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Connective tissue regeneration to periodontally diseased roots, planed and conditioned with citric acid and implanted into the oral mucosa.

This investigation used autogenous submucosal implants of root sections to study the connective tissue healing to periodontally diseased roots which had previously been planed and demineralized with citric acid. Eighteen implants were performed, with each being removed 2 to 24 weeks after implantation. The results showed new connective tissue attachment to the old cementum and to the dentin. After 18 weeks, in all specimens new cementum had formed on the dentin, with collagen fibers attached to it. No deposition of new cementum on the old cementum was noted. The formation of new cementum on roots placed in an environment without periodontal ligament cells might be ascribed to the inductive principle of demineralized dentin. The results suggest that a diseased root which has been planed and conditioned with citric acid is likely to form a new connective tissue attachment, even if it is placed in an environment without periodontal ligament cells. They also suggest that the factor inhibiting potential new connective tissue attachment is the condition of the root surface, rather than the lack of an adjacent progenitor cell population.

Adult↗

Clinical effects of scaling and root planing in adults infected with Actinobacillus actinomycetemcomitans.

The periodontal pathogen Actinobacillus actinomycetemcomitans can frequently be isolated from subgingival plaque of adults with chronic inflammatory periodontal disease and individuals with plaque-induced gingivitis. Problems with the persistence of the organism after thorough debridement of root surfaces have been reported. In the present study clinical effects of the hygienic phase of periodontal therapy in ten adult patients with moderate or advanced periodontitis harbouring A. actinomycetemcomitans were analysed. Since proper analysis of highly correlated data within a given patient is crucial for appropriate interpretation, a major objective of this study was to compare the results of different models derived from logistic regression of clinical and microbiological factors on gain or loss of clinical attachment under different assumptions. Subgingival samples from every tooth present were obtained before and 6 weeks after thorough subgingival scaling, and selectively cultivated for the organism. A relevant gain of clinical attachment of 2 mm or more was observed at a total of 36% of periodontitis sites after scaling. Overall, loss of attachment of 2 mm or more was observed at 8% sites. Most loss occurred at sites with gingival enlargement (15%), whereas 3% periodontitis sites lost 2 mm or more. In multivariate analyses erroneously assuming either independence of data or correctly considering the correlated structure of observations attachment gain was mainly associated with deep probing depths at the outset. Presence or absence of A. actinomycetemcomitans before or after therapy was not included into the periodontitis models. Also, loss of attachment of 2 mm or more after subgingival scaling was not influenced by the organism. A direct comparison of the results obtained with both approaches of logistic regression may be helpful in the assessment of the influence of the magnitude of correlation of the data on the regression coefficients.

Actinobacillus Infections↗

An imaging routine for assessing the efficacy of instruments used for scaling and root planing.

Deposits of dental plaque or calculus are typically quantified using planimetric techniques. However, error is introduced into a quantitative analysis of plaque deposits using these methods, since they require a significant amount of human intervention. The purpose of this study is to describe and validate a computerized imaging routine which has the potential to objectively identify material on dental roots and measure the area covered by these deposits. Dentiform teeth with simulated plaque were videorecorded. A computer routine was developed based on a flood-fill algorithm which analyzed images of the dentiform teeth and determined the amount of simulated plaque on their root surfaces. Results showed that the dentiform teeth and their simulated plaque patterns are duplicated by the imaging routine in a rapid and reliable fashion. The system shows a high degree of accuracy with an average error factor of only 0.58%. As well, the system enables precise reproducibility with an average error factor of only 0.71%.

Algorithms↗

Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy.

BACKGROUND: The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients. METHODS: One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks. RESULTS: An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy. CONCLUSIONS: Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.

Adult↗

Instruments and methods for the quantitative measurement of factors affecting hygienist/dentist efforts during scaling and root planing of the teeth.

Manual calculus debridement through scaling accounts for a significant proportion of hygienist efforts in dental and periodontal practices. Despite this, little is quantitatively known concerning the effects of instruments, technique and treatments on debridement (scaling) efficiency or efficacy. The total work effort expended by therapists in calculus debridement results from the sum of the efforts associated with each scaling stroke. Each scaling stroke, in turn, is affected by a variety of physical forces, including those in the control of the therapist and those intrinsic to the calculus substrate. The development of procedures and treatments to facilitate easier calculus removal requires consideration of the physical and technique-related factors which contribute to hygienist effort. Instruments have recently been developed which can quantitatively measure force dynamics associated with scaling procedures, including both therapist-applied forces and forces developed due to the extreme hardness and tenacity of supra- and subgingival calculus deposits. The scaling instrument developed to quantitatively record developed forces in scaling, the Quanticalc, can be used for the assessment of techniques and treatments which can soften calculus, facilitating easier debridement. The device can also be used to instruct therapists on factors contributing to surface roughness and tactile response to these factors. The scaling instrument developed to quantitatively measure therapist applied forces in scaling, the Zappa device, can be used for assessment of techniques which can increase the efficiency of calculus removal with minimal damage to sound root substance. In this paper, the force dynamics associated with manual scaling procedures of dental professionals are defined. These force dynamics account for the total work expended by hygienists and other professionals in the important task of calculus removal. Using this as a foundation, the design, use, calibration and clinical applications of these newly developed scaling-force measurement systems are described.

Algorithms↗

An in vitro study of oscillating instruments for root planing.

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

Dental Calculus↗

IL-1 in gingival crevicular fluid following closed root planing and papillary flap debridement.

