Clinical attachment level measurements with and without the use of a stent by a computerized electronic probe.

OBJECTIVE: The aim of the present study was to evaluate whether a stent should be used when assessing attachment level (AL) by an electronic probe (Florida Probe). METHODS: Twenty patients were recruited and individual stents were obtained to measure relative AL (RAL) with the Florida stent probe. Conventional AL (CAL) measurements were obtained by adding pocket depth and gingival recession recorded by the Florida pocket probe. Duplicate RAL and CAL measurements were taken one hour apart from each other on anterior teeth, at six sites per tooth, by one examiner. Patients were treated and reassessed with both probes after 45 days so that the gain in RAL and CAL could also be compared. RESULTS: Pearson's correlation test showed that correlation was moderate (r = 0.57) and significant (p < 0.001) for duplicate CAL measurements. As for RAL values, correlation was higher (0.91) and significant (p < 0.001). The difference between RAL and CAL gain after 45 days was 0.04 mm (p = 0.85). CONCLUSION: Since the correlation was higher for duplicate RAL measurements than for CAL measurements, the use of a stent should be considered in clinical trials to ensure better reproducibility of measurement of attachment level gains.

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy.

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.

Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a 2-year follow-up.

BACKGROUND: The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period. METHODS: Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (>or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months. RESULTS: In initially deep pockets (>or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing >or=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P <0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008). CONCLUSION: The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.

Clinical attachment loss produced by curettes and ultrasonic scalers.

OBJECTIVES: The aim of this study was to clinically detect the immediate effect of root instrumentation with curettes and ultrasonic scalers on clinical attachment level. MATERIAL AND METHODS: Twelve subjects with moderate chronic periodontitis, presenting probing depths of 3.5-6.5 mm on anterior teeth, upper and/or lower, were selected. Teeth were randomly assigned to one of the following groups: US group--scaled with an ultrasonic scaler; and CC group--scaled and planed with 5-6 Gracey curettes. The selected teeth were probed with a computerized electronic probe, guided by an occlusal stent and subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered trauma from instrumentation. RESULTS: Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (0.77+/-0.51 for US group; and 0.73+/-0.41 for CC group, p<0.0001). However, inter-group analysis did not show statistically significant difference in trauma from instrumentation caused by the two different instruments (p=0.816). CONCLUSIONS: Within the limits of this study, it was concluded that root instrumentation causes a mean immediate attachment loss of 0.75 mm, and that instrumentation with either curettes or ultrasonic scalers do not seem to reduce significantly the trauma from of instrumentation produced.

Reproducibility of clinical attachment level and probing depth of a manual probe and a computerized electronic probe.

The aim of this study was to evaluate the reproducibility of a conventional manual probe (MP) and an electronic probe, the Florida Probe (FP). Twenty patients with chronic periodontitis were assessed for pocket depth (PD) and clinical attachment level (CAL) by one examiner. Replicate measurements were taken one hour apart with each probe, on anterior teeth, at six sites per tooth. Pearson's correlation test and Student's paired t-test were used for the statistical analysis. The results showed that there were no significant differences in PD between the replicate measurements of both FP and MP (p > 0.05), although the correlation value was higher for FP (r = 0.97, p < 0.01) than for MP (r = 0.54, p < 0.05). Considering CAL, no differences were found between replicate measurements for both FP and MP (p > 0.05) and correlation values were similar (0.57 and 0.64, respectively, p < 0.001). Although the FP showed higher correlation values for PD, no significant differences were found between duplicate measurements for both probes. Thus, both electronic and manual probing measurements seem to be reproducible when assessing periodontal disease.

Clinical and microbiologic changes after removal of orthodontic appliances.

The goal of this study was to evaluate the clinical and microbiological factors associated with orthodontic appliances during an episode of gingival inflammation and the impact of appliance removal on periodontal health. This prospective study included 10 patients, aged 12 to 20 years, with clinical signs of gingival inflammation at the final phase of orthodontic treatment (appliance removal). Plaque index, gingival index, and probing depth were evaluated, and microbiological samples were collected from teeth 16, 11, and 26 at 2 times: during the gingival inflammation (baseline) and 30 days after the removal of the appliance and professional prophylaxis. Polymerase chain reaction analysis was used to detect Porphyromonas gingivalis, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens. A statistically significant improvement of the plaque and gingival indexes was seen, as well as a reduction in probing depth (P <.05). Periodontal pathogens were associated with gingival inflammation during orthodontic treatment. The improvement in periodontal health at 30 days was concomitant with a reduction of sites positive for A. actinomycetemcomitans and B. forsythus (P <.05). Periodontal pathogens associated with gingival inflammation during orthodontic treatment can be significantly reduced by orthodontic appliance removal and professional prophylaxis.

