A modification to the experimental gingivitis protocol to compare the antiplaque properties of two toothpastes.

BACKGROUND AND AIMS: Randomised, blind, controlled experimental gingivitis and home-use study protocols are used to evaluate the efficacy of oral hygiene products. The present methodological study combined the two clinical trial designs to compare the preventive and therapeutic potentials of two toothpastes. MATERIAL AND METHODS: The study was a parallel group, randomised, double-blind design, initially involving 73 healthy dentate subjects. A 21-day experimental gingivitis protocol was combined with a 6-week (42 days) home-use protocol. At baseline, modified gingival index (MGI), gingival index (GI) and gingival bleeding (GB) were recorded. A dental prophylaxis was then performed. Subjects were allocated to either control fluoride or stannous fluoride toothpaste based on gender and GI. During the first 21-day period, subjects applied the allocated toothpaste, for 1 min twice a day, to a group of teeth in a plastic shield and brushed the remaining teeth with the same paste. From day 21 the shield was not placed, and subjects brushed all teeth with the toothpaste for 1 min twice per day up to day 42. MGI, GB and a plaque index (PI) were recorded on days 21 and 42. RESULTS: Sixty-nine and 67 subjects completed to days 21 and 42, respectively. For shielded teeth, PI, MGI and GB increased to day 21 and then after ceasing the use of the shield decreased to day 42. At day 21, PI favoured the stannous fluoride toothpaste, but differences did not achieve statistical significance for any parameter at days 21 or 42. For unshielded teeth, there were no significant differences between the toothpastes for any parameter at either time point. CONCLUSION: : The feasibility of combining two gingivitis clinical trial methodologies appears proven, and data on both the preventive and therapeutic chemical and mechanical efficacy of toothpastes can be obtained through such protocols. Specifically from the present study and consistent with some other reports, the plaque inhibitory properties of the stannous fluoride product are limited and do not always translate into an antiplaque/antigingivitis effect.

A method to compare four mouthrinses: time to gingivitis level as the primary outcome variable.

BACKGROUND AND AIM: The experimental gingivitis model is a well-established method in comparing the chemical antiplaque activity of agents and products. The aim of the present study was to use time in order to achieve an exit level of bleeding on probing (BOP) as the primary outcome variable. METHODS: The study was a single blind, randomised four treatment parallel group design employing 76 healthy volunteers. The cohort was accepted into the study proper if they achieved a level of /= 50% BOP. Using the baseline and exit BOP, MGI and plaque, a deterioration rate for each parameter was derived and used as the unit of analysis. RESULTS: There were highly significant treatment differences for all three parameters. Paired analyses revealed chlorhexidine was highly significantly more effective than the other rinses for all three parameters. CPC and triclosan were not different from the control for BOP, but CPC was significantly different from the control for MGI and plaque, and triclosan was different from the control for plaque. There were no differences between the CPC and triclosan rinses. CONCLUSIONS: The method achieved the expected result of differentiating between the chlorhexidine and the other rinses. Some modification of the method, primarily to group sizes, should improve specificity. The method has the considerable volunteer appeal of early exit, particularly when allocated to control or low activity treatments for plaque.

Differential expression of type I cytokeratins in hamster cheek pouch epithelium following treatment with dimethylbenzanthracene.

Cytokeratin (CK) expression in untreated, paraffin-treated or dimethylbenzanthracene (DMBA)-treated hamster cheek pouch epithelium was investigated utilizing monoclonal antibodies AE1 or AE3, which react with type I or type II CKs, respectively, and by in situ hybridization utilizing type I CK-specific probes. The latter were isolated from a cDNA library of hamster cheek pouch mRNA and designated CK 13 and CK 10 based on their respective homologies (> 95% amino acids) with murine CK 13 and human CK 10. Treatment of hamster cheek pouch epithelium with DMBA resulted in increased expression of type I CK, detected immunohistochemically with monoclonal AE1, but decreased expression of type II CKs detected with AE3. Despite an overall increase in type I CKs, in situ hybridization demonstrated differential expression of type I CKs with altered distribution of CK 13 mRNA and reduced expression of CK 10 mRNA, providing additional sensitive markers for DMBA-associated changes in CKs. These changes were constant at 2 to 22 weeks in the pre-neoplastic and neoplastic epithelium following the initial application of DMBA.

Osseointegrated implants: a review of the literature.

The success of osseointegrated implants as a treatment option is extremely high. In recent years the emphasis in implant development has moved towards improved aesthetics. This paper reviews some of the recent advances associated with aesthetics and implant supported restorations. The techniques of bone grafting and guided tissue regeneration have allowed more ideal placement of implant fixtures in many situations. Implant companies continue to improve their components making implant supported prostheses possible for a wider variety of patients. Further advances in the management of the soft tissues, particularly the interdental papillae, are required to optimise aesthetic results.

A review of the current approaches to the management of the severely reduced dentition.

The severely reduced dentition is a continual challenge to the treatment planning skills of the restorative dentist. This paper examines the need for treatment in the context of oral function, social requirements and related disease processes. The philosophy for management should be based on sound knowledge of the outcomes of treatment options. This paper highlights the relevant factors to be assessed in treatment planning for the severely reduced dentition.

Changes in cytokeratins following treatment of hamster cheek pouch epithelia with hyperplastic or neoplastic agents.

The effects of four different hyperplastic agents and of the carcinogen DMBA on cytokeratin expression in hamster cheek pouch epithelia were compared. Reversible hyperplasia was produced by the application of either oil of turpentine, vitamin A or TPA. No hyperplastic changes were produced by application of EPP. Apart from the transient appearance of a 45 kDa cytokeratin in one group treated with vitamin A, the immunohistochemical staining patterns and immunoblot profiles of cytokeratins from cheek pouches treated with each of the hyperplastic agents were identical to controls. Following application of DMBA, the cytokeratins stained with increased intensity in the spinous and granular cell layers. This was associated with increased amounts of 42-56 kDa cytokeratins and decreased production of 62-75 kDa cytokeratins. Monoclonal antibody AE1 detected a 45 kDa cytokeratin in extracts of DMBA-treated epithelia that was not detected in untreated epithelial extracts. Monoclonal antibody AE3 detected an additional 54 kDa cytokeratin band in extracts of DMBA-treated epithelia. These cytokeratin changes were present in preneoplastic epithelia and maintained in neoplastic epithelia.

Comparison of the effects of four hyperplastic agents on hamster cheek pouch mucosa.

Hyperplasia in the hamster cheek pouch was examined using 4 different hyperplastic agents: oil of turpentine 50% v/v in liquid paraffin; vitamin A palmitate 10% w/v in liquid paraffin; 12-O-tetradeconyl-phorbol-13-acetate 16nM in acetone; and ethylphenylpropiolate 0.04mM in acetone. Acetone, paraffin and untreated control groups were also examined. Cheek pouches were painted 3 times a week for up to 4 weeks with each solution. Samples were removed and prepared for light microscopy 24 hours after 2 weeks of painting and 24 hours, 6, 12 and 18 weeks after 4 weeks of painting. Hyperplasia was produced by application of turpentine, vitamin A and TPA after 2 weeks of application. Further increases in epithelial width occurred after 4 weeks of painting in the turpentine and vitamin A groups but a decrease was seen in the TPA group. Six weeks (vitamin A and TPA groups) or 12 weeks (turpentine group) after the completion of treatment the epithelium had a normal histological appearance. No differences between the control or EPP treated cheek pouch mucosa could be detected. Turpentine and vitamin A can be used as models of reversible hyperplasia in the hamster cheek pouch.