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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↗
PubMed1990

Repair potential in localized juvenile periodontitis. A case in point.

An aggressive form of localized juvenile periodontitis (LJP) in a 12-year old West African female is reported. The case was treated with scaling, root planing, debridement, and tetracycline therapy, which resulted in complete resolution of the disease, including elimination of periodontal inflammation, regeneration of lost periodontal structures, and spontaneous repositioning of teeth that had pathologically migrated. A hopelessly involved mandibular right first molar was successfully replaced by an incompletely developed maxillary third molar tooth bud whose roots and pulp structure continued to develop after autotransplantation. It is suggested, that LJP can be successfully treated without periodontal surgery and that the potential for repair in LJP cases is apparently greater than what one can anticipate in adult forms of periodontitis.

Aggressive Periodontitis↗
PubMed1989

[Surgical and non-surgical approach to deep periodontal pockets].

Deepened pockets are a challenge because they offer an anaerobic niche and because of their inaccessibility to personal plaque control measures. Scaling and root planing followed by regular professional plaque removal are effective in arresting the progress of most chronic adult periodontitis. Only when pockets remain inflamed after repeated thorough professional treatment during several months can a surgical pocket elimination technique be used. The results will depend on the type of attachment loss (horizontal vs. irregular) the root anatomy (furcations) and the training level of the operator, general practitioner or periodontologist. There is an increasing trend in the anterior parts of the oral cavity (monoradicular teeth easily accessible for plaque control) to use the Widman technique. Long-term data concerning the stability of this new attachment are lacking. Gingivectomy is less elaborate, does not imply a high-level sterile environment like for mucoperiosteal flap surgery, but leads to phonetic and esthetic side-effects when used in frontal areas. In the distal areas the apically displaced and the shortened repositioned flap techniques are effective in a long-term perspective if regular postoperative monitoring is respected. Discussion remains concerning the stability of a new connective tissue attachment vs. a long epithelial attachment. A recent breakthrough is the so-called Guided Tissue Regeneration where by means of a submucosally membrane the periodontal ligament cells are allowed to regenerate the different periodontal tissue compartments. Preliminary results are very encouraging but need further evaluation.

Dental Plaque↗
PubMed1991

The treatment of acute necrotizing ulcerative gingivitis.

The destruction of the interdental papillae and formation of permanent gingival craters are common sequelae of acute necrotizing ulcerative gingivitis. These craters can be disfiguring, especially in the anterior gingiva, and can act as a nidus for recurrent episodes. Traditional therapy has emphasized a surgical approach for elimination of these defects, often increasing the esthetic problems. The purpose of this paper is to review the treatment modalities of acute necrotizing ulcerative gingivitis and illustrate an alternative treatment approach of periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine. With this therapeutic regimen, the disease process can be reversed and damaged papillae may regenerate.

Chlorhexidine↗
PubMed1983

Fibrin linkage: a precursor for new attachment.

Previous studies indicated that connective tissue attachment to the root surface appeared to be dependent upon a chronologic healing sequence related to fibrin and collagen interactions. It was the purpose of the present study to try and substantiate this hypothesis by using histologic techniques designed to differentiate between fibrin and collagen during healing at the root surface interface. In four squirrel monkeys, 24 normal teeth were extracted and reimplanted after either (i) surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing or, (ii) surgical denudation followed by topical application of citric acid (pH = 1; 3 minutes). Three specimens were available for histological analysis 1, 3, 7 and 21 days after reimplantation. Mallory's phosphotungstic acid hematoxylin staining technique was used to differentiate between fibrin and collagen. Epithelium migrated rapidly along the denuded, non-acid-treated, root surfaces, had reached the alveolar crest at 3 days, and was within the ligament space to the level of root denudation at 21 days. Epithelium did not migrate apically along denuded root surfaces treated with citric acid. At 1 and 3 days, inflammatory cells were enmeshed in a fibrin network which appeared to be attached to the root surface by arcade-like structures. At 7 and 21 days, the region had repopulated with connective tissue cells, and collagen fibers had replaced the fibrin. It was concluded that collagen fiber attachment to the root surface was preceded by fibrin linkage, and that the linkage process occurred as an initial event in the wound healing response.

Animals↗
PubMed2006

[External root resorption].

