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PubMed1982

Histologic probe position in treated and untreated human periodontal tissues.

This study was designed to histologically determine the relationship of the periodontal probe tip to the periodontal tissues during probing of untreated periodontal pockets and periodontal pockets treated with oral hygiene and root planing. Human, condemned, single rooted teeth with buccal probing pocket depth at least 6 mm were used. Two groups of specimens were included: 12 untreated teeth from six patients and 15 treated teeth from 10 patients. In the treated group, the effects of therapy were monitored clinically every 2 weeks until maximum improvement had taken place. A periodontal probe tip was then inserted on the buccal aspect of the tooth using 0.50 N pressure, and block section biopsies were taken. The histologic examination of the untreated teeth showed that the probe tip penetrated beyond the apical termination of the junctional epithelium and into the subjacent connective tissue by a mean of 0.45 +/- 0.34 mm, whereas in the treated specimens the probe stopped coronally to this landmark by a mean of 0.73 +/- 0.80 mm. This study demonstrated that the probe tip most often does not reach the base of the junctional epithelium in pockets treated by plaque control and root planing, and that clinical measurements of attachment levels are not reliable in determining the true histologic level of connective tissue attachment.

Dental Instruments↗
PubMed1993

The effect of citric acid application on periodontally involved root surfaces. II. An in vitro scanning electron microscopic study.

The in vitro effect of citric acid application on periodontally involved root surfaces was investigated using scanning electron microscopy. Teeth were selected following specific criteria. The specimens were prepared for observation, and the features of the root surface were studied. The results demonstrated that a 3-minute application of citric acid (pH = 1.0) to the root surface after scaling and root planing demineralized the outer root surface, opened the dentinal tubules, and exposed collagen fibers. Scaling and root planing alone left the surface with a smear layer, scattered islands of cementum, and no collagen fibers or exposed dentinal tubules.

Citrates↗
PubMed1997

The effect of smoking on mechanical and antimicrobial periodontal therapy.

The aim of this investigation was to evaluate the effect of smoking on the outcome of periodontal therapy. The study consisted of 54 patients who participated in a 4-group parallel-arm clinical trial on the efficacy of three locally delivered antimicrobial systems as adjuncts to scaling and root planing in the treatment of sites with persistent pocketing after a course of scaling and root planing. These groups included scaling and root planing either alone (S) (n = 3), or in conjunction with the application of 25% tetracycline fibers (S&T) (n = 13), 2% minocycline gel (S&Mi) (n = 14), or 25% metronidazole gel (S&Me) (n = 14). In each patient four pockets > 5 mm with bleeding on probing (BOP) and/or suppuration were studied. The number of subjects who smoked was: 8 (61.5%) in the S&T group, 8 (57.1%) in the S&Mi group, 6 (42.9%) in the S&Me group, and 6 (46.2%) in the S group. The probing depth, attachment level and other clinical parameters were assessed at baseline and 6 weeks after treatments. The clinical results of this comparative study have been previously reported. Regardless of the type of treatment, the change in the probing depth (delta PD) and attachment gain (delta AL) were greater in non-smoker subjects than smoker subjects. delta PD was 1.14 mm versus 0.76 mm (P = 0.019), and delta AL was 0.52 mm versus 0.50 mm at (P = 0.845) for non-smokers and smokers respectively. The analysis of variance using the general linear model (GLM) was used for delta PD and delta AL and took into account the variations in the treatments, number of smoker subjects per group, and baseline probing depth. There was a significant interaction between the "smoking" and the "baseline PD." Further analysis using linear regression indicated that, while there was a significant relationship between the baseline PD and the delta PD or delta AL among the non-smokers, weak and insignificant relationship existed among the smoker subjects. Thus, smoking may have an important role in determining the prognosis of periodontal treatment, particularly in persistent and deep pockets.

Adult↗
PubMed1990

[Modified Widman flap--a standard method].

