Validity of fractal analysis of implants in individuals with healthy and diseased peri-implant mucosa.

OBJECTIVE: The purpose of this study was to determine whether fractal analysis could discriminate the peri-implant trabecular bone between individuals with healthy peri-implant mucosa and peri-implant disease using digital periapical radiographs. MATERIAL AND METHODS: The electronic health records of patients with a dental implant were reviewed to determine their eligibility. One hundred four patients (aged 27-89 years) were included and divided into three groups. Group 1) Individuals with healthy peri-implant mucosa; Group 2) Individuals with peri-implant mucositis; or Group 3) Individuals with peri-implantitis. The following clinical measurements for each dental implant were extracted: probing depth (PD), clinical attachment level (CAL), and the presence or absence of bleeding on probing (BOP). Digital periapical images of the implant were used to calculate the fractal dimension (FD) for each implant at two regions of interest (ROI). Summary statistics were calculated for mean PD, mean CAL, mean percent BOP, and mean FD by group. Differences among groups were tested using one-way analysis of variance (ANOVA). Spearman nonparametric correlations were tabulated for mean PD, mean CAL, mean percent BOP, and mean FD. RESULTS: The only measure that did not demonstrate significant differences among groups was FD (p = .559) with all other measures demonstrating a significant difference (p < .001). CONCLUSIONS: Based on this study, FD of the peri-implant bone calculated from a periapical radiograph does not appear to be a valid method to distinguish between healthy and diseased implants, while clinical measures of PD, CAL, and BOP are useful for the diagnosis of peri-implant health, peri-implant mucositis, and peri-implantitis.

Assessment of treatment outcomes for facial prostheses in patients with craniofacial defects: A pilot retrospective study.

STATEMENT OF PROBLEM: The longevity of silicone facial prostheses is short, and published data concerning this type of rehabilitation are limited. PURPOSE: The purpose of this retrospective study was to identify predictive variables for prosthetic failure and to highlight the results that can be expected after treatment with silicone facial prostheses. MATERIAL AND METHODS: After institutional approval, patient records from a single Brazilian institution for the time period 2004 to 2015 were assessed. A standardized form was used to collect patient data. Frailty survival modeling (simple random effects survival model) was used to test whether age, sex, type of prosthesis, source of defect, number of implants, and type of retention have a direct impact on the prosthetic failure rate (α=.05). RESULTS: Auricular prostheses were the most frequently fabricated prostheses. Eighty-four prostheses were fabricated during the follow-up period. The overall survival rate for facial prostheses was 34.5%. Color alteration was the most common reason for new prostheses (27.38%). The implant success rate was 98.18%. The number of implants approached statistical significance (P=.06) with a reduced risk of failure when the patient had 2 implants compared with patients with zero implants and patients with more than 2 implants. CONCLUSIONS: Patients should be recalled frequently so that retouches can be performed, avoiding the repeated fabrication of new prostheses. Well-designed studies are necessary to identify more relevant complications and factors that lead to prosthetic failure.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

AIM: Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS: Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS: At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS: The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.

Laser and scanning electron microscopy evaluation of residual microislands of calculus.

