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PubMed1994

Clinical characteristics of periodontal sites with probing attachment loss following initial periodontal treatment.

Periodontal sites which had undergone probing attachment loss were identified in 16 advanced periodontitis patients subjected to initial periodontal treatment and monitored every 3rd month for 42 months. Many sites with probing attachment loss showed no increase in probing depth and bled on probing at a few of the examinations during maintenance. Others showed increase in depth, frequent bleeding and suppuration. An arbitrary classification of 'questionable periodontitis' sites was used and included sites with the following characteristics: probing depth at 42 months < or = 3.5 mm + bleeding on probing at no more than 5 of the 14 examinations 3-42 months + no suppuration on probing 3-42 months. The % sites in this category ranged from 21-35%, depending upon method used to determine probing attachment loss. Widely varying characteristics of sites identified with probing attachment loss were evident for all surface locations and all subgroups of initial probing depth. From a traditional viewpoint, a significant proportion of the losing sites might not have been afflicted with periodonitis. On the other hand, deterioration does not necessarily have to be coupled with obvious inflammation, particularly following therapy.

Adult↗
PubMed1996

Periodontal diagnosis in treated periodontitis. Why, when and how to use clinical parameters.

The objective of clinical periodontal diagnosis in maintenance patients is to monitor the risk for periodontal disease progression. Risk for progression should be continuously monitored at the patient, tooth and site level at each recall appointment. At the patient level, the significance of systemic diseases, cigarette smoking, compliance with the recall program, loss of support in relation to the patient's age, full mouth plaque and/or bleeding scores, and prevalence of residual pockets are of key importance. At the tooth and tooth-site levels, residual periodontal support, inflammatory parameters and their persistence, presence of ecological niches with difficult access such as furcations, and presence of iatrogenic factors have to be put into proportion with the patient's overall risk profile. The information gathered by clinical monitoring and continuous multilevel risk assessment facilitates an immediate appreciation of the periodontal health status of an individual and the possible risk for further infection and/or disease progression in the dentition and at a particular tooth or site.

Age Factors↗
PubMed1990

Determination of pseudocholinesterase activity in the gingival crevicular fluid, saliva, and serum from patients with juvenile periodontitis and rapidly progressive periodontitis.

By use of a spectrophotometric method, pseudocholinesterase (PCE) activities were determined in gingival crevicular fluid (GCF), saliva, and serum from patients with juvenile periodontitis (JP) and rapidly progressive periodontitis (RPP) and from controls. The PCE activity in the GCF samples was 181 +/- 48 U/L in the JP group, 588 +/- 135 U/L in the RPP group, and 88.5 +/- 29.1 U/L in the control group. Saliva PCE activity levels were 9.1 +/- 1.7 U/L in the JP group, 21.8 +/- 4.5 U/L in the RPP group, and 12.7 +/- 0.8 U/L in the control group. GCF contained a higher PCE activity than saliva but a lower one than that of serum. The RPP group had a significantly higher PCE activity in both the GCF and saliva samples. No significant differences could be found regarding serum enzyme levels. Also, no significant correlations were present between biochemical values and the severity of periodontal disease. GCF may be an important source for the PCE content of saliva. It is suggested that the increased PCE activity seen in RPP patients might be caused by either the direct production of esterases by bacteria or the induction of esterases during periodontal destruction.

Adult↗
PubMed1992

Early effects of periodontal therapy on the detection frequency of four putative periodontal pathogens in adults.

This study aimed to examine early posttreatment changes in the periodontal microflora. Paper point sampling and conventional bacterial cultivation were used to monitor the effects of surgical and non-surgical periodontal therapy on the detection frequency of Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, and Capnocytophaga species in deep periodontal pockets. Ten patients, 5 men and 5 women (mean age 44 years), with advanced periodontal disease were selected from the dental school patient population for the study. A total of 245 teeth in 10 defined areas of the dentition were treated by oral hygiene instruction followed by scaling and root planing alone (121 sites) or with surgical interventions (124 sites). Ninety sites, 47 surgical and 43 non-surgical, with initial pocket depth greater than or equal to 6 mm were sampled at baseline and 3 months after completion of therapy. Treatment by both procedures resulted in significant clinical improvements as assessed by all clinical parameters used. Baseline results may indicate that the level of P. gingivalis was reduced in the presence of P. intermedia, while A. actinomycetemcomitans seemed to be reduced in the presence of P. gingivalis and/or P. intermedia. Three months after therapy, the detection frequency of P. gingivalis was significantly reduced (P less than 0.05) in surgical and non-surgical sites while the reduction for P. intermedia was significant only for surgical sites (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Periodontal regeneration by application of recombinant human bone morphogenetic protein-2 to horizontal circumferential defects created by experimental periodontitis in beagle dogs.

