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Adhesion and growth of cultured human gingival fibroblasts on periodontally involved root surfaces treated by Er:YAG laser.

BACKGROUND: The application of Er:YAG laser irradiation, approved in 1997 to be used on dental hard tissues, has been investigated for periodontal therapy. The aim of this study was to analyze the biocompatibility of root surfaces treated by Er:YAG laser. METHODS: Adhesion and growth of cultured human gingival fibroblasts on root surfaces treated by either irradiation with Er:YAG laser or curet were compared. Thirty single-rooted teeth extracted because of periodontal disease were used. Calculus deposits on all experimental surfaces were removed, and the teeth were divided into three groups according to the applied treatment: group A, root planing with Gracey curet no. 3/4; group B, two irradiations with laser (60 mJ/pulse, 10 Hz; 10" each with 10-second interval, 3 J/cm2); group C, two irradiations with laser (100 mJ/pulse, 10 Hz; 10" each with 10-second interval, 5 J/cm2). Fragments (5 mm x 6 mm) were obtained from the experimental surfaces. Then, 1 x 10(3) cells were seeded on the top of each fragment. One, 2, and 3 days after seeding the specimens were prepared for scanning electron microscopy analysis, and the cells on the electronmicrographs were counted. The data obtained in triplicate were statistically compared by the Kruskall-Wallis test complemented by the Dunn test (P < or = 0.05). RESULTS: Human gingival fibroblasts adhered to and grew on all treated surfaces. Group B presented a significantly higher cell count than did the other two groups at days 1 and 2. Three days after seeding the cultured fibroblasts of groups A and B reached total confluence. The cell count of group B was significantly higher than that of group C. CONCLUSION: The surfaces treated with 60 mJ/pulse Er:YAG laser irradiation promoted faster adhesion and growth than surfaces treated with either root planing or 100 mJ/pulse Er:YAG laser irradiation.

Adult↗

In vitro effects of citric acid application techniques on dentin surfaces.

The present study evaluated the in vitro effects of different application techniques of citric acid on dentin root surfaces. Ten freshly extracted, periodontally involved teeth were obtained and 4 dentin slabs, approximately 4 x 6 x 2 mm, were obtained from the roots of each tooth, for a total of 40 slabs. These slabs were identified by tooth and preserved in 1:1 anhydrous glycerol/absolute alcohol solution. Citric acid pH 1 was applied to 32 of the slabs for 5 minutes with one of 4 different techniques: 1) immersion; 2) placed with a saturated cotton pellet with no rubbing; 3) placed and burnished with a saturated cotton pellet; or 4) applied with a camel hair brush. The remaining 8 dentin slabs were used as negative control specimens, root-planed and non-acid treated. Following the various treatments, the slabs were fixed, dehydrated, critical point dried, and coated for scanning electron microscopic (SEM) evaluation. Scanning photomicrographs were obtained at 2,000, 6,000, and 40,000 magnifications. The surface characteristics of the treated dentin slabs were evaluated descriptively regarding the degree of fiber exposure; the number of exposed tubules and the surface area occupied by tubule orifices were also measured. Friedman's 2-way analysis for block designs was employed. Results demonstrated that root-planed, non-acid treated specimens had an amorphous, irregular surface which corresponded to a smear layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗

Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations.

In a standard periodontal treatment strategy with consecutive root planings (per quadrant at a one- to two-week interval), re-infection of a disinfected area might occur before completion of the treatment. This study examines, both clinically and microbiologically, whether a full-mouth disinfection within 24 hours significantly improves the outcome of periodontal treatment. Ten patients with advanced chronic periodontitis were randomly allocated to a test and a control group. The patients from the control group received scalings and root planings as well as oral hygiene instructions per quadrant at two-week intervals. Full-mouth disinfection in the test group was sought by the removal of all plaque and calculus (in two visits within 24 hours). In addition, at each of these visits, the tongue was brushed with a 1% chlorhexidine gel for one min and the mouth rinsed with a 0.2% chlorhexidine solution for two min. Furthermore, subgingival chlorhexidine (1%) irrigation was performed in all pockets. The recolonization of the pockets was retarded by oral hygiene and 0.2% chlorhexidine rinses during two weeks. The clinical parameters were recorded, and plaque samples were taken from the right upper quadrant at baseline and after one and two months. The test group patients showed a significantly higher reduction in probing depth for deep pockets at both follow-up visits (p < 0.05). At the one-month visit, differential phase-contrast microscopy revealed significantly lower proportions of spirochetes and motile rods in the test group (p = 0.01). Culturing showed that the test group harbored significantly fewer pathogenic organisms at one month (p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months.

