Recolonization of the oral cavity by Streptococcus mutans after a combined mechanical/chemical antisepsis protocol.

AIM: The bacterial colonization of teeth by Streptococcus mutans (StrepM) represents a major risk factor for the development of dental caries. At present, no clinical studies have explored the effect of a combined mechanical-chemical antisepsis protocol in a periodontally-healthy population and the pattern of recolonization of StrepM in subjects whose StrepM infection was successfully eradicated. The present study was designed in order to 1) determine the salivary and plaque changes in StrepM content after a combined mechanical/chemical antisepsis protocol; and 2) evaluate the pattern of recolonization when StrepM was successfully eradicated from saliva and plaque. METHODS: Thirty-five periodontally-healthy and caries-susceptible subjects successfully entered and concluded the study. At baseline, non-surgical periodontal therapy was performed according to the principles of full mouth disinfection. Adjunctive home-based rinsing with a 0.2% chlorhexidine mouthrinse was requested for the following week. StrepM concentration was assessed in saliva and plaque at the initial contact appointment, at baseline, and 1-week, 1-month, 3-month and 6-month follow-up. RESULTS: A significant effect of ''time'' on StrepM concentration in saliva and plaque was observed (P<0.000). In subjects with successful eradication of StrepM at 1 week (N=17 plaque samples), StrepM infection recurrence occurred within 3-6 months. CONCLUSION: The results of the present study demonstrated that 1) the application of the investigated mechanical/chemical antisepsis protocol can effectively reduce StrepM colonies in saliva and plaque of periodontally healthy subjects; and 2) in plaque samples, StrepM infection recurrence tends to occur within 3-6 months.

Comparison between two methods for periodontal risk assessment.

AIM: Risk assessment is increasingly important in periodontology. The aim of this article was to propose a new objective method (UniFe) in order to simplify the risk assessment procedures. UniFe was compared with a computer-based risk assessment tool (PAT(R)). METHODS: Risk scores for both UniFe and PAT(R) were calculated for 107 patients, randomly selected among patients seeking care at a specialist periodontal clinic. For UniFe risk calculation, the ''parameter scores'' assigned to smoking status, diabetic status, number of sites with probing depth 5 mm, bleeding on probing score (BoP) and bone loss/age, were added and the sum was referred to a ''risk score'', ranging from 1 (low risk) to 5 (high risk). PAT(R) generated a risk score on a scale from 1 (lowest risk) to 5 (highest risk). RESULTS: The mean UniFe and PAT(R) risk scores were 4.5+/-0.9 and 4.6+/-0.7, respectively. Cohen k-statistics amounted to 0.7, suggesting a good agreement between methods. Difference in risk score between methods was significantly explained by the parameter scores of BoP and bone loss/age (adjusted R2=0.378). CONCLUSION: The comparison between UniFe and PAT(R) demonstrated a good level of agreement between methods in a randomly selected population referred to a periodontal clinic.

Early childhood caries: case series and suggestions.

The early childhood caries (ECC) is a chronic illness common in children below 6 years. It is a syndrome characterized by presence of deciduous teeth multiple caries lesions. Scientific evidence indicate that ECC is an infectious and transmissible disease. Streptococcus mutans and other cariogenic bacteria are the microbiological agents in the disease. Prolonged contact between sugars in the liquids (like milk and juices) and cariogenic bacteria on the teeth increases caries risk. Lack of appropriate preventive measures can lead to multiple caries in susceptible infants. Ethiological aspects of ECC are investigated. After clinical case presentation, program of counseling, oral hygiene instruction, fluoride treatments, and restorative care effectiveness is described.

Evaluation of peri-implant tissues around single implant supporting single fixed crown: clinical considerations.

AIM: Assessment of peri-implant tissues around single implant-supported single fixed crown restorations can follow different protocols. The aim of this study was to asses peri-implant hard and soft tissues according to clinical periodontal parameters, modified for implant standard, and to radiographic parameters, and to test correlations between clinical parameters and historical bone loss. METHODS: Forty-two Brànemarks implants (implant-supported single fixed crown restorations positioned between two natural teeth) inserted in 24 patients were assessed according to clinical and radiographic parameters, without removing the prosthetic crown. RESULTS: All implants were judged successful according to published criteria. Results of some clinical parameters differed between smokers and non-smokers. Radiographic measurements of peri-implant bone loss were in line with published data. Bone loss also correlated with the distance between adjacent teeth and implants. CONCLUSION: Radiographic parameters were found to be the most appropriate for evaluation of successful implants. While clinical parameters proved useful for distinguishing immediately between swollen and healthy tissues, they did not indicate a negative prognosis for osseointegration nor for potential complications affecting peri-implant soft tissues.

