Alveolar ridge dimensional changes after two socket sealing techniques. A pilot randomized clinical trial.

OBJECTIVES: This pilot study aimed to assess dimensional changes following two different alveolar socket sealing techniques. MATERIAL AND METHODS: Twenty-one patients requiring tooth extraction and implant placement were randomly allocated to two different alveolar ridge preservation techniques. In the control group, demineralized bovine bone mineral (DBBM) and a gingival soft tissue punch were used to fill and seal the socket, whereas in the test group, the extraction socket was filled with DBBM and sealed with a hemostatic gelatin sponge. Digitalized impressions were taken before and 6 months after tooth extraction. The comparison was made on horizontal and vertical dimensional changes. RESULTS: The mean vertical loss was 0.8 ± 0.6 mm for the control group and 0.7 ± 0.5 mm for the test one. No statistical difference was found between groups for the vertical shrinkage. The horizontal dimensional narrowing of the alveolar socket was respectively 7.1/4.0/2.5 mm at levels 1, 3, and 5 mm from a coronal reference level for the control group. The test group showed dimensional changes of 4.8/2.3/1.3 mm at the three different levels, respectively. A significant difference was found at levels 3 and 5 mm. Referring to a visual analog pain scale, patients reported more severe pain in the control group (5.7/10) when compared with the test group (2.8/10). The difference was statistically highly significant (P ≤ 0.001). CONCLUSIONS: A significant difference was found between control and test groups regarding the horizontal dimensional changes and the post-operative pain. CLINICAL RELEVANCE: Regarding this primary result, the socket sealing technique with a hemostatic sponge provides an effective and inexpensive protocol with less post-operative pain.

[Evaluation of periodontal health of Congolese in consultation in dental services of Kinshasa City]. / Evaluation de la santé parodontale des congolais admis en consultation dentaire dans la ville de Kinshasa.

Context: Periodontal diseases are multifactorial infectious pathologies. They affect tissues of support of the tooth and so end in dental losses. No sector of society is spared. Objective: To estimate the state of periodontal health of the patients admitted in consultation in the dental services of the city of Kinshasa. Material and Methods: It is a descriptive and transverse study. It was led on patients admitted in consultations in three dental services of the city of Kinshasa during the period going from January to August, 2015. The study included patients of 12 years old and more who consulted in one of the selected dental service. The selected patients supplied sociodemographic information in particular zone of residence, gender, level of education and social level. Dutch Periodontal Screening Index (DPSI) was used to estimate the periodontal state of every patient. Results: On a total of 642 patients 374 were females and 268 were males. The mean age was of 38.12 years ± 16,303. The patients of upper or more university level and those who had no employment represented successively 58.3% and 35.5%. Dental pain was the main motive for consultation. Majority of the patients had a DPSI around 3, that is 49.1%. 99.9% of the patients presented gingivitis whereas those 64% who suffered from periodontitis were subject to specialized periodontal care. Conclusion: Periodontal disease was present in all patients. The majority of the people had consulted dental surgeons only when they had pain.

Effect of N-chlorotaurine mouth rinses on plaque regrowth and plaque vitality.

The purpose of this 4-day plaque regrowth study was to assess the effect of N-chlorotaurine (NCT) mouth rinses on plaque inhibition and plaque vitality. Eighty volunteers participated in this investigator-blind, randomized, clinical controlled study in parallel groups. No oral hygiene was permitted except rinsing with a 2% or 3% NCT mouth rinse, a positive or a negative control. Primary parameters were the plaque index (Silness and Löe, Acta Odontol Scand, 22:121-135, 1964) and plaque vitality (Netuschil et al., J Clin Periodontol, 16:484-488, 1989) after the final rinse. In addition, another plaque index (Turesky et al., J Periodontol, 41:41-43, 1970), plaque area, and bleeding on probing were recorded. All parameters were taken at baseline and day 5. U test was applied on a 5% error level. No differences in plaque inhibition were found between the two NCT formulations and the negative control. However, a statistically significant reduction of plaque vitality compared to the negative and positive control was observed. Discoloration of the tongue and unpleasant taste were recorded in participants in the NCT groups. NCT mouth rinses did not inhibit plaque regrowth, but they did reduce the vitality of plaque bacteria. Methods of prolonging the substantivity of the NCT mouth rinses should be investigated to enhance the antibacterial properties of these formulations.

