Efficiency of Hyaluronic Acid Versus Red Injectable Platelet-Rich Fibrin (i-PRF) in Treatment of Stage III Periodontitis (Randomized Controlled Clinical Trial)
Phase: PHASE4
Conditions: Periodontitis Chronic Generalized Severe
Sponsor: Beirut Arab University

 
 
 
 
 
Efficiency of Hyaluronic Acid Versus Red Injectable Platelet-Rich Fibrin (i-PRF) in 
Treatment of Stage III Periodontitis (Randomized Controlled Clinical Trial) 
 
 
 
 
 
 
 
 
 
 
 
September 17, 2022  
 

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Title page 
Efficiency of Hyaluronic Acid Versus Red Injectable Platelet-Rich Fibrin (i-PRF) in Treatment 
of Stage III Periodontitis (Randomized Controlled Clinical Trial) 
Authors: 
Toleen A. Mazloum1, Ghassan S. Amhaz2, Ghanem H. Abdullah 3, Nayer M. Aboelsaad4 
Author's contribution: T.M. 1 and G.A. 2 formulated the study design and drafted the protocol. T.M. 1 
performed the experiments. G.A. 2 and G.A. 3 collected the data. N.A. 4 analyzed and interpreted the results then 
revised the entire manuscript. T.M. 1 and G.A.3 . All authors read and approved the final manuscript. 
Author for correspondence: 
Prof. Nayer Aboelsaad 
Phone: +961 1 300 110 ext. (2549) 
Mobile: +961 79109899 
E-mail: n.mohamedaboelsaad@bau.edu.lb 
Word count: 2924 
Total number of figures: 4 
Total number of tables: 2 
Total number of references: 21 
Running title: Hyaluronic acid Vs. Red i-PRF in Treatment of Periodontitis 
Key finding: Both hyaluronic acid and the red i-PRF in conjunction with SRP are effective in treating stage III 
periodontitis with no statistically significant difference between them in efficacy. 
 
                                                          
1 B.D.S., Department of Periodontology, Faculty of Dentistry, Beirut Arab University, Lebanon. 
2 D.D.S., Department of Periodontology, Faculty of Dentistry, Beirut Arab University, Lebanon. 
3 B.D.S., Department of Periodontology, Faculty of Dentistry, Beirut Arab University, Lebanon. 
4  PhD, Department of Periodontology, Faculty of Dentistry, Beirut Arab University, Lebanon. 

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Efficiency of Hyaluronic Acid Versus Red Injectable Platelet-Rich Fibrin (i-PRF) in 
Treatment of Stage III Periodontitis (Randomized Controlled Clinical Trial) 
Abstract 
Background: Several strategies have been introduced in the last few years to enhance the results of scaling and 
root planing (SRP), thus avoiding the need for periodontal surgical interventions in some cases. These new 
strategies include using platelet concentrates or administering locally delivered antibiotics/antiseptics like 
hyaluronic acid (HA). The objective of this study was to compare the clinical efficacy of red injectable platelet-
rich fibrin (i-PRF) with that of hyaluronic acid as adjuncts for SRP in the non-surgical management of stage III 
periodontitis. Materials and Methods: In this study, 75 patients with stage III periodontitis were enrolled. They 
were split into Groups one (G1), which received HA treatment, Groups two (G2), which received red i-PRF 
treatment, and Groups three (G3), which received only SRP treatment. At the baseline, the fourth, eighth-, and 
twelfth weeks following treatment, the plaque index (PI), gingival index (GI), bleeding on probing (BOP), clinical 
attachment level (CAL), and probing depth (PD) were all measured. Results: The PI, GI, and BOP were 
significantly improved when the three groups were compared across the board. In terms of the PD, all three groups 
displayed lower levels over the course of three months, with G1 and G2 experiencing the greatest declines. 
Additionally, groups G1 and G2 showed a considerable increase in CAL, while G3 showed no improvement. 
Conclusion: The current study emphasizes that the application of  HA and red i-PRF in conjunction with SRP 
significantly improves all periodontal metrics. However, there is no statistically significant distinction between 
the two therapies. 
 
