Clinical and microbiological characterization of localized aggressive periodontitis: a cohort study.

BACKGROUND: Localized aggressive periodontitis (LAgP) is an infectious periodontal disease which generally affects young people. Recent data suggest the involvement of different bacterial species in different populations. The causative bacterial species in Israel has never been identified despite a high prevalence of LAgP in this population. The objectives of this study were to characterize the bacterial microbiota of periodontal pockets within an Israeli LAgP population who were also clinically assessed. METHODS: Twenty-one LAgP patients (test) and 12 chronic periodontitis patients (control) were examined. Bacterial samples were collected from periodontal pockets and analysed by both culture and polymerase chain reaction techniques. Mann-Whitney U test and chi-square test were used to compare results between the groups. RESULTS: Higher levels of Parvimonas micra (>10(6) ), Aggregatibacter actinomycetemcomitans (>10(5) ), Fusobacterium nucleatum/F. periodonticum (>10(6) ), and Tannerella forsythia (levels of 10(5) to 10(6) bacteria) were detected in the LAgP group compared to the control (p < 0.05), while levels of Porphyromonas gingivalis and Prevotella intermedia were higher in the CP group. CONCLUSIONS: The characteristic periodontal bacterial flora of LAgP patients in Israel is mainly comprised of P. micra, A. actinomycetemcomitans, F. nucleatum/F. periodonticum and T. forsythia. Similar population based studies of each population will improve the quality of treatment of LAgP when individual sampling is not possible.

Salivary detection of H1N1 virus: a clinical feasibility investigation.

The fast and efficient transportation among continents will continue to play a role in the spread of airborne pandemics. The objective of this study was to detect H1N1 virus in the saliva of individuals who visited the emergency department and were diagnosed as having H1N1 influenza. Nasopharyngeal swabs and saliva samples from those who presented to the emergency department with flu-like symptoms were sent to the laboratory. RNA was extracted from both samples. Real-time RT-PCR tests were performed, and the saliva and nasopharyngeal swab tests were compared. Samples were drawn from 26 individuals. A positive nasopharyngeal swab test and salivary test was found in 14 persons, and negative tests were found in 12 persons. Saliva sampling for H1N1 has excellent predictive value, is highly accurate and reliable, and is more convenient than the nasopharyngeal swab. Clinical trial with the Helsinki Committee at Rambam Health Care Campus, registration number 036309-RMB.

Effects of lower third molar extraction on attachment level and alveolar bone height of the adjacent second molar.

Several conflicting findings have been published in previous literature regarding the effects of impacted third molar extraction on the periodontal health of the adjacent second molar; some authors have shown improvement of periodontal health distal to the adjacent second molar, whilst others have demonstrated loss of attachment and reduction of alveolar bone height. The purpose of this controlled clinical and radiographic study is to evaluate the long-term changes in periodontal health and alveolar bone height distal to the adjacent second molar following extraction of an impacted third molar. This split-mouth design study included 25 patients who underwent extraction of one mandibular impacted third molar (test), whereas the opposite tooth remained intact (control). Pre-operative and current-state panoramic radiographs were than scanned, and alveolar bone height was digitally measured on the distal aspect of the second molar on the test and control sides. Current-state clinical measurements were performed on both sides, and consisted of plaque index, gingival index, periodontal pocket depth, gingival margin position and clinical attachment level. Student's t-test for paired observations was used in order to examine the statistical significance of the differences in clinical parameters between the test and control sides and the differences in alveolar bone height pre- and post-operatively on both sides. Extraction of an impacted third molar resulted in a significant gain of alveolar bone height on the distal aspect of the adjacent second molar on the test side, whereas slight bone loss was noted on the control side. Even though the difference in plaque index between the test and control sides approached statistical significance following extraction, all clinical parameters seem to be unchanged. Further follow-up on clinical and radiological parameters is required for a more profound understanding of the long-term effects of third molar extraction on the periodontal health of the adjacent second molar.

The effect of secondary hyperparathyroidism and hemodialysis therapy on alveolar bone and periodontium.

