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PubMed1986

The effect of mouthrinses on parameters characterizing human periodontal disease.

The objective of the present clinical trial was to assess the efficacy of mouthwashes containing antiseptic agents on established and developing plaque and periodontal disease in adult subjects using a newly described clinical research model. The study was carried out in 21 patients with periodontal disease. At the baseline examination, all tooth surfaces-sites were studied with regard to dental plaque, gingivitis, bleeding on probing to the base of the pocket and probing pocket depths. The patients were subsequently randomly assigned to 1 of 3 groups, each consisting of 7 individuals. Group A rinsed with a 0.01% solution of Sanguinarine, group B rinsed with a 0.2% solution of chlorhexidine and group C rinsed with a placebo solution. No instructions regarding mechanical plaque control measures or information regarding the etiology and pathogenesis of periodontal disease were given to any of the patients during the course of the 6-weeks of trial. The clinical examination was repeated after 2 weeks use of the mouthwash preparations. Following the re-examination, all patients were subjected to scaling and root planing in 2 jaw quadrants chosen at random. After another 2 weeks, the 2nd re-examination was performed and the teeth in the 2 remaining jaw quadrants were thoroughly scaled. The final examination was performed 2 weeks later. During the 4 weeks of rinsing, without adjunctive professional mechanical debridement, the frequency distribution of plaque Index scores 2 + 3 did not change in the group of patients using the placebo solution, but was significantly reduced in both the chlorhexidine and the Sanguinarine groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Depth-force-patterns in periodontal probing.

This investigation was undertaken to study penetration-depth and simultaneous force development during the insertion of a standard periodontal probe tip into a pocket to gain information about the tissue resistance to probing and its relation to the accuracy of depth determination. A piezoelectric force transducer and a linear position transducer were incorporated into a periodontal probe. Depth-force diagrams were obtained on an x-y plotter. In 5 patients requiring treatment for chronic periodontitis, 50 sites were selected and measured 3 times before and 3 times after a treatment phase consisting of hygiene instruction, systematic deep scaling and root planing. The minimal required probing force for reproducible values within a limit of 0.5 mm up to a force of 1.2 N was determined for each record ("b-value") and correlated in a multiple linear regression analysis with a number of clinical parameters of the sites. Depth-force diagrams recorded with the probe showed the characteristics of saturation curves flattening off in the range of 1 N and more. When the probing force was increased from 0.41 N up to 1.2 N, 50% of all measurements showed an increase in depth of more than 0.5 mm. However, increasing from 0.9 to 1.2 N resulted in a change of more than 0.5 mm in only 5% of the measurements. Differences in b-values before and after the treatment were significant (p less than 0.01). Differences related to tooth type (M, PM, I) and conventional pocket depth before treatment were also significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Periodontal conditions of teeth adjacent to extraction sites.

The purpose of the present clinical study was to evaluate the effect of tooth extractions on the periodontal conditions of adjacent teeth. 40 patients were selected for the study. Prior to the extractions, baseline data of the adjacent teeth were obtained. Plaque (PII) and gingival indices (GI), pocket probing depths and probing attachment levels were scored. In addition, the alveolar bone height was determined radiographically in relation to the CEJ adjacent to the extraction sites. The contralateral side of the jaw, where no tooth had to be removed, was examined as a control. A limited hygienic phase (scaling and root planing of all surfaces examined) was performed immediately prior to the extractions. Using the same parameters, all sites were reexamined 2-4 months and 6-9 months following the extractions. After the hygienic phase, the teeth adjacent to the extraction sites indicated a decrease in the pocket probing depths by 0.5 to 1.5 mm. In shallow pockets (1-3 mm), this decrease was less pronounced than in moderate to deep pockets (4-9 mm), where it was composed of shrinkage of the gingival tissues and gain of probing attachment. The radiographic level of the bony alveolar crest in relation to the CEJ of the adjacent teeth was not altered by the extraction procedure. The oral hygiene performances of the patients were not influenced during the 9-month observation period. Therefore, neither PII nor GI scores showed relevant improvements.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Plaque Index↗
PubMed1988

Histiocytosis X: an oral diagnostic problem.

