Oral health-related quality of life and patient-reported outcome measures after 10 years of supportive periodontal care.

OBJECTIVE: The aim of this retrospective study was to evaluate the oral health-related quality of life (oHRQoL) and patient-reported outcome measures (PROMs) after 10 years of supportive periodontal care (SPC). MATERIAL AND METHODS: Patients were re-examined 120±12 months after active periodontal therapy. Dental and periodontal status and oHRQoL by completing Oral Health Impact Profile-G49 (OHIP-G49) and PROMs by marking a visual analogue scale (VAS) for self-perceived esthetics (VASe), chewing function (VASc), and hygiene ability (VASh) were assessed. Patient- and tooth-related factors (age, insurance status, number of SPC, compliance, change of therapist, smoking, tooth loss, need for surgery or antibiotic intake, bleeding on probing (BOP), periodontal inflamed surface area) influencing oHRQoL and PROMs were evaluated. RESULTS: One hundred eight periodontally compromised patients (59 female, mean age 65.4±10.7 years) lost 135 teeth during 10 years of SPC. At re-examination, 1.8% of all sites showed PPD ≥6mm. The mean OHIP-G49 sum score was 17.6±18.5, and VAS resulted in 76.0±22.5 (VASe), 86.3±16.3 (VASc), and 79.8±15.8 (VASh). Linear regression analyses identified a positive correlation with oHRQoL and/or PROMs for private insurance status (OHIP-G49, p=0.015, R2=0.204; VASc, p=0.005, R2=0.084; VASh, p=0.012, R2=0.222) and compliance to SPC (VASe, p=0.032; R2=0.204), as well as a negative correlation for active smoking (VASc, p=0.012, R2=0.084), increased BOP (VASh, p=0.029, R2=0.222) at the start of SPC, and number of lost molars (VASh, p=0.008, R2=0.222). CONCLUSION: It is realistic to obtain satisfactory oHRQoL and PROM values in most of the patients after 10 years of SPC. The identified factors may help to predict patient satisfaction in the long-term course of therapy. CLINICAL RELEVANCE: Systematic therapy of periodontally compromised patients provides values for oHRQoL and PROMs in a favorable range 10 years after therapy. This should encourage dentists to implement SPC in their daily routine. CLINICAL TRIAL NUMBER: NCT03048045.

Targeting Cathepsin C in PR3-ANCA Vasculitis.

BACKGROUND: The ANCA autoantigens proteinase 3 (PR3) and myeloperoxidase (MPO) are exclusively expressed by neutrophils and monocytes. ANCA-mediated activation of these cells is the key driver of the vascular injury process in ANCA-associated vasculitis (AAV), and neutrophil serine proteases (NSPs) are disease mediators. Cathepsin C (CatC) from zymogens activates the proteolytic function of NSPs, including PR3. Lack of NSP zymogen activation results in neutrophils with strongly reduced NSP proteins. METHODS: To explore AAV-relevant consequences of blocking NSP zymogen activation by CatC, we used myeloid cells from patients with Papillon-Lefèvre syndrome, a genetic deficiency of CatC, to assess NSPs and NSP-mediated endothelial cell injury. We also examined pharmacologic CatC inhibition in neutrophil-differentiated human hematopoietic stem cells, primary human umbilical vein cells, and primary glomerular microvascular endothelial cells. RESULTS: Patients with Papillon-Lefèvre syndrome showed strongly reduced NSPs in neutrophils and monocytes. Neutrophils from these patients produced a negative PR3-ANCA test, presented less PR3 on the surface of viable and apoptotic cells, and caused significantly less damage in human umbilical vein cells. These findings were recapitulated in human stem cells, in which a highly specific CatC inhibitor, but not prednisolone, reduced NSPs without affecting neutrophil differentiation, reduced membrane PR3, and diminished neutrophil activation upon PR3-ANCA but not MPO-ANCA stimulation. Compared with healthy controls, neutrophils from patients with Papillon-Lefèvre syndrome transferred less proteolytically active NSPs to glomerular microvascular endothelial cells, the cell type targeted in ANCA-induced necrotizing crescentic glomerulonephritis. Finally, both genetic CatC deficiency and pharmacologic inhibition, but not prednisolone, reduced neutrophil-induced glomerular microvascular endothelial cell damage. CONCLUSIONS: These findings may offer encouragement for clinical studies of adjunctive CatC inhibitor in patients with PR3-AAV.

Retrospectively analysed tooth loss in periodontally compromised patients: Long-term results 10 years after active periodontal therapy-Patient-related outcomes.