Long-term effects of Meridol and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality.

The aim of the present study was to compare the effect on plaque growth and gingival response of Meridol, an amine/stannous fluoride solution, during a three-month investigation, with those of a placebo preparation as a negative control and a chlorhexidine solution as a positive control, in a double-blind study. After having their teeth professionally cleaned, 36 volunteers continued their usual oral hygiene for a period of two weeks. Their teeth were then polished again (month 0) after which they rinsed twice daily (morning and evening) with one of the three mouthrinses in addition to their habitual toothcleaning. After three months of rinsing, plaque indices remained lowest in the chlorhexidine group, although the subjects using Meridol had indices significantly lower than those of individuals rinsing with the placebo solution. The gingival index scores in the Meridol group were higher than in the chlorhexidine group and lower than in the placebo group. The plaque vitality scores showed a bactericidal effect in vivo with chlorhexidine and Meridol during the entire experiment. The use of Meridol resulted in more toothstaining than with the placebo, but significantly less than with chlorhexidine. This study demonstrated that Meridol reduced plaque accumulation, retarded gingivitis development, possessed a definite bactericidal action, and produced only slight toothstaining.

Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4-year follow-up split-mouth study.

BACKGROUND: Treatment with enamel matrix proteins (EMD) and guided tissue regeneration (GTR) with bioabsorbable membranes has been shown to promote periodontal regeneration; however, until now, there were only limited data on the long-term clinical results following these regenerative techniques. Therefore, the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration (GTR). METHODS: Twelve patients, each displaying one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMD or with GTR by means of bioabsorbable membranes. The following clinical parameters were evaluated at baseline, at 1 year, and at 4 years after treatment: plaque index (P1), gingival index (G1), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70% power to detect a 1 mm difference. RESULTS: The sites treated with EMD demonstrated mean CAL change from 9.8 +/- 2.0 mm to 6.4 +/- 1.6 mm (P<0.001) and to 6.8 +/- 1.8 mm (P<0.001) at 1 and 4 years, respectively. No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively. The sites treated with GTR showed a mean CAL change from 9.8 +/- 2.3 mm to 6.6 +/- 1.7 mm (P<0.001) at 1 year and to 6.9 +/- 1.8 mm (P<0.001) at 4 years. The CAL change between I and 4 years did not present statistically significant differences. No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups. CONCLUSIONS: It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period.

Comparison of enamel matrix proteins and bioabsorbable membranes in the treatment of intrabony periodontal defects. A split-mouth study.

BACKGROUND: Enamel matrix proteins (EMP) have recently been introduced as a new modality for regenerative periodontal treatment. However, limited information is available concerning the comparison of the treatment of intrabony periodontal defects with enamel matrix proteins and other regenerative treatment alternatives. METHODS: The aim of the present controlled clinical trial was to compare the treatment of deep intrabony periodontal defects with EMP to that with guided tissue regeneration (GTR) with bioabsorbable membranes. Sixteen patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMP or with a bioabsorbable membrane. Prior to surgery and 8 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Antibiotics (amoxicillin and metronidazole) were given during the first 10 days after surgery. No statistical significant differences in any of the investigated parameters between the 2 groups were observed at baseline. RESULTS: No serious adverse events (e.g., allergic reactions or abscesses) after any of the treatments were noted during the entire observation period. Membrane exposure occurred in 7 out of the 16 GTR treated sites. Clinical examination was performed again 8 months postoperatively. Sites treated with EMP demonstrated a reduction of PD from 8.1+/-1.7 mm to 4.3+/-1.2 mm (P <0.001) and a change in CAL from 10.3+/-1.8 mm to 7.2+/-1.2 mm (P <0.001). The sites treated with GTR showed a reduction of PD from 8.3+/-1.7 mm to 4.3+/-0.7 mm (P <0.001) and a change of CAL from 10.1+/-1.9 mm to 7.1+/-1.7 mm (P <0.001). Both treatment procedures led to significant improvements of PD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control group. CONCLUSIONS: It may be concluded that both therapies led to shortterm improvements of the investigated clinical parameters. Further studies of much higher power are needed to support equivalence.