Root resorption may be a physiological (resorption of deciduous teeth) or a pathological process (resorption of permanent teeth). In the latter case an external and an internal form of resorption can be distinguished. Root resorption may occur on one tooth or on several teeth within a dentition and it may be caused by trauma, periodontitis, orthodontic treatment, internal bleaching, cysts, tumors, or by stimuli from a necrotic dental pulp. Current knowledge concerning the pathogenesis of root resorption and therapeutic approaches are presented. For cervical resorption, it is assumed that the stimulus for the resorbing cells originates from the bacteria within the gingival sulcus and along the affected root surface. The case presented here was initially diagnosed as chronic periodontitis of medium severity. Scaling and root planing were performed resulting in a significant improvement of the periodontal status. Two years later, following a period of irregular recall visits, the patient presented with large areas of cervical resorption on teeth 36 and 37 which made it impossible to preserve these teeth. After another six months, teeth 34 and 35 showed deep destruction caused by external root resorption, mandating the extraction of these teeth as well. Fourteen months later, external root resorptions were evident on teeth 32 and 33, and at the same time, a recurrence of the chronic periodontitis was noted. Periodontal therapy was performed under a systemic antibiotic regime. It was possible to preserve teeth 32 and 33 through surgical crown lengthening procedures. No additional resorption has been observed ever since.

Adult↗
PubMed1990

Biphasic calcium phosphate ceramic combined with fibrillar collagen with and without citric acid conditioning in the treatment of periodontal osseous defects.

The purpose of this study is to determine whether the combination of biphasic calcium phosphate ceramic (BCP) and collagen and citric acid root conditioning would promote accelerated new attachment of periodontal tissue to the root surface in dogs. Intrabony defects were surgically produced for each animal and were made chronic for 16 weeks. These defects were assigned to two study treatment and one control group: ceramic-collagen without citric acid (CO-CE); ceramic-collagen with citric acid (CO-CE-CA); and control (surgical debridement and root planing only). Results showed that all groups gained new attachment level as demonstrated both clinically and histometrically. The treatment groups showed a significant mean gain greater than the control (P less than .005), but no significant difference was found between treatment groups. Small areas of ankylosis was also found in both treatments but there was no evidence of active root resorption. It is concluded that the use of combined BCP and fibrillar collagen is beneficial in promoting new attachment of periodontal tissues to the root surface in dogs. Although citric acid root conditioning did as well or better than ceramic and collagen alone, its benefits are still speculative and need further experimentation.

Animals↗
PubMed1988

Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery.

This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy.

Adult↗
PubMed1997

Guided tissue regeneration (GTR) versus cementum-impregnated gelatine membrane (CGM) techniques: a histologic comparison of relative effectiveness in promoting periodontal attachment.

Some prior reports have suggested that guided tissue regeneration (GTR) procedures achieve only partial regeneration and induces the ankylosis rather than true attachment. Accordingly, others have developed an alternative procedure employing gelatine membrane compounded with bovine cementum particles (CGM) which has proven effective in stimulating a more physiologic form of attachment. This study was undertaken to perform a direct comparison of histological results when CGM and GTR membrane were used at comparable sites in the same monkey. Three monkeys with no periodontal disease were used. Following flap surgery, recession type defects were created on the buccal side of the maxillary lateral incisors and second premolars, and the cementum was removed from the root surface at an area corresponding to the bone crest. The right and left lateral incisors and second premolars were covered with CGM and GTR membrane, respectively. The GTR membranes were removed after 4 weeks. At 6 wks, the animals were sacrificed, and specimens were prepared for histological examination. More coronally placed true new attachment was observed following application of CGM to the planed root surfaces. Application of the GTR membrane resulted in formation of bone-like cementum and ankylosis, whereas CGM established true periodontal regeneration.

Animals↗
PubMed1986

Hemisection and root amputation.

The disciplines of endodontics and periodontics fuse when molars that have bifurcation or trifurcation involvements are treated with hemisection and root amputation. Attempts to save parts of teeth go back 100 years or more, but it is the increased predictability of success of endodontic therapy and the increased sophistication of periodontal treatment that have given us the means to save molars with furcation problems that, otherwise, would be lost. Even when less invasive modes of therapy have failed (scaling, root planing, occlusal adjustment, and flap surgery perhaps with osseous recontouring and synthetic or natural bone grafting material where indicated), it is no longer necessary to lose a molar with complete furcation problems. When restorative dentistry has already been finished, and the retention of part of the tooth will extend the life of a crown or fixed partial denture, the patient certainly deserves the option of hemisection or root amputation rather than extraction.

Dental Plaque↗
PubMed1989

A scanning electron micrographical study of root surfaces and subgingival bacteria after hand and ultrasonic instrumentation.

