A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series.

AIM: The aim of the present study was to evaluate the effect on peri-implant mucosal inflammation from the use of a novel instrument made of chitosan in the non-surgical treatment of mild peri-implantitis across several clinical centers. MATERIALS AND METHODS: In this 6-month multicenter prospective consecutive case series performed in six different periodontal specialist clinics, 63 implants in 63 patients were finally included. The subjects had mild peri-implantitis defined as radiographic bone loss of 1-2 mm, pocket probing depth (PPD) ≥4 mm and a positive bleeding on probing (mBoP) score. The patients were clinically examined at baseline and after 2, 4, 12 and 24 weeks, and radiographs were taken at baseline and at 3 and 6 months. Treatment of the implants with the chitosan brush seated in an oscillating dental drill piece was performed at baseline and at 3 months. Reductions in the clinical parameters (PPD and mBoP) were compared between baseline and the later examination time points. RESULTS: Significant reductions in both PPD and mBoP were observed at all time points compared with the baseline clinical measurements (p < 0.001). The mean PPD and mBoP at baseline were 5.15 mm (4.97; 5.32) and 1.86 (1.78; 1.93), respectively, whereas the mean PPD and mBoP at 6 months were 4.0 mm (3.91; 4.19) and 0.64 (0.54; 0.75), respectively. Stable reductions in PPD and mBoP were evident up to 6 months after the initial treatment and 3 months after the second treatment. All 63 implants were reported to have stable radiographic levels of osseous support. CONCLUSIONS: This case series demonstrated that an oscillating chitosan brush is safe to use and seems to have merits in the non-surgical treatment of dental implants with mild peri-implantitis. To measure the effectiveness of the method, a multicenter randomized clinical trial needs to be undertaken.

Increase in volume of dental local anaesthetic solution while maintaining the tissue lidocaine and adrenaline concentration does not increase acute postoperative pain after gingivectomy.

A randomised, single-blind, within-patient, crossover study was done in 45 patients (29 women and 16 men, mean age 49 years, range 37-71) who had bilateral "identical" gingivectomies. On one occasion a standard volume of local anaesthetic containing 2% lidocaine and 1/80,000 adrenaline was infiltrated into the mucosal tissue before operation. On the other, double the standard volume with 1% lidocaine and 1/160,000 adrenaline was infiltrated. The intensity of postoperative pain was recorded by the patients on a 100 mm visual analogue scale every hour for an 11-hour observation period. The time courses and the sum of pain intensity after injection of the double and standard volumes did not differ significantly. Doubling the volume of local anaesthetic while maintaining the total lidocaine and adrenaline concentration that was infiltrated does not influence the intensity of acute pain after gingivectomy.

Treatment of dentin hypersensitivity by Nd:YAG laser.

BACKGROUND, AIMS: Promising results using Nd:YAG laser against dentin hypersensitivity have been reported. The aim of this double-blind, controlled, split-mouth designed clinical trial was to assess the effect of a single Nd:YAG laser application on alleviating hypersensitivity. METHODS/RESULTS: Seventeen subjects participated in the study. Each of them had two teeth treated; one with the laser activated and one with nonactivated (placebo), for 2 min The assessment of pain was performed by a VAS, after an air blast at baseline immediately after treatment, at 1 week, 4 weeks and 16 weeks. Mean values of VAS for test and control teeth were compared by paired t-test (alpha = 0.05). The results showed mean baseline VAS values of 6.59 (+/- 1.65) and 6.14(+/- 1.95) for test and control teeth, respectively. Immediately after treatment, these values decreased to 4.09(+/- 2.28) and 3.89(+/- 2.11), respectively. After 1 week, 4 weeks and 16 weeks the mean values for test and control teeth were 3.85 +/- 2.36, 4.03 +/- 1.95, 3.60 +/- 2.66, and 4.44 +/- 2.56, 3.41 +/- 2.30, 3.42 +/- 2.30, respectively. There were no statistically significant differences between test and control at any time. However, both groups improved significantly (P < 0.05) from baseline to immediately after application, and at 1 week, 4 weeks and 16 weeks, respectively. The changes that occurred between immediately after application and 1 week, 4 weeks and 16 weeks, respectively, were not statistically significant. CONCLUSION: It is concluded that the effect of treatment of hypersensitive teeth with Nd:YAG laser is not different from placebo. The observed effects seem to last for at least 16 weeks.

Comparison of oral hygiene efficacy of one manual and two electric toothbrushes.

The purpose of the study was to compare the efficacy of two electric toothbrushes (Philips HP555 and the Philips Jordan 2-action Plaque Remover HP510). A manual toothbrush Jordan V-shaped, medium) served as control. Fifty subjects, aged 18-60 years, participated in a randomized, single-blind, 3 x 3 weeks crossover study. Plaque was assessed according to the Turesky modification of the Quigley-Hein index (P.I.), while the Løe-Silness index was used for assessing gingivitis. Adverse effects were assessed according to the ADA specifications. Compliance and preference were assessed through questionnaires and interviews, respectively. All periods mean P.I. (all surfaces) were 2.79, 3.01, and 2.86 for the manual, the HP555, and the HP510 electric brushes and the corresponding gingivitis values were 1.19, 1.22, and 1.21. For both indices, only the difference between the manual and the HP555 yielded significance (P = 0.04 and P = 0.02). Most subjects (28/50) preferred the HP5 10 brush, as it felt more practical to use and was perceived to have better cleaning ability. In conclusion. no clinically relevant differences in plaque reducing and gingivitis controlling ability were observed.