Keywords: periodontitis, hyaluronic acid, red injectable platelet-rich fibrin, root planing.   
 
 
 
 

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Introduction: 
Chronic periodontitis is an irreversible multifactorial inflammatory disease causing progressive destruction of 
periodontal supporting tissues. (1) Primarily, it is identified by the loss of periodontal tissue support, represented 
clinically by clinical attachment loss (CAL), periodontal pockets, gingival bleeding, and radiographically by 
alveolar bone loss.  
Scaling and root planing (SRP) is the gold standard treatment for most patients with periodontitis. However, 
recently, several strategies have been developed to improve SRP results and thus avoid the need for periodontal 
surgical intervention in some cases. (2) These new strategies include systemically or locally administered 
antibiotics and antiseptics (ex: hyaluronic acid, metronidazole, minocycline...), or the use of platelet concentrates.  
Hyaluronic acid (HA) is a linear polysaccharide naturally found in the extracellular matrix of connective tissue, 
synovial fluid, and other tissues. (3) It has many physiological as well as structural functions that help maintain 
tissue structure and haemostatic integrity. It has the potential to control the inflammatory response, which occurs 
when chronically irritated tissues break down high molecular weight HA into lower molecular weight molecules. 
These low-molecular-weight molecules help to identify tissue damage and mobilize immune cells, while high-
molecular-weight molecules slow down the immune response, preventing inflammation from worsening too 
much. (4) Additionally, HA has viscoelastic qualities that reduce the ability of germs and viruses to penetrate the 
tissue. Nevertheless, HA is a naturally hygroscopic molecule. When HA is added to an aqueous solution, hydrogen 
bonding between adjacent carboxyl and N-acetyl groups occurs; this characteristic enables HA to maintain 
conformational stiffness and water retention. Therefore, due to the multiple functions that HA has in the healing 
of wounds, gingiva, and bones, it has been used to repair both mineralized and non-mineralized periodontal 
tissues. (5) 
Furthermore, injectable platelet rich fibrin (i-PRF) is one of the recently introduced platelet concentrates. It comes 
in an injectable form and coagulates after minutes of administration. A slower and shorter centrifugation spin is 
used, thus resulting in regenerating cells with increased concentrations of growth factors and cytokines that may 
enhance the healing potential of both bone and soft tissues. (6) Moreover, its preparation techniques vary 
depending on the different fractions from various areas based on the junction between the enriched fibrin plasma 
and red blood cell layers.  Yellow i-PRF is harvested at the upper yellow zone above the junction, while red i-
PRF is harvested at the interface with the buffy coat layer. The use of Red i-PRF is superior to the yellow i-PRF 

5 
 
as it promotes early-stage wound healing and bone regeneration. In addition it is unlikely to prevent bone 
regeneration or induce premature bone formation outside the desired area. (7) 
Several studies and clinical trials concerning the efficiency of HA or PRF in treating periodontal disease are 
available, but few are the articles that assess the efficiency of i-PRF in the non-surgical treatment of periodontal 
disease. (8  16) Thus, the aim of this clinical trial is to compare the efficacy of HA used as an adjunctive to SRP 
and red i-PRF (for the first time) in the non-surgical treatment of stage III periodontitis. 
Materials and methods 
Seventy-five patients aged between 20 and 60 years were recruited for the study in March 2021. All the selected 
patients had clinical periodontal loss and radiographic bone loss of stage III/grades A and B with no history of 
systemic disease. They had at least four periodontal sites with a pocket depth of six mm or greater, radiographic 
evidence of bone loss extending to the middle third of the root, and clinical attachment loss of five mm or more. 
Moreover, patients were excluded from this study if they had had: uncontrolled systemic conditions (uncontrolled 
diabetes or uncontrolled hypertension), bleeding disorders, or were on anticoagulant therapy; alcohol users; 
pregnant or lactating females; heavy smokers (more than ten cigarettes per day); underwent chemo or radio 
therapy; or used antibiotic/anti-inflammatory drugs over the last three months before treatment. 
Before starting the clinical trial, an institutional review board (IRP) was obtained. After that, complete medical 
and dental histories as well as informed consent were collected from each patient, and periodontal charting was 
done for them. 
The selected patients were allocated into three groups (each containing 25) with the help of a computerized 
randomizer (Randomizer.org): 
 
