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PubMed1992

Non-surgical periodontal treatment: where are the limits? An SEM study.

In the present scanning electron microscopic study, the possibilities and limitations of non-surgical root planing were investigated. 10 single-rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically examined by scanning electron microscopy (SEM) for the presence of residual bacteria and calculus. 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and also in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved completely on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non-surgical root planing in cases of advanced periodontitis, surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the reflection of conservative flaps.

Adult↗
PubMed1988

Root surface debridement--an in vitro assessment.

Root planing has been advocated to render periodontally involved root surfaces 'biologically compatible' with the surrounding soft tissues and thus promote healing. However, recent work has shown that only small amounts of cytotoxic material are likely to be incorporated within the root surfaces, thereby questioning the rationale for the traditional emphasis that is placed upon the removal of 'diseased cementum'. This investigation assessed by limulus amoebocyte lysate (LAL) assay and Polymyxin B affinity chromatography the extent of residual lipopolysaccharide (LPS) following root surface instrumentation in vitro. A conservative regime was carried out, consisting of 15 instrument strokes per surface designed to ensure complete overlapping of the strokes. This harvested varying amounts of LPS from 18 single-rooted teeth while leaving behind less than 0.24 ng of LPS per tooth in the majority (72%) of cases. This finding endorses the growing belief that extensive root planing may not be warranted.

Chromatography, Affinity↗
PubMed2000

The relationship between peripheral levels of leukocytes and neutrophils and periodontal disease status in a patient with congenital neutropenia.

BACKGROUND: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. Oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) increases neutrophil numbers and ameliorates the periodontal status. METHODS: We report the treatment of a 22-year-old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. Diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG-CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. Root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post-treatment. RESULTS: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels. CONCLUSIONS: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG-CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia.

Adult↗
PubMed2002

Effects of CO2 laser treatment on fibroblast attachment to root surfaces. A scanning electron microscopy analysis.

BACKGROUND: The aim of this study was to analyze the CO2 laser effects on root surfaces affected by periodontal disease in comparison to scaling and root planing for fibroblast attachment. METHODS: Thirty single-rooted human teeth extracted because of advanced periodontal disease were included in this study. A total of 60 specimens, obtained from all selected teeth, were randomly assigned to 3 groups: 1) control (untreated); 2) hand scaling and root planing (SRP); or 3) laser (CO2 defocused pulsed) and ultrasonic scaling. All the specimens were incubated in Petri dishes with fibroblast suspension, and then observed by scanning electron microscopy (SEM). RESULTS: The control group showed the lowest number of attached cells, with no tightly attached fibroblasts. The laser plus scaling group showed the highest number of attached fibroblasts, with the tightly attached fibroblast prevailing. The laser-treated and scaled root specimens did not show any damage or morphologic alteration of the root surfaces. CONCLUSION: CO2 laser treatment in defocused, pulsed mode with a low power of 2W combined with mechanical instrumentation constitutes a useful tool to condition the root surface and increase fibroblast attachment to root surfaces.

Analysis of Variance↗
PubMed1988

[Topical application of the controlled release strips containing ofloxacin (PT-01) in periodontal therapy].

