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PubMedDate not supplied

A literature review: oral irrigation therapy. The adjunctive roles for home and professional use.

It is now recognized that there are several different types of periodontal infections. As we learn more about the cause of these diseases, it becomes obvious that we have treatment options. A successful choice of procedures for each individual depends on an accurate diagnosis based on comprehensive data collection of clinical and microbiological findings. Treatment choices include a non-surgical phase which consists of plaque removal, plaque control, scaling, root planing, and the use of chemical agents. For complete debridement of deep pockets, furcations or areas with root surface irregularities, surgical access may be necessary. When considering drug therapy, it must be noted that systemic antibiotics may be necessary to suppress those subgingival periodontal pathogens which have the ability to invade the tissue and resist other methods of eradication. Removal or alteration of pathogenic flora is mandatory to improve a patient's periodontal health. The extensive use of supragingival irrigation as an adjunct for treating gingivitis has led to the interest in subgingival irrigation as a possible adjunct for treatment of periodontal diseases. Targeted lavage and subgingival delivery of effective antimicrobial agents show potential as supplemental office procedures or as a component of a home oral hygiene regime. Additional research is needed to develop more efficacious chemotherapeutic substances than are currently available and to further define the optimum application of each. Substantive medicaments that react specifically against periodontopathic organisms are essential. Exact frequency and duration of professionally-applied and self-administered subgingival irrigation need to be determined for maximum results. Further investigation is required to establish the potential role of adjunctive irrigation and antimicrobial therapy in the treatment of periodontitis. Yet, another important application of irrigation has been recognized. Recently, the American Heart Association revised its guidelines for the prevention of bacterial endocarditis. The amendments to the dentistry sections have been approved by the Council on Dental Therapeutics of the American Dental Association. Included in this text is the recommendation that as an adjunct to antibiotic prophylaxis, sulcular irrigation with chlorhexidine may be useful for those patients considered high risk and/or have poor oral hygiene. Irrigation therapy is undergoing extensive scrutiny in the scientific research community. Presently, considerable conclusive evidence exists to suggest that adjunctive irrigation may play an important role in controlling gingivitis and periodontitis. The overwhelming challenge for any and all successful periodontal therapy will always remain dependent on patient compliance to regular professional and home care.

Anti-Bacterial Agents↗
PubMed1985

The removal of root surface deposits.

The importance of adequate root surface instrumentation has received increasing emphasis. The purpose of this study was to determine the extent to which root planning could produce surfaces free of stainable deposits. Initial laboratory investigations on extracted, periodontally involved roots demonstrated that after meticulous root preparation, totally non-stainable surfaces could be obtained. These surfaces were shown to consist of either thin cementum or dentine. The efficacy of instrumenting periodontally involved buccal root surfaces on the anterior teeth of 33 patients, undergoing routine periodontal flap surgery was then evaluated. Root surfaces were instrumented either before or after the reflection of surgical flaps. Remaining bacterial deposits were disclosed with a gentian violet solution and the root surfaces then photographed. Further root planing, disclosure and photography were then carried out. These photographic slides were analysed for stainable deposits on the root surfaces using an image analysis system, based on densitometric principles, to measure the areas of stainable root surface deposits. The findings revealed that root planning under direct vision at the time of surgery was more effective than blind instrumentation. However, in no instance was any root surface found to be completely free of stainable deposits.

Adolescent↗
PubMed2002

In vitro effect of laser irradiation on cementum-bound endotoxin isolated from periodontally diseased roots.

BACKGROUND: In a previous study, we evaluated the in vivo effects of an Nd:YAG laser on periodontal disease by measuring crevicular interleukin (IL)-1beta levels before and after laser application. It was found that laser therapy was less effective than traditional scaling and root planing. These results might be due to incomplete removal of microbial residues and cementum-bound endotoxin on root surfaces by the laser. In this study, we explored the in vitro effectiveness of an Nd:YAG laser for the elimination of cementum-bound endotoxin by measuring IL-1beta changes in stimulated monocytes. METHODS: Fresh human monocytes were harvested from adults without periodontitis and grown in RPMI 1640 medium. Diseased cementum particles were collected and prepared from teeth with untreated periodontitis and were irradiated with 5 levels of laser energy. Cementum particles were subjected to endotoxin testing by a limulus amebocyte lysate (LAL) assay and then were incubated with cultured monocytes. Production of IL-1beta in stimulated monocytes was measured by enzyme-linked immunosorbent assay and quantified by spectrophotometry. RESULTS: The endotoxin unit (EU) of diseased cementum was 18.4 EU/mg, which seemed to be remarkably lower than that of common periodontal pathogens including Porphyromonas gingivalis (381) at 15,300 EU/mg/ml, Prevotella intermedia (ATCC 25611) at 227 EU/mg/ml, and Fusobacterium nucleatum (ATCC 25586) at 1,987 EU/mg/ml. Monocytes subjected to stimulation by diseased cementum particles without laser irradiation produced 124 to 145 pg/ml IL-1beta, 9- to 18-fold higher than that of unstimulated monocytes (7.07 to 15.95 pg/ml). Diseased cementum particles after irradiation with various energy levels of the Nd:YAG laser could still stimulate monocytes to secrete 89 to 129 pg/ml IL-1beta. No statistically significant difference was found in the production of IL-1beta induced by diseased-bound cementum with or without laser irradiation. CONCLUSIONS: The Nd:YAG laser varying from 50 mJ, 10 pps to 150 mJ, 20 pps, for 2 minutes, did not seem to be effective in destroying diseased cementum endotoxin.

