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PubMed1981

Clinical significance of gingival fluid measurement by "Periotron".

The accuracy of gingival fluid measurement with an electric device was compared with such clinical parameters as Gingival Index scores and pocket depths, and the treatment effect was evaluated by changes in the gingival fluid amount. After the initial examination 10 patients received oral hygiene instruction, scaling, root planing and soft tissue curettage. The operated areas were protected by a periodontal dressing for 1 week and all patients used a 0.2% chlorhexidine mouthrinse twice daily during that period and for the next week. Four weeks later the patients were reexamined for the same factors that were evaluated at the initial examination. The amount of gingival fluid correlated with the Gingival Index (r = 0.65), the pocket depth (r = 0.74) and the total amount of acid phosphatase in the gingival fluid (r = 0.92). Following treatment, a significant improvement in periodontal status was demonstrated by all of the parameters utilized.

Gingival Crevicular Fluid↗
PubMed1983

Subgingival metronidazole in acrylic resin vs. chlorhexidine irrigation in the control of chronic periodontitis.

After initial scaling, root planing and cleaning of subcontact areas, chronic periodontitis patients received oral hygiene instruction consisting of Bass toothbrushing using a sodium fluoride toothpaste, but without stress on interdental cleaning. They were then assigned to two groups, one of which self-administered 0.2% chlorhexidine solution subgingivally, once daily for 4 weeks, while the other was subjected to subgingival application of acrylic resin strips containing 40% metronidazole once weekly for 4 weeks. Plaque Index, Sulcus Bleeding Index, probeable pocket depth and gingival shrinkage were assessed for this treatment period and for a further 8 weeks. Highly significant improvements compared with baseline values were achieved and maintained to the end of the study. There were no significant differences between the groups at any time, except for Sulcus Bleeding Index which at Days 56 and 84 showed metronidazole to be superior. It was concluded that the regimens selected were equally effective in improving periodontal health over a 3-month period.

Acrylic Resins↗
PubMed1984

Periodontal treatment without maintenance. A retrospective study in 44 patients.

This study presents our findings on 44 patients who were treated for periodontal disease and for varying reasons elected not to participate in the maintenance aspect of periodontal care. All patients were initially given intensive instructions in personal oral hygiene, along with initial scaling and root planing. Each patient had two or more quadrants of pocket reduction therapy. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.22 (4.7%). Between examinations, breakdown in the health status of furcations was noted. Mean probing depth scores at the second examination showed no significant differences from the first examination scores. Measurements of bone levels revealed a worsening of bone scores between examinations. The results of this study show that periodontal therapy without maintenance is of little value in terms of restoring periodontal health.

Adult↗
PubMed1985

Identification of Langerhans cells in human gingival epithelium.

The purpose of this study was to qualitatively compare three recent techniques of Langerhans cells detection in oral epithelium and to quantitatively compare Langerhans cells in clinically normal and clinically inflamed human gingival biopsies. Eleven subjects were selected who displayed chronic periodontitis and moderate gingival inflammation. A quadrant associated with clinically inflamed tissues was not treated, while the remaining teeth were scaled and root-planed. Two gingival biopsies were taken: clinically normal, treated tissue; and clinically inflamed, untreated tissue. Langerhans cells were stained using HLD-DR, S-100 and OKT6. They were quantitated using a standard grid for OKT6-stained sections only. Approximately 5 times as many Langerhans cells were identified in the biopsy specimens of clinically inflamed human gingiva as in clinically normal gingiva of the same patient. Of the methods studied, OKT6 was qualitatively determined to be the best for visualization of these cells. An immunologic role in the host response to chronic periodontal disease is postulated for Langerhans cells.

Adult↗
PubMed1985

Hydroxylapatite as an alloplastic graft in the treatment of human periodontal osseous defects.

