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PubMed1993

Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study.

The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis. Two groups were compared; one received the test minocycline ointment and the other a vehicle control. Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks. Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding. These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12. Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Subgingival minocycline ointment resulted in statistically significantly greater reduction of P. gingivalis at weeks 2, 4, 6, and 12; P. intermedia at weeks 2, 4, 6, and 12; and A. actinomycetemcomitans at weeks 6 and 12. Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment. Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed2004

Non-surgical approach to advanced chronic periodontitis: a 17.5-year case report.

This 17.5-year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra-pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10-year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated +2 to +3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non-surgical approach is a viable option while maintaining regular visits for periodontal care.

Adult↗
PubMed2001

A longitudinal study comparing scaling, osseous surgery, and modified Widman procedures: results after 5 years.

BACKGROUND: Scaling and root planing, osseous surgery, and modified Widman procedures are effective methods for treating periodontal diseases. Studies have been carried out to determine if these procedures are more effective than others in reducing clinical probing depths, while maintaining clinical attachment levels. The purpose of this report is to present 5-year results from a longitudinal study comparing scaling and root planing (SRP), osseous surgery (OS), and modified Widman (MW) therapies. The study has been completed for 12 years. METHODS: Sixteen adult patients with moderate to advanced periodontal disease were treated with initial scaling and oral hygiene procedures in a private practice. Posthygiene data were used to compare changes in plaque and gingival indices, probing depth (PD), clinical attachment levels (CAL), and recession. Frequency distributions were used to compare changes at individual sites. The first published report was from baseline to one year. This follow-up report is from baseline through 5 years. RESULTS: At 5 years, there were significant decreases in gingival and plaque scores. For the 3 procedures, there were significant decreases in baseline 4 to 6 mm PD (P<0.0001); however, there were no differences between the methods. Similar findings were noted for PD initially greater than 7 mm. At 5 years, OS had the greatest number of 1 to 3 mm sites (332 sites, 73.2%), while MW had the fewest number of 4 to 6 mm PD (98 sites, 21.8%). SRP had the fewest 7 mm and greater sites (15 sites, 3.4%). At 5 years, CAL loss for 1 to 3 mm PD was statistically significant for the 3 procedures. There were slight gains in CAL for 4 to 6 mm probing depths. These gains were not significant. Similar findings were seen for CAL for probing depths greater than 7 mm. OS had the greatest number of sites losing more than 2 mm of CAL (64 sites), followed by SRP (21 sites) and MW (34 sites), respectively. CONCLUSIONS: This 5-year clinical trial demonstrates that with good patient maintenance excellent clinical results can be achieved with various methods of treatment. Within the limits of this study, SRP, OS, and MW were effective at reducing probing depths with slight changes in clinical attachment levels.

Adult↗
PubMed1990

[Evaluation of time needed to treat periodontal conditions classified according to the C.P.I.T.N. index].

A questionnaire was sent to 623 members of the "French Society of Periodontology" with a view to assessing the time necessary to provide instructions concerning hygiene, carry out root planing, surgery on 3.5 to 5.5 mm pockets, surgery on pockets of 6 mm or more, and to ensure maintenance. 282 responses were received from the practitioners and were computer analysed. The time required for instructions concerning hygiene was estimated to be approximately 15 mn. This information was usually repeated 4 times. It was determined that scaling and root planing require an average of 29.19 mn per sextant. The surgical interventions for 3.5 to 5.5 mm and 6 mm or more pockets are estimated to last an average of 77.03 and 107.36 mn respectively. Finally, the assessment of the time necessary for maintenance of the whole mouth was 30 to 60 mn, with an average of 45.11 mn. A quarterly check-up was recommended by 48.9% of the practitioners. The treatment of complex cases requires much more time, and maintenance is indispensable in order to avoid relapse. A plaque control programme undertaken sufficiently early might avoid long treatment stages.

Dental Scaling↗
PubMed1988

Density and localization of lymphocytes with natural-killer (NK) cell activity in periodontal biopsy specimens from patients with severe periodontitis.

