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PubMed2006

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants.

OBJECTIVE: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis. MATERIAL AND METHODS: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms. RESULTS: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant. CONCLUSION: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

Adolescent↗
PubMed1996

The relationship between gingival crevicular fluid cathepsin B activity and periodontal attachment loss in chronic periodontitis patients: a 2-year longitudinal study.

This study aims to determine whether gingival crevicular fluid (GCF) cathepsin B levels, total activity (TA) and concentration (EC) predict progressive attachment loss (AL). Seventy-five previously untreated patients with moderate periodontitis were recruited. GCF was collected from 16 molar and premolar mesiobuccal sites and probing attachment level (PAL) and probing depth (PPD) were measured with an electronic probe. Gingival, gingival bleeding and plaque indices were then scored. Prior to baseline patients were given basic periodontal treatment after which the above procedures were repeated. Carefully localized radiographs were taken of the test teeth and repeated annually. Patients were seen 3-monthly for 2 yr and the procedures were repeated. One hundred and twenty-one AL sites, 90 rapid AL (RAL) and 31 gradual AL (GAL), in 49 patients were detected. Cathepsin B levels (TA & EC) at RAL sites were significantly higher (p < 0.0001) than paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels (TA & EC) over the study period at GAL sites were significantly higher (p < 0.0001) than paired control sites. Using a critical value (CV) of 7.5 microU/30 s (TA) and 30 microU/microL (EC) showed a sensitivity of 100% and specificity of 99.83% (TA) and 100% and 99.75%(EC) at both ALT & PT. Mean cathepsin B levels (TA & EC) were significantly higher (p < 0.0001) at RAL and GAL sites than non-attachment loss (NAL) sites in AL patients in intrapatient comparisons and mean patient levels were significantly higher (p < 0.0001) in AL patients than NAL patients in interpatient comparisons. These results indicate that GCF cathepsin B may serve as a predictor of attachment loss.

Adult↗
PubMed1992

Comparison of measurement variability in subjects with moderate periodontitis using a conventional and constant force periodontal probe.

This study compared the intra- and inter-examiner measurement error of the Florida Probe, Florida Disk Probe, and conventional periodontal probe in persons having moderate to severe periodontitis. Single pass measurements using the conventional probe were compared to both single and double pass (corrected) measurements using the Florida Probe and Florida Disk Probe. The mean intra-examiner standard deviations of differences in repeated site probing depth measurements ranged from 0.60 to 0.93 mm for the Florida Probe and from 0.52 to 0.89 mm for the conventional probe. Based on overall averages, the conventional probe measured deeper probing depths than the Florida Probe at the same sites. This difference was especially evident in pockets greater than or equal to 6 mm in depth. Based on sites, the mean intra-examiner standard deviations of differences in repeated relative attachment level measurements using the Florida Disk Probe ranged from 0.55 to 0.82 mm. The mean standard deviations of site measurements for attachment level obtained with the conventional probe ranged from 0.62 to 1.14 mm. Inter-examiner measurement error was greater than intra-examiner measurement error for each probing method. It was concluded that use of the Florida Probe and Florida Disk Probe may offer significant advantages in reducing measurement error for some clinical examiners. For other examiners, use of the Florida Probes do not necessarily result in less measurement error than use of conventional probing methods.

Calibration↗
PubMed2005

Clinical and radiographic effects of enamel matrix derivative in the treatment of intrabony periodontal defects: a 12-month longitudinal placebo-controlled clinical trial in adult periodontitis patients.

BACKGROUND: This randomized, double-masked, placebo-controlled clinical trial evaluated the effect of enamel matrix derivative (EMD) on clinical and radiographic parameters of periodontal intrabony defects. METHODS: A split-mouth design was used in 16 chronic periodontitis patients who had similar defects (> or =6 mm of probing depth). Both groups underwent scaling and root planing and were acid-etched with EDTA. The test sites received the EMD solution and the controls a placebo. Clinical examinations of all 16 patients and radiographs of 14 patients were available at baseline and 6 and 12 months after surgery. Clinical outcomes included probing depth (PD) and clinical attachment level (CAL); radiographic analysis was performed using computerized linear measurements. Intergroup comparisons were performed by paired samples t test, and over time comparisons were made by general linear model (alpha = 0.05). RESULTS: A statistically significant improvement over time for PD and CAL and a decrease of the vertical component of the defect was detected in both groups. Comparisons between groups revealed at baseline a mean+/-SD value of CAL of 12.93+/-2.00 and 13.47+/-2.93 for test and control groups, respectively. These values decreased to 10.92+/-1.92 and 11.31+/-1.86 after 12 months for test and control. No statistically significant differences could be observed between groups. PD displayed similar results from 7.57+/-1.02 and 7.38+/-1.16 for test and control groups at baseline to 3.40+/-1.82 and 2.99+/-1.07 after 12 months. If the data are divided into smokers and non-smokers, no differences are observed. CONCLUSION: Use of EMD did not result in more improvement in clinical and radiographic parameters compared to the placebo.