The purpose of this study was to examine the regeneration of periodontal tissue after the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) to horizontal circumferential defects created by experimental periodontitis. Twelve mandibular second premolars in 6 adult beagle dogs were subjected to experimental periodontal breakdown by placing silk ligatures around the teeth until the bone loss exceeded half of the root length. Flap surgery was then performed and the exposed cementum removed. The distance between the bone crest and cemento-enamel junction (CEJ) was about 5 mm. RhBMP-2 (40 micrograms/100 microliters) with a sponge-type carrier material made of gelatin and polylactic acid polyglycolic acid copolymer was placed in the furcation area (5 mm x 5 mm x 5 mm) and around the roots (10 mm x 5 mm x 2.5 mm x 2 pieces). In the control group, the same carrier material without rhBMP-2 was placed in the same manner. The flaps were replaced and sutured to cover these materials completely. Twelve weeks after surgery, the animals were sacrificed and serial sections were prepared in a bucco-lingual plane. Considerable new bone formation was observed in the rhBMP-2-treated sites. New cementum with Sharpey's fibers was observed on the instrumented root surface. On histometric analysis, the amount of new bone, new cementum, and connective tissue attachment was significantly greater in the rhBMP-2-treated group (paired t test; P < 0.01). These results indicate that suitable application of rhBMP-2 can produce considerable periodontal tissue regeneration, even in cases of horizontal circumferential defects.

Alveolar Bone Loss↗
PubMed2002

Tooth auto-transplantation with double periodontal ligament stimulation to replace periodontally compromised teeth.

BACKGROUND: The healing process of autotransplantation puts 2 different tissues in competition: the ligament on the root surface and the bone tissue of the alveolus. This study shows the effects of a protocol with 2 surgical stages, which promote ligament repair, inhibit adhesion between bone and dental root, and reduce the occurrence of the ankylosis-root resorption phenomenon. METHODS: Forty-three patients, 33 to 73 years old, received 47 transplantations of mature teeth (including retained teeth) during a 5-year period. During the first surgical step, the transplanted tooth is extracted, measured, immediately replaced in its origin site, and maintained with an original suture technique. The alveolus to which the tooth will be transplanted is adapted after extraction of the periodontally compromised tooth. The second surgery occurs at day 14, when regeneration of periodontal ligament (PDL) is at a maximum (first stimulation). The tooth is transplanted in its new alveolus and retained using the same suture technique to avoid a rigid splint and to create mechanical stimulation of the PDL (second stimulation). RESULTS: The results were 95.75% positive with normal PDL, with a 4.25% failure rate (transplant loss) and no ankylosis. Mean probing reduction was 8.37 +/- 3.0 mm. Mean radiographic bone gain was 7.73 +/- 4.32 mm. CONCLUSIONS: This study suggests that auto-transplantation with double PDL stimulation can be a viable treatment in clinical practice, especially to replace teeth with large periodontal lesions, deep furcation defects, and/or root fractures. This study shows the high potential of stimulated PDL to regenerate alveolar bone and periodontal structures in severe destruction sites.

Adult↗
PubMed1988

Periodontal awareness, health, and treatment need in dental school patients. II. Periodontal conditions.

The present study aimed to evaluate the periodontal conditions in a group of randomly selected patients scheduled for periodontal treatment in a dental school. The patients' age, sex, and responses to interview questions were used as predictors. About 64% of the lateral tooth surfaces had visible plaque after disclosure with erythrosine, and males had significantly more plaque-covered surfaces than females. All subjects had some areas showing 'bleeding on probing', and a total of 58% of the gingival units bled. About 99% of the subjects, 61% of the teeth, and 33% of the gingival sites had probing depths greater than or equal to 4 mm, whereas 70% of the subjects, 19% of the teeth, and 8% of the gingival sites had probing depths greater than or equal to 6 mm. Mean individual bone score for the 'Ramfjord teeth' was 5.60. Yearly dental visitors tended to keep their teeth to a greater extent than patients with a less regular treatment pattern. This is probably because irregular and emergency patients more often ask for extraction instead of restorative treatment. Since periodontal treatment usually is not offered, the periodontal conditions in the three regularity groups were not considerably different.

