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PubMed2002

[How threatening is periodontitis? Effects of periodontitis on the human body].

Periodontitis is a chronic inflammatory process which is not only threatening for the dentition. Bacteriae and their substances can enter the bloodstream by eating, toothcleaning or dental treatment and harm the body. Known are heart-valve infections by S. sanguis, but also pneumonia is seen more in patients with periodontitis. Recently it appears that periodontitis is probably the main course of preterm low birthweight babies. It has also been shown that there exists a close association between periodontitis and cardiovascular diseases. Investigations even suggest that this might be a causal relation.

Chronic Disease↗
PubMed2003

[The role of Matrix Metaloproteinases in the progression of periodontitis, and the use of specific inhibitors to these enzymes in the treatment of the periodontal disease].

Matrix Metaloproteinases (MMPs) play a crucial role in the pathogenesis of the periodontal disease. This group of enzymes can degrade most of the proteins that compose the extracellular matrix. Recently a new concept of treatment, the "host modulating therapy" (HMT) was developed. The rationale behind this concept is to inhibit the production of the inflammatory mediators and/or to block the production of the host MMPs and thus inhibiting disease production. In the recent years it was found that Tetracyclines (TC) decrease the levels of TNF-alpha, IL-1, Nitric Oxide, and prostaglandins, and via intra and extra cellular mechanisms inhibit the production and activation of the MMPs. A capsule of 20 mg Doxycycline, called later Low Dose Doxycycline (LDD), was the first HMT in the periodontal disease. In a 9 month study it was found that LDD bid after supragingival scaling statistically increased pocket reduction and attachment gain compared to supragingival scaling alone. However, this improvement was found only in pockets of 7 mm or more, and was not compared yet to periodontal supportive therapy every three month. There is a need for more basic and clinical research in the field of HMT in the treatment of periodontal disease, to expand our knowledge and clinical experience that will enable us to decide when and how to use medications to modulate host response.

Anti-Bacterial Agents↗
PubMed2003

[Computer tomograghy study on periodontal patients with anterior displaced teeth before and after combined orthodontic-periodontal treatment].

OBJECTIVE: To evaluate evaluation of the changes of alveolar bone height in the periodontal patients with anterior teeth displacement before and after combined orthodontic-periodontal treatment with circumferential fibrotomy. METHODS: Totally 16 periodontal patients with anterior displaced teeth were analyzed after random clinical trialed as groups with and without circumferential fibrotomy of involving teeth followed by orthodontic intrusion. Evaluations of the changes of alveolar bone were given before and after treatment by means of periapical X-ray film and CT scan of the involving teeth. RESULTS: Orthodontic treatment with circumferential fibrotomy can increase the height of crest bone. Alveolar bone height was increased in the patients with circumferential fibrotomy followed by orthodontic intrusion of displaced anterior teeth. Alveolar bone height was increase by 1.2 mm on average in circumferential fibrotomy patient. In the patients with symmetric alveolar bone loss, 0.8 mm increase of alveolar bone height was observed following treatment. For the patients with asymmetric alveolar bone loss, 0.9 mm increase of alveolar bone height was detected in mild bone loss patients, but 1.4 mm and 2.2 mm increase of alveolar bone height were found in moderate and severe bone loss patients, respectively. For patients having the orthodontic treatment without circumferential fibrotomy, the alveolar bone height was increased by 0.1 mm only. Statistic significance was found between the circumferential fibrotomy group and non-fibrotomy group. CONCLUSION: Combined orthodontic-periodontal treatment with circumferential fibrotomy could correct the malpositioned teeth, and improve the periodontium conditions and gain the crest bone.

Adult↗
PubMed2005

[Ten years of experience with the complex periodontal and orthodontic rehabilitation of patients with periodontal diseases].

In periodontal diseases where the loss of periodontal tissue is very extensive, displacement of the teeth may be observed. In the interest of complete healing, periodontal treatment must be followed by orthodontic treatment in such patients. If the basic rules relating to adult patients with a reduced, but healthy periodontium are adhered to, the orthodontics can be carried out with certainty in adults who have been rehabilitated from a periodontal aspect. An improved long-term result may be observed in the patients who participate in such complex rehabilitation. Teeth that have been restored to their correct position are not only aesthetically more attractive, but also function more appropriately, are easier to keep clean, and can be treated more simply.

Adolescent↗
PubMed2005

Root caries in periodontally treated patients in relation to their compliance with suggested periodontal maintenance intervals.

