Measurement of proteases in human subgingival dental plaque by fluorescence polarization.

Fluorescence polarization (FP) was examined as a rapid quantitative method to assay the proteases in subgingival plaque. Protease activity was measured by a decrease in FP at 0.5-min intervals over 5 min, using BODIPY-alpha-casein, a protein substrate. To quantitate activity, the least absolute deviation (LAD) slope for each assay was determined. Protease activity increased with the quantity of plaque (r=0.416, P<0.001). Of the 208 subgingival plaque samples, 87 contained detectable protease activity, with a mean of about 4 microg trypsin equivalents above a general background of 1 microg per site. The mean plaque protease activity of 89 paired samples from 15 individuals had decreased by 1.1 microg trypsin equivalents per site when measured at 8 months after tooth scaling and root planing (P<0.01). Most isolates of Porphyromonas gingivalis, Treponema denticola, Prevotella nigrescens, and Prevotella intermedia implicated in the pathogenesis of adult periodontitis exhibited high activity in the FP assay. The assay is rapid, quantitative and requires only one-tenth of the plaque sampled using a single pass with a Gracey curette at a single tooth site.

Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study.

BACKGROUND: Freeze-dried acellular dermal matrix (ADM) allograft, originally used for full-thickness burn wounds, was recently introduced as an alternative to the autogenous free gingival graft (FGG) in achieving increased attached keratinized tissue. The aim of part 1 of this study was to investigate the clinical efficacy of the ADM allograft for this particular purpose. METHODS: Twelve patients, 7 males and 5 females, with attached gingiva < or =1 mm on the facial aspect of mandibular anterior teeth demonstrating a tendency of progressive marginal tissue recession, were randomly assigned to either test or control treatment. Six patients received ADM graft (test) and 6 patients received an autogenous FGG harvested from the hard palate (control). Clinical variables including plaque index (PI), gingival index (GI), probing depth (PD), attached tissue width (AT), and gingival recession (GR) were recorded immediately before surgery and at the 6-month postoperative visit. Patients were seen at 2, 4, 6, 8, and 12 weeks to monitor wound healing and oral hygiene performance (PI and GI). Graft width was also measured, in corono-apical direction, on individually involved teeth during the surgery. RESULTS: When values between baseline and 6 months were compared in both groups, there was no statistically significant difference in changes of PI, GI, PD, and GR (P>0.05) with the exception of PD in the FGG group (1.01 +/- 0.03 versus 1.27 +/- 0.20 mm, P= 0.042). There was a statistically significant (P <0.05) increase in AT in both groups. Although the ADM group received wider grafts than the FGG group (8.81 +/- 0.46 versus 6.70 +/- 0.89 mm), the AT gain was significantly smaller (2.59 +/- 0.92 versus 5.57 +/- 0.44 mm) and the graft shrinkage significantly greater (71 +/- 10% versus 16 +/- 12%) in the ADM group than in the FGG group (P<0.01). CONCLUSIONS: The results of this study suggest that in procedures aiming at increasing the width of attached gingiva: 1) the ADM allograft was less effective and less predictable than the autogenous FGG in terms of increasing attached keratinized tissue due to considerable shrinkage and inconsistent quality of the attached tissue gained and 2) the esthetic results using the ADM allograft might be better than those using the autogenous FGG.

Successful treatment of pulpal-periodontal combined lesion in a birooted maxillary lateral incisor with concomitant palato-radicular groove. A case report.

Palato-radicular groove (PRG) is a common developmental anomaly of maxillary incisors, whereas PRG associated with a birooted maxillary incisor is relatively infrequent. The clinical significance of PRG is related to the incidence of localized periodontitis with or without pulpal pathosis, depending on the depth, extent, and complexity of the groove. Successful treatments of PRG in single-rooted incisors have been reported in the literature. However, treatment of PRG in birooted incisors has often been ineffective. This case report describes a pulpal-periodontal combined lesion occurring on a birooted maxillary left lateral incisor with concomitant PRG in a 13-year-old boy which was successfully treated by conventional endodontic therapy in combination with periodontal treatment including accessory root resection, radiculoplasty and bone grafting. Seven-year follow-up is included in this report. The basis of a successful result is accurate diagnosis and elimination of inflammatory irritants and contributory factors. Awareness of the existence of this abnormality by the clinician is important.

Root planing following short-term pocket distention.

This study evaluated the effectiveness of root planing following short-term pocket distention. Seventy-five single-rooted teeth with probing depths > or = 5 mm and < or = 10 mm were selected. The teeth were randomly divided into three treatment groups. In groups 1 and 2 a gingival retraction cord (aluminum sulfate-impregnated in group 1 and non-impregnated cord in group 2) was packed subgingivally for 30 minutes. Following removal of the cord, the teeth were scaled and root planed. In group 3 the teeth were root planed only. Following instrumentation, the teeth were extracted and examined under a stereomicroscope. The residual calculus on the root surface of each tooth was measured using a computerized image analysis system. The quantities were compared using a two-way ANOVA and Chi-square test. The results showed that 46.3% of all root surfaces had detectable residual calculus and that the mean percentage of residual calculus per root surface was 4.41% following root planing. Forty percent of the root surfaces in group 1 had residual calculus, 38.0% in group 2, and 61.0% in group 3. There was a statistically significant difference (P < 0.01) between groups 1 and 2 compared to group 3. The mean calculus per root surface for groups 1, 2, and 3 was 3.03%, 3.04%, and 7.15%, respectively. Significant differences (P < 0.005) were found between groups 1 and 2 compared to group 3. These results indicate that subgingival calculus removal in deep pockets is enhanced with short-term pocket distention, and that there is no added benefit to having aluminum sulfate present in the retraction cord.

Measurements of interleukin-6 in gingival crevicular fluid from adults with destructive periodontal disease.

This paper describes a study of whether or not the amounts of interleukin-6 (IL-6) in gingival crevicular fluid (GCF) are correlated with periodontal clinical measures. A sensitive ELISA was developed to measure IL-6 in GCF. Two male and 3 female adult subjects with periodontal disease were examined at their first appointments, after 3 months, and after 6 months. Data were obtained on plaque index (PI), bleeding index (BI), probing depth (PD), and on the IL-6 content of GCF samples from 16 sites per subject for a total of 240 measurements. Significant correlations were found between BI and IL-6 (P < 0.005) and between PD and IL-6 (P < 0.05), but not between PI and IL-6. Only 6 out of the 80 sites (in 3 of the 5 subjects) showed PD increases of at least 2 mm. However, for each of these 3 subjects, the amounts of IL-6 in the GCF samples from these sites were markedly higher than the mean amounts of IL-6 in the GCF samples from the remaining sites. These findings suggest that IL-6 may be a useful indicator of periodontal disease, although more extensive longitudinal studies are needed to determine the real clinical value of this GCF component.