Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Research Protocol
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZK04 - ZK07 Full Version

Comparison of Open Flap Debridement, with and without Diode Laser in the Management of Chronic Periodontitis: A Randomised Split Mouth Clinical Trial


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58360.17394
Aishwarya Rathod, Priyanka Jaiswal, Deepika Masurkar, Pooja Chitlange

1. Postgraduate Student, Department of Periodontics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2. Professor, Department of Periodontics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 3. Postgraduate Student, Department of Periodontics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 4. Intern, Department of Periodontics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.

Correspondence Address :
Aishwarya Rathod,
Sharad Pawar Dental College Wardha, Maharashtra, India.
E-mail: aishwaryarathod55@gmail.com

Abstract

Introduction: The goals of periodontal therapy include preventing illness, slowing or stopping disease development, replacing lost periodontal tissues, and preserving the therapeutic outcomes. The apical repositioning of the gingival edge during traditional periodontal surgery exposes the root surface to the oral cavity and reduces pocket depth. It may lead to attachment loss, Gingival Recession (GR). It is also commonly recognised that periodontal surgery causes pain and suffering. Laser assisted periodontal therapy has been the subject of study in an effort to address these drawbacks.

Aim: To compare the efficacy of diode laser as an adjunct to Open Flap Debridement (OFD) with that of OFD alone in the management of chronic periodontitis patients.

Materials and Methods: This randomised clinical trial with split mouth study design will be conducted in Periodontics Department at Sharad Pawar Dental College, Wardha, Maharashtra, India, for a duration of six months. Thirteen patients (26 quadrants) with generalised chronic periodontitis patients will be selected. The Probing Pocket Depth (PPD) ≥5 mm after phase I therapy will be included in this split mouth study. Diode laser (920 nm) will be used as an adjunct to OFD (test) as compared with conventional flap surgery (control). Clinical parameters like Plaque Index (PI), Papillary Bleeding Index (PBI), PPD, Relative Attachment Level (RAL) and Relative Gingival Marginal Level (RGML) and GR will be recorded at baseline and six months post-therapy. Visual Analogue Scale (VAS) will be used to determine patient discomfort intraoperatively and after one week. A questionnaire for patient-based outcomes will be administered after period of six months postsurgery and response will be recorded. Student’s paired t-test will be used for comparing the treatment groups at baseline and six months.

Keywords

Periodontal therapy, Periopathogens, Pocket depth, Root planning

Periodontal disease is caused by the intricate interaction of infectious organisms such as bacteria and host factors (1),(2). Periodontitis is commonly recognised as a multi-bacterial infection that requires the action of a relatively less number of members of the anaerobic microorganism inhabiting the subgingival area and leads to the breakdown of the tooth’s supporting components (3),(4). Disruption of the biofilm by manual removal of subgingival plaque and, occasionally, additional use of antibacterial medicines, as well as mechanical surgical debridement of pocket and root surfaces affected by periodontal disease, are the most common procedures used to treat the illness (5).

The nonsurgical treatment results in inflammation resolution, bacterial load reduction, and Probing Pocket Depth (PPD) reduction. Nonsurgical therapy, on the other hand, does not always result in the total elimination of bacterial toxins from root surfaces in deep periodontal pockets. Inaccessible parts such as the furcation, grooves, and concavities (6) are not accessible for instrumentation. Furthermore, according to Schenk G et al., periopathogens are not killed by sonic and ultrasonic apparatus (7). In conditions of chronic inflammation, deeper pockets, class II and III furcation defects, and intrabony defects, surgical treatment is used. It improves access to root surfaces and also to osseous abnormalities (8).

Recently, laser-assisted periodontal therapy has gotten a lot of attention as a possible alternative or supplement to traditional mechanical debridement (9). The wavelength of a diode laser is 810 nm or 910-980 nm, which has little effect on tooth hard tissues. As a result, the laser is an outstanding soft tissue surgical laser that may be used to cut and coagulate gingiva and oral mucosa, as well as for soft tissue curettage and sulcular debridement. It has an antibacterial action as well (10).

The uniqueness of the study is that patients for this split mouth trial from rural areas will be selected to promote the oral hygiene awareness among rural population. After periodontal flap surgery, the patient’s perspective will also be taken into account using a questionnaire. The study is required to determine the laser’s effectiveness in terms of PPD reduction and Clinical Attachment Level (CAL) gain, patient perception as measured by a questionnaire, and patient pain tolerance as measured by a Visual Analogue Scales (VAS) score (11).

There is no other study including laser assisted periodontal flap surgery which includes patients only from rural population measuring VAS score with a questionnaire for patient-based outcomes (12) after periodontal therapy. Hence, this study will be conducted to compare the added effects of a laser in Open Flap Debridement (OFD) to conventional manual debridement using clinical variables such periodontal pocket depth and CAL.

