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PubMed1994

An in vitro study of oscillating instruments for root planing.

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

Dental Calculus↗
PubMed1994

The periodontal status of irregular dental attenders.

The aim of this investigation was to assess the prevalence and severity of periodontal destruction in irregular dental attenders. 50 subjects aged between 20 and 49 years completed a questionnaire and had a periodontal examination. Measurements of plaque, calculus, bleeding, probing depth and clinical attachment level were made at 4 proximal sites per tooth. Results were compared to those for 132 regular attenders. The irregular attenders had more sites with plaque (46.3 +/- 27% versus 17.3 +/- 21.1%) than the regulars and significantly more sites which bled (53.7 +/- 20.4% versus 33.6 +/- 20.7%) and with calculus (35 +/- 21.1% versus 13.4 +/- 12.8%). However, the irregulars had virtually the same number of teeth as the regular attenders, 25.6 +/- 3.3 compared with 25.4 +/- 4.3. Irregular attenders had slightly deeper mean probing depths (2.9 +/- 0.4 versus 2.7 +/- 0.4 mm) but the prevalence and extent of attachment loss was no different between the groups. It was concluded that the prevalence and severity of destructive periodontal disease as indicated by periodontal attachment loss was not related to the regularity of dental attendance in the groups studied.

Adult↗
PubMed1995

Prognostic criteria for the efficiency of non-surgical periodontal therapy in advanced periodontitis.

The aim of the study was to find out which clinical, radiographic and microbiological variables can be used as prognostic criteria for the efficiency of the commonly used initial treatment protocol comprising scaling, root planning and instruction on oral hygiene in advanced adult periodontitis. 46 patients (mean age 48 years) with untreated, advanced periodontitis volunteered for the study. The clinical examination included recordings of plaque, gingival and calculus indices, probing pocket depths, bleeding and suppuration after probing, probing attachment levels and furcation involvements. Infrabony and furcation lesions were assessed from panoramic radiographs. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were cultured from the deepest, most inflamed periodontal Pockets, from surface of the tongue and from saliva. 3 months after the completion of non-surgical treatment comprising meticulous scaling and root planing and instruction on oral hygiene, the healing was assessed clinically, and 13 patients were assigned to a maintenance care programme (MC) and 33 to further treatment procedures (FT). Evaluation of the baseline clinical and radiographic data showed a significantly higher %s of > or = 6 mm deep periodontal pockets, surfaces with suppuration, and sites with subgingival calculus, as well as higher numbers of infrabony lesions, in FT-patients than in MC-patients. Subgingival A. actinomycetemcomitans was isolated at baseline in 55% of the FT-patients and in 38% of the MC-patients, and P. gingivalis in 27% and 23%, respectively. A. actinomycetemcomitans was eradicated by non-surgical treatment from only one patient. P. gingivalis was detected in 15% of the patients in both groups after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Lack of furcal bone loss following the tunneling procedure.

Treatment of molar teeth with severe furcation involvement allows for differing therapies of which the tunneling procedure has been least studied. While subsequent root caries in furcal exposed teeth was believed a major shortcoming, successful periodontal therapy is primarily dependent upon the stability of the attachment and intrafurcal and interproximal bone. We evaluated in each of 18 subjects (10 female, 8 male) a molar tooth with deep grade II/III furcation involvement at time of presentation (T-0), to 1st post-surgical recall following a tunneling procedure (T-1), to most immediate last recall (T-2; mean time T-0 to T-2, 5.80 +/- 0.83 years). Assessments included O'Leary's plaque index (P1-I), attachment levels (AL), root caries and radiographic bone loss. The mean P1-I from T-0 to T-2 decreased 56.8% with some plaque at T-2 detected in furcations of 7/18 teeth. AL across all time periods were not significantly difference except for palatal/lingual AL which from T-0 to T-2 were significantly different. Root caries was found in only 3 teeth at T-2. Adequate radiographs were available for 8 surgically tunneled mandibular molars for analysis of 5 measurements of osseous levels i.e., the mesial and distal levels of the intrafurcal and the interproximal osseous crests, and the distal interproximal osseous crest of a mesial adjacent single-rooted reference tooth which received osseous surgery at the same time. Mean time change values (T-1 to last radiograph taken, T-2a; mean time 3.0 +/- 0.7 years) showed no significant difference among the 5 points measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed1995

Management of furcation-involved teeth. A retrospective analysis.

