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PubMed1993

Gingival response to subgingival placement of monolithic tetracycline-impregnated fibers: microscopic observations.

This study examines and characterizes the soft tissue wall of periodontal pockets after a 10-day in vivo exposure to monolithic tetracycline-impregnated fibers, with and without root planing. Four teeth from each of eight patients were randomly assigned to (1) nontreatment (controls), (2) treatment by root planing only, (3) treatment by tetracycline fiber only, or (4) treatment by scaling and root planing and tetracycline fibers. Ten days after initial therapy, all teeth were extracted with associated soft tissue pocket walls intact. Three specimens were obtained from each tooth for examination by scanning microscopy, energy dispersive spectroscopy, and light microscopy. Results indicated that use of tetracycline-impregnated fibers over a 10-day period did not adversely affect the epithelial lining and had no significant effect on the density or character of the inflammatory response present in adjacent soft tissue and confirmed the antimicrobial effects of the fibers.

Analysis of Variance↗
PubMed1996

Effect of various demineralizing agents on mineral contents of cementum surfaces (an electron probe analysis).

The purpose of this investigation was to determine the surface morphology and mineral content of periodontally diseased cementum surfaces following root planing and conditioning with either citric acid, tetracycline HCL and minocycline HCL. Mineral contents of cementum surfaces were determined with an electron probe. All 3 demineralizing agents caused the exposure of the collagen matrix on the root surface but citric acid was the more effective. Calcium (Ca) and phosphorus (P) showed higher values in citric acid and minocycline HCL treated cementum surfaces compared to nondiseased cementum surfaces. The Ca and P were found to be in similar proportions in the tetracycline HCL treated group and nondiseased cementum surfaces. Although citric acid is a strong demineralizing agent, our specimens' cementum surfaces to which citric acid was treated showed high Ca and P content. In our opinion this difference about the effects of demineralizing agents on the surface morphology and surface element content was found to be related to the facts that whether the total amount of hypermineralized cementum as removed or not with root planing and the lacking criteria to detects the amount of this removal. Our findings suggest that these demineralizing agents can demineralize cementum surface after root planing but can not remove all of the hypermineralized diseased cementum. For this reason, it may be stated that it is more important to remove the pathologically altered cementum than applying various chemical agents.

Analysis of Variance↗
PubMed1994

Clinical and microbiological effects of controlled-release locally delivered minocycline in periodontitis.

The clinical efficacy of minocycline in a subgingival local delivery system was evaluated alone (M) or as an adjunct to scaling and root planing (M + SRP), in comparison to scaling and root planing (SRP) or to no subgingival treatment (NoTx) in adult periodontitis. Fifty-one adult patients with > or = 7 mm periodontal pockets demonstrating the presence by culture of Porphyromonas gingivalis (Pg), Prevotella intermedia (P(i)), or Actinobacillus actinomycetemcomitans (Aa) were randomized into one of the above 4 treatment groups. All sites > or = 5 mm in the most diseased quadrant in each patient received the therapy. Other quadrants were not treated. All patients received standardized oral hygiene instructions at the beginning of the study. At 0, 1, 3 and 6 months following therapy the 7 mm experimental sites were evaluated for selected periodontal pathogens by DNA probe analysis. At these same time points, the plaque index, gingival index, and bleeding on probing were evaluated as well as probing depth and relative clinical attachment level which were assessed by means of an automated probe. Probing depth reduction with M + SRP was significantly greater than all other groups at one month and significantly greater than NoTx and SRP at 3 months. There were no differences in probing depth reduction among groups at 6 months. At 6 months the gain in clinical attachment level was significantly greater for SRP than for either the NoTx or M groups. The prevalence of Pg decreased significantly in the M and M + SRP groups at one month.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1983

Stannous fluoride and subgingival chlorhexidine irrigation in the control of plaque and chronic periodontitis.