BACKGROUND: Alveolar bone is particularly sensitive to increased levels of parathyroid hormone (PTH) from either primary or secondary hyperparathyroidism (HPT). The purpose of this study was to examine the effect of secondary HPT on the periodontium of patients on hemodialysis. METHODS: The experimental group consisted of 35 patients with secondary HPT, with chronic renal failure treated by hemodialysis (E group). A control group (C group) was formed from 35 healthy age- and gender-matched subjects attending the maxillofacial outpatient clinic for a variety of reasons. Blood samples were taken from the E group, and the biologically active intact parathormone molecule, PTH(1-84), was assayed using two-site immunoradiometric assay (IRMA). The time of onset and the duration since diagnosis of HPT was also recorded. In addition, for a subgroup of 25 matched pairs of patients, a clinical periodontal examination was performed, and the Ramfjord index teeth were recorded for: Plaque index (PI); Gingival index (GI); Probing depth (PD); and Clinical attachment level (CAL). A standardized panoramic X-ray was taken from all patients and computer-based linear measurements were used to assess alveolar bone loss (BL). Unpaired Student's t-test served to compare the two groups. Pearson's correlation coefficient test was used to study the association between PI, PTH level, disease duration and BL. RESULTS: Demographically, both groups were similar with no statistical difference. PI was also similar in the C and E group (2.03 +/- 0.13 and 1.76 +/- 0.17, respectively). GI, however, was slightly greater in the C group (1.28 +/- 0.09) compared to the E group (0.97 +/- 0.01). PD in the E group (2.92 +/- 0.14 mm) was almost identical to that of the C group (2.90 +/- 0.12 mm). Likewise, CAL in the E group (4.43 +/- 0.29 mm) did not differ from CAL in the C group (4.03 +/- 0.25 mm). Mean BL was also similar in the E and C groups (3.60 +/- 0.23 mm and 3.85 +/- 0.24 mm, respectively). PI showed a positive, significant correlation with BL (r = 0.457, P = 0.0008). CONCLUSION: From this study it can be concluded that secondary HPT does not have an appreciable effect on periodontal indices and radiographic bone height.

[Implant fracture: a complication of treatment with dental implants--review of the literature].

Dental implants are a functional and esthetic solution to partial and total edentulism. The initial success rate of this treatment modality is 90-95%. But, that treatment modality is not free of complications. One of the rare complications yet, with severe clinical results is fracture of dental implants. The current literature review presents the various causative factors that may lead to implant fracture. Implant failures may be sorted into groups by the timing of their appearance, or by the origin of failure. Fractures belong to the group of late complications, caused by a biomechanical overload. Overload may be caused by inappropriate seat of the superstructure, in-line arrangement of the implants, leverage, heavy occlusal forces (bruxing, clenching), location of the implant and the size of the implant or metal fatigue. Good clinical examinations and correct treatment plans may reduce the risk of implant fracture.

Osseous reconstruction using a membrane barrier following marginal mandibulectomy: an animal pilot study.

BACKGROUND: Invasive and malignant tumors of the oral soft tissues adjacent to the mandible are often treated with partial resection of the osseous structure adjacent to the lesion (marginal mandibulectomy). Autogenous bone graft and composite bone grafts are being used to fill the osseous defects with various degrees of success. The aim of the present study was to explore the utilization of membrane barriers and the principle of guided bone regeneration to negotiate these defects. METHODS: Following the removal of P1, P2, and P3, experimental bilateral marginal mandibulectomy defects were created in 4 adult dogs. The bone segments (measuring 25 mm x 15 mm) were then removed. Each side was then randomly selected for either experimental (titanium-reinforced expanded polytetrafluoroethylene membrane, [ePTFE-TR]) or control (repositioning flaps) treatment. Postoperatively, the animals were put on soft diet, antibiotics, and analgesics. Sutures were removed under light sedation after 4 weeks, and the area was left to heal and mature for 4 to 6 months (mean 5.3 months). The animals were then sacrificed, and block sections of the mandible were obtained for macroscopic and histological evaluation. RESULTS: The size of the residual defect (the vertical distance between the most apical depression in the ridge and the horizontal line connecting the free gingival margins of the proximal teeth) in the experimental sites (6.10 +/- 1.00 mm) was much smaller compared to the controls (10.65 +/- 0.82 mm), which was statistically significant (P = 0.0127). Histomorphometric measurements of new bone formation (NBF) revealed a similar pattern: for the experimental sites, NBF was 8.08 +/- 0.85 mm compared to 4.99 +/- 0.61 mm in the controls. These differences were also statistically significant (P = 0.0257). CONCLUSIONS: A regenerative approach to large mandibular osseous defects has been described. If this new treatment modality is further substantiated in other independent studies, it might prove a useful tool in restoring the lost osseous structure associated with marginal mandibulectomy procedures.