Combined guided tissue regeneration, root conditioning, and fibrin-fibronectin system application in the treatment of gingival recession. A 15-case report.

This paper describes a surgical technique to achieve root coverage in deep, wide gingival recessions using a root isolation procedure with ePTFE membrane, combined with tetracycline conditioning of the root surface and fibrin-fibronectin sealing system application. The technique was used on 15 patients with isolated mucogingival defects 4 to 6 mm deep. A large trapezium-shaped flap was raised 3 to 4 mm apical to the margin of the bone dehiscence. The root surface was thoroughly scaled by hand and rotating instruments. Tetracycline HCl solution (100 mg/ml) was topically applied for 4 minutes. Expanded polytetrafluoroethylene (ePTFE) membrane was adapted at least 1 mm coronal to the CEJ and retained in position by sling sutures. A film of fibrin-fibronectin sealing system was injected between the membrane and the root surface. The flap was sutured coronally and the membrane removed 6 weeks later. The patients were reevaluated 6 months after the reentry procedure. The mean recession depth decreased from 4.7 mm initially to 1.1 mm at the final postoperative appointment. This represents a mean root coverage of 77.4%. Mean probing depth reduction was 0.9 mm and the mean width of keratinized tissue increased from 1.8 mm preoperatively to 2.9 mm 6 months after surgery. These findings show that the treatment of buccal gingival recession using guided tissue regeneration procedure plus tetracycline root demineralization and fibrin-fibronectin glue application results in a consistent and predictable improvement of mucogingival defects.

Clinical effect of tetracycline demineralization and fibrin-fibronectin sealing system application on healing response following flap debridement surgery.

The aim of this controlled clinical trial was to assess the effect on healing following tetracycline (TTC) conditioning and fibrin-fibronectin sealing system (FFSS) application in association with flap debridement surgery (FDS) in 11 patients under treatment for moderate to severe periodontitis. Selection criteria included the presence of two bilateral, homologous, non-molar, interproximal sites with probing depth > or = 5 mm. The areas bilateral to the trial sites were matched for number and type of the teeth, and similar periodontal involvement. After initial therapy, a split-mouth design was used in which one area was treated by flap debridement surgery alone (control), and the contralateral area was treated following surgery with a 4-minute burnishing application of 100 mg/ml TTC solution and FFSS (test). Fibrin glue was applied with a syringe on the demineralized root surfaces and surrounding bone margins. Healing by primary intention was encouraged by flap repositioning with interrupted sutures left in place for 14 days. A monthly maintenance recall program was followed. Patients were clinically evaluated at baseline and 6 months and the following measurements were taken: gingival index, plaque control record, clinical attachment level, probing depth, recession, bleeding on probing. Statistical evaluation indicated that both approaches resulted in significant probing depth reduction and clinical attachment gain. However, the differences in healing between the test and control groups were not clinically nor statistically significant. These results suggest there is no additional benefit with TTC demineralization and topical FFSS application in conjunction with flap debridement surgery.

Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report.

Twenty-four (24) deep wide buccal gingival recessions were treated with ePTFE membrane according to guided tissue regeneration principles (GTR). Factors affecting the surgical outcome of the regenerative procedure were retrospectively analyzed. In 16 cases, the barrier membrane was used in conjunction with tetracycline root conditioning and fibrin-fibronectin system application, and 8 cases were treated with the membrane alone. Healing response was evaluated 12 months after surgery. Since no difference was observed between the two treatment protocols, all available data were grouped. Mean recession depth was reduced from 4.6 mm to 1.3 mm postoperatively, which represents an average root coverage of 71.7%. Fifty percent (50%) of the cases showed clinical attachment gain greater than or equal to 4 mm and a mean increase of keratinized tissue of 1.0 mm was observed. Baseline recession depth and extent of membrane exposure at the reentry procedure significantly influenced the amount of newly-formed tissue under the membrane. Recession reduction positively correlated with the preoperative recession depth and the regenerated tissue gain. Treatment was also affected by tooth location, recession reduction, and attachment gain, being significantly greater in upper than lower archs. Results suggest that GTR technique represents a predictable procedure to improve the soft tissue conditions of deep mucogingival defects. Randomized controlled trials of other forms of management of mucogingival defects as compared to the GTR technique will be necessary to fully evaluate the utility of the GTR technique.

