A Randomized Clinical Trial Evaluating rh-FGF-2/ß-TCP in Periodontal Defects.

Biological mediators have been used to enhance periodontal regeneration. The aim of this prospective randomized controlled study was to evaluate the safety and effectiveness of 3 doses of fibroblast growth factor 2 (FGF-2) when combined with a ß-tricalcium phosphate (ß-TCP) scaffold carrier placed in vertical infrabony periodontal defects in adult patients. In this double-blinded, dose-verification, externally monitored clinical study, 88 patients who required surgical intervention to treat a qualifying infrabony periodontal defect were randomized to 1 of 4 treatment groups-ß-TCP alone (control) and 0.1% recombinant human FGF-2 (rh-FGF-2), 0.3% rh-FGF-2, and 0.4% rh-FGF-2 with ß-TCP-following scaling and root planing of the tooth prior to a surgical appointment. Flap surgery was performed with EDTA conditioning of the root prior to device implantation. There were no statistically significant differences in patient demographics and baseline characteristics among the 4 treatment groups. When a composite outcome of gain in clinical attachment of 1.5 mm was used with a linear bone growth of 2.5 mm, a dose response pattern detected a plateau in the 0.3% and 0.4% rh-FGF-2/ß-TCP groups with significant improvements over control and 0.1% rh-FGF-2/ß-TCP groups. The success rate at 6 mo was 71% in the 2 higher-concentration groups, as compared with 45% in the control and lowest treatment groups. Percentage bone fill in the 2 higher-concentration groups was 75% and 71%, compared with 63% and 61% in the control and lowest treatment group. No increases in specific antibody to rh-FGF-2 were detected, and no serious adverse events related to the products were reported. The results from this multicenter trial demonstrated that the treatment of infrabony vertical periodontal defects can be enhanced with the addition of rh-FGF-2/ß-TCP (ClinicalTrials.gov NCT01728844).

Longitudinal study of bone density and periodontal disease in men.

Bone loss is a feature of both periodontitis and osteoporosis, and periodontal destruction may be influenced by systemic bone loss. This study evaluated the association between periodontal disease and bone mineral density (BMD) in a cohort of 1347 (137 edentulous) older men followed for an average of 2.7 years. Participants were recruited from the Osteoporotic Fractures in Men Study. Random half-mouth dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque, and bleeding. BMD was measured at the hip, spine, and whole-body, by dual-energy x-ray absorptiometry, and at the heel by ultrasound. After adjustment for age, smoking, race, education, body mass index, and calculus, there was no association between number of teeth, periodontitis, periodontal disease progression, and either BMD or annualized rate of BMD change. We found little evidence of an association between periodontitis and skeletal BMD among older men.

Retrospective radiographic analysis of sinus graft and implant placement procedures from the Academy of Osseointegration Consensus Conference on Sinus Grafts.

A retrospective quantitative radiographic analysis determined the effect of graft material and smoking status on the maintenance of graft height over 3 years. Analysis of variance models with planned comparison were constructed to compare mean graft change by (1) graft material and (2) smoking status. Maintenance of bone height was significantly greater in intraoral autogenous grafts versus allografts (P < .05). The effect of smoking on implant loss revealed a significant difference in implant survival (P < .05). Autogenous bone generally resulted in a more favorable outcome over a 3-year period. Smoking adversely impacted implant survival in sinus grafts.

Intrapocket anesthesia for scaling and root planing: results of a double-blind multicenter trial using lidocaine prilocaine dental gel.

BACKGROUND: The efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g in thermosetting agents) for non-invasive periodontal pocket anesthesia was evaluated. METHODS: One hundred twenty-two (122) patients in 8 centers with moderate to severe periodontitis requiring scaling and root planing (SRP) were enrolled in this multicenter, randomized, double-blind, controlled clinical trial. The active dental gel or a matching placebo gel was applied into the periodontal pocket using a blunt applicator. Following a waiting period of 30 seconds to 2 minutes, scaling and root planing were performed. If the patient had any discomfort, a second application of the gel was applied. If the patient continued to experience discomfort, conventional anesthesia was offered. After all teeth in the test quadrant had received SRP, the overall pain was assessed by the patient using a 100 mm horizontal, ungraded visual analog scale in which the left side was marked "no pain" and the right side marked "worst pain imaginable." Patients also assessed pain by using a 5-point verbal rating scale, from "no pain" to "very severe pain." RESULTS: The visual analog scale showed significant reductions in reported pain, favoring the active gel over the placebo (mean reduction, 8 mm; P <0.0005). The verbal rating scale revealed that 90% of patients treated with active gel reported no pain or mild pain compared to 64% of placebo-treated patients (P<0.001). CONCLUSIONS: Intrapocket administration of lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents may be effective for pain control for scaling and root planing and may offer an alternative to infiltration anesthesia.

