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Biomedical subjects

G Greenstein

Publications and source records attributed to G Greenstein.

At least 19 recordsLinked to original sources
PubMed1998

The role of local drug delivery in the management of periodontal diseases: a comprehensive review.

This review article evaluates the role of local drug delivery systems in the management of periodontal diseases. The efficacy of several local delivery devices (i.e., tetracycline fibers, metronidazole and minocycline gels, chlorhexidine chips, and doxycycline polymer) which are either commercially available in the United States or abroad, or are currently under consideration for Food and Drug Administration (FDA) approval are discussed. The drug delivery systems are assessed with regard to their functional characteristics, effectiveness as a monotherapy, as compared to scaling and root planing, and ability to enhance conventional therapy. Furthermore, controversies associated with local delivery are addressed (e.g., induction of bacterial resistant strains, the efficacy of systemic versus local drug delivery, and whether local drug delivery should function as an alternative or as an adjunct to conventional treatment).

Administration, Topical↗
PubMed1997

Tetracycline fibers plus scaling and root planing versus scaling and root planing alone: similar results after 5 years.

This paper presents 5-year data pertaining to a subgroup of patients from a previous investigation who were treated with scaling and root planing plus tetracycline fibers. The parent study demonstrated that 6 months after therapy, scaling and root planing plus tetracycline fiber therapy was significantly better at reducing probing depth and gaining clinical attachment than scaling and root planing alone. However, the long-term data presented here show a regression from the original gains in clinical attachment levels in the fiber group. Ultimately, the use of fibers provided no significant advantage with regards to probing depth reduction or clinical attachment gain. Within the power of this study, which would have required 1.78 mm of change in clinical attachment to show a difference, there was no significant difference between the treatments at 5 years. This study underscores the need for additional long-term evaluation of this mode of therapy.

Analysis of Variance↗
PubMed1997

Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications. A literature review.

This paper addresses the diagnostic and therapeutic implications of increased probing depths. In general, in untreated and treated patients, when deep and shallow probing depths are compared, the data indicate that deep sites are associated with increased bleeding upon probing, elevated subgingival temperatures, higher levels of pathogens, more probing errors, a greater amount of infiltrated connective tissue, reduced ability to remove subgingival deposits with root planing, and diminished effectiveness of oral hygiene to alter the subgingival microbiota. Clinical trials demonstrate that probing depth is not a good predictor of future disease progression. However, deep sites are at greater risk of disease progression than shallow sites in untreated and treated patients. Furthermore, the deeper the probing depth, the greater the risk of future disease progression. Overall, the preponderance of evidence indicates that it is advantageous, but not always necessary, for patients to have shallow probing depths. With regards to surgical reduction of probing depths beyond that attained with non-surgical therapy, clinicians need to consider the advantages (e.g., ease of maintenance, reduced risk of disease progression) and disadvantages (e.g., root sensitivity, cosmetic defects) of treatment procedures. Since numerous variables require consideration (e.g., response to root planing, goals of therapy, acceptable level of risk for future disease progression), treatment decisions will vary depending on the patient and the desired clinical outcome at specific sites.

Bacteria↗
PubMed1997

Bacterial transmission in periodontal diseases: a critical review.

This review paper addresses intra- and extra-familial transfer of bacteria associated with periodontal diseases. Recent advances in molecular biology provide sensitive methods to differentiate organisms within the same species, thereby facilitating tracking routes of their transmission. Evidence for the passing of microorganisms between parents and children is particularly strong. In this regard, molecular genetic techniques have demonstrated that if a child is colonized by a potentially pathogenic species, then one of the parents will usually harbor genotypically identical bacteria. The data also indicate that transfer of bacteria between spouses occur, but it appears to happen infrequently. Saliva appears to be a major vector for bacterial transmission. However, the transfer of organisms does not necessarily result in colonization or infection of the host. Furthermore, individuals who harbor putative pathogens frequently do not manifest any signs of periodontal disease. This is attributed to host defenses, bacterial antagonism, and possibly lack of pathogenicity of infecting organisms. It is concluded, based upon current evidence, that periodontal pathogens are communicable; however, they are not readily transmissible.

Adult↗
PubMed1995

Clinical significance of bacterial resistance to tetracyclines in the treatment of periodontal diseases.

Tetracyclines are frequently employed during the treatment of clinical infections in medicine and dentistry, however, emergence of resistant bacterial strains has decreased the utility of these drugs. Accordingly, there is concern that indiscriminant administration of tetracyclines during periodontal therapy will further contribute to the development of additional resistant microorganisms which can complicate infectious disease therapy. This review paper briefly discusses the utility of tetracyclines as an antimicrobial agent in the treatment of periodontal diseases. It then focuses on the clinical significance of bacterial resistance to tetracyclines. Patterns of resistance that may be associated with the following scenarios are addressed: short- and long-term antibiotic therapy, individuals with a history of prior tetracycline therapy, patients with refractory periodontitis, and following controlled local drug delivery. It appears that selection and development of bacterial resistant strains is an inevitable consequence of antibiotic therapy. Nevertheless, prudent administration of tetracyclines may help delay or prevent the emergence of resistant microorganisms.

