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Biomedical subjects

J Wennström

Publications and source records attributed to J Wennström.

At least 19 recordsLinked to original sources
PubMed1999

The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study.

UNLABELLED: In the present prospective clinical trial, the effect of various regenerative procedures performed at sites with angular bone defects were evaluated. The main outcome variable was probing attachment alteration. MATERIAL AND METHODS: 40 subjects, aged 32-61 years participated. They met the following inclusion criteria: (i) presence of generalized, advanced periodontal tissue destruction; (ii) presence of 2 similar, contralateral, angular bone defects (experimental sites) located in either the maxilla or the mandible; (iii) the defect site must exhibit a probing pocket depth (PPD) of > or = 6 mm, a probing attachment level (PAL) of > or = 7 mm, and a depth of the intrabony component of > or = 3 mm. All subjects had a good oral hygiene standard, were in good general health and did not use any medication. Prior to the start of the study, all subjects received non-surgical treatment for periodontal disease. Baseline clinical measurements (plaque, gingivitis, PPD, PAL and soft tissue recession) of the selected experimental sites were obtained 6 months after the completion of basic therapy. The 40 subjects were randomly divided into 4 treatment groups including 10 subjects each: 3 membrane groups and one Emdogain group. 1 h before surgery, the patients were given 3 g of Amoxicillin. No other antibiotics were prescribed. The test and control sites were treated during the same surgical session. Full thickness flaps were elevated and the exposed root surfaces were planed. Membrane placement: The root surface was rinsed with saline. A barrier membrane (Guidor or Resolut or Periodontal (e-PTFE) material) was positioned to cover the defect and the adjacent 2-3 mm of bone tissue. The control treatment was identical to the test treatment with the exception of barrier placement. Emdogain placement: The exposed root surfaces at both the test and control sites were, during a 2-min period, conditioned with a 24% EDTA gel. Emdogain was applied to the exposed root surface of the test site. In the control site, the vehicle, the PGA gel, was used as placebo control. The flaps were closed and sutured to obtain a complete coverage of the intrabony defect. RESULTS: Re-examinations, which were performed 12 months after surgery, disclosed that regenerative therapy, including either the use of barrier membranes or application of enamel matrix proteins to an instrumented root surface in an angular, intrabony defect, enhanced outcome variables such as probing pocket depth and probing attachment gain. It was furthermore demonstrated that clinical improvements were better at sites with deep, than at sites with shallow, intrabony defects. CONCLUSION: The 4 regenerative modalities tested appeared to be equally effective in terms of PPD reduction and PAL gain, and superior to open flap curettage alone.

Adult↗
PubMed1999

Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports.

UNLABELLED: The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects. MATERIAL AND METHODS: 108 consecutively-treated periodontal patients (mean age 55.8 years) were included. Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria: (i) probing pocket depth > or = 5 mm, (ii) probing attachment loss > or = 6 mm, (iii) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component. A total of 145 defects met the criteria for inclusion. All subjects received non-surgical periodontal therapy. This included subgingival instrumentation in all parts of the dentition. At least 6 months after the completion of this treatment, a baseline examination was performed to characterise the experimental site. Reconstructive therapy was subsequently performed. Full-thickness periodontal flaps were elevated, and the root surface scaled and planed. No bone recontouring was performed. A gel containing 24% EDTA was applied on the exposed root and was kept in place for 2 min. A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space. The flaps were replaced and closed with sutures. The experimental sites were re-examined 12 months after reconstructive surgery. RESULTS: The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects resulted in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm. 87% of all sites treated exhibited a probing attachment gain of > 2 mm. One site suffered probing attachment loss. The radiographic assessments revealed that the bone defect had been reduced in depth by 2.9 mm on average. The reduction in defect size corresponded to an average bone fill of 69% of the original defect. In 43% of the defects, the bone fill amounted to > or = 80%. CONCLUSION: The overall probing pocket depth reduction, probing attachment level gain, and soft tissue recession, that results following Emdogain therapy, is similar to the corresponding outcome variables following GTR.

Combined Modality Therapy↗
PubMed1996

The peri-implant hard and soft tissues at different implant systems. A comparative study in the dog.