A case of prepubertal periodontitis in a 6 1/2-year-old boy is described. Following failure to respond to conventional treatment including scaling, oral hygiene instruction and tetracycline therapy, a biopsy was performed and root planing carried out. The biopsy revealed histiocytic infiltration and a diagnosis of Histiocytosis X of the Hand-Schüller-Christian type was made. This case emphasises the role of biopsy in establishing a diagnosis in cases of prepubertal periodontitis that do not respond to conventional therapy.

Child↗
PubMed1988

The effects of periodontal therapy on serum antibody (IgG) levels to plaque microorganisms.

The influence of periodontal therapy on serum antibody titers to selected periodontal disease-associated microorganisms was assessed in 23 patients having chronic inflammatory periodontal disease (CIPD). The immunoglobulin G (IgG) titers were determined by the microELISA technique in serum samples obtained prior to treatment; following a hygienic phase which included scaling, root planing, and oral hygiene instruction; following surgical treatment; and one year and two years following hygienic phase (maintenance phase). Considerable individual variability existed in the magnitude of immune response to specific bacterial preparations. Significant reductions in the mean antibody titers were seen to A. viscosus, S. sanguis, F. nucleatum, S. sputigena, B. gingivalis, B. intermedius, B. melaninogenicus, T. vincentii, and T. denticola by the end of the second year of maintenance. There was no consistent response to Capnocytophaga. When individual patient responses were examined, 6 of the 23 were found to have elevated titers to at least one of the microorganisms in the interval between pretreatment and the end of the hygienic phase; however, in all but one case, the titers at the end of the second year of maintenance were below pretreatment levels. Antibody levels to bacteria such as S. sanguis were modified during therapy. This would indicate that immune responses to microbes not generally considered to be "periodontal pathogens" may be modified by adjuvant activity associated with subgingival plaque or changes in the environment of the sulcus and that subsequent changes in titer do not necessarily reflect a role of that microorganism in the disease process.

Adult↗
PubMed1990

Sulfadiazines reduce gingivitis and plaque formation in beagle dogs.

The effect of zinc sulfadiazine (ZnSD) and silver sulfadiazine (AgSD) on reducing plaque formation and gingivitis was studied in 12 beagle dogs over a 14-week period. 12 beagle dogs were scaled, root planed and pumiced to bring them to a similar level of gingival health, prior to placing them on a diet of Purina Dog Chow softened with canned gravy and molasses to promote the build-up of plaque and the initiation of gingivitis. At the end of 8 weeks, the dogs were determined to have substantial bacterial plaque accumulation and apparent gingivitis. Thereafter, 4 dogs were treated 2 x daily with topical applications of 3% zinc sulfadiazine; 4 dogs were treated with 2% silver sulfadiazine while 4 dogs were treated with placebo gel serving as control over a 14-week treatment period. By week 2, the zinc and silver sulfadiazine dogs showed a significant decrease in gingival index which was maintained throughout the study. Additionally, by week 2, the % of sites with bleeding was also seen to decrease significantly in the experimental groups. The plaque index remained consistent in all 3 groups until week 6 when the 2 experimental groups indicated significant decrease in plaque accumulation as compared to controls. Probing depths were also seen to decrease significantly in the experimental groups after 10 weeks of therapy. The mean stain index was similar in all 3 groups of dogs throughout the study. Data indicate that both zinc and silver sulfadiazine inhibit plaque formation and reduce existing gingivitis in beagle dogs.

Administration, Topical↗
PubMed1991

Human intrabony lesion responses to debridement, porous hydroxyapatite implants and teflon barrier membranes. 7 histologic case reports.