Periodontal infection and preterm birth: results of a prospective study.

BACKGROUND: Previous studies have suggested that chronic periodontal infection may be associated with preterm births. The authors conducted a prospective study to test for this association. METHODS: A total of 1,313 pregnant women were recruited from the Perinatal Emphasis Research Center at the University of Alabama at Birmingham. Complete periodontal, medical and behavioral assessments were made between 21 and 24 weeks gestation. After delivery, medical records were consulted to determine each infant's gestational age at birth. From these data, the authors calculated relationships between periodontal disease and preterm birth, while adjusting for smoking, parity (the state or fact of having born offspring), race and maternal age. Results were expressed as odds ratios and 95 percent confidence intervals, or CIs. RESULTS: Patients with severe or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16-9.18) for preterm delivery (that is, before 37 weeks gestational age). The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05-13.60) before 35 weeks' gestational age and to 7.07 (1.70-27.4) before 32 weeks' gestational age. CONCLUSIONS: The authors' data show an association between the presence of periodontitis at 21 to 24 weeks' gestation and subsequent preterm birth. Further studies are needed to determine whether periodontitis is the cause. CLINICAL IMPLICATIONS: While this large prospective study has shown a significant association between preterm birth and periodontitis at 21 to 24 weeks' gestation, neither it nor other studies to date were designed to determine whether treatment of periodontitis will reduce the risk of preterm birth. Pending an answer to this important question, it remains appropriate to advise expectant mothers about the importance of good oral health.

Current evidence regarding periodontal disease as a risk factor in preterm birth.

Preterm birth, resulting in babies born too little and too soon, is a major cause of morbidity. Evidence indicates that infections can be major risk factors in preterm birth. Case-control studies point to an association between periodontal infection and increased rates of preterm birth. This paper summarizes evidence to date and the strategies that ongoing intervention studies are using to answer the fundamental clinical question: can periodontal therapy reduce the risk of preterm birth?

Periodontal disease progression.

BACKGROUND: The objective of this investigation is to use noninvasive, state-of-the-art, diagnostic techniques to measure periodontal disease progression and model periodontal disease activity over time. In this investigation, digital subtraction radiography and an electronic controlled force periodontal probe capable of attachment level measurement were used to measure bone loss and attachment loss, respectively. The use of these nearly continuous measures of attachment and bone loss allowed detection of small amounts of disease activity and provided data to be used in modeling of the disease process over time. METHODS: Forty-four patients were studied for 18 months. Examinations used clinical attachment level measures at 1-month intervals and quantitative radiology at 6-month intervals. The sites were analyzed by regression for statistically significant changes. These data were used to determine sites of periodontal disease activity for testing various models of periodontal disease progression. RESULTS: Overall 22.8% of sites lost attachment, 5.4% gained, and 71.7% demonstrated no statistically significant change. The mean time to lose 1 mm of attachment was 8.4 +/- 0.6 months. In the first model tested a step-wise discriminant analysis was used to determine whether or not baseline measurements of plaque (PI), gingival inflammation (GI), attachment loss, and probing depth (PD) could be used to derive a satisfactory model for disease progression. Although the overall model was statistically significant with PI, PD, and GI contributing to the model (Wilks' lambda = 0.859, F = 5.71, P <0.0012), its predictive power was relatively weak. A considerably stronger significant model resulted when the rate of attachment loss over the first 6 months, baseline PI, and baseline GI were included (Wilks' lambda = 0.712, F = 14.17, P<0.00001). A significant model also resulted when bone loss during the first 6 months and baseline probing depth were included (Wilks' lambda = 0.438, F = 61.48, P<0.00001). When the last model was applied to each site, the sensitivity in predicting disease progression was 80.0% and the specificity in ruling out progressive disease was 93.9%. CONCLUSIONS: This study indicates that clinically significant progression of attachment loss in posterior tooth sites occurs as a frequent event in adult periodontitis. The modeling data also suggest that short-term (6 month) measures of periodontal disease progression greatly improve the ability to model attachment loss over a longer period in untreated periodontitis patients.

Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings.

BACKGROUND: Previous multi-center trials demonstrated the efficacy of a biodegradable chlorhexidine-gelatin chip (CHX) in reducing probing depth in patients with periodontitis. The present study utilized a subset of subjects from the parent study to determine if the CHX chip was effective in maintaining alveolar bone over a 9-month period. METHODS: Forty-five subjects with at least four 5 to 8 mm pockets, stratified by smoking status, were enrolled in this double-blind controlled, placebo-controlled trial. Control groups received either placebo chip plus scaling and root planing (SRP) or SRP alone. Test group subjects received active CHX chip or SRP alone (to maintain the blind). Standardized radiographs were taken for quantitative digital subtraction radiography at baseline and 9 months. RESULTS: At 9 months, 15% of SRP treated subjects experienced loss of bone in 1 or more sites, no subject treated with active chip plus SRP lost bone (P <0.01). At 9 months, significant differences in the change in probing depth and clinical attachment levels favoring the active chip over SRP alone or SRP plus CHX chip were also observed (P <0.05). CONCLUSIONS: These data indicate that the CHX chip, when used as an adjunct to scaling and root planing, significantly reduces loss of alveolar bone.

Diagnostic tests for periodontal disease.

This paper reviews the principles and the types of diagnostic tests for periodontal disease. The relevance of the tests, such as sensitivity and specificity, and the consequences after the tests are discussed. Several clinical and laboratory tests such as DNA probes; test for the presence of aspartate aminotransferase or collagenase in gingival crevicular fluid (GCF); and the genetic test for the patients having higher risk to the disease are presented. These tests can serve as the adjunctive tools for traditional periodontal examinations. Understanding and properly utilizing these diagnostic tests would enhance treatment and provide better prognosis for patients.

A comparison of manual and controlled-force attachment-level measurements.

This study compared the intra-examiner and inter-examiner error of 2 constant force probes to the reading of a conventional manual probe. 3 examiners made repeated examinations of attachment level using a modified Florida probe and a manual North Carolina probe (read to 1 mm or 0.5 mm); relative attachment level measurements were made using a Florida disk probe. One probe was used in each quadrant in 8 subjects with moderate to advanced periodontitis. Error was calculated as the mean of the absolute value of the difference between each examination, and the correlation between values at each examination calculated. Statistically-significant differences between probe type, examiners, and sites were detected using a repeated measures ANOVA accounting for the nesting within subjects. There was a significant difference in error by probe type (modified Florida probe 0.62 +/- 0.03 mm, r = 0.86; Florida stent probe 0.55 +/- 0.05 mm, r = 0.82; manual probe to 1 mm 0.39 +/- 0.02 mm, r = 0.88; manual probe to 0.5 mm 0.40 +/- 0.02 mm, r = 0.89; (p < 0.001). Significant differences were observed by examiners (p < 0.01). These data indicate that both manual and controlled-force probes can provide measurement within less than 1 mm of error; however, individual calibration of examiners remains important in the reduction of error.

Clinical and radiographic digital imaging evaluation of a bioresorbable membrane in the treatment of periodontal bone defects.

This study evaluated the use of a bioresorbable membrane (Guidor USA) for treatment of periodontal angular bone defects in eight periodontitis patients. Presurgical measurements consisted of probing depth, clinical attachment levels, and digital radiographic imaging evaluation. Full-thickness buccal and lingual flaps were elevated allowing for soft tissue debridement, scaling, and root planing. Bioresorbable membranes were placed in at least one of the periodontal defects, and controls were left without barrier placement. Clinical and radiographic results 6 months after the surgical procedure showed clinical and radiographic improvement for control and test lesions. However, sites treated with bioresorbable membranes presented a significant gain in clinical attachment and bone mass when compared to sites that had received flap surgery alone.

Risk factors in dental implant failure.

The goal of this study was to assess risk factors for dental implant failure. Eighty-three implants were placed in thirty patients who were followed for three years using digital subtraction radiography. The following putative risk factors for implant failure were employed in the model: age, sex, implant length, implant position, implant surface coating, smoking habit, and presence of infection. Implant failure was defined as progressive bone loss compromising the implant. We found that the presence of infection (P < 0.001) and absence of HA coating (P < 0.001) were the primary factors associated with early implant failure.