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PubMed1994

Experiences with guided tissue regeneration in the treatment of advanced periodontal disease. A clinical re-entry study. Part I. Vertical, horizontal and horizontal periodontal defects.

The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE-membranes (Gore-Tex) in the treatment of advanced periodontal disease. The study presents long-term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL') and the tissue level (TL), a new parameter between cemento-enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re-entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL-Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re-entry (BL-BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at re-entry. The decreased amount of mineralized tissue at re-entry in relation to the tissue gain at membrane removal might be due to formation of a so-called long connective tissue attachment or to mineralization-induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.

Adult↗
PubMed1996

Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem.

It is established that phenytoin, cyclosporin and some calcium antagonists produce gingival overgrowth, but it is not known how this condition may respond to causal periodontal treatment. In order to find out, a longitudinal study was carried out, over a year, comparing a group of patients who were given nifedipine (NG, n = 18) and another group who were given diltiazem (DG, n = 13) with 2 others: one comprised cardiopathic patients who took no calcium antagonists (CG, n = 12) and the other contained patients who were medically healthy, with moderate periodontitis (HG, n = 12). On their basal visit, they were examined and instructed in oral hygiene, and then given causal periodontal treatment, being seen again at 4 and 8 months, when hygiene instructions were reinforced. They were seen for the last time at 12 months, when they were again examined. Groups NG and DG, on their basal visit, showed larger gum size than groups HG and CG, which was statistically significant; on their final visit, these differences remained only at the interproximal level. The number of patients with gingival overgrowth-taking the average of group HG as a minimal value-was much higher in groups CG (92%), DG (100%) and NG (89%) on the basal visit; on the final visit, the differences remained only in groups DG (85%) and NG (83%). The probing pocket depth reduction was much greater in groups HG and CG than in DG and NG, basically due to a greater gaining on clinical attachment level. The % of sites in which the pocket depth improved by more than 2 mm was 39.8% in HG, 54.5% in CG, 23.7% in DG and 28.7% in NG. The % of sites where the attachment gain by more than 2 mm was 46.2% in HG, 55.5% in CG, 22.8% in DG and 21.4% in NG. The amount of plaque and bleeding on probing, which was similar in all groups on the basal visit, decreased throughout the study, especially between the basal and 2nd visit in groups HG and CG. We have demonstrated that patients that take nifedipine and diltiazem show a larger gum size and their response to causal periodontal treatment is poorer than in the healthy and the cardiac groups.

Analysis of Variance↗
PubMed2006

Subgingival microbiota of periodontally untreated Mexican subjects with generalized aggressive periodontitis.

BACKGROUND AND AIM: Specific microbial profiles that may distinguish between generalized aggressive-periodontitis (GAgP) and generalized chronic-periodontitis (GCP) have, to date, not been described. The purpose of the present study was to describe the subgingival microbial composition of Mexican subjects with GAgP and compare it with that of individuals with GCP and periodontal health (PH). MATERIAL AND METHODS: Seventy-seven subjects with GAgP (n=19), GCP (n=39) and PH (n=19) were selected. Clinical measurements included plaque accumulation, gingival erythema, bleeding on probing, suppuration, pocket depth and attachment level. Up to 28 subgingival plaque samples were obtained from each subject and analysed using the checkerboard DNA-DNA hybridization technique. RESULTS: GAgP and GCP subjects harboured significantly higher levels and/or proportion of Porphyromonas gingivalis, Tannerella forsythia (levels: p<0.001, proportion: p<0.01), Prevotella nigrescens (p<0.05 levels) and "red" complex species (p<0.001 proportion) than PH subjects. All GAgP subjects were carriers of P. gingivalis and P. nigrescens. No significant differences in any of the 40 microbial species tested were detected between GAgP and GCP subjects. CONCLUSIONS: Our results revealed that the microbial differences between GAgP and GCP subjects were only discrete and none of the bacterial species tested seemed to specifically differentiate the subgingival microbial profile of either periodontitis group.

Actinomyces↗
PubMed1995

Evidence of a direct relationship between neutrophil collagenase activity and periodontal tissue destruction in vivo: role of active enzyme in human periodontitis.