AIM: The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of new oscillating instruments (Periosonic) using a sonic handpiece compared to hand curettes with a split mouth design after 2 months. METHODS: 11 patients with adult periodontitis participated in this study. Plaque index (PII) (O'Leary), bleeding on probing (BOP), probing pocket depth (PPD), recession (REC) and clinical attachment level (CAL) were recorded at baseline and 2 months after treatment. After oral hygiene instruction, 2 randomly assigned quadrants per patient were scaled and root planed with curettes (control side) and the remaining 2 quadrants with the Periosonic instruments 1 and 2 (test side). The student t-test for paired data was used to test the significance of difference between test and control sides. RESULTS: There was no statistical difference (p>0.05) between the 2 sides for the improvement of the clinical parameters excepted for the group with initial PPD of 4-6 mm (test: 1.3+/-0.4 mm PPD reduction, control: 1.6+/-0.4 mm). For PPD > or =7 mm, the test side had better clinical improvement in attachment levels (2.2+/-0.9 mm), less recession (-0.4+/-0.5 mm) with lower PPD reduction (2.4+/-0.6 mm) than the control side (AL: 1.6+/-1.8 mm; REC: -1.3+/-0.7 mm, PPD reduction: 3.0+/-1.4 mm). CONCLUSION: This clinical study demonstrated that Periosonic(R) instruments are clinically at least as effective as curettes in PPD reduction when initial PPD is < or =6 mm and show better clinical attachment level improvement with less recession for initial PPD of > or =7 mm.

Adult↗

Periodontal regeneration with a combination of enamel matrix proteins and autogenous bone grafting.

