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PubMed1992

Treponema denticola and Porphyromonas gingivalis as prognostic markers following periodontal treatment.

Subgingival plaque samples were collected from individuals with advanced periodontitis before and 3 to 11 weeks after scaling and root planing periodontal treatment. The plaque levels of Treponema denticola and Porphyromonas gingivalis antigens were measured before and after treatment by a quantitative immunoassay procedure using monoclonal antibodies specific for these oral bacteria. A decrease in mean levels of T. denticola (P less than .05) and P. gingivalis antigens (P less than .09) were observed following periodontal therapy. Improved health, as measured by a decrease in probing depth, was associated with a decrease in T. denticola antigen (P less than .05). These results suggest that the T. denticola levels of successfully treated sites decreased, while non-responding sites had levels of this microbial marker which were equal to or greater than the pre-treatment levels. These results provide additional evidence that T. denticola is associated with human adult severe periodontal disease, and can serve as a prognostic marker for disease recurrence.

Adult↗
PubMed1994

Effects of blunt scaling on periodontal status and subgingival microorganisms. A pilot study.

Clinical and microbiological effects of 3 periodontal treatments were investigated: (i) scaling and root planing with sharp instruments combined with pocket flushing, (ii) scaling with blunt plastic curettes and pocket flushing, and (iii) pocket flushing alone. Clinically comparable, randomized sites of 8 patients with progressive adult periodontitis were treated 4 times in intervals of approximately 4 months. Prior to each re-treatment and at the end of the study all sites were clinically monitored and the subgingival microflora was examined. Results showed that all treatments were effective in reducing pocket depths and the subgingival microflora, while attachment levels remained unchanged. At individual sites treatment responses were of considerable heterogeneity. In general, clinically improving sites had strongly reduced and sites loosing > or = 3 mm of attachment high residual bacterial cell numbers. Sites with intermediate residual subgingival plaque levels showed quite variable clinical responses. This preliminary study suggests that weakly abrasive procedures could be very valuable for the initial treatment of periodontal lesions. This hypothesis should be further tested in comprehensive clinical trials.

Adult↗
PubMed1991

The use of sustained release delivery of chlorhexidine for the maintenance of periodontal pockets: 2-year clinical trial.

The release of chlorhexidine from an ethyl cellulose-based dosage form (SRD) has been shown to be effective in the reduction of the flora associated with periodontal pockets as well as in reducing probing depths. In this study, treatment with this dosage form was compared to routine maintenance therapy (RMT) in a 2-year, split mouth clinical trial. Ten patients with 84 pockets greater than or equal to 5 mm who had not received any periodontal therapy or systemic antibiotics over the last 6 months were included. The patients all received a full mouth scaling and root planing together with through oral hygiene instruction. Two months later (baseline) plaque index (P1I), bleeding on probing (BOP), pocket probing depth (PD), and attachment levels (AL) were assessed at all selected sites. Pockets on the control side then received RMT while the experimental pockets were treated with the SRD only. Treatment was repeated every 3 months for 2 years. The SRD treatment resulted in an improvement of greater than or equal to 3 mm in PD of at least 1 pocket in 8 of 10 patients, while RMT resulted in a similar improvement in only 1 of 10 patients (P = 0.012). Similarly a gain of attachment of greater than or equal to 3 mm was found in at least 1 SRD pocket in 8 of 10 patients. The RMT resulted in a similar improvement in only 2 patients (P = 0.012).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Gingival crevicular fluid osteopontin levels in periodontal health and disease.

BACKGROUND: Osteopontin (OPN), a glycosylated phosphoprotein, is a bone matrix component produced by osteoblasts, osteoclasts, and macrophages as a multifunctional cytokine. OPN anchors osteoclasts to the bone surface, and its absence leads to impaired bone resorption. The aim of the present study was to assess the relation between clinical parameters and concentrations of OPN within gingival crevicular fluid (GCF) from inflamed gingiva and periodontitis sites and, subsequently, after the treatment of periodontitis sites. METHODS: A total of 45 subjects were divided into the following three groups based on modified gingival index (MGI) and Ramfjord periodontal disease index (PDI) scores: healthy (group I), gingivitis (group II), and chronic periodontitis (group III). A fourth group consisted of 15 subjects from group III, 6 to 8 weeks after treatment (i.e., scaling and root planing [SRP]). GCF samples collected from each patient were quantified for OPN using the enzymatic immunometric assay. Further, the correlation between OPN levels in situ with clinical parameters was analyzed in all groups and before and after treatment in periodontitis patients. RESULTS: The highest mean OPN concentration in GCF (14.347 microg/ml) was observed in group III, and the lowest mean OPN concentration in GCF (2.522 microg/ml) was observed in group I. Its levels in group III decreased to 8.419 microg/ml after treatment (group IV). Further, GCF OPN levels in all the groups showed a statistically significant positive correlation with clinical attachment loss (P <0.05). CONCLUSIONS: OPN levels increase in GCF from healthy to periodontitis states, and periodontal treatment results in the reduction of OPN levels. The data indicate that OPN may play a key role in, and could be considered a biomarker of, periodontal disease progression.

