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Biomedical subjects

J Egelberg

Publications and source records attributed to J Egelberg.

At least 37 records · Page 2Linked to original sources
PubMed1990

Diagnostic predictability of scores of plaque, bleeding, suppuration and probing depth for probing attachment loss. 3 1/2 years of observation following initial periodontal therapy.

Recordings of supragingival plaque, bleeding, suppuration and probing depth were obtained for 42 months following initial periodontal therapy. Scores accumulated after various time intervals during monitoring were studied for their predictive value in revealing probing attachment loss as determined by regression analysis during the 0-42 month period. Accumulated plaque scores demonstrated low predictability. Accumulated bleeding scores showed modest predictive values. Suppuration on probing was not a frequent finding during the observation interval and also had modest predictive power. Increase in probing depth compared to baseline and deep residual probing depth had modest predictability after 3 and 12 months, but showed increasing accuracy in revealing probing attachment loss over later time intervals. After a few years of maintenance, increase in probing depth, particularly if combined with high frequency of bleeding on probing, showed the highest predictive value for probing attachment loss of the scores examined.

Adult↗
PubMed1990

Treatment of periodontal furcation defects. Coronally positioned flaps versus dura mater membranes in class II defects.

Mandibular class II furcation defects in 19 subjects were treated using 2 different methods of wound closure. In 16 of the defects, the wound was closed with a coronally positioned surgical flap secured by crown-attached sutures. In 15 of the defects, a collagenous membrane (freeze-dried dura mater) was placed to cover the exposed defect, followed by suturing of the surgical flap at the level of the alveolar crest. After use of a coronally positioned flap, an average of 70% of the defect volume became filled with bone, with complete closure by bone fill for 9 of the 16 treated defects. After use of dura mater membrane, 38% of the defect volume was filled with bone, with complete bony closure for 3 of the 15 treated defects. The results following use of coronally positioned flaps support our previous findings and the potentials of this technique. The results following use of dura mater membranes, together with recently reported risk for spread of virus with dura implants, do not justify the use of dura mater for these regenerative purposes.

Adult↗
PubMed1990

Subjective criteria and probing attachment loss to evaluate the effects of plaque control and root debridement.

11 adult patients with moderate to advanced periodontitis were treated with oral hygiene instruction and an initial, single episode of root debridement. Before therapy, 3 independent clinicians examined all patients and identified sites that in their opinion probably would not respond to the therapy and would continue to lose attachment. On 2 occasions, 3 and 12 months later, the clinicians re-examined and re-evaluated all patients and all sites. The results of therapy were also monitored by probing attachment level measurements performed every 3rd month. All 11 patients completed 24 months of follow-up, and 6 subjects were available until 36 months. Sites with probing attachment loss after 12, 24 and 36 months were identified using linear regression analysis and compared to the clinicians' prediction of probing attachment loss. The results demonstrated a limited agreement between probing attachment loss determined by linear regression and the clinicians' predictions of probing attachment loss. It appears that the traditional clinical signs and factors used to forecast and identify periodontal disease activity are only moderately associated with probing attachment loss. This suggests that attachment loss may be caused by several factors, at least following initial therapy. The progression of an inflammatory disease of microbial etiology may be only 1 of such causes. Further studies are needed to clarify the nature and cause of probing attachment loss.

Adult↗
PubMed1989

Effect of placement of occlusive membranes on root resorption and bone regeneration during healing of circumferential periodontal defects in dogs.