OBJECTIVE

1. To evaluate periodontal PPD, CAL gain after conventional periodontal flap surgery.
2. To evaluate periodontal PPD, CAL gain after diode laser assister periodontal flap surgery.
3. To compare the periodontal PPD, CAL gain after conventional periodontal flap surgery and diode laser assisted periodontal flap surgery.

Null hypothesis: OFD in conjunction with laser may not result in significant PPD reduction and CAL gain as compared to OFD alone.

Alternate hypothesis: OFD in conjunction with laser may result in significant PPD reduction and CAL gain as compared to OFD alone.

Material and Methods

This randomised split mouth clinical trial will be conducted in Periodontics Department at Sharad Pawar Dental College, Wardha, Maharashtra, India, for a duration of six months. Ethical clearance was obtained from DMIMS (DU) {(DU)/IEC/2022/753}, Sawangi (Meghe), Wardha. Patients will be given further information about the study’s purpose and will be asked to sign an informed consent form.

Inclusion criteria: Participants aged between 30 to 55 years with chronic periodontal disease characterised by the presence of ≥5 mm or periodontal pockets indicated for flap surgical procedures based on clinical and radiographical confirmation of horizontal bone loss will be included in the study.

Exclusion criteria: Individuals with poor oral hygiene {Plaque Index (PI) ≥1}, patient who smoke (with a recent history of consuming more than 10 cigarettes per day) or use tobacco products of any kind.

Patients with poor endodontic/restorative treatment. Patient’s teeth with more than grade II mobility and a class III or class IV furcation defect. Patient’s with past surgery in the site chosen for investigation; females who are pregnant or nursing. The untreated acute infection determined clinically and/or radiographically in a specific location. If apical pathology, cemental pearls, root abnormalities, and fracture that makes removal difficult by odontoplasty, untreated decaying tooth at Cementoenamel Junction (CEJ) or root surface will be excluded from the study. Patients with any systematic disorder will also be excluded.

Sample size calculation:

Sample size is determined using the following formula

n = (Z1-α/2)2 p(1-p)÷ d2

where,

p=previous expected values 0.54, d=desired margin of error
Z1-α/2 2 confidence interval of 95%, n=sample size, Effect size dz=0.5
α err prob= 0.16, Power (1-β err prob)= 0.95, Output: Noncentrality parameter δ= 2.737
Critical t= 1.054, Df= 22
Total sample size= 26
Actual power= 0.90 (13)

Considering two groups the sample size is 13 in each group, hence the total sample size is 26.

Thirteen patients (26 quadrants) with generalised chronic periodontitis patients from only rural population to create the awareness of oral hygiene will be selected. The PPD ≥5mm after phase I therapy from rural population will be included in this split mouth study.

Diode laser (Biolase) (920 nm) will be used as an adjunct to OFD (test) as compared with conventional flap surgery (control). Clinical parameters: Plaque Index (PI), Papillary Bleeding Index (PBI), PPD, Relative Attachment Level (RAL) and Relative Gingival Marginal Level (RGML) will be recorded at baseline and six months posttherapy. VAS will be used to determine patient discomfort intraoperatively and after one week. It consists of 10 cm scale which had markings from 0 to 10 depicting the pain intensity from minimal to maximal (11). A pretested and prevalidated questionnaire will be used to assess the patient’s perception (12). Fourteen questions will be used, to evaluate the patients’ opinions on the status of gingival bleeding, the amount of food that gets stuck between their teeth, the amount of bad breath they experience, how clean they feel about their teeth, how confident they feel when smiling, how mobile their teeth are, how comfortable they are when chewing, how well they are able to chew hard, fibrous foods, whether they are in pain, how sensitive their teeth are, and overall gain of self-confidence. The patients will be given the questionnaire, after period of 6 months postsurgery and responses will be scored with a maximum of five and a minimum of one (12).

The mean and standard deviation (Mean±SD) values will be calculated for response of Questionnaire to assess the Patient- Based Outcomes following Periodontal Therapy (QPBOPT) questionnaire (12) and also for all clinical parameters including PI, PBI, RGML, RAL, PPD, and Gingival Recession (GR).

Primary outcome: Will be reduction in PPD and gain in CAL. Secondary outcome will be reduction in PI, PBI, and patient’s perception after flap surgery.

Two surgical sites requiring periodontal flap surgeries will be selected and these surgical sites will be randomly assigned to the test and control groups by simple randomisation method using coin toss. The conventional access flap surgery (Control group 0 will be performed first and the second periodontal flap surgery (laser-assisted access flap surgery) (Test group) will be done after the first surgery.