To assess the temporal relationship between periodontal tissue destruction and the activity of collagenase, exudate from inflamed periodontal tissues was collected and latent and active collagenase activities were measured by a functional assay in a longitudinal cohort study. Comparisons were made between human subjects with either: 1) inflammation with a previous history of progressive loss of connective tissue and bone support (n = 14); 2) inflammation and previous history of bone loss but now clinically stable (n = 27); or 3) inflammation and no loss of bone support (n = 17). Experiments using specific enzyme inhibitors, blocking antibodies and SDS-PAGE fluorograph to identify the pattern of collagen substrate degradation demonstrated that the collagenase activity was derived from neutrophils and not from bacteria or other host cells. Active collagenase activity pooled from 6 sites per subject was respectively 5 and 6-fold higher in the group with progressive loss of connective tissue compared to the groups with either inflamed tissues alone or with inflammation and previous bone loss. In contrast, latent collagenase was increased up to 2 fold higher in the group with inflammation but no bone loss compared to the group with progressive lesions. Moreover, the ratio of active to total collagenase activity was 50% higher in the group with progressive lesions. Although in all subjects successive measurements of site-specific active collagenase 1 month apart demonstrated wide variation (r < 0.50), only in sites with progressive periodontal destruction was there significant increase of active collagenase with time (1.28 x 10(-4) collagenase units per day). There were also sharp elevations in active enzyme level at the time of detection of loss of connective tissue attachment in specific sites of 8 subjects. At the time of detection of connective tissue attachment loss, there was an overall 40% increase of pooled active collagenase activity in all subjects with progressive loss of connective tissue compared to pre-breakdown sampling times. These data provide strong in vivo evidence for a direct role of active neutrophil collagenase in the pathological destruction of periodontal connective tissue.

Adult↗
PubMed1986

Periodontal destruction in Down's syndrome and in juvenile periodontitis. How close a similarity?

Advanced destruction of the periodontium, with similarities in alveolar distribution, age range, and diminished host responses of varying severity, may be seen in Down's syndrome and in juvenile periodontitis. This review compares and contrasts periodontal destruction and immunologic mechanisms in the two conditions. Both are characterized by raised serum immunoglobulins, selective cell-mediated immunodeficiencies, and defective neutrophil polymorphonuclear leukocyte chemotaxis. There is a possibility of defective monocyte chemotaxis in both conditions, although this is less clear in juvenile periodontitis. By contrast, antigen-induced DNA synthesis is enhanced in Down's syndrome, but reduced in juvenile periodontitis.

Aggressive Periodontitis↗
PubMed1992

Subgingival distribution of periodontal pathogenic microorganisms in adult periodontitis.

The association between specific plaque microorganisms and periodontal diseases has been the subject of much recent interest due to its potential importance in the diagnosis and classification of these diseases. In order to optimize microbiological tests in periodontal therapy, it is important to know how many subgingival plaque samples must be assayed from a single patient in order to ascertain infection with a periodontal pathogen. To answer this question the present study assessed the distribution of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, and Prevotella intermedia in multiple subgingival plaque samples. The samples were quantitatively assessed for specific bacteria by indirect immunofluorescence, a technique previously found to correlate well with cultural assessment of these same organisms. Subgingival plaque from the mesial pockets/sulci of all teeth except third molars was sampled in 12 patients with adult periodontitis, 22 to 28 sites/patient for a total of 315 samples. These patients demonstrated an average mesial probing depth and loss of attachment of 3.7 +/- 1.2 mm and 3.1 +/- 1.5 mm, respectively (mean +/- SD). P. gingivalis, P. intermedia, and B. forsythus were demonstrated in one or more sites from all patients, while A. actinomycetemcomitans was found in one or more sites in 8 of 12 patients. The proportion of positive sites per subject varied, but it was, on average, similar for the 3 black-pigmented organisms and ranged from 44% to 54%. In contrast, A. actinomycetemcomitans was identified, on average, in only 11.4% of the sites in these same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Periodontal repair in dogs: supraalveolar defect models for evaluation of safety and efficacy of periodontal reconstructive therapy.

It is increasingly evident that controlled preclinical models with reproducible defect characteristics and biologic reaction are critical for evaluation of safety and efficacy of periodontal reconstructive protocols. Our investigations have characterized a supraalveolar periodontal defect in the mandibular premolar region in the beagle dog. This surgically-created critical size defect heals with almost complete connective tissue attachment following immediate reconstructive surgery. When the defect is exposed to periodontitis-simulating conditions prior to surgery the new connective tissue attachment is reduced. Bone and cementum regeneration is limited for both defect variations. Critical aspects relative to animal selection and management, surgical protocol, histologic and statistical analysis are discussed. This preclinical model has proven effective for evaluation of safety and efficacy of devices and biologics used adjunctive to periodontal reconstructive therapy.

