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PubMed2000

The rôle of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. Long-term clinical and microbiological observations.

BACKGROUND/AIMS: Recent studies reported significant additional clinical and microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard treatment strategy with consecutive root planings quadrant per quadrant. The one stage full-mouth disinfection procedure involves scaling and root planing of all pockets within 24 h in combination with an extensive application of chlorhexidine to all intra-oral niches such as periodontal pockets, tongue dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one stage full-mouth disinfection protocol. METHODS: Therefore, 3 groups of 12 patients each with advanced periodontitis were followed, both from a clinical and microbiological point of view, over a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant. at two-week intervals. The 2 other groups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth root planing) the adjunctive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbiological samples were taken from different intra-oral niches (tongue, mucosa, saliva and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media in order to evaluate the number of CFU/ml for the key-periodontopathogens. At baseline, an anonymous questionnaire was given to the patients to record the perception of each treatment (post operative pain, fever, swelling etc.). RESULTS: All 3 treatment strategies resulted in significant improvements for all clinical parameters, but the Fdis and FRp patients reacted always significantly more favourably than the control group, with an additional probing depth reduction of +/- 1.5 mm and an additional gain in attachment of +/- 2 mm (for pockets > or = 7 mm). Also from a microbiological point of view both the FRp and Fdis patients showed additional improvements when compared to the control group, as well in the reduction of spirochetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differences between FRp and Fdis patients were negligible. CONCLUSIONS: These findings suggest that the benefits of a "one-stage full-mouth disinfection" in the treatment of patients suffering from severe adult periodontitis probably results from the full-mouth scaling and root planing within 24 h rather than the beneficial effect of chlorhexidine. The raise in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.

Adult↗
PubMed1985

Improved periodontal conditions following therapy.

The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths. The material consisted of 16 patients, 35-65 years of age. Following a Baseline examination including assessments of oral hygiene status, gingival conditions, probing pocket depths and probing attachment levels, the patients were subjected to periodontal treatment. A "split-mouth" design approach of therapy was used and the jaw quadrants were randomly selected for the following different treatment procedures: (1) scaling and root planning, (2) scaling and root planing in conjunction with a gingivectomy procedure, (3) scaling and root planing in conjunction with an apically repositioned flap procedure without bone recontouring, (4) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring, (5) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and (6) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks during a 6-month period of healing, after which a final examination was performed. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in a low frequency of gingival sites which bled on probing, a high frequency of sites with shallow pockets (less than 4 mm) and the disappearance of pockets with a probing depth of greater than 6 mm. Between the Baseline examination and the 6-month re-examination, the probing attachment level for initially shallow pockets remained basically unaltered, but with a tendency of a minor apical shift. This occurred in all 6 treatment groups. For sites with initial probing depths of 4-6 mm and greater than 6 mm, there was in all groups some gain of probing attachment. This gain was most pronounced in the initially deeper (greater than 6 mm) pockets. With the use of regression analysis, the "critical probing depth" (CPD) value (i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level resulted) was calculated for each of the 6 methods of treatment used. A comparison of the CPD-values between the 6 treatment groups did not reveal any major differences.

Adult↗
PubMed1999

Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing.

This clinical study was designed to determine if mechanical instrumentation (root planing) of the exposed root is useful in treating gingival recession caused by traumatic toothbrushing following a coronally advanced flap (CAF). Ten patients with high levels of oral hygiene (full-mouth plaque score <20%), from 25 to 57 years of age, were selected for the study. Each patient showed 2 bilateral Class I or II maxillary recessions. A total of 20 recessions were treated. The difference in the recessions was < or =1 mm. In each patient, one recession was randomly assigned to the test group and the contralateral one to the control group. In the test group, the exposed root surface was polished at slow speed with a rubber cup and prophylaxis paste for 60 seconds. In the control group, the exposed root surface was planed with a sharp curet. In both test and control groups, a trapezoidal full- and partial-thickness flap was elevated, coronally displaced, and sutured to cover the treated root surface. Before treatment, the mean recession depth in the test group (polishing) was 3.1+/-1.1 mm; and in the control group (root planing), 2.9+/-1.0 mm. Three months after the described procedures, the test group (polishing) showed a mean recession reduction of 2.6+/-0.6 mm; mean percent root coverage was 89+/-14%. In the control group (root planing), the mean recession reduction was 2.3+/-0.7 mm and mean percent root coverage was 83+/-16%. The difference of recession reduction between the test and control group was not statistically significant (P = 0.1405), even though the test group showed slightly better clinical results in terms of root coverage. This prospective clinical, controlled, randomized study shows that mechanical instrumentation (root planing) of the exposed root surfaces is not necessary when shallow recessions caused by traumatic toothbrushing are treated using a coronally advanced flap (CAF) in patients with high levels of oral hygiene.

