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[Management of developmental anomalies in the maxillary incisors: case report].

This report presented a case having a vital maxillary lateral incisor with a talon cusp, dens invaginatus and radicular palatal groove. A periodontal pocket of 6 mm. was found adjacent to the radicular palatal groove. The treatment for this case included the prophylactic grinding of the talon cusp, restoration of dens invaginatus, and filling the supragingival portion of the radicular palatal groove with light-cured composite resin to erradicate plaque retention. Only degranulation and root planing was performed in order to establish the healthy dentogingival unit without any treatment of the subgingival portion of the radicular palatal groove. The patient was motivated to maintain good oral hygiene for preventing or minimizing the recurrence of periodontal disease.

Dens in Dente↗
PubMed2002

The prognostic value of several periodontal factors measured as radiographic bone level variation: a 10-year retrospective multilevel analysis of treated and maintained periodontal patients.

BACKGROUND: Assigning a prognosis to a periodontal patient is one of the greatest challenges in clinical practice. Many different factors can affect the result of periodontal therapy. The purpose of this study was to evaluate the prognostic value of some clinical, genetic, and radiographic variables in predicting bone level variation in periodontal patients (aged 40 to 60) treated and maintained for 10 years. METHODS: Sixty consecutive non-smoking patients (mean age 46.77 +/- 4.96) with moderate to severe chronic periodontitis 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. At baseline (T0) and at least 10 years later (T2), the following clinical variables were evaluated: probing depth (PD), tooth mobility (TM), presence of prosthetic restorations (PR), and molar teeth (MT). 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 T2, a genetic test to determine the IL-1 genotype and genetic susceptibility for severe periodontal disease was performed for all 60 patients. Based on the results of this assay, the patients were categorized as IL-1 genotype positive (G+) or negative (G-). The differences between the bone levels measured at T0 and T2 (ABD), indicating the bone level variation, was used as the outcome variable. Different predictor variables were then tested using a 3-level statistical model (multilevel statistical analysis; patient, tooth, and site level). At the patient level these were: age, gender, and interaction between mean bone loss and the IL-1 genotype (mean CEJ-BD(T0) x IL-1 genotype). At the tooth level the variables were: TM(T0), PR(T0), MT(T0); and at the site level the evaluated factors were: the infrabony component of the defect (CEJ-BD(T0) - CEJ-BC(T0), PD(T0), bone level (CEJ-BD(T0)), and the residual supporting bone (BD-RA(T0)). RESULTS: Among the considered predictor parameters, the following were significantly associated with the outcome variable: 1) mean CEJ-BD(T0) x IL-1 genotype (P = 0.0019); 2) TM(T0) (P < 0.0000); 3) CEJ-BD(T0) (P < 0.0000); 4) CEJ-BD(T0) - CEJ-BC(T0) (P < 0.0000); 5) PD(T0) (P = 0.0010). Deeper probing depths at a site and tooth mobility at baseline were associated with worst prognosis. Greater CEJ-BD(T0) distance and infrabony component at a site at baseline were associated with a better prognosis. The interaction between mean CEJ-BD measurement at baseline and IL-1 genotype was significantly associated both with a good or a poor prognosis. The other parameters evaluated - age, gender, presence of molars and prosthetic restorations, and residual supporting bone - were not significantly associated with bone level variation. CONCLUSIONS: Within the scope of this study design, many traditional prognostic factors were ineffective in predicting future bone level variation and therefore were of no prognostic value. Conversely, a few specific factors at each level emerged as valuable prognostic factors. At the patient level, the prognostic factor was initial mean bone level in conjunction with a positive IL-1 genotype. At the tooth level, the prognostic factor was tooth mobility. At the site level, the significant prognostic factors were initial bone level at a site, the infrabony component of a defect, and initial probing depth at a site. The use of these factors may be of value to clinicians as predictors of bone level variation when assigning a prognosis to a patient, a tooth, or a site.

