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PubMed2004

Destructive membranous periodontal disease (ligneous periodontitis): a case report and 3 years follow-up.

Destructive membranous periodontal disease is a rare, destructive and poorly defined entity, which is the part of a systemic disease due to plasminogen deficiency and fibrin deposition. The disease is characterised by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. Biopsy is essential to rule out other periodontal disease in the differential diagnosis.

Adult↗
PubMed1993

A preliminary report on the Stone-Kaplan instrumentation for CO 2 laser periodontics. Phase I: periodontal pocket opening surgical procedure.

A preliminary report on the Stone-Kaplan instrumentation for CO 2 laser periodontics is presented describing the instrumentation and introducing the first phase of its clinical usage. The design enables the introduction of a hollow fiber delivered CO 2 laser beam into the depth of a periodontal pocket enabling invasive surgical procedures to be carried out with exacting control of the laser beam as afforded by the design of the instrumentation. This design enables the performance of pocket-opening surgical procedures with ease of performance for the operator enhanced by the "instrument-in-hand" tactile-feedback and blind-visualization phenomena afforded by this unique design. The basic performance for a periodontal pocket opening procedure is presented here.

Carbon Dioxide↗
PubMed1990

Cellular reactions in pulpal and periodontal tissues after periodontal wound debridement.

Periodontal wounds in monkeys were prepared with a bur followed by the application of microbially contaminated cotton pellets. 3 weeks later, the wounds were debrided by scaling followed by etching with citric acid or by treatment with carbonate/peroxidate. The cellular reactions in the periodontal tissues and in the pulp 4, 11, 25, 39 and 53 days after treatment were followed with light microscopy. The marginal periodontium showed heavy inflammatory reactions immediately after treatment, regardless of the debridement procedure. 25 days after debridement, a long epithelial junction had been formed. The apical part of the epithelium deviated from the root surface into the connective tissue, delineating a heavily inflamed part of the connective tissue. After 39 to 53 days, most of the experimental wounds were covered by an epithelial lining. The pulpal reactions were generally limited to a production of irregular dentin on the pulpal wall facing the periodontal wound. It was concluded that the marginal healing pattern following various chemical treatments to the root surface followed, in all essential aspects, conventional treatment with scaling and root planing.

Animals↗
PubMed2005

A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars.

AIM: This randomized, single-blinded control trial investigated the local effects of periodontal care on the mandibular second molar delivered during and after impacted third molar surgical extraction. METHOD: Thirty subjects (50% male, 32.1+/-7.8 years) out of 35 enrolled, with a mesio-angular impacted mandibular third molar, having probing pocket depth (PPD) >5 mm at adjacent second molar distal, and crestal radio-lucency between the two teeth, completed the study. Oral hygiene instruction, scaling and caries stabilization were performed before surgery. Controls (n=16) had their third molar extracted followed by standard socket debridement. Test group subjects (n=14) received the same treatment, except that before wound closure the operator was informed of the group allocation and ultrasonic root debridement on the second molar was performed, followed by a three-visit plaque control programme. RESULTS: Six months post-extraction, statistically significantly (p<0.007) better plaque control and shallower probing depths were observed at test second molars' distal (%plaque=21; PPD=3.2+/-1.2 mm) than at control second molars (%plaque=88; PPD=5.2+/-0.7 mm). CONCLUSIONS: The periodontal interventions investigated prevented residual pockets on periodontally involved second molars 6 months after ipsilateral impacted mandibular third molar removal.

Adult↗
PubMed1985

Host responses to bacteria and bacterial products in periodontal disease: immunosuppressive effects of periodontitis-related microorganisms?

Several recent investigations indicate that some patients with adult periodontitis have lowered serum antibody levels or reduced lymphoproliferative responses to certain periodontitis-related microorganisms. Many such patients tend to show increased responses after therapy. Some suggested mechanisms of such responses are reviewed and the possible significance of immunosuppressive effects of periodontitis-related microorganisms are briefly discussed.