Adult↗
PubMed1995

Prognostic criteria for the efficiency of non-surgical periodontal therapy in advanced periodontitis.

The aim of the study was to find out which clinical, radiographic and microbiological variables can be used as prognostic criteria for the efficiency of the commonly used initial treatment protocol comprising scaling, root planning and instruction on oral hygiene in advanced adult periodontitis. 46 patients (mean age 48 years) with untreated, advanced periodontitis volunteered for the study. The clinical examination included recordings of plaque, gingival and calculus indices, probing pocket depths, bleeding and suppuration after probing, probing attachment levels and furcation involvements. Infrabony and furcation lesions were assessed from panoramic radiographs. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were cultured from the deepest, most inflamed periodontal Pockets, from surface of the tongue and from saliva. 3 months after the completion of non-surgical treatment comprising meticulous scaling and root planing and instruction on oral hygiene, the healing was assessed clinically, and 13 patients were assigned to a maintenance care programme (MC) and 33 to further treatment procedures (FT). Evaluation of the baseline clinical and radiographic data showed a significantly higher %s of > or = 6 mm deep periodontal pockets, surfaces with suppuration, and sites with subgingival calculus, as well as higher numbers of infrabony lesions, in FT-patients than in MC-patients. Subgingival A. actinomycetemcomitans was isolated at baseline in 55% of the FT-patients and in 38% of the MC-patients, and P. gingivalis in 27% and 23%, respectively. A. actinomycetemcomitans was eradicated by non-surgical treatment from only one patient. P. gingivalis was detected in 15% of the patients in both groups after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Comparative clinical and microbiological effects of subgingival metronidazole application in adult periodontitis; 12-months results.

The aim of the present study was to evaluate the clinical and microbiological effects of subgingival application of 25% metronidazole dental gel as an adjunct to scaling and root planing (SRP) in the treatment of adult periodontitis. Eighty teeth in 18 patients were evaluated using a split mouth design. The test teeth received SRP and a 25% metronidazole gel applied subgingivally on days 0 and 7. The control teeth received SRP only. Clinical and microbiological examinations were carried out before treatment and on weeks 1, 3, 7, 13, 26, 38 and 52 of the experimental period. Colony forming units of Porphyromonas gingivalis and Prevotella intermedia / Prevotella nigrescens were determined. Both treatments provided significant improvements in all the clinical and microbiological parameters (P<0.05). However, none of the differences between the study groups were statistically significant (P > 0.05). As a conclusion, the present study does not provide evidence in favour of the routine use of adjunctive metronidazole dental gel in the treatment of adult periodontitis.

Administration, Topical↗
PubMed2006

Supportive periodontal therapy using mechanical instrumentation or 2% minocycline gel: a 12 month randomized, controlled, single masked pilot study.

OBJECTIVE: To compare the short-term performance of subgingival local delivery of 2% minocycline gel and conventional subgingival debridement in supportive periodontal therapy (SPT) patients. METHODS: Forty adult patients having completed active treatment for moderate to advanced chronic periodontitis were included in a randomized, controlled, single masked maintenance care pilot study. Sites with residual pocket probing depths > or =5 mm and bleeding on probing were treated with either minocycline gel (minocycline-group) or scaling and root planing only (debridement-group) at baseline, 3, 6, and 9 months. Clinical and microbiological examinations were performed at baseline, 3, 6, 9, and 12 months. RESULTS: Full-mouth plaque and bleeding scores remained <10% and <20%, respectively, for both groups throughout the study. In both groups there was a persistent reduction in number of teeth and sites with probing pocket depths > or =5 mm (p<0.05) with no significant differences between the groups. The prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens, remained at levels < or =10(5) in the majority of patients and sites in both groups. CONCLUSION: This pilot study failed to show a difference between local delivery of 2% minocycline gel as mono-therapy and traditional subgingival debridement in patients on SPT.

Adult↗
PubMed2005

Periodontal dressing (Vocopac) influences outcomes in a two-step treatment procedure.

