Healing of human intrabony defects following regenerative periodontal therapy with a bovine-derived xenograft and guided tissue regeneration.

The purpose of the present study was to histologically evaluate the healing of human intrabony defects following treatment with either a bovine-derived xenograft (BDX) and guided tissue regeneration (GTR) [BDX + GTR] or a bovine-derived xenograft mixed with collagen (BDX Coll) and GTR [BDX Coll + GTR]. Eight patients with chronic periodontitis and each with one very deep intrabony defect around a tooth scheduled for extraction were treated with either a combination of BDX + GTR (five patients) or with BDX Coll + GTR (three patients). The postoperative healing was uneventful in all eight cases. After a healing period of 6 months, the teeth or roots were extracted together with some of their surrounding soft and hard tissues and subsequently fixed in 10% buffered formalin. Following decalcification in EDTA, the specimens were embedded in paraffin and 8-microm histological sections were cut in the mesio-distal direction, parallel to the long axes of the teeth. The sections were alternatively stained with hematoxylin and eosin, van Giesson's connective tissue stain or with the Ladevig's connective tissue staining method and examined under the light microscope. Generally, formation of new cementum with inserting collagen fibers was found in seven out of the eight treated cases, whereas in the remaining case (treated with BDX + GTR) the healing was characterized by formation of a long junctional epithelium along the debrided root surface and no formation of cementum or bone. In the specimens demonstrating periodontal regeneration the new cementum was always of a cellular type. In most cases, the graft particles were surrounded by bone. In some areas, the bone tissue around the graft particles was connected by perpendicularly inserting collagen fibers to the newly formed cementum on the root surface. The epithelium downgrowth stopped always at the most coronal part of the newly formed cementum. No remnants of the membrane material were observed in any of the biopsies. Connective tissue encapsulation of the graft particles was rarely observed and was limited to the most coronal part of the defects. The findings of the present study provide evidence that treatment of intrabony defects with both BDX + GTR and BDX Coll + GTR may enhance periodontal regeneration in humans.

[Bacteriologic investigation of periodontal infections]. / Mikrobiológiai vizsgálatok parodontális eredetú gyulladásos kórképekben.

The gingivitis and periodontitis are very common diseases in Hungary: more than 80% of the adult population suffers with gingivitis and 15-20% has destructive periodontitis. The composition of peridontopathogenic bacterial flora is totally different from that of the bacterial flora causing dental infections. In periodontal infections dominantly facultative and obligatory anaerobic microorganisms occur (Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Bacteroides forsythus (B. forsythus). The main objective of the study was to investigate the microbial flora of the rapidly progressing periodontitis with special respect to the occurrence of the Actinobacillus actinomycetemcomitans. The antibiotic susceptibility of the A. actinomycetemcomitans was also determined against the most frequently used conventional antibiotics. Twenty-five samples collected from patients with rapidly progressing periodontitis were examined. Prevalence and ratio of A. actinomycetemcomitans and other species of the periodontal anaerobic flora were investigated. MIC values of different antibiotics used routinely--clindamycin, amoxicillin/clavulanic acid, tetracycline, metronidazole--were measured. Prevalence of black pigmented bacteroides (50%), and A. actinomycetemcomitans (30%) was comparable to data of foreign investigators. A. actinomycetemcomitans spp. appear to be more sensitive to clindamycin and amoxicillin/clavulanic acid and more resistant to metronidazole compared to published data. The knowledge of microbial composition of the periodontal flora could help to diagnose the different forms of periodontitis. It can also assist the indication of the most appropriate antibiotic therapy.

[Effect of the quality of restorations and of dental prosthesis on the alveolar bone loss in patients with chronic destructive periodontitis]. / A konzerváló és protetikai munkák minóségének hatása krónikus destruktív parodontitisben szenvedó betegek alveoláris csontnívójára.

In recent years many risk factors have been implicated in the etiology of destructive periodontitis. The quality of the previous dental works might play a decisive role in the development of periodontal attachment loss. The main objective of the present clinical study was to evaluate the aggravating role of the subgingival restorations with questionable quality and the interproximal untreated carious lesions in the progression of periodontal attachment loss in a randomly selected group of patients with destructive periodontitis. The panoramic radiographs of 170 randomly selected patients suffering with destructive periodontitis were analyzed and the quality of the approxima restorations, the presence or absence of interproximal untreated carious lesions and the interdental bone loss were recorded. The level of interproximal bone around the teeth with restorations or with approxima carious lesions were compared with the sound contralateral counterparts and with the overall average alveolar bone level. Some more than 50% of 2175 approxima restorations were faulty. 280 untreated carious lesions were present in 170 subjects. The interproximal bone loss was always greater around teeth with untreated carious lesions or with faulty restoration. The differences between the control teeth and the carious teeth were statistically significant (P < 0.01) excepting the maxillary front and mandibular premolar region. The differences between the teeth with faulty restorations and the controls were statistically significant (P < 0.01) in the mandible and in the maxillary molar region. Although there were significant differences between teeth with untreated carious lesions or with faulty restoration and the controls in many regions of the dental arch, the differences clinically were not always necessarily significant, showing only less than 0.5 mm differences in bone levels, In conclusion the faulty restorations and untreated carious lesions do not seem to be decisive aggravating risk factors leading to bone loss in patients with chronic destructive periodontitis.

[Laboratory and clinical investigation of multifunctional dentifrices. Clinical study of a new triclosan-containing toothpaste]. / Multifunkcionális fogkrémek laboratóriumi és klinikai vizsgálata. Egy új Triclosan-tartalmú fogkrém klinikai kipróbálása.

