Clinical effectiveness and soft tissue compatibility of a temporary restorative material.

OBJECTIVE: The purpose of this six-week study was to evaluate in vivo the effectiveness of Systemp.inlay as a temporary restorative material. METHOD: Subjects with the proper indication for a class II restoration were entered into the study. Twenty-three subjects and twenty-nine temporary restorations were evaluated at time of placement, three and six weeks. Two faculty members were calibrated to evaluate the material. Following the six-week trial, the temporary restorative material was removed and the test teeth were restored with a definitive restorative material. RESULTS: The temporary restorative material provided mechanical and anticariogenic protection of tooth structure while preventing dental sensitivity and patient discomfort. It promoted soft tissue health as evidenced by the enhanced plaque and gingival indices found associated with the temporarily restored teeth. Its ease of placement and removal makes it an attractive alternative for the dental practitioner. The change in color of the material over the six-week duration of the study may limit its use to posterior teeth and to lingual/palatal surfaces of anterior teeth. CONCLUSION: Ease of placement and removal and retention of the temporary restorative material were extremely good. Marginal and surface integrity of the material was maintained and no or minimal sensitivity was reported throughout the study. The material did not promote the accumulation of plaque nor result in gingival inflammation. The color change noted was not of clinical importance. Therefore, this temporary restorative material was demonstrated to be clinically effective in Class II cavity preparations.

Agents for the management of plaque and gingivitis.

Numerous chemical agents have been evaluated for the supplementation of patient-dependent mechanical plaque control and thus the reduction or prevention of oral diseases. Agents discussed in this paper are those most frequently evaluated in recent studies and include chlorhexidine, essential oils, triclosan, sanguinarine, fluorides, oxygenating agents, quaternary ammonium agents, prebrushing rinses, enzymes, and antibiotics. Of the agents discussed, the greatest effect on the reduction of plaque and gingivitis can be expected from chlorhexidine, essential oils, and triclosan-containing products. These chemical agents vary in dosage form and include mouthrinses, gels, and dentifrices. Some may also be of value as irrigants. Adverse effects vary according to the chemical agent and include poor taste, burning sensation of oral tissue, staining of teeth and soft tissues, excess supragingival calculus, oral lesions in young patients, and allergic reactions. When a product is selected for a patient, consideration should be given to necessity, efficacy, adverse effects, and cost-effectiveness.

Medications as risk factors for periodontal disease.

As the United States population ages, people will be taking more medications which may benefit their general health but not necessarily their periodontal health. The effects of medications have been grouped into six categories as follows: behavioral alteration of oral hygiene methods, alteration of plaque composition, effect on gingival tissues, effect on alveolar bone, effect on gingival crevicular fluid, and effect on salivary flow. Although most medications discussed in this paper increase the risk for periodontal disease, a few may actually decrease the risk. These include the effect of phenytoin on alveolar bone, the antibacterial effect of antibiotics, the anticollagenolytic effects of tetracyclines, and the effect of non-steroidal anti-inflammatory drugs on decreasing alveolar bone resorption.

Subgingival delivery by an oral irrigation device.

Irrigating devices have been incorporated into numerous oral hygiene regimens. Newer types of these devices are designed to deliver irrigating solutions directly into the periodontal pocket. We examined the ability of a powered irrigating device with a soft rubber tip to deliver subgingivally into periodontal pockets. When subgingival irrigation was used, the mean pocket penetration was 90% of the pocket depth (less than or equal to 6 mm) compared to a mean of 21% in the oral rinse group. The irrigation was not uncomfortable to patients.

Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study.

This study demonstrates changes in the gingival vascular supply of humans following various periodontal surgical procedures. A special system was used to photograph circulatory changes following an i.v. injection of sodium fluorescein to visualize blood supply. The results of this study suggest that the following concepts are important in the design of periodontal flaps. 1. Flaps should be broad enough at their base to include major gingival vessels. 2. A flap's length to width ratio should not exceed 2:1. 3. Minimal tension should be produced by suturing techniques and the tissue should be managed gently during the surgical procedure. 4. Partial thickness flap preparations to cover avascular areas should not be too thin so that more blood vessels are included in them. 5. The apical portion of periodontal flaps should be full thickness when possible.

Tissue concentration and localization of tetracycline following site-specific tetracycline fiber therapy.