Subpedicle connective tissue graft versus guided tissue regeneration with bioabsorbable membrane in the treatment of human gingival recession defects.

The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full-mouth and defect-specific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase.

Ultrastructural features of cyclosporine A-induced gingival hyperplasia.

The present work collected data on the ultrastructural features of the attached gingiva in kidney transplant patients who showed gingival hyperplasia following cyclosporin A (Cy A) treatment. Ultrastructural examination was carried out on biopsies of attached gingiva obtained from 8 male patients (30 to 60 years old) undergoing treatment at the Dental Clinic of the University of Ferrara. The data showed that, although many fibroblasts are present in Cy A-induced hyperplasia, there is a particular abundance of amorphous substance compared to fibrous, as well as marked plasma cell infiltration. On the basis of the data collected, we hypothesize that the morphological features of the dimensional increase in gingival tissue associated with Cy A treatment in kidney transplant patients may be considered local manifestations of a systemic phenomenon.

Effect of tetracycline HCl on periodontally-affected human root surfaces.

Scanning electron microscopy was used to evaluate surface characteristics of periodontitis-exposed instrumented human cementum and dentin surfaces following topical application of tetracycline HCl (TTC). Specimens were randomly assigned to application of sterile saline for 1 minute (control); TTC (10 mg/ml) for 1 minute and 4 minutes, respectively; and TTC (100 mg/ml) for 1 minute and 4 minutes, respectively. Solutions were applied with a cotton pellet using a burnishing technique. Control specimens exhibited an amorphous irregular surface smear layer. TTC treatment of cementum for 1 minute resulted in a relatively debris-free, nonhomogeneous surface. The 4-minute application resulted in a surface exhibiting a densely fibrillar, mat-like texture. Dentin specimens conditioned for 1 minute showed a smooth surface with many tubule openings partially occluded by debris. The 4-minute treatment exposed a 3-dimensional network of intertubular and peritubular collagen fibrils. No consistent morphologic differences were observed between cementum or dentin specimens treated with TTC at concentrations of 10 and 100 mg/ml, respectively. The results suggest that topical application of TTC produces morphologic alterations of periodontitis-exposed cementum and dentin that appear related to application interval rather than concentration of the drug.

Effects of tetracycline HCl conditioning and fibrin-fibronectin system application in the treatment of buccal gingival recession with guided tissue regeneration.

A split-mouth clinical trial was designed to evaluate the effect of treating deep wide buccal gingival recession with guided tissue regeneration using expanded polytetrafluoroethylene membrane combined with tetracycline HCl (TTC) root conditioning and fibrin-fibronectin sealing system (FFSS) application. Eight patients, aged 25 to 57 years, each presenting two similar mucogingival defects, were selected. The two bilateral recessions were randomly assigned in each patient to either test or control treatment procedure. After initial therapy, each patient was examined for assessment of plaque, gingivitis, recession depth (RD), probing depth (PD), probing attachment level (PAL), and keratinized tissue width (KT). The test procedure included the elevation of mucoperiosteal flap at the buccal aspect of the alveolar process. The root was debrided and demineralized with 100 mg/ml TTC solution for 4 minutes using a burnishing technique with cotton pellets. A teflon membrane was secured and a film of FFSS was applied between the membrane and the root surface. The buccal flap was sutured to completely submerge the membrane. Control treatment included gingival flap surgery with barrier membrane alone. After 6 weeks, the membrane was removed. Healing was evaluated 6 months after surgery. Both test and control procedures resulted in highly significant recession reduction (3.0 mm +/- 1.1 and 2.6 mm +/- 1.2, respectively) and attachment gain (3.6 mm +/- 1.7 and 2.6 mm +/- 1.1, respectively). Mean root coverage was of 67% in the TTC + FFSS treated sites and 60% in membrane-only treated sites. However, only treatment with TTC + FFSS significantly reduced PD and increased KT (P < 0.05). When treatments were compared, changes in PD and PAL were significantly greater in TTC + FFSS treated sites (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Histomorphological analysis of the effect of rigid fixation on growing sutures in the rabbit.