The association of periodontopathic bacteria in the subgingival plaque with human periodontal disease has been well established. However, past attempts at reducing the level of pathogenic bacteria by using antibiotics as well as other antibacterial substance, so far, have not been fully successful. In this study, the effect of topical application of ofloxacin (OFLX), a synthetic antibiotic, was evaluated in relation to the clinical parameters. For this purpose, the new developed controlled release strips containing OFLX (PT-01), in which there were structurally immediate- and sustained-releasing portions, were used. 147 adult patients suffering from moderate to severe periodontitis were selected for this study. The patients had received no periodontal treatment previously and had taken no antibiotics within the preceding 6 months. Three different sites with a deep probing pocket depth (greater than or equal to 5 mm) were randomly selected in each patient, and were divided into three groups, i.e., PT-01 applied site (T), placebo-applied site (P) and control site (C). Periodontal treatments consisted of oral hygiene instruction and supragingival scaling on day 0 and 7, and subgingival scaling and root planing on day 14. PT-01 was applied in the periodontal pocket weekly on day 0 to 35, and clinical parameters on each site were recorded weekly. The results showed that, during first 14 days, significant reduction in the percentage of the sites which showed bleeding on probing, pus discharge or mobility of the tooth was observed in the PT-01 applied site. However in placebo and/or control group, no significant change in any parameters was observed in this period. While, after subgingival scaling and root planing, significant improvement was found at all sites in every clinical parameter. Especially, PT-01 applied sites showed significant improvement in the gingival index and bleeding on probing, compared to placebo-applied or control sites. These results suggest that weekly insertion of PT-01 in the periodontal pocket along with the subgingival scaling and root planing could have significant effect on the improvements in the gingival inflammation. Taken together, weekly application of PT-01 might have ameliorating effect as adjuncts of mechanical subgingival plaque control in the periodontal treatment.

Administration, Topical↗
PubMed2005

A systematic review on the effects of subgingival chlorhexidine gel administration in the treatment of chronic periodontitis.

BACKGROUND: Since scaling and root planing are not always successful, predominantly when access to periodontal defects is compromised, various antimicrobial agents as adjuncts have been suggested to enhance their efficacy. Gel vehicles delivering chlorhexidine (CHX) have become available and tested for these indications. METHODS: An electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual search were made to detect studies concerning the use of chlorhexidine gels as a single measure of treatment and as an adjunct to scaling and root planing. Only full-text randomized controlled trials published in English up to January 2005 were included. RESULTS: Eight studies were finally selected. Due to considerable heterogeneity in study design and outcome variables measured a qualitative data analysis was performed. There is evidence that subgingival chlorhexidine gel administration as a monotherapy temporarily reduces bleeding tendency on probing; a clinical effect coinciding with relevant microbiological changes described in all but one study. To what extent chemical effects contribute to these changes appears to be related to the frequency of gel administration. There seem to be little to no data indicating that the treatment outcome of scaling and root planing will benefit from the adjunctive subgingival administration of a CHX gel. CONCLUSION: The limited data currently available on the effects of subgingival chlorhexidine gel application do not justify its use in the treatment of chronic periodontitis.

Anti-Infective Agents, Local↗
PubMed1990

Intracrevicular application of tetracycline in white petrolatum for the treatment of periodontal disease.

In vitro tests in our laboratory have shown that 40% tetracycline HCl in a white petrolatum carrier (TTC-WP) has potential as a sustained release, autodissipating system. The present study tested subgingival placement of TTC-WP via syringe in vivo. Quadrants (2 diseased sites in each) in 9 patients with moderate/severe periodontitis were randomly assigned to receive the following treatments: (1) TTC-WP; (2) WP only; (3) scaling and root planing; (4) untreated control. TTC release into gingival crevicular fluid (GCF) over time (baseline, 1, 8, 24, 72 and 168 h) was measured using an agar diffusion bioassay. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were also evaluated over time (baseline, 2, 4, 8, 12 weeks). Results indicated that TTC-WP was easily placed into periodontal pockets and biologically effective TTC was released into GCF for at least 3 days (mean concentration = 115.8 +/- 43.1 micrograms/ml at 3 days). TTC-WP reduced probing pocket depths and bleeding on probing relative to baseline measurements for 8-12 weeks post-treatment, and reduced %s of motile rods and spirochetes, with an accompanying increase in cocci, for 2-8 weeks. Similar effects were noted in the scaled and root-planed sites, but for a longer duration. TTC-WP and WP were clinically dissipated after 2 weeks and no adverse tissue reactions were observed. From these findings, subgingival TTC-WP cannot replace scaling and root planing therapy, but has characteristics useful in subgingival plaque control.

Administration, Topical↗
PubMed1991

A study on citric acid as a proposed replacement resorption inhibitor.

