Bacterial reduction effect of four different dental lasers on titanium surfaces in vitro.

Compare the effectiveness of selected dental lasers for decontamination of machined titanium surfaces in vitro. Seventy-two sterile machined surface titanium discs were individually inoculated with strains of Streptococcus mutans (Sm), Streptococcus oralis (So), Aggregatibacter actinomycetemcomitans (Aa), or all three bacteria together (MIX) at 34.0° C, 20.8% O2 and 5% CO2 for 12 h. After incubation, the discs were divided into six groups: 1) no treatment, 2) 0.12% chlorhexidine gluconate (CHX), and 3) 10,600 CO2, 4) 810 nm diode, 5) 2780 nm Er,Cr:YSGG, 6) 1064 nm Nd:YAG laser groups. After treatment, any remaining viable bacteria were liberated from the discs via sonication, transferred onto brain heart infusion (BHI) agar plates for culturing, and colony-forming units (CFUs) were recorded. Statistical analysis was performed. There were statistically significantly differences (SSD) (p < 0.01) in bacterial reduction of discs individually inoculated with Aa between the Er,Cr:YSGG and Nd:YAG lasers. There was also a SSD (p < 0.01) lower effect with the MIX with the Er,Cr:YSGG compared with all other modalities. Bacterial reduction with the CO2 was better (p < 0.001) than treatment with CHX or the Er,Cr:YSGG laser on killing of So. Although all modalities of treatment showed a mean of 98% or greater viable bacterial reduction, the most consistent bacterial reduction of all titanium discs was with the Nd:YAG laser (100%).

Lasers in minimally invasive periodontal and peri-implant therapy.

Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri-implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium-doped yttrium aluminium garnet (Nd:YAG), erbium-doped yttrium aluminium garnet (Er:YAG) and erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta-analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence-based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri-implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser-treatment modalities of different wavelengths and better-defined indications for each protocol.

Periodontal and peri-implant wound healing following laser therapy.

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Clinical evaluation of Laser-Assisted New Attachment Procedure® (LANAP®) surgical treatment of chronic periodontitis: a retrospective case series of 1-year results in 22 consecutive patients.

PURPOSE: Treatment for periodontitis has evolved over the years as new technologies have become available. Currently, lasers seem attractive as a treatment modality, but their effectiveness needs to be verified. The purpose of this project was to evaluate Laser Assisted New Attachment Procedure® (LANAP®) surgery as a single treatment modality. METHODS: As part of a mandatory training program for periodontists and other dentists, 22 consecutive patients diagnosed with moderate to severe periodontitis (probing depth [PD] up to 11 mm) were treated with the LANAP® surgical approach using a 1064-nm Nd:YAG laser as part of a multi-step protocol. Following single-session active therapy, they were entered into a maintenance program. Their clinical status was re-evaluated at 12-18 months following surgery. RESULTS: All 22 patients completed the 12- to 18-month follow-up. PD, clinical attachment level, and furcation (FURC) showed substantial improvement. Recession was minimal (mean, 0.1 mm), while 93.5% of PD measurements were 3 mm or less at re-evaluation. Furthermore, 40% of grade 2 FURC closed clinically. CONCLUSIONS: Within the limits of this case series, LANAP® was found to be an effective, minimally invasive, laser surgical therapy for moderate to advanced periodontitis.

Evaluation of Different Dental Lasers' Ability to Congeal Pooled Blood: An In Vitro Study.

Most dental lasers claim that they can aid in hemostasis during oral and periodontal surgery. To date, there are no studies that compare different lasers' ability to congeal pooled blood. The aim of the study was to see if there was a difference in dental lasers' ability to congeal pooled human blood in vitro. Whole blood was collected from donors, with 0.5 mL (premolar socket volume for all tests) aliquoted into microcentrifuge tubes. Different dental lasers (810-nm diode, 940-nm diode, 1,064-nm Nd:YAG, 2,790-nm Er,Cr:YSGG, 2,940-nm Er:YAG, and 10,600-nm CO2) were applied to the whole blood for 0, 15, 30, and 45 seconds. The sample tubes were centrifuged, and the supernatant color was scored to assess the degree of congealing. Additional samples of blood were tested for time needed for maximum congealing and temperature change. Analysis of supernatant colors showed that there were significant differences in the degrees of congealing for the 810-nm diode, 940-nm diode, and 2,790-nm Er,Cr:YSGG lasers when compared to the 1,064-nm Nd:YAG, 2,940-nm Er:YAG, and 10,600-nm CO2 lasers, but not within those groupings. Additionally, the 1,064-nm Nd:YAG laser increased the temperature of the blood samples more than the other lasers and had a shorter time for maximum congealing. There were differences in the dental lasers' ability to congeal pooled human blood in an in vitro model. Nd:YAG, Er:YAG, and 10,600-nm CO2 lasers were able to achieve a greater degree of congealing at an earlier time point. The Nd:YAG laser produced the most heat and was the fastest to complete coagulation.