Group one (G1): 25 patients were treated with hyaluronic acid gel as an adjunct to scaling and root planing 
by applying one ml of 0.8% HA to the base of the pocket (subgingivally) and 0.2 ml of 0.2% HA topically 
(applied by the patient). 
 Group two (G2): 25 patients were treated with red i-PRF as an adjunct to scaling and root planing.  
 Group three (G3): 25 patients were treated with scaling and root planing only. 
The clinical examiner was not informed of the treatment groups' distribution. 

6 
 
Before the baseline examination, a full mouth supragingival scaling and root planing was performed under local 
anesthesia in one or two sessions (over a 24-hour period). Patients were informed on self-performed plaque control 
measures including using the modified Bass brushing technique using a soft toothbrush and regular toothpaste 
twice a day and interdental cleaning using interdental brushes once a day. Note that patients received the same 
toothbrushes, toothpaste, and interdental brushes. Oral hygiene was reinforced at every visit. 
The clinical periodontal parameters were recorded by one blinded examiner (G.A. 2) from the mesio-buccal, mid-
buccal, disto-buccal, disto-lingual, mid-lingual, and mesio-lingual surfaces of each tooth and checked by another 
blinded examiner (N.A 4). Examiners were calibrated to ensure intra-examiner as well as inter-examiner 
agreement when measuring PD and CAL values. Twenty patients were examined twice before the trial, 24 hours 
apart. Calibration was considered accepted if both measurements at the baseline and after 24 hours were similar 
to one mm at the 90% level. 
Clinical measurements included the clinical attachment level (CAL), probing depth (PD), plaque index (PI), 
gingival index (GI), and bleeding on probing (BOP). First, the PI and the GI were measured from four sites per 
tooth. Gingival bleeding was recorded within 15 seconds. Afterwards, patients were asked to rinse with water so 
as not to misinterpret gingival bleeding as BOP. Following that, all teeth were probed at six different locations 
per tooth. Moreover, CAL was measured as the distance from the cemento-enamel junction (CEJ) to the depth of 
the pocket, while the PD was measured as the distance from the gingival margin to the base of the pocket. 
Regarding the BOP, it was recorded 15 seconds after probing. Note that the clinical parameters were recorded at 
the baseline (1st visit) before the treatment and were repeated in the fourth week (2nd visit), eighth week (3rd 
visit), and twelfth week (fourth visit). During this period, reinforcement of plaque control and additional 
instructions were given to maintain good oral hygiene. 
The sample size is calculated with the help of this formula: (17) 
= [
(z α
 2 + zβ) σ
δ
] 2 ( 1
Q1 + 1
Q2)
𝑁
 
 
 

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Data from previous studies were used to calculate the sample size (Zijnge et al., 2010) regarding the PD change 
measurement. (18). It was found that the difference in PD (δ) is around 0.3mm, whereas the standard deviation in 
groups (σ) was around 0.2mm. Our aim was to achieve a statistical power of > 90% as well as a 0.05 significance 
level. Thus, 18 participants per group were needed. However, as some dropouts may be expected, a minimum of 
25 patients per group were recruited. 
 