OBJECTIVES: It is not clear if periodontal dressing influences the long-term results in a non-surgical treatment procedure. MATERIAL AND METHODS: The periodontal parameters (pre-baseline) of 36 patients with aggressive periodontitis were obtained before the patients were treated initially (1st step) by a dental hygienist, who completely removed the supra- and subgingival concrements. Baseline parameters were raised 3 weeks after the 1st step, before the 2nd therapy step was conducted. It consisted of a non-surgical procedure, which comprised a closed full-mouth manual root curettage (root planing), immediate systemic application of metronidazole, and the placement of a periodontal dressing (Vocopac, Voco). The patients were randomized to two test groups having their periodontal packs removed after 3-4 days (group 1, n=12) and 7-8 days (group 2, n=12), respectively and a control group (n=12) without periodontal dressing. Clinical parameters were raised again after 6 and 24 months. RESULTS: Six and 24 months later, changes in probing pocket depth (PPD) and probing attachment level (PAL) were observed in all three groups compared with baseline, but the difference was significant in group 2 only. In addition, group 2 showed a greater reduction in mean PPD and also a significantly greater gain of attachment in comparison with the controls. CONCLUSION: Wound dressing has a positive effect on clinical long-term results using a two-step non-surgical procedure. Moreover, removing the dressing after 7-8 days leads to clearly better results than removing it earlier.

Administration, Oral↗
PubMed1992

Changes in amount of gingival crevicular fluid after a single episode of periodontal treatment.

A total of 51 periodontal sites from 6 adults with no systemic diseases or medication were selected for the study. All sites showed radiologic bone loss and pockets of 4 mm or more. Crevicular fluid (CF) was collected by inserting filter paper strips into periodontal pockets for 5 s and was measured by Periotron. Samples were collected before and 2, 5, 10, 20, and 40 days after a single episode of periodontal treatment (scaling, root planing and curettage). Plaque Index (P1I), Papilla Bleeding Index (PBI) and pocket depth (PD) were measured before and 40 days after treatment. The amount of bone loss was estimated from orthopantomograms taken immediately before the trial. Two days after treatment an increase in the amount of CF was seen. After this the amount of CF decreased, reaching the pretreatment level on day 5 after treatment and a level clearly below pretreatment level on day 10 after treatment. Forty days after treatment a slight increase in the amount of CF was seen. The difference between pretreatment values and values at days 2, 10, 20, and 40 was highly significant. In pretreatment samples, positive correlations were found between the amount of CF and PD, PBI and bone loss and, in samples collected 40 days after treatment between CF and PD. CF measurements made before treatment were of no value in predicting the changes in clinical parameters after treatment.

Adult↗
PubMed2003

Subjective intensity of pain during the treatment of periodontal lesions with the Vector-system.

The aim of this study was to measure subjective intensities of pain during the treatment of periodontal lesions with the Vector-system when compared to pain occurring during the treatment with conventional methods. Twenty patients, each of whom had three teeth with comparable periodontal pocket depths, were treated using three different methods: (i) scaling and root planing with hand instruments, (ii) cleaning with a conventional ultrasonic instrument (Siroson S) and (iii) cleaning with the Vector-system. The subjective intensities of pain during the treatment were measured with an intermodal intensity comparison. A visual analog scale was used for the evaluation after the treatment. The results of the intermodal intensity comparison during treatment showed that the use of the Vector-system caused less pain than the cleaning with hand instruments or the conventional ultrasonic system (P < 0.05). The intermodal intensity comparisons of cleaning with hand instruments and cleaning with the conventional ultrasonic system were not significantly different (P > 0.05). These results could be confirmed by the visual analog scale. Using the Vector-system for cleaning periodontal lesions it is possible to reduce pain sensations compared to conventional methods. Using cleaning methods that cause less discomfort and pain, it might be possible to increase the patient's compliance during non-surgical periodontal therapy and recall.

Alveolar Bone Loss↗
PubMed1994

["Chairside" microbiological tests in periodontics].

Based on the specific plaque theory in periodontology, several chairside tests have been introduced for the microbiological examination of periodontal patients. For the majority of these patients, however, a standard therapy (root planing in combination with good oral hygiene) results in a favorable outcome. Therefore, only for a small minority of periodontal patients a microbiological analysis could possibly contribute to better treatment. For such patients, a choice can be made between a culture technique (which is labour intensive and has a long waiting time before an answer is available) and one of the chairside tests. The culture technique has the advantage to examine most of the flora. The chairside tests have the advantage of giving immediate results, but are limited to a small number of species or morphotypes. As long as the outcome of a microbiological examination in general cannot be translated into a more specific treatment strategy, the frequent use of microbial analyses should not be advocated. Since the validity of the chairside tests have yet to be fully examined through clinical trials, culturing should be the method of choice, because their antibiogram could lead to a more specific antibiotic therapy for the few patients in need.