BACKGROUND: Recent studies suggest a role for microscopic crystalline particles of residual dental calculus in the pathogenesis of periodontitis. The purpose of this ex vivo study was to compare the effectiveness of scaling and root planing (SRP) alone versus SRP combined with 24% ethylenediamine-tetra acetic acid (EDTA) gel in removing calculus from extracted teeth and to determine the optimal length of time for application of the EDTA. METHODS: Specimens consisted of 32 extracted teeth with heavy root calculus. A 4-mm diameter site was prepared on the root surface of each tooth which then underwent SRP. EDTA was applied to four timed groups: 30 s; 60 s; 120 s; and 180 s. Photomicrographs were taken at 40× magnification using white light (WL) and laser fluorescence (LF). Photomicrographs were analyzed using ImageJ. Specimens were also evaluated with scanning electron microscopy (SEM). RESULTS: The mean area of residual calculus after SRP was 45%-53% (45.6% ± 19.6% WL, 53.8% ± 19.7% LF). Burnishing with EDTA for one minute following SRP reduced calculus to only 14%-18% (13.9% ± 12.5% LF, 18.2% ± 11.1% WL). Use of EDTA for greater than 1 min showed no further calculus removal. SEM revealed the surface of remaining calculus was altered by burnishing with EDTA. CONCLUSION: SRP alone or SRP + 24% EDTA gel failed to remove all calculus. SRP alone removed >60% of calculus from root surfaces. Adjunctive use of 24% EDTA gel burnished on the root surface removed most of the calculus residual after SRP. Calculus remaining after EDTA burnishing exhibited a significantly altered morphologic appearance.

The Use of Enamel Matrix Derivative during Surgical Therapy for Peri-Implantitis: A Case Series.

Peri-implantitis is a growing concern and currently, there is no agreement on the best method for treating this condition. This study looked at surgical intervention with the use of enamel matrix derivative (EMD) for treating this condition. A cohort of 25 (34 implants) consecutive patients treated with EMD for peri-implantitis was followed for up to 6.4 years. The survival of the implants as well as changes in clinical parameters are reported. Statistical analysis was performed using paired t tests and general estimating equations. The mean length of time implants were followed post-surgery was 3.05 ± 1.53 years. All but two of the treated implants survived in function (94%). Both failed implants were lost in the same patient, who was a heavy smoker. The changes in mean probing depth (1.94 ± 1.18 mm), change in deepest probing depth (3.12 ± 1.45 mm), and reduction in bleeding on probing (73.6 ± 43.9%) according to patient means were all highly significant (p < 0.001 for all changes). When EMD is used during surgical treatment of peri-implantitis, there is a high survival rate of implants and significant improvements in clinical parameters.

The effect of phosphoric acid pre-etching and thermocycling on self-etching adhesive enamel bonding.

STATEMENT OF PROBLEM: When inserting a resin-bonded prosthesis, it is not known whether pumicing, rinsing, and using a self-etching primer (SE) on prepared surfaces is sufficient or whether the use of an additional conventional acid etchant is warranted due to the increased time and risk of contamination. PURPOSE: The purpose of this study was to evaluate the effects of pre-etching with phosphoric acid (PA) and thermocycling (TC) on the enamel shear bond strength (SBS) of an autopolymerizing adhesive system on ground enamel. MATERIAL AND METHODS: Human teeth were embedded in phenolic rings with methyl methacrylate resin, and their enamel surfaces were ground flat to a 600 grit surface. The teeth were then divided into 4 subsets (n=22): 1) PSN, PA pre-etch with SE, no TC; 2) PST, PA pre-etch with self-etching primer and TC; 3) SEN, self-etching primer alone, no TC; and 4) SET, self-etching primer and TC. A multifactorial study design was used to evaluate 2 factors (pre-etching with PA and TC) at 2 levels (presence or absence) by grouping different subsets. Pre-etch consisted of teeth being etched for 30 seconds with PA, rinsed, re-etched, and rinsed. Self-etching consisted of 60 seconds with ED Primer. Rods of Rexillium III, airborne-particle abraded with 50 µm aluminum oxide, were bonded to enamel surfaces with Panavia 21 OP under a 19.6 N load. Thermocycling consisted of alternating between water baths of 5 ± 2°C and 55 ± 2°C for 5000 cycles. Shear bond strength (SBS) was determined by loading the specimens to failure at a crosshead speed of 1 mm/min. Mean values were analyzed with a 2-way ANOVA (factors were surface treatment and TC) at α=.05. RESULTS: Pre-etching with phosphoric acid showed greater SBS to enamel (P=.028) than the self-etching primer alone. Thermocycling did not have a significant effect (P=.424). CONCLUSIONS: There was a significant difference in SBS between pre-etching enamel surfaces with phosphoric acid in addition to the self-etching primer and using the self-etching primer exclusively. Thermocycling did not significantly affect SBS.