The purpose of this work was to assess the in vitro antibacterial effectiveness of three dentifrices containing antimicrobial agents and to test the in vivo anti plaque and anti gingivitis effect of a toothpaste containing triclosan (CAOLA). The in vitro tests showed a marked antibacterial effect of both triclosan and chlorhexidine containing dentifrices. The randomized clinical trial presented good evidences that the triclosan had some but statistically non significant plaque and gingivitis reduction in patients even without previous mechanical cleaning. Nevertheless the triclosan dentifrice was effective in reducing the plaque and gingivitis scores in combination with initial mechanical debridement and oral hygienic instructions.

[Clinical experience with the treatment of gingival hyperplasia induced by calcium channel blocking agents]. / A kalcium-csatorna-blokkoló szerek okozta ínyhyperplasia kezelésének klinikai tapasztalatai.

The prevalence of the nifedipine-induced gingival hyperplasia is ranging from 0.5-83% in the dental literature. The pathomechanism of the nifedipine-induced gingival hyperplasia is not clearly understood. Evaluating the dental history and the course of disease of 34 patients treated and followed up at the Department of Periodontology the following answers were raised: What sort of local and systemic factors are enhancing the recurrence of the gingival overgrowth and how this can be anticipated in patients on continuous Ca channel blocking medication. Eight out of the 34 patients participating in the clinical trial did not remember the onset of their gingival overgrowth. 10 cases developed three years and three cases after less then one year of the onset of the drug administrations. 27 out of the 34 cases required gingival surgery and seven showed good clinical improvement after the hygienic phase of the comprehensive periodontal treatment. 70% of the gingival hyperplasia cases presented no clinical sign of recurrence one year after the completion of the active phase of the treatment. A positive correlation was found between the oral hygiene and the recurrence rate of gingival overgrowth. Oral hygiene seems to play a decisive role in the development of gingival enlargement. The present findings and substantial evidences from the dental literature indicate that the gingival enlargement can be successfully controlled even under the continuous nifedipine administration by meticulous professional and individual oral hygiene.

[A 3-year experience with guided tissue regeneration procedures]. / Az irányított szövetregenerációs technikákkal nyert három éves klinikai tapasztalatok.

The Guided Tissue Regeneration (GTR) procedures are promoting a clinically and radiologically as well as histologically verifiably periodontal attachment gain. The objective of the study was to evaluate the clinical efficacy of these GTR techniques. In the past four years different barrier membranes (Gore-tex, Resolut and Guidor) were used around 318 teeth of 196 patients. 169 periodontal defects of 140 patients were followed up at least for two years. 54 patient had chronic adult type periodontitis, 67 suffered with rapidly progressing periodontitis and 15 had different severe mucogingival lesions. 111 vertical bony defects, 43 Class II-III furcation lesions and 15 mucogingival lesions were surgically corrected. The average preoperative probing depth (PD) and the clinical attachment loss (CAL) of the vertical bony defects were 5.3 +/- 1.7 mm and 6.2 +/- 1.9 mm respectively. The PD of the deepest Class III furcation lesion was 11 mm. The average gingival recession of the mucogingival lesions was 4.5 +/- 1.1 mm. The GTR technique provided the best results in the Class II-III furcation lesions, where an average 2.4 +/- 0.9 clinical attachment gain was observed one year postoperatively. The GTR techniques provided an average 1.8 +/- 1.2 mm attachment gain in the vertical bony crater cases. In both groups of cases a marked gingival recession followed the healing and the periodontal regeneration. In this way the average reduction in the probing depth exceeded the average attachment gain by more that 1.5 mm. 1 year after the operation the average radiologic bone fill was about 0.9-1.2 mm. The resorbable barrier membranes resulted in clinically significant root coverage and an average 3.5 +/- 1.7 mm gain in the width of keratinized gingiva. The success or failure of our cases were mainly determined by the patient's compliance, the level of the postoperative professional and individual oral hygiene and the number of periodontal recalls. These findings are also underlining the importance of the high standard of oral hygiene in the postoperative periodontal regeneration.

[Importance of periodic follow up of periodontal diseases for the maintenance of periodontal health and the longevity of dental restoration]. / A fogágybeteg rendszeres ellenörzésének jelentösége a paradontium épségének megörzésében és a fogpótlás élettartamának meghosszabbításában.

The major objective of the author's investigation was to determine if the progression of attachment loss, the recurrence of active phase of periodontitis and development of new carious lesions can be controlled and prevented in individuals with prior history of aggressive periodontitis provided full mouth reconstruction and maintained at a proper level of oral hygiene. The results of a group on regular periodontal recall program were compared with the five years dental and periodontal findings on a matched group of patients having not been on regular maintenance program. The well maintained group of patients' annual recall data did not vary markedly. In five years basically the same amount of attachment apparatus was maintained. The reexamination of the non recall group at the end of the fifth year shoved a total deterioration of dentition due to the progression of periodontal disease and attachment loss. Especially those of rapidly progressing periodontitis cases shoved 70 to 100% attachment loss. This comparative study attempted to outline the insufficiency of our former dental philosophy of patient management and follow up. Authors emphasize the importance of the follow up, and maintenance of a very high level.

[The significance of the styloid process syndrome in the differential diagnosis of temporomandibular dysfunction]. / A processus styloideus syndroma jelentösége a temporomandibuláris ízületi diszfunkció differenciáldiagnosztikájában.

Two cases are reported on, both patients came to the clinic on the suspicion of temporo mandibular joint disfunction. Their complaints was caused by overdeveloped processus styloideus. After surgical removal of the processus styloideus the complaints ceased. In cases of seemingly temporo mandibular joint disfunction not improving on conventional treatment the possibility of the processus styloideus syndroma has to be considered.