Adult↗
PubMed1983

Effects of gingival curettage when performed 1 month after root instrumentation. A biometric evaluation.

The purpose of the present study was to evaluate biometrically the periodontal response to gingival curettage. 15 subjects having suprabony pockets were selected. Gingival Index (GI) was initially determined for the selected teeth. Measurements of probing depth, and the distance from the free gingival margin to the cemento-enamel junction were also taken at that time, as well as immediately after scaling and root planing of the selected teeth. 4 weeks after scaling and root planing, the clinical parameters were recorded. A split mouth design was used to select 2 quadrants of the mouth in which gingival curettage was to be performed. Immediately after, experimental measurements were again recorded. 5 weeks after gingival curettage, gingival inflammation, probing depth and the location of the free gingival margin were recorded for the last time. All data were analyzed statistically. It was shown that gingival inflammation, the distance from the free gingival margin to the cemento-enamel junction, and the probing depth were reduced after 4 and 9 weeks. The level of clinical attachment improved after 9 weeks. All these changes were statistically significant. These results were observed after scaling and root planing, as well as after scaling, root planing and gingival curettage. No differences were found between both treatment modalities in any of the parameters analyzed. Gingival curettage did not improve the condition of the periodontal tissues more significantly than scaling and root planing.

Adult↗
PubMed1983

A scanning electron microscope study of the effects of various agents on instrumented periodontally involved root surfaces.

This study evaluated the effects of chemical and biologic agents on periodontally diseased root surfaces which had been scaled or root planed. The proximal surfaces of 25 teeth were scaled to remove all visible calculus, and the proximal surfaces of another 25 teeth were vigorously root planed to remove all cementum and to achieve a hard, smooth, glass-like surface. Five scaled and five root planed specimens were randomly selected for light microscopic examination to determine the amount of cementum removed. Cementum remained on all scaled surfaces but root planing had removed most of the more coronal cementum. Each of the 40 remaining teeth (20 scaled and 20 root planed) was longitudinally sectioned to obtain an experimental and control specimen. Four scaled and four root planed sections were randomly selected as experimental specimens for a test of each of the following five agents: (1) saturated citric acid for three minutes; (2) 15% EDTA for 5 minutes; (3) sodium hypochlorite for 5 minutes, followed by a 30-second application of 5% citric acid; (4) sodium hypochlorite alone for 5 minutes; and (5) 2% sodium deoxycholate (NAD) for 1 minute, followed by a 1-minute rinse in distilled water, and then a 1-minute application of 5% Cohn's fraction IV1. The control for each experimental specimen was treated with saline. All samples were prepared for SEM and examined at 3,000 X. Areas of particular interest were also examined at 12,000 X. The chemical treatments exposed only individual collagen fibers or irregular fiber bundles on the scaled surfaces. Saturated citric acid, EDTA, and sodium hypochlorite with citric acid neutralization removed debris and exposed openings in the root surfaces. Sodium hypochlorite alone and NaD/Cohn's fraction IV1 were less effective in removing surface debris and had an effect similar to that seen in the saline controls. Application to root planed specimens of saturated citric acid, EDTA, and sodium hypochlorite followed by 30 seconds of citric acid neutralization resulted in surfaces virtually free of debris and with numerous collagen fibers exposed on the surface. EDTA appeared to cause a morphologic change in the collagen fibers. Sodium hypochlorite alone, sodium deoxycholate followed by Cohn's fraction IV1, and physiologic saline were relatively ineffective in surface debridement.

Adult↗
PubMed1981

A randomized four-years study of periodontal therapy.