Validation of two clinical color measuring instruments for use in dental research.

OBJECTIVE: There are several shade matching instruments developed for clinical use, but the validity of their use in dental research has not been thoroughly investigated. The objective of this study is to evaluate the accuracy of using two clinical color measuring instruments, VitaEasyshade and Spectroshade, against a referent laboratory color measuring instrument (Spectroradiometer PR670). METHODS AND MATERIALS: The validity and repeatability of the referent laboratory color measuring instrument was assessed using standard color patches with certified CIE L*a*b* values. 10% of the 240 color patches were randomly selected and measured ten times in a random order to test for repeatability. 16 metal ceramic specimens, fabricated from base metal alloy veneered with porcelain of different Vita Classic shades, were measured for L*a*b* values using the PR670, Vita EasyShade and the Spectroshade. The CIE L*a*b* values obtained from the three color measuring instruments were compared using repeated measures ANOVA and post hoc using the Bonferroni test. The color difference, CIEDE2000 (∆E00), between the gold standard (PR670) and the two color measuring instruments were also determined and compared against the known perceptible color difference. RESULTS: L*a*b* values varied significantly between the three instruments. When comparing the mean ΔE00, the differences in values between PR670 and Spectroshade were not clinically significantly. However, the mean ΔE00 values between PR670 and Vita Easyshade were both clinically and statistically significant. CONCLUSION: The lack of clinical significance in values obtained from the SpectroShade when compared to those obtained by the PR670 suggests that the SpectroShade may be recommended for use in dental color research. CLINICAL SIGNIFICANCE: The SpectroShade instrument and PR670 spectroradiometer provided values that lacked clinical significance, suggesting that its use may be highly beneficial for clinical shade matching as well as color research.

A radiographic method for distinguishing noncavitated from cavitated proximal carious lesions: A proof of concept clinical trial.

OBJECTIVES: We propose a new topical radiographic contrast method for distinguishing noncavitated from cavitated radiolucencies. Laboratory tests and a pilot clinical trial were designed to test the feasibility and efficacy of the method. STUDY DESIGN: Twenty-two adults with 27 proximal radiolucencies had conventional bitewing (BW) examinations. After exclusion, 21 surfaces were evaluated. A concentrated solution of sodium iodide was placed in the interdental spaces via a microsyringe and BWs were again exposed. A class II cavity preparation was made in the adjacent tooth and polysiloxane impressions were made of the study surfaces. The impressions were scanned by visible light, creating a high resolution 3D replica. Cavitations, if present, were measured. RESULTS: Nine surfaces were noncavitated and 12 surfaces were cavitated. The microsyringe dispensed a variable volume of liquid, which affected the accuracy of the test. The sensitivity for cavitation was 50%, specificity was 88.9%, and accuracy was 66.7%. This compares to a reported 60% sensitivity, 62% specificity, and 62% accuracy for BW examinations. Intraexaminer reliability for classifying noncavitated or cavitated lesions using the kappa test was 0.649. CONCLUSIONS: This method needs improvement but was an advance over conventional BWs and could result in reduction of restorations in low- and high-risk patients.

Oral microbiota of children in a school-based dental clinic.