The modified Widman flap offers such clinical advantages over root planing as root visualization. Treating periodontal pockets, which after preliminary treatment show a depth of 4 mm and more and remaining sulcus bleeding upon probing we obtained with this procedure a reduction of pocket depths and of gingival inflammation and gain of clinical attachment. The maintenance of these results as well as the further loss of attachment are directly related to the frequency of the maintenance recall appointments. The success of this procedure does not depend on the age of the patients. The healing following this procedure is normally achieved after 21 days and is by a long junctional epithelium, which may be seen as a stable treatment success.

Epithelial Attachment↗
PubMed1993

[Migratory ability of cells derived from periodontal tissues and their attachment to root surfaces].

The migratory ability of cells from the periodontal ligament (PDL), alveolar bone and gingiva of monkeys was compared in vitro using a three-dimensional collagen gel model. In addition, the cell attachment to cementum and dentin was examined ultrastructurally. Cultured cells were obtained from monkey periodontal tissues using an explant method. Type I collagen solution was pipetted into the wells of 24 multi-well plates and polymerized. And the cell invasion assay was performed by seeding test cells onto the gel, and subsequent culture for 1, 3 and 7 days. The specimens were fixed and embedded in epoxy resin. Semi-thin sections of 1 micron thickness were obtained and subjected to visual assay under a light microscope. Parameter was two fold; numbers of cells migrating into the gel and the maximum distance from the gel surface to the leading front of migrated cells. Secondly, two kinds of root surface conditioning were performed on extracted monkey teeth, in which included scaling only surface cementum and root planing. Each root fragment was placed into the wells and collagen solution was subsequently pipetted into the well. And the collagen solution was polymerized to prepare the 100 microns-wide gel layers on the root fragments. Test cells were seeded onto the gel and cultured for 2 and 3 weeks. The interaction between the cells and the root surfaces was examined under a transmission electron microscope. The migratory ability of PDL cells was less than that of cells from bone and gingiva. Although the migrated bone and gingival cells produced fibrillar materials on the cementum, the PDL cells could not establish an ideal attachment to either cementum or dentin.

Animals↗
PubMed1991

Effect of surgical and non-surgical periodontal treatment on periodontal status and subgingival microbiota.

The purpose of this study was to evaluate, on a short-term basis, the clinical and microbiological effects of a single course of scaling and root planing as compared with those obtained by flap surgery in patients with moderate to advanced periodontitis. 11 patients participated in the study. Using a split-mouth design, one quadrant of the mouth was treated with reverse bevel flap surgery, whereas the contralateral one was subjected to a single course of scaling and root planing. 2 approximal sites on single-rooted teeth with a pocket depth greater than or equal to 5 mm were monitored clinically and microbiologically for 16 weeks after active treatment. Both techniques resulted in a gain of probable attachment levels, a reduction in bleeding on probing and a reduced mean pocket depth, although 31.2% of the sites in the scaling and root planing group still had 6-7 mm deep pockets at 8 and 16 weeks after treatment. Both techniques reduced median relative proportions and frequencies of detection of black-pigmented Bacteroides species. A highly statistically significant increase (p less than 0.01) in median proportions of oral streptococci was recorded only for surgery within the 1st month post-operatively. No correlation was found between residual pocket depth and any of the microbiological parameters considered in the study, suggesting that residual pocket depth does not exert a significant influence on bacterial subgingival recolonization after therapy. The results from this study suggest that surgery can be as effective as scaling and root planing in favoring the establishment of micro-organisms compatible with periodontal health, although this effect is limited to the 1st month after therapy.

Adult↗
PubMed2004

Microbiological changes with the use of locally delivered doxycycline in the periodontal treatment of smokers.

BACKGROUND: The aim of this study was to evaluate the effect of the association of locally delivered doxycycline 10% and scaling and root planing in the subgingival plaque of smokers. METHODS: Sixteen smokers with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to one of the following groups: scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Subgingival plaque samples were collected from initially moderate (5 to 6 mm) and deep (> or = 7 mm) pockets at baseline and 3 months. Polymerase chain reaction (PCR) analysis was used to detect the frequency of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythensis (Tf). RESULTS: No statistically significant difference was found in the reduction of Aa in either the SRP-D or SRP group (P > 0.05). The reduction in Tf, Pg, and Tf + Pg was statistically significant for SRP-D only (P = 0.016, 0.027, and 0.027, respectively). The proportion of sites free of Tf at 3 months was 53% for SRP-D and 9% for SRP (P = 0.02). For Pg, this proportion was 82% and 40%, respectively (P = 0.05). CONCLUSION: The use of locally delivered doxycycline may promote the elimination of T. forsythensis and P. gingivalis in a greater proportion of sites compared to conventional scaling and root planing in smokers.