The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery. Seventeen subjects with moderate to advanced periodontitis received through scaling and root planing as well as oral hygiene instruction. A modified Widman flap was then randomly performed for one-half of each subject's dentition. Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy. Shallow crevices (1--3 mm)subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements. Moderately deep pockets (4--6 mm) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level. Pockets initially greater than or equal to 7 mm exhibited the greatest reduction in depth and attachment gain. Gingivitis was reduced following either procedure for moderate and deep pockets. No difference in supragingival plaque retention was noted and both procedures reduced calculus. The results indicate that both procedures were effective in treating moderate to advanced periodontitis. However, the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets.

Adult↗
PubMed1980

In vitro cytotoxicity of periodontally diseased root surfaces.

The purpose of this experiment was to develop a model system for controlled in vitro testing of root surface toxicity. Human gingival fibroblasts were placed into a depression created in the root surfaces of ten heat sterilized periodontally involved teeth, one half of which were root planed to remove all irritants. The teeth and fibroblasts were incubated in culture medium for 5 days, after which the cells were fixed and stained. Each tooth was examined for migration of cells onto the root planed and non-root planed areas of the tooth, and for evidence of any cytotoxic reaction. No difference in pattern of cell growth, cell migration, or cytotoxic reaction was discernible between root planed and non-root planed areas. Normal fibroblasts could be detected on the surfaces of dentin, calculus, periodontally involved cementum, and enamel. It appears that heat-sterilized periodontally-involved root surfaces, as well as calculus and calculus-laden enamel, were not toxic to human gingival fibroblasts in cell culture.

Cell Division↗
PubMed2004

Comparative effectiveness of hand and ultrasonic instrumentations in root surface planing in vitro.

BACKGROUND/AIMS: A variety of techniques are employed for planing and scaling of the superficial root surfaces, of which hand and ultrasonic instrumentations have been preferentially used in routine periodontics clinics. This study was undertaken to compare the effectiveness of ultrasonic scalers and hand curettes in facilitating fibroblast attachment to the scaled root surfaces. MATERIALS AND METHODS: Sixteen patients with periodontally involved teeth and nine subjects without periodontal diseases (control subjects) were selected. Two single-rooted teeth were extracted from each subject. Mesial and distal surfaces of teeth were selected in treated and untreated groups, respectively. The mesial surface of each tooth was randomly chosen to be treated either by hand curettes or ultrasonic instrumentation. The degree of cell attachment on the root surfaces of treated and untreated groups from control subjects and patients was then determined by the use of a gingival fibroblast line established and employed at early passages. The attachment and proliferation of gingival fibroblasts on the root surfaces were evaluated using neutral red assay and scanning electron microscopy (SEM). RESULTS: Fibroblast survival and proliferation on the surfaces of untreated periodontally involved roots were found to be significantly lower compared with control untreated surfaces (p<0.0001) or treated surfaces from patients (p<0.0001). No significant difference, however, was observed between root surfaces treated either by hand curettes or ultrasonic scalers. CONCLUSION: These results indicate the beneficial effectiveness of both techniques in root treatment and planing.

Adult↗
PubMed2000

Local delivery of liposome-encapsulated superoxide dismutase and catalase suppress periodontal inflammation in beagles.

BACKGROUND, AIMS: The purpose of this study was to evaluate the influence of oxygen free radical scavengers on periodontal inflammation and healing process. METHOD: Experimental periodontitis was induced by elastic ligatures around premolars (P2, P3, P4) and 1st molars (M1) in the upper and lower jaws of 15 beagle dogs. 9 months after the beginning of the experiment, the ligatures were removed. After 3 weeks of stabilization period, all teeth were supragingivally scaled. The animals were divided into 3 groups of 5 dogs. The 1st group received a liposome-encapsulated superoxide dismutase (SOD), the 2nd group a liposome-encapsulated catalase (CAT) and the 3rd group received both enzymes encapsulated in liposomes. 4 treatment modalities were tested in each group; i.e., supragingival scaling only (1), supragingival scaling and enzymes (2), supra- and sub-gingival scaling and root planing (3) and supra- and sub-gingival scaling and root planing with subgingival application of enzymes (4). Enzymes were delivered subgingivally on a daily basis for a period of 6 weeks. Gingival index (GI), probing depth (PD), clinical attachment level (CAL), radiographic analysis and the histological evaluation were performed. RESULTS: Around the teeth with scaling and root planing followed by the application of SOD, the greatest suppression of gingival inflammation (GI = 1.8 +/- 0.1 before versus GI = 1.2 +/- 0.2 after treatment) (p<0.003), the smallest size of connective tissue infiltrate (5.5 +/- 4.3%) (p<0.01), the greatest reduction of PD (PD= 3.2 +/- 1.0 mm before versus 2.00.7 mm after treatment) (p<0.001), and gain of CAL (CAL=3.0 +/- 1.7 mm before versus CAL=2.4 +/- 1.1 mm after treatment) (p<0.001) were observed. In addition, radiographic analysis showed the greatest alveolar bone apposition in the group of teeth treated with scaling and root planing followed by subgingival application of SOD or both enzymes (p<0.001). CONCLUSION: In conclusion, we demonstrated that scaling and root planing with subgingival application of liposome-encapsulated SOD suppress peridontal inflammation on experimentally induced periodontitis in beagle dogs.

