# Comparison of the Efficacy of Adjunctive Aids After Scaling and Root Planing in Patients With Chronic Periodontitis

## TL;DR

This study compares how well silver nanoparticle gel and platelet-rich fibrin help heal gum disease after a common dental cleaning procedure.

## Contribution

The study introduces a direct comparison of two local drug delivery systems as adjuncts to nonsurgical periodontal therapy.

## Key findings

- AgNP gel showed the greatest reduction in gum inflammation and pocket depth.
- i-PRF resulted in the best improvement in clinical attachment level.
- Both treatments improved healing more than the standard procedure alone.

## Abstract

Background: Periodontitis is a chronic inflammatory disease marked by periodontal tissue destruction and alveolar bone loss due to microbial biofilms and an exaggerated host immune response. Local drug delivery (LDD) systems are introduced to enhance site-specific therapeutic efficacy while minimizing systemic effects. Nanoparticle-based gels offer sustained drug release and improved tissue penetration, whereas injectable platelet-rich fibrin (i-PRF), an autologous biologic, is rich in growth factors and promotes periodontal regeneration.

Aim: To assess the efficacy of silver nanoparticle (AgNP) gel and i-PRF as adjuncts to nonsurgical periodontal therapy.

Methods: This was an interventional single-arm study. Thirty systemically healthy patients with chronic periodontitis were recruited, each group comprising 10 individuals. Investigator (KRR) examined the patients at baseline for the clinical parameters and again after 24 h to check the reproducibility of the measurements. The calibrations were considered reproducible when the baseline and 24‑h measurements tallied within 1 mm, 95% of the time. The samples were screened and randomly assigned in sealed envelopes by investigator KRR into Groups A, B, and C. Treatment was performed by investigator SG. Investigator (SG) performed scaling and root planing (SRP) at the second visit (after 24 h), following which, patients were administered the local delivery systems in the test groups A (SRP+AgNP gel) and B (SRP+i-PRF), whereas no LDD was administered in Group C (control group). The clinical parameters, gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were assessed at baseline and after six weeks.

Results: Intragroup comparison was performed using the paired t-test. One-way analysis of variance (ANOVA) was used to compare the mean values of the clinical parameters between the groups. Post hoc Tukey test was applied to evaluate the differences between groups. A p-value of <0.05 was considered statistically significant. At six weeks, all three groups showed statistically significant improvements in the clinical variables, compared to baseline (p < 0.05). The AgNP gel group (Group A) demonstrated the greatest reduction in GI (1.44 ± 0.33) and PPD (3.9 ± 0.74 mm), while the i-PRF group (Group B) showed superior CAL gain (4.2 ± 0.86 mm). Inter-group comparison revealed a statistically significant difference in GI (p = 0.046), favoring the adjunctive therapies over SRP alone. No adverse effects were reported throughout the study.

Conclusion: Both AgNP gel and i-PRF effectively enhanced periodontal healing when used after SRP. AgNP showed stronger antimicrobial action, while i-PRF promoted better tissue regeneration, highlighting their potential as valuable adjuncts to nonsurgical periodontal therapy.