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PubMed1987

Juvenile periodontitis--a new perspective.

Juvenile periodontitis (JP) is a severe disease of the periodontium in adolescents. It is usually localized to the first permanent molars and (less commonly) the central incisors. The bacteria Actinobacillus actinomycetemcomitans (Aa) is currently implicated in the aetiology of JP since its numbers are high in JP pockets and low in subjects with healthy periodontal conditions or with adult periodontitis. However, Aa harvested from JP pockets and transferred to healthy sites in the same mouth are unable to colonize these areas or initiate disease (17). The conflicting evidence implicating intrinsic or induced impairment of host defence is reviewed. It is hypothesised that JP lesions are primarily of endodontic origin. By-products of an inflammatory process in the pulp enter the periodontium via dentinal tubules, lateral or furcation canals and drain through the periodontium into the mouth. The environmental conditions of the sinus select for bacteria such as Aa which secondarily infect the site and exacerbate the clinical situation by their potent virulence factors. Localized deep defects involving only one side of an interproximal space in an otherwise periodontally healthy mouth result. Studies of the pulpal status of JP teeth are indicated.

Actinobacillus↗
PubMed1994

A combined endodontic retrofill and periodontal guided tissue regeneration technique for the repair of molar endodontic furcation perforations: report of a case.

This is a report of a case in which the techniques of endodontic retrofill and guided tissue regeneration were used together to treat a perforation of the mesiofacial root of a maxillary left first molar (a strip perforation). After full-thickness flap reflection, the root received a retrograde filling and a large fenestration defect was surgically created to allow access to the furcal (distal) surface of the mesiofacial root. The roots were treated with tetracycline, the defect was filled with freeze-dried, demineralized, irradiated human cadaver bone, and the access fenestration was covered with a piece of barrier membrane. Healing was uneventful and the defect showed 100% bone fill at the time of reentry to retrieve the membrane 7 months after the initial surgery. Fifteen months after surgery the area appears clinically and radiographically healthy and the tooth has been employed as an abutment for a fixed partial denture.

Adult↗
PubMed1999

Attempts to obtain re-osseointegration following experimental peri-implantitis in dogs.

The purpose of this study was to examine the healing potential and re-osseointegration in peri-implant infection defects adjacent to various implant surfaces. In 7 female Beagle dogs, a total of 41 titanium oral implants (ITI, Straumann, Waldenburg; Switzerland) with a sink depth of 6 mm (diameter 2.8 mm) were placed transmucosally. Four different surface configurations (TPS: titanium plasma sprayed (10); SLA: sand blasted and acid-etched (13); M: machined and smooth (11); TPS furc.: titanium plasma sprayed with coronally placed perforation to mimic a furcation (7) were distributed among the animals and locations. Following a healing period of 3 months, silk ligatures were placed and oral cleaning procedures abolished for 4 months to induce a vertical bone loss of about 40%. Following mechanical and chemical cleansing (chlorhexidine and metronidazole) and disinfection, the lesions were either sham operated (11) or subjected to a GTR procedure using ePTFE (30). After 6 months of healing the animals were killed and the jaws histologically evaluated. Six membranes were lost TPS: (1); SLA: (2); M: (2); TPS furc: (1) and 3 membranes exposed TPS: (1); M: (2) and excluded from further evaluation. Owing to the loss of 1 implant and infection of the membranes in the TPS furc group, this implant configuration was discarded from further analysis. For TPS surfaces, bone fill was 2.6 mm (73% of the distance from the bottom of the defect to the shoulder of the implant) sites with (4 GTR) and 0.33 mm (14%) for sites without membrane (2 controls). Re-osseointegration was 0.5 mm (14%) in the test group and 0.3 mm (14%) in the control. For SLA surfaces bone fill was 2.3 mm (83%) for sites with (7 GTR) and 0.41 mm (15%) for sites without membranes (4 controls). Re-osseointegration was 0.6 mm (20%) and 0.3 mm (11%) respectively. Corresponding values for M surfaces were 2.2 mm (62%) with 4 GTR) and 0.82 mm (31%) without membranes. Re-osseointegration was 0.07 mm (2%) and 0.19 mm (7%) respectively. This study has documented that peri-implant infections defects may heal with bone fill provided that the infection is controlled through effective antibacterial therapy. However, true reosseointegration appears to be difficult to achieve.