OBJECTIVES: Dental caries disproportionately affects disadvantaged subjects. This study hypothesized that there were greater caries extent and higher levels of caries-associated and anaerobic subgingival bacterial species in oral samples of Hispanic and immigrant children compared with non-Hispanic and US born children. METHODS: Children from a school-based dental clinic serving a community with a large Hispanic component were examined, and the extent of caries was recorded. Microbial samples were taken from teeth and the tongues of children. Samples were analyzed using DNA probes to 18 oral bacterial species. RESULTS: Seventy five children were examined. Extent of caries increased with child age in immigrant, but not in US born or Hispanic children. There were no differences in the microbiota based on ethnicity or whether the child was born in US or not. There was a higher species detection frequency from teeth than tongue samples. Levels of Streptococcus mutans and other Streptococcus spp increased with caries extent. Prevotella intermedia, Tannerella forsythia and Selenomonas spp were detected at low levels in these children. CONCLUSIONS: We conclude that, while there was a high rate of dental caries in disadvantaged school children, there were no differences in the caries-associated microbiota, including S. mutans, based on ethnicity or immigration status. Furthermore, while anaerobic subgingival, periodontal pathogens were also detected in children, there was no difference in species detection based on ethnicity or immigration status. Increased levels of streptococci, including S. mutans, however, were detected with high caries levels. This suggested that while it is beneficial to target preventive and treatment programs to disadvantaged populations, there is likely no additional benefit to focus on subgroups within a population already at high risk for dental disease.

Pediatric clinicians can help reduce rates of early childhood caries: effects of a practice based intervention.

OBJECTIVE: Early childhood caries (ECC) is a serious and preventable disease which pediatric clinicians can help address by counseling to reduce risk. RESEARCH DESIGN: We implemented a multifaceted practice-based intervention in a pediatric outpatient clinic treating children vulnerable to ECC (N = 635), comparing results to those from a similar nearby clinic providing usual care (N = 452). INTERVENTION: We provided communication skills training using the approach of patient centered counseling, edited the electronic medical record to prompt counseling, and provided parents/caregivers with an educational brochure. OUTCOME MEASURES: We assessed changes in provider knowledge about ECC after the intervention, and examined providers' counseling practices and incidence of ECC over time by site, controlling for baseline ECC, patient sociodemographics and parents'/caregivers' practice of risk factors (diet, oral hygiene, tooth-monitoring), among 1045 children with complete data. RESULTS: Provider knowledge about ECC increased after the intervention training (percentage correct answers improved from 66% to 79%). Providers at the intervention site used more counseling strategies, which persisted after adjustment for sociodemographic characteristics. Children at the intervention site had a 77% reduction in risk for developing ECC at follow up, after controlling for age and race/ethnicity, sociodemographics and ECC risk factors; P

The association of occlusal contacts with the presence of increased periodontal probing depth.

AIM: This study evaluates relationships in humans between various occlusal contacts and the presence of deeper probing depths, reduced width of keratinized tissue, and less than favourable initial prognosis. MATERIALS AND METHODS: The tooth level relationship between various occlusal contacts and pocket probing depths, width of keratinized gingiva, and prognosis at the time of initial examination was evaluated (multivariate model) in a group of patients (85 patients, 2219 teeth) with active periodontal disease. RESULTS: The following were noted to be associated with significantly deeper pocket probing depths: premature contacts in centric relation (0.89 mm, p<0.0001), posterior protrusive contacts (0.51 mm, p<0.0001), balancing contacts (1.01 mm, p<0.0001), combined working and balancing contacts (1.13 mm, p<0.0001), and the length of slide between centric relation and centric occlusion. Protrusive contacts on anterior teeth were significantly associated with shallower probing depths (-0.18 mm, p=0.0076) and a wider zone of keratinized tissue (0.16 mm, p=0.0065). Balancing contacts with and without working contacts and centric prematurities were all associated with an increased incidence of a less than "Good" prognosis CONCLUSIONS: Multiple types of occlusal contacts were shown to be associated with deeper probing depths and the increased assignment of a less than "Good" initial prognosis.

Prevalence of early childhood caries among very young urban Boston children compared with US children.