BACKGROUND AND OBJECTIVE: Long-term tooth retention is the ultimate goal of periodontal therapy. Aim of this study was to evaluate tooth loss (TL) during 10 years of supportive periodontal therapy (SPT) in periodontal compromised patients and to identify factors influencing TL on patient level. MATERIAL AND METHODS: Patients were re-examined 120 ± 12 months after active periodontal therapy. TL and risk factors [smoking, initial diagnosis, SPT adherence, interleukin-1 polymorphism, cardiovascular diseases, age at baseline, bleeding on probing (BOP), change of practitioner, insurance status, number of SPT, marital and educational status] influencing TL on patient level were assessed. RESULTS: One-hundred patients (52 female, mean age 65.6 ± 11 years) lost 121 of 2428 teeth (1.21 teeth/patient; 0.12 teeth/patient/y) during 10 years of SPT. Forty-two of these were lost for periodontal reasons (0.42 teeth/patient; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P < .001). Smoking, baseline severity of periodontitis, non-adherent SPT, positive interleukin-1 polymorphism, marital and educational status, private insurance, older age at baseline and BOP, small number of SPT were identified as patient-related risk factors for TL (P < .05). CONCLUSION: During 120 ± 12 months of SPT, only a small number of teeth was lost in periodontally compromised patients showing the positive effect of a well-established periodontal treatment concept. The remaining risk for TL should be considered using risk-adopted SPT allocation.

Twenty-year results after connective tissue grafts and guided tissue regeneration for root coverage.

BACKGROUND: Evaluation of clinical long-term results 20 years after connective tissue grafting (CTG) or guided tissue regeneration (GTR) using bioabsorbable barriers for root coverage therapy. METHODS: Initially, 15 patients with 38 Miller Class I and II recession defects underwent CTG or GTR according to random assignment. At baseline, 3, 120 ± 12, and 240 ± 12 months after surgery, data on probing depth, clinical attachment level, recession depth and width, amount of keratinized tissue, and bleeding on probing were obtained. Additionally, patients' smoking habits and participation in supportive periodontal therapy were investigated. RESULTS: Eight patients contributing 23 recessions were available at the 240 ± 12 months follow-up. Three and 120 ± 12 months after therapy with CTG, significantly better root coverage was observed compared with baseline (3 months: 3.01 ± 1.74 mm; P = 0.003; 120 ± 12 months: 2.11 ± 1.86 mm; P < 0.024). GTR resulted in significantly better root coverage compared with baseline after 3 months (2.25 ± 1.89 mm; P < 0.012). Although there were no significant changes in the recession depth between 3 and 240 ± 12 months in both groups (CTG: P = 0.097; GTR: P = 0.190), 1.57 ± 2.12 mm (CTG) and 1.19 ± 2.31 mm (GTR) of the achieved coverage after 3 months were lost. CTG showed significantly better relative root coverage percentage than GTR after 3 (P = 0.026) and 120 (P = 0.038) months. This study failed to detect a significant difference in the stability of root coverage after 240 ± 12 months between CTG and GTR (P = 0.448) and patients' assessments of their treatment outcomes (P = 0.503). CONCLUSION: Long-term stability of root coverage and patient-perceived esthetic outcomes failed to show significant differences between CTG and GTR at 20 years post-surgery.

Clinical and patient-centred long-term results of root coverage using the envelope technique in a private practice setting: 10-year results-A case series.

AIM: Evaluation of long-term results after connective tissue graft (CTG) using the envelope technique and the effect on patient-centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting. MATERIALS AND METHODS: Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre-operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator. RESULTS: Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (-1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation. CONCLUSIONS: Within the limitations of the study design with a high risk of bias in a practice setting, long-term stability of recession reduction, OHIP and patient-perceived satisfaction remained stable over 10 years.

Infrabony defects 20 years after open flap debridement and guided tissue regeneration.

AIM: Evaluation of 20-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. MATERIALS AND METHODS: In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra-lateral defect (OFD) each (split-mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. RESULTS: Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split-mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months. CONCLUSIONS: Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place.

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.

Inflammatory serum markers up to 5 years after comprehensive periodontal therapy of aggressive and chronic periodontitis.