Alveolar Bone Loss↗
PubMed2001

Associations between serum antibody levels to periodontal pathogens and early-onset periodontitis.

BACKGROUND: The role of antibodies to periodontal microorganisms in the development of periodontal tissue destruction is still unclear. The aim of this study was to investigate the association between serum levels of IgG, IgA, and IgM antibodies to 6 periodontal microorganisms and clinical subtypes of varying severity of early-onset periodontitis (EOP) in young African American adults. METHODS: The study group consisted of 159 African Americans aged 19 to 25 years (mean 22 years) and included 97 cases with EOP and 62 controls with no clinical signs of EOP. These subjects were selected from a nationally representative sample of adolescents who received an oral examination as part of the National Survey of Oral Health of United States Children in 1986-1987. The group was examined clinically a second time 6 years later and blood samples were collected. Serum levels of IgG, IgA, and IgM reactive to Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus, Eikenella corrodens, and Fusobacterium nucleatum were assessed. RESULTS: Serum levels of IgG and IgA antibody reactive to P. gingivalis and A. actinomycetemcomitans and IgA antibody to P. intermedia were significantly higher in generalized EOP cases compared to healthy controls. IgM antibody levels did not show any significant associations with EOP for any of the 6 bacterial species tested. There were no significant differences in antibody levels between controls and the 13 subjects in our study who were classified with localized EOP. CONCLUSIONS: The findings suggest that antibodies to P. gingivalis, P. intermedia, and A. actinomycetemcomitans may play a significant role in the pathogenesis of EOP. Substantial longitudinal studies that monitor antibody levels and avidity prior to disease onset, during progression, and following clinical intervention will be necessary to fully understand the role of this component of the immune response in protection versus tissue destruction and the potential use in EOP risk assessment and disease management.

Adolescent↗
PubMed2000

[Effects of autogenous periodontal ligament cell transplantation on periodontal tissue regeneration in dogs].

OBJECTIVE: To evaluate the effect of autogenous periodontal ligament cell (PDL) transplantation in periodontal tissue regeneration. METHODS: PDL cells derived from the same dog were cultured with alpha-MEM. 1 x 10(5) cells of first passage were allowed to attach to the collagen membrane for 24 hours. The membrane-cells were transplanted into periodontal defect in the same dog. Then the defects were covered with e-PTFE membranes. The defects covered only with e-PTFE were the controls. Eighteen teeth of 6 dogs for each group were included. The dogs were sacrificed after 6 weeks. RESULTS: The results showed that new bone formation (4.00 +/- 0.13) mm in test group was significantly higher than that of in control group (3.09 +/- 0.28) mm, P < 0.05. The new cementum formation in test group was better than control group (P < 0.05). CONCLUSION: The results suggested that PDL cell transplantation with guided tissue regeneration technique could enhance periodontal tissue regeneration in dogs.

Animals↗
PubMed1992

[Bleeding tendency and periodontal diagnosis. Evaluation of the prognostic significance of bleeding tendency for periodontal diagnosis].

Since differences in susceptibility to periodontal breakdown do exist, it is essential to predict future breakdown on the basis of a prognostic indicator. The experimental gingivitis model was chosen to investigate the clinical differences related to the degree of susceptibility to periodontal breakdown. Both bleeding upon probing and the amount of plaque seems to depend on the history of inflammatory periodontal disease. It is concluded that the bleeding/plaque ratio may act as a prognostic indicator to predict periodontal breakdown.

Dental Plaque↗
PubMed1992

Diagnostic studies on juvenile, rapidly progressive and adult periodontitis before and after periodontal therapy (II).

The use of antibody levels may identify subjects developing destructive periodontitis or provide markers of disease type. Clinical parameters can be used to group cases but they are incapable of detecting differences in host-susceptibility and host immune response. The validity of radial immunodiffusion (RID) as a laboratory screening method in diagnosis based on antibody quantitation has been evaluated in 36 patients before and after periodontal therapy. It was concluded that the serum IgA, IgG, IgM and parotid IgA concentration profiles, measured with RID have little value in determining the subgroups of early onset periodontitis patients but they can be used to differentiate these groups from slowly progressing adult periodontitis patients.