Natural killer lymphocytes (NKL) in gingival biopsy specimens of 13 patients with advanced periodontitis and 6 normal control subjects have been evaluated by the monoclonal antibody NC 1, anti-B4 and a double immunoenzymatic labeling technique, combining the peroxidase-anti-peroxidase (PAP) method with the alkaline-phosphatase-anti-alkaline-phosphatase (APAAP) technique. Mononuclear cells with NK-activity (NKA) were mainly accumulated in the upper to middle third of the periodontal pocket. The concentration of NC-1-positive cells (CNC) of the baseline biopsy specimens was significantly increased at p = 0.05 compared to the CNC after hygiene training. The statistical difference rose to p = 0.01 following scaling, root planing and curettage therapy. The healthy gingiva of control subjects showed an average of 1-2 NKL, and no statistical difference could be found when compared to the CNC of the biopsy specimens of patients after periodontal therapy. These data support the hypothesis that antibody-dependent cytotoxic immunoreactive lymphocytes in chronic inflammatory periodontal disease can be reduced by scaling and root planing therapy.

Dental Scaling↗
PubMed1994

Use of membranes containing 20% chlorhexidine and 40% doxycycline for treatment of chronic periodontal pockets.

A study was carried out to compare the effects of subgingival applications of resorbable hydroxypropylmethylcellulose (HPMC) membranes containing 20% chlorhexidine (CHx) and 40% doxycycline (DOXY) placed subgingivally in periodontal pockets greater than 5 mm in depth. Each of 11 patients had at least four pockets. HPMC strips containing CHx and DOXY were inserted into each pocket twice a week for 6 w. One pocket was kept as a control and the other received subgingival scaling and root planing at 0, 1, 3 and 6 w. The microbial flora of 44 pockets from the 11 patients was examined using dark-field microscopy at the baseline and at 1, 3, 6 and 10 w. Clinical parameters including probing depth, crevicular fluid flow, bleeding on probing and gingival shrinkage were also recorded. The CHx and DOXY-administered or root-planed pockets showed marked reduction of both pocket depth and the number of motile organisms. Less bleeding was also observed in CHx and DOXY-inserted pockets.

Adult↗
PubMed1995

Compliance with supportive periodontal treatment in private periodontal practice. A 14-year retrospective study.

The purpose of this study was to determine the degree of compliance with supportive periodontal treatment (SPT) recommended in private periodontal practice and to determine if any significant differences existed in the characteristics of compliant, non-compliant, and erratically compliant patients. The study covered a period of 14 years (1977 to 1991) and included 521 patients who were classified by sex, age, socioeconomic class, disease severity, treatment rendered, and the year maintenance began. Compliance was categorized into four groups: complete compliance, erratic compliance, patients who discontinued SPT, and patients who never presented for SPT. Females began SPT more often than males (P = 0.054). Only 27.4% of the patients were in complete compliance at the end of the study. A significantly greater percentage of females (P = 0.032) and patients who had been treated by only scaling and root planing (P = 0.014) were in complete compliance. Drop-out rates from SPT tended to decrease during the first 6 years from 13.9% in the first 2 years to 9% in the sixth year. Thereafter, the percentage of patients presenting for SPT stabilized at 48.4% after 6 and 43.2% after 11 years. Younger patients (P = 0.04), those who had received only scaling and root planing (P = 0.008), and individuals in socioeconomic class I (P = 0.017) had a significantly lower tendency to drop out. The results confirm that compliance to SPT in private periodontal practice is far from ideal. Suggestions for improving compliance are discussed.

Adult↗
PubMed1988

Combined antibiotic (metronidazole) and mechanical treatment effects on the subgingival bacterial flora of sites with recurrent periodontal disease.