BACKGROUND: Attempts to stimulate periodontal regeneration in the past have focused on either filling the defect with some type of material or providing a space for host cells to repopulate the site and elicit new tissue. In some cases, these approaches have been combined with the assumption that the filler material will help maintain the space necessary for the host cells to invade the area. Growth stimulating substances such as growth factors and other proteins have also been used to encourage periodontal tissue regeneration and histological evaluation supports the use of these substances. Thus, the role for and the necessity of a certain amount of space maintenance for periodontal regeneration is not exactly understood. In addition, it is not known if there is some critical size required for space maintenance or for exactly how long the space must be maintained in order for the host cells to stimulate new cementum, periodontal ligament, and bone. The goal of this study was to evaluate periodontal regeneration in intrabony defects of various sizes treated with a combination of enamel matrix proteins and autogenous bone graft. METHODS: Periodontal defects ranging in size from 1 to 6 mm were randomized and created bilaterally beside three teeth in the mandibles of baboons. Plaque was allowed to accumulate around wire ligatures placed into the defects. After 2 months, the wire ligatures were removed, the teeth and roots scaled and root planed, and a notch was placed with a chisel at the base of the defect. On one side of the mandible, neutral ethylene diamine tetracetic acid and enamel matrix derivative (EMD) were first used to treat the defect. Autogenous bone taken from the same surgical site was treated with enamel matrix derivative in a dampen dish and then added to the EMD-treated defects. The other side of the mandible served as control with neutral ethylene diamine tetracetic acid and scaling and root planing. Flaps were sutured and the animals were allowed to heal without oral hygiene procedures. After 5 months, the animals were sacrificed and the teeth were processed for histological evaluation. RESULTS: The results revealed new cementum, periodontal ligament with Sharpey's fibers, and new bone tissue similar to native periodontal tissues. Remnants of the autogenous bone chips were still present at this 5-month post-healing period. Thus periodontal regeneration occurred in all sizes of the periodontal defects. In general, EMD plus autogenous graft treatment resulted in greater tissue formation than controls. In fact, in many cases, very dramatic tissue formation occurred far coronal to the base of the defects in the EMD plus autogenous graft-treated lesions. In addition, horizontal bone fill occurred in the defects and was prominent in the 4 or 6 mm wide lesions. When evaluating the combined 1 and 2 mm defects, the height of new cementum with EMD plus graft was 3.88 mm versus 2.03 mm in the controls, a statistically significant (P < 0.005) difference. In the wider (4 and 6 mm) lesions, this difference was not significant and was much less between treated and control lesions with 2.78 and 2.57 mm of new cementum respectively. In the case of new bone height, in the smaller lesions EMD plus graft resulted in 4.00 mm new bone versus 2.22 mm in the controls, again a statistically significant (P < 0.005) difference. In the larger lesions, EMD plus autogenous bone graft had 3.24 mm new bone height compared to 2.71 mm in the controls, a difference that was not statistically significant. Additionally, in the smaller lesions, new cementum width at the level of the notch was twice as great (statistically significant, P < 0.015) in the EMD plus graft sites compared to control. The width of the periodontal ligament at the coronal aspect of the new bone tissue was similar in the smaller lesions between treated and control sites. The results from the wider defects must be interpreted cautiously as the interproximal bone heights were remodeled adjacent to the wider defects and likely limited the potential for regeneration. CONCLUSIONS: The combination of enamel matrix derivative plus autogenous bone graft stimulated statistically significant periodontal regeneration in the more narrow 1 and 2 mm lesions. No statistically significant difference was observed in the wider 4 and 6 mm lesions. In many cases, dramatic amounts of new cementum, Sharpey's fibers, periodontal ligament, and bone tissue were formed far above the notch placed at the base of the contaminated defects. This was especially significant considering the width of some of the defects and the fact that no oral hygiene was performed over the 5-month healing period. This periodontal regeneration occurred in the absence of exogenous growth factors or barrier membranes. In summary, the combination of enamel matrix derivative and autogenous bone represents a therapeutic combination that can be highly effective in stimulating significant amounts of periodontal regeneration.

Alveolar Bone Loss↗

Gingival crevicular fluid collagenase-2 (MMP-8) test stick for chair-side monitoring of periodontitis.

BACKGROUND: A rapid chair-side test based on the immunological detection of elevated levels of collagenase-2 (matrix metalloproteinase-8, MMP-8) in gingival crevicular fluid (GCF) was developed to identify and monitor the course and treatment of adult periodontitis. METHODS: MMP-8 was determined in GCF from periodontitis (11 patients, 90 sites), gingivitis (10 patients, 58 sites) and healthy control (8 patients, 59 sites) sites (i) by a test stick incorporating monoclonal antibodies to two epitopes on MMP-8 and (ii) by measuring MMP-8 concentration by a quantitative immunofluorometric assay. Patients with adult periodontitis were treated by scaling and root planing (SRP) and received oral hygiene instructions. GCF MMP-8 testing and clinical measurements were done before and after SRP. RESULTS: MMP-8 GCF levels and chair-side test differentiated periodontitis from gingivitis and healthy control sites. MMP-8 GCF levels > 1 mg/l and positive chair-side test identified especially severe periodontitis sites. A positive and negative test stick result, the outcome of which was rapidly detectable in 5 mins, in GCF correlated well with MMP-8 immunofluorometric assay analysis from the collected GCF samples and the severity of periodontitis. Scaling and root planing reduced the MMP-8 levels in severe periodontitis sites with positive MMP-8 test and gingival probing pocket depth (PD) > 5 mm before treatment. The test stick result and the quantitative assay were discrepant in only 18 of the 207 sites tested, thus agreement was very good (kappa = 0.81). With a threshold of 1 mg/l MMP-8 activity the chair-side test provided a sensitivity of 0.83 and specificity of 0.96 (n = 207). CONCLUSION: The MMP-8 test can be used to differentiate periodontitis from gingivitis and healthy sites as well as to monitor treatment of periodontitis. A reduction in GCF MMP-8 levels and a change in test stick result provide a means to optimize patient control during maintenance of periodontal treatment.