Adult↗
PubMed1984

Bacteriological study of periodontal lesions in two sisters with juvenile periodontitis and their mother.

A total of five bacteriological samples from the periodontal pockets of two sisters with localized juvenile periodontitis and their mother with advanced periodontitis was studied. Gram-negative anaerobic rods were predominant in the samples. Bacteroides intermedius and Bacteroides loescheii were the most predominant species. The antigenicity and bacteriocinogenicity of these isolates were quite similar. Serum immunoglobulin G antibody levels of the subjects to gram-negative periodontopathic bacteria were measured by using the micro-enzyme-linked immunosorbent assay. The levels of antibodies to saccharolytic black-pigmented Bacteroides species were significantly higher than the levels in healthy young females.

Adolescent↗
PubMed1997

Can one acquire periodontal bacteria and periodontitis from a family member?

Recent findings suggest that two major periodontal pathogenes, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, are transmitted among family members. The authors discuss the evidence of person-to-person transmission of periodontal bacteria, the significance of saliva as a vehicle of transmission and the methods of verifying clonal similarity of bacterial strains obtained from family members. The authors also discuss the prophylactic and therapeutic implications of the person-to-person spread of periodontal bacteria.

Adult↗
PubMed2001

An economic evaluation of a chlorhexidine chip for treating chronic periodontitis: the CHIP (chlorhexidine in periodontitis) study.

BACKGROUND: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. METHODS: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. RESULTS: Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. CONCLUSIONS: Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. CLINICAL IMPLICATIONS: In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.

Adult↗
PubMed1984

Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease.

A retrospective analysis was carried out to determine the frequency and onset of endodontic complications occurring in 52 patients treated for advanced periodontal disease. Comparisons were made between teeth which, following periodontal treatment, were used as abutments in fixed prosthetic reconstructions and nonabutment teeth. The study included 672 teeth with initially vital pulps (255 abutment teeth and 417 nonabutment teeth). The observation period varied from 4 to 13 years with a mean of 8.7 years. Pulpal necrosis including periapical lesions developed with a significantly higher frequency in abutment teeth than in nonabutment teeth (15% vs. 3%). The majority of these lesions did not appear until several years following the completion of active treatment. Conceivable reasons for the development of pulpal necrosis in teeth subjected to combined periodontal and prosthetic treatment are discussed.

Adult↗
PubMed1987

Periodontal status and bruxism. A comparative study of patients with periodontal disease and occlusal parafunctions.

This study investigated a possible association between bruxism and severity of periodontal disease. Subjects consisted of 51 patients (mean age 47.3 years) referred to the Department of Periodontology for treatment of moderate to severe periodontal disease (Perio-group) and 40 patients (mean age 48.9 years) referred to the Department of Stomatognathic Physiology for treatment of symptoms related to bruxism (Bruxism-group). Examination of the two groups included measurements of the alveolar bone height, probing attachment level, tooth mobility, and attrition of teeth. A questionnaire was also used to gain information on the patient's awareness of bruxism and tooth mobility. Awareness of clenching and/or grinding was reported by 57% of patients in the Bruxism-group and 24% of patients in the Perio-group. The perio-patients reported significantly higher frequency of tooth mobility than did the bruxism-patients. Alveolar bone loss, attachment loss, and tooth mobility were significantly more pronounced in the Perio-group than in the Bruxism-group. The Bruxism-group showed a higher frequency of tooth attrition than the Perio-group. Periodontal disease and bruxism seldom occurred in the same individual, and the results indicate that the two phenomena are in general not closely associated.

Adult↗
PubMed1988

A rationale for monitoring the periodontal microbiota after periodontal treatment.

