A new multiple anti-infective non-surgical therapy in the treatment of peri-implantitis: a case series.

BACKGROUND: Peri-implantitis is a frequent disease that may lead to implant loss. The aim of this case series was to evaluate the clinical results of a new non-surgical treatment protocol. METHODS: Fifteen patients with dental implants affected by peri-implantitis were treated with a multiple anti-infective non-surgical treatment (MAINST) which included two steps: 1) supra-gingival decontamination of the lesion and sub-gingival treatment with a controlled-release topical doxycycline; 2) after one week, a session of supra and sub gingival air polishing with Erythritol powder and ultrasonic debridement (where calculus was present) of the whole oral cavity was performed along with a second application of topical doxycycline around the infected implant. Primary outcome measures were: implant failure; complications and adverse events; recurrence of peri-implantitis; secondary outcome measure were presence of Plaque (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD). Recession (REC), Relative Attachment level (RAL). RESULTS: Neither implant failure nor complications nor adverse events were reported. Statistically (P<0.01) and clinically significant reductions between baseline and 1 year of PI (100% vs. 13.9%, 95% CI: 72.4% to 93.7%); BOP (98.5% vs. 4.5%, 95% CI: 85.4% to 98.5%) and PPD (7.89 vs. 3.16 mm, 95% CI: -5.67 to -3.77), were detected. At baseline, all 15 patients had a PPD>5 mm at the affected implant(s), whereas only 3.7% at 3-month follow-up a PPD>5 mm, and none at 6 and 12 months. CONCLUSIONS: Within the limits of this study, the MAINST protocol showed improvement of clinical parameters for the treatment of peri-implantitis, which were maintained for up to 12 months.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

Comparative evaluation of short- and long-term treatment of periodontitis with alpha-lipoic acid.

The ultimate goal of research was to make a comparative evaluation of efficiency of periodontitis treatment with alpha-lipoic acid in the short-term and long-term period in people which are under the influence of heavy metal salts of low intensity. 50 patients residing on the territory under the influence of heavy metal salts of low intensity, were under observation and they were given medical treatment to evaluate the efficiency of periodontitis treatment with the help of alpha-lipoic acid in short-term and long-term period. The patients were undergone clinical evaluation of periodontal status according to general indexes and data of laboratory examinations prior to treatment, in 14 days and in 12 months. After intaking of 600 mg of alpha-lipoic acid per day during 14 days the condition of periodontitis tissues in the reference group and in the basic group has no statistically significant differences. The basic group took alpha-lipoic acid during 2 months, that favored improving of clinical and laboratory indexes. In comparison with the reference group in the basic group PMA index decreased in 2.3 times, IIS in 1.4 times, BPI in 1.8 times, complex parodontal index improved in 1.3 times, leucocytes emigration decreased in 1.2 times and microbial contamination of epithelium in 1.22 times. Efficiency of anti-inflammatory therapy was 1.4 times higher. Depth of gingival pockets and level of oral hygiene had no statistical significant differences.

Flies blown disease--oral myiasis.

Myiasis, a term first introduced by Hope (1840), refers to the invasion of tissues and organs of animals and human wounds and certain body cavities by the dipteran larvae which manifests as subcutaneous furunculoid or boillike lesions. Oral myiasis is a rare pathology and a risk to the patient's life. Higher incidence is seen in rural areas affecting the tropical and sub-tropical zones of Africa and America. Myiasis affecting the oro-dental complex is rare. Here is a case report of oral myiasis in an 18-year-old male patient who is mentally challenged with anterior open bite, incompetent lips, and periodontal disease. The lesion was treated with turpentine oil, which forced larvae out and irrigated with normal saline solution. Follow-up examination revealed complete remission and healing of the lesion.

Evaluation of hyaluronan gel (Gengigel(®) ) as a topical applicant in the treatment of gingivitis.