Regarding the preparation of red I-PRF, first, 20 mL of patient’s blood was collected by venipuncture of the 
median cubital vein. Then, the blood was distributed into two ten mL glass tubes (containing no anticoagulant).  
The tubes were shaken before being placed into a centrifuge to prevent clots from developing. The centrifuge was 
set for 700 rpm for three min (60 g force) at room temperature using a Choukroun PRF Duo Centrifuge. After 
centrifugation, three layers were formed in each tube: the red blood cells in the bottom, the PRF layer in the 
middle, and the platelet poor plasma at the top. After that, one mL was taken from the upper liquid red and yellow 
layer with the buffy coat (demonstrate the red i-PRF) (figure 1). Note that the bevel edge of the harvesting needle 
as used as a reference point. (19,20) 
After that, topical anesthesia was applied to the site of injection. Then, the obtained red i-PRF was placed in a 2.5 
cc dental injector (27-gauge needle). The red i-PRF was injected into the pocket at the point of interdental space 
(figure 2). Moreover, to control bleeding due to the needle tip after the procedure, a saline-soaked sponge was 
placed between the lip and the gingiva and removed after 15 minutes. A total of four sessions of i-PRF were 
administered to patients at a ten-day interval. On the other hand, after scaling and root planing, hyaluronic acid 
(GENGIGEL®) was applied in the following forms (one ml of 0.8% HA was injected subgingivally once every 
four weeks), topically (0.2 ml of 0.8% HA was applied by the patient twice daily for the following 14 days after 
the subgingival application). 
Statistical analysis was done using SAS 9.4 Software (SAS Institute Inc., Cary, NC, USA). Means and standard 
deviations (SD) were calculated for all continuous variables (periodontal parameters: CAL, PD, BOP, GI, PI) at 
the baseline, fourth week, eighth week, and twelfth week. Repeated linear mixed-effects models (PROC MIXED 
in SAS) were used to examine the changes in all periodontal parameters over the four-time points within each 
group and between groups. An unstructured covariance matrix was used, residual plots were visually reviewed to 
check model fit, and extreme outliers were eliminated using the restricted likelihood distance. A Tukey-Kramer 

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correction was applied to all pairwise comparisons. One-way ANOVA was used to examine group differences in 
PD reduction and CAL. A p-value of 0.05 was considered statistically significant. 
Results  
Patient recruitment began in March 2021 and data collection ended in June 2022. A total of 138 patients were 
checked for eligibility of which 75 had met the inclusion criteria. However, 12 were lost throughout the study. 
Therefore, complete data analysis was possible for 63 patients who finished the study (figure 4). Note that no teeth 
were lost throughout the study period. In addition, no postoperative systemic deficits were reported by any of the 
patients, and no postoperative problems were observed. 
The gingivitis and plaque indices are shown in Table 1. At the follow-up visits, all treatment groups showed a 
statistically significant reduction in both indices compared to the baseline (p<0.05). At any of the observation 
intervals, there was no statistically significant difference in PI and GI. 
Moreover, both groups G1 and G2 demonstrated a statistically significant reduction in the mean PD values 
postoperatively when compared to the baseline (p<0.05), which was largely based on improvements within the 
first four weeks of treatment. However, a slight reduction in the PD was noticed in G3 where SRP was done 
without any adjunctive treatment (Table 1). Moreover, after three months, patients treated with HA as an addition 
to SRP had a significantly higher PD reduction than patients treated with SRP alone (p<0.05). Similarly, patients 
treated with red i-PRF as an adjunct to SRP had a significantly higher PD reduction than those treated with SRP 
only (p<0.05). However, there was no statistically significant difference between both groups, G1 (HA + SRP) 
and G2 (i-PRF + SRP). (Table 2) 
Furthermore, throughout the trial period, significant gains in clinical attachment (CAL gain) were observed in 
both groups G1 and G2 where adjunctive treatment is applied to SRP, while in G3, where SRP is done solely, no 
significant gain was noticed (p<0.05) (Table 1). However, no statistically significant difference between G1 and 
G2 was observed. (Table 2) 
Nonetheless, in all three treatment groups, the proportion of sites with BOP significantly decreased after three 
months (p<0.05) (Table 1). 
 

