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Biomedical subjects

C M Cobb

Publications and source records attributed to C M Cobb.

At least 37 records · Page 2Linked to original sources
PubMed1997

Determination of energy density threshold for laser ablation of bacteria. An in vitro study.

The Nd:YAG and CO2 lasers have been shown to be bactericidal at relative low energy densities. However, at energy densities exceeding 120 J/cm2 (CO2) and 200 J/cm2 (Nd:YAG), laser irradiation also causes irreparable root surface damage. The purpose of this study was to determine, in vitro, the energy density threshold at which microbial ablation could be achieved while inflicting the least amount of damage to the root surfaces of human teeth. Pairs of Escherichia coli colonies cultured on broth agar were treated with a CO2 laser using a pulsed waveform at approximate energy densities ranging from 3 to 110 J/cm2. One of each colony-pair was then examined by scanning electron microscopy (SEM) and the other subcultured for viable microbes. Roots of extracted teeth were lightly scaled and treated by CO2 laser, again with pulsed beam using approximate energy densities of 3 to 110 J/cm2: and examined by SEM. Regardless of the level of energy density, residual bacteria could be subcultured from all laser treated microbial colonies. The inability of the laser to completely obliterate microbial colonies was likely due to: depth of energy penetration, difficulty in precisely overlapping beam focal spots, irregular beam profile, and presence of microbes at the periphery of the beam focal spot. The threshold energy density for bacterial obliteration was determined to be 11 J/cm2 and that for root damage was 41 J/cm2. Root damage was evident by charring, crater formation, melt-down and resolidification surface mineral, and increasing surface porosity. The results of this in vitro study indicate that when used at an energy density between 11 and 41 J/cm2 the CO2 laser may destroy microbial colonies without inflicting undue damage to the tooth root surface.

Dose-Response Relationship, Radiation↗
PubMed1997

Laser irradiation of bone. I. An in vitro study concerning the effects of the CO2 laser on oral mucosa and subjacent bone.

The purpose of this study was twofold: first, to evaluate the histologic effects of CO2 laser irradiation on biopsies of porcine oral mucosa and underlying bone under conditions that simulate the applications of the laser during gingival surgery; and second, to evaluate the histologic effects on cortical bone following irradiation with increasing energy densities. Specimens consisting of mucosa and underlying bone were subjected to multiple passes of the laser beam in the same line of incision at energy densities ranging from 240 to 1,032 J/cm2. A second group of specimens consisting only of cortical bone was irradiated by a single pass of the laser at energy densities ranging from 40 to 2,062 J/cm2. In both groups the mean depth of ablation, width of surface damage, and widths of the zones of thermal necrosis and thermal damage were determined. Results showed a direct correlation between increasing energy density and/or number of energy beam passes and increasing depths of ablation and widths of surface damage. Further, more than three passes at 1,032 J/cm2 penetrated the mucosal layer to involve underlying bone. The mean depth of ablation for bone specimens following a single pass of the energy beam ranged from 0.02 mm at 160 J/cm2 to a maximum of 0.75 mm at 2,062 J/cm2. Using those energy densities most common to oral soft tissue surgery, the mean depth of ablation in bone specimens ranged from 0.17 mm at 240 J/cm2 to 0.28 mm at 640 J/cm2 to 0.35 mm at 1,032 J/cm2. All specimens regardless of tissue composition, energy density, or number of energy beam passes exhibited a distinct layer of residual carbonized tissue, a zone of thermal necrosis characterized by tissue coagulation, and a zone of tissue exhibiting thermal damage.

Animals↗
PubMed1997

Histologic evaluation of soft tissue attachment to CO2 laser-treated root surfaces: an in vivo study.

There is little support in the dental literature to justify the use of lasers for periodontal root therapy. To the contrary, there are several in vitro studies suggesting potentially adverse effects when lasers are applied to root surfaces. The purpose of this study was to evaluate, in vivo, soft tissue attachment to root surfaces following CO2 laser irradiation. Using a four-quadrant design with one quadrant serving as an untreated control, the remaining quadrants in each of two dogs were treated by (1) scaling and root planing, (2) laser only, and (3) laser followed by scaling and root planing. Prior to the assigned treatments, the roots of three teeth in each quadrant (including the control) were exposed by flap reflection and ostectomy. After root therapy the flaps were repositioned and allowed to heal for 28 days. Clinical attachment levels were determined prior to surgery, at 28 days, and by histologic measurement. Results indicate that specimens treated with laser only lost attachment compared to controls and other treatment groups. Furthermore, there was no histologic evidence of soft tissue attachment to a laser-treated surface that featured a residual char layer.