The purpose of this study was to investigate the possible benefits of stannous fluoride dentifrice (SnF2) and once daily chlorhexidine (CH) in the control of chronic periodontitis, following a single course of scaling and root planing. 14 adult patients with pockets 4 mm or deeper received a thorough scaling and root planing, followed by instruction in the irrigation of those pockets with CH. They were given either SnF2-containing or a placebo dentifrice, and a new multituft toothbrush, but no instruction in routine oral hygiene. Plaque Index (PII), Sulcus Bleeding Index (SBI) and pocket depth were recorded prior to scaling on day 0. The same parameters and gingival shrinkage were recorded at weeks 1, 2, 4, 8 and 12. CH irrigation was discontinued at day 28. Both groups showed highly significant improvements in all parameters except gingival shrinkage after 28 days. PII was significantly less at all stages in the SnF2 group. It reached baseline values by day 56 in the placebo and day 84 in the SnF2 group. Periodontitis as assessed by SBI remained reduced significantly below baseline values in both groups at the end of the study. At this time there was no significant difference between the groups as regards SBI. It was concluded that a single course of thorough scaling and root planing followed by once daily subgingival irrigation with CH for 1 month, produced a reduction in periodontitis still apparent 2 months after cessation of irrigation. This regime allows a 3-month interval between oral hygiene visits. SnF2-containing dentifrice had a plaque control effect additional to that produced by the regime but had no effect on periodontitis as assessed by SBI.

Adult↗
PubMed2001

Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis.

BACKGROUND: Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP. METHODS: After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group). RESULTS: In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG). CONCLUSIONS: These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

Administration, Oral↗
PubMed2003

Effect of ER:YAG and diode laser irradiation on the root surface: morphological and thermal analysis.

BACKGROUND: The aim of the present study was to compare the effects of Er:YAG and diode laser treatments of the root surface on intrapulpal temperature after scaling and root planing with hand instruments. METHODS: Fifteen extracted single-rooted teeth were scaled and root planed with hand instruments. The teeth were divided into 3 groups of 5 each and irradiated on their buccal and lingual surfaces: group A: Er:YAG laser, 2.94 microm/100 mJ/10 Hz/30 seconds; group B: diode laser, 810 nm/1.0 W/0.05 ms/30 seconds; group C: diode laser, 810 nm/1.4 W/0.05 ms/30 seconds. The temperature was monitored by means of a type T thermocouple (copper-constantan) positioned in the pulp chamber to assess pulpal temperature during and before irradiation. Afterwards, the specimens were longitudinally sectioned, and the buccal and lingual surfaces of each root were analyzed by scanning electron microscopy. RESULTS: In the Er:YAG laser group, the thermal analysis revealed an average temperature of -2.2 +/- 1.5 degrees C, while in the diode laser groups, temperatures were 1.6 +/- 0.8 degrees C at 1.0 W and 3.3 +/- 1.0 degrees C at 1.4 W. Electronic micrographs revealed that there were no significant morphological changes, such as charring, melting, or fusion, in any group, although the specimens were found to be more irregular in the Er:YAG laser group. CONCLUSIONS: The application of Er:YAG and diode lasers at the utilized parameters did not induce high pulpal temperatures. Root surface irregularities were more pronounced after irradiation with an Er:YAG laser than with a diode laser.

Aluminum Silicates↗
PubMed1995

Specific serum IgA titres as realistic indicators of treatment prognoses.

Some patients with adult periodontitis (AP), as defined by the American Academy of Periodontology, experience better healing than others after scaling and root planing. It is well documented that AP evolves by exacerbation and remission stages and that treatment during one of these stages influences the healing of periodontal pockets. Antibodies directed against major periodontal pathogens involved in AP could be used as indicators of active tissue destruction in AP. The levels of anti-Porphyromonas gingivalis (Pg) antibodies in the sera, saliva and crevicular fluid of ten patients with moderate AP were determined before and after root planing. The results suggest that testing serum IgA levels before scaling and root planing could help improve treatment prognoses.

Adult↗
PubMed2002

A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis.

OBJECTIVE: To systematically review the evidence of effectiveness of surgical vs. non-surgical therapy for the treatment of chronic periodontal disease. METHODS: A search was conducted for randomized controlled trials of at least 12 months duration comparing surgical with non-surgical treatment of chronic periodontal disease. Data sources included the National Library of Medicine computerised bibliographic database MEDLINE, and the Cochrane Oral Health Group (COHG) Specialist Trials Register. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers (L.H., F.H., L.T.). The primary outcome measures evaluated were gain in clinical attachment level (CAL) and reduction in probing pocket depth (PPD). RESULTS: The search provided 589 abstracts of which six randomized controlled trials were included. Meta-analysis evaluation of these studies indicated that 12 months following treatment, surgical therapy resulted in 0.6 mm more PPD reduction (WMD 0.58 mm; 95% CI 0.38, 0.79) and 0.2 mm more CAL gain (WMD 0.19 mm; 95% CI 0.04, 0.35) than non-surgical therapy in deep pockets (>6 mm). In 4-6 mm pockets scaling and root planing resulted in 0.4 mm more attachment gain (WMD -0.37 mm; 95% CI -0.49, -0.26) and 0.4 mm less probing depth reduction (WMD 0.35 mm; 95% CI 0.23, 0.47) than surgical therapy. In shallow pockets (1-3 mm) non-surgical therapy resulted in 0.5 mm less attachment loss (WMD -0.51 mm; 95% CI -0.74, -0.29) than surgical therapy. CONCLUSIONS: Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain.