Periodontal changes in liver cirrhosis and post-transplantation patients. I: clinical findings.

BACKGROUND: Cyclosporin A (CsA) is widely used to prevent liver transplantation failure. CsA-induced gingival overgrowth is a common side effect. However, the effect of cirrhotic liver disease, liver transplantation, and immunosuppressive therapy on the periodontium is yet unclear. The aim of the present cross-sectional study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy on the periodontium. METHODS: The experimental group (LC) consisted of 13 liver cirrhosis patients. A second experimental group (PT) included 24 patients, post-liver transplantation, receiving immunosuppressive therapy. Seventeen healthy subjects formed a control group. The Ramfjord index teeth were recorded for plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO). RESULTS: Mean PI and mean GI for the LC, PT, and C groups were not statistically different (P >0.05). Mean PD for the LC (3.32+/-0.24 mm) and PT group (3.41+/-0.13 mm) was significantly higher (P = 0.0001, ANOVA) compared to the C group (2.45+/-0.16 mm). Likewise, CAL for the LC (4.89+/-0.47 mm) and PT group (4.68+/-0.47 mm) was significantly higher (P = 0.001, ANOVA) than the C group (2.78+/-0.23 mm). Patients in the PT group exhibited the greatest mean GO scores (0.88+/-0.09) compared to the LC group (0.37+/-0.07) and the C group (0.09+/-0.02). All 3 groups were significantly different from each other (P = 0.0001) despite great variability within the groups. GO in the CsA-treated patients (1.1+/-0.09) was significantly higher (P = 0.0001) than in those treated with tacrolimus (0.57+/-0.1). CONCLUSIONS: Liver cirrhosis patients demonstrated greater pocketing and attachment loss compared to healthy matched controls. These same differences were observed in patients post-transplantation. Gingival overgrowth occurred as a result of the immunosuppressive therapy with CsA, while to a lesser degree with tacrolimus. Replacement of CsA by tacrolimus in patients manifesting gingival overgrowth might be recommended whenever possible to overcome this problem.

The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis.

BACKGROUND: The significance of early membrane exposure on the regenerative outcome in guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures is somewhat controversial. Several clinical trials have shown better response when the membranes remained submerged (S) compared to those that have become exposed (E) during healing. Other studies have failed to show any such difference. Small sample size and/or large standard deviation of the changes might account for these discrepancies. The purpose of this meta-analysis is to critically combine the existing data in order to provide meaningful information based on a large database. METHODS: Studies of GTR in Class II furcation and intrabony defects (IBD), together with GBR around dental implants, where the membrane became exposed during the postoperative period, were combined to form 3 separate databases. A meta-analysis was employed to compare the 2 subgroups (E versus S) in each of the databases. First, weighted mean changes and weighted standard errors were calculated for each subgroup. Next, an individual study P value was calculated (1-tailed Student t test); finally, a combined Fisher's P statistic (with 5% significance level) was calculated from the individual P values. RESULTS: Five studies with a total of 101 sites were included in the furcation database; 43 of these sites became exposed. Mean horizontal attachment level (AL) gain for the S sites (3.72 +/- 0.15 mm) was slightly greater than that of the E sites (3.06 +/- 0.15 mm; P = 0.030257). For the intrabony group, there were 309 sites in 5 studies: of these, 142 sites became exposed. Mean gain in vertical AL was 4.22 +/- 0.15 mm and 4.69 +/- 0.13 mm for the E and S group, respectively (P = 0.011415). The GBR group included 60 sites in 2 studies: new bone formation in the 24 S sites (3.01 +/- 0.38 mm) was 6-fold greater compared with the 36 E sites (0.56 +/- 0.45 mm). These differences were also statistically significant (P = 0.001875). CONCLUSIONS: Membrane exposure during healing had a major negative effect on GBR around dental implants but only a minimal effect on GTR around natural teeth.