Adult↗
PubMed1980

Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures.

The present study was undertaken to determine the effect of four periodontal regenerative procedures on the connective tissue attachment level. The procedures tested were: 1) the modified Widman flap procedure, 2) the modified Widman flap procedure combined with transplantation of previously frozen autogenous red marrow and cancellous bone, 3) the modified Widman flap procedure in combination with implantation of beta tricalcium phosphate, and 4) periodic root planing and soft tissue curettage. Eight adult Rhesus monkeys, divided into four equal groups, were used. Periodontal pockets were produced around contralateral teeth in a standardized manner. In each group of animals, the pockets on one side of the jaws were subjected to one of the above-mentioned surgical treatments, while the contralateral pockets remained as unoperated controls. Three weeks before surgery, a carefully designed plaque control program was instituted and continued until the animals were sacrificed 12 months after surgery. In histologic sections, linear measurements along the root surfaces were made from the cemento-enamel junction (CEJ) to the most apical cells of the junctional epithelium (JE). These measurements from operated and unoperated sites were then compared. The data revealed that healing following the four different regenerative procedures resulted in the reformation of an epithelial lining (long junctional epithelium) along the treated root surfaces, with no new connective tissue attachment.

Alveoloplasty↗
PubMed1995

Histological study of lectin binding in regenerated rat junctional epithelium.

We investigated the expression of carbohydrate residues in regenerated junctional epithelium (JE) cells histopathologically with lectin staining to clarify the mechanisms responsible for the changes in their expression in JE cells derived from residual oral epithelium. Curettage and root planing procedures were performed on the buccal gingival sulci of rat first lower molars, and JE and connective tissues were completely removed. The mandibles were resected after 12 h and 1, 2, 3, 4, 5, 7, 10 and 14 days, fixed with paraformaldehyde, decalcified with EDTA and embedded in paraffin. Serial sections were stained histochemically with four kinds of lectins (PNA, DBA, GS I, UEA I) to clarify the expression patterns of carbohydrate residues in regenerating epithelium. No binding of PNA or DBA was observed even when the regenerating epithelium was attached to the root surface, and they showed the same negative reactions as the basal cells of oral gingival epithelium (OGE). Positive reactions were, however, observed on the more stratified regenerating epithelium along the root surface. Positive reactions with GS I and negative reactions with UEA I were observed throughout the regeneration process, and these were the same as those observed in the basal cells of OGE. Therefore, we concluded that the basal cells and regenerated epithelium derived from OGE expressed the same carbohydrate residues. Furthermore, the expression of carbohydrate residues, one of the characteristics of JE, was related not only to the attachment to the tooth surface but also to changes of cell shape and cytoskeleton with stratification along the root surface.

Animals↗
PubMed1986

Calculus revisited. A review.

Although there is no doubt that gingivitis can develop in the absence of supragingival calculus, it is not clear to what extent the presence of mineralized deposit enhances gingival inflammation. Partial inhibition of plaque mineralization can be accomplished by chemical agents, but there has been no demonstration in humans of a reduction in gingivitis. It remains to be established what level of inhibition (if any) is required to have more than a cosmetic effect. Since the accepted scenario is that apical growth of supragingival plaque precedes the formation of subgingival calculus, there is no longer an issue of whether subgingival calculus is the cause or the result of periodontal disease. Subgingival mineralization results from the interaction of subgingival plaque with the influx of mineral salts that is part of the serum transudate and inflammatory exudate. This chronology, however, should not be the basis for relegating calculus to the ash heap. Morphologic and analytical studies point to the porosity of calculus and retention of bacterial antigens and the presence of readily available toxic stimulators of bone resorption. When coupled with the increased build up of plaque on the surface of the calculus, the combination has the potential for extending (beyond that of plaque alone) the radius of destruction and the rate of displacement of the adjacent junctional epithelium. The centrality of thorough scaling and root planing in the successful maintenance of periodontal health supports the view that subgingival calculus contributes significantly to the chronicity and progression of the disease, even if it can no longer be considered as responsible for initiation.

