Periodontal probing: probe tip diameter.

BACKGROUND: Periodontal probing is one of the most common methods used in diagnosing periodontal disease. The purpose of this study was to determine the importance of the diameter of periodontal probing tips in diagnosing and evaluating periodontal disease. METHODS: The literature discussing periodontal probe diameters in human, dog, and monkey studies was reviewed and compared. Tip diameters varied from 0.4 to over 1.0 mm in these studies. Probe advancement between the gingiva and the tooth is determined by the pressure exerted on the gingival tissues and resistance from the healthy or inflamed tissue. The pressure is directly proportionate to the force on the probe and inversely proportionate to the probe tip diameter. The larger probing diameters reduced probe advancement into inflamed connective tissue. This effect of change in probe diameter reduced the pressure in a greater manner than an increase of similar change in probe force. RESULTS: In the studies reviewed, the pressure used to place the probe tip at the base of the periodontal sulcus/pocket was approximately 50 N/cm2 and at the base of the junctional epithelium, 200 N/cm2. A tip diameter of 0.6 mm was needed to reach the base of the pocket. Clinical inflammation did not necessarily reflect the severity of histological inflammation, and the recordings may not illustrate probing depth. Furthermore, probing depth did not identify anatomical locations at the base of the pocket. CONCLUSIONS: Probe tips need to have a diameter of 0.6 mm and a 0.20 gram force (50 N/cm2) to obtain a pressure which demonstrates approximate probing depth. This pressure was needed to measure the reduction of clinical probing depth, which included formation of a long junctional epithelium as a result of therapy. In addition, different forces or diameter tips are needed to measure healthy or inflamed histological periodontal probing depths.

Effectiveness of a medicament containing silicon dioxide, aloe, and allantoin on aphthous stomatitis.

This research protocol was designed to test the effectiveness of a gel containing silicon dioxide, aloe vera, and allantoin in the healing of recurrent aphthous ulcers. The subjects were patients with histories of developing multiple ulcers on the oral mucosa during a 3-to-4-month period. The parameters used to evaluate healing were number of lesions during a 3-to-4-month period, length of the interval between ulcers, size of ulcers, and pain from ulcers. An approach was used in which data were accumulated from diaries maintained by the subjects throughout the study intervals. Because 3 active substances were present in the gel, a preliminary study (study I) was performed to indicate the effect of each active substance and each combination. In this phase, different combinations of the substances were compared with the use of the 2(3) factorial experimental design. The results of this study demonstrated that statistical differences in the durations of lesions (P = .017) were present when all 3 substances were included in the gel. In the next study (study II), which was initiated to test the results of study I, additional subjects were divided into 2 groups; one used a control gel with silicon dioxide, and the other a gel with all 3 active substances. Study II found no statistical differences in the parameters when the 2 groups were compared. In study III, a modified crossover design was used with the subjects of study II, and a significant difference was found in lesion-free intervals (P = .0335) and length of time for the study (P = .0001). The differences in lesion intervals may have been caused by the differences in study length. Alteration in the occurrence of aphthous ulcers was demonstrated by the reduction in numbers of lesions in study I and by the increase in length of intervals between lesions in study III. However, a consistent pattern was not present; this indicated a lack of effect of the gel on aphthous ulcers.

Human periodontal ligament fibroblast response to PDGF-BB and IGF-1 application on tetracycline HCI conditioned root surfaces.