Twelve patients, 32 to 60 years of age, received a polycrystalline ceramic form of pure dense hydroxylapatite as an alloplastic bone implant material in intrabony defects following reflection of full mucoperiosteal flaps, root planing and defect-curettement. The defects were measured from an acrylic stent, using an endodontic silver point which was placed to the base of the defect. Similarly, debrided and curetted defects in the same patients were not implanted and served as controls. Recalls for documentation and plaque control were at 1, 2, and 4 weeks, and at 3, 6 and 9 months. Measurements relating to changes in defect-depth were made upon reentry at 9 months. The twelve defects, serving as controls, showed very little difference between the pretherapy and 9-month measurements. The initial mean measurement from the base of the defect to the highest alveolar crest was 4.27 mm and the 9-month mean measurement after curettage only was 3.36 mm. In terms of resolution of the original defect this amounted to 19.49% reduction, but a 0.46-mm mean loss in height of the alveolar crest provided an actual percentage fill of the original defect of 9.91%. Of sixteen experimental defects, the same initial mean measurement from the base of the defect to the highest alveolar crest was 5.18 mm and the 9-month mean measurement after grafting was 2.43 mm. In terms of resolution of the original defect, this amounted to a 53.57% reduction, but in contradistinction to the curettage sites, a mean increase in height of the highest alveolar crest of 0.61 mm gave a true percentage fill of the original defect of 66.89%. At the 9-month reentry, the implanted mass seemed to be partially "calcified" and was resistant to penetration with a probe or removal with a curette. The data and clinical impression strongly suggest that hydroxylapatite has a potential as an alloplastic implant with clinically apparent acceptance by the soft and hard tissues.

Adult↗
PubMed1985

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. II. Twelve month reentry results.

Thirteen patients received Durapatite, a hydroxylapatite ceramic (Periograf), as a bone implant material in various types of intrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the cemento-enamel junction (CEJ) at specific locations using a standardized periodontal probe. Similarly debrided, nonimplanted defects served as controls. Defect selection as either experimental or control site was based on an alternating defects design after local therapy was completed. Periodontal dressing and systemic tetracycline were used for 10 days. Postsurgical visits for documentation and plaque control were at 10, 20 and 30 days, and 3, 6, 9 and 12 months. Measurements relating to defect changes were made at the 12-month surgical reentry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.0 mm (47%) for the implanted defects and 0.3 mm (33%) for the control sites (significantly different at P less than 0.05). In Group II (3-6 mm) defect fill of 1.7 mm (44%) for implanted sites was significantly better (P less than 0.05) than the 0.8 mm (29%) found in control sites. In the deepest group (Group III, greater than 6 mm) Durapatite placement yielded 2.1 mm (32%) of defect fill while debridement alone resulted in 1.8 mm (26%) of fill (P greater than 0.05). Hard tissue responses demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Salt and peroxide compared with conventional oral hygiene. I. Clinical results.

The purposes of this 2-year longitudinal study were to: compare the clinical effectiveness of patient applied sodium bicarbonate, hydrogen peroxide, and sodium chloride (S/P) to the use of conventional oral hygiene methods and to investigate the motivational effect of using phase-contrast microscopy in teaching effective oral hygiene. Initially, 972 subjects were screened for signs of periodontitis. From these, 347 with early to moderate periodontitis were selected and each was randomly assigned to one of four home treatment regimens after scaling and root planing. The four treatment regimens included: conventional oral hygiene procedures, conventional oral hygiene procedures plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation, S/P oral hygiene, and S/P oral hygiene plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation. Plaque, bleeding, gingival inflammation, probing depth, and clinical attachment level were recorded at baseline, 8, 16, and 24 months. Subjects were recalled for reinforcement of oral hygiene and periodontal prophylaxis at various intervals. Data were analyzed based on disease severity, location of index sites and compliance. The results indicated that both conventional oral hygiene procedures and the S/P regimen were effective in reducing clinical signs of disease when combined with professional care. There were no differences between the two regimens in clinical effectiveness and trends favoring microscopic viewing of subgingival plaque for motivational purposes were not statistically significant.

Adult↗
PubMed1987

Salt and peroxide compared with conventional oral hygiene. III. Patient compliance and acceptance.