Strict control of dental plaque accumulation remains the cornerstone of successful maintenance of the treated patient. However, some recurrences of periodontitis appear to take place despite good oral hygiene habits. A proportion of these are likely due to qualitative features of the periodontal microbiota rather than merely increased mass. Microscopic as well as cultural monitoring of qualitative features of the periodontal microbiota may be helpful in detecting critical changes. This review presents some of the research findings that provide a rationale for microbiological monitoring. Some of the advantages as well as difficulties encountered with these procedures are discussed.

Bacteria↗
PubMed1991

Periodontal repair in dogs: healing in experimentally created chronic periodontal defects.

A need exists for well-defined animal models to objectively evaluate surgical principles and a possible role for biochemical wound conditioning and biomaterials in promoting periodontal regeneration. To test an existing model for its usefulness in quantitative evaluation of periodontal wound healing, large supraalveolar periodontal defects were surgically created around the mandibular premolars (P2, P3, P4) in left or right jaw quadrants in 5 beagle dogs. The defects were exposed to the oral environment for 6 months and were then subjected to reconstructive flap surgery (chronic defects). Healing in these defects was compared to healing following reconstructive surgery in similar contralateral defects which had not been exposed to plaque and calculus (acute defects). The animals were sacrificed after a 4-week healing period and tissue blocks including teeth and surrounding structures were processed for histometric analysis. Mean defect height (+/- s.d.) for chronic and acute defects amounted to 4.6 +/- 0.3 and 4.4 +/- 0.4 mm, respectively. Mean connective tissue repair to the root surface in chronic defects amounted to 62% (range 49% to 74%) of the defect height. Mean connective tissue repair in the acute defects exceeded 94% of the defect height in 4 of the dogs, but amounted to only 48% in 1 dog. Regeneration of alveolar bone and cementum was limited under both experimental conditions. Root resorption was frequently encountered, whereas ankylosis was seen in only few teeth. This study indicates that healing may vary not only as a result of controlled experimental variables, but also due to differences in biological response between dogs or to fortuitous traumatic factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed1995

Compliance with supportive periodontal treatment in private periodontal practice. A 14-year retrospective study.

The purpose of this study was to determine the degree of compliance with supportive periodontal treatment (SPT) recommended in private periodontal practice and to determine if any significant differences existed in the characteristics of compliant, non-compliant, and erratically compliant patients. The study covered a period of 14 years (1977 to 1991) and included 521 patients who were classified by sex, age, socioeconomic class, disease severity, treatment rendered, and the year maintenance began. Compliance was categorized into four groups: complete compliance, erratic compliance, patients who discontinued SPT, and patients who never presented for SPT. Females began SPT more often than males (P = 0.054). Only 27.4% of the patients were in complete compliance at the end of the study. A significantly greater percentage of females (P = 0.032) and patients who had been treated by only scaling and root planing (P = 0.014) were in complete compliance. Drop-out rates from SPT tended to decrease during the first 6 years from 13.9% in the first 2 years to 9% in the sixth year. Thereafter, the percentage of patients presenting for SPT stabilized at 48.4% after 6 and 43.2% after 11 years. Younger patients (P = 0.04), those who had received only scaling and root planing (P = 0.008), and individuals in socioeconomic class I (P = 0.017) had a significantly lower tendency to drop out. The results confirm that compliance to SPT in private periodontal practice is far from ideal. Suggestions for improving compliance are discussed.

Adult↗
PubMed1996

Comparison of 3 periodontal local antibiotic therapies in persistent periodontal pockets.