OBJECTIVES: The aims of this study were to compare prevalence of early childhood caries (ECC) in 1- to 3-year-old children seeing primary-care pediatricians at two urban medical centers in Boston to the prevalence of ECC in similarly aged US children surveyed as part of the Third National Health and Nutrition Examination Survey (NHANES III) and to assess risk factors for ECC among this cohort of children compared with risk factors among similarly aged US children. METHODS: Characteristics of 787 1- to 3-year-old children from two urban Boston medical centers were compared with those of 3,644 similarly aged US children surveyed as part of NHANES III. Demographic and social characteristics and ECC prevalence by putative risk factors were compared. A multiple logistic regression model was fit to assess putative risk factors and difference between groups simultaneously. RESULTS: Race, age, previous dental visit, parents' education, and household income were significantly associated with ECC prevalence. Parents' place of birth was a significant effect modifier with lower ECC among Boston children of immigrants than among US children of immigrants. CONCLUSIONS: Lower ECC prevalence among urban Boston children of immigrant parents compared with US children of immigrant parents may reflect changing immigrant composition in the United States since NHANES III or a different immigrant composition in the Boston area compared with the United States. This finding reinforces the need for further research of immigrants in order to understand cultural practices that may affect oral health. Finally, low ECC prevalence among very young children reinforces the importance of early intervention in reducing ECC.

Multivariate Exponential Survival Trees And Their Application to Tooth Prognosis.

This paper is concerned with developing rules for assignment of tooth prognosis based on actual tooth loss in the VA Dental Longitudinal Study. It is also of interest to rank the relative importance of various clinical factors for tooth loss. A multivariate survival tree procedure is proposed. The procedure is built on a parametric exponential frailty model, which leads to greater computational efficiency. We adopted the goodness-of-split pruning algorithm of LeBlanc and Crowley (1993) to determine the best tree size. In addition, the variable importance method is extended to trees grown by goodness-of-fit using an algorithm similar to the random forest procedure in Breiman (2001). Simulation studies for assessing the proposed tree and variable importance methods are presented. To limit the final number of meaningful prognostic groups, an amalgamation algorithm is employed to merge terminal nodes that are homogenous in tooth survival. The resulting prognosis rules and variable importance rankings seem to offer simple yet clear and insightful interpretations.

The clinical efficacy of deproteinized bovine bone mineral with 10% collagen in conjunction with localized piezosurgical decortication enhanced orthodontics: A prospective observational study.

BACKGROUND: Evidence exists on the clinical efficacy and safety of periodontally accelerated osteogenic orthodontics (PAOO) with "Piezocision"-a minimally invasive, flapless alternative to corticotomy for alveolar bone augmentation. Allograft has been extensively studied for alveolar bone augmentation in Piezocision; however, the use of deproteinized bovine bone mineral with 10% collagen (DBBM-C) in Piezocision for PAOO has not been investigated. METHODS: This study is a prospective, observational, cohort study of 19 patients of Angle Class I malocclusion with a total of 692 teeth assessed for maintenance of health of the periodontal attachment apparatus. Patient-centered pain, sensitivity, and satisfaction outcomes, digital photographs and radiographs, and changes in probing depth, clinical attachment level, width of keratinized tissue, percussion sensitivity, pulp vitality tests, radiographic pathology, and root-crown-ratio were all recorded. RESULTS: Overall treatment was significantly faster (5 to 7 days between clear aligner tray changes), periodontal parameters remained stable, and alveolar bone loss was not observed. Visual analog score for healing, sensitivity/duration, bleeding/duration, swelling/duration, appearance, and inflammation, demonstrated no significant differences between DBBM-C and control (no bone graft) groups. Patient-centered outcomes revealed high levels of satisfaction with Piezocision. Piezocision-treated teeth with DBBM-C tended to exhibit less root resorption, although it was not statistically significant (P = 0.074). CONCLUSIONS: Within the limits of the study, our results show that the use of DBBM-C with piezosurgically enhanced orthodontics is effective and safe. This study was not designed to demonstrate equivalence with other materials that might be used in Piezocision. To understand whether there is an advantage to using DBBM-C, additional studies may be required.

The Association Between Occlusal Status and the Soft and Hard Tissue Conditions Around Single-Unit Dental Implants.