Administration, Topical↗
PubMed2005

Root surface removal and resultant surface texture with diamond-coated ultrasonic inserts: an in vitro and SEM study.

BACKGROUND: A new diamond-coated ultrasonic insert has been developed for scaling and root planing, and it was evaluated in vitro for the amount of root surface removed and the roughness of the residual root surface as a result of instrumentation. METHODS: 48 extracted single-rooted human teeth were ground flat on one root surface and mounted (flat side up) in PVC rings of standard height and diameter with improved dental stone. Each tooth surface was treated with either a plain ultrasonic insert (PI), an ultrasonic insert with a fine grit diamond coating (DI) or sharp Gracey curettes (HI). The mounted teeth were attached to a stepper motor which drove the teeth in a horizontal, reciprocal motion at a constant rate. The thickness from the flattened bottom of the ring to the flattened tooth surface was measured before and after 10, 20, and 30 instrumentation strokes for each root surface with each of the experimental instruments. A number of treated teeth were randomly selected for examination with SEM and a profilometer. Statistical analysis (analysis of co-variance) was performed to compare the amounts of tooth structure removed among the 3 instruments and t-test was used to compare the roughness of the treated root surfaces. RESULTS: The mean depth of root structure removed was PI 10.7 microm, HI 15.0 microm, and DI 46.2 microm after 10 strokes; and PI 21.6 microm, HI 33.2 and DI 142.0 microm after 30 strokes, respectively. On average, 0.9 microm, 1.3 microm, and 4.7 microm of root surface was removed with each stroke of PI, HI and DI, respectively. PI and HI were not different from each other for all the stroke cycles, while DI was significantly different from PI and HI for all the stroke cycles (p<0.0001). Analysis with the profilometer showed that the smoothest surface was produced by the PI followed by the HI. The DI produced a surface that was significantly rougher than the surface produced by the PI or HI. CONCLUSION: These results suggest that diamond-coated ultrasonic instruments will effectively plane roots, and that caution should be used during periodontal root planing procedures. Additionally, the diamond-coated instruments will produce a rougher surface than the plain inserts or the hand curettes.

Analysis of Variance↗
PubMed1994

Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy.

The purpose of this study was to assess the clinical and microbiological effects of a newly developed root conditioning gel system containing tetracycline or a mixture of tetracycline and citric acid on non-surgical periodontal therapy. Sixty-four (64) single-rooted teeth with a probing depth of 4 to 6 mm were randomly subjected to one of the following four treatments; 1) root planing alone (RP group); 2) tetracycline-containing gel alone (TCG group); 3) root planing plus tetracycline-containing gel (RP + TCG group); or 4) root planing plus a mixture of tetracycline and citric acid-containing gel (RP + TC-CAG group). Probing depth, attachment level, and tooth mobility were measured and the presence of dental plaque and gingival inflammation was recorded at baseline and after 2, 4, 8, and 12 weeks. Subgingival plaque samples from each site were collected at the same visits and examined with phase contrast microscopy for proportions of motile rods and spirochetes. Plaque index, gingival sulcus bleeding index (SBI), probing depth, and attachment level decreased significantly in all groups compared to the baseline values (P < 0.05). A significant decrease in probing pocket depth was noted after 12 weeks in RP + TC-CAG group compared to the other groups (P < 0.05). Significantly more gain in attachment was detected in the RP + TC-CAG group compared to the TCG group (P < 0.05). Tooth mobility scores also decreased later in the study. A significant decrease in the proportion of motile rods was found primarily in the RP + TC-CAG group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial.

BACKGROUND: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline. METHODS: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months. RESULTS: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups. CONCLUSIONS: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Administration, Topical↗
PubMed2000

Some effects of non-surgical therapy on gingival inflammatory cell subsets in patients with adult and early-onset periodontitis.