The effect of internal rigid fixation (IRF) on bone growth was studied in an experimental model set up in the rabbit. The frontonasal suture of the right side was surgically bridged by a microplate. As reference for bone growth, four screws were placed symmetrically in the four bony segments including the frontonasal suture on both sides. The suture development was followed dynamically for 40 days on the basis of the position of the screws established radiographically. The rate of bone formation along the sutural bones was evaluated by means of the tetracycline labelling technique. The structure of the newly formed bone and its degree of mineralization were respectively analysed under polarized light and with microradiography. It was demonstrated that IRF prevents growth of the sutural membrane but not of the osteogenic process; as a consequence the constrained sutures soon undergo synostosis. This fact must be taken into consideration when IRF is employed in children in order to avoid delayed removal of the plate irreversibly stopping the growth of the constrained suture.

Nondiseased cementum and dentin root surface following tetracycline hydrochloride conditioning: SEM study of the effects of solution concentration and application time.

Tetracycline hydrochloride treatment of cementum and dentin surfaces derived from human teeth not affected by periodontitis resulted in the removal of the smear layer and uncovered a fibrillar collagen substrate. In cementum specimens, the amount of exposure of the organic matrix appeared to be more related to morphologic structure of the cementum and mechanical instrumentation of the root surface rather than to concentration and time of application of tetracycline solution. Time-dependent changes were observed in dentin surfaces, the intertubular "matted" collagen matrix being evident only in the 4-minute specimens.

Complete root coverage of denuded root surface using expanded polytetrafluoroethylene membrane in conjunction with tetracycline root conditioning and fibrin-fibronectin glue application: case reports.

A new surgical technique can promote complete root coverage in deep and wide recessions. A root isolation procedure with expanded polytetrafluoroethylene membrane is combined with tetracycline treatment of the root surface and fibrin-fibronectin glue application. Treatment of two patients resulted in the disappearance of the anatomic defect and an increase in the amount of keratinized gingiva.

Clinical evaluation of plaque removal by counterrotational electric toothbrush in orthodontic patients.

In the present crossover clinical trial, the plaque-removing efficacy of a counterrotational toothbrush was compared to that of a normal toothbrush in orthodontic patients. Twenty subjects, aged 11 to 26 years, who had orthodontic brackets on all fully erupted teeth of at least one arch were selected. At the first appointment, a prophylaxis was given to bring the plaque score to 0. Ten subjects received counterrotational brushes, and 10 subjects received manual brushes according to a randomized list. At 14 days, plaque scores were recorded and another prophylaxis was given. The subjects who were using the electric brush were assigned to the manual brush and vice versa. At 28 days, plaque scores were reassessed. Results showed that the counterrotational brush was significantly more effective in removing supragingival plaque from bracketed teeth than was the manual brush. The differences in plaque-removing effectiveness were particularly consistent on the proximal surfaces of the teeth.

Clinical effect of subgingival tetracycline irrigation and tetracycline-loaded fiber application in the treatment of adult periodontitis.

A controlled clinical trial was carried out to compare the clinical effect of combined antimicrobial-mechanical treatment modalities on moderate-to-deep periodontal pockets in patients with adult periodontitis. Twelve patients having at least three nonadjacent sites of periodontitis were included in the split-mouth study. Gingival Index, Plaque Record, bleeding on probing, probing depth, attachment level, and recession depth were recorded immediately before treatment. In the control site, supragingival and subgingival scaling was performed with an ultrasonic scaler. One experimental site received supplemental irrigation with 15 mL of a 100-mg/mL tetracycline solution, while the other received a tetracycline-loaded fiber after mechanical instrumentation. Fibers were left in place for 10 days. Reevaluation 30 and 60 days after treatment showed that all three treatment modalities were effective in improving clinical parameters. No adjunctive effect on the healing response was obtained by augmenting mechanical debridement with tetracycline.

[Stage grouping for head and neck cancer: a meta-analysis]. / Steage grouping dei carcinomi del distretto testa-collo: meta-analisi.