Previous studies indicate that root resorption is a frequent sequela to significant amounts of periodontal repair in animal models. A model was developed in labrador dogs to study periodontal wound healing in large circumferential defects in the absence of influence from the oral environment. A polytetrafluorethylene membrane of 1 micron pore size (GORE-TEX) was used to occlude cells from specific tissues from populating the healing dentin-connective tissue wound. 3 modalities were studied: (1) control, in which no membrane and therefore no cell occlusion was used, (2) flap occlusion, in which the internal surface of the flap was lined with the membrane preventing contribution of cells from the flap, (3) bone occlusion, in which the reduced alveolar bone was lined with the membrane preventing contribution from bone cells. Wound closure included total submergence of teeth and membranes. The membranes remained incorporated and no exposure of membranes or teeth occurred during the 3 months healing period. Histology revealed bone regrowth in all 3 treatment modalities. It is suggested that inductive elements in the connective tissue or dentin, or bone cells from periosteum were responsible for bone regrowth in the bone membrane treatment modality. No significant difference was seen for root resorption between the 3 treatment modalities. This study found that physical occlusion of cells from the inside of the surgical flap, or from the pre-existing bone, is not sufficient to prevent root resorption in periodontal wound healing.

Alveolar Process↗
PubMed1989

Placement of a porous membrane underneath the mucoperiosteal flap and its effect on periodontal wound healing in dogs.

This study was designed to investigate the healing of surgically induced, horizontal periodontal defects in dogs following placement of a biocompatible, porous polytetrafluorethylene membrane around the roots of the treated teeth and to compare the healing to that of control teeth without membrane. Mandibular premolar teeth of 5 beagle dogs were used for experimentation. Specimen blocks were removed 3 months postoperatively for histological evaluation of contralateral experimental and control teeth. Mean apical migration of junctional epithelium among the experimental surfaces amounted to 0.1 mm as compared to 1.3 mm for the control surfaces. Accordingly, the amount of connective tissue attachment, defined by the distance from the base of the junctional epithelium to the apical termination of root planing, was greater for experimental than for control surfaces. As this increased amount of connective tissue attachment was associated with more coronal bone apposition, a periodontal ligament space was more prevalent in experimental than in control surfaces. A limited amount of ankylosis was observed for both experimental and control surfaces. Root resorption was more prevalent in control than in experimental surfaces. Conceivable reasons for the differences in healing between experimental and control teeth are discussed.

Alveolar Process↗
PubMed1989

The impact of regression towards the mean on probing changes in studies on the effect of periodontal therapy.

The purpose of this report was to evaluate the magnitude of the regression towards the mean (RTM) relative to the observed changes in probing measurements following periodontal therapy in 2 groups of patients. Regression lines were calculated for observed changes in probing depths and probing attachment levels related to the initial probing depths of the individual sites. Regression lines, adjusted for the RTM effect, were also calculated. For the extreme subgroups of recorded shallow and deep sites, the RTM effect (mm) was found to amount to a maximum of 0.6 mm. It appears unlikely that erroneous conclusions have been made in previous clinical studies evaluating probing depth changes in deep sites, since the RTM accounts for a limited portion of the observed changes. For probing depth changes in shallow sites and for probing attachment level changes in both shallow and deep sites, the RTM accounts for a larger proportion of the observed mm changes. It therefore seems prudent to be careful about interpretation of these changes in clinical studies, where the RTM effect has not been adjusted for. Whenever possible, duplicate initial recordings should be taken to allow determination of and subsequent adjustment for the RTM effect.

Adult↗
PubMed1989

Probing depth at re-evaluation following initial periodontal therapy to indicate the initial response to treatment.

9 adult subjects with severe periodontitis were monitored following oral hygiene instruction and a single episode of crown and root debridement. Baseline recordings for probing attachment level were obtained both immediately pre-instrumentation and immediately post-instrumentation. Sites with gain, no change or loss of probing attachment level at 3 and 12 months compared to both pre- and post-instrumentation were identified. The classification was based upon the use of triplicate recordings at each time point, a site-specific standard deviation for measurement variability, and the requirement of a minimum of 1.0 mm change. The relative frequencies of gain, no change, and loss of probing attachment were then calculated for sites of various residual probing depths at 3 and 12 months. This was performed to evaluate if a given probing depth at re-evaluation, e.g., 7.0-7.5 mm, could be used as an indicator of the need for supplementary treatment following the initial therapy, based upon the observed probing attachment changes compared to baseline. As an example of the results of the present study, 60% of sites with residual probing depths of 7.0-7.5 mm showed probing attachment gain greater than or equal to 1.0 mm compared to the post-instrumentation baseline, and only 2% had undergone probing attachment loss greater than or equal to 1.0 mm. The overall results suggest that a relatively deep residual probing depth at re-evaluation following initial therapy, by itself, provides little evidence of lack of improvement compared to baseline. On this basis, the use of a specific probing depth at 3 or 12 months following treatment as a yardstick for the provision of supplementary treatment may not be justified.

