Retrospective evaluation of the influence of the interleukin-1 genotype on radiographic bone levels in treated periodontal patients over 10 years.

BACKGROUND: A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin-1 (IL-1) polymorphism on the rate of bone and tooth loss in non-smoking periodontally treated patients during maintenance. METHODS: Sixty consecutive non-smoking patients (mean age 46.8 +/- 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cemento-enamel junction [CEJ]-root apex, CEJ-bottom of defect mesial and distal, CEJ-bone crest mesial and distal, crown-root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 +/- 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL-1 genetic susceptibility testing was collected and sent for analysis. RESULTS: Twenty-three of the 60 patients (38.3%) were IL-1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL-1 genotype negative group and 24 of 609 (3.9%) in IL-1 genotype positive group. The mean variation in bone defect level (DeltaBD) averaged -0.04 mm in IL-1 genotype negative patients and 0.01 mm in IL-1 genotype positive patients. The mean variation in bone crest level (DeltaBC) averaged -0.24 mm in IL-1 genotype negative patients and -0.28 mm in IL-1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL-1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL-1 positive patients. IL-1 positive patients with severe initial bone loss showed a better response to the therapy than IL-1 negative patients. CONCLUSIONS: On average, there were no significant differences related to IL-1 genotype in tooth loss after 10 years in a non-smoking, well-maintained periodontal population. On an individual patient basis, the IL-1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation.

Occurrence of Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola in periodontally healthy and diseased subjects as determined by an ELISA technique.

The aim of this study was to assess by means of an ELISA technique, the occurrence of 3 putative periodontopathogens, Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola, in 3 clinically-defined adult periodontal conditions. Thirty systemically-healthy subjects were selected and grouped into 3 categories according to their periodontal health: 1) 10 periodontitis subjects (PS), having moderate adult chronic periodontitis; 2) 10 untreated gingivitis subjects (UGS), exhibiting no signs of periodontal destruction but presenting with clinical signs of mild gingivitis; and, 3) 10 treated gingivitis subjects (TGS), having the same clinical status as UGS, but who received a thorough prophylaxis treatment within the past 7 to 14 days prior to the baseline examination. A total of 60 samples were collected subgingivally from the six Ramfjord teeth per subject in each group and ELISA analysis was carried out to give a semiquantitative estimate of P. gingivalis. B. forsythus, and T. denticola. The immunologic detection method suggested the presence of antigens of P. gingivalis, B. forsythus, and T. denticola in subjects from each of the 3 groups. When a global analysis for the 3 disease groups was performed at one time, statistically significant differences were found among the ELISA scores of the 3 bacterial species. For example, comparisons of the ELISA scores showed that the concentrations of P. gingivalis differed significantly when comparing TGS to UGS and PS, but not when examining UGS/PS. The ELISA scores for B. forsythus were significantly different between TGS and PS. Mean concentrations of T. denticola were significantly different when comparing PS to TGS or UGS, whereas no difference was found between the latter categories. Within the limited scope of this study, the concentration of antigens detectable from putative periodontopathogens like P. gingivalis, B. forsythus, and T. denticola differed among the 3 diseased groups, with periodontitis subjects often showing the greatest level of antigens. Thus, it is reasonable to expect that, when using sensitive immunological detection methods, antigens of suspected periodontal pathogens can be found irrespective of the individual's clinical status. However, while detectable in the periodontal sites, the concentrations of these microorganisms are most likely to be above the threshold necessary to induce clinically-significant disease. Studies with larger sample size and standardized antigens are necessary to determine if the groups we found not to differ, were, in fact, different.

Rapidly progressive periodontitis. Neutrophil chemotaxis inhibitory factors associated with the presence of Bacteroides gingivalis in crevicular fluid.