BACKGROUND: To compare the correlation of TANIS and 1997 UICC stage grouping with survival rate in head and neck carcinoma. METHODS: A series of 820 patients affected by primary carcinoma of paranasal sinuses (43 patients), oral cavity (100 patients), oropharynx (64 patients), larynx (599 patients) and parotid gland (134 patients) was considered in this retrospective study for a minimum follow-up of 5 years. The data set was classified according to 1997 UICC T-category and then grouped as recommended by the two systems. Data were analyzed by means of survival analyses (Kaplan-Meier and Cox algorithms). RESULTS: The total disease-specific survival rate at 5 years was 44% for paranasal sinuses, 54% for oral cavity, 28% for oropharynx, 86% for larynx and 65% for parotid gland. Globally, univariate analysis by means of Log Rank Test yielded significant p-values both for TANIS and 1997 UICC systems. Multivariate analysis (Cox regression adjusted for age and gender) showed a significant correlation between the two staging systems with the mortality rate. However, TANIS resulted in a higher prognostic value in oral cavity, oropharynx and larynx that are three sites affected by a homogeneous histological type of carcinoma (i.e. squamous cell carcinorna). CONCLUSIONS: TANIS stage grouping better defines the prognosis for head and neck cancer than the 1997 UICC system.

Granular cell myoblastoma. Review of the literature and report of a case.

The origin and nature of granular cell myoblastoma (GCM) have been debated since the original description of a granular cell tumor by Abrikossoff in 1926. Many cell types have been implicated in its histogenesis, including muscle cells, histiocytes, fibroblasts, neural sheath cells and undifferentiated mesenchymal cells, but the origin of the lesion remains still controversial. The authors present a review of the clinical features and the histopathologic and histochemical findings of this nebulous entity. They also report a case of granular cell myoblastoma of the tongue.

[The psychological aspects of patients with the burning mouth syndrome]. / Aspetti psicologici nei pazienti affetti da Burning Mouth syndrome.

Burning mouth syndrome (BMS) is a distinct clinical entity characterized by a chief complaint of unremitting oral burning concomitant with no oral mucosal clinically observable lesions. Numerous causes of this condition have been suggested, including local factors, systemic factors, and psychogenic disorders. A total of 33 consecutive subjects, 29 women and 4 men, complaining of BMS, who had attended the Dental Clinic of the University of Ferrara during a period of 2 years, was studied. The results obtained using a specific questionnaire to assess the psychological status of BMS patients were reported. Psychological factors were present in more than two thirds of the subjects (67%). Anxiety was the predominant disorder and the most recalcitrant obstacle to cure. On the other side, an improvement of the psychogenic state was observed in relation to burning reduction. Furthermore, a remission or resolution of the oral symptoms following a reassurance alone as to the benign nature of the condition was found in 24% of the patients. These results seem to suggest an association between oral complaint and personality disturbance. However, whether the psychogenic disorder is causative or whether it is a result of the burning sensation is still uncertain.

[The burning mouth syndrome. A clinical study]. / Burning mouth syndrome. Studio clinico.

Burning mouth syndrome (BMS) is a distinct clinical entity characterized by a chief complaint of unremitting oral burning concomitant with no oral mucosal clinically observable lesions. Numerous causes of this condition have been suggested, including local factors, systemic factors, and psychogenic disorders. A total of 36 consecutive subjects, 32 women and 4 men, complaining of BMS, who had attended the Dental Clinic of the University of Ferrara during a period of 2 years, was studied. The method of assessment followed closely a strictly co-ordinated management protocol based on conventional guidelines, namely history, clinical examination and special investigations. A detailed history was taken of duration of the condition, site affected, and pattern of burning. The severity and the response to treatment were assessed with a Visual Linear Analogue Scale (VLAS). A full medical history was taken, with regard to xerostomia-inducing drug assumption. The presence and the severity of menopausal symptoms were explored. Inquiries were made on use of mouthwashes. For the denture-wearers, specific questioning was directed to the length of denture-wearing experience, temporal association of the symptom with the wearing of dentures, relationship to burning sensation of any relines or repairs, denture cleaning technique, and use of fixatives. A complete routine intraoral and extraoral examination was performed. The presence of parafunctional habits, such as tongue thrusting, clenching, grinding, lip and cheek biting, was investigated. If dentures were worn, their design and condition were examined. In particular, the relation between the vertical and horizontal components of the jaw and the denture base extension was assessed and the freeway space measured.(ABSTRACT TRUNCATED AT 250 WORDS)