Bacteria↗
PubMed2002

Laser curettage: where do we stand?

The literature suggests that curettage has no benefit beyond traditional scaling and root planing. However, claims abound as to the benefits of curettage with the laser, including less postoperative pain, less bleeding, and reduction in microbial count. This paper explores whether any of these claims are true and whether laser curettage has any benefit in periodontal treatment.

Dental Pulp↗
PubMed1988

The effect of retained subgingival calculus on healing after flap surgery.

This study investigated the effects of retained subgingival calculus on healing of the periodontium at ten, 30 and 120 days. Eight beagle dogs between eight and ten years old with naturally occurring periodontal disease were used. One dog that died before any procedures were done provided information on the extent of gingival inflammation prior to surgery. Quadrants from seven dogs meeting the criteria for inclusion were selected, and each quadrant was randomly designated as either an instrumented or noninstrumented, surgical site. The gingival index for the selected sites was recorded along with clinical probing measurements. Instrumented sites were treated by reflection of a facial mucoperiosteal flap followed by thorough root planing. Non instrumented sites were treated by a facial mucoperiosteal flap alone. All flaps were returned to their preoperative position and secured with interrupted sutures. No antibiotics were given. Meticulous daily plaque control was begun the day after surgery and continued until sacrifice. There was a statistically significant reduction in gingival index scores for the 30- and 120-day instrumented sites and for the 120-day noninstrumented sites. Mean probing depths for the instrumented group showed a significant reduction at 30 and 120 days and for the noninstrumented group at 120 days after surgery. Forty percent of the noninstrumented roots and 10% of the instrumented roots displayed subgingival calculus. At all evaluation periods and in both instrumented and noninstrumented roots, inflammation was more intense when calculus was present; the difference was significant at ten days with the instrumented and at ten and 30 days with the noninstrumented specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Evaluation of clinical and radiographic scoring methods before and after initial periodontal therapy.

The purpose of the present study was to compare the determination of the attachment level by probing and by measuring bone heights prior to and after the completion of a hygienic phase of periodontal therapy. 68 patients with moderate to severely advanced periodontitis underwent initial (hygiene phase) therapy including scaling and root planing, oral hygiene instructions and the elimination of plaque retention factors. Measurements of pocket probing depths, probing attachment levels and the location of gingival margins in relation to the cemento-enamel junction were performed at 4 aspects of each tooth with a thin calibrated probe at a baseline examination and 3 to 5 months following treatment. During these 3 to 5 months, the patients were kept in a maintenance care program. On the full-mouth radiographs obtained at baseline, the distance from the cement-to-enamel junction to the marginal alveolar crest was measured in millimeters and as a % of the root length. Furthermore, a subgroup of 11 patients, who were scheduled for modified Widman flap procedures, received another full-mouth radiographic examination before the surgical treatment. In addition, the level of the alveolar crest was assessed with a periodontal probe during the surgical procedure. The comparison of the different clinical and radiographic parameters showed the best correlations between the various radiographic measurements of bone heights (r = 0.87; r = 0.86). Clinical measurements of probing attachment level and probing level of the alveolar crest revealed slightly weaker correlations (r = 0.72). When comparing radiographic bone heights with clinical measurements of probing attachment levels, the lowest correlations were found (r = 0.65; r = 0.61; r = 0.61).

Adult↗
PubMed1995

Guided tissue regeneration in human furcation defects after using a biodegradable barrier: a multi-center feasibility study.

