Topical metronidazole application as an adjunct to scaling and root planing.

AIM: This study was carried out to investigate the effect of 2 applications of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling with root planing. METHOD: 59 of the original collective of 64 patients with adult periodontitis were observed for a 9-month period. This randomised single-blind study was carried out in split-mouth design. Each patient had to have at least 2 pockets with a probing depth of > or =5 mm in each quadrant. The clinical parameters, pocket probing depth (PPD), attachment level (AL) and bleeding on probing (BOP), were recorded at all teeth on days 0, 91, 175 and 259; in addition, subgingival plaque samples taken from 45 patients were analysed by means of dark-field microscopy. Therapy comprised subgingival scaling and root planing (SRP) of all quadrants and additional application of metronidazole 25%, dental gel in 2 randomly selected quadrants (SRP+Metro). Treatment was confined to teeth with a baseline PPD of > or =5 mm. Average PPD and AL and the incidence of BOP were computed for all pockets with a baseline PPD of > or =5 mm, and the 2 methods compared. The main efficacy variable for evaluation of the 2 treatments was the difference in PPD on day 259. RESULTS: Comparison of the 2 treatments revealed a statistically significant improvement in the clinical parameters for both treatment methods over the study period. Between baseline and day 259, significant differences in PPD (SRP+Metro: from 6.00 to 4.63 mm, SRP: from 6.02 to 4.83 mm) and BOP (SRP+Metro: from 67 to 31%, SRP: from 64 to 36%) were observed between the 2 treatment groups. Evaluation according to different patient groups demonstrated significant advantages of the combined therapy in previously-untreated patients, especially in female probands. Dark-field microscopy revealed a shift in the bacterial flora towards "healthy conditions". CONCLUSIONS: The results show that only minor advantages are to be gained from the application of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling. The distinctly better results of combined therapy in previously-untreated patients calls for more thorough investigation.

Guided tissue regeneration in a combined periodontal and orthodontic treatment: a case report.

Periodontal defects in adolescents or young adults are often an incidental finding within an orthodontic treatment. Most of these patients suffer from a special form of periodontal disease: juvenile periodontitis. Guided tissue regeneration offers a technique for long-term therapy in such cases. In the case presented in this report, periodontal problems were aggravated by malpositioning of the affected teeth. Orthodontic and periodontal treatment enabled the correction of malpositioning and regeneration of osseous defects.

The influence of end abutment and cantilever fixed partial dentures on periodontal health.

The influence of end abutment and cantilever fixed partial dentures on periodontal health was examined in 12 patients with periodontally reduced residual dentition. The prosthetic appliances had been integrated for 4 to 6 years before the first follow-up examination and had no technical defects at baseline. Two follow-up examinations were performed at a 12-month interval to record clinical and microbiologic parameters of 62 abutment teeth, 45 of which were fitted with end abutment fixed partial dentures and 17 with cantilever fixed partial dentures. Both types of fixed partial dentures were represented in all patients. The patients were on a 6 to 8-week recall schedule throughout the study period and had good oral hygiene. At both examinations, subgingival plaque samples were taken at all proximal surfaces and evaluated by dark-field microscopy. The clinical parameters used were Gingival Index, Plaque Index, pocket probing depth, and attachment level. The results showed that both types of fixed partial dentures were compatible with periodontal health subject to optimal oral hygiene. The clinical parameters recorded remained stable at a very low level throughout the study period and were almost identical in both groups. A slight gain in clinical attachment level, with a mean value of 0.19 mm for abutment teeth fitted with cantilever fixed partial dentures and of 0.32 for end abutment fixed partial dentures, was registered during the study period. The composition of the subgingival plaque showed a microflora reflecting virtually health periodontal conditions. The proportion of motile rods and spirochetes was slightly elevated in both groups. In conclusion, it can be stated that both fixed partial denture types display identical characteristics in the periodontally damaged dentition and do not lead to deterioration of the periodontal situation if oral hygiene is closely monitored.

An in vitro study of various instruments for root planing.

Rotating instruments are becoming increasingly significant in the scaling and planing of the root surface. The objective of this in vitro study was to test various root-planing instruments on extracted teeth and then to compare the treated surfaces using scanning electron microscopy. Two manual instruments (scaler and curette) and five mechanically rotating instruments (Desmo-Clean; Perio-Set; Viking-Set; and 40-microns and 15-microns diamond finishers) were investigated. From a total of 42 teeth, six root surfaces were treated with each instrument. The results confirm the clear superiority of the manual instruments (especially the curette). The manual instruments permit good root planing with minimum ablation from the root surface and only a thin smear layer (a compound of grinding dust, dentinal fluid, and water). The best planing results by rotating instruments were achieved with the Desmo-Clean and the 15-microns diamond finisher, whose performance was almost equal to that of the manual instruments. The rotating instruments, however, were associated with higher ablation and a marked smear layer. Manual instruments remain the media of choice on easily accessible root surfaces; however, rotating instruments are of advantage in inaccessible areas (eg, furcations) because of their handling properties.