Adult↗
PubMed1990

[The surgical verification of the periodontal probe and endoral radiography in assessing the bone substance loss in periodontal disease. A proposal for optimizing the methods].

It is difficult to compare levels of bone loss in periodontal disease measured by periodontal probe and X-ray and to verify them versus surgical techniques. In fact, there are relatively few published reports on the subject. To this purpose the Authors describe their personal experience using plates equipped with guide tracks and center-film boxes with personalized bites. The suitability of the two methods (probe, intraoral X-ray) to determine levels of bone loss similar to those revealed by surgical verification was assessed on the basis of an analysis of the respective bone loss in 44 sites surrounding 19 dental elements. This method, which is accurate but time-consuming, demonstrated an broadly analogous underestimate (approx. 20%) using both preoperative probe and X-ray techniques in comparison to the true level of bone loss measured during surgery.

Adult↗
PubMed1988

Neutrophil function in patients with localized juvenile periodontitis and with rapidly progressive periodontitis.

PMN chemotactic function and oxydative metabolism were investigated in 13 patients with rapidly progressive periodontitis (RPP) and 9 patients with localized juvenile periodontitis (LJP) using a chemotaxis assay (CHA), luminol chemiluminescence (CL) and nitroblue-tetrazolium (NBT) tests. In the LJP patients there was a significantly lower CHA than in the RPP patients (less than 40%). Three out of the 13 RPP patients displayed a cell-dependent increase of CHA and in 3, the reduced CHA measured was serum-associated whilst among the 9 LJP patients, a cell-dependent defect of CHA was present in 5 patients, a serum-associated defect in one patient and a combined cell- and serum-associated defect was found in another patient. The average values of CL in the RPP patients were significantly lower (1309.3 +/- 814.2) than those measured in the LJP group (2208 +/- 826.9). In contrast, the mean NBT test values indicated a lower phagocytic function in the LJP patients than in the RPP ones suggesting also the presence of a serum-dependent factor in RPP and that of a combined cell- and serum-response in LJP. According to these results, the neutrophil dysfunction in RPP, as indicated by both the chemotaxis and the oxydative metabolism nature, was frequently associated with a serum factor.

Adolescent↗
PubMed1993

Prevalence of Treponema denticola and Porphyromonas gingivalis in plaque from periodontally-healthy and periodontally-diseased sites.

Intracrevicular plaque from periodontally-healthy individuals who had refrained from oral hygiene measures for 24 h prior to sampling, and subgingival plaque from diseased sites of patients with chronic periodontitis were screened by ELISA for the presence of Porphyromonas gingivalis and Treponema denticola. The samples were also subjected to the PerioScan test to detect the presence of enzymes capable of degrading N-benzoyl-DL-arginine-2-naphthylamide (BANA). Of the 141 samples from periodontally-healthy sites, 73% contained T. denticola antigens and 78% P. gingivalis antigens, compared to 43% and 59%, respectively, in plaque samples from the 159 diseased sites. A positive reaction in the PerioScan test was obtained in 89% of plaque samples from diseased sites and in 60% of those from healthy sites. The correlation between the results of the two assays was poor in the case of intracrevicular plaque from healthy sites. However, with plaque samples from diseased sites, the results of the PerioScan test showed very strong correlation with those obtained with the ELISA, suggesting that the former may be a useful, rapid means of indicating the presence of T. denticola and P. gingivalis in such plaque samples.

Adolescent↗
PubMed2006

Application of periodontal tissue engineering using enamel matrix derivative and a human fibroblast-derived dermal substitute to stimulate periodontal wound healing in Class III furcation defects.