Adult↗
PubMed1990

Veneered osseous graft. Case report and technique.

Attempts to develop a predictable method of osseous regeneration evolved into the veneered osseous graft. The author has taken advantage of and incorporated several different aspects of regenerative periodontal therapy. Having treated several hundred cases with good to excellent results, success is directly related to meticulous detail. Flap design, root surface preparation, bony wall therapy and graft placement are all equally important in predicting success. By introducing into a clean bone cavity against a clean root an osteogenic base material protected by a veneer to prevent down growth of epithelium one can expect improvement of an osseous lesion. This one-step procedure is a cost effective answer to the two-step procedure. Osseous grafting with a variety of materials has become an established part of regenerative periodontal therapy. Most reports comparing grafting to surgical debridement has demonstrated an advantage with grafting no matter what the material. Successful osseous grafting does require a biologically compatible material, preferably with osteogenic potential, which would prevent a down growth of epithelium until the graft has established a "home." Equally important is site preparation. Most reports in the literature describe site preparation as "thorough root planing." This description is inadequate as actual procedures can vary widely. Specifics are missing so duplication is difficult. Chemical root conditioning was introduced as an adjunct to effective root preparation. The frequency of osseous graft success began to improve with the addition of citric acid conditioning to very mechanical root preparation regardless of the grafting material used. The development of the veneered osseous graft technique over the years has taken advantage of and incorporated several different aspects of regenerative therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Transplantation↗
PubMed2001

Periodontal regeneration of a class II furcation defect utilizing a bioabsorbable barrier in a human. A case study with histology.

This case report describes human histologic data of periodontal regeneration following guided tissue regeneration therapy (GTR) with a bioabsorbable barrier composed of polylactic acid. The tooth that was examined was part of a previously published study of the clinical effects of GTR therapy without the use of bone or bone substitutes on Class II furcation defects. Twenty-five months following the surgical procedure, the tooth was extracted for non-periodontal reasons. During this extraction, the bone within the furcation that was treated in the study was luxated with the tooth. At the completion of the study (month 12), the furcation's vertical probing depth had decreased by 2 mm with a 2 mm gain in clinical attachment. The horizontal furcation measurement decreased by 3 mm. Following extraction, the tooth was prepared for light microscopy and sectioned in the mesial-distal plane. Reference notches were not placed in the tooth at the time of surgery as there were no plans to perform histologic analysis in the study. However, using the buccal root prominences and what we interpreted to be root planing marks on the cementum, we were able to demonstrate that complete periodontal regeneration occurred on the root surface that was exposed to the pocket environment prior to surgery. New alveolar bone, cementum, and periodontal ligament were consistently observed throughout the furcation in the areas that demonstrated clinical attachment gain and a decrease in horizontal probing depth. This case report adds to the accumulating evidence of histologic periodontal regeneration following guided tissue regeneration with bioabsorbable polylactic acid barriers.

Absorbable Implants↗
PubMed2000

Treatment of Class II furcations with autogenous bone grafts and e-PTFE membranes.

This article reports a successful clinical regimen of treatment for the Class II furcation defect. Twenty-eight patients with molar teeth demonstrating Class II furcations were treated with regenerative therapy with the goal of regenerating lost interradicular periodontium. The treatment selected included scaling and root planing, surgical flap design that would enable the flap to completely cover the surgical site, complete enucleation of granulation tissue, tetracycline root conditioning, a particulate autogenous bone graft, and an expanded polytetrafluoroethylene (e-PTFE) membrane. Of the twenty-eight consecutive patients treated, twenty-five demonstrated no postoperative clinical evidence of furcation invasion, for a success rate of 89%. Eleven sites were reopened 8 to 9 months postsurgical and presented complete furcation fill with a hard, bone-like tissue. Three teeth were judged to be failures because clinical assessment revealed persistent furcation invasion. The absence of histologic evidence precludes the presumption that complete periodontal regeneration occurred.