Calculus removal with diamond-coated ultrasonic inserts in vitro.

BACKGROUND: Efficient calculus removal is a primary goal in periodontal therapy. Diamond-coated ultrasonic inserts (DIs) offer promise for improved scaling and were evaluated in vitro. METHODS: Extracted human teeth with moderate to severe calculus had areas of calculus ( approximately 5 x 5 mm) delineated with small burs. Each calculus area was treated under 2.5x magnification to the point of visible root cleanliness with sharp Gracey curets (hand instruments [HIs]), plain ultrasonic inserts (PIs), or ultrasonic inserts with fine-grit diamond coating; the latter two were used in a magnetostrictive ultrasonic instrument at a medium power setting. Each curet or insert was used for four teeth and then replaced by a new instrument. The time needed to clean each tooth/surface was recorded. The total area treated and the area of the residual calculus were calculated using an imaging analysis program. RESULTS: The mean time required for clinical calculus removal was 29.7 seconds for DIs, 91.9 seconds for PIs, and 49.8 seconds for HIs (all P <0.0001 from each other). Overall, the mean percentage of residual calculus was 6.3% for DIs, 5.4% for PIs, and 3.1% for HIs (significant differences between HIs and the other treatments). CONCLUSIONS: In vitro calculus removal was faster with DIs, followed by HIs and PIs. More residual calculus was found with the DIs; however, the 1% to 3% difference (93.7% clean versus 94.6% clean versus 96.9% clean with DIs, PIs, and HIs, respectively) does not seem to be clinically significant.

Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans.

This report presents histologic results in humans following a laser-assisted new attachment procedure (LANAP) for the treatment of periodontal pockets. Six pairs of single-rooted teeth with moderate to advanced chronic periodontitis associated with subgingival calculus deposits were treated. A bur notch was placed within the pocket at the clinically and radiographically measured apical extent of calculus. All teeth were scaled and root planed with ultrasonic and hand scalers. One of each pair of teeth received treatment of the inner pocket wall with a free-running pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to remove the pocket epithelium, and the test pockets were lased a second time to seal the pocket. After 3 months, all treated teeth were removed en bloc for histologic processing. LANAP-treated teeth exhibited greater probing depth reductions and clinical probing attachment level gains than the control teeth. All LANAP-treated specimens showed new cementum and new connective tissue attachment in and occasionally coronal to the notch, whereas five of the six control teeth had a long junctional epithelium with no evidence of new attachment or regeneration. There was no evidence of any adverse histologic changes around the LANAP specimens. These cases support the concept that LANAP can be associated with cementum-mediated new connective tissue attachment and apparent periodontal regeneration of diseased root surfaces in humans.

Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration.

OBJECTIVE: Deficient bony ridges often complicate the implant treatment plan. Several treatment modalities are used to regenerate bone, including guided bone regeneration (GBR). The purpose of this study was to summarize the knowledge on different types of membranes available and currently used in GBR procedures in a staged approach or with simultaneous implant placement. The primary role of the membranes is to exclude epithelial and connective tissue cells from the wound area to be regenerated, and to create and maintain the space into which pluripotential and osteogenic cells are free to migrate. DATA SOURCES: A literature search was performed for articles that were published in English on the topic. A selected number of studies were chosen in order to provide a review of the main characteristics, applications, and outcomes of the different types of membranes. Resorbable membranes are made of natural or synthetic polymers like collagen and aliphatic polyesters. Collagens are the most common type used. They have similar collagen composition to the periodontal connective tissue. Other materials available include human, porcine, and bovine pericardium membranes, human amnion and chorion tissue, and human acellular freeze-dried dermal matrix. Nonresorbable membranes used in GBR include dense-polytetrafluoroethylene (d-PTFE), expanded-polytetrafluoroethylene (e-PTFE), titanium mesh, and titanium-reinforced polytetrafluoroethylene. CONCLUSIONS: The most common complication of nonresorbable membranes is exposure, which has detrimental effect on the final outcome with both types of membranes. For vertical bone augmentation procedures, the most appropriate membranes are the nonresorbable. For combination defects, both types result in a successful outcome.