AIM: To clinically and histopathologically evaluate the anti-inflammatory effect of 0.2% hyaluronan gel alone and with mechanical therapy on gingivitis. The argyrophilic nucleolar organizer region staining technique was attempted to routinely determine its diagnostic and prognostic dependability for periodontal lesions. METHODS: In each of the 28 gingivitis patients, the four quadrants were subjected to different treatments: scaling, scaling + topical hyaluronan gel, only topical hyaluronan gel, and topical + intrasulcular hyaluronan gel. Clinical parameters were recorded at baseline, and on days 7, 14, and 21. Biopsies were taken from each quadrant, inflammatory infiltrates were graded, and the argyrophilic nucleolar organizer region count was measured before and after treatment. RESULTS: A significant reduction was seen in clinical parameters, inflammatory infiltrates, and the argyrophilic nucleolar organizer region count within the groups. The effect of topical + intrasulcular gel was equivalent to scaling (P > 0.05). Topical + intrasulcular hyaluronan gel application demonstrated a better reduction than topical hyaluronan gel alone. CONCLUSIONS: Hyaluronan gel is an effective topical agent for treating gingivitis, along with scaling and intrasulcular application. The argyrophilic nucleolar organizer region count can be used as a histopathological indicator in cases of non-responsive gingivitis to assess the severity of gingival inflammation.

Clinical effect of subgingivally delivered simvastatin in the treatment of patients with chronic periodontitis: a randomized clinical trial.

BACKGROUND: Periodontitis is an inflammatory disease that results in bone resorption creating bony defects, which may cause tooth loss. Various drugs have been studied using local delivery to improve the periodontal health and to achieve periodontal regeneration. Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. The present study was designed to investigate the effectiveness of SMV, 1.2 mg, in an indigenously prepared biodegradable controlled-release gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS: Sixty patients were categorized into two treatment groups: SRP plus placebo (group 1) and SRP plus SMV, 1.2 mg (group 2). Clinical parameters were recorded at baseline before SRP and at 1, 2, 4, and 6 months; they included modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of intrabony defect (IBD) fill was done using computer-aided software. The mean concentration of SMV in gingival crevicular fluid was estimated by reverse-phase high-performance liquid chromatography. RESULTS: All subjects tolerated the drug, without any postapplication inflammation. Both therapies resulted in significant improvements. The decrease in mSBI score at 6 months was greater in group 2 (2.3267 +/- 0.8017) compared to group 1 (0.5033 +/- 0.6815). The mean decrease in PD from baseline to 6 months was 1.20 +/- 1.24 mm and 4.26 +/- 1.59 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 1.63 +/- 1.99 mm and 4.36 +/- 1.92 mm in groups 1 and 2, respectively. In group 2, there was greater decrease in mean IBD (1.41 +/- 0.74 mm or 32.54%) compared to group 1 (0.09 +/- 0.58 mm or 2.16%). CONCLUSION: There was a greater decrease in gingival index and PD and more CAL gain with significant IBD fill at sites treated with SRP plus locally delivered SMV in patients with chronic periodontitis.

Adhesive tablet effective for treating canker sores in humans.

A new mucoadhesive tablet, which releases natural active agents for pain reduction and rapid healing of canker sores, has been prepared and characterized. Adhesive tablets were prepared by compression molding of mixed powders of crosslinked polyacrylic acid and hydroxypropyl cellulose, absorbed with citrus oil and magnesium salt. The rate of tablet erosion and the rates of citrus oil and magnesium release were determined as well as the adhesiveness of the tablet using bovine gingival tissue and an Instron tensiometer. A clinical trial was conducted on 248 volunteers who had canker sores. Tablets adhere well to the mucosal tissue and gradually erode for 8 h releasing the citrus oil in a zero-order pattern whereas the magnesium is released during a period of 2 h. Both experimental and plain tablets were effective in reducing pain and decreasing healing time (p < 0.05) without adverse side effects. However, the tablets loaded with active agents were more effective.

Locally delivered antimicrobials for the treatment of chronic periodontitis.

The basic treatment of chronic periodontitis is a mechanical debridement of periodontal pockets by scaling and root planing (S/RP) in combination with efficient plaque control. Locally delivered antiseptics (LDA) have been proposed to practitioners and, while subgingival irrigation of antiseptics is still used in clinical practice, the introduction in our therapy of a slow release and sub-gingival delivery of tetracycline has changed the rationale from a mechanical treatment towards a combined therapy for full mouth/sites disinfection. Various antibiotics, antiseptics and resorbable carriers are now proposed with similar targets to arrest disease progression. In chronic periodontitis, LDA cannot be used routinely in combination with S/RP, because of the limited clinical benefit, even if an increased percentage of deep sites may show an improvement. Prospective multicenter studies considering risk factors for disease progression have to be designed to identify patients who may benefit the most from LDA. For non-responding sites or recurrent pockets, the controversies are limited, because a combined S/RP and LDA may avoid the need for surgery. However, the patient cost/benefit ratio needs to be estimated as well as adverse effects in particular antibiotics.

