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At least 595 records · Page 33Linked to original sources
PubMed2002

A systematic review of the prevalence of root sensitivity following periodontal therapy.

OBJECTIVES: To systematically review the evidence on the prevalence of root sensitivity following periodontal therapy. MATERIAL AND METHODS: Cross-sectional and longitudinal clinical studies were searched for in electronic databases, hand searched journals and through contact with authors directly. The screening and data extraction were conducted by several reviewers independently. The main outcome measure was prevalence of root sensitivity following periodontal therapy. RESULTS: The prevalence of root sensitivity was 9-23% before and 54-55% after periodontal therapy. An increase in the intensity of root sensitivity occurred 1-3 weeks following therapy, after which it decreased. CONCLUSIONS: It is concluded that there are insufficient randomized controlled trials to adequately address the stipulated question. However, based on the scarce evidence from only two studies, root sensitivity occurs in approximately half of the patients following subgingival scaling and root planing. The intensity of root sensitivity increases for a few weeks after therapy, after which it decreases. In clinical practice, it may be recommended that patients should be made aware of the potential for root sensitivity prior to treatment. In research, it may be recommended to conduct randomized controlled and prospective studies with both short and long follow-up periods. Furthermore, to investigate the effects and the relationship of root instrumentation with the aetiology of root sensitivity, the efficacy of preventive and therapeutic regimes for root sensitivity, and the incidence and severity of root sensitivity by subjective patient-reporting, and the response to different modes of stimuli. Protocols should follow the criteria used in dentine hypersensitivity studies.

Clinical Trials as Topic↗
PubMed1985

Assessment of plaque by image analysis.

The uneven distribution and pattern of staining, revealed on root-planed, periodontally-involved root surfaces by the application of a plaque-disclosing solution, precludes the use of conventional plaque scoring indices or other methods of assessment based on planimetric and gravimetric techniques. A method has been developed and evaluated to quantify stained areas using image analysis. The method is reproducible, with an error factor of 1.32%, and represents a comparatively simple, yet effective technique for quantifying plaque on irregular root surface areas.

Dental Plaque↗
PubMed1988

Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth.

In this study the bacterial invasion in root cementum and radicular dentin of periodontally diseased, caries-free human teeth was examined. In addition, structural changes in these tissues, which could be related to the bacterial invasion, were reported. Twenty-one caries-free human teeth with extensive periodontal attachment loss were studied by light and scanning electron microscopy. At the base of the gingival pocket, bacteria were found in the spaces between remnants of Sharpey's fibers and their point of insertion in the cementum. In teeth that had been scaled and root planed, most of the root cementum had been removed. Bacterial invasion was found in the remaining root cementum. The invasion seemed to start as a localized process, often involving only one bacterium. In other areas bacteria were present in lacunar defects in the cementum. These lacunae extended into the radicular dentin. In 11 teeth bacteria had invaded the dentinal tubules. Most bacteria were located in the outer 300 microns of the dentinal tubules, although occasionally they were found in deeper parts. In two of the nontreated teeth, bacteria were detected on the pulpal wall. No correlation was found between the presence of bacterial invasion and the absence of radicular cementum. No bacteria were found in the portion of the root located apically to the epithelial attachment. These data are in agreement with our results from cultural studies of the bacterial flora in these structures. It was also demonstrated that in spite of meticulous scaling and root planning and personal oral hygiene, bacterial plaque remained present on radicular surfaces. Both the invaded dentinal tubules and the lacunae could act as bacterial reservoirs from which recolonization of treated root surfaces occurs. From these reservoirs bacteria could also induce pulpal pathoses. Since these bacterial reservoirs are not eliminated by conventional mechanical periodontal treatment, it seems appropriate to combine mechanical periodontal therapy with the use of chemotherapeutic agents.

Bacteria↗
PubMed2003

Root surface debridement and endotoxin removal.