Bacterial resistance following subgingival and systemic administration of minocycline.

The aim of the present study was to compare total numbers of cultivable bacteria and prevalence of resistance to minocycline among periodontal bacteria following subgingival or systemic application of minocycline in patients suffering from periodontal disease. 10 adult patients were administered 2% minocycline ointment subgingivally into their periodontal pockets at baseline, week 2 and months 1, 3, 6 and 9. Patients had scaling/root planing at baseline and month 6. In addition, 10 patients undergoing scaling/root planing followed by a 10-day course of systemic minocycline therapy, were studied and compared with the subgingival application group. Bacterial samples were taken from the 4 deepest pockets before each subgingival application of the drug. The systemic administration group was sampled at baseline and at week 2, as well as months 1 and 3 after completing the antibiotic treatment. For each patient at each sampling, bacterial samples were pooled, diluted, seeded on parallel blood agar plates and incubated aerobically and anerobically. After incubation, 30 colonies were picked at random and transferred to blood agar plates supplemented with 10 micrograms/ml minocycline, to estimate prevalence of minocycline-resistant bacteria. The results of this study indicate that subgingival application of minocycline ointment resulted in an initial reduction in total numbers of cultivable bacteria, which then remained depressed during the full year of the study. No such observation was made in the systemic administration. Both in the subgingival and the systemic administration group, the % of cultivable aerobic and anaerobic minocycline-resistant bacterial strains increased transiently following administration of the drug, but returned to baseline levels within 3 months post-treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbiologic tests in epidemiologic studies: are they reproducible?

Microbiologic assessments are often included in longitudinal studies to elucidate the significance of the association of certain Gram-negative bacteria and the development of periodontal diseases. In such studies, the reliability of methods is crucial. There are several methods to identify putative pathogens, and some of them are commercially available. The purpose of the present study was to compare the reproducibility of four different methods for detecting Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in order to evaluate their usefulness in epidemiologic studies. The test panel consisted of 10 young subjects and 10 adult periodontitis patients. Subgingival plaque was sampled from sites showing bone loss and "healthy" control sites. The four different methods for detecting the target bacteria were 1) cultivation, 2) Evalusite (a chair-side kit based on ELISA), 3) OmniGene, Inc, based on DNA probes, and 4) indirect immunofluorescence (IIF). The test procedure was repeated after a 1-wk interval and was performed by one examiner. Sites reported to be positive for a microorganism by any of the four methods at one or both examinations were considered to be positive for that organism and included in the analysis. The reproducibility of the four methods was low. The IIF and the cultivation methods showed somewhat higher reproducibility than did the commercial systems. A second test was done for Evalusite, three paper points for sampling being used instead of one as described in the manual. The reproducibility of the second test was improved, indicating that the detection level of the system may influence the reliability.

Incidence of early periodontitis in a group of young individuals during 8 years: associations with selected potential predictors.

The aim of the present study was to assess the incidence of early radiographic bone loss in a birth cohort over 8 years and to assess possible associations between incidence of bone loss and reported dental behavior, ethnic background, and previous orthodontic treatment. In a case control study comprising a proportion of the study population, the detection of black pigmented Bacteroides and Actinobacillus actinomycetemcomitans and their association with early radiographic bone loss was assessed. At the beginning of the study in 1984, there were 2,767 subjects. In 1992 sets of bite-wing radiographs were obtained from 215 subjects, who also filled out a questionnaire concerning their present and past dental behavior, ethnic background, and orthodontic treatment. Radiographic alveolar bone loss was recorded if the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm. Thirteen subjects (6%) showed new sites with bone loss over the 8-year period. Subgingival plaque was sampled from these 13 subjects and from 13 control subjects. None of the independent variables could be associated with the observed incidence of radiographic bone loss in this cohort, with the possible exception of the presence of A. actinomycetemcomitans which was detected in about 50% of the new sites with bone loss.

A cohort study of radiographic alveolar bone loss during adolescence.

The aim of the present study was to assess the changes in prevalence of early radiographic alveolar bone loss in a birth cohort (all subjects born 1970) over a period of 8 years as related to sex, ethnic origin, orthodontic treatment and socio-economic status. In 1984, the target population consisted of 2767 subjects. In 1986, 1988 and 1992, sets of bite-wing radiographs were obtained from samples of the same population. Alveolar bone loss was recorded if the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm measured on posterior bite-wing radiographs. The frequency of subjects with radiographic alveolar bone loss increased significantly with age (p < 0.05). The number of subjects with 3 or more lesions also increased with age. The demographic variables studied did not seem to influence the prevalence of bone loss significantly in the present cohort study.