Evaluation of allogeneic bone graft substitute for treatment of periodontal osseous defects: 6-month clinical results.

This article is an initial clinical evaluation of the use of Puros, a specially processed allogeneic bone graft substitute, for treatment of periodontal osseous defects. Nine patients with chronic periodontitis contributed 1 osseous defect each. Clinical and surgical measurements were taken at the time of the initial grafting and 6 months later at the time of a surgical re-entry. On average, probing depth improved by 3 mm, and there was 2.5 mm bone fill. Resorption of the alveolar crest was minimal. All cases healed satisfactorily, and at the time of re-entry only 1 case required re-treatment. Puros appears to be a useful and beneficial material for the treatment of proximal type human periodontal defects.

A Novel Treatment Decision Tree and Literature Review of Retrograde Peri-Implantitis.

BACKGROUND: Although retrograde peri-implantitis (RPI) is not a common sequela of dental implant surgery, its prevalence has been reported in the literature to be 0.26%. Incidence of RPI is reported to increase to 7.8% when teeth adjacent to the implant site have a previous history of root canal therapy, and it is correlated with distance between implant and adjacent tooth and/or with time from endodontic treatment of adjacent tooth to implant placement. Minimum 2 mm space between implant and adjacent tooth is needed to decrease incidence of apical RPI, with minimum 4 weeks between completion of endodontic treatment and actual implant placement. The purpose of this study is to compile all available treatment modalities and to provide a decision tree as a general guide for clinicians to aid in diagnosis and treatment of RPI. METHODS: Literature search was performed for articles published in English on the topic of RPI. Articles selected were case reports with study populations ranging from 1 to 32 patients. Any case report or clinical trial that attempted to treat or rescue an implant diagnosed with RPI was included. RESULTS: Predominant diagnostic presentation of a lesion was presence of sinus tract at buccal or facial abscess of apical portion of implant, and subsequent periapical radiographs taken demonstrated a radiolucent lesion. On the basis of case reports analyzed, RPI was diagnosed between 1 week and 4 years after implant placement. Twelve of 20 studies reported that RPI lesions were diagnosed within 6 months after implant placement. A step-by-step decision tree is provided to allow clinicians to triage and properly manage cases of RPI on the basis of recommendations and successful treatments provided in analyzed case reports. It is divided between symptomatic and asymptomatic implants and adjacent teeth with vital and necrotic pulps. CONCLUSIONS: Most common etiology of apical RPI is endodontic infection from neighboring teeth, which was diagnosed within 6 months after implant placement. Most common findings, radiographically and clinically, are lesions around implant apex and sinus tract. A small number of implants did not improve with treatment. Decision tree provides a path to diagnose and treat lesions to facilitate their management. Further studies are needed to focus on histologic data around periapical microbiota to establish specific etiology and differential diagnoses compared with marginal peri-implantitis and other implant-related conditions.

Comparative evaluation of decalcified and non-decalcified freeze-dried bone allografts in rhesus monkeys. I. Histologic findings.