Anti-Bacterial Agents↗
PubMed1995

Guided tissue regeneration in human furcation defects after using a biodegradable barrier: a multi-center feasibility study.

This multi-center study evaluated guided tissue regeneration (GTR) in Class II furcation defects using a polylactic acid biodegradable barrier in 29 patients with mandibular and maxillary molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites scaled and root planed. Furcation defect perimeter was measured and a customized barrier (thickness 600 to 750 mu) was applied to cover the defect. Barriers adhered directly to tooth and bone. At baseline, sites were measured for probing depth (PD) (6.0 +/- 0.2 [SE] mm), gingival margin location (GML) (-0.2 +/- 0.2 mm), and attachment level in both vertical (AL-V) (6.2 +/- 0.2 mm) and horizontal (AL-H) (5.4 +/- 0.2 mm) directions. After the surgical procedure, there was good compatibility between the gingival tissues and barrier material. Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Comprehensive periodontal examination parameters were measured 3, 4, 6, 9, and 12 months after baseline. A repeated measures ANOVA was used to evaluate changes from baseline. At 6 and 12 months postsurgery, GML was close to the presurgical level (-0.5 +/- 0.2 mm). There was clinically and statistically significant improvement in all other parameters: mean PD reduction (2.2 mm), AL-V gain (1.7 mm), and AL-H gain (2.5 mm). These results indicated favorable clinical regenerative outcomes after using this barrier material in Class II furcation defects in humans.

Adult↗
PubMed1995

Understanding diagnostic testing for periodontal diseases.

Probability computations are used to characterize new periodontal diagnostic tests and are an integral facet of risk assessment for periodontal diseases. However, misinterpretation of these data can result in confusion and erroneous conclusions regarding the relationship of test results to the presence or absence of disease in a subject, or to episodes of periodontal destruction at specific sites. This paper was written to provide clinicians with a primer to help in understanding calculations used to evaluate diagnostic tests and risk assessment.

Decision Making↗
PubMed1995

Treating periodontal diseases with tetracycline-impregnated fibers: data and controversies.

This article addresses the use of tetracycline-impregnated fibers in the treatment of periodontal diseases. Clinical and microbiologic data are reviewed to provide pragmatic guidelines for fiber use. In addition, controversial issues associated with the labeling of Actisite, the potential of developing antibiotic-resistant strains, and the benefits of systemic vs local drug delivery are discussed. Ultimately, the article concludes that tetracycline-impregnated fibers can be used as an adjunct to scaling and root planing in certain patients at sites that do not respond to conventional therapy.

Aggregatibacter actinomycetemcomitans↗
PubMed1994

Synthetic bioabsorbable barrier for regeneration in human periodontal defects.

Guided tissue regeneration (GTR) may result in the formation of new bone, cementum, and periodontal ligament. The purpose of this study was to assess the efficacy of a resorbable synthetic material, which has been used extensively in general surgery for wound support, to promote GTR. Forty healthy patients with adult periodontitis, each having a Class II furcation defect, participated in the study. After initial therapy, mucoperiosteal flaps were elevated and furcations debrided with hand and rotary instruments. In 20 patients the molar Class II furcation defects were treated with a GTR procedure using the resorbable synthetic material (experimental), and 20 patients received a mucoperiosteal flap debridement procedure without barrier placement (control). Probing depth and attachment level measurements were taken immediately before surgery, at 6 weeks, and 2, 3, 4, 5, and 6 months after surgery. All areas healed uneventfully. Comparison of clinical attachment level measurements indicated significantly greater gain of attachment at sites receiving barriers. Fifteen of 20 Class II furcations in the synthetic barrier group, but only one of 20 in the control group, were converted to Class I defects. Barriers were still clinically detectable at 4 weeks, but were absent at 6 weeks. The synthetic barriers enhanced gain of clinical attachment in human Class II furcation defects.

Analysis of Variance↗
PubMed1994

Diagnosis of periodontal diseases.

This article provides an overview of currently available periodontal diagnostic methods. It also addresses several prototype test kits undergoing in-office evaluations. Diagnostic techniques are critically evaluated in light of current concepts regarding the etiology and pathogenesis of periodontal disease. Furthermore, suggestions are made with regard to strategies for using multiple diagnostic assays.

Alveolar Bone Loss↗
PubMed1994

Oral irrigation in the treatment of periodontal diseases.

Conceptually, supragingival and subgingival irrigation are techniques that may assist conventional therapy in the treatment and maintenance of periodontal patients. However, the dental literature contains diverse data on the efficacy of oral irrigation, and this variability leads to considerable confusion regarding its utility. This review attempts to place in perspective the advantages and disadvantages of supragingival and subgingival irrigation. Recommendations for use of irrigation therapy are based on the results of published clinical trials and are discussed herein. Shortcomings of comparative study designs are also noted to provide a context for decision making by clinicians.

Clinical Trials as Topic↗