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Discussion 
In the current clinical trial, two different treatment strategies have been investigated in order to prove their clinical 
benefit as an adjunct to SRP and to compare them in efficiency. 
Since the introduction of locally delivered drugs in the dental field, several studies have been conducted to 
examine their efficacy in treating dental diseases, including chronic periodontitis. Some studies found that these 
substances (such as HA) when used as an adjunct to SRP had no actual significant difference compared to SRP 
alone (8), (9), (10). However, other studies showed that there was significant improvement in the periodontal 
parameters when HA was used as an adjunct to SRP rather than when SRP was performed solely (11), (12), (13), 
(14), (15).  
In our clinical trial, the results of the group where HA was used as an adjunct to SRP (G1) were consistent with 
the latter research studies. A significant difference was noticed in G1 where around 1.98 mm gain in CAL and a 
2.76 mm reduction in the PD were noticed, whereas in G3 where only SRP was performed, only around 0.36 mm 
of CAL gain and a 0.89 mm PD reduction was observed. 
On the other hand, other treatment protocols were introduced as an adjunct to SRP. One of these protocols includes 
the use of i-PRF. There is no doubt that the PRF causes enhancement in all periodontal parameters when used to 
treat periodontal problems as it contains growth factors. All the studies done on it confirm this fact. However, the 
use of i-PRF in the non-surgical treatment of periodontitis was done by Vučković et al. in 2020 for the first time. 
(16) It showed significant improvements in the periodontal parameters.  
Recently, research has started to differentiate between red and yellow i-PRF. But, to our best knowledge, to date, 
the clinical efficacy of red i-PRF in treating periodontal diseases has not been investigated. Thus, our concern was 
to examine the clinical efficiency of the red i-PRF in treating stage III periodontitis non-surgically for the first 
time and to compare it to the HA, which has been more familiar in the field for the past few years. 
Going more into the details of this clinical trial, the randomization strategy used allowed for an evenly dispersed 
number of patients at the baseline. However, some dropouts were noticed in the three treatment groups. Most of 
these dropouts occurred as a result of patients' postponing or canceling some of their multiple weekly 
appointments, resulting in treatment intervals of more than four weeks between visits. 

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Nonetheless, the three treatment groups were demographically balanced, and the final sample size in each group 
was greater than the minimum required (n = 18) for sufficient statistical power. 
After conducting the treatment for the three groups, the results came out to show that there was no statistically 
significant difference in the plaque and gingival indices between them all at any time period. This could be due 
to the fact that all patients were given the same oral hygiene recommendations and used the same oral hygiene 
equipment. 
Similarly, there was no statistically significant difference in the reduction of BOP between the three groups despite 
the significant reduction in the PD. This has been discussed in previous studies (Fang et al., 2016). The removal 
of the major biofilm mass during SRP may be the reason behind the resolution of tissue inflammation and 
vasodilation, thus leading to a decrease in the BOP. (21) 
Regarding the CAL gain, both groups G1 and G2, where adjunctive treatment was done in addition to SRP, 
showed significant improvement during the three-month period. Around 1.98 mm of gain in CAL was noticed in 
G1 where HA was used. Similarly, around 2.04 mm of gain in CAL was observed in G2 where red i-PRF was 
applied. However, G3, where only SRP was done, showed no significant gain (only 0.36 mm). This shows that 
both adjunctive treatments, HA and i-PRF, cause significant improvement in the CAL in comparison to SRP 
alone, with no significant difference between them. 
Likewise, for the PD reduction, both groups G1 and G2, where adjunctive treatment was done in addition to SRP, 
showed significant improvement during the three-month period. A 2.76 mm reduction in PD was noticed in G1 
where HA was used. Similarly, a 2.83 mm decrease in PD was observed in G2 where red i-PRF was applied. 
However, no significant reduction was observed in G3 where only SRP was done (almost 0.36 mm). This means 
that both treatments, HA and i-PRF, lead to a significant reduction in the PD in comparison to SRP alone, with 
no significant difference between them. 
Note that there were some limitations to the study. Blinding of the therapists was not possible due to the typical 
specification of the number of appointments (HA applied every four weeks whereas red i-PRF was applied within 
a ten-day interval) and content of the treatment (special measures should be taken after the application of red i-
PRF such as the sponge soaked in saline). However, this didn’t affect the double blindness of the study since the 
examiners who were collecting data as well as the patients were blinded. 