Prevention of transmission of resistant bacteria between periodontal sites during subgingival application of antibiotics.

This study was designed to investigate whether antibiotic resistant micro-organisms are able to contaminate and survive on syringe tips used for subgingival deposition of antibiotics, and to test simple and effective means of disinfecting the syringe tip between applications. In the first part of the study, syringe tips used for application of Minocycline subgingival formula in 20 adult periodontitis patients were cultured for bacteria resistant to this drug before and after disinfecting them with ethanol. The results showed that 80% of the unwashed syringes were culture positive for minocycline resistant bacteria, whereas only 1 ethanol washed syringe tip was contaminated. In part II of the study, after dispensing minocycline periodontal formula in 20 patients, 10 of the syringe tips were washed with ethanol while 10 were left untreated. All syringes were stored in a refrigerator for 8 days, whereafter the tips were sampled for resistant bacteria. 20% of the unwashed tips were contaminated after 8 days incubation at 4 degrees C. None of the ethanol washed syringe tips were culture positive. We conclude that syringe tips may be contaminated with antibiotic resistant bacteria after dispensing the antibiotic in periodontal pockets. The transmission of these bacteria to other periodontal sites may be avoided by disinfecting the syringe tip with ethanol between applications. We have also shown that antibiotic resistant bacteria may survive on the syringe tip following 8 days storage in a refrigerator, suggesting that syringes used for subgingival deposition of an antibiotic should not be stored for reuse.

Association between detection of oral Actinobacillus actinomycetemcomitans and radiographic bone loss in teenagers. A 4-year longitudinal study.

The aim of the present study was to assess a possible association between radiographic bone loss and presence of Actinobacillus actinomycetemcomitans on the site and subject level over time. Forty-six teenagers with registered radiographic bone loss and 8 controls participated in the study, which began in 1984. In 1986 and 1988 new sets of bite-wing radiographs were obtained and examined for bone loss. Subgingival plaque was sampled from both diseased and contralateral healthy sites in the same individual. Only 15 of the 46 originally diseased sites persisted with bone loss in 1986, and 60% of these sites harbored A. actinomycetemcomitans. Of the 31 "healed" sites, 29% contained A. actinomycetemcomitans. The difference was statistically significant at P less than 0.05. Six of the contralateral healthy sites had developed bone loss during these 2 years and 50% of them contained A. actinomycetemcomitans, while 35% of the remaining contralateral sites harbored A. actinomycetemcomitans. The difference was not statistically significant (P greater than 0.05). The difference between patients with and without persistent bone loss regarding presence of A. actinomycetemcomitans was statistically significant in 1986; however, none of the observed differences were statistically significant in 1988. A. actinomycetemcomitans was found 2 to 3 times more frequently in patients with radiographic bone loss at all examinations than in "healthy" subjects. Detection of A. actinomycetemcomitans on the site level appeared to be a poor predictor of future radiographic bone loss.

Changes in radiographic bone level in orthodontically treated teenagers over a 4-year period.

In 1984 the prevalence of subjects with radiographic bone loss was assessed in all 14-year-old schoolchildren in Oslo (n = 2767). An overrepresentation of subjects with bone loss was found among those undergoing orthodontic treatment. The aim of the present study was to assess the effect of orthodontic treatment on the prevalence and incidence of radiographic bone loss during the following 4-yr period. Bitewing radiographs from 1984, 1986, and 1988 of a sample of 438 subjects from the original population constituted the study material. Bone loss was recorded if the distance from the alveolar crest to the cementoenamel junction exceeded 2 mm. 111 subjects (25.3%) had received orthodontic treatment. In 1984, 18 of them (16.2%) exhibited bone loss. The corresponding figure for the 327 non-treated children was 14 (4.3%). The incidence of subjects with new tooth sites with bone loss among those with a record of previous orthodontic treatment was 1.1% and 3.2% in the periods 1984-86 and 1986-88, respectively. Among those who had never received such treatment the incidence figures were 3.2% in the period 1984-86 and 2.0% in the last period. The results indicated that the majority of the bone loss observed during or immediately after termination of orthodontic treatment was transient in nature.

Variation in prevalence of radiographic alveolar bone loss in subgroups of 14-year-old schoolchildren in Oslo.

The aim of the present study was to assess the prevalence of radiographic alveolar bone loss, as related to selected background variables in 2767 14-year old schoolchildren. Bone loss was recorded when the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm. The radiographs were magnified approximately 10 times. 3% of the subjects and 18.5% of the sites were excluded because of indistinct radiographic reference points. Radiographic bone loss was found in 4.5% of the subjects. Horizontal lesions were more prevalent than vertical defects. Most subjects with bone loss had 1 (75%) or 2 (22%) lesions. No subject was diagnosed with juvenile periodontitis kind of lesion. The prevalence of bone loss depended on the variables sex, orthodontic treatment and ethnic background.