This multi-center study evaluated guided tissue regeneration (GTR) in Class II furcation defects using a polylactic acid biodegradable barrier in 29 patients with mandibular and maxillary molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites scaled and root planed. Furcation defect perimeter was measured and a customized barrier (thickness 600 to 750 mu) was applied to cover the defect. Barriers adhered directly to tooth and bone. At baseline, sites were measured for probing depth (PD) (6.0 +/- 0.2 [SE] mm), gingival margin location (GML) (-0.2 +/- 0.2 mm), and attachment level in both vertical (AL-V) (6.2 +/- 0.2 mm) and horizontal (AL-H) (5.4 +/- 0.2 mm) directions. After the surgical procedure, there was good compatibility between the gingival tissues and barrier material. Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Comprehensive periodontal examination parameters were measured 3, 4, 6, 9, and 12 months after baseline. A repeated measures ANOVA was used to evaluate changes from baseline. At 6 and 12 months postsurgery, GML was close to the presurgical level (-0.5 +/- 0.2 mm). There was clinically and statistically significant improvement in all other parameters: mean PD reduction (2.2 mm), AL-V gain (1.7 mm), and AL-H gain (2.5 mm). These results indicated favorable clinical regenerative outcomes after using this barrier material in Class II furcation defects in humans.

Adult↗
PubMed1980

Histological evaluation of probing depth following periodontal treatment.

The aim of this study was to compare the periodontal probing depth in teeth exposed to periodontal treatment with teeth having received no treatment. In pockets deeper than 4 mm, a significant difference was found between the two groups. In the non-treated teeth, metal strips used for probing penetrated an average of 0.29 mm into the connective tissue apical to the junctional epithelium. The average probing depth for teeth exposed to scaling, root planing, curettage and chlorhexidine rinses for 1 month was 0.31 mm coronal of the connective tissue attachment within the junctional epithelium. The results indicate that care should be taken when evaluating changes in periodental probing measurements during longitudinal studies.

Connective Tissue↗
PubMed2000

Histologic evaluation of periodontal healing in humans following regenerative therapy with enamel matrix derivative. A 10-case series.

BACKGROUND: Enamel matrix derivative (EMD) has been developed as a stimulus of periodontal regeneration. Human histology following its use has not been evaluated on pathologically altered root surfaces. METHODS: Ten intrabony defects in 8 patients were evaluated at 2 centers. Teeth with advanced adult periodontitis that were treatment planned for extraction were 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; conditioning with citric acid; application of EMD; wound closure with sutures; and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of small block section biopsies at about 6 months. The biopsies were fixed, decalcified, step-serial sectioned at 6 microns to 8 microns, and stained with hematoxylin and eosin or Masson's trichrome. RESULTS: Histologic evaluation of the region coronal to the base of the calculus notch showed evidence of regeneration (new cementum, new bone, and new periodontal ligament) in 3 specimens, new attachment (connective tissue attachment/adhesion only) in 3 specimens, and a long junctional epithelium in 4 specimens. No evidence of root resorption, ankylosis, or untoward inflammation was seen. CONCLUSIONS: The results of this study fulfill the proof of principle that use of EMD can result in periodontal regeneration on previously diseased root surfaces in humans, but on an inconsistent basis.

Adult↗
PubMed1990

The use of autologous fibronectin in the surgical repair of through-and-through furcation lesions in man. A pilot study.

4 subjects with bilateral through-and-through mandibular furcation lesions were assessed for the healing response in terms of attachment gain following surgical debridement, root planing, citric acid demineralisation and topical application of autologous fibronectin. The results were compared with sham-operated and saline-treated contra-lateral sites. There was no significant difference in the attachment gain at sites treated with autologous fibronectin and citric acid compared with sites treated with citric acid alone.

Bone Regeneration↗
PubMed1984

Treatment of localized juvenile periodontitis. Results after 5 years.

