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PubMed1997

Root coverage of large localized gingival recession: a biometric study.

With the objective of obtaining root coverage in areas of large localized gingival recessions, 16 cases of localized gingival recessions varying from 3.5 to 10 mm (total recession) were treated with a coronally positioned gingival autograft in conjunction with mechanical (root planing) and chemical (saturated citric acid) treatment of the exposed root surfaces. Changes in sulcus depth, percentage of root coverage, and gain in attached gingiva were observed over the course of a 6-month period. The results showed no significant change in sulcus depth, coverage of 72.17% of the exposed root surfaces, and a gain of 3.0 +/- 1.4 mm in attached gingiva in areas where little or no attached gingiva had existed prior to treatment. A positive correlation between the bone level and total visible recession before treatment was also demonstrated. We conclude that the coronally positioned gingival autograft is a highly predictable surgical technique for the treatment of large localized gingival recessions.

Adult↗
PubMed1989

Systemic metronidazole in the treatment of periodontitis.

The present study evaluated the effect of systemic metronidazole on advanced periodontitis in 10 patients with inadequate oral hygiene. Clinical and microbiological observations were made at a total of 173 bleeding pockets of 5 mm depth or more. The clinical observations comprised plaque index scores, dichotomous measurements of gingival redness and suppuration, pocket depths and attachment levels. The microbiological variables investigated were the % spirochaetes, % black-pigmented Bacteroides species, % facultative streptococci and presence of absence of Bacteroides gingivalis. At baseline, after clinical measurements and microbiological samples had been taken, each patient received a thorough scaling and root planing. After 3 months, the clinical measurements and microbiological sampling were repeated and a 5-day course of metronidazole was administered while one side of the mouth was scaled and root planed. After a further 3 months, the final measurements and samples were taken. In comparing pre- and post-treatment data, the following significant differences were observed: for debridement alone, a reduction in mean % spirochaetes from 11.5% to 4.9% and an increase in mean % streptococci from 4.7% to 8.8%; for metronidazole alone, a 0.3 mm gain in mean attachment level, a 0.4 mm reduction in mean pocket depth and a reduction in the frequency of suppurating sites from 32% to 16%; for debridement plus metronidazole, a 0.2 mm gain in mean attachment level, a 0.5 mm reduction in mean pocket depth and a reduction in mean % spirochaetes from 5.6% to 2.5%. Thus systemic metronidazole, either alone or accompanied by debridement, produced a modest clinical improvement after debridement alone had failed.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1989

[Nonsurgical treatment: a long-term study].

This retrospective study was carried out on 20 patients with periodontal lesions treated by the same operator by scaling root planing. The investigation was designed to study the variability of the level of attachments through different charts of probing before and after treatment over a period of 5 years maintenance. Through efficient scaling and root planing different results were obtained according to sites of different localisations and depth. It shows the uncertain and occasional characteristics of periodontal lesions, and gives useful informations for treatment choices and regular maintenance program.

Dental Prophylaxis↗
PubMed1988

A multivariable approach toward predicting dental motor skill performance.

The purpose of the present study was to examine the potential of a multivariable approach in predicting dental motor skill performance. Variables measuring cognitive knowledge, motor abilities, educational background, and family demographics were examined. Data were obtained from 33 first-year dental students. Scaling and root planing tests were administered to each student at the beginning and end of a 14-week preclinical periodontal course. Correlations were low and no variable significantly predicted pre- or posttest scaling and root planing performance. Results are discussed in terms of the problems associated with predicting motor performance.

Aptitude Tests↗
PubMed1989

The role of systemic antibiotics in periodontal therapy.

The Specific Plaque Hypothesis (SPH) has resulted in a renewed interest in the use of systemic antibiotics in the treatment of periodontal disease. Current data indicate that most cases of periodontitis can be treated satisfactorily with scaling and root planing alone. There are some cases of periodontitis however which remain refractory to mechanical debridement or which recur shortly after treatment. The data indicate that the use of antibiotics along with scaling and root planing during the treatment of these cases of periodontitis will result in significant improvement in the periodontal health of these patients. Antibiotics may also be indicated in patients with systemic diseases which may adversely affect the periodontium.

Anti-Bacterial Agents↗
PubMed1988

Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes.