The effect of postsurgical antibiotics on the healing of intrabony defects following treatment with enamel matrix proteins.

BACKGROUND: Regenerative treatment with enamel matrix proteins has been shown to promote healing in intrabony defects. However, up to now various postoperative antibiotic regimens have been used in combination with enamel matrix proteins and therefore it cannot be excluded that the results may also be attributable to the effect of the antibiotic treatment. The aim of this randomized, controlled, blinded, clinical investigation was to determine the effect of postsurgical administration of antibiotics on the healing of intrabony periodontal defects treated with enamel matrix proteins. METHODS: Thirty-four patients each of whom exhibited one deep intrabony defect were randomly treated with either enamel matrix proteins plus antibiotics (test: EMD + AB) or with enamel matrix proteins alone (control: EMD). The antibiotic regimen consisted of a combination of 3 x 375 mg amoxicillin and 3 x 250 mg metronidazole daily for 7 days. The following parameters were recorded at baseline and at 1 year by the same calibrated and blinded investigator: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Power analysis to determine superiority of antibiotic treatment showed that the available sample size would yield 85% power to detect a 1 mm difference. RESULTS: No statistically significant differences in any of the investigated parameters between the 2 groups were observed at baseline. No serious adverse events such as allergic reactions or abscesses after any of the treatments were observed during the entire study period. The results have shown that in the EMD + AB group the PD decreased from 9.1 +/- 1.5 mm to 4.5 +/- 1.1 mm (P<0.0001) and the CAL changed from 11.0 +/- 1.6 mm to 7.5 +/- 1.4 mm (P<0.0001). In the EMD group the PD decreased from 9.0 +/- 1.7 mm to 4.3 +/- 1.7 mm (P <0.0001) and the CAL changed from 10.6 +/- 1.6 mm to 7.3 +/- 1.5 mm (P <0.0001). There were no significant differences in any of the investigated parameters between the 2 groups. CONCLUSIONS: It can be concluded that the systemic administration of amoxicillin and metronidazole adjacent to the use of EMD for the surgical treatment of intrabony periodontal defects does not produce statistically superior PD reduction and CAL gain when compared to treatment with EMD alone. Hence, the present results do not support the routine administration of amoxicillin and metronidazole following regenerative treatment with EMD.

High-performance liquid chromatography analysis of purine nucleosides in human gingival crevicular fluid.

Samples of human crevicular fluid were collected and analysed by high-performance liquid chromatography (HPLC) for purine nucleotides, nucleosides and bases. The complex chromatograms, had concentrations of compounds in two regions. Region (I) corresponded to purine bases and nucleosides, adenine and hypoxanthine were specifically identified. In region (II), where purine nucleotide mono- and diphosphates are generally observed, IMP and AMP were identified. In one subject with advanced periodontitis, additional compounds in region II were observed; crevicular fluid in gingivitis had the majority of their purine-containing compounds in region I.

Deposition and retention of vital and dead Streptococcus sanguinis cells on glass surfaces in a flow-chamber system.