This study was undertaken to evaluate patient compliance with, and acceptance of, a salt and peroxide oral hygiene regimen compared with conventional oral hygiene regimens without or with the use of phase-contrast microscope viewing of subgingival plaque over a period of 2 years. A total of 231 subjects with early to moderate periodontitis were randomly divided into four groups. All groups were repeatedly instructed and motivated in their respective regimens. Subjects also received scaling and root planing using clinical and microbial criteria. Compliance with, and acceptance of, the two oral hygiene regimens were determined at the end of the study using a structured self-administered questionnaire. Results indicated that 74% and 58% (P less than or equal to 0.01) of subjects in the conventional and salt/peroxide groups, respectively, used their assigned regimen 4 to 7 days a week during the entire study. More than half of the subjects (54%) using each of the oral hygiene regimens indicated that they flossed once daily. Inconvenience was cited by 23% of the conventional and 43% of the salt/peroxide groups (P less than or equal to 0.01) as the main reason for not using their regimens. Twenty-three per cent of conventional group and 14% of salt/peroxide group indicated that shared their oral hygiene supplies with others. Eighty per cent and 57% (P less than or equal to 0.01) of the conventional and salt/peroxide groups, respectively, stated that they liked their regimens. Ninety-six per cent of all subjects felt that their regimen helped their periodontal status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Phenotypic and functional analysis of T cells extracted from chronically inflamed human periodontal tissues.

T-cell subsets extracted from chronically inflamed periodontal tissues were identified using monoclonal antibodies, and their functional activity was analysed using the autologous mixed lymphocyte reaction (AMLR). Tissue was obtained from a total of 33 adult periodontitis (AP) patients and 6 normal/marginal gingivitis (N/MG) patients. All AP patients had received repeated oral hygiene instruction and root planing prior to the surgery, and the majority (30 out of 33) had at least one site with greater than 6 mm loss of attachment from the cementoenamel junction within the surgical field. The N/MG patients had no loss of attachment, and probing depths were less than 3 mm. Single cell suspensions were obtained following collagenase digestion (90 minutes at 37 degrees C) and mechanical disruption of the tissue. T-cell subsets were identified using an indirect immunofluorescence assay on cells obtained from 19 AP patients and the 6 N/MG patients. The mean (+/- standard error) helper:suppressor (T4:T8) ratio for the AP patients was found to be 0.94 +/- 0.48 compared with 1.65 +/- 0.16 for the N/MG group and 1.51 +/- 0.12 for peripheral blood controls. HLA-DR positive macrophages were identified and were found to include both acid phosphatase (AcP) positive and adenosine triphosphatase (ATPase) positive populations. Functional analysis was carried out using cells extracted from the remaining 14 AP patients. Cells from six of these 14 patients were found to be capable of spontaneous proliferation. Co-culture experiments using autologous T and non-T populations revealed that cells from only four patients were able to respond in an AMLR while those from only one of the 14 patients were able to stimulate the AMLR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Abnormal lymphocyte profiles and leukotriene B4 status in a patient with Crohn's disease and severe periodontitis.

THIS CASE REPORT DESCRIBES clinical and laboratory findings for a 60-year-old woman with recently diagnosed Crohn's disease and severe generalized periodontitis. Comparison of dental radiographs taken in 1975, in 1983, and at the time of our evaluation in 1986 revealed dramatic progression of alveolar bone loss over that period. Standard laboratory blood tests did not reveal any remarkable significant leukocyte abnormalities, but flow cytometric analysis of lymphocytes revealed a paucity of B cells stained with anti-light chain antibodies, and an increased proportion of T lymphocytes which were dully-stained with anti-CD5 monoclonal antibody. B cell function as determined by in vitro proliferative responsiveness to anti-IgM antibody was only about 50% of that observed with cells from two healthy normal subjects. Serum leukotriene B4 (LTB4) was elevated to 150% of normal values, in spite of the fact that the patient was taking a systemic anti-inflammatory drug which is known to reduce LTB4 levels. The microbial flora was highly mixed and included several putative periodontopathic bacteria. Therapy consisted of oral hygiene instruction, scaling and root planing, mucoperiosteal-flap curettage, extracoronal splinting, and selective extraction of three teeth. The periodontal status improved markedly with therapy. Possible relationships between the patient's immunological status, her Crohn's disease, and the severe periodontal breakdown are discussed.