5 patients in maintenance, 1-3 years after periodontal therapy who showed sites with reinfected pockets and bleeding despite regular recall visits were selected. Darkfield microscopy from 3 sites in each patient showed an average of 41% spirochetes and 21% motile rods. Probing depths ranged from 7 to 9 mm and loss of clinical attachment from 6 to 13 mm in these sites. The patients were given 3 times 250 mg/day of metronidazole (Flagyl) for 10 days. Darkfield microscopy and microbiological cultures of the subgingival plaque were performed twice prior to the study, at the end of the medication and after 3 weeks, 3 and 6 months. The plaque and gingival indices, probing depth and loss of clinical attachment were recorded. During the medication and at 3 and 6 months, the teeth were scaled and root planed. The samples were obtained with 3 paper points and cultured anaerobically in the glove box on non-selective and selective media and representative bacterial colonies identified by aerobic growth, gram stain and rapid biochemical tests. Presumptive pathogenic micro-organisms including Bacteroides were identified. The % of spirochetes, motile rods and non-motile bacteria were enumerated by darkfield microscopy. The clinical results show that administration of metronidazole and repeated root planing significantly decreased gingival inflammation, probing depth and loss of clinical attachment in reinfected sites. After treatment, these sites harbored significantly less spirochetes and more non-motile bacteria, while motile rods tended to return to baseline levels with time. The combined antibiotic and mechanical therapy resulted in a statistically significant decrease of gram-negative rods, Fusobacteria and Bacteroides gingivalis over 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Factor XIIIa+ dendritic cells and S-100 protein+ Langerhans' cells in adult periodontitis.

OBJECTIVE: The purpose of this study was to evaluate the presence of factor XIIIa+ dendritic cells and S-100 protein+ Langerhans' cells in the gingival epithelium and connective tissue of periodontal pockets, before and after non-surgical periodontal therapy. BACKGROUND: The microbial flora in periodontal pockets provokes complex immune reactions. Dendritic cells play a critical role in primary and secondary immune responses and are considered as antigen-presenting cells. Factor XIIIa positive dendritic cells and S-100 protein positive Langerhans' cells identified by immunoreactivity against factor XIIIa antigen and S-100 protein, respectively, are two distinct subpopulations of dendritic cells. METHODS: Fifty-four gingival tissue samples were obtained from periodontal pockets of initial depth 4-5 mm and > or = 6 mm. Each group was subdivided in to three subgroups. The first subgroup consisted of samples taken on baseline day and used as control. The second and third subgroups included those obtained 1 month after plaque and calculus removal, and 1 month after scaling and root planing, respectively, additionally to oral hygiene instructions. The tissues were removed from the palatal gingiva under local anaesthesia during routine periodontal surgery. Immunohistochemical staining with antibodies against factor XIIIa and S-100 protein was performed to identify dendritic cells positive and Langerhans' cells positive, respectively. RESULTS: Factor XIIIa+ dendritic cell numbers decreased compared to controls after plaque and calculus removal, oral hygiene instructions and scaling and root planing in periodontal pockets of 4-5 mm, but not in those of > or = 6 mm depth. S-100+ Langerhans' cell numbers decreased after periodontal treatment in the periodontal pockets > or = 6 mm. CONCLUSION: These results may reflect a tendency for reduction of these two distinctive subpopulations of dendritic cells after non-surgical periodontal therapy.

Adult↗
PubMed1999

[The elastase activity in gingival crevicular fluid from rapidly progressive periodontitis].

OBJECTIVE: It is now generally accepted that polymorphonuclear neutrophil (PMN) chemotactic defect increases the patient's susceptibility to early-onset periodontitis. However, some reports including ours have failed to show defective PMN chemotaxis in rapidly progressive periodontitis(RPP) patients. The purpose of the study was to survey the role of PMN in the progression of RPP. METHODS: The elastase activity in gingival crevicular fluid from 22 RPP patients and 11 healthy controls were studied. For the control group and 12 RPP patients, 30 s GCF and clinical data were obtained at the first visit. For other 10 RPP patients, 30 s GCF and clinical data were collected prior to treatment and 4 weeks after scaling and root-planing. The elastase activity was measured with a low molecular weight substrate (L-Pyroglutamyl-L-prolyl-L-valine-p-nitroaniline, S2484) specific for granulocyte elastase. RESULTS: The pre-treatment elastase activity was much higher (0.63 +/- 0.38, Abs/site) in RPP patients than that in control subjects (0.07 +/- 0.05, Abs/site). The elastase activity was positively correlated with GCF volume, probing depth, attachment loss and gingival bleeding. Scaling and root-planing resulted in decrease of both clinical data and elastase activity. CONCLUSION: These results suggested that PMN with the increased accumulation or the increased release of lysosomal enzymes may play a role in the pathogenesis of RPP.