Adult↗
PubMed1989

Clinical effects of root debridement in molar and non-molar teeth. A 2-year follow-up.

12 patients were studied longitudinally to monitor the effects of basic periodontal therapy in molar and non-molar teeth. Periodontal sites were grouped into molar furcation sites, molar flat-surface sites and non-molar sites. Clinical measurements were taken at baseline and directly followed by full mouth root debridement. Subsequently, measurements were taken every 3rd month until 24 months. At each of these appointments, the patients were monitored for their oral hygiene performance and given supragingival prophylaxis. The mean results indicated that initially moderately deep and deep molar furcation sites responded less favorably to therapy compared to non-molar sites and molar flat-surface sites of similar probing depth. Initial improvements in probing measurements for moderately deep and deep molar furcation sites were limited and also tended to revert during the observation interval. Identification of individual sites with probing attachment loss disclosed that 25% of molar furcation sites lost probing attachment as compared to 7% for non-molar sites and 10% for molar flat-surface sites. These results corroborate previous findings and call for additional or alternative treatment regimens for periodontal furcation pockets.

Adult↗
PubMed1989

[Surgical procedures to improve cleansing of the root surface and reduce pocket depth].

In recent years numerous reports have appeared in the dental literature comparing different methods of treating periodontitis. These researches have not indicated that surgical procedures have particular advantages over thorough hygiene therapy. This review considers several relevant hypotheses and the results of clinical research into this topic. Particular note has been taken of the research of Ramfjord et al. (1987) whose conclusions are typical of many others. This review discusses such conclusions from several standpoints and shows that there is a need for further research. It is derived from a review by the same authors in the journal of the Swedish Dental Association, Tandläkartidingen.

Humans↗
PubMed1988

Treatment of intraosseous periodontal defects with a combined adjunctive therapy of citric acid conditioning, bone grafting, and placement of collagenous membranes.

A total of 25 proximal, intraosseous periodontal defects were treated in 21 adult patients. A 3-prong adjunctive, regenerative treatment approach was used. The treatment included (1) citric acid conditioning of the root surfaces, (2) grafting of particles of decalcified, freeze-dried homologous bone, and (3) placement of freeze-dried, homologous dura mater sheets between the replaced surgical flaps and the tooth surfaces. The results, as evaluated by probing attachment and probing bone level measurements, during 1 year of observation, demonstrated limited improvements of the treated defects. The limited results were similar to previous observations in our clinics following treatment of intraosseous defects using different treatment modalities. It appears that new treatment approaches need to be sought to accomplish clinically significant and predictable regeneration in proximal, intraosseous periodontal defects.

Adult↗
PubMed1988

Repair of periodontal furcation defects in beagle dogs following reconstructive surgery including root surface demineralization with tetracycline hydrochloride and topical fibronectin application.

This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Administration, Topical↗
PubMed1988

The relative effects of therapy and periodontal disease on loss of probing attachment after root debridement.