Topical metronidazole application in recall patients. Long-term results.

The aim of this randomised study in split-mouth design, in which 24 patients from the recall programme of Marburg University Department of Periodontology were enrolled, was to compare topical application of a metronidazole 25% dental gel with subgingival scaling. The clinical parameters used were pocket probing depth (PPD) and bleeding on probing (BOP); these were recorded at baseline and 1, 3, 6, 14, 18 and 24 months after completion of treatment. In addition, plaque samples were taken from all mesial pockets for evaluation by dark-field microscopy. All patients had at least one tooth in each quadrant with a PPD of 5 mm or more showing BOP when they entered the study. The treatment consisted of 2 applications of dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as subgingival scaling of the remaining quadrants. Statistical evaluation of all sites with a baseline PPD of 5 mm or more showed that both methods led to a significant reduction in PPD and BOP in the first 6 months. The average reduction in PPD was 1.3 mm in the gel group and 1.5 mm in the scaling group, with the tendency to bleeding being reduced by ca. 50% in both groups. After 24 months, improvements of 0.6 mm and 0.5 mm respectively were observed in PPD. The tendency to bleeding had undergone a slight increase but was still below baseline values. No statistically significant differences were observed between the two methods, although the results recorded with subgingival scaling were slightly better. Dark-field microscopy revealed a shift in the composition of the bacterial flora, suggesting a more physiological situation, which was maintained for 6 months before reverting consistently after 18 months to the baseline values of the plaque composition. Overall, application of a metronidazole 25% dental gel led in recall patients to an improvement in the investigated clinical and microbiological parameters comparable with subgingival scaling. After 24 months, the clinical parameters still displayed a very slight improvement over baseline values; after 18 months the microflora had reverted to its baseline composition.

Osseointegrated implants in patients treated for generalized severe adult periodontitis. An interim report.

This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis. Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure. Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth. Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure. Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline. Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter. The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05). The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4. The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants. Neither the GI nor the PI revealed any significant difference between teeth and implants. Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm. Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location. Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient. Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants. The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years. These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis. The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies.

Topical metronidazole application compared with subgingival scaling. A clinical and microbiological study on recall patients.

The aim of this study was to compare the topical application of a metronidazole 25% dental gel with subgingival scaling. 30 patients from the recall program participated in this open randomised study with split-mouth design. Pocket probing depths (PPD) and bleeding on probing (BOP) were measured before and 2, 12 and 24 weeks after the end of the treatment period. In addition, subgingival plaque samples were taken from all mesial sites and analysed with dark-field microscopy. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more that should bleeding on probing, when entering the study. The treatment consisted of 2 applications of the dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as simultaneous subgingival scaling of the remaining quadrants. Oral hygiene instruction was given on day 21. The average PPD and the average frequency of BOP were calculated for all sites with an initial PPD of 5 mm or more and continued at each examination, using the same sites. The statistical analyses showed that both treatments were effective in reducing PPD and BOP over the 6-month period. At the end of the follow-up period, the mean reduction in PPD was 1.3 mm after gel treatment and 1.5 mm after subgingival scaling. BOP was reduced by 35% and 42%, respectively. No significant differences between the 2 treatments were detected. Dark-field microscopy showed a shift toward a more healthy microflora for both treatment modalities; this persisted throughout the 6-month period. Application of a 25% metronidazole dental gel on recall patients seems to be as effective on the investigated clinical and microbiological parameters as subgingival scaling.

[The GTR technic within the framework of combined periodontal-orthodontic treatments. A case report]. / GTR-Technik im Rahmen einer kombinierten parodontal-kieferorthopädischen Behandlung. Eine Fallbeschreibung.

Periodontal defects in adolescents or young adults are often an incidental finding within the framework of orthodontic treatment. Often these patients are suffering from a special form of periodontal disease, juvenile periodontitis. Guided tissue regeneration (GTR) offers a technique for long-term therapy in such cases. In the case presented here, the periodontal problems were aggravated by malpositioning of the affected teeth. Orthodontic and periodontal treatment enabled the malpositioning to be corrected and the osseous defects to be largely regenerated. Controls on regular bases up to now revealed a stable status over 2 years.

An in vitro study of oscillating instruments for root planing.

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

[Sulcus fluid in periodontal diagnosis. A review]. / Die Sulkusflüssigkeit in der parodontalen Diagnostik. Eine Ubersicht.

In the present review, the composition of the gingival crevicular fluid (GCF) as well as its important role in the diagnosis of periodontal disease have been discussed. Furthermore, the different sampling methods and the subsequent analytical procedures have been described. Some of the GCF-components, such as elastase, prostaglandin, arylsulphatase and beta-glucuronidase, are examined for their use as suitable markers of future disease activity. At the present time, the interest of research is focussing on the host-parasite interaction, the prediction of disease activity, and the identification of risk groups of patients. Therefore, GCF is considered a valuable research subject and a possible diagnostic marker.