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Biomedical subjects

G Greenstein

Publications and source records attributed to G Greenstein.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1993

The role of metronidazole in the treatment of periodontal diseases.

This article discusses the ability of metronidazole to improve periodontal health. Review of the drug's pharmacology and potential side effects indicate that it poses little threat to humans of inducing acute toxicity, mutagenesis, or cancer if used according to recommended dosing regimens. Studies addressing metronidazole utilization in a variety of clinical conditions demonstrate that its routine use does not enhance root planing. However, adjunctive antibiotic therapy may be advantageous in the treatment of sites where effective root planing is precluded due to deep pockets or when anaerobic periodontal infections do not respond to conventional therapy.

Animals↗
PubMed1993

Effect of calculus and irrigator tip design on depth of subgingival irrigation.

This study addressed three factors that may affect the penetration of medicaments into periodontal pockets: calculus, ejection site pressure, and irrigator tip design. Ejection site pressure for the Max-I-Probe, the Viadent and Water-Pik tips were determined with a variant of Bernoullis' equation. Depth of irrigant penetration was determined by delivering disclosing solution supragingivally and subgingivally. Following irrigation, assessed teeth were extracted and the percentage of pocket penetration by the dye was calculated. The Max-I-Probe and Viadent tips had significantly greater penetration than did the Water-Pik tip. Furthermore, calculus deposits reduced irrigation penetration in deep pockets (7 to 10 mm). Ejection site pressures of the three tips ranged from 0.10 to 4.80 psi. The ejection site pressure of the Max-I-Probe side-port delivery system was lower than that of the other two systems. Results indicated that subgingival calculus, irrigator tip design, and placement of the tip affect the depth to which drugs can be delivered subgingivally.

Anti-Infective Agents, Local↗