Alveolar Bone Loss↗
PubMed1984

Molar and nonmolar teeth compared over 6 1/2 years following two methods of periodontal therapy.

Limited information is available comparing the relative longitudinal effectiveness with respect to tooth type of scaling and root planing alone and scaling and root planing followed by flap procedures. The purpose of this study was to investigate these treatment methods as applied to molar and nonmolar teeth on a longitudinal basis in humans. Seventeen subjects with chronic periodontitis received thorough scaling and root planning as well as oral hygiene instruction. A modified Widman flap was then randomly performed for one-half of each subject's dentition. Routine recall prophylaxis and oral hygiene reinforcement were administered postsurgically every 3 to 4 months. Pocket depth and clinical attachment levels were recorded by a single calibrated examiner before therapy and at intervals up to 61/2 years following active treatment. Ten subjects remained as participants after 61/2 years. A paired t test was used to test for the mean difference in pocket depth and clinical attachment level between molar and nonmolar teeth for each treatment method. For pockets initially 4 to 6 mm, the results indicated greater pocket depth and more apical clinical attachment level on molars than nonmolars treated by either method of therapy. For pockets initially greater than or equal to 7 mm there was no difference between pocket depth on molar and nonmolar teeth following scaling and root planing alone. However, there was less overall pocket depth on nonmolars than molars following the flap procedure, indicating a greater effect of pocket reduction on nonmolar than molar teeth with the flap procedure. No difference between tooth types was found for clinical attachment level in pockets initially greater than or equal to 7 mm with either treatment method. Both treatment methods resulted in at least maintenance of pretreatment attachment levels adjacent to molar and nonmolar teeth.

Adult↗
PubMed1993

The role of subgingival irrigations in the treatment of periodontitis.

While the efficacy of oral irrigations with antimicrobial agents on the clinical and microbial parameters of gingivitis is well established, the study of the efficacy of intrapocket irrigants on periodontitis has yielded conflicting and inconclusive results regarding both clinical and microbiological parameters. The overall goal of this review paper is to summarize the available information on the efficacy of intrapocket irrigation in the treatment of patients with periodontitis. The following topics are addressed: 1) the penetrability of the irrigant; 2) pocket irrigation without scaling and root planing; 3) professional pocket irrigation following scaling and root planing; 4) irrigations between recalls; and 5) safety of intrapocket irrigation. Single irrigation of periodontal pockets for short periods of time before or after scaling and root planing has limited effects on periodontal healing. However, continuous irrigation of the periodontal lesion with agents such as povidone iodine during thorough scaling and root planing, such as that carried out under local anesthesia, has promise as an antimicrobial adjunct in periodontal therapy.

Anti-Infective Agents↗
PubMed1996

A clinical and microbiological evaluation of systemic and local metronidazole delivery in early onset periodontitis patients.

