Validity of clinical assessments related to the cemento-enamel junction.

The distance measured from a constant reference to the subgingival cemento-enamel junction by four observers with two different probes in 11 patients was compared to independent precision measurements of the same distance performed during periodontal surgery. The findings question the validity of probe measurements with relation to the cemento-enamel junction.

The effect of amoxicillin on destructive periodontitis. A case report.

In a 22-year-old female patient, advanced localized periodontal destruction was observed. The planned treatment consisted of oral hygiene instructions, professional plaque control, deep scaling and root planning and finally modified Widman flap surgery. One molar had to be extracted but was left untreated initially as a control. During the treatment period of 9 months and during 1 year thereafter, samples were taken of the subgingival plaque for dark-field microscopy. The unplanned use of amoxicillin by the patient for a middle ear infection resulted in a suppression below detection level of spirochetes at the investigated sites. At the nontreated control site, the absence of spirochetes was accompanied by a 3-mm reduction of pocket depth and a 2-mm gain in clinical probing attachment, while some formation of new alveolar bone was observed. At the treated sites, clinical improvement was observed. However, a distinction between the effect of the periodontal therapy and the nonscheduled use of amoxicillin could not be made at the treated sites. It is concluded that a single course of systematically administered amoxicillin changed the composition of the subgingival microflora over a long period of time (17 months) and had a beneficial effect upon the status of the periodontium.

[Radiological findings in teeth and periodontium in a group of Swiss youths]. / Röntgenologische Befunde bei Zähnen und Zahnhalteapparaten einer Gruppe Schweizer Jugendlicher.

Bite-wing x-ray films of 1084 Swiss recruits were examined. Approximately 96% of the recruits showed signs of early bone loss around one or more teeth. Only a very small number had recognizable bone changes in furcation areas. Per recruit, 7.3 carious lesions were found; the majority of these were entirely within enamel. Of 6287 restored approximal posterior surfaces, 71.4% were inadequate. A number of these filled surfaces showed secondary caries.

[Clinical periodontal findings in a group of Swiss youths]. / Klinische Parodontalbefunde bei einer Gruppe Schweizer Jugendlicher.

A clinical epidemiological examination of the health status of the teeth and supporting structures of 1084 recruits at a summer recruits-school was conducted. With one exception all of the Swiss cantons were represented among the recruits. Only one recruit had a clinically healthy periodontium; all of the others showed inflammatory changes of the gingivae. The average PDI was 3.58. In the majority of the recruits signs of early bone loss around one or more sites was observable. Teeth with markedly abraded chewing surfaces did not show an increased prevalence of bone loss. An examination of existing fillings and crowns revealed a large number of unsatisfactory filling margins. The average DMFT value of 14.5 was mainly the result of the high number of filled teeth.

The importance of a coordinated restorative and maintenance program following periodontal therapy: a case report.

The problems arising during the maintenance phase of therapy following a combination of periodontal, orthodontic, and restorative treatment are illustrated by this case report. Emphasis is placed on the combined responsibility of the patient, general dental practitioner, and periodontist to recognize signs of recurrent disease at an early stage, thereby allowing corrective measures to be initiated promptly. By applying these principles, even when disease recurs during the maintenance phase, re-treatment is possible and a satisfactory result can be achieved.

[Effective treatment of periodontitis]. / De effectieve behandling van parodontitis.

Based upon clinical periodontal parameters and roentgenographic diagnosis a temporary treatment plan is made, which results in a definite one after the initial treatment. Only a rigorous removal of dental plaque guarantees an effective and efficient working manner, which starts with indirect scaling and rootplaning sustained by the personal oral hygiene. If the indirect therapy appears to fail, the roots must be cleaned under direct view. After the active phase, the supportive treatment takes place every three months, assessed to be of equal importance.

[How sensible are bacteriological tests in periodontology?]. / Hoe zinvol zijn bacteriologische testen in de parodontologie?