BACKGROUND: Limited information is available to determine if there is a distinction in local cellular immunity between adult and early-onset periodontitis. Furthermore, the effect of scaling and root planing on various lymphocyte subsets is sparsely described. METHODS: Clinical measurements were recorded and gingival biopsies were performed before and after scaling and root planing in 10 subjects with adult (AP) and in 10 with early-onset periodontitis (EOP). The specimens were cut into serial sections and, using the alkaline phosphatase-anti-alkaline phosphatase technique, monoclonal antibodies to CD20 (B-cells), CD30 (plasma cells), and CD45RO (T-memory cells) were applied, as well as polyclonal antibodies to alpha, gamma, and mu chains (Ig A, G, and M). Areas showing the largest infiltration cells were counted. RESULTS: Mean counts of all cell phenotypes in the AP versus the EOP group did not show any significant differences before therapy (P >0.05). Following scaling and root planing, numbers of all phenotypes decreased in both groups. Comparing the data before and after therapy, P values were >0.05 in the AP group, except for IgA-positive cells. In the EOP group, the differences before and after therapy reached statistical significance (P<0.05) for all cell counts, except for IgM-positive cells. Furthermore, reduction of probing depth and gain of clinical attachment reached the 0.05 level of statistical significance only in EOP subjects. CONCLUSIONS: Local cellular immunity in patients with adult onset periodontitis does not appear to differ from the immune response in patients with early onset periodontitis. Scaling and root planing causes a decrease in the inflammatory cells subsets tested, however, this decline seems to be more pronounced in EOP than in AP subjects.

Adult↗
PubMed2006

A comparative study between different techniques in non-surgical periodontal treatment.

AIM: This study was carried out to compare a conventional manual instrumentation with an ultrasonic technique (Odontoson M) in scaling and root planing periodontal treatment. The effects of subgingival irrigation with 10% iodised solution in association with Odontoson M were studied. METHODS: Sixty patients were selected: they were suffering from adult periodontitis, aged between 35 and 65 and non-smokers. They were randomly divided into 3 groups (Gs1, Gs2, Gs3). Gs1 was treated with curettage using Gracey curettes, Gs2 was treated with scaling and root planing using Odontoson M, while in Gs3 scaling and root planing with Odontoson M irrigated with a 10% iodised solution were performed. Clinical parameters (probing depth, bleeding on probing, dental mobility, loss of attachment level) were measured before treatment (T0), after 30 days (T1), after 90 days (T2) and after 120 days (T3). RESULTS: No statistical significant differences between Gs1 and Gs2 were observed. The improvement of clinical parameters in Gs3 was greater and statistical significant differences with other groups treated were recorded. CONCLUSIONS: There are no significant differences between the effectiveness of scaling and root planing with manual instruments and with Odontoson M. The 10% iodised solution used such as topic antiseptic carries out greater effects in not surgical periodontal treatments.

Adult↗
PubMed2001

Efficacy of subantimicrobial dosing with doxycycline. Point/counterpoint.

BACKGROUND: This article addresses the role of subantimicrobial dosing with doxycycline, or SDD, in the treatment of chronic periodontitis. The authors discuss and debate 10 issues with regard to SDD's utility as an adjunct to scaling and root planing. TYPES OF STUDIES REVIEWED: The authors reviewed reports of controlled clinical trials that assessed the efficacy of SDD. The main focus of this article is data from the U.S. Food and Drug Administration's phase 3 clinical trial that evaluated the efficacy of SDD in terms of alterations of probing depth, clinical attachment levels and disease progression. RESULTS: The authors compared data from test groups, which underwent root planing plus SDD, with data from control groups, which underwent root planing alone. The mean data suggest that SDD provides a defined but limited improvement of periodontal status when used in conjunction with scaling and root planing. Furthermore, several in vivo studies indicated that a nine-month course of SDD did not cause development of drug-resistant bacterial strains or alteration of the subgingival microbiota. CLINICAL IMPLICATIONS: Some patients may benefit from SDD. However, there are several issues that should be clarified before widespread use of SDD is recommended for patients with chronic periodontitis. The evidence indicates that suppression of the bacterial challenge, which reduces the host response, is the most efficient way to control periodontal diseases.