The material consisted of 36 one-rooted immature teeth in 6 mongrel dogs. 12 teeth were immediately replanted after extraction, while 24 teeth were extracted and stored dry for 120 min before re- or autotransplantation. Root planing and topical citric acid treatment of the root of dry-stored teeth did not prevent the development of progressive root resorption and ankylosis, not even when special care was taken to prevent damage to the superficial, demineralized layer of the root during and after the transplantation procedures in an experimental model, which included autotransplantation of teeth to sockets, which were much larger than their original sockets.

Alveolar Process↗
PubMed1987

Periodic subgingival antimicrobial irrigation of periodontal pockets (I). Clinical observations.

The present investigation was undertaken to study the clinical effect of professionally performed periodic subgingival irrigation per se and as an adjunct to scaling and root planing. 10 patients suffering from moderate-severe periodontal disease participated in the study. Following an initial 3-month period of supervised supragingival plaque control, a total of 102 periodontal sites with probing pocket depth greater than or equal to 6 mm and "bleeding on probing" were selected and subjected to a Baseline examination comprising assessments of oral hygiene and gingival conditions, probing depths and probing attachment levels. The pockets in the various jaw quadrants were randomly assigned to one of the following treatment groups: (1) periodic subgingival irrigation with hydrogen peroxide, (2) periodic subgingival irrigation with chlorhexidine, (3) periodic subgingival irrigation with saline and (4) no subgingival treatment. During the first part of the study (baseline-32 weeks), no mechanical debridement of the subgingival area was performed. The irrigation treatment was carried out by the operator 3 times per week during weeks 1 + 2 and 5 + 6 of the trial. In the 2nd part of the trial (32-52 weeks), the sites were subjected to scaling and root planing combined with professional irrigation during weeks 32-38. The previously non-irrigated control sites were not subjected to adjunctive irrigation when mechanically debrided. During the entire study, the patients were recalled for professional tooth cleaning once every 4 weeks. Re-examinations were carried out at 4, 6, 32, 40 and 52 weeks. The results revealed that repeated professional irrigation of unscaled periodontal pockets with chlorhexidine or hydrogen peroxide resulted in a temporarily reduced frequency of bleeding sites, but not in any clinically significant changes in probing assessments. A similar improvement of bleeding scores was observed in the saline-irrigated control group. Scaling and root planing, in combination with an optimal supragingival plaque control, resulted in a marked resolution of the clinical symptoms of periodontal disease. Adjunctive irrigation with chlorhexidine or hydrogen peroxide did not improve the healing result above and beyond that obtained after mechanical debridement alone or in combination with saline irrigation. Hence, the study failed to demonstrate that professionally performed periodic subgingival irrigation with chlorhexidine or hydrogen peroxide, used alone or in combination with thorough mechanical debridement, has a significant therapeutic effect.

Adult↗
PubMed1994

Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients.

The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel+SCRP; (c) Tetracycline paste+SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.

Administration, Topical↗
PubMed2002

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures.

BACKGROUND: This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV. TYPES OF STUDIES REVIEWED: MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing. RESULTS: The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions. CLINICAL IMPLICATIONS: Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

Acquired Immunodeficiency Syndrome↗
PubMed2003

The efficacy of minocycline microspheres in the treatment of chronic periodontitis: statistical vs clinical significance.

This article addresses the benefits of using minocycline microspheres as an adjunct to conventional periodontal therapy. The author reviewed data from a large controlled clinical trial. The investigation indicated that scaling and root planing, plus minocycline microspheres, attained statistically significant improvements, with regard to several clinical parameters, when compared with scaling and root planing alone. Because it is the clinical meaningfulness of data that determines whether a therapy should be implemented, these data are interpreted with respect to their clinical relevance.

Anti-Bacterial Agents↗
PubMedDate not supplied

Clinical study to evaluate the use of electronic anesthesia during dental hygiene procedures.