Animals↗
PubMed1997

Atypical palatal papillomatosis treated by excision and full-thickness grafting.

Papillary lesions of the oral cavity are extremely common, and inflammatory palatal hyperplasia is well known to dental practitioners. Advanced sophistication in viral laboratory technologies makes it apparent that various forms of the human papilloma virus are often causative. However, this is not true for inflammatory palatal hyperplasia. This article describes a patient with anatomically well-demarcated, multiple squamous cell papillomas of the palate that could not be classified as inflammatory palatal hyperplasia, nor could a viral etiology be ascertained, despite exhaustive laboratory studies. The lesion recurred despite numerous surgical ablation attempts. Eradication was achieved only after applying free soft-tissue grafts over the areas of excision. The differential diagnosis of papillary lesions with an emphasis on viral etiology, laboratory studies associated with their identification, and a hypothesis that explains why grafting was the only successful means of treatment are also discussed.

DNA Probes, HPV↗
PubMed1997

Lasers in periodontics: use and abuse.

Despite the suggestions that lasers are a desirable alternative to traditional periodontal root instrumentation and the recent FDA approval of the Nd:YAG laser for such application, numerous peer-reviewed articles concerning in vitro and in vivo results strongly suggest caution with respect to clinical application. There appears to be a high potential for laser-induced irreparable physical damage to the root surface. Further, residual char layers resulting from repeated laser exposure or improper choice of parameters may inhibit reattachment of soft tissues to the root surface. In addition, the use of lasers to remove calculus from subgingival pockets appears to be more efficient or predictable than traditional instrumentation and may, in fact, require root planing subsequent to the laser therapy to achieve the desired clinical goal.

Dental Cementum↗
PubMed1996

Morphologic changes following in vitro CO2 laser treatment of calculus-ladened root surfaces.

BACKGROUND AND OBJECTIVE: The purpose of this study was to compare morphologic changes following C02 laser or manual curette treatment of calculus-ladened tooth root surfaces. STUDY DESIGN/MATERIALS AND METHODS: Laser treatment consisted of repeated single passes with a 6 Watt focused beam at 20 pulses per second, a pulse length of 0.01 second, and a manufacturer's laser efficiency rating of 86% (i.e., the amount of total power delivered through the aperture). The rate of beam passage over the target surface was controlled at 4 mm/second using an 0.8 mm diameter tip. The calculated energy density was 240 J/cm2 for each pass of the beam. Scaled and root planed surfaces were treated with a standardized force of 600 grams using new curettes. Specimens were evaluated by scanning electron microscopy. RESULTS: Laser-induced surface changes included charring, meltdown and resolidification of calculus mineral, and ablation of microbial plaque. Laser-treated specimens also exhibited residual calculus and microbial plaque deposits in areas directly adjacent to the beam path. Scaled and root planed surfaces featured smooth and/or scale like smear layers and islands of residual calculus and microbial plaque. CONCLUSIONS: The rough surface topography resulting from laser treatment and residual calculus and microbial plaque deposits indicates that C02 laser treatment of exposed root surfaces is, at best, an adjunct to traditional methods of therapy.

Dental Calculus↗
PubMed1996

Treatment of root fracture by CO2 and Nd:YAG lasers: an in vitro study.

The purpose of this in vitro study was to use scanning electron microscopy and polarized light microscopy to evaluate the feasibility of using either the CO2 laser or an Nd:YAG laser in combination with air/water surface cooling to effect fusion of fractured tooth roots. The experimental unit consisted of 81 single-rooted teeth, each with an induced root fracture. Fifty-six teeth that had been reapproximated in dental stone and 25 teeth that had been reapproximated with C-clamps were assigned to untreated control groups or groups for treatment using CO2 and Nd:YAG lasers. Laser treatment consisted of multiple passes along the line of fracture, which was inspected using a dissecting microscope after each pass until a visual indication of fusion or irreparable damage resulted. Scanning electron microscopy evaluation of the treated lines revealed heat-induced fissures and cracks, areas of cementum meltdown and resolidification, crater formation, and separation of cementum from underlying dentin. In no instance-regardless of reapproximation technique, laser type, energy, and other parameters-did the treatment effect fusion of the fractured root halves.

Argon↗
PubMed1996

Effectiveness of a prescale gel on subgingival calculus.