7 vertical lesions at 7 teeth in 3 adults with severe periodontitis were treated using open surgical debridement, porous hydroxyapatite grafts and placement of a barrier membrane. Roots were notched at both gingival margins and deepest visible calculus. Flaps were sutured coronally and patients were placed on 0.12% chlorohexidine gluconate twice daily for 2 weeks, post-surgery. Patients returned frequently for plaque control until block removal at 16 to 28 weeks post-surgery. 1 additional block was harvested after 28 weeks. The latter site received root planing only and closed by epithelial adhesion. In the 7 experimental sites, clinical responses were uneventful, and gain in clinical closure varied from 1.7 to 5.0 mm (average = 3.6 mm). Histologically, 2 sites exhibited closure by a long junctional epithelium. The remaining 5 sites showed gingival recession to be apical to the calculus notch or the calculus notch to be epithelialized. However, apical to the notch and within the osseous crater, cellular cementum deposition was marked as was increased bone mass. The increase in bone mass was the result of osteogenesis within the surrounding graft particles which often fused with osseous seams of the crater. A functionally-oriented PDL was seen usually at these sites.

Adult↗
PubMed1991

Short-term effects of initial periodontal therapy (hygienic phase).

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy on probing pocket depths and probing attachment levels using a patient group with moderate to advanced periodontitis. 68 patients with moderate to advanced periodontitis underwent hygienic phase therapy including oral hygiene instructions, scaling and root planing and elimination of plaque retentive factors. Assessments of the plaque control record (PCR), bleeding on probing (BoP), probing depths and probing attachment levels were performed at baseline examination and 3 to 5 months following active treatment. The measurements were obtained at 4 interproximal aspects of each tooth with a thin calibrated probe. Mean BoP values decreased from 63.2 +/- 21.9% at baseline to 16.6 +/- 7.3% after therapy, and mean PCR decreased from 78.6 +/- 16.4% to 12.7 +/- 7.1%, respectively. A reduction in mean probing pocket depth from 3.96 +/- 1.39 mm at baseline to 3.30 +/- 1.16 mm after therapy was noted. Sites with initial probing depths of 1-3 mm showed no change, sites with initial values of 4-6 mm revealed a reduction of 1.03 +/- 1.04 mm, while initial pockets of 7-9 mm decreased in depth by 2.28 +/- 1.62 mm. A gain in the mean probing attachment level from 4.16 +/- 1.80 mm to 3.74 +/- 1.71 mm was observed as a result of treatment. The group with the shallow initial probing depths of 1-3 mm showed no alteration in probing attachment level. Pockets with baseline values of 4-6 mm showed gain of clinical attachment of 0.69 +/- 1.43 mm. The greatest gain in clinical attachment of 1.51 +/- 1.75 mm was obtained in sites with initially deep pockets of 7-9 mm. From the results of this study, it can be concluded that non-surgical periodontal therapy is an effective means to reduce probing pocket depths and to improved clinical attachment levels in patients with moderate to advanced periodontitis.

Adult↗
PubMed1991

Clinical, microbiological and immunological characteristics of subjects with "refractory" periodontal disease.

The aim of the present study was to analyze the relationship between attachment loss and clinical, microbiological, and immunological parameters in a group of 21 human subjects exhibiting poor response to previous periodontal therapy. All had been treated with periodontal surgery, tetracycline, and subsequent maintenance recalls to periodontists who, upon detection of disease progression, referred the subjects to our clinic. In our clinic, each subject received oral hygiene instruction and a thorough subgingival scaling and root planing utilizing as many appointments as necessary. Clinical indices, including gingival index, bleeding on probing, suppuration, plaque index, pocket depth, and duplicate measurements of attachment level from an acrylic stent, were collected at monthly intervals. Probing measurements were performed using the Florida Probe. When significant attachment loss (0.8-1.2 mm) was detected in at least 1 site, a bacterial sample was taken from that site and from a comparably deep, but non-progressing, control site. Microbial samples were enumerated by darkfield microscopy, on selective and non-selective media, and by predominant cultivable technique. Blood samples were also collected to determine antibody levels against potential pathogens. There was no difference in the amount of plaque present in sites gaining or losing attachment, but losing sites exhibited more bleeding and suppuration. 20 of the 21 subjects were tested; of these, 17 exhibited elevated serum antibody against one or more of the following microorganisms: Actinobacillus actinomycetemcomitans, Bacteroides, gingivalis, and Eikenella corrodens. However, few, if any, of the "classical" pathogens were detected in the plaque samples obtained at the time progressive disease was diagnosed. The only exception was Streptococcus intermedius, which occurred in slightly higher numbers in active sites.