B-Lymphocytes↗
PubMed1988

Tetracycline therapy in patients with early juvenile periodontitis.

Tetracycline therapy, when used in conjunction with surgery or root planing, has been shown to be effective in controlling the progression of juvenile periodontitis. However, the ability of tetracycline alone to control the disease has not been assessed. The present study evaluated the effects of tetracycline therapy, with supragingival plaque control, on clinical attachment levels and radiographic bone height in patients with clinical and radiographic evidence of juvenile periodontitis. The four patients (mean age 15.2 +/- 0.3 yrs) each demonstrated loss of attachment of greater than or equal to 2 mm at one or more probing sites and had accompanying radiographic evidence of early localized bone loss. Following an initial clinical evaluation consisting of pocket depths, attachment levels and standardized radiographs, the patients received systemic tetracycline therapy (1 gm/day for three to six weeks) and oral hygiene instruction. At the completion of antibiotic therapy, patients received a supragingival professional prophylaxis every two weeks for three months, whereupon the initial evaluation was repeated. On comparing the initial and three-month clinical and radiographic data, there were significant decreases in clinical and radiographic measurements. For a total of 85 affected probing sites around 26 teeth, 79% decreased in pocket depth by greater than or equal to 2 mm (with no sites increasing in pocket depth) and 69% gained clinical attachment (with only one site losing attachment of 1 mm). Radiographic measurements revealed an increase in both the height and area of coronal alveolar bone. The findings indicated that six weeks of systemic tetracycline therapy combined with supragingival plaque control was effective in the initial control of early juvenile periodontitis.

Adolescent↗
PubMed1989

The effect of local doxycycline with and without tricalcium phosphate on the regenerative healing potential of periodontal osseous defects in dogs.

The purpose of this study was to evaluate the clinical and histological effects of high concentration doxycycline on osseous regeneration in adult beagle dogs. Four 5 mm two-wall periodontal osseous defects were created in the premolar and molar area of each quadrant yielding a total of 48 defects in the three dogs. Ligature-induced periodontitis was maintained for 6 weeks. Two weeks following ligature removal, one of the following graft procedures was randomly assigned to each defect: 1) doxycycline alone (DOX); 2) tricalcium phosphate alone (TCP); 3) a combined graft of DOX plus TCP, or 4), surgically debrided control. All areas received thorough scaling and root planing at the time of surgery. Clinical parameters evaluated at 4, 12, and 20 weeks after the surgical treatment included the gingival index and probing depths. Crevicular fluid was examined at 3, 10, and 28 days postoperatively for tetracycline fluorescence. Direct clinical measurements from the CEJ to a notch placed at the base of the defect and from the CEJ to the alveolar crest were made at the time of surgical treatment and reentry. The reentry procedures were performed at 4, 12, and 20 weeks postoperatively. Immediately following reentry block sections were obtained from each quadrant and prepared for examination with the light microscope. The gingival index and probing depth measurements showed greater improvement in the DOX and DOX + TCP groups. Increased regeneration (new bone, cementum, and periodontal ligament) and reduced alveolar crest resorption were observed more frequently in DOX and DOX + TCP defects, while healing by long junctional epithelium was more common in defects not treated with doxycycline.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1989

Human freeze-dried dura mater allografts as a periodontal biological bandage.