AIM: The aim of the study is to assess the long-term effect of active periodontal therapy on serum inflammatory parameters in patients with aggressive (AgP) and chronic (ChP) periodontitis in a non-randomised clinical study. METHODS: Twenty-five ChP and 17 AgP were examined clinically prior to (baseline), 12 weeks and 60 months after subgingival debridement of all pockets within 2 days. Systemic antibiotics were prescribed if Aggregatibacter actinomycetemcomitans was detected (10 AgP, 8 ChP), flap surgery was rendered if required. Neutrophil elastase (NE), C-reactive protein (CRP), lipopolysaccharide binding protein, interleukin 6, 8, and leukocyte counts were assessed at baseline, 12 weeks and 60 months. RESULTS: Clinical parameters improved significantly in both groups from 12 weeks to 60 months. Eleven AgP and 18 ChP patients received surgical treatment after the 12 weeks examination. Only 3 patients in each group attended ≥ 2 supportive maintenance visits per year. NE and CRP were significantly higher in AgP than ChP at baseline and 60 months (p < 0.01). For leukocyte counts in ChP, significant changes were observed (baseline: 6.11 ± 1.44 nl-1; 12 weeks: 5.34 ± 1.40 nl-1; 60 months: 7.73 ± 2.89 nl-1; p < 0.05). Multiple regression analysis identified African origin, surgical treatment and female sex to correlate with better clinical improvement. CONCLUSION: Despite comprehensive periodontal treatment, AgP patients exhibit higher NE and CRP levels than ChP patients up to 5 years after therapy. CLINICAL RELEVANCE: Systemic inflammatory burden in AgP patients is higher than in ChP patients even 5 years after periodontal treatment.

Is gingival bleeding a symptom of type 2 and 3 von Willebrand disease?

BACKGROUND: Von Willebrand disease (VWD) is the most common inherent bleeding disorder. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also a leading symptom of plaque-induced gingivitis and untreated periodontal disease. In type 1 VWD gingival bleeding was not increased compared to controls. Thus, this study evaluated whether type 2 and 3 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. METHODS: Twenty-four cases and 24 controls matched for age, sex, periodontal diagnosis, number of teeth and smoking were examined hematologically (VWF antigen, VWF activity, factor VIII activity) and periodontally (Gingival Bleeding Index [GBI]), bleeding on probing [BOP], Plaque Control Record [PCR], periodontal inflamed surface area [PISA], vertical probing attachment level). RESULTS: BOP (VWD: 14.5±10.1%; controls: 12.3±5.3%; p = 0.542) and GBI (VWD: 10.5±9.9%; controls: 8.8±4.8%; p = 0.852) were similar for VWD and controls. Multiple regressions identified female sex, HbA1c, PCR and PISA to be associated with BOP. HbA1c and PCR were associated with GBI. Number of remaining teeth was negatively correlated with BOP and GBI. CONCLUSION: Type 2 and 3 VWD are not associated with a more pronounced inflammatory response to the oral biofilm in terms of BOP and GBI.

Discomfort/pain due to periodontal and peri-implant probing: Implant type and age.

AIM: There is evidence that patients experience more discomfort/pain after peri-implant probing than periodontal probing. However, there are several plausible factors to additionally influence this observation: e.g., implant type, age, smoking. Thus, this study was designed to compare discomfort/pain after periodontal and peri-implant probing in different implant types. METHODS: Two dentists recruited and examined 80 patients, each of them exhibiting a dental implant with a contralateral natural tooth. Only two types of implants were included. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth were measured first was randomly assigned. Immediately after probing patients scored discomfort/pain using a visual analogue scale (VAS). RESULTS: Eighty patients (median; lower/upper quartile: age 57; 47.5/65.5 years; 40 females, 11 smokers) were examined. With the exception of PPD and PAL at the deepest site as well as mean PPD (p < .05) clinical parameters (PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 9.0; 5.0/17.0) caused significantly (p = .038) more discomfort/pain than periodontal probing (5.5; 2.0/13.5). This was confirmed by repeated measures analysis of variance adjusting for several factors (p = .011). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing.

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.

Processing of Neutrophil α-Defensins Does Not Rely on Serine Proteases In Vivo.

The α-defensins, human neutrophil peptides (HNPs) are the predominant antimicrobial peptides of neutrophil granules. They are synthesized in promyelocytes and myelocytes as proHNPs, but only processed in promyelocytes and stored as mature HNPs in azurophil granules. Despite decades of search, the mechanisms underlying the posttranslational processing of neutrophil defensins remain unidentified. Thus, neither the enzyme that processes proHNPs nor the localization of processing has been identified. It has been hypothesized that proHNPs are processed by the serine proteases highly expressed in promyelocytes: Neutrophil elastase (NE), cathepsin G (CG), and proteinase 3 (PR3), all of which are able to process recombinant proHNP into HNP in vitro. We investigated whether serine proteases are in fact responsible for processing of proHNP in human bone marrow cells and in human and murine myeloid cell lines. Subcellular fractionation of the human promyelocytic cell line PLB-985 demonstrated proHNP processing to commence in fractions containing endoplasmic reticulum. Processing of 35S-proHNP was insensitive to serine protease inhibitors. Simultaneous knockdown of NE, CG, and PR3 did not decrease proHNP processing in primary human bone marrow cells. Furthermore, introduction of NE, CG, and PR3 into murine promyelocytic cells did not enhance the proHNP processing capability. Finally, two patients suffering from Papillon-Lefèvre syndrome, who lack active neutrophil serine proteases, demonstrated normal levels of fully processed HNP in peripheral neutrophils. Contradicting earlier assumptions, our study found serine proteases dispensable for processing of proHNPs in vivo. This calls for study of other protease classes in the search for the proHNP processing protease(s).

Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study.

BACKGROUND: Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. METHODS: Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level]. RESULTS: GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP. CONCLUSION: VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP.

Long-term results after treatment of periodontitis in patients with Papillon-Lefèvre syndrome: success and failure.

AIM: Retrospective evaluation of periodontal status in patients with Papillon-Lefèvre syndrome (PLS) observed for ≥10 years; identification of factors that may influence treatment outcome; and reporting of the outcome of dental implants in four PLS patients. METHODS: All PLS patients currently registered at the Department of Periodontology, Goethe-University Frankfurt with a follow-up ≥10 years (13-33 years; mean 22 years) were recruited. Eight patients (aged 17-46 years) from five families (three pairs of siblings) were included. RESULTS: After comprehensive periodontal therapy in eight PLS patients, teeth were retained in only two. In six patients, all teeth were extracted, almost entirely due to periodontal reasons. In four patients, teeth were prosthodontically restored with implants. Currently, three patients already show peri-implantitis. CONCLUSIONS: In some PLS patients, periodontitis may be arrested by: combined mechanical and antibiotic periodontal treatment; extraction of severely diseased teeth; oral hygiene instructions; intensive maintenance therapy; and microbiological monitoring and treatment of the infection with Aggregatibacter actinomycetemcomitans. Implants in PLS patients who did not follow any maintenance programme have a high risk of peri-implantitis and implant loss. Treatment of PLS patients has always to be considered as high-risk cases.

IL-1-polymorphism and severity of periodontal disease.

OBJECTIVE: To determine the association between the interleukin (IL)-1-polymorphism and the severity of periodontal disease prior to active periodontal therapy. MATERIALS AND METHODS: Two hundred and six patients with obtained baseline x-rays were tested for IL-1-polymorphism. Relative bone loss before active periodontal treatment was measured with a Schei ruler and classified in five groups. Descriptive statistics and backward stepwise linear regression analyses were performed. RESULTS: Forty-nine patients with moderate (mChP), 79 with severe chronic (sChP) and 78 with aggressive periodontitis (AgP) were included. Age correlated significantly with bone loss and number of teeth at baseline. Gender, smoking and IL-1-polymorphism were neither associated with bone loss nor with number of teeth prior to treatment. After adjusting for age as well as gender, AgP was significantly associated with more severe bone loss in untreated periodontal disease (p = 0.036). In non-smokers, mean number of teeth prior to active periodontal therapy correlated significantly with presence of IL-1 polymorphism. CONCLUSION: The IL-1-polymorphism is associated with lower number of teeth in non-smokers with untreated periodontal disease. Untreated AgP is associated with more severe bone loss than untreated ChP.

Evaluation of two siblings with Papillon-Lefèvre syndrome 5 years after treatment of periodontitis in primary and mixed dentition.

BACKGROUND: This case report describes the clinical and microbiologic long-term outcome 5 years after periodontal therapy of two siblings diagnosed with Papillon-Lefèvre syndrome (PLS) and tinea capitis. METHODS: In 2005, two brothers diagnosed with PLS and tinea capitis began periodontal treatment. Both of them showed premature mobility of the primary dentition, markedly increased probing depths, and subgingival Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans; Aa). Initial therapy consisted of scaling and root planing based on the concept of full-mouth disinfection, extraction of periodontally hopeless deciduous teeth, and systemic antibiotics. Reevaluation of clinical parameters revealed a dramatic improvement. After that, the patients were enrolled in a stringent maintenance program. Microbiologic monitoring was performed 1 and 5 years after treatment. RESULTS: Five years after initial treatment, the periodontal situation was stable in both patients. Residual deciduous teeth, with the exception of one tooth, could be retained and no further teeth were lost. Further disease progression on the previously involved teeth was controlled, and development of periodontitis on erupting teeth was prevented for a period of 5 years. CONCLUSIONS: Even periodontally affected deciduous teeth can be treated successfully in patients with PLS. Suppression of Aa and a stringent maintenance program are of high importance.

Comprehensive treatment of periodontitis in patients with von Willebrand disease.