Anti-Bacterial Agents↗
PubMed1992

Treatment of an osseous lesion associated with a severe palato-radicular groove: a case report.

This is a case report that describes the management of a severe periodontal defect associated with a palato-radicular (palato-gingival) groove affecting the maxillary right lateral incisor of a 50 year-old male. The patient presented with pain, gingival swelling, and a 10 mm periodontal pocket on the distopalatal aspect of the right maxillary lateral incisor. The defect was initially treated by scaling and root planing. Several days later a flap was elevated, the osseous defect was debrided, and odontoplasty was performed to eliminate the groove. The root surface was treated with citric acid for 3 minutes, the osseous defect was filled with non-porous hydroxyapatite, a periodontal membrane was placed, and the flap was readapted to the tooth. Postoperative care included systemic (minocycline) and local (chlorhexidine) antimicrobial therapy. The membrane was removed 6 weeks postoperatively and 14 months postoperatively the gingiva appeared healthy; radiographs suggested substantial resolution of the osseous defect and about 7 mm of probing attachment gain was recorded. Further studies are necessary to determine which of the several modes of therapy used to treat this lesion are necessary for success.

Alveolar Bone Loss↗
PubMed1993

Periodontal therapy: prospects for the future.

Prior to the 1950s, periodontitis was treated mostly by tooth exfoliation or extraction, and that is still the predominant treatment for most of the world's populations today. Debridement of the root surface by scaling and root planning came into relatively common use in the first half of the present century and has become the central feature held in common by all currently-used forms of periodontal therapy. Until the 1980s, the most commonly-used treatment consisted of scaling and root planing, followed by resective surgery aimed at achieving zero pocket depth. During the 1980s, data were obtained demonstrating that the thoroughness of root debridement and subgingival infection control, not the presence or absence or periodontal pockets, is the major determinant of successful periodontal therapy, and non-surgical therapy became a commonly-used treatment. Neither resective surgery nor non-surgical therapy results in significant regeneration of periodontal attachment. With the realization that periodontitis is an infectious process, the use of antibiotics and other anti-infective agents came into common use as adjuncts to other standard therapies. An understanding of the pathways by which the soft and calcified tissues of the periodontium are destroyed has led to the likelihood of widespread future use of the non-steroidal, anti-inflammatory family of drugs to suppress alveolar bone destruction by blocking prostaglandin production, and to the use of chemically-modified tetracyclines that chelate divalent cations and thereby block tissue destruction by the metalloproteinases. Recent data clearly show that regeneration of the previously-destroyed periodontal attachment tissues is biologically possible, and regeneration has become the goal of therapy for the 1990s. Use of osteoconductive and osteoinductive graft materials can, under favorable conditions, induce roughly 60% to 70% regeneration of bone lesion height or volume with concomitant improvement in the clinical conditions. Regeneration by grafting may be further enhanced by use of barrier membranes that exclude gingival fibroblasts and epithelium from the healing site. Still further enhancement seems to be possible by local application of various growth factors, although studies in this important area are now only in their infancy. The future of periodontal therapy is exceedingly bright.(ABSTRACT TRUNCATED AT 400 WORDS)

Forecasting↗
PubMed2006

The attachment of V79 and human periodontal ligament fibroblasts on periodontally involved root surfaces following treatment with EDTA, citric acid, or tetracycline HCL: an SEM in vitro study.

OBJECTIVE: The present in vitro study has been designed to establish and compare the effects of citric acid, EDTA, and tetracycline HCl on human periodontally diseased roots on the structure, attachment, and orientation of V79 (primary Chinese hamster lung fibroblasts) cells and human periodontal ligament fibroblasts (HPDL). MATERIALS AND METHODS: Commercially available V79 cells and HPDL derived from healthy human third molars were used in this study. These fibroblasts were left in solution for seven days in order to attain confluence. Forty single-rooted teeth were obtained from patients diagnosed with periodontitis. The crown part was removed under constant irrigation and the root was split vertically into two equal halves, thus, yielding 80 specimens. Following scaling and root planing, the specimens were washed with phosphate buffered saline (PBS) and kept in 50 microg/ml gentamycin sulphate solution for 24 hours. The root pieces were then treated as follows: citric acid at pH 1, 24% EDTA, or with a 10% solution of tetracycline HCl and were then placed in V79 fibroblast cultures and HPDL cultures. The specimens were harvested after four weeks and were fixed in 2.5% glutaraldehyde in PBS before preparation for scanning electron microscopy (SEM). RESULTS: The behavior of V79 cells was similar to that of human periodontal ligament cells on root conditioned surfaces. V79 and HPDL showed a healthy morphology on root surfaces treated with citric acid and EDTA and a relatively unhealthy appearance on root surfaces treated with tetracycline HCl and distilled water (control group). CONCLUSION: The results suggest the use of citric acid and EDTA as root conditioning agents favorably affects the migration, attachment, and morphology of fibroblasts on human root surfaces, which may play a significant role in periodontal healing and regeneration.

