Enamel matrix proteins and systemic antibiotics as adjuncts to non-surgical periodontal treatment: clinical effects.

OBJECTIVES: The purpose of the present study was to evaluate the clinical effects of non-surgical periodontal treatment, supplemented with enamel matrix derivative (EMD) and/or systemic antibiotics, in deep periodontal pockets of patients with chronic periodontitis. METHODS: This was a randomized, placebo-controlled longitudinal clinical trial of 12 months duration. Using a split-mouth design, 16 subjects were randomly assigned to scaling and root planing (SRP) with EMD or placebo in contra-lateral dentition areas. One half of the subjects received 250 mg metronidazole and 375 mg amoxicillin three times a day for 7 days and the other half received a placebo. One inter-proximal periodontal lesion was chosen as study site in each of the contra-lateral quadrants. RESULTS: Subjects treated with systemic antibiotics yielded significantly better clinical results than those treated with placebo. In these cases, probing pocket depth was reduced significantly more after 6 months (3.0+/-2.1 mm versus 1.6+/-1.4 mm, p=0.05), and the mean clinical attachment gain was significantly greater after 6 months (2.3+/-1.9 mm versus 0.7+/-1.6 mm, p=0.02) and 12 months (2.3+/-3.5 mm versus 0.4+/-3.8 mm, p=0.02). Sites treated with the antibiotics plus EMD gained the largest amount of clinical attachment. There was no significant benefit of EMD adjunctive to SRP in subjects not treated with antibiotics. CONCLUSIONS: The present study supports the notion that optimal repair and regeneration of the periodontium requires suppression of the microbiota causing periodontal disease.

Geometric alignment and chromatic calibration of serial radiographic images.

OBJECTIVE: To develop software for automated registration and intensity calibration of serial dental radiographs for the analysis of longitudinal changes in bone density. METHODS: Serial dental radiographs were acquired using a positioning device designed to minimize projection divergence. Each radiograph included an image of a standardized aluminium wedge. The radiographs were scanned on a flatbed scanner (AGFA Duo Scan) with a spatial resolution of 300 dpi, and pixel intensity coded in 16-bit grey scale. The intensity was calibrated using serial images of selected areas with defined thickness of the aluminium wedge. A robust B-splines multiresolution registration algorithm was implemented to overcome the acquisition misalignment. Radiographs, taken before and after periodontal therapy, were subtracted to assess bone density evolution. RESULTS: The intensity calibration decreased the maximum intensity variations between serial radiographs from 30+/-17% to 1+/-1% (mean+/-standard deviation), and improved the visual comparison between the radiographs. The registration stage allowed correcting the misalignment of the radiographs on the scanner screen and superimposing the radiography contents. The observed residual motion was about 0.02+/-0.01 mm. CONCLUSION: Very user-friendly software was developed. The manipulator needs to scan the radiographs only one time. The software performs all subsequent processing steps.