A prescale gel product, designed to facilitate the removal of calculus, has recently been introduced and marketed to the dental profession. The purpose of this study was to evaluate the effectiveness of this gel on the removal of subgingival calculus. 10 patients, each with 5 periodontally diseased teeth scheduled for extraction, participated in this in vivo/in vitro study. 4 teeth per patient were randomly assigned using a 2-by-2 block design and treated in vivo with either active or placebo gel, with or without scaling, prior to extraction. To assess possible overexposure to the product, 10 selected teeth from the sample were treated with active gel for an extended exposure time. Standardized scaling was performed on a 4x4 mm treated root area in vitro on groups as assigned. Quantification of residual calculus was determined by one examiner blind to treatment group assignment using SEM photomicrograph montages and the Java image analysis computer system. Repeated measures ANOVA showed no statistically significant treatment effect for gel (p > 0.05) in the scaled and no-scaled groups. The 5th group exposed to the prescale gel for an extended time was evaluated descriptively for root surface morphological changes with no noticeable effect. Based on the results of this investigation, treatment of subgingival calculus with prescale gel offers no advantage for calculus removal over scaling alone. The findings suggest no significant clinical impact of product use.

Adult↗
PubMed1996

The effects of CO2 laser and Nd:YAG with and without water/air surface cooling on tooth root structure: correlation between FTIR spectroscopy and histology.

Morphologic and chemical characterization of root surfaces treated with either the CO2 laser, Nd:YAG, or Nd:YAG with water/air surface cooling (Nd:YAG-C) was completed using scanning electron microscopy (SEM) and FTIR photoacoustic spectroscopy (FTIR/PAS). Specimens for morphologic analysis consisted of 20 extracted single rooted teeth unaffected by periodontal disease. The specimens were exposed at varying energy densities to a single pass of the laser. SEM examination revealed, for all lasers, a direct correlation between increasing energy densities and depth of tissue ablation and width of tissue damage. The Nd:YAG-C required higher energy densities than either the CO2 or Nd:YAG lasers to achieve the same relative depth of tissue ablation. Regardless of energy density, and in contrast with other laser types, areas treated with the Nd:YAG-C did not exhibit collateral zones of heat damage. Specimens for spectroscopic examination consisted of 12 disks, 6 x 2 mm, cut from debrided root surfaces of extracted, unerupted human molars. The spectral results indicate a substantial reduction in the absorption bands attributable to protein and an additional band at 2015 cm-1 in specimens exposed to the Nd:YAG without water. In the presence of water/air coolant, the band at 2015 cm-1 appears only at a substanially higher energy density. The spectra of the CO2 treated specimens, with the char layer present, show a significant reduction in the protein bands and additional bands at 2015 and 2200 cm-1, that are tentatively assigned to the cyanamide and cyanate ions, respectively. These results suggest a reaction of the organic matrix and mineral with laser exposure.

Acoustics↗
PubMed1996

Migration of human gingival fibroblasts over guided tissue regeneration barrier materials.

The purpose of this investigation was to determine the ability of human gingival fibroblasts, in vitro, to migrate along a chemotactic gradient over 3 different guided tissue regeneration barrier materials; i.e., polytetrafluoroethylene, polylactic acid, and sterile calcium sulfate. Forty petri dishes were divided into 4 equal groups. In each group of 10 dishes, a different barrier material served as the fibroblast substrate with the polystyrene floor of one group of Petri dishes serving as the control. The under agarose technique of measuring cell migration was employed using platelet derived growth factor-BB homodimer as the chemoattractant and Hanks balanced salt solution to test random migration. In addition, fibroblasts were directly cultured on triplicate sets of barrier materials and the control surface for 24 hours and examined by scanning electron microscopy. Comparative analysis of the fibroblast migration data showed the mean migration distance (adjusted for random migration) for controls to be significantly greater than any of the three barrier materials. Further, mean migration distance over calcium sulfate was significantly greater when compared to that of the polylactic acid barrier group. All other comparisons between groups were not statistically significant. Scanning electron microscopic examination fibroblasts cultured directly on barrier membranes and compared to controls indicated that the calcium sulfate substrate appeared to facilitate cell attachment and spreading whereas cells on polytetrafluoroethylene and polylactic acid barriers exhibited a morphology not conducive to migration or, in many cases, cell health. Based on these limited in vitro results and, given the 3 barrier materials considered, it would appear that calcium sulfate offers the greater potential for guided tissue regeneration in surgical sites where primary wound closure cannot be obtained.

Becaplermin↗
PubMed1996

Histologic evaluation of porcine skin incisions produced by CO2 laser, electrosurgery, and scalpel.