The present investigation was performed to study the effect on localized juvenile periodontitis (LJP) of a treatment program which included tetracycline administration, surgical elimination of inflamed tissues, scaling and root planing, and careful plaque control during healing. Treatment of LJP lesions was carried out on 16 individuals aged 14 to 18 years (JP group). Lesions in first molars and incisors in a group of patients with adult periodontal disease (AP) were treated in an identical manner and served as controls. The presence of angular bony defects adjacent to first molars and incisors was first documented in all patients. Thereafter, a clinical examination was carried out, including assessments of oral hygiene status, gingival conditions, probing depths and attachment levels. The patients were subjected to a treatment program involving administration of tetracycline (250 mg 4 times per day for 2 weeks), removal of granulation tissue after flap elevation, and root curettage. After surgery, the patients were instructed to rinse the mouth with 0.2% chlorhexidine for 2 min twice a day during the first 2 postsurgical weeks. Professional tooth cleaning was carried out once every 3 months during a 5-year period. At 6, 12, 24 and 60 months after surgical treatment, the patients were re-examined regarding oral hygiene, gingival conditions, probing depths and attachment levels. Treatment of LJP lesions resulted in resolution of gingival inflammation, gain of clinical attachment, and refill of bone in angular bony defects. The healing of the lesions of this patient sample was similar to healing observed in patients with AP.

Adolescent↗
PubMed2005

Three-dimensional micro-computed tomographic evaluation of periodontal regeneration: a human report of intrabony defects treated with Bio-Oss collagen.

This study utilized three-dimensional micro-computed tomography (micro-CT) to evaluate the regenerative response to Bio-Oss Collagen when used alone or in combination with a Bio-Gide bilayer collagen membrane for the treatment of four intrabony defects (5 to 7 mm) around single-rooted teeth. The micro-CT observations are compared to the clinical, radiographic, and histologic results, which have been previously reported. After reflecting a full-thickness flap, thorough degranulation and root planing were accomplished. Bio-Oss Collagen was then used to fill the defects, and in two cases a Bio-Gide membrane was placed over the filled defect. Radiographs, clinical probing depths, and attachment levels were obtained before treatment and immediately preceding en bloc resection of teeth and surrounding tissues 9 months later. A mean pocket depth reduction of 5.75 mm and mean clinical attachment level gain of 5.25 mm were recorded. The histologic evaluation demonstrated the formation of a complete new attachment apparatus with new cementum, periodontal ligament, and alveolar bone at the level of and coronal to the calculus reference notch. Micro-CT evaluation confirmed the histologic results and demonstrated the absence of ankylosis or root resorption for all specimens. This human histologic study demonstrated that Bio-Oss Collagen has the capacity to facilitate regeneration of the periodontal attachment apparatus when placed in intrabony defects. Micro-CT observations confirmed the histologic results and enhanced the three-dimensional understanding of periodontal wound healing. The results indicate that micro-CT may be useful for three-dimensional evaluation of periodontal regenerative procedures.

Animals↗
PubMed1984

Recolonization of a subgingival microbiota following scaling in deep pockets.

The present investigation was carried out to study some aspects of the recolonization of a subgingival microbiota following subgingival instrumentation in sites with deep pockets. 16 patients were recruited for the study. From each patient 4 inflamed gingival sites with deep pockets were selected. These sites were examined for plaque, overt gingivitis, bleeding on probing and probing depth. Samples of the subgingival microbiota were obtained and examined in the darkfield microscope and in a Neubauer chamber. Following the Baseline examination the teeth of all 4 jaw quadrants were carefully scaled and planed. Subgingival instrumentation was carried out under local anesthesia and required between 2-4 appointments. The patients were subsequently divided into 2 groups (Groups A and B) consisting of 9 and 7 subjects, respectively. During the first 16 weeks of maintenance the patients of Group A were not supervised regarding their self-performed plaque control measures and they accumulated supragingival plaque. The patients of Group B, however, were during these 16 weeks recalled once every 2 weeks for professional tooth cleaning. In addition they rinsed twice daily with a 0.2% solution of chlorhexidine digluconate. Reexaminations including assessments of the same parameters as those studied at Baseline were performed after 2, 4, 8, 12 and 16 weeks. After the 16-week examination the patients of Group A received a new sequence of subgingival scaling and root planing. During the subsequent 16 weeks the patients of Group A were also recalled for professional tooth cleaning. They were reexamined 18, 20, 24, 28 and 32 weeks after the Baseline examination. Subgingival scaling followed by carefully supervised oral hygiene measures resulted in a marked improvement of periodontal conditions. This improvement was accompanied by a pronounced and sustained reduction in the motile segments of the subgingival microbiota. In the presence of supragingival plaque (Group A), however, a subgingival microbiota containing large numbers of spirochetes and motile rods was soon (4-8 weeks) reestablished. A small number of sites with deep pockets (greater than or equal to 8 mm) was not substantially reduced in depth following subgingival instrumentation. In these sites which were kept free from supragingival deposits a subgingival microbiota with a large proportion of motile bacteria soon recurred.

