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Title Periodontal Therapy Effective in The Treatment of Cyclosporin A-Related Gingival Hyperplasia
Clinical Question In patients with cyclosporin A-related gingival hyperplasia, does the implementation of periodontal therapy cause cessation or reduction of the gingival overgrowth compared to oral hygiene instructions alone?
Clinical Bottom Line Periodontal therapy is superior to oral hygiene instructions alone in reducing cyclosporin A - related gingival hyperplasia. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 10397513Kantarci/199915 patients who received oral hygiene instructions, supra and subgingival scaling, polishing, and gingival curettage; 16 control subjects who received oral hygiene instructions aloneRandomized Control Clinical Trial
Key resultsIn comparison to the patient pool in the control group who received oral hygiene instructions alone, the periodontal parameters markedly decreased in the treatment group following periodontal therapy. After the observation period, in addition to decreases in the periodontal probing depth (PD) and gingiva hyperplasia (GH) scores, there were also statistically significant decreases in the plaque index (PI) and gingival Index (GI) scores in the treatment group compared to the control group. The calculus index (CI) score was the only parameter that did not statistically differ from the treatment group. When the study was first launched, both patient groups exhibited clinically significant gingival hyperplasia (GH) (>30%). Of the treated patients 7 out of the 15 individuals (47%) responded well to the periodontal therapy and when evaluated their GH scores dropped to <30%. On the contrary, 94% of the control group continued to display gingival overgrowth.
#2) 15985985Aimetti/2005Thirty patients who received etiological periodontal treatment and were re-evaluated every 2 months for 12 monthsCase Series/Clinical Trial
Key resultsIn evaluating the effects of non-surgical and supportive periodontal treatment on cyclosporin A-induced gingival overgrowth, thirty patients underwent periodontal treatment and were re-evaluated every two months for twelve months. The parameters assessed included the plaque index, bleeding index, probing depth, degree of gingival overgrowth via the Seymour index (hypertrophy index, HI), and the distance between the mucogingival junction and the base and apex of each individual interdental papilla. At the start of the study 22 patients exhibited HI values of greater than 30%. Both anterior and posterior segments were comprised of 376 gingival units each, that exhibited gingival overgrowth with a mean HI value of 2.22 +/-1.95 and 1.24 +/-1.57, respectively. Implementation of periodontal treatment caused marked improvement of all the parameters that were assessed (P <0.0001). There was a definite decrease in the mean HI values for the anterior and posterior segments (0.42 +/- 0.77 and 0.39 +/-0.85, respectively). None of the HI values exceeded 30%.
Evidence Search Search "Dental Plaque Index"[Mesh], Related Articles for PubMed, Related Articles by Review for PubMedSearch Limits: Randomized Controlled Trial, Limits: Review "Dental Scaling"[Mesh], Search dental scaling, Search "Oral Hygiene"[Mesh], Search "Gingival Hyperplasia"[Mesh] Search "Cyclosporine"[Mesh]
Comments on
The Evidence
The article containing the “best evidence” described a Clinical Trial/Randomized Control Trial. The groups were similar at the beginning of the study as they were comprised of 31 renal transplant recipients (15 in the test group, 16 in the control group) with similar transplant histories and on similar drug regimens. The two groups exhibited > 90% completion rate. The individual groups were treated in the same manner and there seemed to be adequate follow-up. Confirmation if the study was double-blind or not was not provided in this article. Overall, this is a valid study with sufficient evidence that can aid dentists in treating patients if a particular case of drug-related gingival hyperplasia was to arise.
Applicability If a patient presenting with cyclosporin A-related gingival hyperplasia were to approach a dentist with regards to this problem, these articles provide enough evidence to consider implementing periodontal therapy in addition to rigorous oral hygiene instructions as part of the patient’s treatment plan. In both studies described above, the parameters that were assessed (periodontal probing depth, gingival index, plaque index, etc.) decreased markedly following treatment. No adverse effects from periodontal therapy were reported.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Cyclosporin, gingival hyperplasia, oral hygiene, periodontal therapy
ID# 608
Date of submission: 04/02/2010spacer
E-mail kuruvilla@livemail.uthscsa.edu
Author Mary E. Kuruvilla
Co-author(s) e-mail
Faculty mentor/Co-author Vidya Sankar, DMD, MHS
Faculty mentor/Co-author e-mail SankarV@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Leigh Martin, Evan Adams (San Antonio, TX) on 01/07/2013
Could not find any new research pertaining to this Topic. It is our opinion that this CAT is still correct and up to date with today’s evidence.

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