The effects of hand and ultrasonic instrumentation on root surface topography and subgingival plaque were studied. One approximal subgingival root surface on each of two single rooted teeth of six patients was root planed. The opposing proximal surfaces were not treated and served as controls. On each patient, the two test surfaces were randomly treated by hand or ultrasonic instrumentation (Cavitron) until clinically smooth. The teeth were extracted, divided into mesial and distal sides, and processed for scanning electron microscopy (SEM). The observations were restricted to an area 2 mm by 3 mm just coronal to the plaque-free zone. The root surfaces were scanned by SEM, both at low (x 100) and at higher magnifications (x 5000). At low power, a photomontage was produced of the surface area of the test teeth. At low magnifications (x 100, x 500), the topography resulting from hand instrumentation appeared smooth with parallel scratches compared to scaly but flat surfaces with occasional deep gouges with the ultrasonic method. At high magnifications (x 5000), tooth surfaces were similar in topography when instrumented by either hand or ultrasonic methods. Root surfaces were covered in some areas by a fibrillar-like membrane that resembled fibrin. Individual bacteria were found on the surfaces of this material. On other areas not covered by this membrane, bacterial plaque was only observed when tooth surfaces had not been contacted by either hand or ultrasonic instrumentation.

Aged↗
PubMed1993

Root resection and root amputation.

Attachment loss in furcal areas is a challenge for the clinician. Root resection and root amputation techniques have been used to overcome the instrumentation problems that these areas pose. Recent reports indicate that this approach is effective and reliable but extremely technique-sensitive and expensive for endodontic and prosthetic involvement. A more conservative approach, such as scaling and root planing, is suggested only for shallow class II furcation. Guided tissue regeneration in deep class II and class III furcation seems to be unpredictable and the efficacy of this therapy in such areas is still questionable.

Apicoectomy↗
PubMed2001

Systemic and local antimicrobial use in periodontal therapy in England and Wales.

BACKGROUND/AIMS: The aim of this study was to investigate antimicrobial use during periodontal therapy in dental practice in England & Wales. METHOD: This was a postal questionnaire survey of 800 dentists, 400 general dental practitioners (GDP) in National Health Service practice and 400 members of the British Society of Periodontology (Periodontal Society) primarily in dental practice. We designed and piloted a questionnaire to evaluate both systemic and local antibiotic use with periodontal therapy as well as factors affecting their prescription. In addition, we also investigated the potential use of antibiotic sensitivity testing, since this has been recommended prior to prescribing antibiotics. Two follow-up mailings were used to encourage non-responders. RESULTS: The useable return rate for the questionnaires was 587/800 (73%). Systemic antibiotics were used by 7.4% Periodontal Society members and 18.4% GDP for untreated adult periodontitis patients (p<0.001). Antimicrobials were prescribed more frequently by Periodontal Society members in early onset (52.7%) and refractory periodontitis patients (49.6%), and this was highly statistically significantly greater usage than GDP (p<0.001). Regarding local antimicrobials, usage for untreated adult periodontitis was Periodontal Society 8.9% and GDP 5.4%. Higher usage of local antimicrobials was found both for the treatment of recurrent pocketing in adult periodontitis (Periodontal Society 26.3%, GDP 14.8%, p<0.014) and refractory periodontitis (Periodontal Society 30.8%, GDP 15.2%, p<0.001). As reasons for using local antimicrobials, more than 80% of all respondents stated superiority over root debridement alone. Barriers to use included cost, no perceived need and lack of supporting research data. The percentage of responders considering diagnostic microbiology either theoretically or at a cost of pound 60 were by group, Periodontal Society 83% & 70.4% and GDP 76% & 51.2%. 33% of Periodontal Society members and 3.8% of GDP spent at least 45 min per quadrant on root planing and Periodontal Society members had a greater exposure to lectures on both systemic and local drug therapy compared with GDP (p<0.001). CONCLUSIONS: Systemic antimicrobial use was infrequent for adult periodontitis and generally in line with current recommendations for other disease types. Whilst local antimicrobial therapy for periodontitis was not widespread, a substantial minority of dentists use this form of therapy and most believe that it is more effective than root debridement alone.

Adult↗
PubMedDate not supplied

Caries prevention in a community-dwelling older population.

A clinical trial was conducted to compare the effect of different caries-preventive strategies on caries progression in lower-income, ethnically diverse persons 60 years of age and older. Two hundred and ninety-seven subjects were randomized into one of five experimental groups. Group 1 received usual care from a public health department or a private practitioner. Group 2 received an educational program of 2 h duration implemented twice a year. Group 3 received the educational program plus a 0.12% chlorhexidine rinse weekly. Group 4 received the education and chlorhexidine interventions and a fluoride varnish application twice a year. Group 5 received all the above interventions as well as scaling and root planing every 6 months throughout the 3-year study. A carious event was defined as the onset of a carious lesion, a filling, or an extraction on a surface which was sound at baseline. Two hundred and one subjects remained in the study for the 3-year period. Groups that received usual intraoral procedures (groups 3, 4, and 5) had a 27% reduction for coronal caries events (p = 0.09) and 23% for root caries events (p = 0.15), when compared to the groups that received no intraoral procedures (groups 1 and 2). Routine preventive treatments may have had only a small-to-moderate effect upon caries development.