Actinobacillus↗
PubMed1991

Immediate response to nonsurgical periodontal treatment in subjects with diabetes mellitus.

The short-term response (3-4 months) to non-surgical periodontal treatment, i.e., oral hygiene instruction, scaling and root planing, was determined in 34 diabetic and 45 control subjects. Measurements of probing pocket depth and gingival bleeding (%) were used for evaluation. No significant difference could be observed in the response to non-surgical periodontal treatment between the diabetics and controls.

Adolescent↗
PubMed1991

Cell-seeding of periodontal ligament fibroblasts. A novel technique to create new attachment. A pilot study.

This study was undertaken to test the hypothesis that seeded periodontal ligament cells are able to create new attachment. In one beagle dog, a premolar was removed and scrapings of the ligament were cultured. Artificial periodontal defects were made and the cultured ligament cells were seeded on the planed root surfaces and covered with muco-periosteal flaps. The opposite side served as control. After 4 months, the dog was sacrificed and histological and electron microscopical sections were prepared. The seeded root surfaces were almost completely covered with cementoblasts, whereas in controls, epithelial down-growth could be observed. We conclude that seeding of periodontal ligament cells could be a promising technique to create new connective tissue attachment.

Alveolar Process↗
PubMed1993

The effect of a mouthrinse based on nisin, a bacteriocin, on developing plaque and gingivitis in beagle dogs.

The aim of this study was to evaluate the effect of nisin, an antimicrobial peptide, on the development of plaque and gingivitis in beagle dogs when compared with 0.12% chlorhexidine and a placebo. 16 female beagle dogs 1 year of age were brought to optimum gingival health by scaling, root planing and polishing. At the conclusion of the pretreatment phase, the dogs were divided into 4 groups for the application of the test agents and were placed on a plaque promoting diet of Purina Dog Chow softened with water. Test agents included 100 micrograms/ml nisin and 300 micrograms/ml nisin formulated in a vehicle containing 1 mM NaEDTA; negative control comprised of exactly the same formulation but omitting nisin; and 0.12% chlorhexidine as Peridex. Throughout the treatment period, formulations were applied 2x daily to premolar teeth in each quadrant for 1 min using a Monojet syringe. The development of plaque and gingivitis was monitored at 15, 27, 39, 53, 74 and 88 days during the treatment phase using standard measurements of gingival index, plaque index, stain index and bleeding to probing. Throughout the treatment phase, plaque accumulation increased in all groups, but the rate of plaque build-up was less in groups treated with either nisin or chlorhexidine formulations compared with the placebo treated group. The gingival index of dogs in all groups increased throughout the study period. However, from day 27 onward, the groups receiving nisin had lower gingival index scores than did the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1993

Late onset Papillon-Lefèvre syndrome? A chromosomic, neutrophil function and microbiological study.

We had the opportunity to study a family with one of the most destructive forms of periodontal disease known, the Papillon-Lefèvre syndrome. The parents had no consanguinity and were not affected, and were therefore to be considered carriers of the disease. 2 sisters, the eldest and youngest, showed periodontal breakdown and hyperkeratotic skin lesions, but their deciduous dentition was not affected. 2 brothers had skin lesions only and another brother and sister were healthy. Furthermore, 2 babies died at birth one after a 9-month pregnancy and the other after a 6-month pregnancy, and the mother also suffered 3 miscarriages. For 4 years, we studied the family: in the case of both sisters, mechanical periodontal treatment and antibiotics were unable to control the disease. In the chromosomic study of the 2 sisters affected, the GTG banding technique found no trace of anomalies in the cells analyzed, whose chromosomic formation was 46,XX. Before treatment, the chemotaxis of the PMN, the phagocytosis of opsonized Staphylococcus aureus, and production of superoxide radicals by PMN was significantly impaired in both sisters. Despite scaling and root planing, the periodontal lesions still progressed, but the PMN functions evaluated were now normal in both sisters. An orally asymptomatic but dermatologically affected brother showed no significant defect in the phagocytic activity and the production of superoxide radicals.