The proportion of vital as compared with dead Streptococcus sanguinis cells attached to glass surfaces was monitored and related to varying proportions of planktonic vital as compared with dead Strep. sanguinis cells. In a flow chamber with six parallel-mounted glass plates, Strep. sanguinis was suspended in pretreated sterile human saliva. Deposition of Strep. sanguinis took place, with a proportion of vital sanguinis streptococci in saliva (%VSs) of 90%, 45% or 22.5%. After exposure times of 30, 60, 90, 120 and 240 min, adherent microorganisms were labelled with two fluorescence stains to differentiate between vital and dead bacteria. Proportions of vital attached streptococci (%VSa) were determined microscopically. Dead bacteria were detected on all glass plates. The %VSa at 30 min and 60 min was significantly lower than the baseline %VSs. During the course of a single run the %VSa frequently increased after either 30, 60 or 90 min without exceeding the %VSs at 4 h. %VSs was the only variable exerting a significant effect on %VSa at 30 and 60 min. It is suggested that during the initial events of microbial attachment the dead rather than vital Strep. sanguinis cells attach preferably to solid surfaces.

A pilot study of confocal laser scanning microscopy for the assessment of undisturbed dental plaque vitality and topography.

Confocal microscopy and vital fluorescence techniques were combined for the first time to investigate ex vivo human dental plaque. The vital fluorescence technique used discriminates vital from dead cells, while confocal laser scanning microscopy allows the optical sectioning of undisturbed biofilms leaving the samples intact during analysis. The concomitant use of both methods made an examination of the three-dimensional architecture of dental plaque possible. The topography of plaque biofilms that were allowed to accumulate in situ on glass and enamel was recorded. The distribution of plaque microflora vitality as well as its accumulation varied according to plaque age. A plaque thickness of up to 8, 35 and 45 microm was estimated ex vivo on enamel after 1, 2 and 3 days, respectively. Young and sparse plaque biofilms consisted mainly of dead material. Vital bacteria were observed on top of this dead layers.

An approach to differentiate between antibacterial and antiadhesive effects of mouthrinses in vivo.

An experimental set-up allowing differentiation in vivo between antibacterial and antiadhesive properties of mouthrinses is described. The percentage of vital bacteria (= microbial vitality) and the bacterial counts were microscopically evaluated in saliva and in supragingival dental plaque both collected simultaneously at various times during de novo plaque formation. In a cross-over design, 12 healthy participants refrained from all oral hygiene for four separate periods of 2 x 4 h and 2 x 72 h after having rinsed with either an amine fluoride/stannous fluoride solution (Meridol) or 0.9% NaCl (placebo). Stimulated whole saliva was collected before and after the rinse. Together with whole-saliva samples, representative 4, 24 and 72-h-old plaque samples were separately taken from defined vestibular tooth surfaces that had been either exposed to the mouthrinse (unprotected sites) or temporarily covered with inert plastic films (protected sites) during rinsing. The pooled plaque and saliva were stained with fluorescent dyes to differentiate vital from dead micro-organisms which permitted the estimation of the percentages of vital bacteria. The total bacterial counts were quantified under the darkfield microscope. The Wilcoxon test was used for selected pairwise comparisons (alpha = 0.05). The percentage of vital bacteria in saliva fell significantly from 80-95% to about 50-60% as a result of the antibacterial activity of the test solution. These baseline values and those found in the presence of 4 and 24-h-old plaque were frequently lower than those recorded after the placebo rinse. In comparison to the placebo, microbial vitality was significantly reduced in early supragingival plaque formed on unprotected sites after applying the test solution. The similar total bacterial counts in 4-h-old plaque recorded after the use of the test solution on the unprotected and the protected areas did not point to an antiadhesive effect of the agent. It is concluded that this new experimental set-up allows decoding of the mode of action of a mouthrinse.

Immunohistochemical investigation on the pattern of vimentin expression in regenerated and intact monkey and human periodontal ligament.