In the last few years several bacteriological and immunological studies have investigated the role of bacteria and immune defects in order to establish the etiopathogenesis of periodontal disease. With regard to the immune system, a defect in polymorphonuclear neutrophil (PMN) chemotaxis has been frequently reported in patients with rapidly progressive or juvenile periodontitis. The purpose of this study was to investigate in five patients with rapidly progressive periodontitis and normal chemotaxis of peripheral blood PMNs the presence of chemotaxis inhibitory activity in gingival fluid and to relate such activity to three types of bacteria, often involved in rapidly evolving periodontal lesions, that are able to inhibit in vitro PMN chemotaxis: Bacteroides gingivalis, Capnocytophaga sp., and Actinobacillus actinomycetemcomitans. We found strong inhibitory activity in three of these patients. This activity was consistently associated with the finding of B. gingivalis in gingival pockets. We cannot rule out, however, that other substances not of bacterial origin could be responsible for such inhibitory activity. The strict association with B. gingivalis, known to secrete blocking factors, is highly suggestive, although this data must be considered preliminary.

Effectiveness of adjunctive irrigation in early periodontitis: multi-center evaluation.

The purpose of this study was to determine the effect of daily water irrigation versus regular oral hygiene alone on gingival and periodontal health in periodontitis patients receiving supportive periodontal treatment. The study also sought to determine if there are enhanced benefits from using an antiplaque zinc sulfate rinse as an irrigant. One hundred fifty-five patients who have had periodontitis and had been treated either surgically or non-surgically completed the 6-month multi-center multi-national study. Patients with at least two 5 mm sites demonstrating bleeding on probing were assigned to 3 equal groups by balanced randomization. In all centers Group A (n = 57) performed regular oral hygiene only, and Group B (n = 58) irrigated with 500 ml water once daily after regular oral hygiene. Group C (n = 40) patients irrigated with a total of 500 ml once daily; following irrigation with 300 ml water, the patients then irrigated with an additional 200 ml with a zinc sulfate solution. The irrigants were diluted to provide the manufacturer's recommended daily dosage. The supragingival irrigation was performed with a commercially available oral irrigator. Bacterial measurements at baseline, 3 months, and 6 months were taken to determine the effect of irrigation on the target organisms and will be reported elsewhere. Gingival index: irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) and irrigation with zinc sulfate (Group C) (P < 0.05) in reducing gingival inflammation. Bleeding on probing: significant reductions in bleeding on probing occurred for water (Group B) compared to normal oral hygiene (Group A) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Future diagnostic possibilities in periodontology.

From the clinical point of view the possibility of predicting the evolution of periodontal disease is currently lacking. In order to properly plan periodontal treatment it is necessary to determine specific risk categories, specification of risk patients within the risk categories and the risk sites in each patient. In order to achieve this goal it is necessary to base research on: epidemiological data, individual characteristics and specific diagnostic tests which anticipate the evolution of the disease. Tests which enable the indentification of the causative agents and those which characterise host response are particularly interesting owing to their possible clinical application. The current state of research suggests that in the future easily applied tests will be available to satisfy the above diagnostic requirements.

Tetracycline fiber used alone or with scaling and root planing in periodontal maintenance patients: clinical results.

This study evaluated the 6-month clinical response to sustained-release tetracycline fibers used alone or with scaling and root planing in 25 adult periodontal maintenance patients. All subjects had at least one pocket > or = 4.0 mm that bled on probing and required therapy. Thirty-six teeth were treated with tetracycline fibers for 7 to 12 days; twelve of the 36 teeth also received scaling and root planing. The selection of teeth for scaling and root planing was based on the condition of the teeth. Therapeutic results were evaluated by changes in probing depth and frequency of bleeding on probing. Use of tetracycline fibers and fibers with scaling produced 1.8- and 1.7-mm reductions in probing depth, respectively, 1 month after treatment; reductions declined to 1.3 and 0.8 mm at 3 months, but rebounded to 1.5 and 1.3 mm at 6 months. The percentage of teeth exhibiting bleeding on probing decreased from 100% at baseline to 68% and 50% in the fiber and fiber plus scaling groups, respectively, at 6 months. None of the differences was statistically significant. Tetracycline fibers clearly decreased clinical signs of periodontal inflammation. Addition of scaling and root planing at the time of fiber placement further decreased, although not significantly, the degree of inflammation.

[Modifications in the clinical and microbiological parameters of the periodontal tissues after the removal of overhanging class-II amalgam fillings]. / Modificazioni dei parametri clinici e microbiologici dei tessuti parodontali dopo rimozione di otturazioni in amalgama di II classe debordanti.