Adult↗
PubMed2005

Relationship between position of probe tip and periodontal tissues after periodontal surgery in dogs.

The aim of this study was to investigate postsurgical periodontal probe penetration by using clinical information and histometric data. Thirty-eight three-walled defects were created in four dogs, then maintained for 3 months. Subsequently, 26 defects were subjected to periodontal surgery (surgical group), while 12 defects served as controls. The dogs were sacrificed at 4, 8, 12, and 16 weeks. Immediately before sacrifice, endodontic silver points were placed in the gingival crevices as substitutes for periodontal probes and fixed on the teeth. Following block sections, histologic and histomorphometric evaluations were undertaken: location of the probe tip in relation to the apical termination of the junctional epithelium, length of new junctional epithelium in relation to the apical junctional epithelium, and mean length of connective tissue adhesion in relation to the apical junctional epithelium. Probe tips were located -1.37 +/- 1.73 mm and -0.20 +/- 0.15 mm apical to the apical junctional epithelium for the surgical and control groups, respectively, at 4 weeks, while the probe tip was located 0.58 +/- 0.31 mm and 0.40 +/- 0.20 mm coronal to the apical junctional epithelium, respectively, at 16 weeks. Length of new junctional epithelium in relation to apical junctional epithelium was significantly less for the surgical than the control group at 4 weeks (0.73 +/- 0.60 mm vs 1.19 +/- 0.02 mm) and 8 weeks (1.77 +/- 0.52 mm vs 2.15 +/- 0.00 mm). There were no significant differences between the groups in regard to connective tissue relationship to the apical junctional epithelium. Periodontal probing is not recommended for at least 2 months after surgical procedures; before this stage, probing forces may damage the soft tissue-tooth interrelationship.

Alveolar Bone Loss↗
PubMed2005

[Caries and periodontal state of pregnant women. Part II. Periodontal state].

A great number of clinical studies focused on the periodontal health of the pregnant women in the last decades, since an association has been presumed between the pregnant women's periodontal disease and the adverse pregnancy outcome. Altogether 161 healthy women were examined soon after delivery in Szeged/Hungary. The periodontal status of the patients was recorded by the Silness-Löe Plaque index (0.67), frequency of calculus (21.07%), mean probing pocket depth (1.67 mm) and the frequency of bleeding on probing (37.8%). A significant correlation was found between the state of the periodontium and the educational level and the pregnant women's profession. The periodontal state of women with higher education and the intellectuals was much better, than of the less educated patients and the manual workers.

Adult↗
PubMed1993

[The relationship between periodontal diseases and prostacyclin in saliva of periodontal patients by RIA]

The purpose of this investigation was to measure the changes of Prostacyclin(PG12) occuring in gingivitis and periodontitis.Fifteen cases of periodontitis,ten cases of gingivitis and ten cases of healthy participated in this study,Saliva was taken before treatment,Prostacyclin in saliva was measure by radioimmunoassay(RIA).The results showed that prostacyclin of human saliva is increased from healthy gingivitis to periodontitis.There is a statistical difference between groups,6-k-PGF1alpha in saliva of periodontitis is 3.6 folds of healthy.Gingivitis is 2.6 folds of healthy.There is also a significant difference between adult periodontitis our findings suggested that prostacyclin may play an important role in etiology of periodontal disease.Measured 6-k-PGF1alpha in saliva may indicate the severity of periodontal disease.

Journal Article↗
PubMed2005

Periodontal regeneration techniques for treatment of periodontal diseases.

The ultimate goal of periodontal therapy is the regeneration of structures lost to disease. Conventional surgical approaches such as open-flap debridement offer only limited regeneration potential.Currently, surgical procedures for predictable regeneration of periodontal tissues are being developed, analyzed, and employed in clinical practice. This article addresses current trends in periodontal regeneration. Various materials/agents such as bone replacement grafts, barrier membranes, and biologic modifiers currently used for the regeneration of periodontal infrabony and furcation defects are discussed.