The expression of vimentin is well documented in the intact animal and human periodontal ligament (PDL), but there is limited information on the pattern of vimentin expression in the regenerated PDL. The aim of the present study was to investigate the pattern of vimentin expression in the regenerated and intact monkey and human PDL. A total of 12 chronic recession-type defects were created in three monkeys (Macaca fascicularis) and treated either with guided tissue regeneration (GTR), or with an enamel matrix protein derivative (EMD). After 5 months, the animals were sacrificed and specimens containing the defects and surrounding tissues were dissected free, decalcified in EDTA and embedded in paraffin. Sections were labelled immunohistochemically by using monoclonal antibody against vimentin (VIM 3B4). Twelve patients, each of whom displayed one deep intrabony defect scheduled for extraction were treated with GTR, EMD or combination of EMD+natural bone mineral (NBM). Following a healing period of 6 months, the teeth were extracted "en block" and immunohistochemically analysed according to the same protocol as described in monkeys. The results revealed that in both monkeys and humans the newly formed PDL was labelled similarly for vimentin to the intact (non-treated) PDL. In all specimens, the newly formed PDL was in continuation with the intact parts of PDL, thus suggesting that the mesenchymal cells capable of regenerating the attachment apparatus may have their origin in the intact PDL. In conclusion, the present findings indicate that (a) the reformed PDL displayed a similar expression of vimentin to the intact (original) PDL, and (b) the cells capable of regenerating new PDL and new cementum appear to be of mesenchymal origin and their source may be in the intact PDL.

Spatial distribution of vital and dead microorganisms in dental biofilms.

To examine the spatial structure of dental biofilms a vital fluorescence technique was combined with optical analysis of sections in a confocal laser scanning microscope (CLSM). Enamel slaps were worn in intraoral splints by three volunteers for five days to accumulate smooth-surface plaque. After vital staining with fluorescein diacetate and ethidium bromide the specimens were processed for CLSM examination. Optical sections 1 microm apart were analysed in the z-axis of these dental biofilms. One of the films was 15 microm high, sparse and showed low vitality, i.e. <16%, while the others were taller (25 and 31 microm) and more vital, i.e. up to 30 and 69%, respectively. In all instances the bacterial vitality increased from the enamel surface to the central part of the plaque and decreased again in the outer parts of the biofilm. The spatial arrangement of the microorganisms in the biofilm showed voids outlined by layers of vital bacteria, which themselves were packed in layers of dead material.

Oral health status of a group of elderly Canadian Inuit (Eskimo).

Fifty-four Inuit elders, representing 90% of the individuals 60 yr of age and older in three communities in the Keewatin region of the Canadian Northwest Territories, were examined for dental caries, periodontal disease, levels of edentulism, and the fit and quality of denture prostheses. These elders had a mean of 2.8 +/- 3.5 decayed teeth and a DMFT of 26 +/- 13 which reflected significant tooth loss. The Root Caries Index for subjects with gingival recession was 19%. Periodontal pocket assessments revealed that 86% of the individuals examined had CPITN readings of either 3 or 4. Over one third of the elders were totally edentulous, most of them female. Only 47% of these individuals wore complete dentures. Denture fit assessment revealed that 36% of the complete maxillary dentures and 42% of the complete mandibular dentures fit poorly. The overall oral health findings for these Inuit elders differed from those found in other older populations; however, the present findings may be the norm for a population undergoing a cultural transition.

Treatment of intrabony periodontal defects with an enamel matrix protein derivative (Emdogain): a report of 32 cases.

Enamel matrix proteins, including Emdogain, have been proposed as a new modality for regenerative periodontal treatment. However, limited information is available concerning the clinical applicability and therapeutic results with Emdogain. The aim of the present study was therefore to evaluate the clinical outcome following the application of Emdogain in the treatment of intrabony periodontal defects. Twenty-eight patients with marginal periodontitis (thirty-two 2- and 3-walled intrabony defects) were included in this study. The following parameters were evaluated prior to treatment and 8 months after treatment: probing pocket depth, recession of the gingival margin, and clinical attachment level. The postoperative healing phase was uneventful in all cases. There were no complications such as allergic reactions, abscess formation, or infections throughout the entire study period. The mean probing pocket depth was reduced from 8.7 +/- 1.5 mm at baseline to 4.3 +/- 1.6 mm after 8 months (P < 0.001), the mean gingival recession increased from 1.8 +/- 1.2 mm to 3.3 +/- 0.9 mm, and the mean clinical attachment level changed from 10.6 +/- 1.9 mm to 7.6 +/- 1.8 mm (P < 0.001). New hard tissue formation was radiographically observed in 26 of the 32 defects. The present results suggest that the treatment of intrabony periodontal defects with Emdogain may lead to significant improvements of all of the investigated clinical parameters. However, controlled histologic and clinical trials are needed to compare this treatment modality with other conventional and regenerative periodontal surgical methods.

