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At least 649 records · Page 36Linked to original sources
PubMed2003

Atypical localized deep pocket due to a cemental tear: case report.

A 71-year old patient with a history of minimal periodontal attachment loss presented with an asymptomatic, non-bleeding, isolated deep pocket on the mesio-facial of a central incisor. Such localized, deep pockets are most frequently associated with a root fracture or an abscess, but in this case an atypical ledge-like projection determined to be a cemental tear was detected at the base of the 6 mm pocket. Periodontal flap surgery revealed a partial detachment of the cementum. Uneventful resolution of the pocket was achieved following root planing to remove the cemental fragment and placement of a bone graft and resorbable membrane. This article reviews the nature, predisposing factors, causes, clinical significance, and treatment of cemental tears.

Aged↗
PubMed2002

Periodontal regeneration following use of ABM/P-1 5: a case report.

ABM/P-15 is a combination of a natural anorganic bovine-derived hydroxyapatite matrix (ABM) and a synthetic cell-binding peptide (P- 15; PepGen P- 15) that has shown the capacity to encourage substantial clinical fill of periodontal infrabony defects. Human histology following its use has not been evaluated on pathologic root surfaces. A maxillary lateral incisor with advanced adult periodontitis that was treatment planned for extraction was treated with sulcular incisions, full-thickness flap reflection, debridement of granulomatous tissue from the defect, placement of a notch in the root at the apical extent of calculus, mechanical root planing, brief cleansing with citric acid, grafting with ABM/P-15, wound closure with sutures, and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of a small block section biopsy at about 6 months. Histologic evaluation of the region coronal to the apical edge of the calculus notch showed evidence of regeneration (new cementum, bone, and periodontal ligament). Graft particles were still present at 6 months, but no evidence of root resorption, ankylosis, or untoward inflammation was seen. This case report fulfills the proof of principle that use of ABM/P-15 can result in periodontal regeneration on previously diseased root surfaces in humans.

Acid Etching, Dental↗
PubMedDate not supplied

The role of the general dentist in periodontal care.

Epidemiologic studies find the rate of periodontal disease in the U.S. to be of sufficient significance that periodontal therapy should not be placed uniquely in the domain of the specialist. It is advisable that periodontal record-keeping and treatment, particularly with nonsurgical techniques including scaling and root planing and subantimicrobial and antimicrobial therapy, become part of the daily routine in the general practitioner's office.

Anti-Bacterial Agents↗
PubMed1999

Locally delivered doxycycline hyclate: case selection, preparation, and application.

This article presents the perspective of a private practice clinician who participated in the phase III clinical trials of Atridox (doxycycline hyclate) 10%. The selection of periodontal cases most likely to benefit from treatment with Atridox as part of overall comprehensive case management is discussed. Atridox may be used either before or after scaling and root planing or, in more rare circumstances, as a stand-alone therapy. Preparation of the material is discussed, and guidance for optimal application is provided.

Anti-Bacterial Agents↗
PubMed2006

The potential prognostic value of some periodontal factors for tooth loss: a retrospective multilevel analysis on periodontal patients treated and maintained over 10 years.

