Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls.

AIM: To evaluate the stability of attachment achieved in infrabony defects by regenerative treatment over 60 ± 12 months compared to control teeth. METHODS: Patients treated regeneratively in at least one infrabony defect between 2004 and 2010 were screened for this retrospective cohort study. Complete examinations available for baseline, 12 and 60 ± 12 months after surgery, and a respective control tooth without treatment, provided eligibility for analysis. RESULTS: Twenty-seven patients (age 58 ± 11.7 years; 12 females, five smokers) were included, each contributing one infrabony defect and one control tooth. Regenerative therapy resulted in significant attachment gain (2.7 ± 1.6 mm; p < 0.001) after 1 and (3.0 ± 2.2 mm; p < 0.001) 5 years. Control teeth were stable (vertical probing attachment level [PAL-V] change: 1 year: 0 ± 0.8 mm; 5 years: -0.2 ± 1.2 mm). The study did not detect any significant change of PAL-V from 1 to 5 years after surgery for regenerative (-0.3 ± 2.4 mm) and control teeth (-0.2 ± 1.4 mm). Multivariate analysis associated smoking and generalized recurrence of periodontitis (amount of sites with PPD > 5 mm) with attachment loss. CONCLUSIONS: PAL-V achieved by regenerative therapy in infrabony defects is as stable over 5 years as periodontally reduced but gingivally healthy or gingivitis sites. Smoking and periodontitis recurrence are associated with attachment loss.

Detection of subgingival periodontal pathogens--comparison of two sampling strategies.

OBJECTIVE: The aim of the study is to compare detection frequency of periodontal pathogens in patients with aggressive/severe chronic periodontitis using pooled plaque samples from the deepest pockets per quadrant/per sextant. METHODS: In 100 patients with aggressive/chronic periodontitis, subgingival plaque was sampled from the deepest pockets per quadrant (MT4) and per sextant (MT6). Plaque samples were taken using two sterile paper points simultaneously. One paper point from each pocket was pooled with the three other paper points of the pockets (MT4). Subsequently, the remaining four paper points were pooled with two paper points from the deepest pockets from the two remaining sextants (MT6). The content of each vial was analyzed with nucleic-acid based methods for Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, and Capnocytophaga sp. RESULTS: The detection frequency of A. actinomycetemcomitans (MT4/MT6) at 22/24 %, T. forsythia at 93/96 %, P. gingivalis at 78/79 %, T. denticola at 88/90 %, P. intermedia at 40/46 %, P. micra at 75/79 %, F. nucleatum at both 99 %, C. rectus at 84/89 %, E. nodatum at 62/65 %, E. corrodens at 80/87 %, and Capnocytophaga sp. at 49/58 % was higher with MT6 than with MT4. None of these differences were statistically significant. CONCLUSION: The detection frequency of the investigated periopathogens was statistically insignificant higher with the sampling method MT6 compared with MT4. CLINICAL RELEVANCE: In daily dental practice, the plaque sampling of the deepest pockets per quadrant seems to be sufficient.

Subgingival plaque sampling after combined mechanical and antibiotic nonsurgical periodontal therapy.

AIM: This study aimed to make a comparison of two sampling strategies of subgingival plaque after combined mechanical-antibiotic periodontal therapy. METHODS: Thirty patients (18 female) suffering from aggressive (n = 12) or generalised severe chronic (n = 18) periodontitis were included. Aggregatibacter actinomycetemcomitans had been detected subgingivally in all prior to anti-infective therapy (AT) and combined mechanical-antibiotic AT had been rendered. After AT clinical examinations were performed and subgingival plaque was sampled from the same four sites as prior to AT (ASPRE) as well as from the four deepest sites after AT (DEEP). Per patient two pooled samples (ASPRE/DEEP) were generated and analysed for A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola using a commercial 16S rRNA test. RESULTS: ASPRE failed to detect A. actinomycetemcomitans, DEEP detected A. actinomycetemcomitans only in two patients (7 %). Only for T. forsythia DEEP (53 %) provided higher detection frequencies than ASPRE (27 %; p = 0.005). Detection frequencies of P. gingivalis and T. denticola ranged from 47 to 53 %. CONCLUSION: After combined mechanical-antibiotic AT sampling the deepest sites revealed higher detection rates. Combined mechanical-antibiotic AT suppresses A. actinomycetemcomitans to a higher extent than P. gingivalis, T. forsythia and T. denticola.

Regenerative therapy of infrabony defects with or without systemic doxycycline. A randomized placebo-controlled trial.