The present study describes selected clinical and microbiological results obtained by treatment with local (Elyzol) and systemic (Flagyl) use of metronidazole alone and/or mechanical subgingival debridement in early onset periodontitis (EOP). Twelve patients, with lesions not distributed as in classical localized juvenile periodontitis, were included. They were randomly divided into local and systemic treatment groups each comprising 6 individuals, in each of whom 4 sites (one site/quadrant) with a probing depth of > or = 5 mm were selected and treated with separate treatment modalities. The overall treatment design provided 6 different test groups. Groups of quadrants received 1) scaling and root planing 2) local metronidazole treatment 3) systemic metronidazole treatment 4) local metronidazole combined with scaling and root planing 5) systemic metronidazole combined with scaling and root planing 6) No treatment. The microbiological and clinical effects of treatment modalities were monitored over 42 days. The results demonstrated reductions in mean counts of obligate anaerobic and capnophilic microorganisms coupled with significant improvements in mean clinical measurements (gingivitis, probing depth, attachment level) in all groups, except the untreated. Scaling and root planing provided an initial clinical improvement with a selective reduction of periodontopathogens (92.6% obligate anaerobes, 42.9% capnophilic microorganisms), whereas the combination of local or systemic metronidazole with scaling and root planing were found superior in reducing capnophilic bacteria (93.7% and 93.4%, respectively). It is of critical importance to have a treatment rationale for EOP, since bacterial differences exist in the etiological subforms of periodontitis. Microbial testing may be justified before prescribing the adjunctive antibiotic and selecting the mode of delivery for the successful clinical management of EOP.

Administration, Oral↗
PubMed1984

Fluoride-treated roots and viability and attachment of human gingival fibroblasts.

Topical fluoride treatment is used to help prevent root caries. It may also be useful in periodontal therapy because of its antimicrobial property. In addition, for therapeutic new attachment to occur, the fibroblasts approximating the treated root surface should remain viable, and should also be able to attach and grow onto the treated root surface. These conditions, at least, are required for fluoride not to interfere with new attachment. This study was designed to determine whether treatment of roots with fluoride adversely affects human gingival fibroblasts in culture; and what effect fluoride treatment has on attachment and growth of cells to the root surface. Cells originally obtained from human gingiva were allowed to grow to confluency in multi-well tissue culture petri dishes, and were then incubated for 24 hr in the presence of root sections as follows: (1) no treatment; (2) root-planed only; (3) 2% NaF only; (4) root-planed + 2% NaF; (5) root-planed + citric acid, pH 1 + 2% NaF. In addition, cells were plated onto roots similarly treated and were subsequently allowed to incubate for 72 hr. Viability of cells was determined by exclusion of vital dye and 51Cr retention. Attachment and growth of cells were determined by histology and scanning electron microscopy. Results indicated that, after 24 hours' exposure, there was little or no difference in cell viability between different treatment groups and control cultures. Also, all roots which had been planed accommodated cell attachment, regardless of additional treatment rendered.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗
PubMed2001

The significance of prior mechanical therapy for changes of periodontal status achieved by local delivery of a doxycyclinehyclate containing gel.

AIM: The purpose of this retrospective analysis was to examine what effect, if any, the time elapsed between an individual's last episode of scaling and root planing and subsequent treatment with a sustained-release doxycycline hyclate gel (DH) alone or scaling and root planing alone (SRP) would have upon adult periodontitis. METHODS: A total of 207 subjects were included in the DH group and 210 patients in the SRP group. Periodontitis was defined as those sites which presented with pocket depths > or =5 mm and exhibited bleeding upon probing. In both DH and SRP groups, 3 sub-groups of subjects were identified according to their last episode of scaling and root planing prior to the study baseline: within 2 to 6 months, >6 but < or =12 months, and one or more times in their life but not within the last 12 months. Each study site was treated twice over a 9-month study period, once at baseline and again at 4 months. Data from the study sites at 4, 6, and 9 months were then evaluated for changes in probing depth, clinical attachment level, and bleeding upon probing. RESULTS: At the 9-month evaluation, all sub-groups in the DH and SRP treatment arms presented with improvement in the measured clinical parameters, as compared to baseline. No significant differences were observed in the measured periodontal indices among the study sites between the three sub-groups for either treatment. CONCLUSIONS: It is concluded that the time interval since the last episode of scaling and root planing had no observable effect on the results achieved when treating periodontitis sites with locally delivered doxycycline hyclate alone or scaling and root planing alone. The treatment of periodontitis sites with locally delivered doxycycline hyclate resulted in clinical improvement comparable to scaling and root planing irrespective of the patient's prophylaxis frequency.