Adult↗

Effectiveness of periodontal treatments on cyclosporine-induced gingival overgrowth in transplant patients.

OBJECTIVE: Evaluation of the effectiveness of periodontal treatments on cyclosporine-induced gingival overgrowth. DESIGN: Longitudinal study between months 6 and 12 after transplant, in 80 cyclosporine-treated heart, liver and kidney transplant patients. SETTING: Madrid Puerta de Hierro Hospital. SUBJECTS AND METHODS: The 37 patients who had developed overgrowth in the sixth month were randomly split into three study groups. The remaining 43 were split into two additional groups. INTERVENTIONS: The first group underwent professional cleaning; the second underwent, additionally, scaling and root planing, and the third group received no treatment. The fourth and the fifth groups received no treatment and professional cleaning, respectively. MAIN OUTCOME MEASURES: O'Leary plaque index, Lenox and Kopczyk gingival index, and average gingival overgrowth. RESULTS: A significant (P = 0.008) increase in overgrowth was found in the third group that did not undergo treatment. Significantly (P = 0.002) less was found in the first and second groups. Highly significant (P = 0.001) reductions in the plaque and gingivitis indices were also found in these two groups. The fifth group showed a highly significant (P = 0.0001) decrease in the plaque and gingivitis indices. CONCLUSIONS: Professional cleaning is effective in reducing both gingivitis and cyclosporine-induced gingival overgrowth; the combination with scaling and root planing reinforces its effectiveness.

Adult↗

Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications. A literature review.

This paper addresses the diagnostic and therapeutic implications of increased probing depths. In general, in untreated and treated patients, when deep and shallow probing depths are compared, the data indicate that deep sites are associated with increased bleeding upon probing, elevated subgingival temperatures, higher levels of pathogens, more probing errors, a greater amount of infiltrated connective tissue, reduced ability to remove subgingival deposits with root planing, and diminished effectiveness of oral hygiene to alter the subgingival microbiota. Clinical trials demonstrate that probing depth is not a good predictor of future disease progression. However, deep sites are at greater risk of disease progression than shallow sites in untreated and treated patients. Furthermore, the deeper the probing depth, the greater the risk of future disease progression. Overall, the preponderance of evidence indicates that it is advantageous, but not always necessary, for patients to have shallow probing depths. With regards to surgical reduction of probing depths beyond that attained with non-surgical therapy, clinicians need to consider the advantages (e.g., ease of maintenance, reduced risk of disease progression) and disadvantages (e.g., root sensitivity, cosmetic defects) of treatment procedures. Since numerous variables require consideration (e.g., response to root planing, goals of therapy, acceptable level of risk for future disease progression), treatment decisions will vary depending on the patient and the desired clinical outcome at specific sites.

Bacteria↗

The role of metronidazole in the treatment of periodontal diseases.

This article discusses the ability of metronidazole to improve periodontal health. Review of the drug's pharmacology and potential side effects indicate that it poses little threat to humans of inducing acute toxicity, mutagenesis, or cancer if used according to recommended dosing regimens. Studies addressing metronidazole utilization in a variety of clinical conditions demonstrate that its routine use does not enhance root planing. However, adjunctive antibiotic therapy may be advantageous in the treatment of sites where effective root planing is precluded due to deep pockets or when anaerobic periodontal infections do not respond to conventional therapy.

Animals↗

Effect of two toothcleaning frequencies on periodontal status in patients with advanced periodontitis.

OBJECTIVE: To compare the effect of once a day toothcleaning with once in 2 days toothcleaning in patients with advanced periodontitis. MATERIAL AND METHODS: Twenty-two patients, aged 34-54 years were given intensive oral hygiene (OH) and half their mouth root planed with re-assessment 6 weeks later. The patients were randomised into either a once a day toothcleaning group or a once in 2 days toothcleaning group. The effects of the two cleaning regimens were assessed during a 6-week follow-up period. Two patients were excluded from the study. Analysis of covariance was used to test the difference between the two groups at baseline and at 6 weeks. RESULTS: There was a statistically significant difference between the two groups in plaque reduction (p=0.01) and reduction of probing pocket depth >6 mm (p=0.05) in the OH-only sites. No significant difference was found between the two cleaning regimens in the combined oral hygiene with root planing sites. CONCLUSION: The present study demonstrated that in patients with advanced periodontitis, once a day toothcleaning is more effective than once in 2 days toothcleaning in otherwise untreated sites.