Chronic Disease↗
PubMed2002

Comparative evaluation of adjunctive oral irrigation in diabetics.

AIM: The purpose of this study was to assess the response of diabetics to scaling and root planing treatment and subgingival oral irrigation as adjunctive therapy. METHOD: A total of 52 type 1 and 2 diabetics (mean age 51.3+/-14) with adult periodontitis were randomized to two groups. Treatment included ultrasonic scaling and scaling and root planing in both groups (control and test) plus subgingival water irrigation 2x daily for the test group. Assessments were made prior to and at 6 and 12 weeks after treatment. Parameters measured were modified gingival index (MGI), probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), and bleeding on probing (BOP). Systemic measurement of Reactive Oxygen Species (ROS) generation, cytokines (TNF-alpha, IL-1beta, IL-10, and PGE2), and glycated hemoglobin (HbA1C). RESULTS: After treatment, analysis of data showed that both groups had clinical and systemic improvement. The test group had a statistically significant reduction for MGI, PI, and BOP compared to controls (p<0.03) at 12 weeks and for ROS generation at 12 weeks (p<0.012). Unlike controls, systemic analysis of cytokines showed a statistically significant reduction from baseline for IL-1beta at 6 weeks and PGE2 at 6 and 12 weeks (p<0.05) within test group. CONCLUSION: These results suggest that scaling and root planing and adjunctive therapy may be of value in establishing a healthy periodontium in diabetics.

Adolescent↗
PubMed1996

Microleakage of human saliva through dentinal tubules exposed at the cervical level in teeth treated endodontically.

This study investigated the possibility of saliva recontamination occurring between the root canal wall and sealer through dentinal tubules exposed after the cementum was removed at the cervical level by root planing and treatment with citric acid. Thirty-four extracted human maxillary anterior teeth were randomly placed into five groups after chemomechanical preparation and obturation with gutta-percha and sealer; the sealer was allowed to set for 48 h. A ring 3 mm high, at the cervical level, was subjected to root planing, with complete removal of the cementum. All specimens were coated with two layers of nail polish and two layers of sticky wax, except for the ring subjected to root planing that was treated with citric acid for 30 s. The specimens were exposed to human whole saliva for 20 to 80 days and then immersed in dye to determine microleakage. Specimens were cleared and measurements made to the maximum point of dye penetration. All of the specimens exposed to saliva showed leakage except for the negative control, wherein no dye penetration was seen. Where leakage was found, the dye penetrated between the canal walls and the sealer to increasing depths, proportional to the time of exposure to the saliva. Statistical analysis confirmed these data, evidencing a difference between the means, which was highly significant for all pairs.

Analysis of Variance↗
PubMed2004

Effects of a new ultrasonic scaler on fibroblast attachment to root surfaces: a scanning electron microscopy analysis.

OBJECTIVE: A study was conducted to examine the effectiveness of scaling and root planing using a new ultrasonic scaler (Vector). METHODS: Eighty extracted teeth affected by periodontal disease were sorted into four groups of 20, each of which was subjected to one the following procedures: use of the Vector, Vector with polish, Enac and a Gracey scaler. The time spent on cleaning was measured. Half of the sample teeth were examined at random for surface roughness, and the surface texture was evaluated by means of the Remaining Calculus Index (RCI) and the Roughness and Loss of Tooth Substance Index (RLTSI). The remaining samples were incubated in dishes with a suspension of fibroblasts. After measuring the number of attached cells, the attachment of fibroblasts was observed by scanning electron microscopy. RESULTS: The RLTSI values in the Vector and Vector with polish groups were significantly lower than those in the Enac and Gracey groups, whereas the number of attached cells in the Vector with polish group was larger than in the Enac group. Cell attachment in the Vector and Vector with polish groups proved to be better than in the Enac and Gracey groups. CONCLUSION: Since use of the Vector with polish was able to provide scaling and root planing with minimal damage and tight attachment of fibroblasts, it is suggested that this may be a useful instrument for scaling and root planing.