Administration, Topical↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: clinical response.

The purpose of this investigation was to evaluate the clinical efficacy of controlled-release tetracycline fiber therapy in adult periodontitis patients. One hundred-twenty-two (122) adult patients from 3 dental centers were enrolled at baseline for this study. each patient provided at least one site in each of four quadrants that was > or = 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10-day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12-month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred-sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy.

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: microbiological response.

In a 12-month multi-center study of 116 adult periodontitis subjects, six putative periodontal pathogens were monitored by DNA probe methods in a subset of 31 subjects. Monitored species included Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Eikenella corrodens (Ec), Campylobacter rectus (Cr), and Actinobacillus actinomycetemcomitans (Aa) with an average detection limit of 1.8 x 10(4) bacterial colony forming units/sample. The microbiological response to four periodontal treatments was studied, one treatment in each quadrant; scaling and root planing (S), scaling and root planing with tetracycline (TC) fiber (SF), a single application of TC fiber (F) and two serial applications of TC fiber (FF). Generally two sites were sampled in each quadrant, however, in some quadrants only one site was selected. These treatments were evaluated at baseline; immediately following therapy; and post-treatment at 1, 3, 6, and 12 months. The study was conducted with a split-mouth design with no maintenance therapy over a 12-month period. At baseline, 70.8% of sites had detectable Fn; 42.9% Pg; 63.5% Pi; 29.7% Ec; 28.3% Cr; and 5.5% Aa. No significant differences were seen in baseline proportions of these species between centers. Numbers and proportions of detectable pathogens (with the exception of Pg) exhibited a triphasic temporal response: a precipitous initial decrease immediately following therapy; a rise in proportions in the 1- to 3-month post-therapy period; and a spontaneous decline in the absence of therapy over the 3- to 12-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Effects of short-term administration of metronidazole on the subgingival microflora.

The effect of a 5-day course of systemic metronidazole was investigated in 11 recall maintenance patients over a period of 3 months. Crevicular fluid flow, bleeding on probing, pocket depth, and composition of the subgingival microbiota as observed by dark-field microscopy, were measured. The study design allowed patients to act as their own controls. At baseline 1 (day 0), each patient had a randomly assigned quadrant scaled and root-planed, and received oral hygiene instruction. Microbiological and clinical parameters were measured at baseline 1 (before treatment) and at 3, 6, and 12 weeks in both the root-planed and a designated no-treatment quadrant. At baseline 2 (12 weeks), the contralateral quadrant was scaled and root-planed, and the oral hygiene instruction was reinforced. At this appointment, each patient was given 15 metronidazole tablets (250 mg), 1 to be taken 3 times per day for 5 days. At the end of this period, patients were seen 1-2 h after taking their last tablet, and blood and crevicular fluid samples were taken to determine the concentration of metronidazole by microbiological assay in the serum and crevicular fluid. Microbiological and clinical parameters were measured at baseline 2 (before treatment) and at 13, 15, 18, and 24 weeks in both the root-planed and designated non-root-planed (metronidazole only) quadrants. Results demonstrated that in this group of recall maintenance patients, metronidazole was no more effective than root-planing alone in reducing the relative % of total motile organisms and spirochetes in 5-8 mm pockets. Crevicular fluid flow was, however, significantly reduced for 11 weeks; serum and crevicular fluid levels of metronidazole were similar 1 to 2 h after drug ingestion.

Adult↗
PubMed1986

Healing after application of tissue-adhesive material to denuded and citric acid-treated root surfaces.

This study was undertaken to evaluate the effects of a commercially available tissue adhesive upon healing of the coronal periodontium. In four squirrel monkeys, 24 teeth were extracted, and the coronal third of the roots planed free of fibers and cementum. Eight teeth were replanted without further alteration and eight were coated with tissue adhesive prior to replantation. In the remaining eight teeth, the planed surface was decalcified, coated with tissue adhesive and replanted. Histological observations were made at 1 and 7 days after replantation. In the teeth replanted after root planing alone and root planing plus tissue adhesive, epithelium migrated apically and was within the ligament space lining the denuded root at 7 days. In contrast, those teeth which were decalcified prior to application of tissue adhesive demonstrated fiber attachment to the planed root surface and little or no epithelial downgrowth.

Animals↗