Adult↗

Full- versus partial-mouth disinfection in the treatment of periodontal infections. Long-term clinical observations of a pilot study.

A classical treatment for chronic adult periodontitis consists of four to six consecutive sessions of scaling and root planing at a 1- to 2-week interval. Such a so-called "quadrant or sextant therapy" might result in a reinfection of a previously disinfected area by bacteria from an untreated region. The purpose of this study was to investigate, over an 8-month period, the clinical benefits of full-mouth disinfection within a 24-hour period in the control of chronic periodontitis. Ten adult patients with advanced chronic periodontitis were randomly assigned to a test and a control group. The control group received the standard scheme of initial periodontal therapy, consisting of scaling and root planing of the four quadrants was performed within 24 hours and immediately followed by a thorough supra- and subgingival chlorhexidine application to limit any transfer of bacteria. The latter involved tongue brushing with a 1% chlorhexidine gel for 60 seconds, mouthrinsing with a 0.2% chlorhexidine solution twice for 60 seconds, repeated subgingival irrigation of all pockets with a 1% chlorhexidine gel (3 times within 10 minutes), and mouthrinsing twice daily with a 0.2% chlorhexidine solution during 2 weeks. In addition, both groups received thorough oral hygiene instructions. The plaque index, gingival index, probing depth, gingival recession, and bleeding on probing were recorded prior to professional cleaning and at 1, 2, 4, and 8 months afterwards. Although the test group scored higher plaque indices than the control group, especially at months 2 and 4, the gingival index and bleeding tendency showed similar improvements with time. However, when the gingival/plaque ratio was considered, the latter was lower in the test group at all follow-up visits. For pockets > or = 7 mm, full-mouth disinfection showed a significantly (P = 0.01) higher reduction in probing depth at each follow-up visit with, at month 8, a reduction of 4 mm (from 8 mm to 4 mm), in comparison to 3 mm (from 8 mm to 5 mm) for the classical therapy. The increase in gingival recession in the full-mouth disinfection group remained below 0.7 mm, while in the control group it reached 1.9 mm after 8 months. This resulted in a gain of clinical attachment level of 3.7 mm for the test group versus 1.9 mm for the control group. A radiographical examination also indicated a superior improvement for the test group when compared to the control group. This pilot study suggests that a full-mouth disinfection in one day results in an improved clinical outcome in chronic periodontitis as compared to scalings per quadrant at 2-week intervals over several weeks.

Adult↗

Influence of different periodontal curette grips on the outcome of mechanical non-surgical therapy.

AIM: To determine to whether successful scaling and root planing (SRP) depends upon the grip used on the periodontal curette. METHODS: The hand grips used by dentists for holding periodontal curettes were examined and the dentists were allocated to one of two matched groups, one in which they used a modified pen grip, the other in which they did not. Using a split-mouth technique, patients scheduled for SRP had one quadrant treated by a dentist from each group. Instrument application force was recorded as were periodontal measures at operation and 3-months later. RESULTS: During scaling, forces reached a mean of 0.77N in dentists using a curette with a non-pen grip and 0.54N in those using a pen grip and during root planing, 0.93N and 0.64N respectively. These forces were statistically significantly different between the two groups. Pocket depth reduction in teeth treated by the two groups was similar but attachment levels were statistically significantly different. CONCLUSIONS: Instrument grip had a significant effect on response to SRP, suggesting that dentists using a modified pen grip achieved better clinical results.

Adult↗

Short-term sequential administration of amoxicillin/clavulanate potassium and doxycycline in the treatment of recurrent/progressive periodontitis.