OBJECTIVE: This study assessed associations between the number of standardized scaling strokes and the reduction of endotoxin on the root surface. BACKGROUND: Therapy of periodontally involved teeth attempts removal of accretions by scaling and root planing. The amount of mechanical therapy required to free the root surface from etiologic factors remains unknown. METHODS: Twenty-four extracted human caries-free single rooted teeth with at least 5 mm attachment loss were used. A region of interest (ROI) which contained subgingival calculus was defined on the root surface of each tooth. Standardized force instrumentation was applied using a force-measuring curet. Fifty working strokes were applied to every ROI. Forces applied were recorded. The force recordings were converted from Millivolts into Newtons (N). After every unit of 5 strokes, presence of calculus was evaluated and scaling debris was collected. Endotoxin concentration was determined in the debris samples. RESULTS: The endotoxin values for strokes 1-5 were statistically significantly greater than the values from all other stroke intervals. Complete calculus removal occurred after a mean of 9.3 strokes. The endotoxin concentration reached a minimal level with concentrations of 0.03-0.306 EU/ml after calculus removal was complete. CONCLUSION: These findings suggest that completion of calculus removal coincides with endotoxin levels associated with clinically healthy teeth.

Chromogenic Compounds↗
PubMedDate not supplied

An in vitro comparative study of a reciprocating scaler for root surface debridement.

OBJECTIVES: A number of instruments are available for debriding periodontally involved root surfaces. The aim of this SEM study was to assess and compare the efficiency of the recently marketed EVA scaling system with that of ultrasonic (Cavitron-Dentsply) and hand instruments (Ash Dental Products). METHODS: Forty-five periodontally involved extracted teeth were divided into three equal groups for instrumentation. The teeth were mounted onto typodonts, set in phantom heads and instrumented to tactile smoothness and visual cleanliness. Replica specimens of the debrided roots were prepared for the SEM and views were recorded on video film. The efficiency of instrumentation was assessed using the Remaining Calculus Index (RCI) and the Roughness and Loss of Tooth Substance Index (RLTSI). Five original specimens from each group were prepared for light microscopy to confirm histologically the appearances seen under the SEM. RESULTS: Observations indicated that there were no statistically significant differences between the different instruments but the EVA system took significantly longer than either the ultrasonic (P < 0.0001) or hand instruments (P < 0.025) to achieve visual cleanliness. The results supported the view that no instrument removes all extraneous deposits and all were capable of cavity roughness and minor damage to root cementum. Only the hand and ultrasonic instruments left scratches after instrumentation, although the greater part of all the surfaces was surprisingly smooth and calculus free after root surface debridement. CONCLUSIONS: Recently marketed EVA inserts are comparable to ultrasonic and hand instruments for root planing, with respect to calculus removal and quality of the remaining root surface.

Debridement↗
PubMed2006

Effect of two different approaches for root decontamination on new cementum formation following guided tissue regeneration: a histomorphometric study in dogs.

BACKGROUND AND OBJECTIVE: The aim of the present study was to evaluate comparatively the effect of two different approaches for root decontamination on new cementum formation following guided tissue regeneration (GTR). MATERIAL AND METHODS: Nine mongrel dogs were used to obtain bilateral chronic class III furcation defects by placing cotton ligatures around both third mandibular premolars. The teeth were randomly assigned to receive one of the following treatments: scaling and root planing, by means of hand and rotatory instruments, in order to remove soft and hard deposits as well as all root cementum (group A); or removal of only soft microbial deposits, by polishing the root surface with rubber cups and polishing paste, aiming for maximum root cementum preservation (group B). Both groups were treated with GTR, with the use of resorbable polyglycolic-lactic acid membranes (RESOLUT XT). RESULTS: Four months later, data analysis showed that a superior length (mm) (3.59 +/- 1.67 and 6.20 +/- 2.26 for groups A and B, respectively; p = 0.004) and a thicker layer (microm) (18.89 +/- 9.47 and 52.29 +/- 22.48 for groups A and B, respectively; p = 0.001) of new cementum was achieved by keeping the root cementum in place during root decontamination (group B). Regardless of the treatment modality, the new cementum was predominantly of a reparative, cellular extrinsic and intrinsic fiber type. CONCLUSION: Within the limits of the present study, it may be concluded that root cementum preservation may affect the new cementum formation following GTR in class III furcation defects, and the treatment modality did not influence the type of newly formed cementum.

Animals↗
PubMed2004

Comparison of the effects of various periodontal rotary instruments on surface characteristics of root surface.