BACKGROUND: The great challenge in clinical periodontology is assigning a prognosis to a periodontally affected patient. Many different factors can affect the long-term maintenance of periodontally compromised teeth. The main questions usually considered by the periodontist are: 1) Will a tooth lose more bone in the future? 2) Will the tooth itself be lost in the future? The purpose of this retrospective study was to evaluate the value of some clinical, genetic, and radiographic variables in predicting tooth loss in periodontal patients (aged 40 to 60 years) treated and maintained for 10 years. METHODS: Sixty consecutive non-smoking patients (aged 46.77 +/- 4.96 years) with moderate to severe chronic periodontitis (CP) were treated with scaling and root planing (SRP). Some patients also underwent additional surgical treatments. All patients were maintained in the same private practice for 10 years. The frequency of recall appointments was 3.4 +/- 1.0 months. At baseline (T(0)) and 10 years later (T(2)) the following clinical variables were evaluated: the number of teeth, probing depths (PD), tooth mobility (TM), and presence of prosthetic restorations (PR). In addition, radiographic measurements were taken of the mesial and distal distances from the cemento-enamel junction (CEJ) to the bottom of the defect (BD), to the bone crest (BC), and to the root apex (RA). At T(2), a genetic test to determine the IL-1 genotype and genetic susceptibility for severe periodontal disease was performed for all 60 patients, and they were classified as IL-1 genotype positive (G+) or negative (G-) according to the test results. Tooth loss was used as the outcome variable. Different predictor variables were then tested using a two-level statistical model (patient and tooth levels). At the patient level, these were: age, gender, mean bone loss (mean CEJ-BD)(T0), the interleukin-1 (IL-1) genotype, the interaction between mean bone loss, and IL-1 genotype (mean CEJ-BD(T0) x IL-1 genotype). At the tooth level, the variables were: TM(T0), prosthetic restorations (PR)(T0), molar teeth (MT)(T0), the infrabony component of the defect (BC-BD)(T0), PD(T0), bone level (CEJ-BD)(T0), and residual supporting bone (BD-RA)(T0). RESULTS: Among the considered predictor variables, the following were significantly associated with the outcome variable: 1) MT(T0) (P <0.0001); 2) BC-BD(T0) (P = 0.0377); and 3) BD-RA(T0) (P <0.0001). MT(T0) were found to be more prone to loss and the amount of BD-RA(T0) prognostic for tooth loss: the lower the residual amount of supporting bone, the higher the probability of tooth loss. Conversely, the BC-BD(T0)was associated with a reduced probability of future tooth loss: the greater the infrabony component, the lower the probability of tooth loss. None of the other considered predictors proved predictive for tooth loss. CONCLUSIONS: Within the scope of this study, many traditional prognostic factors were ineffective in predicting future tooth loss and, therefore, were of no prognostic value. Conversely, a few specific factors at the tooth level emerged as viable prognostic factors. The use of these factors may be of great value to practitioners as predictors of tooth loss when assigning a prognosis.

Adult↗
PubMed1999

Influence of different curette insertion depths on the outcome of non-surgical periodontal treatment.

This study was undertaken to compare the effects of scaling and root planing (Sc/RP) performed from approximately 1 mm coronal to (test Sc/RP) or at the bottom of (control Sc/RP) the probeable pocket to the gingival margin. 2 male and 5 female patients with moderate to severe periodontitis participated in the study. Initial examination was performed with respect to probing pocket depth (PPD) and probing attachment level (PAL) using a pressure-controlled periodontal probe and stents. The patients received repeated instruction in oral hygiene, and their plaque control reached an excellent level. Baseline examination including PPD and PAL measurements was then performed. Following the baseline examination, single-rooted teeth in 1 quadrant of each dentition were randomly selected and subjected to the test Sc/RP (test teeth) or control Sc/RP (control teeth). The PPD and PAL were measured 1 and 3 months following Sc/RP. It was demonstrated that: (i) the PPD reduction following Sc/RP was larger at the sites with initially deep pockets than at the sites with shallow pockets; (ii) the mean PPD reduction at the sites with an initial PPD > or =3.5 mm was significantly larger in the control teeth than in the test teeth; (iii) there was a significant PAL gain in the initially deep pockets but not in the initially shallow pockets; (iv) the PAL gain in the initially shallow pockets was significantly larger in the control teeth than in the test teeth. In the treatment of periodontitis, trauma caused by Sc/RP to the most coronal part of the connective tissue attachment seems to be of minor importance compared to the effective removal of subgingival deposits.

Adult↗
PubMed1996

Cervical cemental tears in older patients with adult periodontitis. Case reports.

This communication reports 5 cases of cervical and 1 apical cemental tears. The diagnosis of the cervical tears was made by a characteristic feature which presented radiographically as a prickle-like body. The fragment of cementum could be detached by root planing or during periodontal surgery and uneventful healing was obtained following these procedures. The process of aging in addition to continuous occlusal strain may lead to this phenomenon. Cervical cemental tear may be one of the contributing factors in the progress of adult periodontitis.

Aged↗
PubMed2001

Retrospective evaluation of the influence of the interleukin-1 genotype on radiographic bone levels in treated periodontal patients over 10 years.

BACKGROUND: A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin-1 (IL-1) polymorphism on the rate of bone and tooth loss in non-smoking periodontally treated patients during maintenance. METHODS: Sixty consecutive non-smoking patients (mean age 46.8 +/- 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cemento-enamel junction [CEJ]-root apex, CEJ-bottom of defect mesial and distal, CEJ-bone crest mesial and distal, crown-root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 +/- 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL-1 genetic susceptibility testing was collected and sent for analysis. RESULTS: Twenty-three of the 60 patients (38.3%) were IL-1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL-1 genotype negative group and 24 of 609 (3.9%) in IL-1 genotype positive group. The mean variation in bone defect level (DeltaBD) averaged -0.04 mm in IL-1 genotype negative patients and 0.01 mm in IL-1 genotype positive patients. The mean variation in bone crest level (DeltaBC) averaged -0.24 mm in IL-1 genotype negative patients and -0.28 mm in IL-1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL-1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL-1 positive patients. IL-1 positive patients with severe initial bone loss showed a better response to the therapy than IL-1 negative patients. CONCLUSIONS: On average, there were no significant differences related to IL-1 genotype in tooth loss after 10 years in a non-smoking, well-maintained periodontal population. On an individual patient basis, the IL-1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation.