BACKGROUND: Controversy exists regarding the relative merits of decalcified (DFDBA) and non-decalcified (FDBA) freeze-dried bone allografts when used in periodontal or other oral surgical procedures. METHODS: Under typical sedation, six rhesus monkeys had nylon mesh cylinders containing either DFDBA or FDBA implanted into surgically created vertical grooves on the facial aspects of all posterior quadrants. Each quadrant received three cylinders containing one type of bone, plus one empty cylinder (E) as negative control, and the full thickness flaps were closed to completely cover the cylinders. Cylinders were retrieved at 1, 2, and 3 months and processed for histologic evaluation. Photomicrographs taken at 8x were randomly evaluated using a histometric grid point counting technique for new bone and old bone within the chambers, and the data were analyzed with analysis of variance plus post-tests. RESULTS: The nylon chambers and their contents were well-tolerated by the tissues. FDBA chambers contained more new bone and total bone than either the DFDBA or E chambers at all time periods (P <0.05). DFDBA was not statistically significantly different than E at any time period. FDBA had less old bone than DFDBA at 3 months (P<0.05). FDBA and DFDBA had more total bone (grafted plus new) present than E at all time periods (P<0.05). CONCLUSION: These results suggest that FDBA may stimulate earlier, more rapid, and more substantial new bone formation than DFDBA in a monkey jaw defect model system.

Outer membrane vesicles from Porphyromonas gingivalis affect the growth and function of cultured human gingival fibroblasts and umbilical vein endothelial cells.

BACKGROUND: The purpose of this study was to examine the effects of outer membrane vesicles (OMV) obtained from Porphyromonas gingivalis (Pg) on the growth and function of human gingival fibroblasts (HGF) and human umbilical vein endothelial cells (HUVEC). METHODS: OMV were obtained from a cell-free growth medium of Pg ATCC 33277 by 40% NH2SO4 precipitation and ultracentrifugation. Cell proliferation was measured by 3H-thymidine incorporation into growing HGF and HUVEC. Endothelial cell function was determined by their capacity to form a network of capillary tubes on an extracellular matrix (ECM). RESULTS: Proliferating HGF and HUVEC demonstrated a significant dose-dependent inhibition of 3H-thymidine uptake when cultured with 0 to 40 microg/ml of OMV protein. HGF and HUVEC showed an IC50 of growth of about 9.0 microg/ml and 4.5 microg/ml of OMV protein, respectively. Capillary tube formation by HUVEC cultured on an ECM was suppressed by 70% to 80% with 5 microg/ml OMV protein after 18 hours of incubation. The presence of proteolytic enzymes in the OMV did not contribute to capillary tube disruption, since blocking enzyme activity with specific inhibitors did not reduce the suppression of capillary tube formation. After heating at 90 degrees C for 5 minutes, OMV significantly lost their capacity to suppress capillary tube formation. CONCLUSIONS: OMV significantly inhibit the proliferation of cultured HGF and HUVEC in a dose-dependent manner. OMV suppressed the capillary tube formation by cultured HUVEC. The factor(s) appeared to be a protein and not endotoxin because its inhibitory activity was markedly reduced by heat inactivation. These studies suggest that OMV contribute to chronic periodontitis by suppressing cell proliferation and revascularization in periodontal tissues.

Periodontal regeneration with peptide-enhanced anorganic bone matrix in particulate and putty form in dogs.

BACKGROUND: Peptide-enhanced (using the peptide 15 [P-15] synthetic peptide) anorganic bone matrix (ABM) particulate (PPart) grafts have demonstrated clinical and histologic success in human periodontal defects. Dispersion of ABM/P-15 in sodium hyaluronate carrier (PPutty) improves the handling properties of the graft material. The healing of ABM/P-15 particulate and ABM/P-15 putty was compared in critical-sized fenestration defects in 16 mongrel dogs. METHODS: After full thickness flap reflection, 7 mm diameter fenestrations were made with a trephine in the mid-root of both maxillary canines in each dog. Bone, periodontal ligament, and cementum were removed as completely as possible with hand root planing within the trephine-produced notches. By random allocation, each defect was filled with PPart or PPutty, and the flaps were closed with sutures. One dog contributing two defects served as a negative control. Block sections were retrieved at 3 and 8 weeks for histologic processing. Three 6-mu step serial sections in the center of the defects were used for analysis. Parameters measured included the original length of the wound, linear amount of periodontal regeneration including new cementum, bone and connective tissue, and area measurements of new bone and remaining particles. PPutty and PPart results were compared for significant differences using the Wilcoxon rank sum test. RESULTS: Clinical healing was uneventful in all cases. There was no evidence of inflammation or adverse tissue reactions with either material. The controls showed minimal regeneration at the periphery of the defect. Histomorphometric evaluation of the grafted defects revealed the following: at 3 weeks, there was minimal new bone formation (occupying 4.2% of the grafted area for the PPutty and 1.2% for the PPart). The grafted particles occupied 21.2% and 35.6% of the area for the PPutty and PPart, respectively (P = 0.039). At 8 weeks, there was a tendency for greater new bone formation compared to 3 weeks with both materials. There was significantly more new bone with the PPutty (49.3%) compared to the PPart (14.8%) (P = 0.045). The grafted particles occupied 7.9% and 17% of the grafted area for the PPutty and PPart, respectively (no significant difference). There were no significant differences for any of the linear measurements. ABM/P-15 PPutty had superior handling characteristics. CONCLUSIONS: Both ABM/P-15 materials yielded satisfactory healing and resulted in the greater regeneration of fenestration defects in dogs at 8 weeks compared to controls. In addition, AMB/P-15 putty resulted in more bone formation compared to ABM/P-15 particulate.