Clinical Enzyme Tests↗
PubMed1996

Interleukin-1 beta, prostaglandin E2, and immunoglobulin G subclasses in gingival crevicular fluid in patients undergoing periodontal therapy.

Determination of the presence of inflammatory products found in gingival crevicular fluid (GCF) may be of value in evaluating both periodontal disease status and the outcome of therapy. Immunoglobulin G subclasses 1 through 4 (IgGs), interleukin 1-beta (IL-1 beta), and prostaglandin E2 (PGE2) have all been shown to be present in GCF. This study monitored IgGs, IL-1 beta, and PGE2 in GCF of 18 adult patients as they progressed through periodontal treatment toward maintenance therapy. Sites were selected from the most severely affected sextant as determined by probeable crevice depth (PD) at initial examination (IE). GCF was collected on four occasions: initial examination; 4 weeks after completion of initial therapy (oral hygiene counseling, and scaling and root planing); 3 months after completion of surgery; and 7 to 9 months later at a maintenance visit. All variables were reduced to binary form (positive or negative), and break points chosen to separate the approximately symmetrical bell-shaped areas (negatives) from the skewed tails (positives). Repeated measures analyses of variance were performed to detect significant changes in all variables across time. Significant improvements were observed for all the clinical variables measured: PD, attachment level, and bleeding on probing. However, significant reductions for the GCF components only occurred in the concentrations of IL-1 beta and PGE2, but were not evident until the maintenance sampling. Surprisingly, GCF:serum ratios of IgG subclasses did not change significantly over the course of the investigation. The robustness of the levels of these components may be due to inflammation associated with the healing process, or to a further plaque induced response.

Adult↗
PubMed1992

Cathepsin B/L-, elastase-, tryptase-, trypsin- and dipeptidyl peptidase IV-like activities in gingival crevicular fluid. A comparison of levels before and after basic periodontal treatment of chronic periodontitis patients.

20 chronic periodontitis patients were given a full periodontal examination, including measurements of probing depth, clinical attachment loss, gingival index, bleeding index and plaque index. At a second visit, gingival crevicular fluid (GCF) was collected from the deepest accessible probing site of each tooth. The patients then received scaling, root planing and other appropriate nonsurgical treatment. GCF was collected from the same sites as sampled pretreatment and clinical parameters were measured again. Cathepsin B/L-, elastase-, tryptase-, trypsin-, and dipeptidyl peptidase IV-like activities in GCF samples were determined by fluorimetric assay with peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin. Following treatment, there were reductions in all clinical parameters and all protease activities. Most were statistically significant both on a patient level using average patient values and on a site level using either individual patient or pooled patient data. As in previous pre-treatment comparisons, post-treatment protease levels correlated positively and significantly with the corresponding clinical parameters at patient and site levels. The reductions and correlations were more marked for total enzyme activities than concentrations. GCF protease levels appear to reflect the clinical status of periodontal lesions and may thus be of value in monitoring disease activity.

Adult↗
PubMed1994

Immunohistochemical study of neutrophil- and fibroblast-type collagenases and stromelysin-1 in adult periodontitis.

Eight adult periodontitis (AP) patients were studied immunohistochemically to determine the presence of matrix metalloproteinases (MMPs) MMP-1, MMP-3, and MMP-8 in the marginal gingival and gingival granulation tissue specimens obtained from periodontal flap surgery after scaling and root planing. Clinically healthy gingival tissue specimens obtained from impacted third-molar extraction operations served as controls. MMP-type-specific antisera were applied by the avidin-biotin-peroxidase complex staining method. Moderate immunoreactivity for neutrophil collagenase (MMP-8) was found both in the AP patients' marginal gingival connective tissue and in gingival granulation tissue specimens. Immunoreactivity for fibroblast-type collagenase (MMP-1) and stromelysin-1 (MMP-3) was detected only in the AP patients' gingival granulation tissue specimens. In the control specimens, no immunoreactivity for the MMPs could be detected. For the first time, this finding demonstrates immunohistochemically the presence of MMP-8 in human inflamed gingiva in situ, and further highlights the importance of MMP-8 in periodontal tissue destruction, evidently during the acute phase(s) of the disease. However, our results confirm and extend previous studies indicating that other types of MMPs from resident gingival cell sources also seem to participate in the chronic and destructive course of periodontal inflammation.