Interleukin (IL)-1 alpha and beta are cytokines which can mediate inflammatory, bone resorbing, and reparative effects in the periodontium, but few longitudinal data exist exploring their role following periodontal therapy. This study examined gingival crevicular fluid (GCF) concentrations of IL-1 alpha and IL-1 beta at sites with shallow sulci (SS) or inflamed moderate/advanced pockets (M/AP) before and 6 months after treatment with closed scaling/root planing (SC/RP) or papillary flap debridement (PFD), all in the same subject (n = 14 patients). No significant differences were noted in IL-1 alpha or beta concentrations (determined with two-site enzyme-linked immunosorbent assays) between SS and M/AP sites at baseline. While both therapies improved clinical parameters of periodontal disease, IL-1 alpha concentration increased significantly (p < 0.05) in M/AP-PFD sites 6 months after treatment, but were unchanged in other groups. IL-1 beta concentrations were numerically lower after therapy, except for a significant increase (p < 0.05) in M/AP-PFD sites. These data suggest that surgical wound healing in an inflamed, plaque-infected site (M/AP-PFD) results in prolonged production of IL-1, which may be a reflection of the extent of tissue trauma and delayed wound healing. In spite of increased IL-1 levels, these sites demonstrated significant short-term improvement in clinical attachment level (+ 1.8 mm, p < or = 0.001) postoperatively.

Adult↗

The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results.

BACKGROUND/AIMS: Previously, we reported that SRP resulted in a decrease in mean pocket depth and attachment level and reduced prevalence and levels of Bacteroidesforsythus, Porphyromonas gingivalis, and Treponema denticola at 3 and 6 months post-SRP in 57 subjects with adult periodontitis. 32 of the 57 subjects were monitored at 9 and 12 months. Thus, the purpose of the present investigation was to evaluate the microbial and clinical effects of SRP in 32 (mean age 48+/-11) subjects over a 12-month period. METHOD: Clinical assessments of plaque, gingival redness, suppuration, bleeding on probing, pocket depth and attachment level were made prior to SRP and at 3, 6, 9, and 12 months post-therapy. Subgingival plaque samples were taken at each visit and analyzed using the checkerboard DNA-DNA hybridization technique for the presence and levels of 40 subgingival species. Each subject also received maintenance scaling at each of the subsequent monitoring visits. Differences in clinical parameters and prevalence and levels of bacterial species were analyzed pre- and post-therapy using the Wilcoxon signed ranks test. The Quade test for related samples was used for analysis of multiple visits. RESULTS: Mean pocket depth (mm+/-SEM) decreased from 3.2+/-0.3 at baseline to 2.9+/-0.3 at 12 months (p<0.01). Mean attachment level showed significant reduction at 6 months, but did not diminish further. Bleeding on probing and plaque were significantly reduced at 12 months (p<0.001, p<0.05, respectively). P. gingivalis, B. forsythus and T. denticola decreased in prevalence and levels up to the 6-month visit and remained at these lower levels at 9 and 12 months. Significant increases in levels and prevalence were noted at 12 months for Actinomyces naeslundii genospecies 2, Actinomyces odontolyticus, Fusobacterium nucleatum ss polymorphum, Streptococcus mitis, Capnocytophaga sp, and Veillonella parvula. CONCLUSIONS: The data suggest that the maintenance phase of therapy may be essential in consolidating clinical and microbiological improvements achieved as a result of initial therapy.

Actinomyces↗

[Subgingival irrigation combined with scaling and root planing. Results of a study with chlorhexidine and sodium hypochlorite].

Scaling and root planning is more and more associated with subgingival irrigation in chronics periodontal treatment. It is unreasonable to expect to control periodontal infections by mechanical treatment alone. Most patients do not achieve the necessary level of manual dexterity or motivation to control their plaque at home. It is rather better to deliver antimicrobial agents directly into the periodontal pocket. The aim of this study is to evaluate the action of subgingival irrigation associated to periodontal scaling on the clinical parameters and to compare the effects of chlorhexidine (Eludril) and sodium hypochlorite (Dakin Cooper) on adult's chronics periodontitis treatment. At the level of Plaque Index, Gingival Index and Bleeding on Probing, the results show that Eludril irrigation associated to scaling is lightly efficacious than Dakin cooper irrigation associated to scaling. And, the last one also is lightly efficacious than scaling alone. However, at the level of pocket depth, scaling alone has been also effective than scaling associated with subgingival irrigation.

Adult↗

[Root planing].

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Dental Prophylaxis↗

The effectiveness of subgingival scaling and root planing. II. Clinical responses related to residual calculus.

This study related 3-month clinical changes following scaling and root planning to the presence or absence of calculus on the root surfaces detected after extraction. Seven patients provided 646 sites evaluated for plaque, bleeding upon probing (BOP), probing pocket depth (PPD), and probing attachment level (PAL) at baseline and monthly following instrumentation. The teeth were extracted and evaluated for the presence and the percent surface area of calculus. Diagnostic sensitivity and predictability values for initial and residual PPDs, loss of PAL, and BOP in detecting residual calculus were determined. Calculus was found on 376 surfaces with a mean percent surface area of 3.13%. Predictability values were similar for all PPD ranges, while sensitivity decreased with increasing PPD. Probing attachment level changes were found to be unrelated to the presence or the amount of residual calculus. Bleeding upon probing had high levels of predictability, but sensitivity values were low. None of the clinical parameters evaluated in this study provided both a high level of predictability and sensitivity in detecting residual calculus.

Adult↗