AIM: Comparison of regenerative therapy of infrabony defects with and without administration of postsurgical systemic doxycycline (DOXY). METHODS: In each of 61 patients one infrabony defect was treated with enamel matrix derivative (EMD), EMD plus filler or membrane at two centres. By random assignment patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Prior to and 6 months after surgery probing pocket depths (PPD) and vertical attachment level (PAL-V) were obtained. RESULTS: Fifty-four patients (DOXY: 27; PLAC: 27) were re-examined after 6 months and had been treated exclusively with EMD. Seven to 8 days after surgery 81% of defects in both groups showed complete flap closure. In both groups significant (p < 0.001) PPD reduction (DOXY: 3.87 ± 1.44 mm; PLAC: 3.67 ± 1.30 mm) and PAL-V gain (DOXY: 3.11 ± 1.50 mm; PLAC: 3.32 ± 1.83 mm) were observed. However, the differences failed to be statistically significant (PPD: 0.20; p = 0.588; PAL-V: 0.21; p = 0.657). CONCLUSIONS: Two hundred milligram systemic DOXY administered for 7 days after therapy of infrabony defects with EMD failed to result in better PPD reduction and PAL-V gain compared with PLAC which may be due to low power (50%) and, thus, random chance.

Comparison of Two Different Sampling Methods for Subgingival Plaque: Subgingival Paper Points or Mouthrinse Sample?

BACKGROUND: The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control). METHODS: In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens. RESULTS: Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum. CONCLUSIONS: There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4.

Long-Term Stability After Regenerative Treatment of Infrabony Defects: A Retrospective Case Series.

BACKGROUND: This study aims to evaluate long-term stability of attachment achieved in infrabony defects (IBDs) by regenerative treatment. METHODS: All patients who had received regenerative treatment for at least one IBD between 2004 and 2010 were screened for this retrospective case series. If complete examinations (plaque/gingival index, probing depth [PD], vertical clinical attachment level [CAL-V]) were available for patients at baseline and 12 months after surgery, they were invited for reexamination 60 ± 12 months after surgery. Reexamination involved testing for interleukin (IL)-1 polymorphism and counting number of supportive periodontal treatment (SPT) visits. Forty-one patients (24 males and 17 females; age, median: 62.0 years, lower/upper quartile: 49.8/68.3 years; six smokers, and 9 IL-1 positive) were included for analysis, each contributing one IBD. RESULTS: Regenerative therapy resulted in significant attachment gain after 1 (median: -3 mm, lower/upper quartile: -1.5/-4 mm; P <0.001) and 5 (median: -3 mm, lower/upper quartile: -1.9/4.5 mm; P <0.001) years. The study failed to detect median change of CAL-V from 1 to 5 years after surgery (median: 0 mm; lower/upper quartile: -1/1.5 mm; P = 0.84). Multiple regression analysis identified that number of SPT visits is correlated with CAL-V gain from 1 to 5 years after surgery. IL-1 polymorphism and percentage of sites with PD >6 mm at 5-year reexamination are correlated with CAL-V loss from 1 to 5 years after surgery. CONCLUSIONS: CAL-V achieved by regenerative therapy in IBDs may have retained stability over 5 years. Frequent SPT is associated with stability. IL-1 polymorphism and generalized reinfection are associated with less stability.

Enamel matrix derivative in propylene glycol alginate for treatment of infrabony defects with or without systemic doxycycline: 12- and 24-month results.

BACKGROUND: This aim of this study is to compare regenerative therapy of infrabony defects with and without administration of post-surgical systemic doxycycline (DOXY) 12 and 24 months after therapy. METHODS: In each of 57 patients, one infrabony defect (depth ≥ 4 mm) was treated regeneratively using enamel matrix derivative at two centers (Frankfurt am Main and Heidelberg). By random assignment, patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Twelve and 24 months after surgery, clinical parameters (probing depths [PDs] and vertical clinical attachment level [CAL-V]) and standardized radiographs were obtained. Missing data were managed according to the last observation carried forward. RESULTS: Data of 57 patients (DOXY: 28; PLAC: 29) were analyzed (26 males and 31 females; mean age: 52 ± 10.2 years; 13 smokers). In both groups, significant (P <0.01) PD reduction (DOXY: 3.7 ± 2.2 mm; PLAC: 3.4 ± 1.7 mm), CAL-V gain (DOXY: 2.7 ± 1.9 mm; PLAC: 3.0 ± 1.9 mm), and bone fill (DOXY: 1.6 ± 2.7 mm; PLAC: 1.8 ± 3.0 mm) were observed 24 months after surgery. However, the differences between both groups failed to be statistically significant (PD: P = 0.574; CAL-V: P = 0.696; bone fill: P = 0.318). CONCLUSIONS: Systemic DOXY, 200 mg/day for 7 days, after regenerative therapy of infrabony defects did not result in better PD reduction, CAL-V gain, or radiographic bone fill compared with PLAC 12 and 24 months after surgery, which may be attributable to low power and, thus, random chance.