In the present study, data from more than 550 periodontally diseased patients with more than 1100 furcation invasions were retrospectively analysed. There were apparent differences in the distribution of different furcation degrees in patient populations treated by 2 differently experienced operators. However, treatment modality patterns were rather similar. Scaling during periodontal flap surgery was the most often performed treatment procedure in degree I (97-98%) and II (75-83%) involvements. About 44% of degree III involved teeth were extracted. In order to determine the influence of degree of furcation involvement, tooth type and operator variability on treatment modality, logistic regression analysis was applied. Degree of furcation involvement was an important indicator variable in all models. Scaling as a sole measure was mainly performed in relation to degree I of furcation involvement. With every increase in degree, the odds of scaling decreased by factor 12.7. The odds of root resection was upper 1st molars 46 x higher than in wisdom teeth or lower 2nd molars with the same degree of involvement, but only 3.3 x higher than in lower 1st molars. Tunnel preparation as well as regenerative procedures were mainly confirmed to lower molars. Operator variability was only introduced as a covariate in the extraction model. hence, despite of different operator skill and severity of periodontal disease in treated populations, decision for one or the other treatment modality seems to depend essentially on degree of furcation involvement as well as tooth type.

Adolescent↗
PubMed1996

A comparative study of a surgical method and scaling and root planing using the Odontoson.

This investigation compared a traditional periodontal surgical method with a non-surgical treatment of scaling and root planing by an ultrasonic device (Odontoson M) using irrigation with an iodised solution. 8 adult patients with periodontal disease were each treated at 2 randomly chosen quadrants by a Widman flap type surgical technique, and the remaining non-surgically. The patients then attended bi-monthly oral hygiene sessions over a period of 1 year. At that stage, clinical evaluation revealed that the Odontoson M plus an ionized irrigant solution achieved a statistically comparable outcome to that of surgical treatment, even in the pockets initially up to 7 mm in depth.

Adult↗
PubMed1996

Molar furcation involvement associated with cigarette smoking in periodontal referrals.

The aim of this study was to investigate the relationship between cigarette smoking and furcation involvement in molar teeth. A consecutive group of 50 smokers were recruited from referrals to a periodontal clinic and age and gender matched with never smokers. Smokers consumed an average of 18.0 (SD 6.7) cigarettes per day and had smoked for 2.7 (SD 6.5) years. Radiographs of all molar teeth were assessed 2 x by an examiner blinded to the smoking status. Smokers had slightly fewer molar teeth 6.7 (SD 2.6) than the never smokers, 7.3 (SD 2.3), t = 1.2, P = 0.22. More smokers (72%) had evidence of furcation involvement than never smokers (36%), x2 = 13.0, P = 0.0003. The odds ratio for a smoker having 1 molar with furcation involvement was 4.6 (c.i. 2 - 10.6). Smokers had more molars with furcation involvement 1.94 (SD 1.7) compared with never smokers, 0.94 (SD 1.4), t = 3.1, P = 0.003. It is concluded that cigarette smoking is associated with a greater expression of molar furcation involvement in periodontitis affected subjects.

Adult↗
PubMed1996

The reproducibility and validity of furcation measurements using a pressure-calibrated probe.