Animals↗
PubMed1993

Guided tissue regeneration with dentin biomodification.

This study was undertaken to provide histologic observations on the effectiveness of citric acid and tetracycline HCl root surface demineralization when used in conjunction with guided tissue regeneration (GTR) procedures. Eight beagle dogs with naturally-occurring periodontitis were initially treated with scaling and root planing. Four weeks later, 12 mandibular quadrants were treated surgically with modified Widman flap and expanded polytetrafluoroethylene (ePTFE). The teeth in 4 of the quadrants were randomly root conditioned with tetracycline HCl, while those in 4 additional quadrants were randomly treated with citric acid. ePTFE membranes were sutured in place. The beagles received prophylaxis (chlorhexidine and toothbrushing) 3 times a week. After 6 weeks, the membranes were removed; prophylaxes continued for 4 months. Histological evaluation revealed new cementum on the root surfaces. A new periodontal ligament with fibers inserting into the new cementum was noted. Statistical evaluation of the buccolingual measurements demonstrated membranes alone resulted in significantly more new connective tissue and new bone formation than membranes with root conditioning agents. Within the furcation, no significant differences were found. However, there was a trend for more bone formation with membranes alone. Within the limits of this study it may be concluded that GTR utilizing an ePTFE membrane results in new connective tissue attachment and bone regeneration in the beagle dog. Root surface demineralization with citric acid or tetracycline HCl does not enhance the results achieved with GTR when used alone.

Analysis of Variance↗
PubMed1990

New attachment formation following periodontal surgery in a dog.

We evaluated new attachment following treatment of experimental periodontitis in a canine model. Periodontal destruction was induced over an 8-month period using silk ligatures and a soft diet, and this remained stable for 170 days before surgery. After surgical scaling and root planing of eight bicuspid teeth, the apical end of the pockets was estimated using an occlusal stent and a periodontal probe, then marked with a blade. The root surfaces of three bicuspids were treated with citric acid for 3 min, and tetracycline salt was applied to the root surfaces of two teeth. The remaining three bicuspids served as controls. Postoperatively, no attempts were made to improve oral hygiene, and on day 48 light microscopic examination of biopsy materials revealed new attachment in all treated teeth. However, in some sections new cementum and new collagen formation was much more extensive and complete in both groups of experimental teeth than in the control teeth.

Animals↗
PubMed2006

Intentional replantation for a periodontally involved hopeless incisor by using autologous platelet-rich plasma.

The aim of the present case is to describe the use of autologous platelet-rich plasma (PRP) in an intentional replantation procedure for a periodontally involved lower right central incisor with 18 months follow-up. Brief information is also given on the preoperative preparation of PRP in the dental office. PRP preparation is a new biotechnology, and the prepared material contains thrombocyte concentrates and high levels of growth factors. This material promotes healing time in a range of various sites. In this case, a tooth with severe periodontal breakdown was treated with PRP with intentional replantation procedure. This tooth was previously treated with root canal treatment and root planing. The tooth was extracted, and was replanted with autologous PRP. Clinical and radiographic follow-up for 18 months demonstrated new bone formation around the apical portion of the root and all clinical parameters indicated a trend of healing. The mobility of this previously grade III mobile incisor returned to normal limits. We speculate that intentional replantation with PRP application may induce wound healing and may induce bone formation.

Adult↗
PubMed1998

Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study.