The purpose of this study is to investigate the correlation between the degree of patient compliance with the suggested periodontal maintenance treatment intervals and the new root caries development 5 years after the completion of the active periodontal treatment. The percentage of root surfaces with new root caries was low for both the erratic and the complete compliance patient groups. Erratic compliance with the suggested maintenance intervals 5 years after the active periodontal treatment leads to greater root caries prevalence, greater percentages of patients and root surfaces with new root caries, greater root caries prevalence for smokers, and greater percentages of new defects in root surfaces with further clinical attachment loss and plaque retention. The prevention of root caries development is based on the daily plaque removal and the high patient compliance with the therapist's suggestions for periodontal maintenance intervals.

Adult↗
PubMed2006

[Prevalence of putative periodontal microorganisms in Chinese patients with aggressive periodontitis].

OBJECTIVE: To evaluate the prevalence of putative periodontal microorganism in Chinese patients with aggressive periodontitis (AgP). METHODS: A total of 72 subgingival plaque samples were collected from 55 AgP patients and 17 healthy subjects. Seven putative periodontal microorganisms including Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Treponema denticola (Td), Campylobacter rectus (Cr), Prevotella intermedia (Pi) and Prevotella nigrescens (Pn) were detected by using 16S rRNA based polymerase chain reaction (PCR). RESULTS: The prevalence of Aa in AgP patients was very low (1.8%), while Pg, Tf, Td and Cr were more frequently detected in AgP patients (prevalence: 81.8%, 83.6%, 80% and 81.8%) than in healthy controls (prevalence: 17.6%, 11.8%, 5.9%, 29.4%, P < 0.01). CONCLUSIONS: The prevalence of Pg, Tf, Td and Cr were very high in aggressive periodontitis patients, and the combination of these bacteria may play an important role in AgP.

Adolescent↗
PubMedDate not supplied

[The mechanism of the therapeutic effect of periodontal cytomedin on the course of experimental periodontitis].

Periodontitis induction causes a drastic elevation of free-radical lipid peroxidation, of ceruloplasmin level, and a reduction of antioxidant enzyme activities. Blood analysis shows hypercoagulation, appearance of paracoagulation products, reduced fibrinolysis, enhanced proaggregation activity of the periodontium, elevated levels of circulating immune complexes; this may by regarded as adaptation failure manifesting by these reactions. Morphologic examinations show foci of destructive changes. Administration of periodontal cytomedin reduced the level of free-radical oxidation, enhanced the activity of antioxidant enzymes, normalized antiaggregation activity of the periodontium and hemostasis and fibrinolysis parameters, and reduced the level of circulating immune complexes. The inflammatory reaction disappears completely, that is seen from reduced ceruloplasmin level and clinically. Morphologic study shows disappearance of foci of destruction. Thus, cytomedin of periodontal tissues may be regarded as an effective agent for the therapy of experimental periodontitis.

Animals↗
PubMed2004

Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients.

OBJECTIVE: The aim of the present study was to evaluate the role of a combined orthodontic-periodontic treatment in determining the reconstruction of midline papilla lost following periodontitis. MATERIAL AND METHODS: Twenty-eight patients, with infrabony defect and extrusion of one maxillary central incisor, were treated. At baseline, all patients presented opening of the interdental diastema and loss of the papilla. At 7-10 days after open-flap surgery, the intrusive movement started. For each patient, probing pocket depth (PPD), clinical attachment level (CAL) and papilla presence index (PI) were assessed at baseline, end of treatment and after 1 year. PI was also evaluated independently in patients with narrow or wide periodontal biotype (NPB-WPB). RESULTS: All parameters showed statistical improvement between the initial and final measurements, and showed no changes at follow-up time. The mean residual PPD was 2.50 mm, with a decrease of 4.29 mm, while the mean CAL gain was 5.93 mm. Twenty-three out of 28 patients improved the PI score at the end of therapy. No statistical difference was recorded in PI values between groups NPB and WPB. CONCLUSION: The presented clinical protocol resulted in the improvement of all parameters examined. At the end of orthodontic treatment, a predictable reconstruction of the interdental papilla was reported, both in patients with thin or wide gingiva.

Adult↗
PubMed1987

Periodontal repair of periapical lesions: the borderland between pulpal and periodontal disease.

A series of cases demonstrating the destruction of periapical periodontal structures, without pulpal involvement has been presented. Treatment using both surgery and antibiotics resulted in extensive healing without any concommitant endodontic therapy. The results suggest that lesions affecting the apical periodontium are either periodontal or pulpal in origin. Careful diagnosis allows the maintenance of pulp vitality in cases where apical destruction has a source other than an infected pulp. The commonly held belief that lateral and accessory canals are a significant source of pulpal contamination from deep periodontal pockets has been questioned.

Adult↗
PubMed1989

Effect of non-surgical periodontal therapy combined with adjunctive antibiotics in subjects with "refractory" periodontal disease. (I). Clinical results.