Anti-Bacterial Agents↗
PubMed2001

Is loss of attachment due to root planning and scaling in sites with minimal probing depths a statistical or real occurrence?

BACKGROUND: Following root planing and scaling many studies have implied an association between a loss of clinical attachment at sites with initially shallow pockets (1 to 3 mm) and gains in attachment level for deeper probing depths. However, these effects are also consistent with a statistical phenomenon referred to as regression towards the mean. This principle suggests that extreme values will moderate the next time they are recorded. The purpose of this report was to estimate the effect that regression towards the mean has on perceived changes in attachment level after root planing and scaling. METHODS: During the initial examination, 2 different investigators conducted 2 full-mouth probings. Two quadrants were randomly selected to be root planed and scaled until the root surfaces were smooth by tactile touch of an explorer. The 2 remaining quadrants were not treated. At 4 to 6 weeks after treatment, another full mouth probing was done. An examiner who was blind to the quadrants that had been scaled measured attachment level and probing depth after therapy. This study design provided periodontal measurements before and after root planing and scaling, measurements before and after a period of 4 to 6 weeks of no therapy, and duplicate measurements at the beginning of the study. RESULTS: Using the repeat examination when no true change could occur, shallow sites (< or =3 mm of probing depth) showed average negative differences between repeat attachment level measurements (-0.23 mm), which mimicked loss of periodontal attachment. Deep sites, (>6 mm) showed average positive values (0.40) mimicking gain in attachment level. These results suggest that regression towards the mean is a significant effect in this data set. Both shallow non-scaled and scaled sites had similar differences in repeat measures (-0.28 mm, -0.25 mm) which were also similar to and not statistically different from changes after therapy for both non-scaled (-0.21 mm) and scaled sites (-0.08 mm). Thus not only does this data set exhibit regression towards the mean, but it explains the majority of perceived loss of periodontal attachment after scaling at sites that have minimal probing depth. CONCLUSIONS: These results suggest that the majority of perceived loss of attachment due to scaling at sites of minimal probing depth that have been reported in many studies may be due a statistical phenomenon called regression towards the mean.

Dental Scaling↗
PubMed1994

The effects of spiramycin and/or scaling on advanced periodontitis in humans.

It has long been questioned whether antibiotics, used as a supplement to traditional therapy, provide any lasting benefit in the treatment of chronic periodontitis. This study was designed to evaluate Spiramycin as an adjunct to scaling and root planing in the treatment of advanced chronic periodontitis. In total, 193 patients with advanced periodontitis were recruited in seven centres using selection criteria previously described. After undergoing thorough scaling and root planing, all patients randomly received either Spiramycin, 1,500,000 international units, twice per day (IU, bid) for 14 days (96 patients), or a visually-identical placebo capsule (97 patients). The clinical parameters measured were plaque index, crevicular fluid level, probing depths, bleeding on probing and attachment level changes. Data was recorded at baseline, two-, eight-, 12- and 24-weeks visits. A total of 189 patients completed the study (96 placebo, 93 Spiramycin). Statistically significant differences in probing depth, favoring Spiramycin, were seen at two weeks (p < 0.0125), eight weeks (p < 0.0020), 12 weeks (p < 0.0032) and 24 weeks (p < 0.0075). Spiramycin also produced a significant improvement in attachment level at 12 weeks (p < 0.0146). All other clinical parameters showed no difference between drug and placebo. This study shows that Spiramycin, as an adjunct to thorough scaling and root planing, provides a statistically significant improvement in probing depths for up to 24 weeks when compared with scaling and root planing alone. Both longer studies and microbiologic evaluations are necessary to determine whether a more lasting benefit is possible.

Adult↗
PubMed2000

[The effect of non-surgical periodontal and adjunctive minocycline-HCL treatments on collagenase activity].