The systemic use of a single antibiotic was compared to that of a sequential antibiotic regimen in the treatment of A. actinomycetemcomitans and/or P. gingivalis-associated periodontitis. Eleven patients with recurrent/progressive periodontitis and demonstrating subgingival infection with A.a. and/or P.g. were selected. Six patients received oral administration of doxycycline (Do), 200 mg the first day and 100 mg for 4 days thereafter, and then amoxicillin/clavulanate potassium (Au), 500 mg 3 times daily for 5 days. The other 5 patients received only doxycycline for 10 days. Eight sites with > or = 5 mm probe depth per patient were selected, of which 4 received root planing at time 0. Clinical measurements (GI and PI, probing pocket depth, probing attachment level, and bleeding upon probing/suppuration) and microbial infection levels (2 sites/patient as per DNA probe) for A.a. and P.g. were recorded at 0, 4, 12, and 25 weeks. Clinical data were subjected to statistical analysis of variance and t-tests for significance. The Do + Au groups produced significant reduction in probing pocket depth (PPD) at 4, 12, and 25 weeks (1.1, 1.3, and 1.1 mm, respectively). The Do group produced significant reduction in PPD only at 4 and 12 weeks (0.8 and 0.8 mm); the Do + Au group produced significant gain of 0.8 mm in probing attachment level at 4 and 12 weeks; and the Do + Au group in conjunction with root planing produced the most sustained reduction in PPD and gain in PAL. These findings suggest that the sequential use of multiple antibiotic agents may offer greater promise as an adjunctive treatment approach for the management of recurrent and/or progressive periodontitis than a single antibiotic regimen.

Administration, Oral↗

Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus.

BACKGROUND: The literature suggests that an alteration in glucose metabolism occurs as a result of antibacterial periodontal therapy. The objective of this study was to monitor the effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus (DM). METHODS: Thirty type 2 DM subjects with periodontitis were randomly divided into two groups. Group 1 (G1), 15 subjects, received one-stage full-mouth scaling and root planing (FMSRP) plus amoxicillin/clavulanic acid 875 mg; group 2 (G2), 15 patients, received only FMSRP. At baseline and after 3 months, the glycated hemoglobin (HbA1c) values, fasting glucose, and clinical parameters (with computerized probing and individualized acrylic stents) were recorded. Following therapy, the subjects were enrolled in a 2-week interval maintenance program for 3 months. RESULTS: After treatment, both groups showed clinical improvements. A probing depth (PD) reduction of 0.8 +/- 0.6 mm (P < 0.05) occurred in G1 and 0.9 +/- 0.4 mm in G2 (P < 0.05), but there were no significant changes in attachment level. Treatment reduced the HbA1c values after the 3-month observation period in both groups; however, the reduction in HbA1c values for the G2 group was statistically significant, but not for the G1 group. The changes in fasting glucose levels were not significant for either group. CONCLUSIONS: Periodontal therapy improved glycemic control in patients with type 2 DM in both groups; however, the reduction in HbA1c values reached statistical significance only in the group receiving scaling and root planing alone [correction].

Amoxicillin-Potassium Clavulanate Combination↗

The effects of antiformin-citric acid chemical curettage on the microbial flora of the periodontal pocket.

This study investigated the hypothesis that antiformin-citric acid chemical curettage combined with scaling and root planing (SRP/AF) would significantly reduce pathogenic bacteria of the periodontal pocket when compared to scaling and root planing alone (SRP). Ten patients with moderate periodontitis participated. Four pockets per patient, one in each posterior sextant, were chosen. Pocket depths, attachment levels, and gingival index (GI) were measured. Bacterial samples were examined under dark-field microscope for: (1) spirochetes, (2) motile rods, and (3) all others. A randomized four-sextant treatment design was used. One sextant received no treatment, a second received SRP, and the two remaining sextants received identical treatments of SRP/AF. Of these two sextants, one was sampled at baseline and 12 weeks only in order to serve as an additional control. The remaining sextants were sampled at 1, 4, 8, and 12 weeks. Both SRP and SRP/AF significantly reduced the percentage of spirochetes and motile rods. A significant reduction in GI and pocket depths was also noted. Attachment level showed no significant change. Results of both treatment groups showed no significant differences among any of the parameters. A comparison of the two SRP/AF groups indicated no significant difference among clinical or bacterial parameters due to sampling.

Adult↗

Minocycline slow-release formulation effect on subgingival bacteria.