Adult↗
PubMed2000

Periodontal relevance of anterior crowding.

The periodontal relevance of anterior and posterior crowding concerns 3 main aspects: 1. oral hygiene/plaque retention, 2. altered topography of gingiva, septum and orofacial alveolar bone and 3. periodontal therapy (scaling, root planing, regenerative approaches). These aspects are discussed with regard to the literature and to the author's own clinical and histological findings. Present-day knowledge suggests that the following positive periodontal effects can be expected from correction of orthodontic crowding: better access for oral hygiene, improved morphology of soft and hard periodontal tissues; future research has to substantiate the value of this benefit, simplified mechanical and surgical therapy (scaling, root planing, curettage), more favorable conditions for periodontal regeneration.

Cuspid↗
PubMed1978

Evaluation of student performance in the four-year study of expanded functions for dental hygienists at the University of Iowa.

A comparison was made of the quality of selected operative and periodontal procedures completed by expanded-function dental hygiene and senior dental students. Each student group included 48 students selected from all academic quartiles of their respective classes. The evaluated operative procedures included a Class II preparation and amalgam restoration and a Class III preparation and composite restoration. Both operative procedures were completed twice, once on a patient and once on a Dentoform. The periodontal procedures were completed on patients and included a periodontal examination, a periodontal treatment plan, and one quadrant of root planing and soft tissue curettage. Three examiners independently rated each student's performance in an examiner-blind situation. Examiners judged numerous criteria for each procedure as satisfactory or unsatisfactory. In addition, an overall rating of excellent, clinically acceptable, or unacceptable was given to each procedure. Comparisons between student groups of the time required to complete procedures showed that dental students completed cavity preparations of all operative procedures and quadrants of root planing and curettage in significantly less time than did dental hygiene students. For restorations, periodontal examinations, and treatment plans, there was no significant difference between student groups in the time required to complete procedures. In general, the results of the study showed that the dental hygiene students were able to perform selected operative and periodontal procedures at a comparable level to that of senior dental students.

Clinical Competence↗
PubMed1998

The use of locally delivered metronidazole in the treatment of periodontitis. Clinical results.

Local delivery of antimicrobials has been investigated as a possible method for controlling and treating periodontal disease. A number of antimicrobial agents have been studied both as adjunctive therapies with scaling and root planing and as stand-alone chemotherapies. More recent investigations have focussed on the delivery of antimicrobials in sustained-release formulations designed to maintain effective concentrations of drug within the periodontal pocket. This article provides an overview of the development of the use of locally-delivered metronidazole in periodontal therapy and the current state-of-the-art of the technique. It is concluded that treatment with local delivery of metronidazole seems to be as effective as scaling and root planing in untreated as well as in recall subjects. However, there are reasons to suggest that local delivery of metronidazole should not be used as a substitute for conventional treatment of periodontal disease, since side-effects of long-term use and repeated use are not known. The antibiotic regimen should preferably be used as an adjunct to surgical and non-surgical therapy.

Administration, Topical↗
PubMed2005

Felodipine-influenced gingival enlargement in an uncontrolled type 2 diabetic patient.

BACKGROUND: The potential of calcium channel blockers (CCBs) to induce gingival enlargement (GE) as well as the influence of diabetes mellitus on periodontal tissues has been well documented. This case report documents a conservative clinical approach to the management of felodipine-influenced gingival enlargement and displays a clinical and histologic case of felodipine-influenced GE in an undiagnosed type 2 diabetic patient. METHODS: At the initial examination, a medical consultation was requested and two incisional biopsies were taken for pathological evaluation. The patient was diagnosed with uncontrolled type 2 diabetes. Felodipine was withdrawn and the diabetes was controlled before dental treatment was initiated. The patient then underwent selective extractions and full-mouth scaling and root planing as well as oral hygiene instructions. No surgical therapy was indicated. RESULTS: The histological results demonstrated the presence of elongated rete pegs; fibrous hyperplasia; a low-grade chronic inflammatory infiltrate, predominantly consisting of lymphocytes; and collagen bundle groups randomly distributed. These features were similar to those present in other drug-influenced GE. Clinical results have demonstrated almost complete resolution of GE after the withdrawal of felodipine and the control of diabetes. Further improvements were seen after scaling and root planing and oral hygiene instructions. No recurrences were noted 12 months after initial therapy. CONCLUSIONS: This report demonstrated that the control of systemic factors seemed to have the most influence on success for this particular case. Since the control of diabetes was managed at the same time as the felodipine withdrawal, it remains difficult to speculate how these two factors impacted both the severity of the GE and the therapeutic results. More importantly, the conservative treatment rendered demonstrated the stability of periodontal status during maintenance phase and the avoidance of surgical interventions.