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Conclusion  
In conclusion, when used in conjunction with SRP to treat stage III periodontitis non-surgically, both treatment 
modalities, HA and the red i-PRF, significantly improve all periodontal metrics compared to when used alone, 
especially in terms of CAL gain and PD decrease. However, when comparing these two therapy modalities, there 
is no statistically significant difference between them, and they both practically have the same efficacy. 
 
Conflict of interest: none declared  
Acknowledgments: We thank Ricerfarma (Milano-Italy) for providing the GENGIGEL products, and the 
Faculty of Dentistry at Beirut Arab University for technical assistance and providing devices. 
Funding: There was no specific grant from any funding agency in the public, private, or non-profit sectors. 
 
 

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of Chronic Periodontitis. J Periodontol 2004;75:1114-1118.  
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(12): Johannsen, A., Tellefsen, M., Wikesjö, U., & Johannsen, G. Local delivery of hyaluronan as an adjunct to 
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(13): Pilloni, A., Annibali, S., Dominici, F., Di Paolo, C., Papa, M., Cassini, M. A., & Polimeni, A. Evaluation of 
the efficacy of an hyaluronic acid-based biogel on periodontal clinical parameters. A randomized-controlled 
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(14): Karakostas, P., Davidopoulou, S., & Kalfas, S. Use of Hyaluronic Acid in Periodontal Disease Treatment: 
A Systematic Review. J Contemp Dent Pract 2022;23:355–370. 
 
(15): Olszewska-Czyz, I., Kralik, K., Tota, M., & Prpic, J. The Influence of Hyaluronic Acid Adjunctive Therapy 
of Periodontitis on Salivary Markers of Oxidative Stress: Randomized, Controlled Clinical Trial. Antioxidants 
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(19): Wang, X., Zhang, Y., Choukroun, J., Ghanaati, S., & Miron, R. Behavior of Gingival Fibroblasts 
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(20): Thanasrisuebwong, P., Surarit, R., Bencharit, S., & Ruangsawasdi, N. Influence of Fractionation 
Methods on Physical and Biological Properties of Injectable Platelet-Rich Fibrin: An Exploratory 
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Figure legends: 
Figure 1:  one  mL  taken  from  the  upper  liquid  red  and  yellow  layer  with  the  buffy  coat 
Figure 2: The  red  i-PRF  injected  into  the  pocket  at  the  point  of  interdental  space 
Note  that  the  red  color  on  teeth  is  the  topical  anesthesia  gel.  
Figure 3: subgingival  injection  of  0.8%  HA. 
Figure 4: Diagram  depicting  the  process  of  selecting  and  allocating  study  participants. 
 
 
 
 
 
 
 
 
 
 
 

15 
 
Tables:
Table 1
Patient's characteristics and full-mouth clinical parameters at the baseline and follow-up visits (mean 
± standard deviation)5
                                                          