The purpose of this study was to determine the microbiological efficacy of an adjunctive minocycline periodontal formulation delivered subgingivally. Subjects were systemically healthy but exhibited severe periodontitis; i.e., probing depths greater than 6 mm. The two study groups included individuals who received minocycline or a placebo periodontal formulation after root planing. Subgingival plaque samples were obtained at baseline; prior to treatment; and at 1, 3, and 6 months. Plaque was evaluated by darkfield microscopy and further analyzed for total dark-pigmented Bacteroides species, P. intermedia, P. gingivalis and Streptococcus, Actinomyces, Eikenella, Actinobacillus, Capnocytophaga, and Fusobacterium species using cultivable flora techniques. In addition, plaque was evaluated for yeast on a selective agar medium. When compared to the placebo, the minocycline group had significantly lower proportions of spirochetes at 1 and 3 months and lower proportions of motile rods at 3 months. Furthermore, when compared to the placebo group, the minocycline patients had lower mean proportions of dark-pigmented Bacteroides spp. and P. intermedia at 1 and 3 months as well as lower proportions of E. corrodens at 1 month. The minocycline group had significant decreases in proportions of spirochetes at 1 and 3 months, motile rods at 1 and 3 months, and increases in cocci at 1, 3, and 6 months when compared to baseline. In the placebo group, root planing was also effective at decreasing spirochetes at 1, 3, and 6 months, but with significant differences seen only at 3 and 6 months. However, the degree of reduction in spirochete proportions was greater in the minocycline group when compared with the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomyces↗

Effectiveness of metronidazole gel on cyclosporine-induced gingival overgrowth in heart transplant patients.

To evaluate the efficacy of metronidazole on cyclosporine-induced gingival overgrowth (GO), a prospective intra-subject double-blind longitudinal study was performed on six heart transplant patients with GO. All patients underwent scaling and root planing before any treatment. Metronidazole gel (Elyzol, Cabon) was then applied in two of the four anterior hemi-sextants of each subject, following a balanced random pre-programmed list, with a placebo gel being applied to the remaining two hemi-sextants. Plaque index (PI), bleeding on probing (BP) and probing depth (PD) were recorded for all teeth of the four anterior hemi-sextants before and at 1, 2, 3, and 4 months after gel application. A general linear model was fitted and ANOVA for repeated measurements with split-plot design and Chi-square analysis were used for statistical analysis. PD significantly decreased after 1 month following both treatments. Analogous results were obtained as regards PI and BP. No statistically significant difference was detected between results obtained with metronidazole and placebo. However, PD in the group of teeth treated with placebo significantly increased after 4 months, while PD values obtained from teeth treated with metronidazole remained statistically unchanged with respect to the 1st month. In conclusion, short-term results suggest that metronidazole and placebo are equally effective in reducing periodontal parameters and GO when associated with scaling and root planing. Long-term results, however, showed greater efficacy of metronidazole with respect to placebo in controlling cyclosporine-induced GO.

Analysis of Variance↗

Increase in cariogenic bacteria after initial periodontal therapy.

This study examined the hypothesis of an intra-oral shift, during initial periodontal therapy, from a periopathogenic to a cariogenic flora. Seventy-one patients with periodontitis were randomly allocated to one of the following treatment strategies: (1) scaling and root planing, quadrant by quadrant, at two-week intervals (NC); (2) full-mouth scaling and root planing within 24 hrs (FRP); or (3) full-mouth disinfection within 24 hrs, including antiseptics [chlorhexidine (CHX) or amine fluoride/stannous fluoride (F) for 2 mos, or CHX for 2 mos followed by F for 6 mos (CHX+F)]. At baseline and after 2, 4, and 8 mos, bacterial samples were taken from supra- and subgingival plaque, saliva, and tongue. The detection frequencies and relative proportions of Streptococcus mutans increased in the NC and FRP groups, but decreased in the F group. In the CHX group, these species disappeared temporarily, but they disappeared for the entire 8 mos in the CHX+F group. These observations were similar for all sample locations. The periopathogens decreased in all groups. This finding confirms the abovementioned hypothesis and indicates a need for caries prophylactic regimens.

Adult↗