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study.

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.

Outcome variables in periodontal research: means and threshold-based site changes.

BACKGROUND: The exclusive use of mean measurements in periodontal research might at times be misleading, as changes in different sites in the same individual might nullify each other. The purpose of the present study was to compare disease progression and response to periodontal therapy using both individual site activity with thresholds and mean patient changes. METHODS: Seventy-nine (79) subjects with established periodontitis were monitored for 1 year (no treatment [NTx] group); 108 subjects who received scaling, root planing, and quarterly prophylaxis were observed in a similar time interval (treatment [Tx] group). Probing depth (PD), attachment level (AL) and alveolar crestal height (ACH) were measured at baseline and 1 year using pressure-sensitive probes and computer-assisted image analysis of radiographs. RESULTS: Mean reduction in PD (0.50 mm) was observed in the Tx group compared to a small increase (-0.04 mm) in the NTx group (P= 0.0001). Treatment resulted in mean AL gain (0.44 mm) compared to net AL loss (-0.21 mm) in the NTx group (P= 0.0001). Subjects in the Tx group had twice as many sites with AL gain (beyond the threshold) compared to NTx subjects (16.64+/-1.07% versus 8.11+/-0.68%) which was highly significant (P = 0.0001, Student t test). Similarly, although in the opposite direction, percentage of sites with AL loss beyond threshold was 6.21+/-0.47% (Tx group) and 14.02+/-1.15% (NTx group) which was also highly significant (P = 0.0001, Student t test). Change in ACH was minimal for the Tx group (-0.07+/-0.03 mm) while NTx subjects experienced greater bone loss throughout the year (-0.16+/-0.02 mm); percentage of sites with ACH loss was similar for both groups, while the Tx group had 3 times the number of sites with ACH gain (11.76% versus 3.42%), suggesting that the reduction in mean bone loss in the Tx group did not result from a reduction in losing sites, but rather from an increase in gaining sites. The use of both means and binary data seems to supplement the information regarding the nature and mechanism of disease progression and arrest. CONCLUSIONS: The characteristics of periodontal disease with its multifactorial patient, local, and site-related etiology support the use of both mean and site-based changes in clinical studies of periodontal disease and treatment.

Cyclosporine A-induced gingival hyperplasia pemphigus vulgaris: literature review and report of a case.

Gingival hyperplasia appears in 8% to 85% of patients treated with cyclosporine. Most studies show an association between oral hygiene status and the prevalence and severity of this gingival overgrowth. Thus, besides attempting to substitute this drug with another whenever possible, treatment usually involves maintenance of strict oral hygiene coupled with scaling and root planing and removal of iatrogenic factors. Sometimes a second treatment phase involving periodontal surgery is necessary. Cyclosporine-induced gingival overgrowth has been mainly described in post-organ transplant patients. The present case describes, for the first time, a severe form of cyclosporine-induced gingival overgrowth arising in a 15 year-old male with pemphigus vulgaris. Periodontal treatment included oral hygiene and scaling and root planing under local anesthesia. There was a significant reduction in gingival enlargement, as well as a reduction in plaque levels and inflammation. Cessation of drug administration, combined with continuous periodontal treatment, brought further improvement. This successful conservative treatment of cyclosporine-induced gingival overgrowth in a pemphigus vulgaris patient suggests that early diagnosis and comprehensive treatment of these lesions may yield good response and reduce the need for periodontal surgery.

Primary gingival malignant melanoma. Report of 3 cases.

BACKGROUND: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma. METHODS: Three cases are presented. One case was in the right mandibular molar area; the second in the right maxillary canine-premolar area; and the third in the left mandibular canine-premolar region. All patients were treated surgically, with postoperative radiotherapy. RESULTS: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow-up after 18 months. CONCLUSION: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the prognosis for these patients.

The effect of smoking and periodontal treatment on salivary composition in patients with established periodontitis.