Initial therapy: Full mouth scaling will be performed on the initial appointment, along with root planing under local anaesthetic if necessary. A coronoplasty will be performed, and the patient will be given oral hygiene recommendations. Plaque control methods will be repeated until the plaque score drops to less than one. Periodontal examination will be done every two weeks after the initial treatment. A custom built occlusal acrylic stent will be made for the standardisation of probe angulations and correct positioning.

An alginate impression will be taken for the preparation of the cast model, on which the occlusal stent will be created using acrylic material. The stent should cover the occlusal surface of the test tooth, atleast one adjacent tooth, and the coronal third of the teeth. To allow consistent periodontal probe settings, a reference point (slot) will be marked on the stent at the deepest site of the affected tooth. The apical border will be a fixed reference point and will be linear.

Clinical Measurements

PI, PBI, PPD, RCAL, RGML and GR will be documented at baseline and after 6 months. PI, which depicts plaque build-up over the gingival edge of teeth, will be utilised to evaluate the patient’s oral health. PBI will be used to assess gingival inflammation (13).

A. Indices

1. Plaque Index (PI)- (Turesky Gillmore Glickman Modification of Quigley-Hein 1970) (14);
2. Papillary Bleeding Index (PBI)- (Muhlemann HR 1977) (15).

B. Probing Measurements

Both the groups will be documented in order to analyse the results. The PPD will be measured from the bottom of the pocket to the gingival margin. This measurement will be taken by a UNC-15 (University of North Carolina, Hu-Friedy) periodontal probe. These clinical parameters will be collected at baseline and 6 months following surgery after the creation of an acrylic stent (13).

Surgical procedure: Before surgery, individuals will be asked to rinse their mouths with 0.2% Chlorhexidine (CHX) gluconate solution for 1-2 minutes. Under all aseptic circumstances, nerve block will be administered using a local anaesthetic solution of 2% xylocaine with 1:1,000,000 epinephrine.

Flap Design (Incisions): For the reflection, Bard-Parker no. 12 or 15 surgical blades will be employed. Intra-crevicular incisions will be made on the buccal and lingual surfaces to reflect the flap. The incisions should be made as far inter-proximally as possible to promote primary wound closure and preserve entire interdental papillae. Vertical releasing incisions will be made on adjacent teeth to increase exposure.

Flap reflection: A periosteal elevator (24G Hu Friedy, USA) will be utilised to lift the full thickness flap in order to acquire access to alveolar bone in the location of the bone defect. Debridement of the defect will be completed by removing sick tissue from the flap’s under-surface while also taking precautions to preserve the flap from rupturing or papillae loss.

Procedure for test groups: The 920 diode laser at power of 1.5 W in contact mode will be used by placing the fiber-optic tip at a 45° angle to the inner aspect of the flap, avoiding directing it toward the bone and teeth. Horizontal overlapping strokes will be used on the inner lining of both facial and palatal flaps for about 10 seconds in relation to each tooth. Following this, the site will be irrigated with normal saline. Sutures {Johnson & Johnson Ethicon Mersilk nonabsorbable surgical suture (4-0)} will be used to close the flaps, and a periodontal pack will be applied for seven days.

Procedure for control group: Hand scalers and curettes (Gracey curettes, Hu-Friedy, United States of America) will be used to debride the osseous defect first, then by power driven scalers. To avoid over-trimming the flap, the inner surface of the flap or papillae will be debrided cautiously. Hand instruments will be used to accomplish a thorough root planing. Sutures will be used to close the flaps, and a periodontal pack will be applied for seven days.

Postoperative care: Antibiotics and analgesics will be administered for five days as part of the postoperative treatments. For roughly six weeks, patients will be instructed to swish with 0.2% chlorhexidine mouthwash. Eight to 10 days after surgery, the periodontal dressing and sutures will be removed. For the next six weeks, no teeth cleaning or biting will be permitted in the surgical site. Individuals will be instructed to clean the surgical site in an apicocoronal orientation for a further 2-3 weeks using cotton pellets dipped in 0.2% chlorhexidine. Following that, oral hygiene procedures such as brushing and interdental cleaning aids will be reintroduced, along with the use of chlorhexidine mouthwash.

Maintenance care: Patients will be evaluated for PI and PBI at six months after surgery. At visit the patient will receive oral hygiene care as well as ultrasonic scaling. Upto six months after surgery, no probing will be done. VAS score will be recorded for patient’s discomfort intraoperatively and after one week.

Re-examination: At six months after surgery, a full postoperative examination will be performed. All clinical measurements and parameters will be re-evaluated. At six months after surgery, clinical pictures will be taken. Questionnaire for patient-based outcomes after periodontal therapy will be administered to patients and response will be recorded.

Statistical Analysis

The mean and standard deviation (Mean±SD) values will be calculated for PI and PBI, response of QPBOPT questionnaire and also for all clinical parameters including RGML, RAL, PPD. Association will be done with baseline data to six months data for each treatment group by the use of student’s paired t-test. This test will be used for comparing the treatment groups at baseline and six months. If the probability value p-value >0.05, the difference seen will be measured as insignificant and if p-value <0.05, it will be considered significant.