Adolescent↗
PubMed2003

Influence of interleukin-1 gene polymorphism on the outcome of supportive periodontal therapy explored by a multi-factorial periodontal risk assessment model (PRA).

BACKGROUND: Multi-factorial risk models have been proposed to enhance the ability to predict risk for the progression of treated chronic periodontitis. AIMS: to study if the outcomes of supportive periodontal therapy (SPT) based on a multi-factorial periodontal risk assessment are influenced by IL-1 gene polymorphism (IP) status. MATERIAL AND METHODS: Information about the IP and smoking status, clinical periodontal conditions and age related bone level measurements were used to calculate a peridontal risk assessment model (PRA). The surface area of this diagram was calculated for 224 subjects who had participated in an SPT program over four years. Baseline and 4-year follow-up data were studied in relation to the IP status. RESULTS: Positive IP tests were obtained for 80/224 (35.7%) of the subjects. At baseline the mean PRA for the IP positive group was 79.9 units, which at year four had increased to 81.3 units (mean diff: 1.4 units, S.D.+/-16.5, p<0.45, 95% CI: 2.3 to 5.1). At baseline and year four the mean PRA for the IP negative group was 44.2 and 38.6 units, respectively. This difference was statistically significant (mean diff: 5.6, S.D.+/-16.1, p<0.001, 95% CI: 3.0 to 8.3). Independent t-tests confirmed that the IP status was significantly associated with a less favorable change in PRA over the four-year period (PRA difference: 7.04, t=3.01, p<0.003, 95% CI: 2.4 to 11.65). Bleeding on probing, and probing depth values alone did not differ between positive and negative IP status. Regression analysis demonstrated that the best-fit model for change in PRA included bleeding on probing at baseline, IP status, proportional alveolar bone loss in relation to the age, and gender. CONCLUSION: The PRA allowed the assessment of the outcomes of SPT therapy. Subjects with positive IP did not respond to individualized SPT as favorably as did IP negative subjects.

Adult↗
PubMed1986

Assessment of periodontal status by CPITN and its applicability to the development of long-term goals on periodontal health of the population.

CPITN data from 40 countries have been used to assess periodontal status at ages 12, 15 and 35-44 years. There are broad differences in the numbers of healthy sextants between developing countries and those which are highly industrialized. At 12 years this component of the Index could provide the basis of a global indicator of periodontal health--not less than 3 healthy sextants per child by the year 2000. At 15 years zero sextants with periodontal pockets is a feasible aim. It is less easy to set goals for periodontal health in adults.

Adolescent↗
PubMed1994

[Longitudinal study on periodontal disease activity in treated periodontitis patients].

The aim of this study was to estimate the incidence of periodontal disease activity (PDA) in treated periodontitis patients in a longitudinal survey. Seven periodontitis patients with 170 teeth (970 sites) participated in this 6 to 12 month study. After initial therapy, the clinical parameters including attachment level (AL) were recorded as the baseline data and then repeated every two months. Occlusal stents were used for each patient to assure the accuracy and reproductivity of the attachment level measurements. Detection of > or = 2 mm of new AL between two consecutive visits was required to designate a site as PDA. During the study period, 21 sites out of 970 sites showed PDA. For better accuracy, we calculated the yearly PDA rate based on the 6-month data because not all the seven patients finished the 12-month observation. The estimated PDA rate per year was 2.8%. Data also showed that maxillary bicuspids and molars on both jaws were more susceptible to PDA. Interproximal sites and sites with > or = 6 mm pockets before treatment showed significantly greater PDA rate than buccal (lingual) sites and sites with < or = 4 mm initial pocket depth. Our data supports the tooth specific and site specific concept in periodontal disease.

Adult↗
PubMed1994

Prevalence of periodontal disease in an active duty military population as indicated by an experimental periodontal index.