The efficacy of scaling and root planing using various periodontal rotary instruments was examined. Eighty extracted human teeth with a history of periodontal disease were divided into four groups of 20 and subjected to one of the following procedures: Use of 1) a Root Burnisher, 2) a Perio Planing Bur (both rotating instruments for contra angle handpieces), 3) a Tooth Planing Bur (rotating instrument for use with an air turbine), or 4) a Gracey Scaler. In each case, the time required for cleaning was measured. Twenty healthy extracted human teeth were used as untreated controls. After treatment, the surface roughness of 10 specimens out of each group were measured using a profilometer and observed by scanning electron microscopy (SEM). Half of the samples were then incubated in dishes with a suspension of fibroblasts. After counting the number of attached cells, the attachment of fibroblasts was observed by SEM. The root surfaces treated with the rotary instruments appeared smooth and there were no significant differences between groups. From the SEM observations, smooth root surfaces with different surface textures were evident and a tight attachment of fibroblasts was observed. The results of this study suggest that use of rotary instruments is superior for periodontal scaling and root planing.

Cell Adhesion↗
PubMed2005

Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy.

Current literature supports the use of powered instrumentation over traditional hand instrumentation. The objective of scaling and root planing is the complete removal of plaque and calculus from root surfaces. While this is unrealistic, the accepted end-point is a smooth, glassy root surface during periodontal instrumentation. This often has resulted in overinstrumentation and excessive removal of cementum. Cementum removal has been deemed generally unnecessary. What is essential is the removal of plaque, calculus, and the endotoxin adherent to the root surface. This cleaning of root surfaces is best done with judicious use of powered instrumentation. The excessive removal of cementum during hand instrumentation is due to the lack of visualization. Using endoscopic technology, the ability to visually debride roots can improve chances of success in a more conservative and minimally invasive way. This article provides a brief review of micro ultrasonic technologies and periodontal endoscopy, its implementation in our practice, and a limited case series.

Aged↗
PubMed1998

Root instrumentation. Power-driven versus manual scalers, which one?

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. Taken together, it appears that use of ultrasonic or sonic scalers for periodontal débridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.

Anti-Infective Agents, Local↗
PubMed1995

Effects of citric acid treatment on the Ca, P and Mg contents of human dental roots.

An electron microprobe analyser associated with a scanning electronic microscope was used to measure Ca, P and Mg contents of the human dental root hard tissues, before and after a citric acid treatment (pH = 1). The measurements were made on transverse sections through the cervical 1/3 of the molar roots. The measurements were performed at the following 8 levels: the internal cementum, the cementum-dentine junction, cementum-related dentine, 4 external dentine levels located at 220 microns, 420 microns, 620 microns and 820 microns from the cementum-dentine junction, and finally the juxta-pulpal dentine. After the citric acid treatment, the losses in Ca and P, but not in Mg, varied significantly with the level; an acid-resistant dentine layer of approximately 600 microns was found under the cementum-dentine junction. An increase in the Ca/P ratio was also observed in this layer. Since this external dentine zone is less demineralized by the citric acid than the underlying dentine, the collagen matrix in this region may also be less exposed. These differences in the response to citric acid that depend on the distance from the root surface may explain the unpredictability of periodontal healing after citric acid treatment of diseased root surfaces, because the amount of tissue removed during root planing is not constant.

Calcium↗
PubMed2001

A multidisciplinary approach to the diagnosis and treatment of early-onset periodontitis: a case report.

BACKGROUND: The diagnosis and treatment of early-onset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP. METHODS: The 17-year-old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly. RESULTS: Using a non-surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2-year follow-up period. CONCLUSIONS: This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP.

Adolescent↗
PubMed1993

Two approaches to the treatment of true combined periodontal-endodontal lesions.

Periodontal endodontal lesions present a difficult diagnostic and treatment challenge to the clinician and treatment often requires a combined therapeutic effort. Both endodontal and periodontal surgical procedures may be indicated for access and treatment of these lesions. This case report presents an early onset periodontitis patient with bilateral periodontal-endodontal lesions on mandibular first molars. Treatment included apical surgery followed by repeated scaling and root planing on one tooth and root canal obturation followed by a periodontal bone grafting procedure on the other. Both procedures resulted in clinical attachment gain as well as radiographic evidence of alveolar bone gain. This case report once again demonstrates that proper diagnosis followed by removal of etiologic factors and nonsurgical therapy or periodontal regenerative procedures can restore health and function in cases of severe attachment loss.

Adult↗
PubMed2000

Retention of multi-rooted teeth with class III furcation lesions utilizing resins. Report of 17 cases.