Alveolar Process↗
PubMedDate not supplied

Nonsurgical repair of furcal perforations: a literature review.

The important steps in the management of a furcal perforation are immediate action, adequate isolation, debridement, and sealing of the defect. Studies have shown that repair materials or underlying matrix material such as amalgam, Cavit, calcium hydroxide, glass ionomers, hydroxylapatite, tricalcium phosphate, and demineralized freeze-dried bone have not been able to produce consistent results. However, current research on new materials such as mineral trioxide aggregate may advance treatment modalities significantly for furcation repair.

Aluminum Compounds↗
PubMed1997

Periodontal regeneration by application of recombinant human bone morphogenetic protein-2 to horizontal circumferential defects created by experimental periodontitis in beagle dogs.

The purpose of this study was to examine the regeneration of periodontal tissue after the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) to horizontal circumferential defects created by experimental periodontitis. Twelve mandibular second premolars in 6 adult beagle dogs were subjected to experimental periodontal breakdown by placing silk ligatures around the teeth until the bone loss exceeded half of the root length. Flap surgery was then performed and the exposed cementum removed. The distance between the bone crest and cemento-enamel junction (CEJ) was about 5 mm. RhBMP-2 (40 micrograms/100 microliters) with a sponge-type carrier material made of gelatin and polylactic acid polyglycolic acid copolymer was placed in the furcation area (5 mm x 5 mm x 5 mm) and around the roots (10 mm x 5 mm x 2.5 mm x 2 pieces). In the control group, the same carrier material without rhBMP-2 was placed in the same manner. The flaps were replaced and sutured to cover these materials completely. Twelve weeks after surgery, the animals were sacrificed and serial sections were prepared in a bucco-lingual plane. Considerable new bone formation was observed in the rhBMP-2-treated sites. New cementum with Sharpey's fibers was observed on the instrumented root surface. On histometric analysis, the amount of new bone, new cementum, and connective tissue attachment was significantly greater in the rhBMP-2-treated group (paired t test; P < 0.01). These results indicate that suitable application of rhBMP-2 can produce considerable periodontal tissue regeneration, even in cases of horizontal circumferential defects.

Alveolar Bone Loss↗
PubMed1993

Healing of furcation perforations in primate teeth after repair with decalcified freeze-dried bone: a longitudinal study.

Furcation perforations were created in 18 maxillary and mandibular molars in three adult rhesus monkeys. The perforations were located in the center of the pulp chamber floor and were 1 mm in diameter and 3 mm in depth. Teflon was used as a negative control to cover the perforation site in three teeth and the bony defects in the other 15 teeth were filled with decalcified freeze-dried bone. At the end of the 6-month experimental period the gingival tissues were clinically healthy, there was normal sulcular probing depths around all teeth, and only one tooth demonstrated furcal bone loss, radiographically. The histological picture for the Teflon and decalcified freeze-dried bone groups was very similar. There was a layer of epithelium immediately beneath the perforation site and deep to this was fibrous connective tissue and bone. Chronic inflammation was present in the connective tissue of all 3 Teflon samples but in only 2 of the 15 decalcified freeze-dried bone samples. New bone formation was not observed in any of the samples.

Animals↗
PubMed1999

Periodontal regeneration: myth or reality?

One of the goals of periodontal therapy is regeneration. During the past 20 years, several materials and techniques have been developed and tested for enhancing periodontal regeneration. This paper evaluates flap debridement, allogenic and alloplastic grafting, and the use of nonresorbable and resorbable barrier membranes as regenerative techniques. One of the most predictable regenerative therapies is treatment of the three-walled intrabony defect. This defect can be repaired with 2 to 2.5 mm of bone fill and results in significant gains in clinical probing attachment and decreases in probing depths. There is a slightly greater improvement in periodontal measures with barrier membranes. Commercial preparations of allogenic bone and alloplastic fillers have a long, safe history of use and are primarily osteoconductive. They decrease probing depths and provide short-term gains in clinical attachment levels. Barrier membranes provide short-term evidence of improving Class II furcation invasions, however there is insufficient evidence that these improvements are sustained long-term. Class III furcations are not predictably treated by regenerative therapies. To date, there is an absence of clinical evidence that regenerative therapy increases the long-term life span of teeth.

