Factors influencing clinical treatment for severe chronic periodontitis.

Electronic patient records (EPR) may facilitate further articulation, quantification and improvement of the parameter on chronic periodontitis and periodontal treatment decisions.

Treatment of intrabony defects with bovine-derived xenograft alone and in combination with platelet-rich plasma: a randomized clinical trial.

BACKGROUND: In the treatment of periodontal intrabony defects, the benefits of adding platelet-rich plasma (PRP) to a bone replacement grafting material have not been tested. The purpose of this study was to compare the clinical outcomes obtained by the combination of PRP and a bovine derived xenograft (BDX) to those obtained from the use of the bone replacement graft alone. METHODS: Thirteen patients were enrolled in a randomized, split mouth, double-masked clinical trial. Bilateral defects were matched according to their intrasurgical measurements. Qualifying defects had loss of attachment of > or = 6 mm, a radiographically detectable defect of > or = 4 mm, at least two remaining osseous walls, and not primarily related to a furcation involvement. After the hygienic phase, at the baseline examination, probing depth (PD), clinical attachment level (CAL), and recession (REC) were measured. During open flap debridement, the defects were randomly assigned to receive either BDX mixed with PRP or BDX alone. Baseline osseous intrasurgical measurements were obtained. Post-surgical follow-up and maintenance were performed and PD, CAL, and REC were remeasured at 6 months. The mean baseline and 6-month PD, CAL, and REC of the deepest buccal and lingual measurements related to the defect for each group were computed. The change from baseline to 6 months for each parameter measured was calculated. Pre- and postoperative comparisons were made between treatment groups at 6 months. RESULTS: Randomization of the defects resulted in comparable groups (P > or = 0.05). At 6 months, paired t test comparisons within groups showed statistically significant benefits with both treatment modalities (P < or = 0.05). The mean changes (delta) at 6 months for the test and the control groups at the deepest sites were: PD reduction: 3.54 and 2.53 mm; CAL gain: 3.15 and 2.31 mm; and REC: -0.38 and -0.23 mm, respectively. Paired t test comparisons yielded significant differences between treatments for PD and CAL (P < or = 0.05). CONCLUSION: In this 6-month clinical trial, the addition of a high concentration of autologous platelets to a bovine derived xenograft to treat intrabony defects significantly improved their clinical periodontal response.

Protocol for outpatient screening and initiation of continuous subcutaneous insulin infusion therapy: impact on cost and quality.

PURPOSE: The purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 1/2 years. METHODS: One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2 1/2 years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin A1C (A1C) were measured and compared. RESULTS: The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). A1C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections. CONCLUSIONS: A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2 1/2 years.