The purpose of this study was to investigate the effect of 2 growth factors, platelet-derived growth factor-BB (PDGF-BB) and insulin-like growth factor-1 (IGF-1), alone or in combination, on the adherence of human periodontal ligament fibroblast (PDL) to tetracycline HCl (TTC) conditioned and nonconditioned periodontally involved root surfaces. There were 80 root dentine chips from 80 patients, ranging from 35 to 70 years of age, each with one periodontally involved tooth requiring extraction. A root dentine chip was obtained from the subgingival surface opposite to the periodontal pocket of each extracted tooth. The dentine chips were randomly distributed into one of 8 groups. In group 1, PDL fibroblasts were cultured and allowed to attach on the dentine surface. In group 2, PDL fibroblasts were cultured on a PDGF-BB pre-treated dentine surface and in group 3, they were cultured on a IGF-1 pre-treated dentine surface. In group 4, PDL fibroblasts were cultured on a dentine surface pretreated with a combination of PDGF-BB and IGF-1. In group 5, PDL fibroblasts were cultured and allowed to attach on the TTC conditioned dentine surfaces. In groups 6 and 7, surface of dentine chips were conditioned with TTC and then were treated with PDGF-BB or IGF-1 respectively, followed by placement of PDL fibroblast and cultured. In group 8, dentine surfaces were conditioned with TTC and then pre-treated with a combination of PDGF-BB and IGF-1 before the fibroblasts were cultured. After 24 h of incubation, the media was removed and samples were fixed and processed for SEM at magnifications of x34, x750, x2000. Photographing and evaluation of samples was performed at x750 in which fibroblast adherence was measured by counting cells within a standard test area. The results of the non-TTC conditioned root surfaces demonstrated a significant increase in fibroblasts adherence in the PDGF-BB and combination PDGF-BB/IGF-I treatment groups (groups 2, 4) when compared to the control (group 1) as well as the TTC control (group 5). The combination of PDGF-BB/IGF-1 (group 4) did not significantly improve the adhesion of cells compared to PDGF-BB alone (group 2), but did significantly improve adhesion when compared to IGF-1 alone (group 3). There were no significant differences in cell morphology between the growth factor groups (groups 2, 3, 4) and control (group 1). In general, the cells demonstrated a flat, stellate-shaped morphology. The results of the TTC conditioned root surfaces, showed a statistically significant increase of cellular adherence in the PDGF-BB group (group 6) when compared to the TTC control (group 5), similar to the non-TTC group (group 2). However, the morphology of the cells in groups 5, 6, 7, and 8 demonstrated generally a rounded or oval shape with only an occasional cell exhibiting a flat form. In the experimental system of this study, the inclusion of PDGF-BB on the surface of dentine chips increased the number of adhering PDL cells, and the addition of TTC conditioning had little effect except to change the morphology of adhering cells.

Medication-induced gingival enlargement: a clinical review.

This review discusses the etiology and treatment of gingival hyperplasia. It cites evidence that medications such as phenytoin, an anticonvulsant; cyclosporine, an immunosuppressant; and numerous calcium channel blocking agents have been shown clinically and histologically to produce analogous gingival enlargements. A multiphasic approach to treating disfiguring gingival hyperplasia through mechanical and chemical plaque control, in conjunction with the surgical removal of the hyperplastic tissue, is discussed.

The late development of oral pyogenic granuloma as a complication of pregnancy: a case report.

An oral pyogenic granuloma can develop during or just after the first trimester of pregnancy. Usually, an oral pyogenic granuloma is an early, slow-growing mass that, on excision, does not leave a large defect in the periodontium that requires surgical repair. This article presents an unusual case of a very late, rapidly growing, large tumor that developed as a complication of pregnancy and an undiagnosed isolated area of periodontal disease.

Effect of gingival wall on resistance to probing forces.

This study was conducted to determine whether the gingival tissue lateral to the periodontal sulcus contributes resistance to the advancement of a periodontal probe tip into the sulcus under different applied pressures. An electromechanical device was used to advance a probe tip 0.6 mm in diameter into the facial sulcus at a constant speed until resisting forces of 0.70 N were encountered. The device registered the resisting force and probe advancement simultaneously. The gingiva of all 2nd incisors, 2nd premolars, and 1st molars of 4 young adult male beagle dogs were tested. After the first measurement, the buccal gingiva of experimental sites were incised mesiodistally from the gingival margin to the alveolar crest and the sulcus was reprobed. 2 experimental and control quadrants were selected randomly resulting in 6 sets of both experimental and control data from each animal. The data were analyzed with analysis of variance. The analysis demonstrated significant variation from site to site, and dog to dog; therefore, only changes between the 1st and 2nd probings at the same sites could be compared. Less variability of probing distance in different animals occurred at higher forces; however, the incision had a significant effect on probing distance at these forces. The pressure at which probing distance had less variability among animals and least affected when the gingival sulcular wall was incised was estimated to be 106 N/cm2. This corresponds to 30 g force on the 0.6 mm diameter probe.

Human periodontal ligament and gingival fibroblast response to TGF-beta 1 stimulation.