The furcation involvement of 100 molars in 25 patients suffering from moderate to advanced periodontitis was investigated. The horizontal probing attachment level (PAL-H) within the furcations was assessed 2x within 2 weeks using the pressure-calibrated (0.25 N) flexible plastic universal explorer version of the TPS probe (TPS). To determine the measurement error of PAL-H assessments, the standard deviation of single measurements was calculated. The measurements were repeated using a colour-coded Nabers probe and compared to the TPS assessments. 253 furcations were evaluated (100 buccal, 47 lingual, 53 mesiolingual and 53 distolingual, respectively). For buccal, lingual, mesiolingual and distolingual furcations, the standard deviations were 0.486 mm, 0.598 mm, 0.846 mm, 1.039 mm, respectively. Measurement error was less in buccal and lingual furcations than in mesiolingual and distolingual sites (p < 0.005). The agreement of replicate measurements of furcation degrees was excellent for buccal and lingual furcations (weighted kappa [standard error] 0.824 [0.076] and 0.779 [0.107], respectively), but only moderate for mesiolingual and distolingual furcations (weighted kappa 0.688 [0.096] and 0.544 [0.101], respectively). Only in distolingual sites there was a significant (p < 0.025; paired t-test) underestimation of PAL-H by the TPS as compared to the Nabers probe. At all locations the TPS underestimated furcation degrees significantly (p < 0.1; Stuart-Maxwell's chi 2) as compared to Nabers probe. Measurement error of mesiolingual and distolingual furcations was significantly higher than of buccal or lingual sites. The reproducibility of PAL-H measurements in furcations using TPS is comparable to data published for scorings with colour-coded Nabers probes. Through and through furcations are likely to be underestimated by using the flexible plastic version of the TPS probe. Hence, it seems to be unsuitable for a proper assessment of the degree of furcation involvement.

Adult↗
PubMed1996

Bone density of class II furcation lesions treated by guided tissue regeneration. A follow-up study by digital analysis of superimposable radiographs.

12 buccal or lingual class II furcation lesions were selected in the lower molars of 7 patients after treatment by routine scaling. In each of the 7 patients, 1 lesion was treated by guided tissue regeneration (GTR) with expanded polytetrafluoroethylene membranes, while 5 neighbouring molars underwent conventional flap operations. The index of gingival inflammation, the plaque index, the depths of the pockets, the horizontal and vertical attachment levels were measured before and 6 months, 1 year and 2 years after surgery. Standardized reproducible radiographs were taken before treatment, post-operatively (at the time of membrane removal for the GTR treated sites), at 6 months, 1 year and 2 years after treatment. The density of bone was quantified in several areas by using high-resolution digital analysis. With the exception of the higher gain in horizontal attachment observed in the GTR treated furcations, the improvement of clinical parameters was similar in all sites during the 2 years of follow-up. The radiographical analysis showed no statistically significant changes neither in the GTR nor in the conventionally treated lesions over this period of time, even when they were compared to untreated bone control areas. However, in this study limited to 7 patients, the interdental bone next to the GTR treated furcations showed significant signs of remodeling.

Absorptiometry, Photon↗
PubMed1996

Prevalence of furcation involvements in patients referred for periodontal treatment.

The aim of this study was to evaluate the prevalence of furcation-involved molars in a patient sample referred for periodontal treatment. A total of 222 patients aged, 14-73 years (mean age 45 years), and with signs of destructive periodontal disease in at least 2 quadrants of the dentition were included in the study. The clinical examination involved assessments of oral hygiene status, gingival conditions, probing pocket depth and presence/degree of furcation involvement. In addition, a full mouth intraoral radiographic examination was performed. The results revealed that 4% of the patients presented with all 12 molars, while 3% had lost all molars. 52% of the individuals had at least 8 molars; 95% of subjects < 30 years of age and 19% in the age 60+ years. In patients aged > or = 40 years, every 2nd molar showed advanced periodontal destruction in the furcation area. The prevalence of furcation involved molars was higher in the maxilla than in the mandible. From the age of 30 years, about 50% of the 1st and 2nd molars in the maxilla showed at least 1 furcation site with deep involvement, while in the mandible a similar prevalence was observed first after the age of 40 years. The highest frequency of furcation involvement was found at the distal site of the maxillary 1st molar (53%), and the mesial aspects of the maxillary 2nd molar showed the lowest frequency (20%). Furcation sites with a probeable trunk region were observed at a frequency of 17-22% at the various tooth sites. It was concluded that tooth morphology may be an important factor that accounts for the variability in prevalence of molar furcation involvement.

Adolescent↗
PubMed1996

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

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

Age Factors↗
PubMed1997

Types and dimensions of root trunk correlating with diagnosis of molar furcation involvements.