The occlusal status of single-unit dental implants were evaluated using traditional and computerized methods. The type of occlusal contact in maximum intercuspation and the presence of occlusal contacts on the implant during eccentric movements were recorded. A digital sensor was used for computerized analysis of occlusion. Forty-four patients with 74 implants were included. Twenty-nine implants (39%) presented with "heavy" occlusal contacts, 40 implants (54.1%) presented with "light" contacts, and 5 implants (6.8%) presented with "no contact." No statistically significant association was found between the occlusal status and any of the soft and hard tissue condition variables (P > .05).

Clinical dimensions of the supraosseous gingivae in healthy periodontium.

BACKGROUND: To estimate the amount of supraosseous gingivae (SOG), the soft tissue height from the bone crest to the free gingival margin, that will reform after crown-lengthening surgery, dental professionals have relied on a histologic mean dimension of 3 mm. This figure was derived from an autopsy study, and it represents the average of a significant range of values, from 0.0 to 6.5 mm. Other studies provided information on SOG dimensions; however, it seems that no clinical study in individuals without a history of periodontitis or attachment loss has been made that included all tooth types in the maxillary and mandibular arches. The main purpose of this investigation was to determine the clinical SOG dimensions around molar, premolar, canine, and incisor teeth in upper and lower jaws. METHODS: In 23 patients without a history of periodontal disease, incisor and canine (zone 1), premolar (zone 2), and molar (zone 3) SOG dimensions were measured by transsulcular probing (TSP) after injecting local anesthetic. The reliability of TSP to determine the SOG dimensions was established before any measurements were taken. RESULTS: Clinical overall (facial and palatal) maxillary SOG dimensions for zones 1, 2, and 3 were 3.66, 3.82, and 4.19 mm, respectively. Overall SOG measures for maxillary teeth varied by tooth type (P <0.001). Similarly, site-level SOG measures varied by tooth type (P <0.02), except for mesial-facial SOG measures of maxillary teeth (P = 0.051), which only approached significance. Clinical overall (facial and lingual) mandibular SOG dimensions for zones 1, 2, and 3 were 3.31, 3.62, and 3.89 mm, respectively. Overall SOG measures for mandibular teeth varied by tooth type (P <0.001). Similarly, site-level SOG measures varied by tooth type (P <0.03), except for mesial-facial and mid-facial SOG measures of mandibular teeth (P = 0.074 and P = 0.144, respectively). CONCLUSION: Clinical variation in SOG dimensions exists within patients for similar and different tooth types, arches, and surfaces.

Root proximity as a risk factor for progression of alveolar bone loss: the Veterans Affairs Dental Longitudinal Study.

BACKGROUND: The purpose of the present longitudinal study was to evaluate the association between root proximity and the risk for alveolar bone loss (ABL). METHODS: We used data from the Veterans Affairs Dental Longitudinal Study, a closed-panel longitudinal cohort study of 1,231 men enrolled in 1968 with triennial follow-up examinations. Periapical radiographs of mandibular incisors from subjects with > or =10 years of follow-up were selected. Interradicular distance (IRD) at the cemento-enamel junction and alveolar bone levels at baseline and last follow-up were measured using digitized radiographs. The rate of progressive ABL was determined and expressed as millimeters per 10 years. Site-specific multivariate regression models were fit to evaluate the association between IRD and ABL rate, adjusting for age and smoking. Empirical standard errors and generalized estimating equations were used to account for the correlation among sites within subjects. RESULTS: There were 473 dentate subjects, aged 28 to 71 years at baseline, with > or =10 years of follow-up data available for analyses. The mean follow-up time was 23 years. The mean IRD was 1.0 +/- 0.3 mm, and the mean ABL rate during 10 years was 0.61 +/- 0.59 mm. There was a significant non-linear association between IRD and ABL rate (P <0.005). Compared to sites with IRD > or =0.8 mm, sites with IRD <0.6 mm were 28% (95% confidence interval [CI]: 11% to 48%) more likely to lose > or =0.5 mm of bone during 10 years (relative risk: 1.28 [95% CI: 1.11 to 1.48]) and 56% (95% CI: 11% to 117%) more likely to lose > or =1.0 mm of bone during 10 years (relative risk: 1.56 [95% CI: 1.11 to 2.17]). CONCLUSIONS: IRD <0.8 mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth. Measurement of IRD may have important prognostic value in making treatment decisions.