GTR with bioresorbable membranes in the treatment of intrabony defects: a clinical and histologic study.

The aim of the present study was to evaluate clinically and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier. Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration (GTR) with a bioresorbable membrane. Results were evaluated by assessing probing pocket depth, recession of the gingival margin, and clinical attachment level at baseline and at 1 and 2 years after therapy. Bone level changes were evaluated radiographically. The postoperative phase was uneventful in all cases. There was a mean probing pocket depth reduction from 8.4 to 3.6 mm, a mean increase of gingival margin recession from 1.5 to 3.0 mm, and a mean clinical attachment level change from 9.9 to 6.5 mm. Mean attachment gain was 3.4 mm. Two teeth scheduled for extraction were also treated with the same bioresorbable membrane. The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases. Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent, at least in part, true periodontal regeneration.

Effects of technical parameters on image perception using two types of dental radiographs.

In radiology a sufficient diagnostic accuracy must be obtained with a minimal radiation dosage to which the patients are exposed. In-vitro studies designed to evaluate the influence of technical parameters on the quality of images on Kodak Ektaspeed and Kodak Ultra-Speed dental radiographs are presented. The following series of experiments were performed: 1. Evaluation of the Minray dc, Soredex and Oralix 65, Philips X-ray machines. 2. Comparison between two different Oralix 65 machines. 3. Evaluation of automatic and manual film processing as well as film-focus distances of 30 cm and 39 cm. 4. Evaluation of pairs of radiographs and their subtraction images obtained from different film and X-ray machine combinations. A dried mandible with and without bone splits within the central X-ray beam area on the alveolar crest between the teeth 46 and 47 served as object for the standardized images. A blind comparison of the series of images was performed by 3 certified periodontists. Irrespective of the film type used the highest rankings were given to the Oralix 65 X-ray machine, when the films were exposed at 39 cm from the focus and the automatic processing mode was used. X-ray images with good anatomical and technical details may be obtained on Ektaspeed and Ultra-Speed films. However, preference must be given to Ektaspeed films because of the possibility of reducing the radiation exposure.

[Periodontal disease and its treatment]. / La maladie parodontale et sa guerison.

A well known development of the chronic periodontal disease is reviewed. However, the histological picture of a gingiva varies at a much lower speed than its clinical picture, and slower than previously described. In presence of periodontitis there may exit a zone of reversible disease of about 2 mm, which give the possibility of obtaining a re-attachment of unknown magnitude. A new connective tissue attachment (on top of the re-attachment) seems only possible if the periodontal ligament cells are allowed to proliferate coronally.

Human dental plaque formation on plastic films. A quantitative SEM study.

The initial colonization of bacteria in previously clean teeth or artificial surfaces inserted in mouth has been reported to occur at various periods of time. Rönström et al., using light microscopy, saw that bacteria were present 10 seconds after prophylaxis. Bacterial culture studies have shown that microorganisms associated with the surface coating on tooth surfaces appeared within minutes after prophylaxis. Furthermore, Rönström et al. noted that the number of bacteria increased over a period of four hours. In contrast, ultrastructural investigations of early plaque have demonstrated bacterial colonization only within the first two hours of plaque development in a few samples obtained on a smooth surface and in most samples on a rough surface. However, microorganisms have been found regularly after four hours of plaque accumulation in subjects with healthy gingiva. The aim of the present investigation was to determine the earliest occurrence of bacterial colonization in situ and to observe the pattern of the initial formation of human dental plaque.