BACKGROUND: The purpose of this study was to evaluate the effect of smoking on the periodontal status and the salivary composition in subjects with established periodontitis before and after periodontal therapy. METHODS: Our study group included 26 healthy subjects, 12 smokers and 14 non-smokers with established periodontitis. Clinical measurements and non-stimulated whole saliva were obtained and analyzed at baseline and after scaling and root planing. Smokers presented at baseline with significantly greater probing depth (4.16+/-0.26) compared to non-smokers (3.52+/-0.32) which was statistically significant (P = 0.0268); likewise, baseline clinical attachment level was greater in smokers (4.49+/-0.31 compared to non-smokers 3.87+/-0.13; P = 0.0620). Mean plaque index was also greater in smokers compared to non-smokers (0.86 and 0.65, respectively; P = 0.0834). Baseline pretreatment sodium values were significantly greater in non-smokers (14.36 mEq/l compared to 9.31 mEq/l in smokers; P = 0.0662); likewise non-smokers exhibited 50% greater salivary calcium levels (6.04 mg/100 ml compared to 4.32 mg/100 ml in smokers; P = 0.0133). RESULTS: Post-treatment probing depth and clinical attachment level were not different between smokers and non-smokers; this in spite of significant difference in plaque index in smokers (0.35 compared to 0.13 in non-smokers; P = 0.0135). Post-treatment, smokers had reduced calcium concentration (3.58 mg/100 ml compared to 5.11 mg/100 ml in non-smokers; P = 0.0438). Treatment affected albumin level in smokers only, consequently non-smokers had significantly greater salivary albumin concentration (1.1 mg/100 ml compared to 0.38 mg/100 ml in smokers; P = 0.0274). CONCLUSIONS: Subjects with established periodontitis exhibited elevated concentrations of salivary electrolytes and proteins. Within this study group, smokers exhibited greater disease level but reduced sodium, calcium, and magnesium concentrations. Smokers responded favorably to treatment. The clinical improvement eliminated the differences in salivary composition.

Longitudinal study of predictive factors for periodontal disease and tooth loss.

Longitudinal assessment of risk factors for periodontal disease is necessary to provide evidence that a putative risk factor or risk indicator is a true risk factor. The purpose of the present study was to explore longitudinally a variety of markers as possible periodontal risk factors in subjects with little or no periodontal disease at baseline. 415 subjects with mild or little periodontal disease were examined: medical and dental history; socioeconomic profile, clinical measurements, microbial samples and radiographic assessment of bone height were performed at baseline, and at a follow-up examination 2 to 5 years later. Mean probing pocket depth (PPD) at baseline was 1.99+/-0.37 mm while mean overall change was 0.1 mm which amounts to an annual rate of 0.04 mm. Overall mean clinical attachment level (1.75+/-0.6 mm) at baseline resulted in mean attachment change of 0.28 mm (0.12 mm annually). Alveolar crestal height (ACH) at baseline (mean 2.05+/-0.85 mm) resulting in a mean net loss of 0.1 mm. Approximately 10% of all sites presented for the second visit with attachment loss exceeding the threshold (4.4% annually), while only 2.2% of all sites exhibited attachment gain (0.88% annually). Older individuals exhibited greater mean bone loss but the least amount of attachment loss. Current smokers exhibited greater disease progression compared to non-smokers. Tooth morbidity (0.17 teeth/patient/year) was associated with greater baseline CAL and ACH loss, and an assortment of systemic conditions. Subjects who harbored Bacteroides forsythus (Bf) at baseline had greater loss in ACH; likewise, these subjects experienced greater proportions of losing sites and twice as much tooth mortality compared to Bf-negative patients. Baseline clinical parameters correlated strongly with the outcome, i.e., subjects with deeper mean pocket depth at baseline exhibited greater increase in pocket depth overtime; while subjects with greater attachment loss at baseline exhibited greater attachment loss between the 1st and 2nd visits.

Radiographic and clinical responses to periodontal therapy.