Adult↗
PubMed2004

Patients' experience of pain and discomfort during instrumentation in the diagnosis and non-surgical treatment of periodontitis.

BACKGROUND: The present multicenter study aimed to survey the patients' experiences in relation to the diagnosis and non-surgical treatment of periodontitis according to current treatment routine. METHODS: Patients (N = 268) treated for plaque-related periodontitis were enrolled in two groups: group 1 received primary probing of pocket depths (PD 1) and/or primary scaling and root planing (SRP 1); group 2 consisted of patients who were scheduled in the different centers for recall PD/scaling/subgingival instrumentation. Data collection included a full periodontal status, anesthesia employed, procedure time, and patient self-completed questionnaires to assess their previous and current experience of pain and discomfort during anesthesia and periodontal treatment. RESULTS: Ninety percent of the patients received infiltration anesthesia during primary SRP, compared to only 2% during recall scaling/instrumentation and none during PD. Many patients (40% in SRP group 1 and 52% in the recall scaling/instrumentation group) were most bothered by the scaling procedure, while others (35% in the primary SRP patients) by the anesthetic injection. Painful experiences during previous primary PD and present SRP were highly correlated (r = 0.6). CONCLUSIONS: From these results, it is evident that subgingival instrumentation causes pain and discomfort, an aspect that should be considered in periodontal therapy. Unfortunately, the use of local infiltration anesthesia to reduce pain is in itself a cause of discomfort. Attractive alternatives for anesthetic applications are much needed.

Adult↗
PubMed1998

Guided tissue regeneration in Class II furcation involved maxillary molars: a controlled study of 8 split-mouth cases.

The purpose of this study was to clinically evaluate the effectiveness of polytetrafluoroethylene membranes in the healing of interproximal Class II furcation defects in maxillary molars using a surgical treatment technique based on the principles of guided tissue regeneration. Eight subjects with similar bilateral Class II furcation lesions on the mesial aspect of maxillary first molars participated in this study. Patients received initial therapy consisting of oral hygiene instructions, scaling and root planing, and occlusal adjustment if necessary. Clinical parameters evaluated included plaque index, sulcular bleeding index, probing depth, attachment level, gingival recession, and open horizontal and vertical furcation fill. An acrylic occlusal stent was used to assure reproducibility of measurements. Experimental sites received a polytetrafluoroethylene membrane following surgical exposure of the furcation. Control sites were treated in the exact same manner but without a membrane. Membranes were removed at 6 weeks after the first surgery. Reentry surgeries were performed at 9 months. Postsurgical results showed a significant improvement in probing depth, attachment level, and open horizontal furcation fill for both groups when compared to baseline values, with experimental sites performing significantly better than controls. Control sites showed a slight loss in open vertical furcation fill while experimental sites remained unchanged. This study suggests that guided tissue regeneration using polytetrafluoroethylene membranes is of some but limited value in the treatment of maxillary molar interpoximal Class II furcation lesions.

Adult↗
PubMed1991

Determining the value of a periodontal diagnostic test.

The purpose of this analysis is to present a method to determine the value of diagnostic tests for evidence of bacterial activity related to periodontal disease. Five population studies are discussed: 1) screening the general population; 2) screening the patients of a general practice; 3) diagnosing initial patients referred to a periodontist; 4) monitoring periodontal maintenance patients; and 5) monitoring postsurgical refractory patients. A decision tree is constructed in which the primary decision branches are test and no test. Chance branches after the test branch were test positive and test negative. The treatment alternatives in the treatment branches were prophylaxis and oral hygiene, scaling and root planing, and advanced periodontal therapy (including surgical intervention and/or antibiotics or chemotherapies). Probabilities for the prevalence of disease in each population were obtained from epidemiological surveys. Disease activity and outcome states were estimated from clinical studies of periodontal treatment. For initial periodontal patients, using a sensitivity of .87 and a specificity of .84 the value of the test branch is .851 versus .566 for the no test branch. Assumptions on the diagnostic test's sensitivity and specificity and the utility of outcomes were tested with the decision analysis techniques of sensitivity and 2-way threshold analyses. These analyses show that using a test had a greater value than no test for older patients in the general practitioner's office, and for the 3 types of periodontal treatment patients. In contrast, using the test had a lower value than not using the test in younger dental patients in the general practitioner's office and for screening the general population. The diagnostic and treatment schemes proposed here are amendable to rigorous testing to evaluate their reliability and usefulness.

Adult↗
PubMed2002

The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy.

BACKGROUND: The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. METHODS: This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. RESULTS: The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). CONCLUSIONS: Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.

Adult↗