Multi-center clinical evaluation of a chairside method for detecting certain periodontopathic bacteria in periodontal disease.

The association of bacteroides gingivalis, Bacteroides forsythus, Treponema denticola, and Actinobacillus actinomycetemcomitans among others with periodontal disease offers the opportunity for the development of diagnostic tests that are based upon the detection and/or quantification of one or more of these organisms or their by-products in the plaque. Three of the putative periodontal pathogens namely, T. denticola, B. gingivalis, and B. forsythus, can hydrolyze the synthetic trypsin substrate, N-benzoyl-DL-arginine-2-naphthylamide (BANA) forming a color reaction. The present investigation evaluated a commercially developed solid state assay for BANA hydrolysis that can be read after 15 minutes incubation at chairside. A total of 702 subgingival plaque samples were collected from 117 patients seen at four university dental clinics and placed on reagent cards. The color development on the cards was compared to the presence of T. denticola and B. gingivalis in the plaque, and with the clinical appearance of the sampled sites. This multi-center study demonstrated that antibodies to B. gingivalis and T. denticola could detect these organisms by an ELISA in the majority of the subgingival plaque samples. Comparable information could be obtained when the same plaques were evaluated by the reagent card format for BANA hydrolysis. The ELISA and reagent card were comparable in their ability to distinguish between clinically healthy and diseased sites. Both diagnostic procedures detected the periodontopathogens in plaques from sites that were judged clinically healthy.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonsurgical treatment of patients with periodontal disease.

OBJECTIVE: To determine whether the short-term use of systemic antimicrobials (metronidazole or doxycycline) and locally delivered antimicrobials (metronidazole, chlorhexidine) in patients with advanced forms of periodontal disease could prevent the normally necessary access surgery. STUDY DESIGN: Ninety-four patients were randomly assigned with the use of a double-blind protocol. RESULTS: There was a 93% reduction in the need for periodontal surgery about individual teeth and an 81% reduction in the need for tooth extractions. Only 93 teeth of an initial total of 783 teeth actually needed surgery or extractions. Eighty-one percent of the patients entered into the maintenance phase of treatment without needing surgical treatments. CONCLUSION: These findings indicate that a treatment paradigm based on the diagnosis and treatment of anaerobic infections is likely to be successful in those patients for whom access surgery is recommended.

A logistic regression model for the decision to perform access surgery.

Access surgery may be recommended to about 80% of patients who present with advanced forms of periodontal disease. In this report, a multivariate logistic regression analysis which incorporated several clinical parameters for each tooth examined, i.e., tooth type, furcation involvement, bleeding on probing, attachment level, probing depth, mobility and BANA test score, was conducted using generalized estimating equations (GEE). This approach identified parameters that were significantly associated at p < 0.05 level with the need for access surgery or extraction for periodontal purposes. The estimated probabilities derived from the GEE model were plotted over the complete spectrum of operating conditions to obtain a receiver-operator characteristic (ROC) curve. At a probability cutpoint of 0.8, the decision threshold for surgery/extraction at the pretreatment examination would have a sensitivity of 76.1% and a specificity of 75.3%. We have taken this 0.8 cut point to look at specific clinical decisions made by our examiners after the patients had received scaling and root planing plus 2 weeks unsupervised usage of systemic antimicrobials. The clinicians' decision was taken as the primary reference standard. The model's estimated decision agreed with the clinicians' decision in 226 of the 284 teeth, for an accuracy of 80%. The specificity was 90% and the sensitivity was 43%.

Correlation between electronic and visual readings of pocket depths with a newly developed constant force probe.

The purpose of this study was to compare probing measurements obtained using a newly developed constant force electronic probe, which eliminates errors of visual reading and variable force, to those obtained using a standard periodontal probe. The probe was connected to a digital readout through a linear variable differential transformer; the digital readout was connected to a printer and a foot switch. When the probe was in position and the foot switch depressed, the pocket depth was printed to the nearest 0.1 mm. 12 subjects with minimal to early periodontitis were selected for the study. The pocket depths of each patient were recorded electronically utilizing a constant force of 25 g, and conventionally using the same instrument in a "locked" position and visual reading. Probings were performed on each subject by 3 different examiners, on 3 separate occasions 2-3 days apart. The results showed a high correlation between manual and electronic probing. The average correlations for the 3 investigators between examinations were consistently higher for the electronic probings. In comparing the 3 examiners to each other, consistently higher correlations were found for the electronic pocket readings. Correlations for single-rooted teeth were lower for all 3 examiners. The pocket depth measurements recorded when using the manual probe with visual readings were consistently deeper than those obtained using the electronic probe with computer readings. It was concluded that the reproducibility of measurements obtained with the electronic probe was significantly superior to that obtained with a manual probe.