Cell Adhesion↗
PubMed2002

A clinician's 3-year experience with perioscopy.

A medical endoscope has been modified for assisting the clinician in subgingival scaling and root planing. The dental endoscope provides real-time indirect visualization of the root surface for aiding the removal of root deposits and biofilm. When the majority of biofilm and visible calculus is removed from the root surface in a periodontal pocket, the pocket will most often close, resulting in a shallow sulcus. Many lesions on single-rooted teeth can be treated successfully with this technique, resulting in a significant reduction in probable pocket depth and a gain in the calibrated attachment level. Other sites, such as furcations and maxillary first bicuspids, may demonstrate significant improvement but not complete resolution of these parameters. Perioscopy is scaling and root planing aided by indirect vision with an endoscope. This technique can offer many patients an alternative to periodontal surgery in carefully selected sites. This article describes the clinical rationale for perioscopy, defines those sites that most predictably will respond to this mode of therapy, and offers some guidelines on integrating this technology into the dental practice. The observations and recommendations in this article are based on the author's 3-year experience with the dental endoscope in his periodontal practice, the experience of other periodontists and dental hygienists, and published reports.

Biofilms↗
PubMed1989

Citric acid burnishing of dentinal root surfaces. A scanning electron microscopy report.

The integrity of formalin-fixed periodontally diseased root surfaces was assessed following root planing to dentin and citric acid application. Extracted human teeth (fixed in 10% formalin), with crowns removed, were vertically sectioned in half. A horizontal groove on each proximal surface marked the extent of attachment loss. The diseased root surface was vigorously root planed to expose dentin. Cotton pellets, soaked in a saturated solution of citric acid, were either "placed" (control) or "burnished" (vigorously rubbed using root planing pressure) (experimental) on the prepared root surface for 5 min. Pellets were changed 2 times/min. The teeth were fixed and prepared for scanning electron microscope viewing and photography. A representative print was selected for each specimen. To confirm differences between test and control groups, untrained raters were asked to perform 2 sorting exercises. First, they were asked to sort the representative photographs of each specimen into 2 piles based on surface characteristics. Second, they were asked to choose from pairs of photographs, representing matched specimens, the one photograph which appeared to have the greatest collagen surface area. The surfaces of experimental specimens revealed patent dentinal tubules and an intertubular area with a very distinct "shag carpet" appearance of deeply tufted collagen fibrils. Control samples also exhibited open dentinal tubules, yet the intertubular surface displayed a "matted collagen" surface. Results of the 2 sorting exercises confirm that burnishing of formalin-fixed dentin root surfaces for 5 min with cotton pellets soaked in a saturated solution of citric acid consistently produces a distinct tufted collagen fibril surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1998

A controlled multicenter study of adjunctive use of tetracycline periodontal fibers in mandibular class II furcations with persistent bleeding.

The aim of this randomized single-blind multicenter controlled clinical trial was to clinically evaluate the effectiveness of adjunctive local controlled drug delivery in the control of bleeding on probing in mandibular class II furcations during maintenance care. 127 patients presenting with a class II mandibular furcation with bleeding on probing were included in the study. They had been previously treated for periodontitis and were participating in supportive care programs in periodontal specialty practices. Treatments consisted of scaling and root planing with oral hygiene instructions (control) and scaling and root planing and oral hygiene combined with local controlled drug delivery with tetracycline fibers (test). The following outcomes were evaluated at baseline and 3 and 6 months after therapy at the furcation site: bleeding on controlled force probing (BOP), probing pocket depth (PD) and clinical attachment levels (CAL). Levels of oral hygiene and smoking status were also assessed. Both test and controls resulted in significant improvements of BOP and PD at 3 and 6 months. The test treatment, however, resulted in significantly better improvements: BOP decreased by 52% in the control group and by 70% in the test group at 3 months; at 6 months, however, the difference was no longer significant. The test treatment resulted in a 0.5 mm greater reduction of PD than the control at 3 months, the improvement was highly significant but its duration did not extend until the 6 months evaluation. No differences were observed in terms of changes in CAL. These data indicate that addition of tetracycline fibers to mechanical therapy alone resulted in improved control of periodontal parameters during periodontal maintenance of class II mandibular furcations. Short duration of the effect, however, requires further investigations to optimize conservative treatment of these challenging defects.

Adult↗
PubMed2003

The use of tetracycline fibres in the treatment of generalised aggressive periodontitis: clinical and microbiological findings.