Effect of locally delivered doxycycline hyclate on human fibroblast attachment to subgingival calculus.

BACKGROUND: Clinical studies using locally applied doxycycline hyclate (DHV) have demonstrated significant probing depth reduction and gain in clinical attachment as a monotherapy without scaling and root planing. The mechanism for this attachment level gain to the non-root planed tooth is not understood. The purpose of this study was to investigate the effect of locally applied doxycycline hyclate on human gingival fibroblast attachment to subgingival calculus on contaminated root surfaces. METHODS: Two separate experiments were performed, both on subgingival calculus. In experiment 1, teeth with subgingival calculus were treated with either doxcycycline hyclate in bioabsorbable vehicle (DHV) or with vehicle control (VC) in vivo. In experiment 2, teeth with subgingival calculus were treated with DHV, VC, scaling and root planing (SRP), or no treatment in vitro. The amount of cell attachment to calculus-covered root surfaces was quantitatively compared using a fluorescent dye assay and epifluorescence microscope. Values for cell attachment are presented as the mean standard deviation of the mean. The data were evaluated using Student t test. RESULTS: In both experiments, there was no statistically significant difference in fibroblast attachment in the DHV, VC, or no treatment groups (P >0.05). The SRP group showed significantly more cellular attachment to tooth surfaces formerly covered by subgingival calculus than all other groups (P <0.001). In general, more cells attached to cementum than to calculus. Root chips that showed no attachment to the subgingival calculus also had no cells attached to the adjacent cemental root surface. CONCLUSION: The addition of doxycycline hyclate in a bioabsorbable vehicle used as a locally delivered drug did not enhance the initial cellular attachment of human gingival fibroblasts to subgingival calculus or contaminated root surfaces.

Gingival/soft tissue abscess following subepithelial connective tissue graft for root coverage: report of three cases.

BACKGROUND: The subepithelial connective tissue graft (SCTG) is a predictable technique for root coverage. The small number of potential postoperative problems make SCTG the current treatment of choice for reversing gingival recession. METHODS: The purpose of this article is to report three cases of complications after the use of an SCTG where an abscess occurred following the initial healing phase. The surgical technique that was used and the treatment that was provided for the abscesses are reported, and the possible causes of these complications are discussed. RESULTS: The abscesses were treated conservatively, and no recurrence has been observed after treatment. CONCLUSIONS: Possible causes of the abscesses include "stitch abscess" or reaction to the suture material used for the submerged sutures, or a possible role of epithelium implanted during the procedure. The clinical outcome of the root coverage procedure was not affected.

The putative collagen-binding peptide P-15 promotes fibroblast attachment to root shavings but not hydroxyapatite.