BACKGROUND: Enamel matrix derivative (EMD) has been shown to promote several aspects of periodontal regeneration in vitro and in vivo. Recently, a bioengineered tissue (DG) was developed to promote wound healing of chronic skin ulcers. This pilot study sought to assess the effects of EMD and DG, alone or in combination, on periodontal wound healing in surgically created Class III furcation defects. METHODS: Six female baboons received bilateral ostectomy of approximately 10 mm around the first and second mandibular molars to achieve Class III, subclass C furcation defects. Wire ligatures and cotton pellets were left in place for 2 months to maintain the depth of the defects and promote plaque accumulation. Each furcally involved molar was then assigned to one of four treatments: open flap debridement (OFD), OFD plus EMD, OFD plus DG, or OFD plus DG and EMD. This resulted in six total sites per treatment group. Seven months after defect creation and 5 months after treatment, and after no oral hygiene, tissue blocks of the mandible were taken for blinded histometric analysis to assess parameters of periodontal regeneration adjacent to furcal root surfaces and from the mid-furcal aspect (i.e., new bone, new connective tissue attachment, new epithelial attachment, and new cementum formation). RESULTS: Histometric analysis demonstrated differential regenerative responses with respect to treatment within each animal. However, statistically significant differences between treatments from all six animals were not observed (P >0.20, mixed-model analysis of variance). EMD-treated sites presented mildly positive regenerative results and no negative responses. Both DG only and combination therapy demonstrated similar or less than positive responses relative to OFD controls. CONCLUSION: The descriptive analysis may suggest a positive effect of enamel matrix proteins and a negative effect of DG used alone or in combination with enamel matrix proteins on the regeneration of Class III furcation defects in baboons.

Animals↗
PubMed1998

Advances in periodontal diagnosis. 7. Proteolytic and hydrolytic enzymes link with periodontitis.

Biomarkers of periodontal disease activity may be obtained from potential proteolytic and hydrolytic enzymes of inflammatory cell origin. Studies that have sought to correlate these enzymes with periodontal disease activity are reviewed with special consideration given to collagenases, cysteine, aspartate and serine proteinases, beta-glucuronidase, arylsulphate, alkaline and acid phosphatases, myeloperoxidase, lysozyme and lactoferrin.

Acid Phosphatase↗
PubMed1981

Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis.

Healing events after nonsurgical periodontal therapy in patients with periodontal pockets 4--7 mm deep were investigated. Incisors, cuspids and premolars in 15 patients were treated by plaque control and supra- and subgingival debridement using hand or ultrasonic instruments in a split mouth approach. The results were evaluated by recordings of plaque scores, bleeding on probing, probing pocket depths and probing attachment levels. All these parameters were improved during the initial 4--5 months after start of therapy. Little change occurred during the rest of the 13-month observation period. No difference of results could be observed comparing hand and ultrasonic instrumentation or comparing the results of two different operators. Initially a total of 106 sites demonstrated probing pocket depths greater than or equal to 6 mm. At 13 months only 13 such sites were observed. The apparently successful results of conservative treatment of patients with 4--7 mm deep pockets in the present study raise the question to what extent nonsurgical therapy is feasible also in patients with severely advanced lesions.

Adult↗
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↗
PubMed1991

A fractal model for periodontal breakdown in periodontal disease.

This paper presents a computer model of periodontal breakdown based on 1/f noise. The model is multifactorial and simulates the disease advancing with age in bursts and remissions, as seen in previous epidemiologic studies. Changing the weight of some parameters changed the simulated periodontal breakdown dramatically, disclosing antagonistic and synergistic effects between the causal factors.

Age Factors↗
PubMed1995

Assessment of periodontal status with PSR and traditional clinical periodontal examination.

The system of peridontal screening and recording was developed by the American Dental Association and the American Academy of Periodontology to simplify early detection of periodontal pathology. The authors evaluated the results of PSR against those of a conventional periodontal examination in 24 subjects, each of whom had a minimum of 18 natural teeth. The results of this study suggest that the PSR examination, while a useful screening tool, could be improved to further enhance its identification of patients with peridontal diseases.

Adolescent↗
PubMed1975

Primate model for testing periodontal treatment procedures: I. Histologic investigation of localized periodontal pockets produced by orthodontic elastics.

Experimental periodontal lesions have been produced in Rhesus monkeys using orthodontic elastics. These lesions are characterized by an irreversible apical positioning of the junctional epithelium and both horizontal and angular bone loss. It was concluded that this lesion is suitable for testing the effect of periodontal treatment.