Adult↗
PubMed1994

Type I collagen carboxyterminal telopeptide in human gingival crevicular fluid in different clinical conditions and after periodontal treatment.

A total of 126 gingival crevicular fluid (GCF) samples were collected from 20 adults using paper strips. Patients were divided into a periodontitis-affected group (13 subjects) and a periodontitis-free group (7 subjects) by pocket depth and radiological bone loss. 4 subjects from the periodontitis-affected group received a single episode of periodontal treatment (scaling, root planing and curettage) and GCF samples were collected 2, 5, 10, 20 and 40 days after treatment. Type I collagen carboxyterminal telopeptide (ICTP) in GCF was extracted into saline solution and determined by a radioimmunological method. Mean GCF ICTP concentration was 425 micrograms/l (SEM 45) in periodontitis patients and 148 micrograms/l (SEM 25) in periodontitis-free subjects, i.e., GCF ICTP concentrations were about 100 x higher than serum reference values. Significant positive correlations were found between GCF ICTP total amount per site and plaque index (R = 0.362), papilla bleeding index (R = 0.259), pocket depth (R = 0.464) and radiological bone loss (R = 0.418). Periodontal treatment decreased GCF ICTP concentration to the level seen in healthy subjects. However, large variations were seen between subjects and sites. ICTP levels below the detection limit were often found in deep pockets, as well as high values in periodontitis-free subjects. It was concluded that GCF ICTP reflects the local type I collagen degradation in periodontal tissues, and probably gives information about the tissue destruction process beyond the reach of the clinical parameters.

Adult↗
PubMed1995

Tetracycline-resistant micro-organisms recovered from patients with refractory periodontal disease.

Tetracycline in combination with scaling and root planing is frequently used to treat refractory periodontal disease. This study examined tetracycline resistance in bacteria recovered from periodontal pockets of patients with refractory periodontitis. Bacterial isolates resistant to 10 micrograms/ml of tetracycline were isolated from plaque samples of 17 patients, of whom 6 had received tetracycline within 8 weeks prior to sampling. Minimal inhibitory concentrations (MICs) of tetracycline and minocycline were determined by agar dilution. In the 6 patients who had received tetracycline, a mean of 22.9% (+/- 38.2) of the total cultivable subgingival flora were resistant to tetracycline, compared with a mean of 7.2% (+/- 8.5) in the untreated group. Although various organisms were isolated, in most patients, the tetracycline-resistant organisms were dominated by Streptococcus spp. Overgrowth of Candida was found in one patient, and of Enterobacteriaceae in another patient, while small numbers of yeast or Staphylococcus spp. were isolated from the plaque samples of 9 others. 3 out of 4 patients who did not respond to tetracycline treatment had a variety of tetracycline-resistant anaerobic Gram-negative rods present. No correlation was found between increased proportions of tetracycline resistance in the whole bacterial sample and the presence of resistant periodontal pathogens.

Adult↗
PubMed1995

An evaluation of the effects of an Nd:YAG laser on subgingival calculus, dentine and cementum. An in vitro study.

The aim of this study was to evaluate the effects of Nd:YAG laser treatment on subgingival calculus, cementum and dentine, in vitro at different power settings and durations. The study included 2 experiments. In the 1st experiment, 32 extracted teeth with calculus were divided into 8 laser treatment groups. Each tooth was treated on 2, 3 or 4 sites. In the 2nd experiment, 3 extracted cementum covered teeth and 3 extracted root planed teeth with exposed dentine were selected. 1 surface of each tooth was subjected to 8 different laser treatments. In both experiments, all specimens were assessed using scanning electron microscopy. Micrographs were taken from each treated site at x 100 and x 750 magnifications. An arbitrary scale (from 0 to 3) was used to score the degree of damage caused by the laser. Generally, the laser caused greater damage on calculus than either cementum or dentine. Linear regression analysis showed that higher total energy input caused a greater mean damage score on calculus (R2 = 66%, p < 0.001). 3-way analysis of variance showed that for calculus, the power setting, number of pulses per second and the duration of exposure contributed independently to the mean damage score in an additive way. Cementum specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s), treatment 2 (50 mJ, 10 pps, 5 s), and treatment 5 (50 mJ, 20 pps, 1 s). Dentine specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1996

Evaluation of the long-term efficacy and safety of locally-applied minocycline in adult periodontitis patients.