The purpose of this study was to measure the time-sequence response of RNA and protein synthesis to transforming growth factor-beta 1 (TGF-beta 1) by human periodontal ligament (HPDLF) and gingival (HGF) fibroblasts in culture. HPDLF and HGF were cultured from explants of healthy gingival tissue and freshly extracted teeth. Cultures of 8 x 10(4) cells/ml were exposed to medium containing 3H-uridine and 35S-methionine with TGF-beta 1 at concentrations from 10(-9) M to 10(-21) M, or control medium, for up to 60 hours in order to assess RNA and protein synthesis. Protein concentrations of comparable cultures were also assayed colorimetrically. Results were reported as specific activity (CPM/microgram protein). The results indicate that 10(-9) M TGF-beta 1 treated cultures showed a significant increase in RNA synthesis by HPDLF and HGF over time, as compared to the control cultures. HPDLF showed a significant increase in protein synthesis over time while that by HGF was not significant as compared to the control cultures. Lower concentrations of TGF-beta 1 demonstrated no significant differences from control. Results suggest that the effects of TGF-beta 1 on HPDLF and HGF are both time and dose dependent, with 10(-9) M TGF-beta 1 providing the best response of those concentrations tested. These findings support the concept that TGF-beta 1 may play a role in periodontal regeneration due to its ability to promote fibroblast RNA and protein synthesis. The results also demonstrate that although these two cells types appear morphologically similar, they exhibit distinct biological responses to growth factors such as TGF-beta 1.

Histological location of a standardized periodontal probe in man.

The purpose of this study was to locate the position of the periodontal probe tip using a pressure of 126 N/cm2 (force of 0.30N using a round periodontal probe tip with a diameter of 0.55 mm). The influence of gingival inflammation on this position was also studied. Subjects with three levels of periodontal health and disease were entered into the study and each contributed one experimental tooth. At each site a standardized probing system was used to place a probe into a clinical pocket. The probe tip was luted to the test tooth surface. The tooth with its gingival tissue and probe tip was extracted, fixed, and processed for histological measurements. Distances in mm were obtained from the cemento-enamel junction (CEJ) to the probe tip, to the base of the crevice/pocket, and to the most coronal connective tissue attachment. Analysis of the data indicated that clinical inflammation was not a factor in the placement of the probe tip at crevice/pocket's landmarks relative to the CEJ; however variability of probing may have caused the non-significance. The probing system placed the probe tip 0.66 mm apical to the base of the crevice/pocket and 0.06 mm coronal to the most coronal connective tissue attachment. These conclusions corroborated the results of the previous study in dogs which predicted probe placement of 0.44 mm apical to the base of the crevice using the standardized pressure of this probing system.

Removal of interproximal subgingival plaque by hand and automatic toothbrushes.

Subgingival plaque removal at interproximal sites by automatic and hand toothbrushes was compared with control sites at which cleansing was not performed. There were 58 patients, 35 to 63 years of age, each with one hopeless tooth requiring extraction. Each patient was randomly assigned to one of four test groups: hand brush; automatic toothbrush 1; automatic toothbrush 2; and no brushing. The brushing instructions as stated by the manufacturers were demonstrated and the patient brushed the sextant containing the test tooth for 20 seconds. The level of the gingival margin was marked at each interproximal test site. The teeth were extracted and processed for SEM, and subgingival plaque was viewed at X100 and X2000 magnifications. A montage of photomicrographs of the gingival groove to the occlusal margin of the bacterial plaque at X100 magnification was made and the distance from the groove to the margin was measured. An ANOVA was performed using P = 0.05 level for significance. Due to processing difficulties, only 33 specimens were available for analysis. The average distances from the groove to the subgingival plaque front for the four test groups were 0.514, 0.132, 0.163, and 0.111 mm respectively. The maximum distance (1.5 mm) of plaque removal was greatest for the hand toothbrush. Due to the large standard deviation (0.636 compared to 0.146, 0.250, and 0.124 respectively), the hand brushing group was excluded from ANOVA. There were no statistically significant differences among the automatic toothbrushes and the no brushing control (P = 0.8393). It was concluded that a single session of oral hygiene instruction with an automatic toothbrush did not result in subgingival interproximal plaque cleansing.

Periodontal disease and type I diabetes mellitus in children and adolescents.

This study compared the periodontal status of a juvenile diabetic study group with that of a non-diabetic control group similar in age and sex. The study group consisted of 26 type I diabetic patients with an average age of 13.42 years and 24 control subjects of similar age. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to obtain a measure of diabetic control. Clinical periodontal evaluations were performed for all teeth in each subject, and consisted of the plaque index, gingival fluid flow, gingival index, probing depths, clinical attachment levels, recession, and bleeding on probing. Analysis of the data demonstrated no statistically significant differences in the overall means for the 2 groups for average attachment loss, probing depths, recession, gingival index, plaque index, gingival fluid flow, or bleeding on probing. There was no significant association between the level of control of diabetes (GHb) and clinical variables. However, comparisons based on site-specific measurements showed the gingival index to be somewhat higher among the diabetics (p = 0.0002), and examination of interaction effect plots showed the diabetic group to have higher average gingival index for most teeth and higher or the same plaque index levels on all teeth relative to controls. Thus, a young study population with type I diabetes mellitus was found to have significantly increased severity of inflammatory gingival disease compared to controls of similar age.