Alveolar Process↗
PubMed1984

Bacterial invasion of periodontal tissues in advanced periodontitis in humans.

Bacterial invasion of the pocket epithelium and underlying connective tissue was found in seven cases of advanced human periodontitis. Four cases showed invasion of the epithelium as well as the connective tissue while in the other three cases bacterial invasion was limited to the pocket epithelium. The microorganisms observed included cocci, rods, filaments, fusiforms and spirochetes and these were morphologically similar to those observed in the apical zone of the subgingival plaque. Most bacteria showed typical Gram-negative cell walls. Bacteria were seen in enlarged epithelial intercellular spaces and among debris of disintegrated epithelial cells. In the connective tissue the bacteria were seen among remnants of collagen fibers and degenerated fibroblasts. Identification of the invading microorganisms may assist in understanding the pathogenesis of chronic periodontitis.

Adult↗
PubMed1993

Periodontal microflora of HIV positive subjects with gingivitis or adult periodontitis.

The subgingival microflora of 39 HIV+ subjects with gingivitis or adult periodontitis was cultured quantitatively anaerobically for bacteria, spirochetes, and mycoplasma and aerobically for yeasts. Isolates were characterized by conventional biochemical tests, polyacrylamide gel electrophoresis of soluble proteins, cellular fatty acid profiles, immunofluorescence, and immunodiffusion. In general, the same types of bacteria were isolated from the subgingival crevice of HIV+ subjects as we previously had isolated from the subgingival crevice of non-HIV subjects. A statistically significant difference was found between the composition of the flora of HIV+ subjects with adult periodontitis (AP) and concurrent studies of a non-HIV+ AP population. Mycoplasma salivarium was significantly elevated in the HIV+ subjects examined. Yeasts were isolated from only 10% of the samples and from 13% of the HIV-positive subjects at 0.05 to 0.0002% of the total cultivable count when present.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Actinobacillus actinomycetemcomitans in adult periodontitis. II. Characterization of isolated strains and effect of mechanical periodontal treatment.

Ten systemically healthy subjects (ages 28 to 60 years) with untreated moderate to severe periodontal disease and evidence of presence of A. actinomycetemcomitans underwent standard mechanical periodontal treatment consisting of oral hygiene instruction and systematic deep scaling and root planing. Before, and 4 to 5 weeks after treatment, clinical measurements and separate subgingival microbiological samples were taken from the mesial and distal aspect of every tooth, with the exception of the third molars. A. actinomycetemcomitans could still be detected in all patients after treatment. In 9 of the 10 patients, all tested isolates from both examinations were of a single type. Two patients carried serotype a; 2 serotype b; 2 serotype c; and 1 serotype e. Two individuals showed only non-typeable isolates lacking serotype a, b, c, d, or e specific antigens. Another subject was colonized by serotype c and, in addition, yielded a non-typeable isolate. Persistence of A. actinomycetemcomitans after treatment was significantly correlated with the frequency of A. actinomycetemcomitans before treatment (P < 0.001) and the mean probing depth before treatment (P < 0.05). No serotype-specific patterns of treatment outcome could be recognized. The analysis of the site specific effect of treatment showed a significant relationship between post treatment levels of A. actinomycetemcomitans and both probing depth reduction as well as attachment gain. Individuals showing evidence of A. actinomycetemcomitans in a multitude of sites appeared to be more difficult to treat than patients with few positive sites only. Within such individuals, the deeper pockets showed the greater resistance to eradication of A. actinomycetemcomitans.

Adult↗
PubMed1990

[Distribution of enzymatically pathogenic bacteria from periodontal pocket in advancing periodontitis].

Production of 9 enzymatic activities of 527 strains freshly isolated from periodontal pockets in advancing periodontitis were investigated. Of these isolates, two strains showed lecithinase activity on egg yolk agar plate. Collagenase, plasmin and lipase were produced by 28 strains, 26 strains and 22 strains, respectively. Two lecithinase-producing strains were identified as Bacteroides intermedius. Nineteen strains of B. intermedius and 1 strain of Fusobacterium species produced lipase on egg yolk agar plate. All of the 28 collagenase-producing strains were B. gingivalis. B. gingivalis (20 strains) and non black-pigmented Bacteroides (6 strains) showed plasmin activity. These results indicate that Bacteroides species, mainly B. gingivalis and B. intermedius may exert an important influence on the exacerbation of the disease.

Bacteroides↗