Eighty-two periodontally involved patients were treated in a split mouth design such that one quadrant received coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resection surgery (FO). The therapy was performed in three phases: Phase I: the teeth previously designated to receive RP, MW, and FO were thoroughly root planed and the teeth designated to receive CS were scaled with no subgingival instrumentation, plaque control was initiated and reinforced for the entire mouth; Phase II: the designated teeth received MW or FO surgery; and Phase III: maintenance therapy every three months. The CS teeth received coronal scaling and polishing during maintenance appointments, while RP, MW, and FO teeth received supragingival instrumentation, subgingival instrumentation and polishing. Clinical measurements were taken initially, four weeks post-Phase I, 10 weeks post-Phase II, and after each of two years of maintenance care. All therapy modalities resulted in a decrease of mean probing depth with the FO producing the greatest decrease followed by MW, RP, and CS. The deeper the initial probing depth, the greater was the mean reduction of probing depth. FO created a loss of mean probing attachment in the 1 to 4 mm category. RP and MW produced the greatest gain of mean probing attachment in the 5 to 6 mm category. RP, MW, and FO produced similar gains in the greater than or equal to 7 mm category. FO created the most gingival recession followed by MW, RP, and CS.

Adult↗
PubMedDate not supplied

Prepubertal periodontitis: a report of 2 cases.

PURPOSE: Prepubertal periodontitis is a term suggested for a form of periodontitis that starts soon after the eruption of primary teeth. There is increased awareness that the disease entity known as "periodontitis" is in all probability a family of related but reasonably discrete diseases. The purpose of this report is to describe the clinical, radiographic, and laboratory findings in 2 patients, as well as treatment of prepubertal periodontitis. METHODS: This study presents 2 cases of generalized prepubertal periodontitis: a 5-year-old girl and a 13-year-old girl. RESULTS: Case 1 presented to the clinic because of parental concern for the early exfoliation of her teeth. All of her teeth with Grade III mobility, ie, 8.5, were extracted and the rest were scaled and root planed with subgingival irrigation of 0.2% chlorhexidine. She received a program of 3-month maintenance scaling and 6 months later, there was no further progression of periodontal lesions. Case 2 demonstrated the destruction of tooth roots along with extensive loss of tooth roots and alveolar bone. Since all the permanent teeth were Grade II mobile, the patient was advised to have total extraction with replacement of teeth by complete denture prosthesis at a later date. CONCLUSIONS: In case 2 premature root resorption was occurring concurrently with unexplained extensive alveolar bone loss. In Case 1, the elimination of the pathogenic microflora during primary dentition by early extraction of the teeth involved, plus daily local, mechanical and chemical control of the irritant factors may have prevented subsequent damage to remaining teeth in prepubertal periodontitis.

Adolescent↗
PubMed1989

Maxillary anterior esthetics. Preservation of the interdental papilla.

Periodontal therapy for the maxillary anterior area requires careful consideration as to the choice of therapy, as esthetic results are just as important as eradication of disease. The extensive shrinkage or loss of the interdental papilla, especially between the two central incisors as a result of periodontal therapy, should be minimized by the proper selection of therapy. Thorough subgingival scaling and root planing without surgical flaps is the treatment of choice as the maxillary anterior area is compatible for this type of therapy from the anatomic and access standpoints. In the posterior dentition, the surgical, conventional flap approach is encouraged after initial scaling, because of the anatomy of the roots (concavities, furcations) and difficulty with access makes thorough root therapy difficult. Fortunately, esthetics is not a major concern in the posterior areas. If surgical therapy is necessary for the maxillary anterior area, the papilla preservation flap technique better preserves the papilla for esthetic purposes but allows good access to the roots for root planing and, if necessary, the placement of graft material.

Dental Plaque↗
PubMed1997

Sustained local delivery of chlorhexidine in the treatment of periodontitis: a multi-center study.

The safety and efficacy of a degradable, subgingivally placed drug delivery system containing 2.5 mg chlorhexidine (CHX) were evaluated in a randomized, blinded, multi-center study of 118 patients with moderate periodontitis. A split-mouth design was used to compare the treatment outcomes of scaling and root planing (SRP) alone with the combined use of SRP and the CHX in pockets with probing depths of 5 to 8 mm. The two maxillary quadrants were used for the two treatment arms of the study. Scaling and root planing was performed at baseline only, while the CHX was inserted both at baseline and at 3 months. Clinical and safety measurements including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) as well as gingivitis, plaque, and staining indices were recorded at baseline, and at 1, 3, and 6 months. The average PD reduction in the CHX-treated sites was significantly greater than in the sites receiving SRP alone at both 3 and 6 months with a mean difference of 0.42 mm (P < or = 0.01) at 6 months. The reduction in CAL at the treated sites was greater than at the SRP sites, although the difference was statistically significant at the 6-month visit only. An analysis of patients with initial probing depths of 7 to 8 mm (n = 56) revealed a significantly greater reduction in PD and CAL in those pockets treated with CHX compared to SRP at both 3 and 6 months. The mean differences between test and control sites at 6 months were 0.71 mm and 0.56 mm PD and CAL respectively.

Adult↗
PubMed1999

Regeneration of intrabony defects: comparing e-PTFE membrane vs. decalcified freeze dried bone allograft--a pilot study.