The aim of this study of the present experiment was to study the marginal periimplant tissues at intentionally non-submerged (1-stage implants) and initially submerged and subsequently exposed implants (2-stage implants). 5 beagle dogs, about 1-year-old, were used, 3 months after the extraction of the mandibular premolars, fixtures of the Astra Tech Implants Dental System, the Brånemark System and the Bonefit--ITI system were installed. In each mandibular quadrant, 1 fixture of each implant system was installed in a randomised order. The installation procedure followed the recommendations given in the manuals for each system. Thus, following installation, the bone crest coincided with the fixture margin of the Astra Tech Implants Dental System and the Brånemark System, whereas the border between the plasma sprayed and the machined surface of the Bonefit-ITI implant system was positioned at the level of the bone crest. Following a healing period of 3 months, abutment connection was carried out in the 2-stage systems (the Astra Tech Implants Dental System and the Brånemark system). A 6-month period of plaque control was initiated. The animals were sacrificed and biopsies representing each important region dissected. The tissue samples were prepared for light microscopy and exposed to histometric and morphometric measurements. The mucosal barrier which formed to the titanium surface following 1-stage and 2-stage implant installations comprised an epithelial and a connective tissue component, which for that 3 systems studied, had similar dimensions and composition. The amount of lamellar bone contained in the periimplant region close to the fixture part of the 3-implant systems was almost identical. It is suggested that correctly performed implant installation may ensure proper conditions for both and hard tissue healing, and that the geometry of the titanium implant seems to be of limited importance.

Alveolar Process↗
PubMed1996

The C-POST system.

This article represents a clinical report from daily experience with the C-POST system, a carbon-fiber post for core build-up. The C-POST was invented in France in 1988 and introduced in Sweden in 1992. When I first started using the system, little literature about it had been published. Because the C-POST fits well in the modern bonding concept, it has become my therapy of choice. In my practice, more than 900 treated teeth have been registered in a computer so that treatment progress can be followed. Every treated tooth was registered according to the type of primer, cement, core material, number of posts, and type of prostheses used. The prosthetics included large composite fillings, porcelain crowns, and/or metal crowns or bridges from 3 to 12 units. Of the 900 treated teeth, 173 of them are between 3 and 4 years old, 2 contain fractured roots, and 1 had a post fracture. This article describes how to fabricate a C-POST core build-up and contains clinical hints and advice. Other applications for the post, such as splinting, bridges, and repair of fixed prosthodontics and vital teeth, are discussed.

Carbon↗
PubMed1995

Clinical and microbiological changes associated with an altered subgingival environment induced by periodontal pocket reduction.

The purpose of the present investigation was to study the effect of an altered subgingival environment, induced by changing the local soft tissue morphology, i.e., pocket depth reduction, on the subgingival microbiota and the clinical conditions. 7 patients aged 30-60 years with generalized marginal periodontitis were selected. Patients were instructed in proper oral hygiene and all teeth were cleaned supragingivally. Mucoperiosteal flaps were raised and the bone re-contoured to eliminate angular bony defects. While the control teeth were carefully debrided and thoroughly root planed, no root instrumentation was performed on the test teeth. Calculus deposits visible to the naked eye were only chipped-off with the tip of a scaler. The flaps were apically repositioned and sutured at the level of the bone crest. Clinical parameters showed a similar pattern of response in the test and control sites over a one year observation period post therapy. Probing depths and probing attachment levels were significantly reduced one month after surgery and remained at a lower level. A significant decrease was also noted for total anaerobic viable bacterial counts. The proportion of the Gram-negative anaerobic rods decreased significantly in both groups. P. gingivalis, Fusobacterium sp., C rectus were detected significantly less often after treatment in both groups. Capnocytophaga and A. odontolyticus, on the other hand, were more frequently isolated after therapy. These findings corroborate the concept that the reduction of selected subgingival microorganisms is the key element for the success of periodontal therapy, rather than the removal of tooth substance and mineralized deposits by root instrumentation.

Actinomyces↗
PubMed1987

Examiner agreement in estimating changes in periodontal bone from conventional and subtraction radiographs.