Discussion

Behdin S et al., investigated the efficacy of dental lasers as an addition to resective or regenerative surgical periodontal treatment in a systematic review and meta-analysis (16). The researcher found that there is inadequate data to demonstrate the usefulness of dental lasers as an addition to resective or regenerative surgical periodontal treatment. Lobo T and Pol D studied the role of diode laser irradiation in OFD in the treatment of chronic periodontitis in 2015 (17). After therapy, all clinical metrics improved dramatically, with no statistically significant differences between the two groups for any of the aspects. The only difference was that the laser-treated group had a significantly lower level of gingival inflammation. The laser treatment was well received by the patient and had no side effects. The researchers found that the diode laser can be employed as an additional to the treatment of chronic periodontitis while also reducing gingival inflammation.

On the basis of clinical indicators and microbiological investigation, Gokhale SR et al., investigated the effectiveness of diode laser as an adjuvant to manual debridement in periodontal flap surgery (13). The study comprised 30 patients with generalised chronic periodontitis who had a Probing Depth (PD) of more than 5 mm following phase I therapy. In a split-mouth trial, a laser was employed as an adjuvant to OFD (group A) vs conventional flap surgery (group B). At baseline and three months after treatment, clinical data (PI, GI, PD, and CAL) as well as subgingival plaque samples from group A and groups B were evaluated. The difference in clinical aspects between the group A and group B was not statistically significant. However, the group A had a significant decrease in colony forming units of obligate anaerobes as compared to the group B. According to the VAS, the diode laser was well tolerated by the individuals. The authors found that the diode laser’s antibacterial impact was clearly demonstrated by a larger reduction in Colony Forming Unit (CFU) of obligatory anaerobes in the group A than in group B.

The clinical results of Er, Cr:YSGG Laser Aided Pocket Treatment (ELAPT) against OFD were examined by Gupta M et al., (18). At two sites, fifteen patients with PD of 5 mm and 8 mm were chosen. ELAPT was used on the test sites (group 1), while OFD was used on the control sites (group 2). PI, Gingival Index (GI), modified Sulcular Bleeding Index (mSBI), PD, CAL, and GR were measured at baseline, three months, and six months. The mean gain of CAL in group 1 at three and six months (1.60±0.78 and 1.80±0.63) was similar (p >0.05) to the value of group 2 (1.93±0.88 and 2.00±0.54). GR increased significantly (p <0.05) only in group 2 at 3 and 6 months (1.80±0.56 and 1.87±0.64) compared to group 1 (0.50±0.68 and 0.60±0.74).

The therapeutic efficacy of laser-assisted and conventional OFD operations was compared by Shetty S et al., (19). In a split-mouth design, 30 sites in 15 patients (9 males and 6 females) with chronic periodontitis and a PD of less than 5 mm following initial therapy was randomly assigned to the group A (laser-assisted flap debridement) or the Group B (traditional OFD). At baseline, 3 months, and 6 months, clinical and microbiological data were examined. The healing index was also used to assess soft tissue recovery at one week, two weeks, one month, three months, and six months.

The alteration in clinical features in the group A and group B was not significant at different time periods. The microbiological study demonstrated a significant decrease in periodontal pathogen colony forming units in the group A when compared to the Group B at immediate postoperative and six months. When compared to traditional OFD, laser aided flap surgeries had higher therapeutic effects in terms of microbiological parameters.

In a split-mouth randomised control trial, Torkzaban P et al., compared the efficacy of Er,Cr: YSGG laser treatment to the usual approach in periodontal flap surgery (20). The three-month follow-up period revealed decreases in PI and GI in both treatment groups. When compared to the control group, the laser-treated sides had much lower indices. The authors found that Er,Cr:YSGG laser assisted periodontal flap surgery produced identical treatment results to the traditional method, and that it might be regarded a safe and effective therapy option. OFD with laser is a more effective procedure than OFD alone because patients experience less pain, there is less bleeding and there is less intraoperative time. It is also a safer method.

Conclusion

There is less mechanical trauma, fewer postoperative complications like pain and swelling, and being a minimally invasive procedure with better patient compliance, shorter procedure times, minimal bleeding, and an added antimicrobial effect seem to be additional benefits of laser-assisted OFD. As a complement to other treatments for chronic periodontitis, the diode laser can be used safely and efficiently.

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DOI and Others

DOI: 10.7860/JCDR/2023/58360.17394

Date of Submission: Jun 09, 2022
Date of Peer Review: Aug 12, 2022
Date of Acceptance: Oct 15, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 25, 2022
• Manual Googling: Oct 06, 2022
• iThenticate Software: Oct 13, 2022 (20%)

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