Clinical evaluation of tetracycline HCl conditioning in the treatment of gingival recessions. A comparative study.

Thirty Class I and Class II recessions in 30 patients were treated with a modified subepithelial connective tissue graft procedure. Fifteen recessions in the test group received a tetracycline hydrochloride (50 mg/ml) root treatment for 5 minutes (TTC-HCl group); the remaining 15 recessions composed the control group and received a citric acid root treatment for 3 minutes (CA group). Clinical assessments were taken at baseline and at 6 months. The differences between treatments were not statistically significant. In the central area of the recession, the mean percentage of root coverage was 81.7% corresponding to a mean percentage of 79.3% and 84.0% for the TTC-HCl and the CA group, respectively. In the test group, 6 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 57.8%. In the control group, 8 of the 15 recessions exhibited complete root coverage; the gingival augmentation was 43.6%. The mean surface area of root exposure was reduced from 11.53 mm2 and 13.30 mm2 to 0.34 mm2 and 0.29 mm2 for the TTC-HCl group and the CA group, respectively. This reduction corresponds to a mean percentage of 97.4% root coverage for both groups. Within the limits of this study, the results indicate that tetracycline hydrochloride and citric acid root conditioning have comparable clinical effects in root coverage surgical therapy. The data also suggest that the measurement of the surface area of the recession is a more accurate criterion in the evaluation of the mean percentage of root coverage than a single central vertical linear measurement.

Fibrin glue application in conjunction with tetracycline root conditioning and coronally positioned flap procedure in the treatment of human gingival recession defects.

A split-mouth clinical study was designed to determine the effect of fibrin glue (FG) in addition to tetracycline HCI (TTC) root conditioning and the coronally positioned flap (CPF) procedure in the treatment of maxillary buccal recession defects. 11 patients presenting with a pair of Class I or II recession defects were selected. After initial therapy, defect-specific and full-mouth oral hygiene standards and gingival condition, recession depth, recession width, probing depth, attachment level, and width of keratinized gingiva were recorded. The surgical procedure included elevation of a full split thickness flap, root debridement and root conditioning with a 10 mg/ml TTC solution for 4 minutes. According to a randomization list, in each patient, 1 defect was treated with topical FG application, while the paired defect did not receive FG. The flap was adapted and sutured coronally to the cemento-enamel junction without tension. Healing was evaluated 6 months postsurgery. Significant recession depth reduction and attachment gain were observed for both treatments. Average root coverage amounted to 65% in FG treated defects and 55% in defects treated with TTC conditioning only. There were no clinical and statistical significant differences between the treatments for any parameter considered. This study suggests that FG may not meaningfully enhance the outcome of the CPF procedure with TTC root conditioning.

Inhibition of epithelial cell matrix metalloproteinases by tetracyclines.

The effects of tetracyclines on periodontal epithelial cells were investigated by culturing cells from porcine rests of Malassez in the presence of oxytetracycline, doxycycline or one of two analogues of tetracycline bearing no antimicrobial activity. Matrix metalloproteinase activity produced by the epithelial cells was assayed by quantitation of radioactive gelatin degradation and by gelatin enzymography. The results show that all tested tetracyclines exerted a direct dose-dependent inhibitory effect on epithelial cell gelatinases. Furthermore, epithelial cells cultured with doxycycline, oxytetracycline and de-dimethylaminotetracycline in concentrations ranging from 1 to 50 micrograms/ml showed a marked reduction in secreted gelatinase activity when grown in alpha minimum essential medium in the absence of fetal calf serum. Viability of cells following this treatment, measured as lactate dehydrogenase activity released to the cell media, was not affected by the presence of any of these drugs at the concentrations used. Scanning electron microscopy revealed striking morphologic changes of the cells following treatment with tetracyclines in the absence of serum which include rounding, decreased intracellular contacts and increased intercellular spaces. No such effects were seen in cells cultured in the presence of serum. These results provide evidence that periodontal epithelial cells produce matrix metalloproteinases whose activities are inhibited by tetracyclines and their non-antimicrobial analogues at concentrations present in gingival crevicular fluid following tetracycline therapy. When used as adjuncts in periodontal therapy, tetracyclines may therefore inhibit epithelial cell mediated degradation of basement membrane and subepithelial connective tissue.

Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing.

This trial tested the adjunctive effects of a 0.12% chlorhexidine rinse (Peridex) upon gingival healing following scaling and root planing. Assessments were made on reduction in plaque (Pl), gingivitis (GI), pocket depth and gingival bleeding as measures of treatment benefit. All subjects had Class II, III or IV periodontal conditions. Following baseline examinations, subjects received a gross supragingival scaling and polishing. Subjects were separated by sex and periodontal classification, arrayed by GI scores, and randomly assigned to either the chlorhexidine rinse or a placebo rinse. Subjects were instructed to rinse with 1/2 ounce of their assigned products for 30 seconds twice daily. Following two weeks of product use, the clinical examinations were repeated and two randomly selected, opposing contralateral quadrants were scaled and root planed. After two more weeks of product use (week 4), clinical examinations were repeated and the remaining quadrants were scaled and root planed. At week 6, final clinical examinations were conducted. Since half-mouths were treated at different times and exposed to the treatment rinses for different periods, the data were analyzed for the half-mouths independently 2 and 4 weeks after gross scaling, and 2 and 4 weeks after root planing. A total of 94 subjects (47 in each treatment group) completed all phases of the trial. Gingival healing following scaling and root planing in subjects using a chlorhexidine rinse (0.12%) was significantly better than subjects using the placebo rinse as evidenced by less gingivitis (29%), fewer GI bleeding sites (48%) and less plaque (54%).

Irrigation with chlorhexidine to resolve naturally occurring gingivitis. A methodologic study.

This study compared oral irrigation and rinsing with chlorhexidine (CHX) and placebo in the treatment of naturally occurring chronic gingivitis. 44 subjects with at least 6 interproximal sites which bled on probing were randomly distributed on a double-blind basis into 4 treatment groups, placebo-rinse, CHX-rinse (0.12%), placebo-irrigation and CHX-irrigation (0.06%). A half-mouth was scaled 2 weeks prior to therapy in all groups. Rinses were performed 2 times daily and irrigation was performed once a day by means of an oral irrigator with the tip directed at a right angle to the tooth. Subjects continued with routine oral hygiene without instruction. The active treatment period was 2 months. Parameters were recorded at baseline and at 60 days. At the conclusion, marginal plaque was cultured for predominant microbial types. CHX-rinse (0.12%) and CHX-irrigation (0.06%) significantly reduced (p less than 0.05) plaque. Gingival bleeding decreased by 26% in both scaled and unscaled sites following CHX (0.12%) rinses and by 40% at both types of sites following CHX (0.06%) irrigation. Bleeding was reduced with CHX-irrigation greater (p less than 0.05) than with the placebo-irrigation. The mean log of colony-forming units of Actinomyces species was significantly lower (p less than 0.05) in the CHX (0.12%) rinse and CHX (0.06%) irrigator groups than in the placebo groups. These data therefore indicate that delivery of CHX (0.06%) by an oral irrigator is an effective means of treating naturally occurring gingivitis.

[Clinical trials of solcoseryl in the treatment of parodontium diseases]. / Ocena kliniczna solcoserylu w leczeniu chorób przyzebia.

The effect of Solcoseryl on the clinical state of the parodontium was assessed in 26 patients aged from 18 to 57 years with the diagnosis of deep parodontopathies. Each patient received 30 ampoules of 2 ml of Solcoseryl for one course of the treatment. Submucous injections of the drug near the teeth 13, 23, 33 and 43 were done as follows: during the first 10 days one ampoule daily, then 10 injections every other day, and 10 injections at three-day intervals. The condition of the parodontium was assessed before and after the treatment by means of the PI, GI, GBI and teeth mobility indices, and measurements of the depth of gingival pouches--K, and volume of fluid in pouches SFFR according to Brill. The therapeutic method applied in these cases had a good effect on reduction of gingivitis, bleeding and volume of secreted pouch fluid but had only a small effect on teeth mobility and depth of gingival pouches.

