal formulas are used in dentistry in the complex treatment and prevention of periodontitis, but it is not always possible to achieve a long-term remission and stimulate regeneration of periodontal structures. Aim: The aim of this randomized clinical trial was to assess the efficacy of chronotherapy with complex phytoadaptogens (CFA) as an adjunct to non-surgical periodontal treatment (NSPT) and to achieve long-term remission. Materials and Methods: Forty systemically healthy patients with chronic generalized periodontitis (probing pocket depth ≥5 mm) were randomly divided into two groups: patients in one group received treatment with NSPT alone (group 2), whereas patients in another group received CFA in addition to NSPT (group 3). Twenty individuals with healthy periodontium (group 1) composed a control group. The clinical outcomes, Simplified Oral Hygiene Index (OHI-S), Sulcus Bleeding Index (SBI), Periodontal Index (PI), and Doppler ultrasound results, were assessed on baseline, after treatment, and 6 months after treatment. Results: There was a statistically significant difference between groups 2 and 3, in favor of group 3 in terms of microcirculation parameters—S (P = 0.03), M (P = 0.02), D (P = 0.03), and RI (P = 0.005); indicators of PI (P = 0.005), SBI (P = 0.03), and OHI-S (P = 0.006) were closer to the normal values during 6-month follow-up. Also there was a statistical difference (P < 0.05) at all time points compared with controls, for several parameters in intragroup comparison. Conclusion: The data obtained confirm the hypothesis that CFA application in chronic periodontitis treatment is more than appropriate for long-term prevention due to their immunomodulatory, anti-inflammatory, antioxidant, stress-limiting, chronotropic effects.
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