Effects of a bisphosphonate on experimental periodontitis in monkeys.

Bisphosphonates have been shown to increase bone mass in estrogen-deficient patients by inhibiting osteoclast activity. The purpose of this study was to measure clinical and radiographic effects of a bisphosphonate on periodontitis development in monkeys. Twenty-seven (27) adult cynomolgus monkeys were studied. After quarantine, baseline data were obtained including plaque index, gingival index, clinical probing depth measurements, and intraoral radiographs. Standardized radiographs were analyzed for quantitative changes in bone density using a computer assisted densitometric (CADIA) system. Animals were divided into 3 groups to receive 1 of the 3 treatment agents; these agents consisted of two levels of the test drug (alendronate) and a saline placebo. Agents were injected in the saphenous vein of the lower leg every 2 weeks for 16 weeks. One week after the initiation of treatment agent injections, mandibular right molars and premolars were ligated with 3-0 silk sutures to induce periodontitis. Ligated teeth were also inoculated with Porphyromonas gingivalis to insure a significant etiologic challenge. Nonligated homologous teeth served as controls. Clinical measurements and radiographs were repeated at 8 and 16 weeks after ligation. The bisphosphonate at a concentration of 0.05 mg/kg significantly retarded the progression of periodontitis as measured by bone density changes. The higher level dose of the test drug did not differ from placebo with respect to loss of bone density. Clinical indices were not affected significantly by the test drugs. Drugs that alter bone metabolism may offer a new approach to the treatment of periodontal disease.

Treatment of gingival recession: comparative study between subepithelial connective tissue graft and guided tissue regeneration.

BACKGROUND: Various procedures have been proposed to treat gingival recession, but few studies compare these procedures to each other. The purpose of this study was to evaluate a clinical comparison of subepithelial connective tissue graft (SCTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recessions in humans. METHODS: Twenty-four defects were treated in 12 patients who presented canine or pre-molar Miller Class I and/or II bilateral gingival recessions. Both treatments were performed in all patients, and clinical measurements were obtained at baseline and 18 months after surgery. These clinical measurements included gingival recession height (GR), root coverage (RC), probing depth (PD), keratinized tissue width (KT), and final esthetic result. RESULTS: Both SCTG and GTR with a bioabsorbable membrane and bone graft demonstrated significant clinical and esthetic improvement for gingival recession coverage. The SCTG group was statistically significantly better than GTR for height of GR (SCTG = 0.2 mm, GTR = 1.12 mm, P= 0.02) and KT (SCTG = 4.58 mm, GTR = 2.5 mm, P<0.0001). However, PD was statistically significantly better for GTR than SCTG treatment (GTR = 1.66 mm, SCTG = 1.00, P= 0.01). The 2 procedures were statistically similar in root coverage (SCTG = 95.6%, GTR = 84.2%, P= 0.073). The esthetic condition after both treatments was satisfactory (P= 0.024). CONCLUSIONS: It was concluded that the gingival recessions treated with the SCTG group were superior for GR, RC, and KT clinical parameters, while GTR demonstrated better PD reduction. The final esthetic results were similar using both techniques.

Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery.

This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy.

Mechanism of irrigation effects on gingivitis.

Although gingivitis is initiated by plaque and plaque removal controls gingivitis, gingival irrigation with water has been shown to reduce gingivitis without reducing plaque. This study attempted to explore possible mechanisms involved in the treatment of gingivitis by water irrigation. Patients (n = 125) with more than 20 teeth, less than 4 sites with probing depth (PD) deeper than 6 mm, bleeding on probing (BOP) frequency of 30% or higher, and no systemic disease were randomized to one of four treatment groups: toothbrushing alone (brush), toothbrushing plus chlorhexidine 0.12% rinse 2x/day (CHX), toothbrushing plus water irrigation 1x/day (irr+H2O), or toothbrushing plus chlorhexidine 0.04% irrigation 1x/day (irr+CHX). Six sites/tooth were examined at baseline, and at 3 and 6 months for BOP and PD using an automated probe, and for gingival index (GI) and plaque index (PI) by standard means. A prophylaxis and oral hygiene instructions were provided after baseline and 6 month measurements. Subgingival microbial samples and crevicular fluid (GCF) were collected from 2 teeth/subject at each time point. Microbial samples were processed for anaerobic culture and the predominant cultivable flora was determined. CHX and irr+CHX had a 30 to 35% decrease in mean PI, while brush and irr+H2O had only a 12 to 16% decrease. BOP was reduced by 14% in the brush group and 23 to 24% in the other groups. GI was significantly correlated with PI in the brush, CHX, and irr+CHX groups, but not in the irr+H2O group. Prevotella intermedia was significantly reduced in both irrigation groups, but not CHX or brush groups.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

A comparative 3-month clinical investigation of the safety and efficacy of a battery-operated and a rechargeable oscillating-rotating power toothbrush.

PURPOSE: To compare the safety and efficacy of two oscillating-rotating power toothbrushes, the rechargeable Braun Oral-B D8 and the battery-powered Colgate Actibrush. MATERIALS AND METHODS: This was a randomized, examiner-blind, parallel-group study, carried out over 3 months of product use, involving a total of 113 healthy subjects with a plaque score of > or = 1.5 and a gingivitis score of > or = 1.1. Subjects were given written and verbal instructions in the use of their respective power brushes and were told to brush twice per day. At baseline, hard and soft tissues were examined, and plaque scores and gingival scores were recorded after 12-18 hrs of no oral hygiene. Subjects returned after 3 months, at which time soft and hard tissues were re-examined and plaque and gingivitis scores were recorded. RESULTS: No evidence was found of soft or hard tissue trauma and both brushes were considered to be safe when used according to the manufacturers' instructions. After 3 months, whole mouth plaque scores had decreased by 7% in the D8 group but had increased by 4.3% in the Actibrush group. The decrease from baseline in the D8 group was statistically significant, but the increase in the Actibrush group was not. The difference between the two groups was statistically significant both for the whole mouth and all individual sites. Whole mouth gingivitis scores were also reduced significantly from baseline in both groups, by 22.5% in the D8 group and by 17.5% in the Actibrush group. For whole mouth scores and all individual sites (interproximal, buccal and lingual), the D8 was significantly more effective than the Actibrush.