The primary objective of this study was to evaluate the concentration and location of tetracycline hydrochloride in tissue adjacent to periodontal pockets treated with a tetracycline impregnated fiber. A secondary objective was to determine if the presurgical placement of fibers had any adverse effects on healing following periodontal surgery. The study population consisted of 10 patients with at least 2 pockets in both maxillary quadrants of > or = 5 mm in depth and exhibiting bleeding on probing. After an initial scaling and root planing, placebo or tetracycline fibers were randomly assigned by quadrant to 2 non-adjacent pockets. Fibers were removed at the time of surgery; i.e., day 8, and periodontal surgery was performed utilizing a flap incision that allowed biopsy of 1 interdental papilla from each of the 2 test sites in each quadrant. One biopsy was analyzed for tetracycline concentrations by high performance liquid chromatography (HPLC). The second biopsy was examined by both light and ultraviolet fluorescence microscopy to determine the location of residual tetracycline and the intensity of inflammatory cell infiltrates. Results showed that the tissue concentration of the antibiotic in tetracycline treated sites was 64.4 +/- 7.01 ng/mg (ng of tetracycline/mg tissue weight) which corresponds to 43 micrograms of tetracycline and was below levels of accurate measurement in placebo treated sites. Tetracycline tissue concentrations corresponded to the ultraviolet fluorescence microscopy with a Pearson correlation coefficient of r = 0.92. Tetracycline fluorescence was noted in the soft tissue wall ranging from 1 to 20 microns.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues.

The purpose of this controlled double-blind, parallel, randomized clinical study was to determine the effect of antiseptic mouthrinse on parameters important to dental implant maintenance. Plaque, peri-implant gingivitis, gingival bleeding, probing depth, and attachment level were assessed over a 3-month test period. Twenty healthy adult patients each of whom had at least two dental implants, a modified gingival index > 1.5, and a modified Quigley-Hein plaque index score > 1.7 were enrolled into the study. After a thorough oral prophylaxis, patients were randomly assigned to either the antiseptic mouthrinse or a 5% hydroalcohol placebo mouthrinse group and instructed to rinse twice daily for 30 seconds with 20 ml of their assigned mouthrinse as an adjunct to their usual oral hygiene procedures. The baseline examination included plaque index, gingival index, bleeding index, probing depth measurement, and attachment level measurements. The plaque and gingival indices were rescored at 1, 2, and 3 months. Probing depths, attachment levels, and bleeding index were determined again at 3 months only. At the end of 3 months, the antiseptic mouthrinse group had statistically significant reductions in plaque index, gingival index, and bleeding index compared to the placebo group. There were no significant differences between groups in probing depth or attachment level. The results of this clinical study indicate that twice daily use of an antiseptic mouthrinse may provide benefits in the maintenance of dental implants.

An evaluation of minocycline in patients with periodontal disease.

The purpose of this study was to determine the passage into and concentration of Minocycline HCl (Minocin) in gingival crevicular fluid (GCF) and the relationship between its concentration of saliva. GCF, serum and changes in periodontal health. Over an 8 day period, 10 adults with periodontal disease received orally 200 mg/day of Minocin and 10 other received 150 mg/day. The parameter evaluated included the DMF, gingival index, plaque index, crevice depth, oral soft tissue evaluation. SMA-12, CBC, prothrombin time, and concentrations of Minocin in serum, saliva and GCF. The DMF score, crevice depth, SMA-12, CBC and prothrombin time were determined on days 1 and 8. All other parameters were evaluated on days 1, 2, 3, 5 and 8. The results of this study showed that Minocin administration resulted in no significant changes in blood chemistry, blood counts and prothrombin time, was effective against oral microorganisms as shown by reductions in plaque scores, produces an improvement in gingival health, is present in serum at therapeutically effective levels when given in doses of either 200 mg or 150 mg per day and is concentrated in gingival crevicular fluid at levels 5 times as high as serum.

Results of limited initial periodontal therapy in smokers and non-smokers.

Eighty-seven adult patients (54 non-smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1-hour full-mouth subgingival scaling and root planing, with no maintenance recalls, during this 9-month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non-smokers was 5.46 +/- .46 mm and for smokers 5.70 +/- 0.66 mm. Data analysis (t test) revealed that both non-smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non-smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non-smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non-smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non-smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 +/- 0.45) than non-smokers (1.45 +/- 0.40). By 9 months only the gingival index of non-smokers decreased significantly compared to baseline (1.26 +/- 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 +/- 0.39) and non-smokers (0.78 +/- 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non-smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non-smokers responded similarly after 9 months to the limited amount of initial therapy provided.

Clinical evaluation of a quaternary ammonium-containing mouthrinse.

This was a double-blind, radomized, crossover study of adult subjects to evaluate the effect of a test mouthrinse (Cepacol) on plaque accumulation. The study was divided into two parts, four weeks each, one in which only a mouthwash was used (part I) and the other in which a mouthwash and toothbrushing were used (part II). 1. The test mouthrinse produced a satistically significant reduction in dental plaque when compared to a placebo rinse. 2. The GI averaged approximately 1.0 throughout the study regardless of which mouthrinse was used. 3. A possible carryover effect of the test mouthrinse was noted. 4. A lower plaque score was seen in 67 to 75% of all patients during the period in which the test mouthrinse was used as compared to the placebo. 5. Ten subjects reported a burning sensation of the tongue with the test mouthrinse. No objective adverse effects were seen.