Clinical attachment loss produced by curettes and periodontal files.

The aim of this study was to clinically evaluate the effect of immediate trauma from instrumentation after scaling and root planing with different instruments. Ten subjects with moderate chronic periodontitis, presenting probing depths of 3.5-6.5mm on anterior teeth, maxillary and/or mandibular, were selected. Teeth were randomly assigned to one of the following groups: PF group - scaled and planed with Hirschfeld periodontal files; CC group - scaled and planed with Gracey conventional curettes. The selected teeth were probed with a computerised electronic probe, guided by an occlusal stent and subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered as trauma from instrumentation. Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (1.28 +/- 1.13 for PF group; and 0.83 +/- 0.41 for CC group - p<0.05). However, inter-group analysis did not show statistically significant difference in trauma from instrumentation caused by the different instruments (p=0.063). Within the limits of this study, it was concluded that root instrumentation causes a mean immediate attachment loss of 1.06mm, with no differences between instrumentation with periodontal curettes or periodontal files.

Locally delivered doxycycline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a clinical study.

BACKGROUND: The aim of this clinical study was to evaluate the association of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers. METHODS: Forty-three patients with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Plaque, bleeding on probing, gingival recession, relative attachment level (RAL), and probing depth (PD) were recorded at baseline, 45 days, and 3 and 6 months. Differences between baseline and each period were considered for analysis. RESULTS: At 6 months, no difference was found between groups regarding plaque, bleeding reduction, gingival recession or PD (P > 0.05). However, RAL gain was greater for SRP-D (1.63 +/- 0.93 mm) than for SRP (1.04 +/- 0.71 mm) (P = 0.025). In addition, deep pockets (> or = 7 mm) showed a significant reduction (3.78 +/- 1.41 versus 2.60 +/- 1.28 mm, P = 0.039) and RAL gain (2.54 +/- 1.27 mm versus 1.29 +/- 0.95 mm, P = 0.01) when doxycycline was applied. The proportion of sites showing RAL gain of 1 to 2 mm was 36.8% versus 21.7% for SRP-D and SRP, respectively (P = 0.01). CONCLUSION: The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers.

Attachment loss after scaling and root planing with different instruments. A clinical study.

OBJECTIVES: The aim of this study was to evaluate clinically the immediate effect of trauma from instrumentation after scaling and root planing with different instruments. MATERIAL AND METHODS: Ten subjects with moderate chronic periodontitis, presenting probing depths ranging from 3.5 to 6.5 mm on anterior teeth, upper and/or lower, were selected. Teeth were randomly assigned to one of the following groups: MC group--scaled and planed with Gracey mini-curettes (MiniFive); CC group--scaled and planed with Gracey conventional curettes. The selected teeth were probed with a computerized electronic probe, guided by an occlusal stent, and then subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered as trauma from instrumentation. RESULTS: Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (0.68 +/- 0.32 for MC group; and 0.83 +/- 0.41 for CC group--p < 0.05). However, inter-group analysis did not show a statistically significant difference in trauma from instrumentation caused by the different instruments. CONCLUSIONS: Within the limits of this study, it was concluded that root instrumentation causes an average trauma from instrumentation of 0.76 mm with no differences between the tested instruments.

Microbiological changes with the use of locally delivered doxycycline in the periodontal treatment of smokers.

BACKGROUND: The aim of this study was to evaluate the effect of the association of locally delivered doxycycline 10% and scaling and root planing in the subgingival plaque of smokers. METHODS: Sixteen smokers with chronic periodontitis and a minimum of four pockets (> or = 5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to one of the following groups: scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP-D). Subgingival plaque samples were collected from initially moderate (5 to 6 mm) and deep (> or = 7 mm) pockets at baseline and 3 months. Polymerase chain reaction (PCR) analysis was used to detect the frequency of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythensis (Tf). RESULTS: No statistically significant difference was found in the reduction of Aa in either the SRP-D or SRP group (P > 0.05). The reduction in Tf, Pg, and Tf + Pg was statistically significant for SRP-D only (P = 0.016, 0.027, and 0.027, respectively). The proportion of sites free of Tf at 3 months was 53% for SRP-D and 9% for SRP (P = 0.02). For Pg, this proportion was 82% and 40%, respectively (P = 0.05). CONCLUSION: The use of locally delivered doxycycline may promote the elimination of T. forsythensis and P. gingivalis in a greater proportion of sites compared to conventional scaling and root planing in smokers.