The present investigation was designed to evaluate the long-term effect of root-resective therapy in the treatment of furcation-involved molars. The patient sample included 72 patients, 21-62 years of age, who presented periodontal lesions in the posteriors segments of the mouth including furcation involvement of various degrees. After an initial examination, each patient was subjected to a series of full-mouth scaling and root planing. They were recalled 1-3 months later for a presurgical examination and subsequently underwent the corrective phase of therapy. During the surgical procedure, the furcation-involved teeth were subjected to root-resective therapy in conjunction with osseous recontouring and apically positioned flaps (test sites). A surgical procedure identical to the test procedure was performed in the non-furcation-involved teeth (control sites) with the exception of the root resection. At the completion of the active phase of treatment, 175 test and 175 control sites were available for the study. After a period of 6 months of healing and plaque control supervision following surgical procedures, the patients were recalled for a baseline examination. They were then enrolled in a maintenance program including professional tooth cleaning every 26 months. The patients were re-examined 3, 5 and 10 years post-operatively. The results of the assessments demonstrated that the survival rate, during the 10-year period of observation, reached 93% at test and 99% at control sites. The positive treatment outcome at the root-resected, furcation-involved teeth as well as at non-furcation-involved teeth was probably the consequence of the reestablishment of a tissue morphology favorable for oral hygiene and careful plaque control by the patients.

Adult↗
PubMedDate not supplied

Irrigation with antimicrobial agents for the treatment of periodontitis--is it effective?

Subgingival irrigation has been proposed as a beneficial adjunct to scaling and root planing or ultrasonic scaling. The most commonly investigated agents are iodine and chlorhexidine. Clinical studies from the past 15 years are reviewed to determine the real benefits of antimicrobial irrigants in conjunction with root planning. With knowledge of the treatment protocols and results of these clinical studies, the clinician is equipped with a biologic rationale for his treatment decisions in nonsurgical periodontics.

Anti-Bacterial Agents↗
PubMed1983

Surface coatings on dental cementum incident to periodontal disease. I. A scanning electron microscopic study.

Root surfaces of extracted human teeth with advanced periodontal disease were studied by the apically migrated junctional epithelium, the topography characteristic of uninvolved cementum was frequently masked by a surface coating. The thickness of the coating increased in a coronal direction where it often blended with calculus. The observations indicate that this surface coating may originate from the inflammatory exudate and corresponds to the dental cuticle. The findings also indicate that the coating may be mineralized and may contain exogenous substances. These observations illustrate a need for further study and reexamination of the rationale for removal of tooth substance during scaling and root planing.

Dental Cementum↗
PubMed1982

Effect of root surface alterations on periodontal healing. I. Surgical denudation.

The present study was undertaken to evaluate the effect of root surface denudation on periodontal healing. Twelve teeth, distributed in four squirrel monkeys, were extracted and reimplanted after surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing. The reimplantation schedule provided three teeth for histologic analysis at 1, 3, 7 and 21 days after reimplantation. One day after reimplantation a zone of fibrin enmeshing erythrocytes and inflammatory cells was interposed between th root surface and the remaining periodontal fibers attached to the alveolar bone. Epithelium migrated rapidly along the denuded root, had reached the alveolar crest at 3 days, and was within the ligament space at 7 days. At 21 days, the epithelium was at the apical limit of root instrumentation, which corresponded to the level of attached connective tissue fibers on the root surface. No evidence of new connective tissue attachment was observed on the denuded root surface. It was concluded that the absence of fibers on the root surface resulted in apical migration of the epithelium, and precluded formation of new connective tissue attachment.

Animals↗
PubMedDate not supplied

[Periodontal disease during pregnancy].

The authors have reported three clinical cases of gingivitis during the pregnancy in the women. These gingivitis were noticed more frequently during the end of the second and the third quarter. The patients were educated to maintain a better oral hygiene and they were treated with scaling and root-planing to obtain the periodontal healing.

Adult↗
PubMed1984

Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog.

The present investigation was performed to assess the inflammatory response in gingival units subsequent to the placement of restorations with subgingivally located margins. 3 beagle dogs were used. Cotton floss ligatures were placed around the neck of the mandibular third and fourth premolars of all dogs. The ligatures were exchanged once a month during the first 6 months of experiment. When 40-50% of the height of the supporting tissues had been lost in an experimental periodontitis the ligatures were removed but the animals allowed to accumulate deposits for another 60 days. The inflamed periodontal tissues were subsequently excised using either an "apically placed flap" procedure or a "gingivectomy" procedure. In the flap procedure the main part of the keratinized gingiva was preserved while in the gingivectomy procedure the keratinized part of the gingiva was removed in toto. Following scaling and root planing the animals were during a maintenance period of 4 months placed on a program involving chlorhexidine application and mechanical tooth cleaning twice daily. On Day 0 a notch was prepared in the buccal surface of each root at the level of the gingival margin. Furthermore, steel bands were placed along the buccal surface of each root of the third and fourth premolars and secured with an apical margin at the level of 1 mm apical to the notch. The bands were cemented to the root surfaces by a cement. The dogs were allowed to accumulate plaque and calculus for 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