The aim of this study was to evaluate the efficacy of 3 commercially available periodontal systems for local delivery of antibiotics as adjuncts to scaling and root planing in treatment of sites with persistent periodontal lesions following a course of scaling and root planing. Fifty-four patients with 4 pockets > or = 5 mm and bleeding on probing and/or suppuration were randomized in 4 treatment groups including: scaling and root planing plus application of 25% tetracycline fiber (S + Tet) (13 patients), scaling and root planing plus application of 2% minocycline gel (S + Min) (14 patients), scaling and root planing plus application of 25% metronidazole gel (S + Met) (14 patients), and scaling and root planing alone (S) (13 patients). Clinical measurements were taken at baseline and 6 weeks after the end of treatment periods. All treatments were applied using the distributors' recommended protocols and resulted in significant improvement in probing depth, attachment level, bleeding on probing and the modified gingival index (MGI) scores. The improvements in clinical parameters were greater in all three adjunctive treatment groups than scaling and root planing alone. The mean probing depth reductions were: S + Tet = 1.35 mm, S + Met = 0.95 mm, S + Min = 0.87 mm and S = 0.60 mm. The probing depth reduction was significantly greater in the scaling plus tetracycline fiber group than the scaling and root planing alone group (P = 0.002). The difference between groups in improvement of attachment level or bleeding on probing was not significant Scaling plus tetracycline fiber treatment resulted in the greatest reduction in the MGI scores which was significantly greater than all other groups. While the frequency of sites with suppuration was markedly reduced following all treatments, it reached zero in the scaling plus tetracycline fiber group. No serious adverse effects were observed or reported for any treatment. While all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regimen of scaling and root planing plus tetracycline fiber replacement gave the greatest advantage in the treatment of persistent periodontal lesions at least during the 6-week period following treatment.

Administration, Topical↗
PubMed2000

Enamel matrix-derived protein stimulates attachment of periodontal ligament fibroblasts and enhances alkaline phosphatase activity and transforming growth factor beta1 release of periodontal ligament and gingival fibroblasts.

BACKGROUND: Although it is claimed that enamel matrix-derived proteins (EMP) can be used to promote new attachment formation around periodontally involved teeth, the underlying biological mechanism is not understood. It was the aim of the present study to investigate the effects of EMP on the behavior of human periodontal ligament (HPLF) and gingival fibroblasts (HGF) in vitro, with special focus on their attachment properties, the expression of alkaline phosphatase (ALP) activity, the release of transforming growth factor (TGF)beta1, and their proliferative rate. METHODS: Fibroblast populations were obtained from 10 individuals with a healthy periodontium and cultured in chemically defined medium on culture plates coated with EMP, purified collagen type I, or their respective vehicles. Experiments were performed in the absence of serum for periods up to 48 hours. RESULTS: It was shown that HGF barely attached and spread on EMP-coated substrata, whereas HPLF attached and spread within 24 hours. However, when cultured on purified collagen type I, both cell types showed rapid attachment and spreading. Furthermore, the expression of ALP activity was significantly enhanced under the influence of EMP, especially in HPLF. HPLF and HGF both released significantly higher levels of TGFbeta1 in the presence of EMP. EMP did not influence 3H-thymidine incorporation by HPLF and HGF. CONCLUSIONS: Our results indicate that HPLF and HGF respond differently to EMP. A more rapid attachment of HPLF to this substratum might contribute, during the initial stages of periodontal healing, to selective outgrowth and colonization of exposed root surfaces in vivo.

Adolescent↗
PubMed2000

Relationship between interleukin-6 levels in gingival crevicular fluid and periodontal status in patients with rheumatoid arthritis and adult periodontitis.

BACKGROUND: The aim of this study was to determine and compare interleukin-6 (IL-6) levels in gingival crevicular fluid (GCF) and clinical periodontal findings in patients with rheumatoid arthritis (RA) and adult periodontitis (AP). METHODS: A total of 45 patients divided into 3 groups (15 patients with RA and AP, 15 patients with AP, and 15 periodontally healthy subjects) were included in this study. Plaque index (PI), gingival index (GI), sulcus bleeding index (SBI), probing depth (PD), and attachment level (AL) values for each patient were recorded. Enzyme-linked immunosorbent assay for quantitative detection of IL-6 in each GCF sample was employed. RESULTS: No significant difference could be detected between the RA and AP groups in the mean clinical parameter data except PI. Although the mean GCF IL-6 level in the RA group was the highest, no significant difference could be found among the groups. There was only a strong negative correlation between GCF IL-6 levels and GI scores in the RA group. CONCLUSIONS: In the patients with RA, despite increased local tissue destruction potential due to autoimmunity and higher PI levels than in the AP patients, our findings suggest that medication including corticosteroid and non-steroidal anti-inflammatory drugs may decrease gingival inflammation, but the synthesis and degradation of IL-6 in gingival tissue of RA patients may be different. To our knowledge, this study is the first report determining GCF IL-6 levels in RA patients.