Alterações de profundidades de sondagem após raspagem com diferentes instrumentos. Acompanhamento de 6 semanas / Changes in probing depth measuremens following scaling and root planing with different instruments. A 6-week follow-up

Os objetivos deste estudo foram detectar as reduções de profundidade de sondagem após a raspagem e comparar as alterações produzidas por diferentes instrumentos sobre a profundidade de sondagem, após o período de 6 semanas de cicatrização. Foram selecionados 9 pacientes com periodontite moderada, apresentando, pelo menos, 5 sítios com profundidade de sondagem variando entre 3,5 e 6,5 mm em dentes anteriores. Os dentes foram aleatoriamente designados para um dos 3 grupos experimentais (grupo LP - limas periodontais de Hirschfeld 3-7 e 5-11; grupo MC - mini-curetas tipo Gracey 5-6 (MiniFiveTM); ou grupo CC - curetas tipo Gracey 5-6 convencionais. Os dentes selecionados foram sondados antes da raspagem com uma sonda eletrônica computadorizada. Seis semanas após a instrumentação, os dentes foram novamente sondados. A análise intra-grupo revelou que houve diferença estatisticamente significante entre os valores de profundidade de sondagem iniciais e após o período de 6 semanas nos 3 grupos experimentais (p<0,05). Entretanto, a análise inter-grupo não revelou diferenças estatisticamente significantes entre os valores de redução de profundidade de sondagem nos diferentes grupos (p=0,568). Dentro dos limites deste estudo, todos os instrumentos avaliados foram capazes de reduzir significativamente a profundidade de sondagem

Uso local da doxiciclina na terapia periodontal / Local use of doxycyclin in periodontal therapy

Os avanços no conhecimento da patogenicidade e da etiologia da doença periodontal têm gerado buscas por intervenções farmacológicas em meio à sua terapêutica. Assim, o uso de dispositivos de liberação controlada de antibióticos tem sido pesquisado a fim de se obterem resultados ainda mais satisfatórios ao final da terapia periodontal, principalmente em casos de doença agressiva e áreas refratárias. Em estudos recentes, a liberação local de doxiciclina tem apresentado resultados satisfatórios quando utilizada como terapia alternativa à raspagem e ao alisamento radicular no tratamento de periodontite crônica e refratária. Este trabalho tem o objetivo de revisar a literatura quanto ao uso da doxiciclina como agente antibiótico local na terapia periodontal, bem como ilustrar a sua utilização clínica

Reattachment of an autogenous tooth fragment in a fracture with biologic width violation: a case report.

An 11-year-old patient that fractured her maxillary left central incisor is presented. The fracture involved two thirds of the crown, compromising the pulp, and extended subgingivally on the palatal aspect, invading the biologic width. The procedure used to repair the fracture included flap surgery with a slight ostectomy and endodontic treatment. The reattachment of the tooth fragment and the restoration were performed with a bonding system and a resin composite. Examination 6 months after treatment revealed periodontal health, good esthetics, and normal function.

A influência do sexo e da idade na prevalência de bolsas periodontais / The influence of gender and age on the prevalence of periodontal pockets

Este trabalho teve como objetivo avaliar a influência dos fatores de risco na prevalência de bolsas periodontais em pacientes atendidos na clínica do terceiro e quarto anos da Faculdade de Odontologia de Piracicaba - Unicamp. Foram avaliados 100 pacientes através do levantamento dos dados contidos nas fichas clínico-anamnésicas, sendo consideradas bolsas de profundidade: 3 mm, 5 mm, 7 mm e 10mm, de acordo com o sistema diagnóstico WS (SALLUM; SALLUM, 1996). Os resultados foram comparados entre as profundidades de sondagem e as variáveis idade, sexo, bem como sua distribuiçäo por sextantes. Observou-se maior prevalência de bolsas periodontais no sexo masculino, bem como maior profundidade de sondagem em pacientes acima de 31 anos. A distribuiçäo de bolsas periodontais entre os sextantes foi homogênea