Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen.

OBJECTIVES: Evaluation of the periodontal status is necessary prior to management with high-dose chemotherapy before hematopoietic stem cell therapy (HSCT). During medical therapy, pre-existing periodontal conditions may exacerbate and cause local and systemic complications. When possible, maximal oral health should be achieved prior to engraftment. In this study, we aimed to determine the alterations occurred in the periodontal status of the patients after periodontal treatment and allogenic HSCT and evaluate the effect of intensive periodontal approach on the short-term complications of HSCT. METHODS: The alterations occurred in the periodontal tissues 3-4 weeks after periodontal treatment and after HSCT periods of 3 months for 29 patients treated with full-mouth periodontal treatment completed in 24 h in addition to eradication of dental foci, and oral hygiene status were evaluated using pocket depth measurements, presence of bleeding on probing and plaque and gingival indices. The incidence and severity of acute graft-versus-host disease (GVHD) and oral mucositis (OM) were recorded. Duration of engraftment period and the episode of febrile neutropenia were also evaluated. RESULTS: There were significant improvements in periodontal status after periodontal treatment (P<0.001). There were 14 (48.3%) patients without acute GVHD and 17 (58.6%) patients with no sign of OM. The majority of OM was at grade II level. There was a negative relation that exists between the percentage of BOP (+) sites and presence of OM (r=-0.518, P<0.05). CONCLUSIONS: Together with a significant reduction in gingival inflammation and maintenance of the improvement in periodontal health, remarkable decrease in the incidence and severity of OM were observed.

Long-term evaluation of surgical periodontal treatment with and without maintenance care.

A study was conducted on the effectiveness of individual maintenance recalls and the long-term effects of surgical therapy on pocket depth and tooth loss in 43 patients with moderate to advanced periodontal disease. Sixteen of the patients had periodic control and 27 were uncontrolled. Intervals of periodic recall ranged from 3 to 6 months according to individual needs. Pocket depths were measured from four aspects of each tooth and initially classified as shallow (1-3 mm), moderate (4-6 mm) or deep (7 mm or more). Changes in each pocket depth level were determined after 10 years. Tenth-year comparisons showed that the uncontrolled group had significantly higher mean pocket depth values. Tooth loss rate was 3.6% in the controlled group, and 14.1% in the uncontrolled group, and the mean numbers of lost teeth were 0.69 and 3.63, respectively, in the ten-year period. It was concluded that periodic recalls were essential for long-term success of periodontal surgery.

New attachment formation following periodontal surgery in a dog.

We evaluated new attachment following treatment of experimental periodontitis in a canine model. Periodontal destruction was induced over an 8-month period using silk ligatures and a soft diet, and this remained stable for 170 days before surgery. After surgical scaling and root planing of eight bicuspid teeth, the apical end of the pockets was estimated using an occlusal stent and a periodontal probe, then marked with a blade. The root surfaces of three bicuspids were treated with citric acid for 3 min, and tetracycline salt was applied to the root surfaces of two teeth. The remaining three bicuspids served as controls. Postoperatively, no attempts were made to improve oral hygiene, and on day 48 light microscopic examination of biopsy materials revealed new attachment in all treated teeth. However, in some sections new cementum and new collagen formation was much more extensive and complete in both groups of experimental teeth than in the control teeth.

Morphological changes in diseased cementum layers: a scanning electron microscopy study.

The aim of this study was to compare the morphological changes that occurred in root cementum layers due to periodontal disease by using scanning electron microscopy (SEM). Ninety-two periodontally hopeless teeth extracted from 29 patients were studied. Measurements of probing depth (PD) and clinical attachment loss (CAL) were taken prior to extractions. After the longitudinal fracturing process of root specimens, healthy and diseased cementum layers of roots were evaluated by SEM for the thickness of the cementum and the morphological changes in collagen fibers. The result of SEM evaluation revealed a significant ( P < 0.001) decrease in the thickness of cementum layer on the diseased root surfaces compared to the healthy surfaces. There were denser and conspicuous collagen fibers with their interfibrillar matrix in cementum layers on the healthy root surfaces compared to the diseased surfaces. Within the limits of this study, the thickness of cementum layers in diseased areas was found to be significantly less than that in the healthy areas of root surfaces. However, there exist variations in the density and visibility of cemental fibers between individuals and within the individual.