Adult↗
PubMed1997

Clinical and microbiological effects of minocycline-loaded microcapsules in adult periodontitis.

Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.

Absorption↗
PubMed1998

The role of local drug delivery in the management of periodontal diseases: a comprehensive review.

This review article evaluates the role of local drug delivery systems in the management of periodontal diseases. The efficacy of several local delivery devices (i.e., tetracycline fibers, metronidazole and minocycline gels, chlorhexidine chips, and doxycycline polymer) which are either commercially available in the United States or abroad, or are currently under consideration for Food and Drug Administration (FDA) approval are discussed. The drug delivery systems are assessed with regard to their functional characteristics, effectiveness as a monotherapy, as compared to scaling and root planing, and ability to enhance conventional therapy. Furthermore, controversies associated with local delivery are addressed (e.g., induction of bacterial resistant strains, the efficacy of systemic versus local drug delivery, and whether local drug delivery should function as an alternative or as an adjunct to conventional treatment).

Administration, Topical↗
PubMed2006

Periodontal healing after non-surgical therapy with a modified sonic scaler: a controlled clinical trial.

AIM: The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using a modified sonic scaler system versus scaling and root planing (S/RP) with hand instruments. MATERIAL AND METHODS: The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and lower jaws. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was investigated. The Wilcoxon signed-rank test (alpha = 0.05) was used for statistical analysis. RESULTS: With both therapy methods, periodontal conditions showed statistically significant clinical and microbiological improvements after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites and less time required for root instrumentation by the sonic scaler, no other clinical and microbiological parameters revealed significant differences between sites treated with the sonic scaler or S/RP. CONCLUSION: The sonic scaler system and S/RP seem to provide similarly favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Adult↗
PubMed2000

Radiographic osseous regeneration after initial therapy with systemic doxycycline.

Early-onset periodontal diseases are often diagnosed in the military as a result of the requirements for annual dental examinations and the youthful population served. A young soldier diagnosed with rapidly progressive periodontitis completed initial therapy of root planing with the systemic antibiotic doxycycline but was poorly compliant with additional treatment. During a subsequent mandatory dental examination, new radiographs demonstrated a significant improvement in the quantity and quality of alveolar bone, illustrating the regeneration potential of the young patient with early-onset periodontal disease.

Adult↗
PubMed2004

A technique to remove epulis: case reports.

The purpose of this study was to describe an alternative surgical approach to removing epulis while preserving and improving the mucogingival complex. After scaling and root planing, six patients underwent surgical treatment to remove the growths. A subepithelial connective tissue graft was interposed between the bone and epulis using a pedicle flap. The lesion was always preserved. The epulis disappeared after several months, with minor variations in healing time among patients. At 60-month follow-up visits, all patients exhibited good gingival health, with no recurrence.

Adult↗
PubMed2005

Clinical and microbiological evaluation of the effectiveness of the Nd:Yap laser for the initial treatment of adult periodontitis. A randomized controlled study.

BACKGROUND: Enhancement of the results obtained by scaling and planing is most often sought by using antimicrobial therapies. Laser beams have been shown to be bactericidal and could possibly target pathogens more effectively and with fewer compliance problems than antiseptic solutions. METHODS: Thirty subjects 20-60 years old presenting periodontal pockets at least 5 mm deep in each quadrant received initial periodontal treatment. The study had a split-mouth design. The control side (SRP) only received scaling and planing, and the test side (SRP+laser) was treated by both SRP and Nd:Yap (yttrium aluminum perovskite doped with neodym) laser. Clinical conditions were evaluated at day 0 and day 90 using the plaque index, gingival index, bleeding on probing, pocket probing depth, and clinical attachment level. Microbial sampling was also performed on days 0 and 90, and the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was analysed by polymerase chain reaction in a commercial laboratory. Post-operative pain or discomfort was measured by the patient using a linear visual scale. Pearson's chi-squared test was used to compare bacterial presence. RESULTS: There was no statistically significant difference concerning clinical data between test and control groups at baseline. Both treatments enhanced the clinical situation compared to baseline; however, results were not significantly different between the two groups. T. forsythensis was the organism most numerous in both groups. Though initial treatment diminished the numbers of all the pathogens it did not do so statistically significantly. Differences between test and control groups were very small and bore no significance. Evaluation of the post-operative pain did not reveal any differences between the groups. CONCLUSIONS: Scaling and root planing was effective in reducing levels of plaque, inflammation, and bleeding upon probing. No additional advantage was achieved by using the Nd:Yap laser.