An experimental periodontal screening examination and index was used to measure the prevalence of gingivitis and periodontitis among 1,334 soldiers at Fort Knox, Kentucky. Although 12.1% of the subjects demonstrated no disease, 40.3% were found to have gingivitis. In this sample group, the occurrence of gingivitis decreased with increasing age. Early periodontitis (probing depths of 3-5 mm) was detected in 35.7% of the subjects, and subjects with moderate to advanced periodontitis (probing depths greater than 5 mm) comprised 11.9% of the sample. The screening exam used is suggested for use as part of each soldier's annual dental examination.

Adolescent↗
PubMedDate not supplied

[The morphology of the microorganisms from the contents of a periodontal pocket in relation to the severity of the periodontitis].

Ninety-five patients with periodontitis of slight and medium severity were examined, 21 of them without concomitant diseases, 44 with essential hypertension, and 30 with diabetes mellitus. Besides clinical signs of periodontal abnormalities, the examinations revealed using phase-contrast microscopy four groups of microorganisms in the periodontal pouch contents: cocci, immovable and movable bacilli, and tortuous forms. Multidimensional analysis of clinico-laboratory data revealed a relationship between the counts of some microorganisms and severity of periodontal pathology.

Adult↗
PubMed1997

A six-month clinical comparison of the efficacy of the Sonicare and the Braun Oral-B electric toothbrushes on improving periodontal health in adult periodontitis patients.

A sonic electric toothbrush (Sonicare) and an oscillating/rotating electric brush (Braun Oral-B) were compared for efficacy in removing supragingival plaque, reducing gingival inflammation, reducing probing pocket depth (Pd) and improving probing attachment levels (PAL) in a 6-month, single-blind clinical trial. Sixty-six adults with early-moderate periodontitis (5-7 mm Pd in at least two quadrants) entered the study, and 54 completed the entire study. The Sonicare and Braun groups were equally matched for plaque scores, and balanced for age, race and gender. Plaque was scored using the Turesky, Gilmore and Glickman Index. Gingival inflammation was determined by the Papillary Bleeding Score (PBS) of Loesche. Probing depths and attachment levels were determined using a manual North Carolina probe. All measurements were recorded at baseline, 2, 4 and 6 months. The mean overall plaque scores improved in both the Sonicare and the Braun groups at each of the follow-up visits. Interproximal plaque scores also improved in both groups with time, and the mean differential Sonicare post-brushing score was significantly better than the Braun at the 6-month visit (t-test; p = 0.039). Gingival inflammation also decreased in both groups over the 6-month period, but the Sonicare group showed significantly superior PBS scores at 4 months (t-test; p = 0.002) and 6 months (p = 0.005). The percentage reduction in inflammation from baseline at 6 months was 31.9% for Sonicare and 18.1% for Braun. Probing depth scores followed a similar pattern, with the Sonicare showing a mean reduction of 0.84 mm (15.8%) from baseline at 6 months, and Braun showing a 0.39 mm (7.2%) reduction (p = 0.002). In the Sonicare group probing attachment levels improved by 8.6% (MANOVA; p = 0.01), but no PAL improvement was seen in the Braun group. Overall, this study demonstrates that long-term use of these two electric toothbrushes improves periodontal health in adult periodontitis patients, and that the Sonicare brush is superior to the Braun brush in reducing gingival inflammation and probing depth. Moreover, 6 months' use of Sonicare led to actual improvement in probing attachment levels of periodontal pockets.

Adult↗
PubMed1998

Prevalence of HIV-associated periodontitis and chronic periodontitis in a southeastern US study group.

OBJECTIVES: This study estimates factors associated with the prevalence of HIV-associated periodontal diseases (HIV-P) and the severity and extent of periodontitis in HIV-infected adults from North Carolina (NC). METHODS: Data are derived from a cross-sectional study of HIV-infected adults (total n = 326, dentate n = 316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV-P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3. RESULTS: In addition to persons with HIV (non-AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range = 19-67); 78 percent were male and 60 percent were black. Sixty-two percent of persons had a probing pocket depth > or = 5 mm; 46% had recession > or = 3 mm, and 66 percent had attachment level > or = 5 mm in one or more sites. Cases of HIV-P (n = 15) were rare. Persons taking HIV-antiretroviral medication were one-fifth (OR = 0.20; 95% CI = 0.07, 0.63) as likely to have HIV-P as those not taking those medications, controlling for CD4+ cell counts. CONCLUSIONS: HIV-infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV-P, which was attenuated by antiretroviral therapy.

Acquired Immunodeficiency Syndrome↗