The objective of the present study was to investigate the possible correlation of dimension, location, prevalence, and types of root trunk with molar furcation involvement (FI). The samples used in the study include 166 maxillary molars (70 1st and 96 2nd molars) and 200 mandibular molars (103 1st and 97 2nd molars). The dimensions of the root trunks and root lengths were measured with an electric caliper and their means and standard deviations calculated. The types of root trunks were identified by the ratio of root trunk dimension to root length and classified as types A, B, and C. The results may be summarized as follows. (1) Short-root trunks were more commonly found buccally, whereas long-root trunks were more commonly found mesially, in both maxillary molars. (2) Short-root trunks were most commonly found buccally, whereas long-root trunks were more commonly found lingually in both mandibular molars. (3) Long-root trunks were more commonly found on the 2nd molars than on the 1st molars. (4) Long-root trunks were associated with short root length. (5) There is a strong correlation between vertical length and type of root trunk and FI. The findings of the study indicated that an awareness of root trunk type together with horizontal and vertical attachment levels in molar FI may be helpful in the prognosis, diagnosis, and treatment of molar FI.

Adult↗
PubMed1997

A logistic regression model for the decision to perform access surgery.

Access surgery may be recommended to about 80% of patients who present with advanced forms of periodontal disease. In this report, a multivariate logistic regression analysis which incorporated several clinical parameters for each tooth examined, i.e., tooth type, furcation involvement, bleeding on probing, attachment level, probing depth, mobility and BANA test score, was conducted using generalized estimating equations (GEE). This approach identified parameters that were significantly associated at p < 0.05 level with the need for access surgery or extraction for periodontal purposes. The estimated probabilities derived from the GEE model were plotted over the complete spectrum of operating conditions to obtain a receiver-operator characteristic (ROC) curve. At a probability cutpoint of 0.8, the decision threshold for surgery/extraction at the pretreatment examination would have a sensitivity of 76.1% and a specificity of 75.3%. We have taken this 0.8 cut point to look at specific clinical decisions made by our examiners after the patients had received scaling and root planing plus 2 weeks unsupervised usage of systemic antimicrobials. The clinicians' decision was taken as the primary reference standard. The model's estimated decision agreed with the clinicians' decision in 226 of the 284 teeth, for an accuracy of 80%. The specificity was 90% and the sensitivity was 43%.

Algorithms↗
PubMed1998

Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study.

The present investigation was designed to evaluate the long-term effect of root-resective therapy in the treatment of furcation-involved molars. The patient sample included 72 patients, 21-62 years of age, who presented periodontal lesions in the posteriors segments of the mouth including furcation involvement of various degrees. After an initial examination, each patient was subjected to a series of full-mouth scaling and root planing. They were recalled 1-3 months later for a presurgical examination and subsequently underwent the corrective phase of therapy. During the surgical procedure, the furcation-involved teeth were subjected to root-resective therapy in conjunction with osseous recontouring and apically positioned flaps (test sites). A surgical procedure identical to the test procedure was performed in the non-furcation-involved teeth (control sites) with the exception of the root resection. At the completion of the active phase of treatment, 175 test and 175 control sites were available for the study. After a period of 6 months of healing and plaque control supervision following surgical procedures, the patients were recalled for a baseline examination. They were then enrolled in a maintenance program including professional tooth cleaning every 26 months. The patients were re-examined 3, 5 and 10 years post-operatively. The results of the assessments demonstrated that the survival rate, during the 10-year period of observation, reached 93% at test and 99% at control sites. The positive treatment outcome at the root-resected, furcation-involved teeth as well as at non-furcation-involved teeth was probably the consequence of the reestablishment of a tissue morphology favorable for oral hygiene and careful plaque control by the patients.

Adult↗
PubMed1998

Instrumentation of furcation with modified sonic scaler inserts: study on manikins, part I.