Alveolar Bone Loss↗
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↗
PubMed1975

The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease.

The present clinical study was initiated in 1969 to test the hypothesis that microbial plaque is the cause of periodontal disease and that hence even advanced cases of periodontitis can be cured in patients willing to exercise optimal plaque control. The material consisted of 75 patients with severe destruction of the periodontal tissues. The patients were selected for the study because of their ability to maintain plaque-free dentition. Following an initial examination, a preliminary treatment plan was presented to the patients. This plan included detailed instructions in plaque control measures, scaling, root planning and emergency dental care, including endodontic therapy and extractions. Three to six months after the termination of the so-called presurgical treatment, surgical elimination of pathologically deepened pockets was performed. The patients were recalled every 3 to 6 months after the end of the treatment. At these reexaminations the following parameters were assessed: Plaque Index, Gingival Index, Pocket Depths, Marginal alveolar bone topography and height. The results demonstrate that it is possible to treat periodontal disease successfully, even in advanced stages, in patients willing to maintain plaque-free dentition.

Adult↗
PubMed1983

Progression of periodontal disease in adult subjects in the absence of periodontal therapy.

Progression of periodontal disease in adult subjects in the absence of periodontal therapy was monitored in 2 populations. One group of 64 Swedish subjects (mean age 40.5 years at entry) with mild to moderate periodontal attachment loss was monitored for attachment level changes at baseline, 3 and 6 years. A second group of 36 Americans (mean age 34.3 years at entry) with advanced destructive periodontal disease was monitored for attachment level changes at baseline and 1 year. Of 4101 sites examined at baseline and at 3 years in the Swedish subjects, only 158 sites (3.9%) showed attachment loss of more than 2 mm. No measurable change was found in 1440 sites (35.1%). Of 4097 sites examined at 3 and 6 years, 67 sites (1.6%) showed attachment loss greater than 2 mm; 57.4% of sites showed no measurable change; and 19 sites (0.5%) showed a decrease in probeable attachment level of more than 2 mm. During the 6-year interval, 523 sites (11.6%) showed attachment loss of more than 2 mm; 20% of sites showed no measurable change and 11 sites (0.2%) showed more than 2 mm of attachment "gain". Approximately 50% of sites that showed no measurable change in the first 3-year period showed loss in the next 3 years. In contrast, of the sites which showed some level of attachment loss in the first period, approximately 2/3 showed no loss in the second monitoring period. Of 3210 sites monitored in the American subjects, 102 sites (3.2%) exhibited more than 2 mm of additional attachment loss; 26% of sites showed no measurable change and 138 sites (4.3%) showed a decrease in probeable attachment level of more than 2 mm. The association between attachment level changes and initial attachment level (baseline) was examined by regression analysis. The slopes of the regression lines for both populations were not consistent with a hypothesis that sites with more advanced attachment loss are more prone to additional destruction, in the absence of treatment, than sites with initially less attachment loss. In the American group, some sites with initially advanced attachment loss, exhibited a decrease in probing attachment level.

Adolescent↗
PubMed1984

Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis.

Healing events following nonsurgical periodontal therapy in patients with periodontal pockets up to 12 mm deep were investigated. Incisors, cuspids and premolars in 16 patients were treated by plaque control and supra- and subgingival debridement using hand or ultrasonic instruments in a split mouth approach. The results were evaluated by recording of plaque scores, bleeding on probing, probing pocket depths and probing attachment levels. Minimal change in gingival conditions occurred during the initial 3 months of experimentation, which were utilized for plaque control measures alone. Subsequent to instrumentation and during the following 9-month period, a gradual and marked improvement of periodontal conditions took place. During the remaining 12 months of the 24-month experimental period no further changes of the recorded parameters were noted. No differences in results could be observed when comparing hand versus ultrasonic instrumentation, or when comparing the results of 2 different operators. Initially, a total of 305 sites demonstrated probing pocket depths greater than or equal to 7 mm. At the 24-month examination 43 such sites remained. The results indicate that there is no certain magnitude of initial probing pocket depth where nonsurgical periodontal therapy is no longer effective.

Adult↗
PubMed1985

Survival analysis of periodontal sites before and after periodontal therapy.

