Abstract: Background: Periodontal diseases are chronic inflammatory conditions caused by microbial dental plaque. Although 0.2% chlorhexidine (CHX) is the gold standard adjunctive mouthwash for plaque control, its long-term use is associated with adverse effects, including tooth staining, altered taste sensation, and mucosal irritation. Attukal Kizhangu (Drynaria fortunei), a medicinal fern with antimicrobial, anti-inflammatory, antioxidant, and regenerative properties, has emerged as a potential herbal alternative. Aim: To formulate and characterize a 0.5% Attukal Kizhangu herbal mouthwash and evaluate its antimicrobial efficacy and clinical effectiveness compared with 0.2% CHX and normal saline. Materials and Methods: A randomized, parallel-arm, examiner-blinded clinical trial was conducted among 72 participants with gingivitis or periodontitis. Participants received normal saline, 0.2% CHX, or 0.5% Attukal Kizhangu mouthwash. The formulation was characterized by high-resolution mass spectrometry, pH, surface tension, stability, and antimicrobial susceptibility testing. Following scaling and root planing, participants used the assigned mouthwash twice daily for 90 days. Clinical outcomes were assessed using the oral hygiene index-simplified (OHI-S), plaque index (PI), gingival index (GI), and gingival bleeding score (GBS). Results: Both the Attukal Kizhangu and CHX groups showed significant reductions in OHI-S, PI, GI, and GBS scores after 3 months ( P < 0.001), with no significant intergroup difference ( P = 0.08). Approximately 75% of participants achieved complete resolution of gingival bleeding. The herbal mouthwash also demonstrated satisfactory physicochemical stability and significant antimicrobial activity. Conclusion: The 0.5% Attukal Kizhangu herbal mouthwash demonstrated efficacy comparable to 0.2% CHX and may serve as a promising herbal adjunct in periodontal therapy. Larger multicenter trials with longer follow-up are required to confirm its long-term safety and effectiveness.
Abstract: Periodontitis gradually breaks down tooth root cementum (CM), periodontal ligament (PDL), and alveolar bone, threatening tooth support and overall oral function. Standard treatments, such as scaling and root planing and surgical interventions, can effectively control infection and inflammation; however, they rarely fully regenerate lost periodontal tissues. To address this limitation, biomaterial-based strategies have gained increasing attention in periodontal therapy. Among these, silica-derived materials, especially bioactive glasses and calcium silicate ceramics, have demonstrated significant osteoconductive and CM-inducing properties. Rice husk, an abundant agricultural by-product rich in silica, represents a sustainable and cost-effective source of biomedical-grade silica. Through various processing methods, rice husk silica can be converted into nano-engineered particles, silica-derived bioactive glasses, or silicate ceramics. These materials have shown promising biological performance, combining environmental sustainability with biomedical functionality. Laboratory-based investigations report enhanced osteoblast proliferation, collagen synthesis, and CM-related gene expression, while PDL fibroblasts display improved adhesion and matrix production on silica-based composites. In animal models, rice husk silica scaffolds have promoted new bone and CM formation with favorable tissue compatibility. Clinical analogs using silica-based bioactive glass in intrabony periodontal defects further support its translational potential, demonstrating improved attachment gain and bone fill. This review synthesizes evidence on rice husk-derived silica in periodontal regeneration, summarizing its physicochemical properties, mechanisms of action, preclinical findings, and translational perspectives. Despite remaining challenges, particularly in achieving consistent CM regeneration and functional PDL orientation, rice husk silica shows potential as an environmentally sustainable, multifunctional scaffold; however, its clinical applicability requires further validation.
Abstract: Background: Smoking is a significant environmental risk factor for chronic periodontitis, with high-risk individuals potentially having poor mechanical therapy responses. Smokers experience deeper probing depths and more attachment loss, whereas high levels of osteopontin (OPN) indicate destructive periodontal disease with loss of alveolar bone. This study aimed to evaluate and compare salivary OPN levels and clinical parameters before and after scaling and root planing (SRP), with or without adjunctive antibiotic therapy, among smokers with periodontitis. Materials and Methods: Thirty-seven otherwise healthy people with untreated persistent periodontitis, aged 25–60 years, were studied and divided into three groups: group 1, nonsmokers receiving only SRP as treatment; group 2A, smokers receiving only SRP as treatment; group 2B, smokers receiving adjunctive antibiotics along with SRP as treatment. The biochemical assessment of OPN levels in saliva was carried out using a commercially available human OPN enzyme-linked immunosorbent assay kit. Results: The outcomes revealed a higher mean OPN concentration at baseline in smokers than in nonsmokers. There was a statistically significant decrease in the mean salivary OPN levels in all the groups; these levels remained substantially higher even after treatment in smokers compared with nonsmokers. Conclusions: According to the findings, smokers show greater bone resorption before and after therapy than nonsmokers. The outcomes of SRP with or without adjuncts for the treatment of periodontitis can be compared in smokers. However, the significance of using an adjunct in this regard remains questionable.
Abstract: Flap perforations during open-flap debridement usually heal by secondary intention but can lead to necrosis, discomfort, and altered treatment outcomes. This report describes the conservative management of an intraoperative periodontal flap perforation that resulted in localized flap dehiscence. A 55-year-old female with generalized periodontitis, Stage III, Grade A, underwent periodontal debridement surgery, during which an inadvertent flap perforation occurred. Due to its small size and well-vascularized location, the perforation was left to heal by secondary intention. By the 7 th postoperative day, localized necrosis was noted on the lingual aspect of tooth #29, with viable tissue underlying the necrotic area. Management included reinforcement of oral hygiene measures, saline and betadine irrigation, and the prescription of antibiotics and analgesics. At 4 weeks, healing was nearly complete. By 9 months, complete tissue recovery was observed, with no evidence of scarring. This case underscores the importance of early recognition, conservative management, and patient compliance in the successful management of surgical complications, thereby ensuring optimal healing outcomes.
Abstract: Background: Platelet-rich fibrin (PRF) concentrates derived from the patient’s blood show promising regenerative potential. Centrifugation speed during PRF preparation affects its efficacy. This study evaluated the regenerative capacity of injectable PRF (i-PRF) concentrates prepared at high and low centrifugation speeds. The findings may inform approaches to interdental papilla regeneration and contribute to dental practice. Materials and Methods: A total of 32 sites with Class I and II interdental papilla loss were included in the study, with 16 in each group treated with i-PRF using either low-speed centrifugation (Group 1) or high-speed centrifugation (Group 2). The papilla priming procedure involved local anesthesia and incisions; i-PRF injections were administered according to a specific protocol at 7- and 14-day intervals. Papillary height gain and reductions in black triangle dimensions for both the groups were analyzed using image analysis at baseline and at 3- and 6-month follow-up. Results: Papillary height gain ( P < 0.001) was 1.71 in Group 1 and 1.25 in Group 2. Image analysis revealed substantial decreases in black triangle dimensions, including height (1.57 and 1.29), width (0.9 and 1.03), and area (2.77 and 2.54) ( P < 0.001) across both the groups. Conclusion: The study demonstrates that i-PRF effectively treats Class I and II interdental papilla loss. i-PRF injections are a minimally invasive approach to enhancing interdental papilla esthetics and warrant further investigation in larger clinical trials. Trial registration: Clinical Trials Registry-India (CTRI) under the number CTRI/2019/09/021395, prospectively registered.