The relationship between the presence of tooth-borne subgingival deposits and inflammation found with a dental endoscope.

BACKGROUND: Inflammatory periodontal diseases are found in many dentate individuals, but therapists and researchers who assess disease activity have had to rely on external clinical signs and symptoms to ascertain the health of the subgingival periodontal tissues. However, by using an endoscope in the subgingival environment, the therapist can see the relationship of subgingival tooth-borne accretions to signs of inflammation in the pocket wall. This study explored those relationships via the endoscope. METHODS: Twenty-six patients with moderate to severe periodontitis were chosen. The study visit involved a standardized, masked examiner who gathered data on the external gingival index, probing depth, gingival recession, and clinical attachment level. A second standardized examiner, masked to the findings of the first, used a dental endoscope. A set of indices (endoscopic biofilm index, endoscopic calculus index, and endoscopic gingival index) specifically developed for subgingival parameters was used. A fixation stent ensured that the periodontal probe and the endoscopic explorer traveled along the same path. RESULTS: A statistically significant relationship was found between deposits of subgingival calculus covered with biofilm and inflammation of the pocket wall, as measured by color change. In >60% of the cases, this inflammation was associated only with biofilm over deposits of calculus, not biofilm alone. Only subgingival calculus was statistically significant in relation to the positive traditional gingival index. CONCLUSIONS: Deposits of subgingival calculus covered with biofilm were directly related to >60% of pocket wall inflammation as measured by increased redness of the pocket epithelium. This was in comparison to biofilm alone.

A pilot study to evaluate a tissue-engineered bilayered cell therapy as an alternative to tissue from the palate.

BACKGROUND: This study evaluated the safety and effectiveness of a tissue-engineered skin product composed of viable neonatal keratinocytes and fibroblasts and compared it to a free gingival graft (FGG) in a procedure to enhance keratinized tissue (KT) and wound healing around teeth that do not require root coverage. METHODS: Twenty-five subjects were enrolled who had at least two non-adjacent teeth in contralateral quadrants exhibiting an insufficient zone of attached gingiva requiring soft tissue grafting where root coverage was not desired. One tooth was randomized to receive an FGG, and the other was randomized to receive bilayered cell therapy (BCT). The amount of KT was measured at baseline and 3 and 6 months, and the texture and color of the grafted tissue were compared to the surrounding tissue at months 1, 3, and 6. A questionnaire was used to determine subject preference at 6 months. Biopsies and persistence studies were performed on a subset of the subjects. RESULTS: The FGG generated statistically significantly (P <0.001) more KT than the test device (BCT) (4.5 +/- 0.80 mm versus 2.4 +/- 1.02 mm); no significant difference in recession or clinical attachment level was detected between treatment groups (P = 0.212 and P = 0.448, respectively); and no significant differences were detected at any time point for bleeding on probing (BOP), resistance to muscle pull, or inflammation. The BCT group had significantly better color and texture match with surrounding tissue (P <0.001), and subject preference was significantly greater for the BCT group (P = 0.041). No device-related adverse events or safety issues occurred during the course of the study. CONCLUSIONS: The tissue-engineered graft BCT was safe and capable of generating de novo KT without the morbidity and potential clinical difficulties associated with donor-site surgery. The amount of KT generated with FGG was greater than generated with BCT; however, 24 of 25 test sites demonstrated an increase in KT at 6 months, with more than three-quarters of the sites yielding > or =2 mm bands of KT.