Periodontal diseases appear to progress with bursts of destructive activity at individual sites. One effect of treatment might be to diminish the frequency of such bursts. Survival analysis was employed to seek such effects on the periodontal sites of 16 individuals with prior evidence of destructive periodontal disease. The subjects were monitored at bi-monthly intervals and actively breaking down sites were detected using attachment level measurements and the tolerance method of analysis. When active sites were detected, control sites of equal pocket depth and attachment loss were selected and microbiological and immunological samples were taken. The subjects were treated by modified Widman flap surgery and systemically administered tetracycline. On completion of therapy, bi-monthly monitoring was reinstituted. Life tables were constructed for periodontal sites in each of the 16 subjects prior to and after therapy. A site losing more than 3 mm of attachment at any time interval was considered to have relapsed or "died". Survivor functions were calculated for each time period indicating the % of sites which survived at any time. The subjects were divided into 3 categories on the basis of post-therapy survivor functions. The annual hazard rate in 9 good treatment response subjects (group 1) was reduced from 0.10/year to 0.01/year. The hazard rate of 5 intermediate treatment response subjects (group 2A) was reduced from 0.16/year to 0.04/year and that of 2 poor treatment response subjects (group 2B) from 0.15/year to 0.07/year. Group 2A and 2B individuals were combined and differences were sought in clinical, microbiological and immunological parameters between the good and poor treatment response groups. 5 out of 7 of the poor responding individuals showed elevated humoral antibody responses to 3 or more gram-negative subgingival species tested. Many of the elevated responses in this group were to organisms which are widely distributed and return quickly after therapy such as Fusobacterium nucleatum, Eikenella corrodens, Bacteroides intermedius and Capnocytophaga sputigena. The predominant cultivable microbiota in subgingival samples taken prior to therapy from the good responding group had significantly greater proportions of Actinobacillus actinomycetemcomitans, C. ochracea and B. intermedius than the poor responding group. The latter group showed significantly elevated proportions of F. nucleatum, Peptostreptococcus micros and Streptococcus intermedius.

Adolescent↗
PubMed1988

Density and localization of lymphocytes with natural-killer (NK) cell activity in periodontal biopsy specimens from patients with severe periodontitis.

Natural killer lymphocytes (NKL) in gingival biopsy specimens of 13 patients with advanced periodontitis and 6 normal control subjects have been evaluated by the monoclonal antibody NC 1, anti-B4 and a double immunoenzymatic labeling technique, combining the peroxidase-anti-peroxidase (PAP) method with the alkaline-phosphatase-anti-alkaline-phosphatase (APAAP) technique. Mononuclear cells with NK-activity (NKA) were mainly accumulated in the upper to middle third of the periodontal pocket. The concentration of NC-1-positive cells (CNC) of the baseline biopsy specimens was significantly increased at p = 0.05 compared to the CNC after hygiene training. The statistical difference rose to p = 0.01 following scaling, root planing and curettage therapy. The healthy gingiva of control subjects showed an average of 1-2 NKL, and no statistical difference could be found when compared to the CNC of the biopsy specimens of patients after periodontal therapy. These data support the hypothesis that antibody-dependent cytotoxic immunoreactive lymphocytes in chronic inflammatory periodontal disease can be reduced by scaling and root planing therapy.

Dental Scaling↗
PubMed1991

Immunoglobulin isotype distribution of locally produced autoantibodies to collagen type I in adult periodontitis. Relationship to periodontal treatment.

Production of antibodies to collagen type I was analyzed by means of an enzyme-linked immunospot (ELISPOT) assay in patients with chronic adult periodontitis (AP) before and after periodontal hygiene treatment. Anti-collagen type I antibody-secreting cells were found among mononuclear cells enzymatically eluted from inflamed gingiva in 9 of 15 patients with untreated AP and in 4 of 14 hygiene-treated patients with a varied isotype distribution. A notably high prevalence of IgG and IgM isotypes was observed for the anti-collagen antibodies in untreated patients. With wide variation, chronic AP was characterized by a high frequency of spontaneous IgG and low numbers of IgA and IgM-producing cells. Periodontal hygiene treatment significantly reduced the number of IgA and IgM-secreting cells. Although AP is not an autoimmune disease in the accepted sense, our results indicate that local autoimmune reactions to collagen type I are common in untreated AP, implying an interplay between periodontal infection and autoimmunity.

Autoantibodies↗