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.

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.

A six-month clinical comparison of the efficacy of the Sonicare and the Braun Oral-B electric toothbrushes on improving periodontal health in adult periodontitis patients.

A sonic electric toothbrush (Sonicare) and an oscillating/rotating electric brush (Braun Oral-B) were compared for efficacy in removing supragingival plaque, reducing gingival inflammation, reducing probing pocket depth (Pd) and improving probing attachment levels (PAL) in a 6-month, single-blind clinical trial. Sixty-six adults with early-moderate periodontitis (5-7 mm Pd in at least two quadrants) entered the study, and 54 completed the entire study. The Sonicare and Braun groups were equally matched for plaque scores, and balanced for age, race and gender. Plaque was scored using the Turesky, Gilmore and Glickman Index. Gingival inflammation was determined by the Papillary Bleeding Score (PBS) of Loesche. Probing depths and attachment levels were determined using a manual North Carolina probe. All measurements were recorded at baseline, 2, 4 and 6 months. The mean overall plaque scores improved in both the Sonicare and the Braun groups at each of the follow-up visits. Interproximal plaque scores also improved in both groups with time, and the mean differential Sonicare post-brushing score was significantly better than the Braun at the 6-month visit (t-test; p = 0.039). Gingival inflammation also decreased in both groups over the 6-month period, but the Sonicare group showed significantly superior PBS scores at 4 months (t-test; p = 0.002) and 6 months (p = 0.005). The percentage reduction in inflammation from baseline at 6 months was 31.9% for Sonicare and 18.1% for Braun. Probing depth scores followed a similar pattern, with the Sonicare showing a mean reduction of 0.84 mm (15.8%) from baseline at 6 months, and Braun showing a 0.39 mm (7.2%) reduction (p = 0.002). In the Sonicare group probing attachment levels improved by 8.6% (MANOVA; p = 0.01), but no PAL improvement was seen in the Braun group. Overall, this study demonstrates that long-term use of these two electric toothbrushes improves periodontal health in adult periodontitis patients, and that the Sonicare brush is superior to the Braun brush in reducing gingival inflammation and probing depth. Moreover, 6 months' use of Sonicare led to actual improvement in probing attachment levels of periodontal pockets.

Performance of seven rapid radiographic processing solutions.

This study evaluated the performance of seven rapid radiographic processing products. A conventional automatic processing solution was evaluated as a standard of comparison. The products were analyzed with respect to image quality and speed. The results indicate that rapid manual processing generally involves some compromise of image quality as well as slower speeds with an accompanying increase in patient radiation exposure. Accordingly, there seems to be little motivation for the use of rapid manual processing solutions unless there is a compelling rationale in terms of time or convenience.