BACKGROUND: Hemophilia A and B and von Willebrand disease (VWD) belong to the most frequent congenital coagulation disorders and are a significant problem in patients who require periodontal therapy or tooth extraction. These patients need specialist management because even minor invasive procedures can precipitate a prolonged bleeding episode. However, although dental care presents major challenges in these patients, only a few studies are available. METHODS: In this case series, the comprehensive periodontal treatment of four patients with hemorrhagic disorders (VWD type I and mild hemophilia B) is described. There was a close collaboration between the periodontist and the hematologist: all patients were scheduled for premedication with desmopressin and other pharmaceuticals at the hematologist's office. After one session of scaling and root planing was performed in all patients, local agents such as tranexamic acid were used. In the course of periodontal therapy, access-flap surgery was performed in one of the four patients. RESULTS: Before treatment, the rates of probing depths (PDs) of 4 to 6 mm (20% to 57%) or ≥ 7 mm (2% to 20%) were high. Three months after treatment, the rates of PDs of 4 to 6 mm (5% to 42%) or ≥ 7 mm (0% to 2%) decreased significantly in all patients. Attachment gains were also observed. A secondary hemorrhage did not occur in any of the patients, and wound healing proceeded without any complications. CONCLUSION: Effective periodontal treatment can be provided to patients with hemorrhagic disorders with the combined efforts of the periodontist and hematologist.

Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage.

BACKGROUND: This study clinically evaluates the 10-year results of connective tissue graft (CTG) and guided tissue regeneration (GTR) therapies using bioabsorbable barriers for root coverage (i.e., the reduction of recession depth). METHODS: In 15 patients, 38 Miller Class I and II recessions were treated. Recession defects received a CTG or GTR by random assignment. At baseline (immediately prior to surgery) and 6 and 120 +/- 12 months after surgery, clinical parameters were obtained. RESULTS: Nine patients, who contributed 24 recession defects, were available for re-examination at 120 +/- 12 months. Six and 120 +/- 12 months after receiving a CTG, statistically significant (P <0.05) root coverage was observed compared to baseline root coverage (6 months: 3.07 +/- 1.74 mm; 120 +/- 12 months: 2.07 +/- 1.89 mm). The GTR therapy resulted in statistically significant root coverage compared to baseline root coverage only after 6 months (2.28 +/- 1.77 mm; P <0.05). Both groups experienced a statistically significant loss of coverage from 6 to 120 +/- 12 months (CTG: -1.0 +/- 0.78 mm; GTR: -2.03 +/- 2.24 mm). At 120 +/- 12 months after CTG surgery, the stability of root coverage was statistically significantly better than 120 +/- 12 months after GTR surgery (P = 0.002). The CTG caused more post-surgical discomfort (P <0.05), but it resulted in a better treatment outcome (P <0.05) than GTR as perceived by patients. CONCLUSION: The long-term stability of root coverage (i.e., the reduction of recession depth) and esthetic results perceived by patients were significantly better 10 years after CTG surgery, statistically, than after GTR surgery using bioabsorbable barriers.

Open flap debridement and guided tissue regeneration after 10 years in infrabony defects.

OBJECTIVE: Evaluation of the 10-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) therapy of infrabony defects in a randomized controlled clinical trial. MATERIALS AND METHODS: In 16 periodontitis patients OFD or polylactide acetyltributyl citrate barriers (GTR; n=23) were assigned randomly to 44 infrabony defects. In a subgroup of 10 patients exhibiting 2 contra-lateral defects each OFD and GTR was assigned to either side (split-mouth). At baseline, 12, and 120 +/- 12 months after surgery clinical parameters were obtained. RESULTS: Fifteen patients (41 defects) were available at 120 months. Twelve and 120 +/- 12 months after therapy both groups showed statistically significant (p<0.01) attachment gain (split-mouth: OFD: 12 months: 3.60 +/- 2.67 mm; 120 months: 3.65 +/- 3.36 mm; GTR: 12 months: 3.50 +/- 1.90 mm; 120 months: 2.85 +/- 2.24 mm; parallel: OFD: 12 months: 3.47 +/- 2.80 mm; 120 months: 3.41 +/- 2.75 mm; GTR: 12 months: 3.67 +/- 2.11 mm; 120 months: 2.89 +/- 2.12 mm). From 12 to 120 months both groups experienced insignificant attachment changes, however, six teeth (two OFD, four GTR) were lost (all for prosthodontic reasons). The study failed to show statistically significant attachment gain differences between both groups after 120 months. CONCLUSIONS: Ten years after OFD and GTR in infrabony defects 35 of 41 teeth were still in place.