Aged↗
PubMed1995

Initial study of guided tissue regeneration in Class II furcation defects after use of a biodegradable barrier.

This study evaluated guided tissue regeneration in Class II furcation defects after use of a polylactic acid biodegradable barrier in nine patients with mandibular molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites were scaled and root planed. Defect perimeter was measured, and a customized barrier (600 to 750 mm thick) that adhered directly to tooth and bone was applied. At baseline, sites were measured for probing depth (6.2 +/- 0.5 mm), gingival margin location (-0.6 +/- 0.6 mm), and attachment level both vertically (6.9 +/- 0.7 mm) and horizontally (5.3 +/- 0.5 mm). Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Six months postsurgery, gingival margin location was close to the presurgical level (-0.4 +/- 0.8 mm). There was clinically and statistically significant improvement in all other parameters: a mean reduction of 3.1 mm in probing depth, a gain of 3.3 mm in vertical attachment level, and a gain of 3.0 mm in horizontal attachment level. These results suggested favorable regenerative outcomes.

Adult↗
PubMed1992

Periodontal regenerative therapy with coverage of previously restored root surfaces: case reports.

Two case reports are presented to demonstrate a treatment that restores proper esthetics, cures hypersensitivity, and enhances periodontal support for cases of root caries or failing Class V restorations associated with gingival recessions. The procedure involves removing the existing restoration, elevating a trapezium-shaped full thickness flap, root planing to achieve a desired concave shape, and placing a barrier membrane. In both cases, satisfying clinical results have been maintained for 18 months.

Adult↗
PubMed1994

Guided tissue regeneration: comparison of bioabsorbable and non-bioabsorbable membranes. Histologic and histometric study in dogs.

This study examined histologic and histometric responses to 2 bioabsorbable membranes made from a synthetic copolymer of glycolide and lactide. They were tested for their biocompatibility, resorption characteristics, and ability to support periodontal regeneration. Expanded polytetrafluoroethylene (ePTFE) was used as control. Nine fox hound dogs with no periodontal disease were used. They were sedated and their teeth thoroughly scaled and root planed. Plaque control was maintained. Two weeks later, each dog was anesthetized using gas anesthesia. Buccal and lingual mucoperiosteal flaps were reflected in the mandibular premolar areas. Randomly selected, buccal alveolar bone was reduced on the 2nd and 4th premolars to a level 5 to 8 mm apical to the cemento-enamel junction creating a Class II buccal furcation defect on one quadrant, while the other quadrant received a Class II buccal defect only on the 4th premolar. Root surfaces were denuded of periodontal ligament and cementum, and notches were placed at the bone level of each root. In one quadrant, one site received Type I membrane and the other site received Type II. The contralateral quadrant received ePTFE. Flaps were positioned slightly coronally and sutured. Sutures were removed 1 week later. One month after surgery, 3 dogs were sacrificed and ePTFE barriers were removed from the remaining 6 dogs. Of these, 3 were sacrificed 3 months after surgery and the other 3 at 6 months. Undemineralized experimental tissues were embedded in methylmethacrylate and 8 to 10 microns thick sections were cut in a bucco-lingual direction throughout the mesiodistal extension of the tooth.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1992

Effect of non-surgical periodontal therapy in an undergraduate dental clinic. Results one year following treatment.

The aim of the present study was to evaluate the effectiveness of non-surgical treatment of moderately to severely advanced periodontitis in patients at the Department of Periodontology of the Aristotle University of Thessaloniki. The patients were treated by senior students of the Dental School under the supervision of specialized personnel. The conservative treatment consisted of oral hygiene instructions and repeated instrumentation (scaling and root planing) for a period of about 3 months. Seventeen patients with advanced periodontitis participated in the study. The following data were recorded: 1. Gingival index (Silness and Löe, 1963), 2. Plaque index (Löe and Silness 1964), 3. Bleeding on probing and 4. Pocket depth and probing attachment level. The measurements were taken by the same examiner four times, that is at baseline, immediately after completion of the conservative therapy, 6 months and 12 months after treatment. Measurements from single and multi-rooted teeth were divided into three groups with respect to the initial pocket depth (less than or equal to 3 mm, 4-6 mm, greater than or equal to 7 mm). The findings of the present study demonstrated that non-surgical therapy can achieved a marked reduction in bleeding on probing scores and pocket depth 12 months after treatment. A gain in probing attachment levels was found for sites with initially deep (greater than or equal to 7 mm) and moderate (4-6 mm) pockets, while in sites with initially shallow pockets (less than or equal to 3.0 mm), a loss of attachment level was established.

Adult↗