The aim of the present study was to evaluate the clinical effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects with refractory periodontitis. 10 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. Clinical registrations including gingival index, plaque index, presence of bleeding and suppuration, pocket depth, and duplicate measurements of attachment level were performed at baseline and at monthly intervals. When disease activity was detected based on the tolerance method, a bacterial sample was taken from the active site and its susceptibilities to a number of antibiotics were determined. For the selected 10 subjects, Augmentin was the antibiotic of choice. Each subject received 750 mg/day for 2 weeks, during which time a full-month scaling and root planing was performed under local anesthesia. Clinical re-evaluation was performed after 3, 6, 9 and 12 months. At the time disease activity was detected, the average loss of attachment at all active sites was 2.2 mm, and the increase in pocket depth 1.5 mm. At 3 months post-therapy, these sites had regained 2 mm of attachment which remained stable through the 12-month examination. Pocket depths decreased 2.5 mm over the first 6 months and then stabilized. The frequency of all sites that gained 1 mm or more of attachment increased by approximately 10% over the first 9 months following therapy. The frequency of all sites that decreased 1 mm or more in pocket depth increased approximately 15% over the same period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Cathepsin B/L-, elastase-, tryptase-, trypsin- and dipeptidyl peptidase IV-like activities in gingival crevicular fluid. A comparison of levels before and after basic periodontal treatment of chronic periodontitis patients.

20 chronic periodontitis patients were given a full periodontal examination, including measurements of probing depth, clinical attachment loss, gingival index, bleeding index and plaque index. At a second visit, gingival crevicular fluid (GCF) was collected from the deepest accessible probing site of each tooth. The patients then received scaling, root planing and other appropriate nonsurgical treatment. GCF was collected from the same sites as sampled pretreatment and clinical parameters were measured again. Cathepsin B/L-, elastase-, tryptase-, trypsin-, and dipeptidyl peptidase IV-like activities in GCF samples were determined by fluorimetric assay with peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin. Following treatment, there were reductions in all clinical parameters and all protease activities. Most were statistically significant both on a patient level using average patient values and on a site level using either individual patient or pooled patient data. As in previous pre-treatment comparisons, post-treatment protease levels correlated positively and significantly with the corresponding clinical parameters at patient and site levels. The reductions and correlations were more marked for total enzyme activities than concentrations. GCF protease levels appear to reflect the clinical status of periodontal lesions and may thus be of value in monitoring disease activity.

Adult↗
PubMed1995

Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients.

16 advanced periodontitis patients were subjected to initial periodontal treatment and monitored every 3rd month during 42 months. Clinical characteristics at baseline and during the 42-month maintenance period were investigated for their association with probing attachment loss over the 42-month period, both on a patient level and on a site level. On a patient level, averaged full-mouth plaque and bleeding on probing scores over the maintenance interval showed little association with probing attachment loss. Little association was also observed for % sites with depth > or = 6 mm at baseline. However, a notable relationship was seen for % sites > or = 6 mm at 3 months. This finding initiated a separation of the 16 subjects into 2 groups based upon % sites > or = 6 mm at 3 months (groups 'high' and 'low'). Site level analyses for these groups showed little association between frequent presence of plaque at the sites over the maintenance interval and probing attachment loss. Frequent bleeding on probing showed limited relationship with attachment loss for group 'low', but an appreciable association for group 'high'. The findings suggest that advanced periodontitis patients with multiple residual probing depths > or = 6 mm at re-evaluation run a greater risk of developing sites with additional attachment loss than patients with few such residual depths. For such higher risk patients, bleeding on probing at maintenance examinations may be a useful indicator of subsequent deterioration at a site level.

Adult↗
PubMed1995

Correlation between gingival crevicular fluid dipeptidyl peptidase II and IV activity and periodontal attachment loss. A 2-year longitudinal study in chronic periodontitis patients.

OBJECTIVE: The aim of this study is to determine whether gingival crevicular fluid (GCF) dipeptidyl peptidase (DPP) II or IV levels, total activity (TA) and concentration (EC), predict progressive attachment loss (AL). SUBJECTS AND METHODS: Seventy five patients with moderate periodontitis were recruited. GCF was first collected from 16 molar and premolar mesiobuccal sites and then probing attachment level (PAL) and probing pocket depth (PPD) were measured with an electronic probe. Finally, gingival index, gingival bleeding and plaque indices were scored. Patients were given basic periodontal treatment prior to baseline after which the above procedures were repeated. Patients were seen 3 monthly for 2 years and the procedures were repeated. Carefully localised radiographs were taken of the test teeth annually. RESULTS: One hundred and twenty AL sites, 88 rapid AL (RAL) and 32 gradual AL (GrAL), in 48 patients were detected. DPP II and IV levels (TA and EC) at RAL sites were significantly higher (P < or = 0.0001) than paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels over the study period of both proteases (TA and EC) at GrAL sites were significantly higher (P < or = 0.0001) than other paired control sites. The GCF levels of DPP IV were always slightly higher than those of DPP II. Critical values (CV) of 5 microU per 30 s (TA) and 25 microU microL(-1) (EC) for both proteases showed high sensitivity and specificity values for TA and EC and these were the same at both ALT and PT. The positive predictive values were slightly higher for DPP II. Mean site DPP II and IV levels (TA and EC) in intra-patient comparisons were significantly higher (P < or = 0.0001) at RAL and GrAL sites than non-attachment loss (NAL) sites in AL patients and mean patient levels were significantly higher (P < or = 0.0001) in AL patients than NAL patients in inter-patient comparisons. CONCLUSIONS: These results indicate that both GCF DPP II and IV may be predictors of periodontal attachment loss.