The objectives of the present study were to establish in a long-term investigation the safety as well as the clinical and microbiological efficacy of scaling and rootplaning combined with local application of 2% minocycline hydrochloride-gel versus placebo-gel in patients with moderate to severe chronic adult periodontitis. This was an 18 months, randomized, double-blind, parallel, comparative study, in which 20 healthy patients with moderate to severe chronic periodontitis participated. At baseline, all patients received professional oral hygiene-instruction and supra- and subgingival scaling and root planing. The minocycline-gel was applied subgingivally baseline, 2 weeks, 1, 3, 6, 9 and 12 months. Microbiological evaluation was carried out using DMDx to identify the following bacteria: Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum and Treponema denticola. In addition standard microbiological techniques were used for the detection of P. gingivalis, P. intermedia, P. micros, A. actinomycetemcomitans, C. rectus, F. nucleatum, C. albicans and Enterobacteriaceae. Results showed a statistically significant improvement for all clinical parameters irrespective of the treatment modality. No differences were observed between test and control with regard to probing depth and attachment level. The DMDx data showed a significant reduction in both the numbers and the prevalence over the 15 months period, but no significant difference between groups. Culture data showed that at baseline two-third were positive for P. gingivalis and P. intermedia. Analysis over the 18 month period showed no significant difference between the two treatment modalities. C. albicans and Enterobacteriaceae were detected only in small proportions at each time interval in a limited number of patients. No adverse reactions were observed during the trial period. The present patient group responded favourably to scaling and rootplaning, but did not benefit from an effect of local of minocycline. Subgingival debridement in combination with oral hygiene instruction by itself has been shown to be effective. It remains to be studied whether local application of minocycline can be effective as an adjunct to mechanical therapy in sites that respond poorly to conventional treatment.

Administration, Topical↗
PubMed1996

2 multi-center trials assessing the clinical efficacy of 5% sanguinarine in a biodegradable drug delivery system.

A biodegradable drug delivery system containing 5% sanguinarium (Sa) was compared to vehicle control (VC), scaling and root planing (SRP), and supragingival plaque control (SPC) in the treatment of adult periodontitis in 2 well-controlled clinical trials. Studies were 4-quadrant (split mouth) designs at 2 centers each, having 94 (Study A) and 107 (Study B) patients. All patients had at least 3 pockets between 5 and 9 mm that bled on probing, in each quadrant. Probing pocket depth (PD), clinical attachment level (AL), bleeding on probing (BOP), and plaque index were recorded at baseline, 14, 30, 60, and 90 days. All treatments gave statistically significant reductions from baseline for PD and BOP, and significant gains for AL. For PD reduction, SRP was superior to all test groups at all time points in both studies (p < 0.001). Sa was superior to VC in Study A at 14 and 30 days and to SPC at all time points. For AL gain at 90 days, in both studies, SRP gave gains of 0.42 and 0.78 mm respectively with superiority seen over the SPC group at 90 days (p < 0.001) in study A only, For BOP reduction, in Study A SRP was superior to Sa, VC, and SPC at 60 and 90 days (p < 0.005) and in Study B superiority to Sa and VC was at 90 days and to SPC at 60 days (p < 0.05). Sa was superior to VC for pocket depth in deep pockets only. Sa failed to demonstrate superiority over VC on a consistent basis. Analysis of residual Sa indicates that Sa potency was insufficient to show an advantage beyond clinical effects inherent in treatments with VC and SPC.

Adult↗