Periodontitis is a mixed infection with subgingival bacteria that belong to the microflora of the host. The bacteriological tests (Microscopy, Culture, Omnigene, Affirm DP and Evalusite) are mainly aimed at spirochetes or A. actinomycetemcomitans, P. gingivalis and P. intermedia. The detection limits of the different tests vary and, therefore, the detection levels are between 0.01-10% of the subgingival microflora. However, threshold levels to distinguish between diseased and carrier state are not established and the low sensitivity and specificity of the tests limit their diagnostic usefulness. The correlation between the tested bacteria and periodontitis does not mean a causal relationship. As a result, the justification of the elimination of the tested bacteria is questionable. The tests of the subgingival plaque do not only add to the microbiological knowledge, but might also promote the overtreatment with antibiotics, such as the in the Netherlands popular combination of amoxicilline and metronidazole. The balance between host and microflora can be restored in most patients by mechanical elimination of the mainly Gram negative anaerobic subgingival plaque. In special occasions metronidazole can be empirically prescribed in order to support the subgingival debridement. In the relatively rare occasions of superinfection, a sensitivity test of the subgingival microbiota is recommended.

[Sharpening of periodontal instruments]. / Het slijpen van parodontale instrumenten.

Sharp hand instruments are the first pre-requisite for scaling and root planing. Different sharpening techniques are reported, and the time at which an instrument is evaluated for its sharpness or dullness is indicated. The shape and form of several instruments are described together with the appropriate sharpening technique.

[Antibiotic use in periodontics. Results from a research study]. / Antibioticumgebruik in de parodontale praktijk. Resultaten van een verkennend onderzoek.

The sensitivity of the subgingival plaque for amoxicillin, doxycycline, ofloxacin and clindamycin was estimated by agar diffusion disks and Etest in 22 periodontal patients. The sensitivity of the subgingival plaque varied per patient. Resistance of the subgingival plaque for amoxicillin was observed in 50% of the patients and was significantly related to the use of antibiotics in the previous 6 months. The resistance to clindamycin was 68% and to doxycycline 82%. The resistance of the subgingival plaque to these antibiotics could not be related to the previous use. A decision-tree was constructed including a step wise use of a microscopical spirochete test and an antibiotic sensitivity test of the subgingival microflora for the above mentioned antibiotics. The clinical implications of the observed long lasting antibiotic resistance and the practical use of a decision-tree including a spirochete test and antibiotic sensitivity tests need further investigation.

Classification, reproducibility and prevalence of root proximity in periodontal patients.

AIM: The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity. MATERIAL AND METHODS: In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts. A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ-BC for root proximity sites and contra-lateral sites were recorded. RESULTS: A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ-BC distance between the root proximity sites and their contra-lateral sites. CONCLUSION: We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ-BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

Root proximity as a risk marker for periodontal disease: a case-control study.

AIM: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. MATERIAL AND METHODS: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. RESULTS: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. CONCLUSION: Root proximity must be taken into consideration as a risk marker for periodontal disease.

[Peridontal conditions in a group of Tibetans]. / Parodontalzustand bei einer Gruppe Tibeter

The possible role of race in periodontal disease has not been thoroughly investigated. As a basis for further discussion regarding this problem, the periodontal status of a group of Tibetans consisting of 38 children and 88 adults was investigated. The parameters evaluated were as follows: in the children the Sulcus Bleeding Index (SBI) and in the adults the modified Periodontal Disease Index (PDI). The results of this study showed that 13 children were free of gingivitis. The PDI was between 3,77 and 4,00 for the 18--19-years old and between 4,72 and 4,90 for the ones over 19 years. Since the PDI values were relative high and the gingival crevice depths were relatively low one can conclude that gingival recession accounts for the major portion of the PDI score.

Splinting of teeth with fixed bridges: biological effect.

Forty abutment teeth with pathological mobility were splinted with telescoped removable bridges. During the first 4 weeks the bridges were fixed. From the beginning of the fifth week they were removed once a day. Mobility was measured prior to placing the bridges and at 4 and 10 weeks intervals. Average mobility of the abutment teeth and the control unsplinted teeth did not change significantly during the experimental period.