Nifedipine-induced gingival enlargement around dental implants: a clinical report.

Calcium channel-blocking agents are used extensively for the management of cardiovascular conditions, including angina pectoris, coronary artery spasm, cardiac arrhythmias, and hypertension. Gingival overgrowth around natural teeth has been previously reported in the literature with patients taking calcium channel-blocking agents. This clinical report describes hyperplasia of tissues around titanium dental implants in a patient taking Nifedipine along with the multiphasic approach to treating this medication-induced hyperplasia of the peri-implant tissues.

Structural and functional changes of cementum surface following exposure to a modified Nd:YAG laser.

A modified Nd:YAG laser was evaluated for its effect on root cementum topography and fibroblastic attachment. Fifteen extracted human teeth were curetted, sectioned, and divided into 60 areas representing 4 groups. Group I were non-lased controls, while groups II, III, and IV were lased with the same power (4 watts, 1 second), but at 3 different laser-target distances (1, 3, and 5 mm), thus delivering 3 different energy levels. Following lasing, 20 areas (5 per group) were examined under SEM for detection of any structural changes. Human gingival fibroblasts were cultured on both experimental and control samples of the remaining 40 areas. Photomicrographs at x 500 were obtained and the number of attached fibroblasts were counted. Results showed that lased cemental surfaces exhibited changes in surface topography which ranged from what appeared to be an apparent fusion of the surface of the covering smear layer (lowest energy level), to cracking and fissuring of the lased surface (highest energy level). When fibroblasts were cultured on the specimens, the results demonstrated the presence of a monolayer of cells on the control surfaces and on the surfaces lased with the lowest energy level (5 mm distance). Specimens lased at the mid-energy level (3 mm) showed decreased numbers of attached cells, but not significantly different from the controls. On the other hand lasing the cementum surface at the highest energy level (1 mm distance) caused a significant decrease in the number of the attached cells as compared to the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Connective tissue grafting for improved implant esthetics: clinical technique.

The subepithelial connective tissue graft can be used to enhance the esthetic appearance and gingival contour of the peri-implant tissues. A technique is described and illustrated to create a soft-tissue root prominence and mask the grayish color that may be present as a result of a thin facial alveolar bony plate and/or thin labial attached gingival tissue over dental implants.

The microbiota of the peri-implant region in health and disease.

The subgingival microflora associated with dental implants has been shown to be similar to that associated with natural teeth. Like the natural tooth, a dental implant may be susceptible to a plaque-induced gingivitis which may progress to peri-implantitis. A similarity exists between the microbial flora around failing implants and organisms classically associated with periodontal disease. The same anaerobic gram-negative organisms are found in periodontitis and peri-implantitis. The periodontium must be in a healthy state before the placement of dental implants and constantly monitored while implants are in function for early detection of potential periodontal and/or prosthodontic problems. The relationship between the microbial flora around dental implants and peri-implantitis is discussed and recommendations are presented to improve the efficacy of dental implants.

Linear tomography in conjunction with pantomography in the assessment of dental implant recipient sites.

Tomography provides a three-dimensional unobstructed and anatomically accurate picture of the region being viewed. Tomography is a radiographic technique in which a "slice" or section of a given internal body structure is imaged in a pre-determined plane. The advantage of utilizing a tomographic evaluation along with a pantomographic survey is that the clinician may examine the exact position or depth in all three planes of visualization. This radiographic modality can also reveal the quality and quantity of alveolar bone in a pre-determined implant site. This information would allow the clinician better to diagnose, plan treatment, and place dental implants more precisely. Therefore, the utilization of laminar or computerized tomography along with pantomography for more precise visualization and accurate measurement of available alveolar bone of the buccal-lingual and labial-palatal perspective will be discussed and illustrated.

The use of free gingival soft tissue to improve the implant/soft-tissue interface.