PURPOSE: The purpose of this study was to determine if the 3M Dental Electronic Anesthesia System 8670 would decrease patients' pain/discomfort levels during scaling and root planing procedures. METHODS: Forty-nine patients possessing hypersensitive teeth and/or 4-6 mm periodontal pockets requiring scaling and root planing were selected as subjects. Patients received treatment using an inactive and then an active stimulator in paired quadrants. The patients scored their pain/discomfort levels after each procedure. They were contacted by telephone 1-2 days following treatment to determine if they experienced any symptoms or discomfort following electronic dental anesthesia. RESULTS: The overall results for the assessment of pain/discomfort indicated that treatment using the active stimulator resulted in significantly lower pain scores for the total patient population. CONCLUSIONS: This study found the 3M Dental Electronic Anesthesia System 8670 to be effective for controlling pain during the dental hygiene procedures specified.

Adolescent↗
PubMed1993

Periodontal repair or regeneration: structures of different types of new attachment.

The present study details the structural and ultrastructural features of healing events between the regenerated periodontal ligament and the root surface after experimental periodontal disease. Experiments were performed on dogs, and the concept of guided tissue regeneration was tested using resorbable polyurethane membranes. Light microscopy, scanning- and transmission electron microscopy were employed to determine if healing events involve regeneration (ie, process by which the architecture and the function are completely renewed) or periodontal repair (ie, healing of a wound by tissue that does not fully restore the architecture of a part). Regeneration occurred in parts of the roots only if some original cementum remained on the root surface after root planing. Repair was observed if peripheral dentin was removed by root planing as this layer was not reestablished. In areas remote from the base of the defect, new collagen fibrils, synthesized by fibroblasts and oriented perpendicular to the root surface, were spliced with severed ends of Sharpey's fiber bundles of original cementum. If circumpulpal dentin was exposed, intermingling between new fibrils with dentinal matrix fibrils occurred. In areas near the base of the defect, the first event was the formation of a cementoid by a cementoblast monolayer and subsequent formation of intrinsic fibrils oriented parallel to the root surface. Afterwards, the cementoblast monolayer disintegrated and extrinsic fiber bundles became anchored in the new cellular mixed fiber cementum. In these areas, linkage between new cementum and pre-existing tissues always occurred by interfacial intermingling of the fibrils, regardless of whether new attachment occurred at circumpulpal dentin or original cementum.

Animals↗
PubMed2004

[The effects of non-surgical periodontal treatment on the formation of root-dentin hypersensitivity].

PURPOSE: To study the effects of non-surgical periodontal treatment on the occurrence of root-dentin hypersensitivity and explore its mechanisms through clinical observations. METHODS: 1453 teeth of 52 patients with chronic periodontitis were given scaling and root-planing procedures. 3 months follow-up of these teeth were taken to find root-dentin hypersensitivity after treatment. RESULTS: 432 teeth of 39 patients had different degree of root-dentin hypersensitivity. However,the symptoms disappeared in most patients after active desensitization treatment. CONCLUSION: Subgingival scaling and root-planing can induce the occurrence of root dentin hypersensitivity,therefore, desensitization treatment should be considered as a part of periodontal treatment plan.

Adult↗
PubMed2002

Effect of cigarette smoking on human PDL fibroblasts attachment to periodontally involved root surfaces in vitro.

BACKGROUND/AIM: Cigarette smoking is one of the most significant risk factors in the development and further advancement of inflammatory periodontal disease. However, no study has been performed to investigate the effect of smoking on the attachment of human periodontal ligament fibroblasts to either periodontally diseased or healthy roots. The present study was conducted to evaluate the attachment of fibroblasts derived from healthy human periodontal ligament (PDL) to periodontally diseased root surfaces of smokers. METHOD: The subjects included 14 smokers and seven nonsmokers with at least a single periodontally involved anterior tooth planned for extraction. In addition, seven impacted third molars, which had been removed from nonsmoking adolescents, were used as a healthy control. The smoking status of each patient was determined by classifying the volunteers into four groups according to their level of cigarette consumption at the initial examination (seven patients each). Nonsmoking subjects who had never smoked cigarettes and had healthy periodontium were called healthy control (G1). In subjects with periodontal diseases, nonsmoking subjects who had never regularly smoked cigarettes (< 2 cigarettes/week) were called positive control (G2), smokers consuming or=20 cigarettes/day were located in group G4. To exclude the effects of all local irritants except for the adsorbed tobacco products, all teeth were subjected to thorough scaling and root planing 1 week before extraction. After 1 week of meticulous home care and continued smoking experience, teeth were extracted and the periodontally involved test areas were prepared for PDL culturing. PDL cells were cultured on root segments for 24 h. Samples were prepared for SEM viewing, photographing and counting at x750 in a standard area. RESULTS: The results of this study indicated that smokers' data (G3, G4) revealed a significant reduction of attached PDL cells when compared to that of nonsmokers' healthy and positive controls (G1, G2). No significant difference in the mean number of attached cells was found between data derived from smokers' groups (G3 vs. G4). The attached cells in all groups varied in shape; they were flatter in the control groups, while they were round in smokers' groups, with no dose-dependent effect. CONCLUSION: The present results suggest that cigarette smoking compromises PDL cell adhesion to root planed surfaces, which might affect periodontal regeneration following therapy.