Adult↗
PubMed1980

Immunoglobulins in periodontal tissues. II. Concentrations of immunoglobulins in granulation tissue from pockets of periodontosis and periodontitis patients.

In recent years evidence in the literature has indicated that the immune response may play an important role in the initiation and progression of the periodontal diseases. A study was initiated to determine the IgA, IgG, and IgM concentrations in the granulation tissue removed from deep infrabony pockets of patients with periodontosis and advanced periodontitis. Comparison of mean immunoglobulin levels between the periodontosis and periodontitis groups revealed a statistically significant increase (P less than 0.05) for IgG in the granulation tissue from the periodontosis group. The possible implications of these findings are discussed.

Adolescent↗
PubMed1984

Mycoplasma in periodontal disease. Isolation in juvenile periodontitis.

Mycoplasma have been identified in one case of juvenile periodontitis by size, morphology, hemadsorption and cultural techniques. These microorganisms were found on the surface of the tooth, on the surface of pocket epithelium and invading the gingival epithelium and adjacent connective tissue. These observations suggest the need for further studies on the role of Mycoplasma in the pathogenesis of advanced periodontal infections. The role of Mycoplasma in periodontal disease is discussed.

Adolescent↗
PubMed1996

Correlation between gingivain/gingipain and bacterial dipeptidyl peptidase activity in gingival crevicular fluid and periodontal attachment loss in chronic periodontitis patients. A 2-year longitudinal study.

The aim of this study is to determine whether either gingival crevicular fluid (GCF) bacterial gingivain/gingipain or dipeptidyl peptidase (DPP) levels, total activity (TA) and concentration (EC), predict progressive attachment loss (AL) in 75 patients with moderate periodontitis. GCF was collected from 16 molar and premolar mesiobuccal sites and then clinical attachment level (CAL) and probing depth (PD) were measured with an electronic constant pressure probe. Lastly, gingival, gingival bleeding, and plaque indices were scored. Prior to the baseline visit, patients were given basic periodontal treatment after which the above procedures were repeated. In addition, carefully localized radiographs were taken of the test teeth and repeated annually. Patients were then seen every 3 months for 2 years and the clinical measurements repeated at each visit. In 48 patients, 124 AL sites, 91 rapid AL (RAL), and 33 gradual AL (GAL) were detected. Gingivain/gingipain and bacterial DPP levels (TA and EC) at RAL sites were significantly higher (P < or = 0.0001) than at paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels over the study period of both proteases (TA and EC) at GAL sites were significantly higher (P < or = 0.0001) than those at paired control sites. The GCF levels of gingivain/gingipain were always higher than those of DPP. Critical values (CV) of 5 microU/30 seconds (TA) and 30 microU/microL (EC) for both proteases showed high sensitivity and specificity values for TA and EC, which were the same at both ALT and PT. The positive predictive values were higher for gingivain/ gingipain. Mean site levels, over the course of the study, of both proteases (TA and EC) were significantly higher (P < or = 0.0001) at AL, RAL, and GAL sites than non-attachment loss (NAL) sites in AL patients and mean patient levels were significantly higher (P < or = 0.0001) in AL, RAL, and GAL patients than NAL patients. These results indicate that both of these bacterial proteases in GCF may be predictors of periodontal attachment loss.

Adhesins, Bacterial↗
PubMed2003

Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT).

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits.

Age Factors↗
PubMed1991

[Periodontal treatment after the method of guided periodontal tissue regeneration].

Results of studies on animal models have shown that only guided periodontal tissue regeneration (GTR) will induce growth of new connective tissue fibers attached to new zement and bone tissue when the root surface had been exposed to plaque or pocket organisms. Studies of various authors suggest that it is exclusively the progenitor cells in the still existing periodontal ligament that permit regeneration. The development of GTR is based on biological principles. In the beginning its application was limited to periodontal surgery and has meanwhile expanded to include other areas such as implantology and oral surgery. Best results can be achieved in the periodontological treatment of three-walled bone defects and class II furcation involvements according to the data of several studies.

Animals↗