5 SRP: Scaling & Root planing  
HA: Hyaluronic Acid 
I-PRF: Injectable Platelet Rich Fibrin  
PI: Plaque Index  
GI: Gingival Index  
PD: Pocket Depth 
CAL: Clinical Attachment Loss 
BOP: Bleeding on Probing 
Variable 
Time point 
G1 
(SRP + HA) 
G2 
(SRP + I-PRF) 
G3 
(SRP) 
Age (years) 
Baseline 
57.8 ±  11.1 
51.8 ±  10.8 
49.9 ±  11.9 
Gender 
(female/ male) 
Baseline 
12 / 9 
9 / 11 
12 / 10 
PI 
Baseline 
1.2 ±  0.6 
1.0 ±  0.6 
0.9 ±  0.7 
4th week 
0.8 ±  0.7* 
0.79 ±  0.6* 
0.6 ±  0.6* 
8th week 
0.76 ±  0.6* 
0.67±  0.6* 
0.5 ±  0.4* 
12th week 
0.72±  0.6* 
0.52 ±  0.5* 
0.43 ±  0.4* 
GI 
Baseline 
1.1 ±  0.7 
1.2 ±  0.6 
1.0 ±  0.6 
4th week 
0.75 ±  0.4* 
0.8 ±  0.5* 
0.64 ±  0.5* 
8th week 
0.73 ±  0.5* 
0.62 ±  0.4* 
0.59 ±  0.4* 
12th week 
0.69 ±  0.5* 
0.78 ±  0.4* 
0.57 ±  0.4* 
PD (mm) 
Baseline 
7.27 ± 0.73 
7.38 ± 0.71 
7.12 ± 0.73 
4th week 
6.03 ± 0.90* 
5.88 ± 0.94* 
6.92 ± 0.91* 
8th week 
5.10 ± 0.75* 
4.98 ± 0.50* 
6.57 ±  0.75* 
12th week 
4.51 ± 1.25* 
4.55 ± 0.57* 
6.23 ± 0.67* 
CAL (mm) 
Baseline 
6.04 ± 0.80 
6.42 ± 0.76 
6.35 ± 0.78 
4th week 
5.17 ± 0.81* 
5.38 ± 0.67* 
6.27 ± 0.82* 
8th week 
4.89 ± 0.58* 
5.01 ± 0.56* 
6.13 ±  0.76* 
12th week 
4.06 ± 1.01* 
4.38 ± 0.74* 
5.99 ± 0.87* 
BOP (%) 
Baseline 
47.6 ± 28.50 
48.64 ± 26.50 
43.79 ± 23.15 
4th week 
23.2 ± 20.11* 
18.06 ± 13.29* 
18.17 ± 13.48* 
8th week 
20.3 ± 17.88* 
18.47 ± 13.88* 
15.3 ± 10.29* 
12th week 
19.87 ± 16.49* 
19.00 ± 14.43* 
14.47 ± 9.88* 

16 
 
Table 2:  
comparison of mean changes between baseline and visits in group 1,2 and 36
 
                                                          
6 * statistically significant difference (p<0.05) within one treatment group as compared to the baseline 
PI: Plaque Index 
GI: Gingival Index 
PD: Probing Depth  
CAL: Clinical Attachment Level 
BOP: Bleeding on Probing  
 
6 * statistically significant difference (p<0.05) within one treatment group as compared to the 
baseline 
PD: Probing Depth  
CAL: Clinical Attachment Level 
 
 
PD  mean 
changes 
4th week 
visit  
8th week 
visit  
12th week 
visit  
CAL  mean 
changes 
4th week 
visit  
8th week 
visit  
12th week 
visit  
G1 
1.24 ± 
0.85 
2.17 ± 
0.81*  
2.76 ± 
1.08* 
G1 
0.85 ± 
0.64 
1.15 ± 
0.70* 
1.98 ± 
0.83* 
G2 
1.5 ± 0. 
66 
2.4 ± 
0.67* 
2.83 ± 
1.26* 
G2 
1.04 ± 
0.81 
1.41 ± 
0.84* 
2.04 ± 
0.85* 
G3 
0.2 ± 0.43  0.55 ± 
0.51*  
0.89 ± 
0.61* 
G3 
0.08 ± 
0.55 
0.22 ± 
0.49* 
0.36 ± 
0.72*