Efficacy of epinephrine concentration in local anesthesia during periodontal surgery.

Blood loss in periodontal flap surgery using lidocaine 2% with either 1:50,000 or 1:100,000 epinephrine was compared. Ten patients from the graduate periodontal clinic were selected for the study. After the initial therapy which included oral hygiene instruction, scaling and root planning and occlusal adjustment, 20 surgical procedures were performed. In any one patient if 1:50,000 epinephrine was used on the posterior sextant of an arch, then 1:100,000 epinephrine was used on the contralateral side, with similar volumes being injected by the same method. Blood loss was determined by the cyanmethemoglobin comparison technique. Procedures using lidocaine 2% with 1:100,000 epinephrine generally had more than twice as much blood loss as those using lidocaine 2% with 1:50,000 epinephrine.

The application of a collagen stabilizer to the gingiva of the beagle dog. Effect on ligature-induced periodontal disease.

The objective of this study was to determine the effect of crevicular application of a collagen stabilizer on ligature-induced periodontal disease in beagle dogs. Fourteen male and female dogs, 15 months of age, were studied. The mandibular first molars and third and fourth premolars were ligated for 6 months and moderate periodontitis resulted. Ligatures were removed for 2 months and then replaced for an additional 3 months to experimentally mimic the episodic changes seen in human periodontal disease. Following this phase, ligatures were removed and the animals were assigned to a placebo or treatment group. Medications were then applied intracrevicularly, three times a week over 5 months using an IMAX irrigator. Clinical indices measured were plaque index (PI), gingival index (GI), gingival crevicular fluid flow (GCF), attachment level (AL), pocket depth (PD) and standardized radiographic analysis of alveolar bone height. While overall changes in PI, GI and GCF were not significant, the results showed that alveolar bone regeneration was increased approximately twice as much in the treatment group as compared to the placebo group, PD improved by 20% vs. 12.5% (P less than 0.001) and AL improved by 8.8% vs. 4.5% (P less than 0.001). The data were also evaluated in terms of the response in more severe sites as compared to those less severe. The results of these evaluations showed the more severe sites to be significantly more responsive to treatment than the less severe sites.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of short-term administration of minocycline HCl on gingival inflammation and subgingival microflora.

The purpose of this investigation was to determine the efficacy of minocycline hydrochloride in the management of subgingival microorganisms and periodontal disease. In a double-blind, split-mouth study, minocycline or placebo was administered systemically for 7 days to 26 adults with moderate-to-serve periodontitis. Four study groups were examined: (i) minocycline-scaled, (ii) minocycline-unscaled, (iii) placebo-scaled, and (iv) placebo-unscaled. The minocycline-scaled group responded most favorably, with improved gingival health for at least 49 days and with marked reductions in total bacterial counts and proportions of spirochetes for at least 70 days (termination of the study). Minocycline administration with no periodontal scaling and root planing also resulted major, long-lasting shifts in the subgingival microflora. Scaling alone was least effective in changing the microflora. The data indicated that minocycline may be a useful adjunct in the treatment of periodontal disease. Further studies are needed, however, to determine the long-term effect of minocycline therapy on the periodontal attachment level.

Effect of a chemotherapeutic agent delivered by an oral irrigation device on plaque, gingivitis, and subgingival microflora.

Sixty-six adults were examined in a double-bind study which examined the effect of an antimicrobial agent delivered by an oral irrigating device. Each subject received a randomized half mouth dental prophylaxis. The Gingival Index, gingival crevicular fluid volume, Plaque Index, Modified Papillary Bleeding Index, probing pocket depth, and probing attachment levels were determined at baseline, 3 weeks, and 6 weeks. The composition of the subgingival microflora in the prophied and non-prophied quadrants was examined by phase contrast microscopy and by immunofluorescence. This study demonstrates that an antimicrobial product delivered by an oral irrigating device could result in significant reductions in plaque, bacterial cell counts, and gingival bleeding and may, therefore, be an effective adjunct to normal oral hygiene.

The effect of an antimicrobial mouthrinse on early healing of gingival flap surgery wounds.