Alveolar Bone Loss↗
PubMed1986

The effects of a simplified oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on chronic inflammatory periodontal disease.

This study compared a simplified oral hygiene regime (scaling, root planing and Bass brushing) with this same regime plus 0.02% chlorhexidine (CH), 0.05% metronidazole (MD) and inactive control (PL) solutions delivered supragingivally by a pulsating water jet irrigator. 22 patients were distributed randomly into 3 groups, 0.02% chlorhexidine (CH), 0.05% metronidazole (MD), and inactive control (PL). Approximal surfaces with associated pockets greater than or equal to 4 mm were monitored at day 0, for plaque index (PII), gingival index (GI), sulcus bleeding index (SBI), baseline measurement for gingival shrinkage and probable pocket depth. All monitored surfaces were then immediately scaled and root planed. All patients received identical oral hygiene instruction (Bass brushing), with a sodium fluoride toothpaste and a multituft toothbrush, and were shown how to use the oral irrigator. Proficiency in use of the oral irrigator was checked again at day 7. No interdental cleaning was taught. The active treatment period was 28 days. Patients were seen at days 7, 28, 56 and 84, and all parameters were recorded at each visit, but no further oral hygiene instruction was given. Within procedure comparisons of the findings at days 28 (end of active treatment) 56 and 84 with those at day 0, showed statistically highly significant improvements in all parameters for all groups. Regarding between procedure comparisons, CH was better in reducing PII at all times except at day 84, and on several occasions in reducing GI and SBI. Irrigated groups were always better than nonirrigated groups. Although the differences were statistically highly significant, clinically the differences between groups were relatively small, except for CH effect on PII.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Suppression of the periodontopathic microflora in localized juvenile periodontitis by systemic tetracycline.

Since recent studies have implicated Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis, this investigation determined the effectiveness of subgingival debridement, topical Betadine Solution, and systemic tetracycline in suppressing subgingival A. actinomycetemcomitans and other microorganisms. A total of 20 deep periodontal pockets and 10 normal periodontal sites of 6 localized juvenile periodontitis patients was included in the study. Each patient was treated in 3 stages over a period of 22 weeks, and the result of treatment was monitored for an additional 38 weeks. The first stage of treatment included plaque control, as well as thorough scaling and root planing, composed of at least 6 h of debridement. No concomitant periodontal surgery was performed. In the second stage, Betadine saturated cotton gauze was inserted into the periodontal pockets for 10 min. Stage 3 involved systemic tetracycline therapy (1 g/day) for 14 days. The subgingival microflora was determined at frequent intervals by selective culturing of A. actinomycetemcomitans and Capnocytophaga and by direct microscopic examination. The clinical effect was assessed by measuring changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic alveolar bone mass, and other relevant clinical parameters. Scaling and root planing reduced the total subgingival bacterial counts and the proportions of certain Gram-negative bacteria, but no periodontal pocket became free of A. actinomycetemcomitans. Betadine application had little or no effect on the subgingival microflora. In contrast, tetracycline administered via the systemic route suppressed A. actinomycetemcomitans, Capnocytophaga, and spirochetes to low or undetectable levels in all test periodontal pockets. A. actinomycetemcomitans reappeared in 9 of the deep periodontal pockets after the administration of tetracycline. Most of these 9 pockets became free of detectable A. actinomycetemcomitans during the second week of tetracycline administration, whereas pockets which yielded no A. actinomycetemcomitans after tetracycline therapy became free of the organisms during the first week of tetracycline treatment. This data suggests that systemic tetracycline therapy of localized juvenile periodontitis should, as a practical rule, be continued for 3 weeks. Periodontal destruction continued in 4 deep pockets which all showed high posttetracycline A. actinomycetemcomitans counts. All 6 pockets which demonstrated a marked gain in periodontal attachment yielded no cultivable A. actinomycetemcomitans. No association was found between periodontal disease status and subgingival Capnocytophaga, spirochetes or motile rods. The present study indicates that A. actinomycetemcomitans is an important etiologic agent in localized juvenile periodontitis.(ABSTRACT TRUNCATED AT 400 WORDS)