It has previously been shown that computer-assisted subtraction of serially-obtained radiographs yields a higher degree of accuracy in the detection of small changes in the marginal periodontal bone than conventional radiographs. This study concerns another important aspect of such diagnostic methods, namely the intra- and inter-examiner agreement rates. On 10 patients with moderate to severe periodontal bone loss involved in a clinical trial to evaluate the effectiveness of subgingival antimicrobial irrigation, conventional radiographs were taken at baseline and after 32 and 52 weeks. The changes in terms of gain or loss of bone occurring between the examination at baseline and that after 32 weeks, as well as those occurring between the examination performed after 32 weeks and that made after 52 weeks, were evaluated by means of conventional radiographs and by subtraction images. Both types of image were interpreted by each of 4 observers. The images were read a 2nd time after a period of at least 2 weeks. The inter-observer as well as the intra-observer agreement were assessed by calculating 3 different measures of agreement: the overall agreement, the specific agreement and the kappa value. Regardless of measure, higher inter-observer agreement rates were found for all observers when the subtraction technique was employed. A similar pattern was found with respect to the intra-observer agreement rates.

Alveolar Process↗
PubMed1986

New attachment formation in the human periodontium by guided tissue regeneration. Case reports.

The aim of the present study was to evaluate whether a regenerative surgical procedure, based on guided tissue regeneration, could predictably result in the formation of a new attachment in human teeth. The material included 12 teeth in 10 patients with advanced periodontal disease. Following flap elevation, scaling, root planing and removal of granulation tissue, a teflon membrane was placed over the denuded root surface in such a way that the epithelium and the gingival connective tissue were prevented from reaching contact with the root during healing. The flap was replaced on the outer surface of the membrane and secured with interdental sutures. This design of wound preparation gives preference to the cells originating from the periodontal ligament (PDL-cells) to repopulate the wound area adjacent to the root. Histologic analysis of the result of treatment was made in 5 of the 12 teeth scheduled for extraction. In the remaining 7 teeth, the result was evaluated using clinical measurements. The result of healing disclosed that in all teeth treated, substantial amounts of new attachment had formed. This suggests that predictable restitution of the attachment apparatus can be accomplished by using a method of treatment which is based on the principle of guided tissue regeneration.

Adult↗
PubMed1986

The effect of mouthrinses on parameters characterizing human periodontal disease.

The objective of the present clinical trial was to assess the efficacy of mouthwashes containing antiseptic agents on established and developing plaque and periodontal disease in adult subjects using a newly described clinical research model. The study was carried out in 21 patients with periodontal disease. At the baseline examination, all tooth surfaces-sites were studied with regard to dental plaque, gingivitis, bleeding on probing to the base of the pocket and probing pocket depths. The patients were subsequently randomly assigned to 1 of 3 groups, each consisting of 7 individuals. Group A rinsed with a 0.01% solution of Sanguinarine, group B rinsed with a 0.2% solution of chlorhexidine and group C rinsed with a placebo solution. No instructions regarding mechanical plaque control measures or information regarding the etiology and pathogenesis of periodontal disease were given to any of the patients during the course of the 6-weeks of trial. The clinical examination was repeated after 2 weeks use of the mouthwash preparations. Following the re-examination, all patients were subjected to scaling and root planing in 2 jaw quadrants chosen at random. After another 2 weeks, the 2nd re-examination was performed and the teeth in the 2 remaining jaw quadrants were thoroughly scaled. The final examination was performed 2 weeks later. During the 4 weeks of rinsing, without adjunctive professional mechanical debridement, the frequency distribution of plaque Index scores 2 + 3 did not change in the group of patients using the placebo solution, but was significantly reduced in both the chlorhexidine and the Sanguinarine groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Design of clinical trials of traditional therapies of periodontitis.

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.

Clinical Trials as Topic↗
PubMed1986

Healing following surgical and non-surgical treatment of juvenile periodontitis. A 5-year longitudinal study.