OBJECTIVE: To evaluate the effect of scaling and root planing combined with local application of 2% minocycline hydrochoride ointment(Periocline) on the level of collagenase activity releasing from PMNs in GCF. METHODS: This was a randomized, single-blinded, split mouth design study. The target sites of 31 patients with moderate to severe periodontitis (PD > 5 mm) was randomized by left-side and right-side into one of the two groups (the test group and the control group). Subsequently each patient was scheduled for two appointments for the full-month supra-gingival scaling and oral hygiene instruction. At baseline all patients received subgingival scaling and root planing and were followed by 4-time applications of Periocline with one-week interval for totally four weeks in the test group. All patients were taken GCF for measuring collagenase by the method of Nakashima et al (1996) and were examined based on four parameters, including plaque index, pocket depth, attachment loss and bleeding on probing. RESULTS: Four weeks after root planing with 4-time applications of Periocline, all clinical parameters and active collagenase in GCF decreased significantly in the test groups[(593 +/- 112) mU/sample vs (311 +/- 98) mU/sample, P < 0.001]. On the other hand, simple root-planing therapy had limited effect on the active collagenase[(611 +/- 123) mU/sample vs (523 +/- 127) mU/sample], although all clinical parameters were also reduce significantly. Interestingly, seven weeks later, gingival inflammation and the active collagenase were reduced more significantly than those after four-week root planing in both groups[Test: (311 +/- 98) mU/sample vs (207 +/- 57) mU/sample; CONTROL: (523 +/- 127) mU/sample vs (345 +/- 117) mU/sample, P < 0.001]. At eleven week, gingival inflammation and the level of collagenase activity were rebounded in the control group[(467 +/- 108) mU/sample]. However, in the test group they were kept in lower level[(213 +/- 121) mU/sample]. The level of collagenase activity showed significantly positive correlation with GCF volumes and AL in two groups. CONCLUSION: These results indicate that local application of 2% minocycline hydrochoride ointment may effectively inhibit the level of active collagenase from PMNs and may inhibit connective tissue breakdown by inhibiting neutrophil collagenase.

Adult↗
PubMed1991

The effects of various agents on root surfaces (a scanning electron microscopy study).

In periodontitis, root surface alterations have been observed in the cementum due to the presence of toxic substances mainly endotoxins of various microorganisms. Elimination of endotoxins from diseased root surfaces by root planing and demineralisation procedures seem to be essential for new attachment procedures. In this study the effects of citric acid and tetracycline HCl on periodontally involved root surfaces which had been scaled and root planed were evaluated by scanning electron microscopy. Our results showed that scaled, root planed and citric acid treated surfaces were relatively even with many dentinal tubules. The planed and tetracycline HCl treated root surfaces, however showed an irregular cemental surface with some debris, whilst the control surfaces found to be irregular with a considerable amount of debris.

Citrates↗
PubMed1990

The utility of the BANA test for monitoring anaerobic infections due to spirochetes (Treponema denticola) in periodontal disease.

Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus each possesses an enzyme(s) that hydrolyzes the synthetic substrate benzoyl-DL-arginine-naphthylamide (BANA). The presence of these organisms in a subgingival plaque sample can be determined by the ability of the plaque to hydrolyze BANA. In the present study, we describe the usefulness of the BANA test at various stages of a clinical trial of the efficacy of metronidazole in the treatment of periodontal disease. A BANA-positive test was significantly associated with high levels and proportions of spirochetes in the plaque, so that it provided information comparable with that which could be obtained by a microscopic examination of the plaque. Patients with such anaerobic spirochetal infections were randomly assigned to a group receiving either metronidazole or placebo (250 mg, three times a day) for one week and whose teeth were scaled and root-planed. The advantages of the decision that metronidazole be used were apparent from the comparison with the results obtained in the patients who received only the scaling and root planing. The initially BANA-positive teeth in the patients treated with metronidazole, scaling, and root planing gained attachment and exhibited a significant reduction in the need for periodontal surgery, when compared with the BANA-positive teeth in the patients who received only placebo, scaling, and root planing. After the conclusion of this therapy, those teeth with persistent BANA-positive plaques had significantly higher proportions and levels of spirochetes than did the teeth with BANA-negative plaques.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