The purpose of this study was to compare the amount of clinical attachment gained when using an expanded polytetrafluoroethylene (e-PTFE) membrane versus the placement of a decalcified, freeze-dried bone allograft (DFDBA) in human deep intrabony defects. Ten 2- and 3-wall intrabony defects were treated with scaling and root planing followed by flap surgery and placement of either an e-PTFE membrane or a DFDBA. The clinical parameters, clinical attachment level (CAL), probing depth (PD) and recession, were evaluated at baseline, following oral hygiene instructions and scaling and root planing, and at 6 and 9 months post-operatively. The e-PTFE group demonstrated an increased CAL of 3.2 mm at 6 months and 3.4 mm at 9 months while the DFDBA group manifested a gain of 2.2 mm at 6 months and 2.6 mm at 9 months. The e-PTFE group had a 6.6 mm decrease in PD at 6 months and 6.2 mm at 9 months while the DFDBA group had a decrease of 4.0 mm and 4.4 mm at 6 and 9 months respectively. The amount of gingival recession was 1.6 mm for both groups at 6 months and slightly less for the PTFE group at 9 months. It was concluded that both treatment groups resulted in a clinically and statistically significant improvement over baseline measurements in clinical attachment gain and PD reduction. No statistical significance could be demonstrated between the two groups. The number of subjects and sites treated by the two treatment modalities--e-PTFE and DFDBA--was too small to conclude that the treatments gave comparable results. A larger sample size is necessary in order to establish whether or not a statistically significant difference exists between groups.

Adult↗
PubMed2005

A chlorhexidine varnish implemented treatment strategy for chronic periodontitis: short-term clinical observations.

OBJECTIVES: The aim of this study was to investigate the clinical outcome of a subgingivally applied chlorhexidine varnish when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIAL AND METHODS: A randomized controlled, single blind, parallel trial was conducted on the basis of 16 volunteers suffering from chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment, however, all pockets were additionally disinfected using a chlorhexidine varnish. The gingival index, plaque index, bleeding on probing, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in PPD and CAL at both follow-up visits by comparison with baseline levels (p<0.001). Yet, at study termination, combination therapy resulted in additional pocket reductions between 0.73 and 1.23 mm (p<0.02), and clinical attachment gains between 0.63 and 1.09 mm (p<0.02). CONCLUSIONS: These findings suggest that a varnish-implemented strategy may improve the clinical outcome for the treatment of chronic periodontitis in comparison with SRP alone.

Adult↗
PubMed1990

Curettage--an enigma in periodontal therapy.

Curettage in periodontics conveys considerable confusion, but may be clarified by applying it to these distinct procedures--root curettage, gingival curettage and periodontal curettage. Root curettage is root planing preformed with a curette and is an essential step in the treatment of all periodontal patients to reduce inflammation and afford the opportunity to achieve varying degrees of repair. Gingival curettage is a surgical procedure removing the gingival crevicular epithelium and is of no additional benefit than scaling and root planing alone. Periodontal curettage may be employed in the treatment of osseous defects whereby the granulation tissue contents of the defect are surgically removed. This procedure, applied in appropriate cases, has significant regenerative potential.

Dental Calculus↗
PubMed1981

Topography of root surfaces treated in vitro with citric acid, elastase and hyaluronidase. A scanning electron microscopy study. Part II.

Sixteen extracted human teeth were separated into two groups, root planed, and treated with either elastase or hyaluronidase following acid demineralization. The duration of enzyme application varied from 5 to 20 minutes. From scanning electron micrographs the following was concluded: (1) The cemental collagen network is composed of previously described extrinsic and intrinsic fiber systems. (2) Root planing, using tactile sense as the final criteria, does not always result in complete elimination of contaminants. (3) Citric acid (pH = 1), applied for 3 to 4 minutes, is an effective means of exposing cemental collagen. (4) Qualitatively, the enzyme treatment subsequent to acid demineralization seemed to result in more effective exposure of the collagen mantle of cementum. (5) Further definitive research must be done to determine, both the usefulness of enzymatic treatment in vitro and in vivo and the optimum enzyme concentrations and duration of application.

Adult↗
PubMed1993

Efficacy of meclofenamate sodium (Meclomen) in the treatment of rapidly progressive periodontitis.