Adolescent↗
PubMed1996

Morphologic changes following in vitro CO2 laser treatment of calculus-ladened root surfaces.

BACKGROUND AND OBJECTIVE: The purpose of this study was to compare morphologic changes following C02 laser or manual curette treatment of calculus-ladened tooth root surfaces. STUDY DESIGN/MATERIALS AND METHODS: Laser treatment consisted of repeated single passes with a 6 Watt focused beam at 20 pulses per second, a pulse length of 0.01 second, and a manufacturer's laser efficiency rating of 86% (i.e., the amount of total power delivered through the aperture). The rate of beam passage over the target surface was controlled at 4 mm/second using an 0.8 mm diameter tip. The calculated energy density was 240 J/cm2 for each pass of the beam. Scaled and root planed surfaces were treated with a standardized force of 600 grams using new curettes. Specimens were evaluated by scanning electron microscopy. RESULTS: Laser-induced surface changes included charring, meltdown and resolidification of calculus mineral, and ablation of microbial plaque. Laser-treated specimens also exhibited residual calculus and microbial plaque deposits in areas directly adjacent to the beam path. Scaled and root planed surfaces featured smooth and/or scale like smear layers and islands of residual calculus and microbial plaque. CONCLUSIONS: The rough surface topography resulting from laser treatment and residual calculus and microbial plaque deposits indicates that C02 laser treatment of exposed root surfaces is, at best, an adjunct to traditional methods of therapy.

Dental Calculus↗
PubMed1989

[Fundamental study of a local drug delivery system by means of intracanal medication. Influence of iontophoresis on the periphery of the root surface].

The purpose of this study was to evaluate a new system of drug delivery to periodontal pocket by means of intracanal dressing and additional iontophoresis in vitro. Forty extracted human teeth with a single root were used. After the root canal was prepared endodontically, the periphery root apex was painted with the Silux system (3 M Co.) to close the apical foramen. Each tooth was planted into an agar block. Three drugs (zinc iodide-iodine, penicillin G. potassium, minocycline HCl) were used (Table 1), and 50 microliters of each drug was injected into an individual root canal. Then a cathodic current (3 mA x 40 min) was applied using an automatic current volte regulater (PAV-200, Jooko Co.) with a platinum wire electrode inserted in the root canal (Fig. 1). The degree of drugs diffusion in the agar around teeth was estimated by individual color reactions zinc iodide-iodin test for starch, penicillin G. potassium test for phosphomolybdic acid, minocycline HCl test for ferric chloride). And also, the effects of root planing and etching by Quick Jet (Yosida Co.) on the root surface were evaluated in the same way. The results were as follow: 1. The degree of diffusion by intracanal electrical medication was greater in the cervical third area than the middle and apical third. 2. Several small areas stained by the iodo-starch color reaction were observed around the cervical root surface where greater diffusion was observed. 3. Many dentinal tubules were observed on a limited root surface where root planing and Quick Jet, were employed caused greater diffusion. 4. The results suggest the new delivery system for management of the microorganisms by intracanal medication and additional iontophoresis.

Humans↗