[The concentration and duration of the action of metronidazole in the gingival pocket following local application]. / Untersuchungen zur Konzentration und Wirkungsdauer von Metronidazol in der Zahnfleischtasche nach lokaler Applikation.

Periodontitis is a locally limited disease caused by bacteria. The local application presents itself useful for the indicated medicamentous therapy of periodontitis by means of metronidazole. In preliminary tests the metronidazole liberation from hollow fibres, in gel and from polyvinyl alcohol platelets has been tested by ultraviolet absorption measurement. The hollow fibres have been evaluated no more because of too small agent absorption in the clinical test. In polyvinyl alcohol metronidazole acts definitely over 3 days. However, the prolonged action in the gel form is not definitely (45 min to 24 h). A single one or repeated twice metronidazole/polyvinyl alcohol platelet application results in a sufficient long and high metronidazole concentration in the gingival pocket.

Clinical evaluation of spiramycin and erythromycin in control of periodontal disease.

Two studies are reported. Each was double-blind in which Spiramycin was compared to Erythromycin and a placebo, to determine the value of Spiramycin as a therapeutic agent in the control of periodontal disease. In Study 1, 48 adults with varying degrees of periodontal disease were randomly assigned to treatment and control groups. Assessments of gingival index, plaque height, pocket depth, crevicular fluid volume and wet plaque weight were made. During this 4-week clinical trial, the patients maintained their usual oral hygiene. The medication was administered systemically for 5 days, starting at the conclusion of week 2. Spiramycin significantly reduced the scores for the five parameters recorded. When comparison were made, the greatest recorded effect with Spiramycin treatment was found in patients with advanced periodontal disease. The indication of this trend favouring Spiramycin led to an extension of this clinical trial involving only patients with advanced periodontal lesions. This second study comprised 54 adults. The same parameters were measured over the same time period as in Study 1. Spiramycin again was responsible for the greatest reduction in the recorded scores. For example, average pocket depth was decreased by approximately 30%, whereas Erythromycin produced a reduction of 15%. It would appear that Spiramycin is of definite benefit in the management of periodontal disease, especially in the more advanced cases.

[The effect of hormones on the periodontal condition--clinical studies on 300 female patients]. / Zur hormonellen Beeinflussung des Parodontalzustandes--klinische Untersuchungen an 300 Patientinnen.

In this study 300 women (100 pregnant women, 100 women taking contraceptives and 100 women without contraceptive medication) were examined, recording the periodontal condition (using a computer-orientated chart) and the periodontal index according to Kötzschke. The values for the total index and the superficial and deep components of the index according to Kötzschke, the pocket depth and the degree of tooth mobility (determined for each tooth) were significantly higher in women under contraceptive medication than in the control subjects.

Treatment of periodontal pockets with tricalcium phosphate in man. A preliminary report.

After oral hygiene instruction 29 infrabony pockets in 9 patients were treated with deep scaling and flap surgery. The pockets were filled with a biodegradable tricalcium phosphate implant paste. 6 months postoperatively the average reduction of clinical pockets was 2.6 mm and the radiographically detectable attachment was 1.1 mm more coronal than preoperatively. 10% of the pockets remained deeper than 3 mm. Easy handling and simple storage are the predominant advantages of the described implantation material. Before recommending it for general use, however, some technical problems will have to be solved.

Human clinical and histologic repair responses following the use of citric acid in periodontal therapy.

Seven blocks containing one tooth each were obtained from two patients undergoing treatment for periodontitis. Sixteen weeks prior to block removal, these sites were treated by periodontal flap surgery. In six teeth a citric acid solution (pH = 1) was applied for 2 minutes to the planed root surfaces. The seventh tooth received identical periodontal therapy except that saline was applied to the planed root for 2 minutes. At the end of the experimental period, the blocks were removed and prepared for histologic study. In five out of six citric acid treated specimens, no evidence was observed suggesting that citric acid applications either initiated or accelerated cementogenesis or functional connective tissue attachment at root surfaces previously exposed to periodontal pockets. In one specimen, repair cementum was seen crestally to the alveolar margin. This cementum was deposited on the surface of acellular cementum. Unfortunately, however, the specimen does not allow us to date the deposition of the repair cementum. It thus remains questionable whether this cemental deposition is indeed a repair response to the specific treatment performed.