BACKGROUND: Regenerative periodontal treatment aims to restore the attachment of the periodontal ligament and gingival collagen fibers to both the cementum of the root surface and alveolar bone. Fibroblasts are the predominant cells of the periodontal ligament and gingiva and have important roles in the function and regeneration of the tooth-supporting apparatus. This study investigated whether a putative collagen-based cell-binding peptide (P-15) increases gingival fibroblast attachment to root shavings and bone replacement graft (BRG) materials. METHODS: Gingival and dermal fibroblast attachment to root shavings and BRG materials, and cell proliferation on root shavings and sections were measured fluorometrically. Root shavings and root sections obtained from periodontally healthy teeth were treated with P-15 at 2 concentrations (200 ng/g or 400 ng/g). Citric acid (CA)-treated root materials were also compared to untreated root shavings and root sections that served as negative control groups. RESULTS: Attachment of all cells to bone fragments (whether freeze-dried or demineralized) was significantly greater than to hydroxyapatite (HA)-based BRG materials. The addition of P-15 to HA did not significantly increase gingival or dermal fibroblast attachment. At a concentration of 400 ng/g, P-15 significantly increased gingival and dermal fibroblast attachment to root shavings as compared to untreated shavings. Bone fragments, HA-based BRG materials, and untreated root shavings inhibited gingival fibroblast proliferation. Treatment of root sections with P-15 did not have any effect on gingival fibroblast proliferation. CONCLUSIONS: P-15 is a potential alternative to CA for promoting fibroblast attachment to root surfaces. However, P-15 did not enhance fibroblast proliferation on root sections.

Periodontal disease in HIV-positive individuals: association of periodontal indices with stages of HIV disease.

BACKGROUND: Periodontal disease has been previously associated with human immunodeficiency virus (HIV) infection, and HIV infection has been considered a modifier of periodontal disease. The aim of this study was to report the prevalence and severity of periodontal disease in a population of HIV-positive individuals and to investigate the association between clinical periodontal indices and the stage of HIV disease, as expressed by CD4 cell counts. METHODS: Thirty-nine male HIV-positive patients were recruited and a medical history was taken. To evaluate periodontal disease, probing depth (PD), attachment level loss (AL), bleeding index (BI), and modified gingival index (MGI) were recorded. Associations between the above indices and CD4 counts were examined. RESULTS: Immunocompromised patients (with CD4 cell counts < 200 cells/microl) showed significantly lower BI and fewer sites with PD and AL > 4 mm compared to patients with CD4 cell counts > 200 cells/microl. When patients with CD4 counts < 500 cells/microl were considered alone, a correlation was observed between CD4 cell counts and BI (r2 = 0.1617, P = 0.0463), MGI (r2 = 0.2123, P = 0.0204), and number of sites with AL > 4 mm (r2 = 0.1469, P = 0.056). CONCLUSIONS: Severely immunocompromised HIV-positive patients showed less severe gingival inflammation than expected. Patients with CD4 cell counts > 500 cells/microl showed no association between CD4 cell count and periodontal indices.

Thirty-six month follow-up of 25 patients treated with combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell-binding peptide (P-15) bone replacement grafts in human infrabony defects. I. Clinical findings.

BACKGROUND: Long-term evaluation of periodontal therapy is important for clinical decision making. METHODS: A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was evaluated as a bone replacement graft in human periodontal osseous defects. Following initial preparation and reevaluation, flap surgery was performed. A variety of 1-, 2-, 3-wall bony defects were curetted and root surfaces subjected to mechanical debridement only. The bone defects were grafted with ABM/P-15, and the host flaps replaced or slightly coronally positioned. Weekly, then monthly deplaquing was performed until surgical reentry at 6 to 7 months. Patients were then followed on approximate 3-month recalls for 3 years. Twenty-five of the original 31 patients qualified for long-term evaluation in that their ABM/P-15 treated sites did not receive any additional therapy at the time of reentry. RESULTS: Significant clinical changes for the overall group of bony defects included improvement in mean clinical attachment level from 5.4 mm at surgery to 4.5 mm at the 6-month reentry to 3.8 mm at 3 years. There was also a decrease in mean probing depth from 5.3 mm at surgery to 3.1 mm at the 6-month reentry to 2.9 mm at 3 years. The mean gingival recession changed from +0.1 mm at surgery to 1.4 mm at the 6-month reentry to 0.9 mm at 3 years. All of these differences were at least P <0.05 from surgery to the 6-month reentry, and surgery to 3 years, but were not significant from reentry to 3 years via repeated measures analysis of variance. CONCLUSIONS: These favorable 3-year results with ABM/P-15 suggest that it may have a beneficial effect in the long-term clinical management of infrabony defects. Further long-term randomized controlled studies are needed to better assess the role of ABM/P-15 in long-term healing of periodontal osseous defects.