Various techniques for the placement of different types of dental implants have evolved to the point where predictable bone-to-implant integration occurs if proper surgical technique is followed. The soft-tissue adaptation to the implant abutment is the first line of defense to prevent the development of peri-implantitis and subsequent bone loss. Given that there is a tenuous protective seal around dental implants, the rationale for soft-tissue augmentation around dental implants to provide an improved, tightly adapted implant/soft-tissue interface definitely exists.

Calcium and phosphorus content of roots exposed to the oral environment.

This study analyzed the calcium and phosphorus content of extracted tooth roots exposed to the in vivo oral environment. 20 teeth were obtained from 16 patients and divided into two groups of 10 teeth each. In group 1, the teeth had gingival probing depths of 5 mm or more, and teeth of group 2 had gingival recessions of 3 mm or more. Prior to extraction, the gingival margin location was recorded by placing a groove on the tooth surface. After extraction, the teeth were sectioned coronal-apically, air dried and coated with carbon. Energy dispersive X-ray spectra, excited in a scanning electron microscope, were analyzed to measure relative calcium and phosphorus contents and for calculation of their ratios. X-rays were collected from two positions on the sectioned root. Experimental positions were selected within the exposed portion of the roots of groups 1 and 2, and unexposed positions were selected from that portion of the same root with attached periodontal membrane. At each position, calcium and phosphorus content was measured at 4 depths into the root surface: in cementum, in dentin three-quarters of the distance to the pulp chamber, and at 2 locations in between on either side of the cemento-dentinal junction. Analysis of data demonstrated large variations in calcium and phosphorus content from surface to surface of individual teeth and from tooth to tooth in a subject. No statistically significant differences were found between experimental and unexposed locations. Calcium and phosphorus contents were greater in roots exposed to pockets when compared to roots exposed by recession at both experimental and unexposed locations.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of two techniques for attaining root coverage.

This study compared the relative success of soft tissue coverage of denuded roots by two surgical procedures: Autogenous free gingival graft (FGG) and a 2-stage coronally-positioned flap (CPF). Eight patients who had bilateral areas of gingival recession were selected. The areas of recession treated were Class I or II according to Miller's classification and caused either an esthetic problem or root sensitivity. The defects were randomly assigned to surgical procedures in each subject. In the FGG, the root surfaces were root planed, conditioned with a saturated citric acid solution, and an adjacent recipient site was prepared surgically. A thick palatal graft was then sutured to the recipient site. In the CPF, an initial autogenous free gingival graft was surgically placed in a recipient site just apical to the root recession. After 1 month of healing, the gingiva was coronally positioned to the level of the CEJ. Standardized photographs were obtained presurgically, at 2 weeks, and at 1 and 3 months. Reduction of areas of exposed root surface and distances from CEJ to gingival margin were computed. Data analysis did not demonstrate a significant difference in success between FGG and CPF at 3 months. Maximum decrease of exposed root surfaces occurred at 2 weeks postsurgically with both procedures and then some recession of each type of graft occurred. The mean distance of the exposed root surfaces decreased from 2.136 mm to 1.301 mm and from 2.187 mm to 1.400 from baseline to 3 months for the FGG and CPF respectively.

A morphological comparison of radicular dentin following root planing and treatment with citric acid or tetracycline HCl.

The conditioning of root surfaces with saturated solutions of citric acid or tetracycline is unpredictable in facilitating new attachment, perhaps due to the low pH of these solutions which may be denaturing the organic matrix of the root as well as demineralizing the surface. The purpose of the present study was to compare the effects of a saturated solution of citric acid (pH = 1) with that of a 0.5% solution of tetracycline HCl (pH = 3.2) on radicular dentin with regard to the removal of the smear layer, exposure of dentinal tubule openings, and demineralization of the peritubular dentin. 10 bovine incisors were used in this study. The crowns and apical 1/3 of the root were resected and the resulting root segments were then frozen in icy freon. The cementum was fractured off of the root to produce a fracture-exposed, non-instrumented dentin surface. This fracture-exposed dentin surface was divided into 4 specimens, the 1st being a fracture-exposed, non-instrumented dentin control specimen (FE). After removal of the (FE) specimen from the root segment, the remainder of the fracture-exposed dentin surface was thoroughly root planed and then subdivided into the 3 remaining specimens. One of these specimens served as the root planed dentin surface (RP); another specimen (CA) was immersed in saturated citric acid (pH = 1) for 5 min and then washed in water for 5 min; the final specimen (T) was immersed in a 0.5 mg/ml solution of tetracycline HCl for 5 min and rinsed in water for 5 min.(ABSTRACT TRUNCATED AT 250 WORDS)