Alveolar Bone Loss↗
PubMed1991

The role of the prosthodontist in restoring root-resected molars: a study of 70 molar root resections.

Root resection is a complex, multidiscipline technique to eliminate molar furcation invasions. In the short term of 3 or 4 years it has been highly successful, but after 10 years approximately one third fail. A substantial number of failures were attributed to recurrent periodontal disease. This study examined 70 root resected molars in 62 patients for the quality of the resections. Twenty-one (30%) of the resections were considered faulty when subgingival, residual roots, furcal lips, and/or ledges were present. Failures were more frequent in maxillary molars (33.3%) than mandibular molars (22.7%). Clinically hidden roots/lips and ledges in mandibular molars were readily observed in radiographs, but were seen radiographically only 37.5% of the time in maxillary molars. Since subgingival defects are believed to encourage future periodontal disease, it is important that the dentist detect these structures and correct them before proceeding with the permanent restoration.

Adult↗
PubMed1991

The use of autogenous periosteal grafts as barriers for the treatment of Class II furcation involvements in lower molars.

This study clinically analyzed the efficacy of a connective tissue graft including the periosteum used as a barrier to enhance new attachment and osseous regeneration. Fifteen patients, with no systemic diseases, and adult periodontitis including 2 Class II furcation involvements in lower molars comprised the study group. After completion of the initial phase of therapy, all patients were treated with full-thickness periodontal flaps, using sulcular incisions, and thorough scaling and root planing. One furca, selected at random, had a connective tissue graft, obtained from the palate and including the periosteum, placed over the furca with the flap sutured over the top of this graft. Control furcas received no graft and the flap was sutured in its original position. Both molars were treated in the same session. The following presurgical measurements were made: probing pocket depth, attachment level, gingival recession, sulcular bleeding index, and plaque index. The horizontal and vertical dimensions of the osseous defects were recorded after flap elevation and debridement. Six months later all clinical parameters were again measured and reentry flaps were performed to measure the bony defects. No statistically significant differences were found preoperatively between control and experimental molars with respect to soft tissue and osseous measurements. Six months after surgery, the experimental molars showed, in comparison to the controls, significant reduction in pocket depth and gain in attachment level as well as in vertical and horizontal measurements of the inter-radicular osseous defect.

Adult↗
PubMed1988

[Application of an air-powder abrasive system in periodontal therapy and its effect on root surfaces].

An air-powder abrasive device used to remove stain and debris adherent to tooth surface is now available for use by dentist. Air Flow was evaluated for its effectiveness in removing stains and debris from teeth. Split design in anterior was used, and half was treated with the device and the contralateral side with a brush cone and tooth polishing paste. Time required by each method to remove stain and debris completely was recorded and compared. A gingival trauma index was assessed according to the method of Weaks L.M. et al. (1984). Air-powder abrasive system removed stain and debris in less time than brush cone technique (P less than 0.001). The system was also most effective in removing stains in pit, fissure and contact areas. The device caused a significant increase (P less than 0.01) in gingival irritation immediately posttreatment, but there was no statistically and clinically significance in the effect on the gingiva at 7 days posttreatment between two techniques. In vitro study, the effect of the device on root surfaces was also assessed. 5, 10, 20, 40 and 60 seconds exposure of a fixed point on root surfaces to the device produced defects 137, 245, 308, 945 and 1,394 microns in depth, respectively. The resulting surface was smooth and all cementum was removed. And the average loss of root structure as a function of the exposure time was also assessed. The average losses were 0.2, 0.6, 1.7, 1.8, 2.0, 2.1, 2.3 and 2.4 mg by 5, 10, 15, 20, 30, 40, 50 and 60 seconds exposures, respectively. Root surface roughness, resulting from hand curette, ultrasonic curette and air-powder abrasive system was examined histologically. The hand curette produced smooth root surface. The ultrasonic instrument produced a surface characterized by irregular ridges. The air powder abrasive system was found to produce a root surface favorably comparable to manual root planing and remove cementum from areas of difficult treatment, such as furcations.