The patient sample used in the present study comprised 16 young individuals who were referred for treatment of advanced periodontal disease. Based upon the age of the patients and the location of the diseased sites, the patients were divided into 2 groups; a juvenile periodontitis group (JP) and a post-juvenile periodontitis group (post-JP). The patients in the JP group had periodontal lesions only at first molars and incisors. All 16 subjects were in excellent general health and none had been treated with antibiotics during a period of at least 12 months prior to the 1st examination. At a baseline examination and 6, 24 and 60 months after active therapy, the diseased sites were examined regarding plaque, gingivitis, probing pocket depths, probing attachment level, recession of the gingival margin and marginal alveolar bone level. Following a case presentation and instruction in proper oral hygiene measures, the 16 subjects were subjected to periodontal treatment, utilizing a split mouth design. By random selection, the diseased sites in one side of the jaws were treated by scaling and root planing in conjunction with a "modified Widman flap" procedure, while in the contralateral jaw quadrants treatment was restricted to scaling and root planing. During the 1st 6 months following active therapy, the patients were subjected to professional tooth cleaning once every 4 weeks. Subsequently, the interval between the recall appointment was 3 months. 2 years after treatment, this maintenance care program was terminated. A final examination was performed 5 years after therapy. None of the patients involved in the trial received antibiotic treatment during the 5 years of observation. The findings of the present study revealed that the response of the periodontal tissues to therapy, both in the JP and the post-JP group of patients, was almost identical to that found for similar types of treatment in patients with adult periodontitis. The re-examinations performed after 6, 24 and 60 months following active therapy of JP and post-JP lesions revealed that excision of the granulation tissue in conjunction with flap elevation did not enhance the degree of probing pocket depth reduction, probing attachment gain and bone fill that occurred following meticulous root surface instrumentation.

Adolescent↗
PubMed1985

Some effects of a Sanguinarine-containing mouthrinse on developing plaque and gingivitis.

The present clinical trial was performed to assess the effect of a Sanguinarine-containing mouthrinse on developing plaque and gingivitis in man. The trial was designed as a blind cross-over study. The active mouthrinse consisted of a 0.03% aqueous solution of Sanguinaria extract; an aqueous solution with similar color and taste as the active rinse was used as the placebo preparation. 14 dental students participated in the trial. At the start of each of 2 test phases, their gingival conditions were normal and their tooth surfaces free from dental plaque. Following a baseline examination, the participants refrained from mechanical tooth cleaning measures for 2 weeks. They rinsed twice daily with either the active or the placebo mouthrinse. Clinical examinations of plaque and gingivitis were repeated after 4, 7 and 14 days use of the mouthrinse preparation. During the second test phase of no mechanical tooth cleaning, the subjects who previously had rinsed with the placebo solution now used the active compound and vice versa. The results demonstrated that the Sanguinarine-containing mouthrinse was effective in reducing plaque formation and retarding the development of gingivitis.

Adult↗
PubMed1983

Plaque-induced gingival inflammation in the absence of attached gingiva in dogs.

The purpose of this experiment was to evaluate the effect of plaque infection on gingival units (1) with or without support of attached gingiva and (2) with different height of the attachment apparatus. 7 beagle dogs were used. Prior to the initiation of the study 4 different types of "dentogingival" units had been established in each dog by the use of excisional and grafting procedures, namely (1) normal non-operated free gingival units supported by a wide zone of attached gingiva and normal height of the attachment apparatus, (2) regenerated free gingival units supported by loosely attached alveolar mucosa and normal height of the attachment apparatus, (3) regenerated free gingival units supported by loosely attached alveolar mucosa and reduced height of the attachment apparatus and (4) regenerated free gingival units supported by a wide zone of attached gingiva and reduced height of the supporting apparatus. A baseline examination involved assessments of plaque, gingivitis, gingival exudate, probing depth, clinical attachment level, position of the "soft tissue margin" and width of attached gingiva. Following this examination 2 of the dogs were scheduled for biopsy and sacrificed. The remaining 5 dogs were for 40 days placed on a diet regimen which allowed plaque accumulation. The clinical examination was repeated and biopsies sampled at the end of this period. Following preparation the biopsy material was subjected to histometric and morphometric analysis. The results showed that the free gingiva which regenerated following surgical excision of the entire gingiva or following soft tissue grafting, was in most respects, clinically as well as histologically, similar to the "normal" free gingiva. The data obtained after 40 days of plaque accumulation did not reveal any differences between the various "dentogingival" units regarding size and apical extension of the infiltrated portion of the connective tissue. It was concluded that a free gingival unit which is supported by loosely attached alveolar mucosa is not more susceptible to inflammation than a free gingival unit which is supported by a wide zone of attached gingiva.