Adult↗
PubMed2002

[Full mouth one stage disinfection of the oropharynx. A new treatment strategy for periodontitis].

Most periodontal pathogens colonise different niches such as the oral mucosa, tongue, saliva, periodontal pockets, all hard intra-oral surfaces and the tonsils. Since intra-oral translocation of these pathogens between these niches is possible, a 'one stage' disinfection of the whole mouth in one or two consecutive days as treatment strategy for periodontal infections must be considered. A one stage full-mouth disinfection is achieved by a scaling and root planing of all periodontal pockets within 24 hours, in combination with a chlorhexidine application in all niches (subgingival irrigation, mouth wash, brushing of the tongue, and spray for the pharynx). As such, reinfection by bacteria of recently instrumented sites is inhibited. This approach results in significant additional clinical and microbiological results compared to the classical approach (scaling and rootplaning per quadrant with several days or weeks between each session).

Dental Plaque↗
PubMed2000

Human histologic evaluation of bioactive ceramic in the treatment of periodontal osseous defects.

This study examined the healing of intrabony defects around 5 teeth treated with bioactive glass ceramic (PerioGlas). Healing was evaluated by clinical measurements, radiographic observation, and histologic analysis. The protocol included a presurgical phase of scaling and root planing therapy, with measurements obtained immediately prior to the surgical procedures and after 6 months of healing. Following therapy there was a mean of 2.7 mm of probing depth reduction, 2.2 mm of clinical attachment gain, and 0.5 mm of recession. The histologic analysis revealed healing by a long junctional epithelium with minimal new connective tissue attachment to the teeth, except in one case where the intrabony region demonstrated new cementum formation and new connective tissue attachment. Graft particles were found to be biocompatible, as evidenced by being embedded in a stroma of dense connective tissue with minimal inflammatory infiltrate. There was minimal new bone formation limited to the most apical borders of the defects. No signs of periodontal regeneration as defined by new cementum, periodontal ligament, and bone formation on a previously diseased root surface were observed. Although the clinical results are encouraging and radiographs evidenced radiopacities within the defects, histologic analysis revealed that as a periodontal grafting material, bioactive glass ceramic has only limited regenerative properties.

Alveolar Bone Loss↗
PubMed1998

Treatment considerations in rapidly progressive periodontitis: a case report.

This article presents a concept for the control of periodontal pathogens in early-onset periodontitis and demonstrates the reparative potential of periodontal tissue when the infection is under control. The patient discussed here was diagnosed with rapidly progressive periodontitis. We were able to reduce the bacterial mass with scaling and root planing and, in conjunction with systemic antibiotics, return the microbial profile to the normal range. Microbiological testing was used to monitor the microbiota and to adjust antimicrobial treatment. Improvements in probing depths and attachment levels were monitored for more than 1 year. Tissue response to this treatment made surgical intervention unnecessary. Although not essential, orthodontic treatment enhanced cleansability and improved esthetics.

Adult↗
PubMed2006

Periodontal disease in a Rubinstein-Taybi syndrome patient: case report.

INTRODUCTION: Rubinstein-Taybi syndrome (RTS) is a rare disorder affecting 1 of 300,000 people, characterized by growth, mental and motor retardation, small stature, broad thumbs and toes, characteristic face, high-arched palate, and recurrent respiratory infections. CASE REPORT: The present report describes the periodontal and immunological status of a 14-year-old female patient with RTS. Probing depth, clinical attachment level, bleeding on probing, and radiographic evaluation were performed. Periodontal examination revealed severe attachment loss in incisors and molars and generalized bleeding on probing. Periodontal treatment consisted of scaling and root planing and oral hygiene instructions. Periodontal treatment resulted in resolution of gingival inflammation and pocket depth reductions. The association of periodontal disease and RTS is previously undescribed. CONCLUSION: This case report underscores the importance of periodontal clinical diagnosis and the possibility of successful periodontal treatment in RTS patients.

Adolescent↗