Mechanical periodontal therapy is widely used for a variety of periodontal conditions. While the clinical efficacy of this treatment has been validated, the radiographic response has not been studied in depth. The purpose of the present study was to examine the clinical and radiographic response to mechanical periodontal therapy, and assess the factors associated with these changes. One hundred and eight patients, with established periodontitis, received oral hygiene instruction and mechanical periodontal therapy for a period of 4 to 5 weeks. Scheduled maintenance visits were performed at 3, 6, 9, and 15 months. Probing depth (PD) and attachment level (AL) measurements were performed at baseline, and at 3 and 15 months. Intraoral radiographs were taken at baseline and 12 to 15 months postsurgery using a Rinn alignment system. Alveolar crestal height (ACH) measurements were performed on a pair of digitized images of the previously taken radiographs. An overall mean of patients' changes for PD, AL, and ACH was initially computed. Active sites (gainers and losers) were determined using a threshold method, and expressed as patient's percentage of active sites (number of active sites of the total sites measured in each patient). Mean overall probing reduction and AL gain was 0.5 mm and 0.44 mm, respectively. Of all sites measured, 16.6% exhibited AL gain, while only 6.2% of all sites exhibited AL loss. Mean overall change in ACH was -0.07 mm, of which 11.8% of all sites exhibited ACH gain, while 15.1% exhibited loss beyond the threshold. Non-smokers presented no change in bone loss, while smokers continued to lose bone at an annual rate of 0.17 mm, despite treatment (P <0.005). Likewise, the average percent of sites per patients showing attachment gain beyond the threshold were much greater in non-smokers (13.9%) compared to 9.0% in smokers (P <0.01). Mean probing reduction was 50% greater among non-smokers (0.6 mm) when compared to smokers (0.4 mm), which was also statistically significant (P <0.05). A positive and significant correlation was established between the percentage of sites with AL gain and sites with ACH gain (Rho =0.40; P=0.0001). It is suggested that monitoring sites for AL and ACH gain expressed as changes beyond a selective threshold is an important outcome variable in treatment studies.

The relationship between radiographic and clinical changes in the periodontium.

Change in clinical attachment level (CAL) and radiographic change in crestal bone height are often used to assess periodontal breakdown and disease progression. These two variables are also used to monitor the effect of treatment. The purpose of the present longitudinal study was to evaluate the correlation between changes in CAL and alveolar bone loss. Following initial screening, 79 subjects with established periodontitis were monitored quarterly for 1 yr, using a pressure-sensitive automated probe. CAL and relative attachment level (RAL) were recorded at 6 sites for each tooth. Radiographs were obtained at baseline and 1 yr. Crestal bone changes were determined using an image enhancement technique. Mean change in attachment level was 0.16 mm. Similarly, mean proximal bone loss measured radiographically was 0.16 mm. In 6.9% of all the sites, and 13.7% of all pooled interproximal sites, AL loss was in excess of the threshold defined as 2 s.d. of repeated measurements (mean 1.54 mm). Similar percentages of sites (12.9%) had radiographic evidence of proximal bone loss exceeding the threshold (0.55-1.08 mm). A site-based analysis of active sites revealed an overall poor correlation between the 2 variables (kappa value = 0.03) which was the result of a very poor sensitivity (0.16) despite a relatively good specificity (0.81). A patient-based comparison of clinical and radiographical changes revealed an overall kappa value of 0.08, with sensitivity and specificity of 0.51 and 0.56, respectively. However, baseline CAL and crestal bone height showed good correlation (r = 0.73; p = 0.0001). It is suggested that changes in CAL and radiographic bone level progress somewhat independently. Over a short-term period of time they might not follow the same course; however, in the long term, these differences seem to level off. For longitudinal monitoring of disease progression and response to therapy both methods may be needed; while for cross-sectional evaluation and long-term prospective studies, either variable may be used alone.

Traumatic bone cyst resembling apical periodontitis.

Among the pseudocysts of the jaws, the traumatic bone cyst is known as an asymptomatic lesion often noted unintentionally during routine radiographic examinations. The lesion neither devitalizes the teeth within its borders, nor does it cause resorption of their roots. The well-demarcated traumatic bone cyst often projects into the intraradicular septa and hence has been described as having scalloped borders. The following presentation is of a traumatic bone cyst that resembled periodontal pathology in its appearance.