Diagnostic discrimination of bleeding on probing during maintenance periodontal therapy.

The purpose of this study was to test the diagnostic discrimination of bleeding on probing in a group of 71 patients who have been treated for periodontitis. They have been maintained over 5 years receiving prophylaxis every 3 months and clinical evaluation once a year. 1,746 teeth were used and extracted and retreated teeth were not included. The presence or absence of bleeding on probing was recorded for each tooth over the five yearly examinations. After recording the site variations between the 1st and the 5th year maintenance values, the highest value of attachment loss per tooth was selected. Teeth were considered diseased when they presented at least one site with 4 mm of probing pocket depth at the baseline (year 1) and 2 mm of attachment loss after 5 years (Criterion 1), or showed 3 mm of attachment loss after 5 years (Criterion 2). The prevalence of disease was 8.19% (143 teeth) for Criterion 1 and 19.7% (344 teeth) for Criterion 2. Bleeding on probing 2 times presented the highest sensitivity (86% Criterion 1 and 64.5% Criterion 2) and the lowest predictability (11.9% Criterion 1 and 21.4% Criterion 2). Bleeding on probing frequency = 5 times showed the highest specificity (93.6% Criterion 1 and 93.4% Criterion 2) and predictability (93.4% Criterion 1 and 81.5% Criterion 2). These results demonstrated that bleeding on probing may not be substituted for clinical attachment levels when evaluating the periodontal attachment loss over time. However, the high specificity and predictability of these tests as a negative one suggests that absence of bleeding after probing may be a good indicator of maintenance of periodontal attachment levels over time.

Risk indicators for periodontal diseases in Guatemalan adolescents.

A random sample of sixty-two 11-15-year-old adolescents from 17 different locations in Guatemala were selected for this study. Pocket depth, Plaque Index, and bleeding upon probing were recorded from 6 randomly selected sites in each subject (a total of 372 sites). Subgingival plaque samples were subsequently collected from these sites and processed by several assays. For cost reasons, in each pair of sites different assays were performed as follows: sites #1, #2--BANA test for T. denticola, P. gingivalis, B. forsythus and screening of plaque samples with polyclonal antibodies (ELISA system) for A. actinomycetemcomitans; sites #3, #4--detection of yeasts by SAB agar; sites #5, #6--detection of Entamoeba gingivalis by the Heidenhain iron hematoxylin modified technique. A total of 66% of the children had at least one site that bled upon probing, 42% exhibited at least one site with pocket depth > 3 mm, and 79% exhibited a high Plaque Index, with the percent of sites affected being 30%, 12% and 41%, respectively. In sites #1, #2 (N = 124), the BANA test assay and A. actinomycetemcomitans tested positive in 77% and 47% of the children accounting for 59% and 31% of the sites, respectively. In sites #3, #4 (N = 124), yeasts were detected in 43% of the children and 29% of the sites. In sites #5, #6 (N = 124), Entamoeba gingivalis was detected in 21% of the children and in 11% of the sites. The risk for severe gingival inflammation and/or increased probing depth was 1.5 and 5.2 times higher if a positive BANA test or A. actinomycetemcomitans test was found in a particular site. No associations could be found for yeasts and Entamoeba gingivalis.

Persistent bacterial colonization of Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in periodontitis and its association with alveolar bone loss after 6 months of therapy.

BACKGROUND, AIMS: The purpose of this study was to determine whether the presence of bacterial antigens for Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque of periodontitis patients after periodontal treatment was associated with progressive alveolar bone loss. METHOD: 39 (39) subjects in good general health previously diagnosed with adult periodontitis within the last 2 years, and still presenting with probing depth >5 mm in 2 to 6 teeth, were studied. All subjects were treated with scaling and root planing. Half of the subjects were randomly assigned to receive adjunctive systemic doxycycline (200 mg the 1st day, then 100 mg per day for 21 days). Subgingival plaque samples were taken at baseline, 1, 3 and 6 months after therapy. A modified ELISA test (Evalusite, Periodontal Test Kit, Eastman Kodak Co., Rochester, NY) was used to test for plaque antigens associated with P. gingivalis, P. intermedia and A. actinomycetemcomitans. Progressive alveolar bone loss was determined using digital subtraction radiography with standardized radiographs taken at baseline and 6 months after treatment. RESULTS: The presence of P. gingivalis in plaque after treatment was significantly associated with progressive bone loss (positive predictive value 84%, negative predictive value 85%, odds ratio 31.9, p<0.0001). In contrast, the presence of P. intermedia in plaque after treatment was not indicative of progressive loss (positive predictive value 39%, negative predictive value 82%). Too few sites had evidence of A. actinomycetemcomitans to be amenable to statistical analysis. No significant difference in bone loss was attributable to the systemic antibiotic therapy. CONCLUSION: These data indicated that, in this population, the presence of P. gingivalis in plaque after treatment might be indicative of progressive alveolar bone loss.

Relationship of "bleeding on probing" and "gingival index bleeding" as clinical parameters of gingival inflammation.

Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E. = 1.36) BOP sites and 35.3% (S.E. = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with < 4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PD. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1-2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)