A short-term longitudinal study was carried out to assess how microbiological and clinical characteristics, measured surrounding periodontal sites with amalgam class II fillings intentionally made to overhang, vary following their replacement with a correct form of filling. The results of the study showed a significant reduction of the total bacterial count and the percentages of Gram-negative and anaerobic organisms spreading from overhanging fillings to non-overhanging fillings. The paper concludes that, as has been already demonstrated in the case of onlays, there are both qualitative and quantitative variations in the subgingival plaque in the presence of overhanging fillings which can lead to periodontal damage.

[The comparative evaluation of the efficacy of surgical and nonsurgical periodontal therapy in relation to the oral hygiene conditions and the severity of the lesions]. / Valutazione comparativa dell'efficacia della terapia parodontale chirurgica e non chirurgica in relazione alle condizioni di igiene orale ed alla gravità delle lesioni.

A retrospective longitudinal study was carried out to evaluate the efficacy of surgical and nonsurgical periodontal therapy in reducing pocket depth values. This evaluation was made in relation to the strictness with which patients observed professional and domestic oral hygiene and in relation to pretreatment pocket depth values. Results showed that the two forms of periodontal therapy offer comparable results in terms of pockets reduction of either restricted or considerable depth, whereas the most important element in order to achieve therapeutic success was the observation of an effective professional and domestic plaque control.

[A longitudinal clinical study of the efficacy of tetracyclines combined with root planing in patients with periodontal disease]. / Studio clinico longitudinale sull'efficacia delle tetracicline associate alla levigatura radicolare in pazienti affetti da malattia parodontale.

A retrospective longitudinal study was performed to assess the effectiveness of tetracycline therapy associated with root planing compared with root planing alone in patients affected by medium to severe periodontal disease. From an analysis of results it appeared that the combined therapy was generally more successful, even though statistical significance was only achieved in cases of healing angular bone lesions. In conclusion, larger studies should be carried out to contribute to broaden the spectrum of indications for the use of antibiotic therapy in periodontal disease in adults.

[Ultrastructural morphological study of supragingival tartar]. / Studio morfologico ultrastrutturale di tartaro sopragengivale.

Specimens of old supragingival calculus, collected from 5 patients with periodontitis, were examined electron-microscopically. Both intracellular and extracellular calcification were found. Intracellular calcification began as needle-shaped crystals or minute amorphous deposits within microorganisms. Extracellular calcification originated within the interbacterial matrix.

[Periodontic-endodontic lesions: diagnostic and therapeutic indications]. / Lesioni endo parodontali. Indicazioni diagnostiche e terapeutiche.

The presence of connections between periodontium and endodontium can lead to the diffusion of an infection from one apparatus to another. The involvement of both periodontium and endodontium is defined as Combined Periodontic-Endodontic lesions. This definition is not based on the initial etiology of the lesion and either the endodontic or periodontal lesion may be the cause or the result of the other or both may develop independently. The lesions must be correctly diagnosed for the best therapeutic approach. The diagnosis is based on clinical symptoms and radiographic analysis; clinical signs must show the presence of periodontal probing and pulpal necrosis. Radiographic examination can confirm the involvement of both periodontium and endodontium only if the lesion is present on the mesial and distal part of the diseased tooth; in the case of a palatal/lingual or vestibular lesion such evidence will not be detectable. The therapeutic approach is always based on an initial endodontic treatment followed, if needed, by the proper periodontal treatment.

[Efficacy of chlorhexidine as a gel and as a mouthwash]. / L'efficacia della clorexidina sotto forma di gel e di collutorio.

In a short-term longitudinal study the authors intended to compare the effectiveness in controlling plaque formation and gingival inflammation of a 1% chlorhexidine gel to the one of a 0.2% chlorhexidine solution. The gel, used once a day, resulted as good as the chlorhexidine solution, but showed a localized activity.

General considerations in the treatment of periodontal disease: infection control, medications, and wound healing.

Although it is difficult to accurately predict the results of periodontal therapy, it may be possible to improve the success of therapy if the patient is considered from an immunologic, microbiologic, social, and behavioral point of view, as a heterogenous entity. The success or failure of a particular treatment can be related to the host's personal response to a therapeutic procedure rather than to the technique used.