This study investigated the immediate effects, and the effects during 12 months, of a single episode of root debridement in 1248 sites in 9 periodontitis patients. Single recordings for probing depths and probing attachment levels were made at baseline, and at 3, 6, 9 and 12 months. In addition, triplicate recordings of attachment levels were made for all sites by 3 independent examiners immediately prior to debridement, immediately post debridement, and at 3 and 12 months. It was found that a mean loss of probing attachment of 0.5 to 0.6 mm occurred as a result of instrumentation, irrespective of initial probing depth. Individual sites were identified as having lost probing attachment using a site-specific standard deviation for measurement variability and a greater than or equal to 1.0 mm change. 5% of all sites lost probing attachment from pre-instrumentation to 12 months. Approximately half of these had probing attachment loss inflicted during instrumentation. 23 sites (2% of all sites) were identified as having lost probing attachment from the post-instrumentation time point to 12 months. The majority of these sites seemed to undergo this probing attachment loss as a result of a remodelling process during the healing phase. Over the observation period used in this study, the majority of the attachment loss identified seems to be either directly attributable to instrumentation or to a remodelling process as a result of the therapy rather than to progressive periodontitis.

Adult↗
PubMed1988

Treatment of periodontal furcation defects. (I). Review of the literature and description of a regenerative surgical technique.

This report provides an abbreviated review of the literature on treatment and prognosis of periodontal furcation lesions. In addition, it describes a surgical technique designed to accomplish bone regeneration in class II furcation defects, together with the rationale for the development of this procedure. Results of treatment of 30 defects with this technique are presented in a subsequent report.

Bone Regeneration↗
PubMed1988

Treatment of periodontal furcation defects. (II). Bone regeneration in mandibular class II defects.

A total of 30 mandibular, buccal class II furcation defects were treated in 22 subjects using a regenerative surgical therapy that included citric acid root conditioning and coronally positioned flaps secured by crown-attached sutures. In addition, grafts of freeze-dried, decalcified allogenic bone were placed in 16 of the 30 defects. The effect of the therapies was evaluated from a series of soft and hard tissue measurements. These measurements demonstrated notable improvement 12 months following therapy. On the average, 67% of the defect volume became filled with bone. 43% of treated defects were completely closed by bone fill. No difference was observed between defects treated with and without bone grafts.

Adult↗
PubMed1988

Clinical and microbiological effects of root debridement in periodontal furcation pockets.

The aim of the present study was to investigate longitudinally over 52 weeks the clinical and microbiological effects of plaque control and root debridement at molar furcation sites. The results were compared with changes at non-molar sites. 24 non-molar sites and 31 grade II molar furcation sites with probing depth greater than or equal to 5.0 mm were monitored in 11 patients. Clinical measurements consisted of plaque scores, probing depths, and changes in probing attachment level. Microbiological monitoring was carried out with phase-contrast microscopy and anaerobic culturing. The debridement resulted in improvement in probing measurements and microbiological counts for both groups of sites. A slightly less favorable clinical response was noted for molar furcation sites. Higher post-operative microbiological counts were found throughout the 52-week observation period for molar furcation sites. Sites with probing attachment loss showed higher microbial counts and higher proportions of spirochetes, black pigmented colony forming units (CFU), and Bacteroides gingivalis CFU than sites with probing attachment gain. Individual site analysis, however, demonstrated marked variations of the microbiological counts at the different postoperative time points. In the few available sites undergoing probing attachment loss, no apparent association between target micro-organisms and periodontal deterioration was observed.

Adult↗
PubMed1988

Radiographic evaluation of the effect of initial periodontal therapy on thickness of the maxillary sinus mucosa.

The thickness of the radiographic image of the maxillary sinus mucosa on intraoral radiographs was evaluated in 13 patients with advanced periodontal disease, prior to and 12 months following initial periodontal therapy. Before treatment, a relationship was observed between the thickness of the sinus mucosa and the mean probing depths of the teeth in the involved sextant. As many as 79% of the available sextants showed swelling of the mucosa prior to periodontal therapy, compared to only 17% after treatment. This report supports previous studies indicating that advanced periodontal disease may cause swelling of the maxillary sinus mucosa and that periodontal therapy will significantly reduce such swelling.

Adult↗