This 6-month, double-blind, controlled clinical trial determined the efficacy of the non-steroidal anti-inflammatory drug, meclofenamate sodium (Meclomen), as an adjunct to scaling and root planing in the treatment of rapidly progressive periodontitis (RPP). 22 subjects (7 male, 15 female) aged 36.5 +/- 7.88 years with RPP and disease-active sites as determined by pretreatment bone scan had standardized radiographs at baseline and 6 months, and clinical measurements at baseline, 3 and 6 months. Following full-mouth scaling and root planing, subjects were randomly assigned to either a placebo, 50 or 100 mg meclofenamate sodium bid group. Bone change over the 6-month period as assessed by subtraction radiography was the primary efficacy determinant. Specialized software was used to isolate the lesion from the subtraction image and to measure bone change along the root surface. ANOVA using the subject as the unit of analysis revealed a significant dose response (p < 0.001) with the placebo group having a mean bone loss of 0.42 +/- 0.06 mm and the low and high dose groups having mean bone gains of 0.07 +/- 0.05 and 0.20 +/- 0.07 mm, respectively. These findings indicate that meclofenamate sodium may be a useful adjunct in the treatment of rapidly progressive periodontitis.

Adolescent↗
PubMed1989

Effects of adjunctive treatment of periodontitis with tetracycline and spiramycin.

The present study was undertaken to compare the efficacy of two antibiotics, spiramycin and tetracycline, with a placebo when used adjunctively with scaling and root planing in the treatment of advanced adult chronic periodontitis. This was a double-blind, parallel, randomized trial with one factor (drug) at three levels. Ninety-six patients (mean age 46 +/- 1) were randomly assigned into one of three groups. All groups were scaled and root planed with each respective group receiving either spiramycin, tetracycline, or a placebo for 2 weeks. Two sites with probing depth of at least 7 mm were evaluated and the following clinical parameters were measured at baseline, 2, 8, 12, and 24 weeks: plaque index, bleeding on probing, crevicular fluid, probing depth, and change in the attachment level. The changes in the subgingival bacteria were monitored also using a differential staining technique. Seventy-nine patients completed the study. At the end of 24 weeks, although all three groups had shown clinical improvement when compared to the baseline data, there were no significant intergroup differences in any of the clinical parameters measured. While the proportion of spirochetes were significantly decreased (P less than 0.05) at 2- and 8-week intervals in both tetracycline and spiramycin groups (26% to 0.04% and 28% to 0.04%, respectively), compared to the placebo group (30% to 7%), only in the spiramycin group was the proportion of spirochetes significantly lower than the placebo group at the 24-week interval (3% and 11%, respectively). At week 24, the proportion of spirochetes in the tetracycline group had rebounded to 7%, which was not significantly different from the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

A 15-month evaluation of the effects of repeated subgingival minocycline in chronic adult periodontitis.

BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Adult↗
PubMed1987

4 modalities of periodontal treatment compared over 5 years.

The purpose of the present study was to assess in a clinical trial over 5 years the results following 4 different modalities of periodontal therapy (pocket elimination or reduction surgery, modified Widman flap surgery, subgingival curettage, and scaling and rool planing). 90 patients were treated. The treatment methods were applied on a random basis to each of the 4 quadrants of the dentition. The patients were given professional tooth cleaning and oral hygiene instructions every 3 months. Pocket depth and attachment levels were scored once a year. 72 patients completed the 5 years of observation. Both patient means for pocket depth and attachment level as well as % distribution of sites with loss of attachment greater than or equal to 2 mm and greater than or equal to 3 mm were compared. For 1-3 mm probing depth, scaling and root planing, as well as subgingival curettage led to significantly less attachment loss than pocket elimination and modified Widman flap surgery. For 4-6 mm pockets, scaling and root planing and curettage had better attachment results than pocket elimination surgery. For the 7-12 mm pockets, there was no statistically significant difference among the results following the various procedures.

Clinical Trials as Topic↗
PubMed1992

Clinical effectiveness of subgingival irrigation with a pulsated jet irrigator versus syringe.

Previous studies have shown clinical and microbiological improvement with subgingival irrigation particularly after scaling and root planing. In this study we monitored the effects of saline irrigation on non-treated periodontal pockets. Ten subjects with severe periodontal disease and symmetrical lesions on multirooted teeth were selected. They had not received periodontal treatment or antibiotics for the previous 6 months. Patients were given simplified oral hygiene instructions. Neither scaling nor root planing was provided during the study. Two teeth were randomly selected per quadrant for subgingival irrigation with saline solution. One side was treated with a syringe and the other side with a pulsated jet irrigator with a modified tip, professionally administered. Clinical parameters (pocket depth, plaque index, gingival index, crevicular fluid, bleeding index, attachment level, and subgingival microflora) were evaluated on days 0, 15, 30, 60, and 90. Both subgingival irrigation products induced changes (reductions) in these indices during the study. Significant differences (P less than 0.001) with the oral irrigator were found for the following parameters: microscopy, pocket depth, crevicular fluid, and plaque index. In this study, professionally administered saline irrigation with a pulsated jet irrigator was more effective than syringe treatment with the same solution. Neither treatment resulted in a detectable gain in probing attachment level. Since gain in attachment level is achievable by other techniques, neither of these subgingival irrigation procedures alone can be considered adequate for periodontal therapy.

Adult↗