The purpose of the present study was to evaluate the effects of tetracycline fibres (TCF) as an adjunct to scaling in the treatment of generalised aggressive periodontitis and to compare the effects with mechanical treatment only. Ten patients, 24-39 years old referred for treatment to the Department of Preventive Dentistry, Periodontology and Implant Biology, Aristotle University of Thessaloniki took part in the study. A split-mouth experimental design was used. Measurements referring to bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL) were performed at 12 sites randomly selected. Clinical recordings were made at baseline, 2 and 6 months, after treatment. Subgingival plaque samples were taken for microbiological analysis using the 'checkerboard' DNA-DNA hybridisation technique at baseline, immediately after treatment and at 2 and 6 months. Full-mouth scaling and root planing were performed, with the exception of 2 pre-selected sites, which served as controls. Tetracycline fibres were applied in 5 pockets located in the same half mouth. Analysis of clinical findings showed that mechanical instrumentation in combination with TCF application led to a greater improvement in clinical parameters than scaling and root planing only. Microbial analysis showed a statistically significant greater reduction in the percentages of detection for B. forsythus, P. nigrescens and A. naeslundii genospecies II in pockets where tetracycline fibres were applied. In conclusion, the clinical and microbiological data of the present study suggest that the adjunctive use of TCF improves the clinical response of scaling and root planing in aggressive periodontitis patients.

Actinomyces↗
PubMed2001

Local drug delivery in the treatment of periodontitis.

The current data suggest that local delivery of antimicrobials into the periodontal pocket can improve periodontal health. However, they do not provide a superior result to scaling and root planing. In conjunction with scaling and root planing, the adjunctive use of local drug delivery devices may enhance the results in sites which do not respond to conventional therapy.

Anti-Bacterial Agents↗
PubMedDate not supplied

The effects of subgingival irrigation with chlorhexidine and stannous fluoride. A preliminary investigation.

This pilot study compared the effectiveness of subgingival irrigation with 0.12% chlorhexidine, 1.64% stannous fluoride, and sterile saline, in addition to scaling and root planing, on levels of Bacteroides porphyromonas and the clinical parameters bleeding tendency, probing depth, and attachment level. A convenience sample of eight patients, exhibiting 32 sites with moderate periodontal disease, was randomly assigned to receive all treatments according to a four-quadrant treatment design. Subgingival irrigation was performed at 0, 1, 2, and 3 weeks following scaling and root planing. Clinical and microbial assessments were measured at baseline, 4, 8, and 12 weeks. Data were analyzed using a two-factor repeated measure analysis of variance, and the Newman-Keuls sequential range test or Friedman test and Kruskal-Wallis test revealed statistically significant (p less than .01) improvements in probing depths, attachment levels, and Bacteroides porphyromonas for all groups at 12 weeks when compared to baseline values. No statistically significant differences occurred between any of the treatment groups at any time period. Based on the findings of this investigation, it has been concluded that four weekly irrigations with 0.12% chlorhexidine, 1.64% stannous fluoride, or saline irrigation did not enhance the beneficial effects of scaling and root planing alone.

Chlorhexidine↗
PubMed1997

Clinical and microbiological effects of subgingival antimicrobial irrigation with citric acid as evaluated by an enzyme immunoassay and culture analysis.

The purpose of the present study was to compare an enzyme immunoassay with culture samples from untreated and non-surgically treated periodontal pockets and to assess the clinical and microbiological effects of citric acid irrigation as a supplement to scaling and root planing. The enzyme immunoassay used in this study is a chairside diagnostic tool aimed at identifying the presence of P. gingivalis, P. intermedia, and A. actinomycetemcomitans. Six sites with pocket depths > or = 6 mm in each of 16 patients were monitored for 24 weeks using clinical and microbiological parameters. In two out of the six sites, scaling and root planing was supplemented with subgingival citric acid irrigation of the pocket after completion of the mechanical treatment. The sensitivity of the immunoassay in relation to culture was calculated to 85.5% and the specificity to 90.2%. The immunoassay corresponded to a detection level of 10(4) as estimated by culture. Sites treated with a combination of scaling and irrigation with citric acid demonstrated a similar healing pattern as sites treated with scaling and root planing alone. The profile of the marker bacteria was almost parallel for the two groups. The results of this investigation thus indicated that the immunoassay can be used as a screening tool for selected periodontal pathogens and that adjunctive irrigation with citric acid has no measurable clinical or microbiological effects.

Adult↗