Adult↗
PubMed2004

Periodontal repair in dogs: analysis of histometric assessments in the supraalveolar periodontal defect model.

BACKGROUND: Traditionally, the mean value from histometric assessments of several histologic sections from the same site has been, used for the histometric characterization of the site. The histometric analysis of the supraalveolar periodontal defect model uses observations from buccal and lingual sites in three step-serial sections representing the central aspect of the mesial and distal root for the third and fourth mandibular premolar teeth. The objectives of this study were to investigate the correlations and determine whether there are significant differences in the measurement values of various histometric parameters between the three step-serial sections and to test the hypothesis that, in this animal model, histometric assessments using the most central section of each root are comparable to the mathematical means of corresponding assessments of the site using the three step-serial sections. METHODS: Histometric analysis using light microscopy, an attached digital camera system, and a personal computer-based image analysis system including a custom program for the supraalveolar periodontal defect model was performed on histologic sections acquired from one jaw quadrant in each of 12 dogs. The animals had received a protocol including placement of a coral biomaterial and guided tissue regeneration (GTR) membranes, and were evaluated following a 4-week healing interval. Twelve parameters were assessed using three central step-serial sections from each root. For each parameter, pair-wise comparisons were performed using the mixed models analysis of variance, and the correlations between measurements were assessed by the intraclass correlation coefficient (ICC). RESULTS: For all parameters assessed, there were no significant differences (P > 0.05) among the three sections. The differences between the central section and the means of the three step-serial sections were small and not statistically significant. Parameters that could be assessed on most or all specimens, such as defect height and area, membrane height, and bone regeneration area, showed high correlations among the three step-serial sections (intraclass coefficient [ICC] approximately 0.91 to 0.98), and between each of the three sections and the mean for the three step-serial sections (ICC > or = 0.95). The most central section had somewhat higher correlation with the mean than measurements made on the lateral sections. CONCLUSION: The results suggest that using the supraalveolar periodontal defect model representative histometric data can be obtained evaluating only the central section from each defect site.

Animals↗
PubMed1988

[Marginal periodontitis and the immune system. III. Differences in peripheral blood lymphocyte subsets before and after treatment in adult periodontitis patients].

The lymphocyte subsets in the peripheral blood of 8 individuals, aged 25 to 57 yr, with moderate to advanced adult periodontitis were analyzed before and after treatment by means of flow cytometry, and then compared with the findings in 20 normal adults (aged 30 to 45 yr). The results were as follows: the percentage of OKT-8+ (CD 8) in the patients (20.25 +/- 7.15%) was lower than that in normal individuals (31.50 +/- 6.03%, P less than 0.01) while the OKT-4/OKT-8 ratio (2.34 +/- 1.18) was higher than the corresponding ratio in the controls (1.23 +/- 0.37); however, there was no significant difference in the percentages of OKT-3+ (CD 3), OKT-4+ (CD 4) and Leu-12+ (CD 19) between patients and normal subjects. The percentages of OKT-3+, OKT-4+, OKT-8+, Leu-12+ and OKT-4/OKT-8 after the periodontal therapy did not show a significant difference compared with the data obtained before treatment. These results indicate that the decrease in suppressor/cytotoxic T-cell population may be a kind of pathological disposition of the initiation and/or course of adult periodontitis.

Adult↗