The purpose of this study was to histologically compare the healing of porcine skin incisions made by CO2 laser, electrosurgery, and conventional scalpel. Incisions were made on the dorsal thorax of two microswine at staggered time intervals allowing the harvest of specimens at 0, 4, 7, 14, and 21 days postsurgery at the time of sacrifice. Each of the following histologic zones were identified and measured for both laser and electrosurgery incisions: (1) zone of tissue ablation. (2) zone of thermal necrosis, and (3) width of surface damage. The depth of cut and width of surface opening was measured for the scalpel incision. Furthermore, for each specimen, the presence and character of inflammatory cell infiltrate was noted, as well as the relative times at which bridging of the incision by connective tissue and coverage of the wound by an intact epithelial layer had occurred. Results showed that in this wound-healing model, the scalpel incisions produced more defined borders, healed more rapidly, and resulted in less collateral tissue damage than those produced by CO2 laser or electrosurgery. It was also noted that to create a wound 1.29 mm in depth required at least five passes of the laser beam within the same line of incision using 206.4 J/cm2 (6 W, continuous mode).

Animals↗
PubMed1995

Increased intracellular levels of lysosomal beta-glucuronidase in peripheral blood PMNs from humans with rapidly progressive periodontitis.

Release of potent lysosomal enzymes by degranulation of polymorphonuclear leukocytes (PMNs) in host gingiva may contribute significantly to tissue destruction and the pathogenesis of periodontal disease. A pilot study established that peripheral blood PMNs from humans with rapidly progressive periodontitis (RPP) contained significantly increased amounts of intracellular lysosomal beta-glucuronidase as compared to healthy controls. This investigation gained insight into the question: are the increased levels of beta-glucuronidase in persons with RPP an a priori genetically determined PMN characteristic, or a reactive phenomenon induced by the periodontal disease process during granulopoiesis? Twelve healthy controls and twelve otherwise healthy individuals with RPP participated in a repeated measures design to T0 (initial, baseline), T1 (four weeks after disease control therapy), and T2 (two months later). At each visit clinical indices (GI, pocket depths, GCF flow, plaque index) were performed and peripheral blood obtained. PMNs were isolated and suspended as 5 x 10(6) cells in 2.0 ml of HBSS. PMN suspensions were tested for total intracellular beta-glucuronidase, degranulation induced by 1 x 10(-6)M and 5 x 10(-7) M FMLP challenges, and unchallenged for non-specific enzyme release. PMNs from individuals with RPP contained significantly higher absolute amounts of beta-glucuronidase and released greater absolute amounts at FMLP challenge at T0, T1, and T2 compared to controls. No relationship was found between any of the clinical indices and beta-glucuronidase levels and no pattern was discovered relating to the repeated measures over time. We conclude that RPP peripheral blood PMNs contain elevated levels of beta-glucuronidase that are not induced by the periodontal disease process.

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: clinical response.

The purpose of this investigation was to evaluate the clinical efficacy of controlled-release tetracycline fiber therapy in adult periodontitis patients. One hundred-twenty-two (122) adult patients from 3 dental centers were enrolled at baseline for this study. each patient provided at least one site in each of four quadrants that was > or = 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10-day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12-month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred-sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy.

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: microbiological response.

In a 12-month multi-center study of 116 adult periodontitis subjects, six putative periodontal pathogens were monitored by DNA probe methods in a subset of 31 subjects. Monitored species included Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Eikenella corrodens (Ec), Campylobacter rectus (Cr), and Actinobacillus actinomycetemcomitans (Aa) with an average detection limit of 1.8 x 10(4) bacterial colony forming units/sample. The microbiological response to four periodontal treatments was studied, one treatment in each quadrant; scaling and root planing (S), scaling and root planing with tetracycline (TC) fiber (SF), a single application of TC fiber (F) and two serial applications of TC fiber (FF). Generally two sites were sampled in each quadrant, however, in some quadrants only one site was selected. These treatments were evaluated at baseline; immediately following therapy; and post-treatment at 1, 3, 6, and 12 months. The study was conducted with a split-mouth design with no maintenance therapy over a 12-month period. At baseline, 70.8% of sites had detectable Fn; 42.9% Pg; 63.5% Pi; 29.7% Ec; 28.3% Cr; and 5.5% Aa. No significant differences were seen in baseline proportions of these species between centers. Numbers and proportions of detectable pathogens (with the exception of Pg) exhibited a triphasic temporal response: a precipitous initial decrease immediately following therapy; a rise in proportions in the 1- to 3-month post-therapy period; and a spontaneous decline in the absence of therapy over the 3- to 12-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: maintenance response.

The purpose of this investigation was to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled-release tetracycline fibers. One-hundred-twenty-two (122) adult volunteers with at least one bleeding pocket > or = 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12-month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1, 3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as > or = 1 mm mean attachment loss at a site during the 3- to 12-month period. One-hundred-sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P < 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care.

Adult↗