Freeze-dried dura mater allografts (FDDMA) were used as a biologic bandage covering periodontal osseous defects which were grafted with autogenous bone particles. Seven consenting adult patients having multiple one-, two-, and wide three-wall periodontal osseous defects participated in the study. Four to 6 weeks following initial preparation, all defects were treated by full thickness flap surgery, debridement of defects, root planing, intramarrow penetration as needed, and autogenous bone grafts that filled the defects. Randomly selected grafted defects in each patient were then covered with FDDMA (experimental) or by the host flap (RF) (control). Periodontal dressing and systemic tetracycline (250 mg q.i.d.) were used for 7 days. Frequent maintenance was performed until reevaluation at 6 months postsurgically. Soft tissue results showed no significant differences in initial probing pocket depths, recession, or gain of probing attachment. There was a significantly greater amount of probing pocket depth reduction and significantly shallower residual pockets when FDDMA was used. Hard tissue findings indicated that there were no significant differences in initial defect depth, amount of crestal resorption, or amount or percent of defect fill with either treatment. There were significant differences in the percent of defect resolution and the depth of the residual defect in favor of the FDDMA treatment. None of the FDDMA sites were felt to need a secondary surgery to correct residual defects or residual pockets. This study suggests that FDDMA may be beneficial as a "biologic bandage" to cover periodontal osseous defects that were filled with autogenous bone grafts. The trends in this study suggest that FDDMA may be very useful in periodontal regeneration procedures.

Adult↗
PubMed1989

Comparison of decalcified freeze-dried bone allograft and porous particulate hydroxyapatite in human periodontal osseous defects.

The purpose of this study was to clinically compare the healing potential of the osteoinductive decalcified freeze-dried bone allograft (DFDBA) with an osteoconductive synthetic graft, particulate porous hydroxyapatite (HA). Six patients ranging in age from 28 to 52 (mean age 42.6) participated in this investigation. They were without significant systemic disorders and had advanced periodontitis with at least two comparable periodontal defects. Each patient received initial therapy consisting of oral hygiene instruction, scaling, root planing, and occlusal adjustment as indicated. Probing pocket depth, gingival recession, attachment levels, and bleeding on probing were recorded in the posthygiene phase of therapy. Alveolar crest height and depth of osseous defect were obtained at the time of surgery. The cemento-enamel junction was used as the fixed reference point. All measurements were repeated at the time of a 6-month reentry. There was no significant difference in any of the soft tissue measurements when DFDBA and HA were compared. However, both treatment modalities reduced pocket depth and demonstrated a gain in clinical attachment levels. There was 2.2 mm of bone repair with DFDBA and 2.1 mm with HA. These values corresponded to a percent defect fill of 61% for DFDBA and 53% for HA. These values were likewise not statistically different.

Adult↗
PubMed1989

The development during pregnancy of pyogenic granulomas superimposed upon a congenital hemangioma: a case report.

A case of a 25-year old female school teacher with pyogenic granulomas of the gingiva developing during her first pregnancy in the area of a congenital hemangioma is described. The recurrence of the pyogenic granulomas of the gingiva during the second pregnancy could be successfully prevented by scaling and root planing prior to and bi-weekly professional tooth cleaning during pregnancy period. Hormonal changes during pregnancy were in this case found not to influence the development of gingival pyogenic granulomas during maintenance of optimal dental hygiene.

Adult↗
PubMed1990

Microbiology in diagnosis and treatment of severe periodontitis. A report of four cases.

The purpose of this report is to illustrate the use of microbiology in the diagnosis and treatment in four cases of severe adult periodontitis. All four patients were subgingivally infected with Actinobacillus actinomycetemcomitans which was the basis for an adjunct minocycline therapy. Scaling and root planing plus minocycline were not able to establish a clinically stable periodontal condition. A. actinomycetemcomitans was not eliminated from the pockets in any of the patients. Good clinical and microbiological results were obtained after continuous conventional treatment with an adjunct therapy of metronidazole plus amoxycillin. With a 7 day course of this antibiotic therapy, the pockets of all four patients became free of A. actinomycetemcomitans and were still negative on repeated sampling on recall visits. Microbiological monitoring of severe periodontitis in adults seems to be a valuable adjunct to clinical examination. Furthermore, effective antibiotic therapy in A. actinomycetemcomitans-associated periodontitis appears of paramount importance in obtaining a stable periodontal situation.

