Comparative evaluation of 0.2% hyaluronic acid gel (Gengigel®) and photodynamic therapy in the Treatment of Chronic Periodontitis: A Clinical Study.
Journal Title: International Journal of Dental Science and Innovative Research (IJDSIR) - Year 2019, Vol 2, Issue 2
Abstract
Introduction Periodontal tissues represent a unique system, where epithelial, non-mineralized, and mineralized connective tissues exist in harmony. The integrity, however, is lost during chronic inflammation associated with periodontal disease.1 Periodontitis is an inflammatory disease, which is characterized by the presence of gingival inflammation, periodontal pocket formation and loss of connective tissue and alveolar bone of the teeth, that results from the extent of subgingival inflammation induced by bacteria present in the plaque.2 The main objective of periodontal therapy is to eliminate deposits of bacteria and bacterial niches by removing the supragingival and subgingival biofilm. The gold standard for the non-surgical treatment of periodontal disease remains the mechanical debridement with scaling and root planing (SRP) that aims at removal of plaque, calculus and endotoxins from both supragingival and subgingival root surfaces of the teeth in order to prevent disease progression.3 The usual nonsurgical treatment modalities for periodontitis include scaling and root planning, local drug delivery, lasers, and certain advanced techniques like photodynamic therapy. Though combination of mechanical and chemical treatment provides good recovery from the initial status of the disease.4 As a part of non-surgical therapy, local drug therapy is a common mode of therapy. Topical delivery has the advantage of bringing a high concentration of drug to a particular targeted site. The side effects of systemic antibiotic therapy and the possible failing compliance of the patient can be minimized by using locally applied delivery systems. Therefore, a positive influence on the subgingival biofilm may be accomplished with a local delivery system.5 In addition to the better-known antimicrobials and biomaterials, there are number of substances which are less well known and less used at present, and at the same time, have the potential to augment results of periodontal therapy. One such molecule is ‘Hyaluronic acid’.6 Hyaluronic acid (HA) is also known as hyaluronan or hyaluronate. It is a linear polysaccharide found in extracellular matrices of connective tissue, synovial fluid and other tissues. Hyaluronan is produced by fibroblasts in the presence of endotoxins.7 Hyaluronic acid is known to enhance the inflammatory cell and extracellular matrix cell infiltration into the wound site. Also, causes elevation of proinflammatory cytokine production by inflammatory cells and extracellular matrix cells. Most commonly scavenges reactive oxygen species, such as superoxide radical and hydroxyl radical thus preventing periodontal destruction.8 In the last decade interest in hyaluronan has intensified in cell biology, pathology and immunology after it has shown that cells have receptors that can specifically recognize its pure polysaccharide structure. Thus, Hyaluronan administration in periodontal disease sites has resulted in many beneficial effects.6,9 Recent advances in non-surgical therapy also includes photodynamic therapy (PDT) which is emerging novel approach used in the treatment of chronic periodontitis. Photodynamic therapy is an oxygen dependent photochemical reaction that occurs upon exposure to a particular wavelength of light in the presence of a suitable photosensitizer dye. The various photosensitizer dyes used include, a) Tricyclic dyes with different mesoatoms., E.g. Acridine orange, proflavine, riboflavin, methylene blue, toluidine blue, fluorescein, and erythrosine. b) Tetrapyrroles. E.g.: Porphyrins and derivatives, chlorophyll, phylloerythrin, and phthalocyanines, and c) Furocoumarins. E.g.: Psoralen and its methoxy-derivatives, xanthotoxin, and bergaptene.10 The various light sources utilized in photodynamic therapy includes lasers of various wavelengths, non-laser light sources like light emitting diodes (LED). The photochemical reaction results in generation of cytotoxic species such as superoxide, hydroxyl radicals, hydrogen peroxide and singlet oxygen. Among these, reactive oxygen species singlet oxygen plays a major role in microbial destruction, as it can interact with large number of biological substrates inducing oxidative damage on the cell membrane and cell wall of bacteria, fungi, and viruses. Photodynamic antimicrobial chemotherapy represents an alternate antibacterial, antifungal and antiviral treatment against drug-resistant organisms. Applications of PDT in dentistry are growing rapidly. PDT is also used in the treatment of oral cancers, bacterial and fungal infections, and also in the photodynamic diagnosis of malignant transformation of oral lesions and also in the non-surgical management of patients with periodontitis.11 Several studies have been done to compare the efficacy of hyaluronic acid as an adjunctive approach to scaling. They revealed positive results with respect to hyaluronic acid based Gengigel.4 Also, there has been significantly good results obtained by the recent studies done on PDT with SRP than SRP alone. But there is paucity of studies which compare the effectiveness of Gengigel with SRP to PDT with SRP. Therefore, present study evaluates the efficacy of Gengigel with SRP, Photodynamic therapy with SRP, SRP alone in the nonsurgical treatment of chronic periodontitis.
Authors and Affiliations
Dr. Esha Tanwar
Keywords
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