The purpose of this study was to determine the suitability of different scaling instruments for the debridement of furcations. 12 upper and 12 lower replicated molars with through-and-through furcations were instrumented 3x with 5 different types of instruments: (i) hand instruments; (ii) hand instruments in conjunction with diamond burrs; (iii) a conventional ultrasonic scaler insert; (iv) a conventional sonic scaler insert; (v) a set of 2 modified diamond coated sonic scaler inserts with different angulated shafts. The plastic replicas were fixed in a manikin head without replicated soft tissues. Following debridement, weight loss and % of instrumented furcation area were assessed. In the case of lower molars, it made little difference whether they were treated with hand instruments, hand instruments combined with diamond burrs, or diamond-coated sonic scaler inserts. On upper molars, however, significantly more area was instrumented with the diamond-coated inserts than with the other instruments. Substance removal was greater with diamond-coated inserts than with the other devices. In conclusion, an effective debridement of the furcation seems possible only with an odontoplasty, in which a furcation is fitted to the instrument by means of intensive instrumentation, thus leading to substance loss. To improve results with these instruments, further research is necessary.

Acrylic Resins↗
PubMed1998

Radiographic periodontal findings in an elderly Finnish population.

By means of panoramic radiography and additional intraoral radiographs, the occurrence of calculus, the extent of horizontal bone loss, the depth and number of infrabony pockets, the number of furcation lesions, and the number of interproximal restoration overhangs were studied in 169 dentate 76-, 81-, and 86-year-old subjects (54 male and 115 females) living at home. Alveolar bone loss (horizontal or vertical) among the participants was common, and in only 8 subjects (5%) was it judged non-existent. It was slight in 30 subjects (18%), moderate in 53 (31%), and advanced in 78 (46%). Infrabony pockets were found in 51% of the subjects and furcation lesions in 28%. The presence of calculus did not correlate with the other parameters. The number of interproximal overhangs was associated with the number of infrabony pockets and of furcation lesions (R=0.3, p<0.001 and p<0.0001) and the number of infrabony pockets with the number of furcation lesions (R=0.4, p<0.0001). Our study shows that periodontal findings are common in the dentate elderly, and associations recently found between periodontal infections and several serious diseases make radiographic examination an integral part of the oral examination of the elderly patient.

Aged↗
PubMed1998

Instrumentation of furcation with modified sonic scaler inserts: a study on manikins (II).

We developed a sonic scaler tip with an ellipsoid diamond-coated bud and contra-angulated shafts to overcome problems resulting from furcation anatomy. In this study, extracted molars were instrumented in a dummy model without any replicated soft tissues using 3 different instrumentation methods (i) curettes, (ii) diamond-coated sonic scaler tips with normal handle and (iii) diamond-coated sonic scaler tips in 2 handles with varying power levels. 15 extracted upper and lower molars were instrumented using each of the 3 instrumentation types. Following debridement, loss of substance and % of furcation area instrumented were assessed. In both upper and lower molars, significantly more surface area was instrumented in one instrumentation run with diamond-coated tips than with curettes. Substance loss was greater with diamond-coated tips than with hand instruments. In conclusion, an effective debridement of the furcation roof seems only possible with odontoplasty. Clinical evaluation of this approach to root debridement is needed.

Curettage↗
PubMed1998

Semi-automated measurement of motility of human subgingival microflora by image analysis.

The purpose of this investigation was to quantitatively estimate bacterial motility by image analysis, and to apply this method for the measurement of motility of human subgingival microflora. We developed a semi-automated method for the quantification of bacterial motility using video microscopy, digitization and image processing. Moving images of both authentic bacterial samples and clinical samples were recorded using a phase contrast microscope with a high speed (1/100 s) shutter camera. The motility was evaluated by measuring the total number of pixels remaining after the subtraction of 2 serial video images. The total number of pixels was significantly correlated with both the sum of the velocity of each bacterial cell and the number of motile bacteria on the same original images. Motility of subgingival microflora from 140 clinical samples tested was measured at 0 pixels to 3600 pixels, whereas the effect of Brownian movement was less than 150 pixels. The motility of subgingival microflora estimated with this image analysis system did not differ much from objective judgments by the naked eyes of experts. These results suggest that a semi-automated image analysis system may be useful in the evaluation of the motility of human subgingival microflora.

Adolescent↗