Actinobacillus↗
PubMed1991

Defective neutrophil function in an insulin-dependent diabetes mellitus patients. A case report.

The objective of this study was to evaluate the polymorphonuclear leukocyte (PMN) function in a poorly controlled adult insulin-dependent diabetic patient (IDDM) with severe recurrent periodontitis, while describing the microbiological and clinical findings. Chemotaxis, superoxide production, and phagocytosis and killing of Porphyromonas (Bacteroides) gingivalis by the IDDM PMN were evaluated 1 week before treatment relative to a healthy, matched control. These analyses revealed a significant (P less than .05) depression in the number of IDDM PMNs migrating along an FMLP gradient (Boyden chamber assay). In addition, a significant (P less than .05) enhancement of IDDM PMN superoxide production in response to opsonized zymosan (cytochrome C reduction) was observed. Phagocytosis and killing (fluorochrome phagocytosis assay) by IDDM PMN of two P. gingivalis strains was also impaired significantly (P less than .05). The subgingival microflora contained significant levels of P. gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, and Peptostreptococcus micros. Periodontal treatment consisted of extraction of hopeless teeth, scaling and root planing and 3 weeks of Augmentin therapy. The antibiotic therapy resulted in unrecoverable numbers of the putative pathogens and a reduction in both gingival inflammation and disease progression. The IDDM healing response to previous surgical treatment and extractions was poor, presumably due to a marked thrombocytopenia (91 x 10(3) platelets/mm3).

Bacteroides↗
PubMed1991

The effects of short-term application of a combination of platelet-derived and insulin-like growth factors on periodontal wound healing.

Polypeptide growth factors are a class of potent natural biologic mediators which regulate many of the activities of wound healing including cell proliferation, migration, and metabolism. Platelet-derived growth factor (PDGF) and insulin-like growth factor-I (IGF-I) have been shown to regulate DNA and protein synthesis in bone cells in vitro and to interact synergistically to enhance soft tissue wound healing in vivo. We have hypothesized that the combination of PDGF and IGF-I may, therefore, enhance regeneration of both the soft and hard tissue components of the periodontium. To test this hypothesis we performed conventional periodontal surgery on all 4 quadrants of the mouth of 13 beagle dogs with naturally occurring periodontal disease. Following flap reflection, degranulation, and root planing, all premolar teeth in 2 quadrants of each dog received a combination of 3 micrograms of recombinant PDGF-B and IGF-I in a methylcellulose gel, while the premolar teeth in the contralateral quadrants received the gel alone. Teeth in 4 additional animals also received 125I-PDGF or 125I-IGF-I in the treated sites. The clearance rate of the 125I-labeled protein, changes in local bone metabolism, and amount of new bone and cementum with inserting collagen fibers were measured. The clearance studies revealed that the half-life of the factors at the site of application was 3.0 hours for IGF-I and to 4.2 hours for PDGF-B. Greater than 96% of the radio-labeled proteins was cleared by 96 hours and no radioactivity was detected 2 weeks after application. There was a significant (P less than 0.01) 2-fold increase in uptake of the bone-seeking radiopharmaceutical Technetium 99-MDP at 2 and 4 weeks in growth factor treated sites compared to controls, indicating that there was increased metabolic activity within the bone at these sites. Computer-aided histologic analyses of biopsies obtained at 2 and 5 weeks post-operatively revealed a significant (P less than 0.01), 5 to 10 fold increase in new bone and cementum in PDGF-B/IGF-I treated sites at both time points compared to controls receiving the placebo gel. The height and total area of new bone continued to increase from 2 to 5 weeks. The new bone underwent a normal maturation process as judged by histologic appearance. A physiologic periodontal ligament space was also formed between the new bone and new cementum. There was no increase in ankylosis in the treated sites.(ABSTRACT TRUNCATED AT 400 WORDS)

Alveolar Bone Loss↗