BACKGROUND: Treatment of periodontally diseased multi-rooted posterior teeth has conventionally consisted of scaling and root planing, apically positioned flaps, tunneling, root amputation, root resection, guided tissue regeneration, osseous grafting, and combination osseous graft and barrier membrane techniques. Successful treatment has often been directed and measured by how well the clinician obtains sufficient access to facilitate patient hygiene efforts. Long-term success is predicated upon tooth retention and the arrest of further destruction within the furcation area. METHODS: Seventeen adult periodontal patients with Class III furcation defects were evaluated. Using an open flap procedure, a resin-ionomer was placed into all 3 furcation defects. The patients were placed on quarterly maintenance appointments and the teeth evaluated up to 1 year. RESULTS: The results revealed that sealing the furcations of multi-rooted teeth with hopeless prognoses seems to be a viable alternative to accessing the same intraradicular areas for maintenance using more conventional modes of therapy. Sealing further decreases the surface area of the furca and simplifies future maintenance. CONCLUSIONS: The present study showed that teeth with hopeless prognoses might be retained by decreasing probing depths, bleeding upon probing, and mobility when furcation areas are sealed with a resin-ionomer.

Adult↗
PubMed2001

Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: a rebuttal case report.

BACKGROUND: Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the treatment of multi-rooted posterior teeth ranging from conventional scaling and root planing (SRP), apically positioned flaps, root amputations, root resections, tunnel procedures, guided tissue regeneration, and restorations. The keys to success depend on the clinician's ability to access the furcation to remove local factors and create an environment that enhances the patient's own hygiene efforts. Long-term success in treating teeth with furcation invasion depends upon tooth retention and arresting the destructive processes within the furcation area. METHODS: A Class III furcation invasion in a mandibular molar was treated by surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration. RESULTS: Initially, the patient was asymptomatic. Within 3 months of treatment, the patient presented with suppuration that was refractory to local efforts. Radiographs taken only 5 months postsurgery demonstrated advanced bone loss apical to the restoration. The tooth ultimately was extracted because mobility increased and the tooth became symptomatic. CONCLUSIONS: The clinician must consider the multi-factorial etiology of periodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to have resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, which have demonstrated excellent results when treating furcations with ionomer restorations.

Adult↗
PubMed2003

Gingival recessions caused by lip piercing: case report.

Fear of losing the teeth is common among patients presenting with gingival recession. This report describes a case in which unusual gingival recessions were caused by lip piercing. Periodontal treatment involved removal of the causative agent, hygiene instruction, scaling and root planing, and coverage of the root with a subepithelial connective tissue graft. The therapeutic measures applied in this case yielded satisfactory root coverage, an increase in the width of the keratinized gingiva, improvement in hygiene status and absence of dental hypersensitivity.

Adult↗
PubMedDate not supplied

Gingival recessions caused by lip piercing: case report.

Fear of losing the teeth is common among patients presenting with gingival recession. This report describes a case in which unusual gingival recessions were caused by lip piercing. Periodontal treatment involved removal of the causative agent, hygiene instruction, scaling and root planing, and coverage of the root with a subepithelial connective tissue graft. The therapeutic measures applied in this case yielded satisfactory root coverage, an increase in the width of the keratinized gingiva, improvement in hygiene status and absence of dental hypersensitivity.

Adult↗
PubMed1995

Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study.

The purpose of the present investigation was to study histologically the healing of periodontal lesions in monkeys during the first 9 weeks following periodontal reconstructive surgery according to the principle of guided tissue regeneration. Horizontal interproximal lesions and through-and-through bifurcation defects were surgically produced in 2 adult monkeys. Following removal of granulation tissue and root planing, notches indicating the level of the reduced bone level were prepared in the root surfaces. Sterile teflon membranes were then adjusted to cover the defects, and the gingival flaps were sutured in a coronally displaced position. Sacrifice of the animals was scheduled to allow for observation periods of 1, 3, 4 and 9 weeks. Evaluation of histological specimens revealed a continuous growth of new connective tissue during a period of 4 weeks. The coronal growth of new tissue did not increase significantly between 4 and 9 weeks. New cementum had formed in the most apical part of one notch after 1 week of healing, and following 3 and 4 weeks, new cementum with inserting periodontal ligament fibers were observed in all notches and to a varying degree, also more coronally on the root surfaces of both interproximal and bifurcation defects. Limited regrowth of alveolar bone was observed in the 9-week specimens. Judged from the course of the blood vessels within the newly formed connective tissue in the defects, the tissue in the central part of the defects had originated from the alveolar bone, whereas the tissue adjacent to the root surfaces seemed to have its origin in the residual periodontal ligament.

Alveolar Bone Loss↗