A randomized double-blind crossover design study using 25 patients requiring bilateral gingival flap surgery was completed. The effect of rinsing postsurgically three times daily with an antimicrobial mouthrinse or physiological saline on dental plaque formation, gingival inflammation, bleeding, wound healing, and patient comfort was evaluated at 7, 14 and 28 days. The antimicrobial rinse was statistically significantly 28.9% more effective than saline at seven days for reducing plaque. It was also significantly more effective for improving wound healing at day 7 as measured by edema (p less than 0.04). There were no significant differences in gingival index scores or bleeding at any time period. Use of an antimicrobial mouthrinse may be an effective aid in early healing of gingival flap surgery wounds.

Correlations among gingival indices: a methodology study.

Using an experimental gingivitis model, 99 subjects completed a 3-week study to determine the correlations between a visual index of gingivitis, the Modified Gingival Index (MGI), and the Gingival Index (GI), the Interdental Bleeding Index (IBI), and the Papillary Bleeding Index (PBI). Following a baseline examination consisting of the MGI and either the GI, IBI, or PBI, each subject received a full mouth scaling and rubber cup polishing to render the teeth plaque and calculus free. Subjects then rinsed twice daily for 30 seconds with 20 ml of either an active antimicrobial or control mouthrinse for 3 weeks while abstaining from all other oral hygiene. The MGI correlated significantly with the GI, IBI, and PBI, both at baseline and at 3 weeks for all subjects.

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis.

BACKGROUND: In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP. METHODS: Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline RESULTS: In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events. CONCLUSIONS: The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.

Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone.

The present studies evaluated the efficacy of a controlled-release biodegradable chlorhexidine (CHX) (2.5 mg) chip when used as an adjunct to scaling and root planing on reducing probing depth (PD) and improving clinical attachment level (CAL) in adult periodontitis. Two double-blind, randomized, placebo-controlled multi-center clinical trials (5 centers each) were conducted; pooled data are reported from all 10 centers (447 patients). At baseline, following 1 hour of scaling and root planing (SRP) in patients free of supragingival calculus, the chip was placed in target sites with PD 5 to 8 mm which bled on probing. Chip placement was repeated at 3 and/or 6 months if PD remained > or = 5 mm. Study sites in active chip subjects received either CHX chip plus SRP or SRP alone (to maintain study blind). Sites in placebo chip subjects received either placebo chip plus SRP or SRP alone. Examinations were performed at baseline; 7 days; 6 weeks; and 3, 6, and 9 months. At 9 months significant reductions from baseline favoring the chlorhexidine chip compared with both control treatments were observed with respect to PD (chlorhexidine chip plus SRP, 0.95 +/- 0.05 mm; SRP alone, 0.65 +/- 0.05 mm, P < 0.001; placebo chip plus SRP, 0.69 +/- 0.05 mm, P < 0.001) and CAL (chlorhexidine chip plus SRP, 0.75 +/- 0.06 mm; SRP alone, 0.58 +/- 0.06 mm, P < 0.05; placebo chip plus SRP, 0.55 +/- 0.06 mm, P < 0.05). The proportion of patients who evidenced a PD reduction from baseline of 2 mm or more at 9 months was significantly greater in the chlorhexidine chip group (19%) compared with SRP controls (8%) (P < 0.05). Adverse effects were minor and transient toothache, including pain, tenderness, aching, throbbing, soreness, discomfort, or sensitivity was the only adverse effect that was higher in the chlorhexidine group as compared to placebo (P = 0.042). These data demonstrate that the adjunctive use of the chlorhexidine chip results in a significant reduction of PD when compared with both SRP alone or the adjunctive use of a placebo chip. These multi-center randomized control trials suggest that the chlorhexidine chip is a safe and effective adjunctive chemotherapy for the treatment of adult periodontitis.

Dentinal hypersensitivity: review of aetiology, differential diagnosis, prevalence, and mechanism.

Dentinal hypersensitivity is a painful response to a non-noxious stimulus applied to exposed dentine in the oral environment. Dentine exposure results from a combination of two or more aetiological factors that lead to loss of enamel and/or loss of cementum. The hydrodynamic theory is the most accepted theory that explains the excitement of pulpal nerve fibres by a stimulus applied to the exposed dentine. Dentinal hypersensitivity had been reported to affect middle age people most often with no gender differences and has been shown to be influenced by tooth location.

Reviewing nonsurgical periodontal therapy.

Selection of the appropriate case and clinical competency in treatment modalities results in success in nonsurgical periodontal therapy. The patient with early periodontitis with significant local factors in the form of professionally accessible plaque and calculus is the most receptive to nonsurgical periodontal treatment. The clinician must make decisions centering around the important question, "Can the patient, or moreover, can the therapist delivering the debridement, gain access to the microbial subgingival plaque on a frequent basis below the host defense threshold of the respective patient?" If the answer is "yes," nonsurgical periodontal therapy will be rewarding. If the answer is "no," other modalities such as periodontal surgery must be instituted.