Animals↗
PubMed1983

Regeneration of gingiva following surgical excision. A clinical study.

The present clinical trial was carried out in order to analyze whether a zone of keratinized and attached gingiva may regenerate following surgical excision of the gingiva. In addition the alterations occurring in the position of the "soft tissue margin" and the clinical attachment level were assessed. 6 patients, scheduled for periodontal surgery in the canine-premolar regions of both quadrants of the lower jaw, participated in the trial. A Baseline examination performed prior to surgery comprised assessments at the buccal surface of the teeth of dental plaque, gingivitis, probing depth, clinical attachment level, position of the "soft tissue margin" and width of the zones of keratinized and attached gingiva. The entire zone of keratinized and attached gingiva was removed surgically using either a "gingivectomy" or a "flap-excision" procedure. In the "gingivectomy" procedure the wounded area was left to heal by second intention, while in the "flap-excision" procedure the alveolar mucosa was repositioned in a coronal position to achieve complete coverage of the surgically exposed alveolar bone. During healing the patients' oral hygiene status was carefully supervised. All parameters included in the Baseline examination were assessed at reexaminations performed 1, 3, 6 and 9 months following surgery. Already 1 month after surgery all "gingivectomy" units and 9 out of the 14 "flap-excision" units demonstrated presence of a zone of keratinized gingiva. At the final examination (9 months following surgery) all surgically treated buccal areas had regained a zone of keratinized gingiva. However, a zone of attached gingiva reformed less frequently. The examination performed 3 months after surgery revealed that the "soft tissue margin" and the clinical attachment level had become displaced in apical direction, 0.9 and 0.4 mm, respectively. Between the 3-month and the 9-month examinations, however, no further alterations were observed and the gingival units were healthy, independent of the presence or absence of attached gingiva or the width of the zone of keratinized gingiva.

Adult↗
PubMed1983

Role of attached gingiva for maintenance of periodontal health. Healing following excisional and grafting procedures in dogs.

The present study was undertaken to analyze the role of attached gingiva for the maintenance of periodontal health in sites with normal and reduced height of the supporting apparatus. Furthermore, the effect of excision and grafting of gingiva on some parameters describing dimensions and location of the periodontal tissues was evaluated. 7 beagle dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions, attachment level, position of the gingival margin and width of the keratinized and the attached gingiva. In the right side of the jaws (experimental side) a 6-month period of periodontal tissue breakdown was followed by surgical excision of the entire zone of the gingiva. After another 4-month period of healing with daily plaque control, a gingival graft was inserted in one quadrant of the experimental side to regain a zone of attached gingiva while the other quadrant of the experimental side was left ungrafted. In the left side of the jaws (control side), the teeth were subjected to daily meticulous plaque control during the entire study. In one of the control quadrants the entire zone of the keratinized and attached gingiva was excised at a time point corresponding to the grafting procedure in the experimental side, while the gingiva in the remaining control jaw quadrant was left unoperated. Clinical examinations of all control and experimental tooth units were repeated at certain time intervals during the course of the study. The final examination was carried out 4 months after grafting. The results of the experiment showed that in sites exposed to careful plaque control measures gingival health could be established and maintained without sign of recession of the gingival margin or loss of attachment, independent of (1) presence or absence of attached gingiva, (2) width of keratinized gingiva or (3) height of the supporting attachment apparatus. Following surgical excision of the entire gingiva, all buccal sites regained a zone of keratinized gingiva, but most sites were lacking attached gingiva. Furthermore, grafting of gingival tissue significantly increased the width of the keratinized and the attached gingiva but had no obvious effect on the position of the gingival margin or the level of the attachment.

Animals↗
PubMed1981

Severe backache as a presenting sign of bacterial endocarditis.

We report on two patients whose presenting sign of bacterial endocarditis was a sudden and severe backache. According to the literature, 25-44% of patients with bacterial endocarditis have musculoskeletal symptoms and in about 27% these symptoms are the first sign of the disease. The most probable pathogenetic mechanism of these symptoms is arterial microembolization consisting of bacteria and immune complexes.

Aged↗