Actinobacillus↗
PubMed2006

The effect of patient-centered plaque control and periodontal maintenance therapy on adverse outcomes of periodontitis.

The purpose of this study was to evaluate systematic reviews that addressed the effectiveness of periodontal maintenance therapy for the management of patients with periodontitis. Recent surveys of dental care patterns suggest a marked increase in preventive and maintenance periodontal care in populations that retain the dentition for an increasingly longer lifetime. A considerable body of clinical investigation concludes that a multitherapy periodontal maintenance approach is effective in improving periodontal outcomes in patients treated for periodontitis. Individual components of such maintenance therapy were assessed, including the effects of an oral examination, personal oral hygiene instructions, supragingival scaling and polishing, subgingival scaling and root planing, adjunctive procedures, and maintenance frequency. There is much controversy about improvement in oral health that may accrue from the placebo effect of an examination and the maintenance ritual. Improved plaque control by the patient in anticipation of a forthcoming examination alone might be reflected in decreased measurements for plaque accumulation and gingival inflammation but the role of placebo effects on periodontitis remains unclear. There are insufficient randomized controlled trials to reach conclusions regarding the individual beneficial effects of repeated oral hygiene instructions or routine scaling/polishing on the recurrence of periodontitis. While subgingival root planing seems an effective component of periodontal maintenance, neither clinical investigations nor randomly controlled trial evidence have established an ideal maintenance frequency based on individual patient risk for periodontitis. The adjunctive beneficial effects of both locally and systemically administered antimicrobial agents were statistically significant for some formulations, and may be particularly useful clinically in patients who are resistant to mechanical therapy. We conclude that few clinical or randomized controlled studies have evaluated the individual benefit or required frequency of the periodontal maintenance ritual for patients who are relatively resistant or susceptible to periodontitis.

Anti-Infective Agents↗
PubMed2001

Periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces.

The purpose of the study was to evaluate periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces. Ten teeth with hopeless prognoses because of extensive alveolar bone loss and deep pockets extending to the apexes only on one or two surfaces, but with a healthy periodontal apparatus on the other surfaces, were selected. A mucogingival flap was elevated and the teeth were extracted carefully so as not to damage the healthy remnant of the periodontal membrane remaining on the root surfaces. Thorough extra-oral debridement was performed on the contaminated root surface and the remnant was carefully conserved. Retrofilling was also done to eliminate an endodontic cause of attachment loss. The teeth were horizontally rotated and then replanted so that the healthy root would face the connective tissue at the initially periodontally involved sites, and the root planed surfaces, which had been periodontally involved, would face the surfaces of the alveolar sockets at initially healthy sites. The teeth were splinted with adjacent teeth. Clinical parameters and radiographic examination were performed pre-operatively, and at 3 or 6 months, 1, 2, and 3 years postoperatively. One tooth was extracted 1.5 years postoperatively due to reduced support and the treatment strategy of the patient. The other nine teeth were well maintained without any discomfort for the whole maintenance period of 3 years. In all teeth, areas that previously had no pocketing but were now against denuded root surfaces maintained the previous pocket depth readings. In areas where a deep pocket was present but now had a root surface with healthy periodontium, a distinct decrease of mean pocket depth was observed at the first reexamination 3 months postoperatively. The mean radiographic alveolar bone level increased from 0.3% to 45.3% in 2 years and was thereafter maintained for the entire observation period. Loss of periodontal space and possible root resorption were observed in only one case without other ankylotic symptoms. These results suggest that the healing without ankylosis of an extensive denuded root surface may occur by mechanisms other than the maintenance of a viable periodontal ligament on the root surface.

Adult↗