Adult↗
PubMed2006

Lasers in periodontics: a review of the literature.

BACKGROUND: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis. METHODS: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author to be purely opinion articles, leaving 278 possible articles. RESULTS: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints. CONCLUSIONS: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.

Chronic Disease↗
PubMed2003

Healing in transplanted teeth with periodontal ligament cultured in vitro.

Regeneration of connective tissue attachment is the ultimate goal of periodontal therapy. It has been suggested that periodontal ligament cells possess the potential to create new connective tissue attachment. However, as cells from gingiva and alveolar bone occupy the root surface during initial wound healing, population by periodontal ligament cells is limited in vivo. We have been developing a new periodontal regeneration technique using in vitro tissue culture of periodontal ligament remaining on a periodontally involved root. The purpose of this study was to examine the periodontal healing after transplantation of teeth with reduced periodontal ligament that had been cultured in vitro. Twenty-five incisors from four beagles were used. After the teeth were extracted, the periodontal ligament and cementum were removed from coronal part of the roots and the roots were planed. The periodontal ligament of the apical part was retained. Fourteen teeth of the experimental group were transplanted following culture for 6 weeks. Eleven teeth of the control group were similarly prepared and immediately transplanted without tissue culture. Four weeks after transplantation, the specimens were prepared for histological analysis. Downgrowth of junctional epithelium on the root of experimental group was significantly less than control. Most of the root planed surfaces of experimental group were covered with periodontal ligament fibers oriented parallel or inclined to the root surfaces and limited new cementum formation was observed near the apical end of the planed root. There was no significant difference between groups in observations on the root surface with remaining periodontal ligament. From the above results, it was concluded that periodontal tissue culture of teeth with root planed surface and remaining periodontal ligament could reduce the extent of epithelium downgrowth and increase connective tissue adhesion on the root planed surface, as well as minimize damage to remaining periodontal ligament, after transplantation of teeth.

Animals↗
PubMed1982

The effect of short-term administration of minocycline HCl on gingival inflammation and subgingival microflora.

The purpose of this investigation was to determine the efficacy of minocycline hydrochloride in the management of subgingival microorganisms and periodontal disease. In a double-blind, split-mouth study, minocycline or placebo was administered systemically for 7 days to 26 adults with moderate-to-serve periodontitis. Four study groups were examined: (i) minocycline-scaled, (ii) minocycline-unscaled, (iii) placebo-scaled, and (iv) placebo-unscaled. The minocycline-scaled group responded most favorably, with improved gingival health for at least 49 days and with marked reductions in total bacterial counts and proportions of spirochetes for at least 70 days (termination of the study). Minocycline administration with no periodontal scaling and root planing also resulted major, long-lasting shifts in the subgingival microflora. Scaling alone was least effective in changing the microflora. The data indicated that minocycline may be a useful adjunct in the treatment of periodontal disease. Further studies are needed, however, to determine the long-term effect of minocycline therapy on the periodontal attachment level.

Adult↗