Dental Prophylaxis↗
PubMed1999

[Simplified periodontal record for pregnant women].

PURPOSE: The assessment using the PSR (Periodontal Screening and Recording) of the prevalence and severity of and the basic treatment needs for periodontal disease in a group of pregnant women who attended the Preventive Dentistry Clinic at the School of Dentistry of Araraquara--UNESP. METHODS: Forty-one pregnant women of 16 to 37 years of age, were examined. The PSR index was evaluated with a suitable periodontal probe (Trinity-model 621-WHO) with index codes scores of from 0 to 4, capable of indicating the presence of the following conditions: periodontal health, bleeding on probing, calculus, shallow and deep pockets. These codes were attributed to each sextant and could be marked with an asterisk (*) to indicate the presence of gingival recession, furcation lesions, mobility or any other mucogingival alterations. RESULT: It is shown that 100% of the pregnant women had some kind of gingival alteration, represented mainly by PSR code 2 (56.1%) and "*" (19.5%). The women in the youngest age groups, 15-19 and 20-24 years, had code 2 as their highest score with no sextant excluded. In the 25-29 age group, the PSR code 2 still prevailed (54.5%) although codes 3 and 4 were already appearing. The code "*" and the occurrence of excluded sextants tended to increase in the oldest age group (30-37). In general, the affected sextants showed codes 1 and 2 more frequently, corresponding to 41.6% and 39.8% respectively, which represented a mean of 2.49 and 2.39 sextants affected in each pregnant woman. Regarding the treatment needs, 90.2% of the women needed some treatment beyond the preventive measures begun, including scaling and root planning and/or corrections of defective restorative margins (61%), and more complex treatment (29.2%). CONCLUSION: The meeting of the treatment needs during pregnancy must include special efforts to increase motivation and promote oral health, minimizing the possibility of vertical transmission of pathogenic microrganisms to the child, and thus contributing to the primary prevention of the main oral diseases.

Adolescent↗
PubMed1996

Repair following treatment of circumferential periodontal defects in dogs with collagen and expanded polytetrafluoroethylene barrier membranes.

This study was designed to evaluate healing following treatment of periodontal defects using 2 collagen barrier membranes with different degrees of cross-linking, and to compare the results to those following use of an expanded polytetrafluoroethylene (ePTFE) membrane. Horizontal, circumferential defects were created in mandibular premolar teeth of 6 beagle dogs, followed by placement of membranes and wound closure. Postoperative healing was monitored clinically for 6 months, at which time the animals were sacrificed and specimens were taken for histological examination. Clinical observations indicated that the highly cross-linked, slow-resorbing collagen membrane did not integrate with the tissues the way the less crosslinked, rapid-resorbing collagen did. Membrane exposure was typical for the slow-resorbing membrane in contrast to the rapid-resorbing membrane which remained covered. The inferiority of the slow-resorbing membrane was evident by the extensive clinical recession and the attachment level measurements taken at 6 months, and it was decided to omit this membrane from histometric analysis. Histological examination of root surfaces treated with rapid-resorbing collagen or ePTFE membranes revealed substantial reparative healing. The connective tissue repair amounted to 84% of the treated root surface height for the rapid-resorbing collagen and 53% for the ePTFE membrane (difference not statistically significant). However, the connective tissue repair to the rapid-resorbing collagen group root surfaces was often associated with a layer of ankylosis (44%, versus 8% of the ePTFE group). It appeared that much of the ankylotic response was initiated from the furcation area and extended around to the buccal and lingual surfaces. In addition, this study provided histological evidence that granulation tissue forming under clinically exposed and plaque contaminated ePTFE membranes can still result in connective tissue repair. It was concluded that the rapid-resorbing collagen membranes and the ePTFE membranes seem capable of stimulating periodontal connective tissue repair, whereas the slow-resorbing collagen membranes were unsuccessful in this effort, as seen in this dog model.

Alveolar Bone Loss↗