Changes in the periodontal membrane due to apical periodontitis.

Teeth with an apical inflammatory lesion were studied by light microscopic morphometrical procedures to estimate the volumetric density of periodontal ligament tissues by point counting. Sixty-four root surfaces were investigated from coronal to apical. The observed tissue changes were similar in groups with and without bacteria, except for an elevated volumetric density of inflammatory cells in the first group. The attachment was lost apically. Principal fibers running to the root surface and extensions in the cementum decreased from coronal to apical, but were replaced by fibers running parallel to cementum and fibers oriented in a network. We suggest that acellular extrinsic fiber cementum was lost, whereas cellular mixed stratified cementum was built. The cellular mixed stratified cementum synthesis was by inclusion of the remaining fibers from the acellular extrinsic fiber cementum. We suspect that the changes were the result of the anti-inflammatory reaction caused by the periapical lesion.

Longitudinal evaluation of aspartate aminotransferase in the crevicular fluid of implants with bone loss and signs of progressive disease.

Aspartate aminotransferase (AST) has been shown to be a promising host marker for periodontal disease progression. The aim of the present study was to analyze AST in the crevicular fluid (CF) of implants exhibiting peri-implantitis and to evaluate the association between AST levels and progressive attachment loss. Twenty patients who had received a total of 42 endosseous cylindric titanium implants were examined. Radiographic assessment of preexisting bone loss and clinical measurements, including electronic attachment of probing, presence or absence of plaque, bleeding on probing, and AST analysis in CF, were performed on 2 occasions 6 months apart. During this study period 13 of 168 sites in 7 patients experienced further loss of attachment greater than or equal to 1.0 mm (median 1.7 mm; interquartile range 0.4 mm). Evaluation of a positive AST test (> or = 300 microIU) in site-specific diagnosis revealed low positive (8%) and high negative predictive values (92%), with a sensitivity of 15% and a specificity of 83%. These results indicate that, in contrast to periodontal disease, the assessment of AST in peri-implant crevicular fluid may be of limited value as a diagnostic and prognostic marker for peri-implant disease.

The diamond-coated sonic scaler tip. Part I: Oscillation pattern of different sonic scaler inserts.

The authors have developed a set of four modified sonic scaler inserts with variously shaped shafts and diamond-coated budded inserts. The inserts are specially designed for the furcation area since instruments used hitherto have not been successful in completely preventing slow continuous periodontal breakdown in multirooted teeth. To test their clinical effectiveness, the displacement amplitude of the different sonic scalers was measured under varying load applications. Each scaler insert generated different and characteristic displacement amplitudes from rest position. The conventional insert was continuously dampened under increasing load application, whereas the diamond-coated inserts showed only minor variations of oscillation pattern. In a clinical situation, both insert types should be used, with the least possible application load to maintain effectiveness and minimize removal of hard tissue.

The diamond-coated sonic scaler tip. Part II: Loss of substance and alteration of root surface texture after different scaling modalities.

The authors have developed a set of four modified sonic scaler inserts with variously shaped shafts and diamond-coated budded inserts. The inserts are specially designed for the furcation area since instruments used hitherto have not been successful in completely preventing slow continuous periodontal breakdown in multirooted teeth. To improve understanding of their clinical effectiveness, instrumentation of dentin samples was done with a curette as well as conventional and modified sonic scaler inserts under standardized conditions. The results showed that significantly greater amounts of tooth substance were removed with the diamond-coated airscaler tips than with the conventional tip. The depth of substance removal was comparable to that obtained with hand instruments and increased with application force. Although differences in surface texture were found among the different modes of scaling, it remains to be determined whether they are of clinical significance.

Heat propagation in dentin during instrumentation with different sonic scaler tips.

It is important to know how much heat is generated when a root surface is debrided with sonic scalers and if that heat can be released satisfactorily into the environment. The temperature changes that occurred in dentinal specimens treated with two different sonic scaler tips, used with and without coolant, were studied. Temperature increases of up to 4 degrees C were observed for both tips when a coolant was used. Heat propagation during instrumentation was dependent to a considerable degree on the temperature of the coolant. Sonic scalers should not be used without coolant, because the dentinal temperature may increase up to 35 degrees C, depending on the force of application. A high positive linear correlation was found between increase in temperature and force of application.

Debridement by operators with varying degrees of experience: a comparative study on manikins.

The treatment of periodontally diseased root surfaces with power-driven instruments is becoming increasingly important as an alternative to the use of hand instruments. Root surfaces of artificial teeth on a manikin were debrided under simulated flap operation conditions to determine if effectiveness was dependent on the instrument used (curettes or a modified sonic scaler tip) and/or the operator's degree of experience. Two quadrants were treated with each instrument. A morphometric evaluation followed. Debridement was faster with the diamond-coated sonic scaler tip than with hand instruments. With the sonic scaler, the time necessary for treatment was reduced by 30%. The experienced operators treated about 80% of the root surface, while the inexperienced operators treated only about 65%. Treatment quality depended on the operator and not on the instrument used.

A clinical study comparing two high-fluoride dentifrices for the treatment of dentinal hypersensitivity.

Amine fluoride, the active ingredient of a currently marketed dentifrice in Germany and other European countries, and sodium fluoride were compared to a placebo dentifrice for their effectiveness in alleviating dentinal hypersensitivity. This was a randomized, double-blind, two-center, parallel clinical study covering 8 weeks of product use by 115 subjects. The hypersensitivity of the affected teeth was assessed by tactile stimulation, cold air stimulation, and overall subjective patient response. The three treatment groups exhibited comparable baseline sensitivity. These three methods of clinical assessment demonstrated that the desensitizing ability of a relatively higher fluoride dentifrice (1,400 ppm), delivered either as amine fluoride or sodium fluoride, did not differ significantly from that of the placebo dentifrice.

[Plaque--gingivitis--periodontitis. (2) Microbiology and pathogenesis of periodontitis]. / Plaque--Gingivitis--Parodontitis. (II) Mikrobiologie und Pathogenese der Parodontitis.

In a survey, current conceptions regarding the origin of gingivitis and periodontitis, as well as their clinical picture, are described. After the build-up of the bacterial plaque in several phases to form a periodontal pathogenic plaque, following a short, acute stage, a chronic gingivitis soon establishes itself in the neighbouring soft gingival tissue, from which, not inevitably, however, a periodontitis can develop after some years, the osseous parts now also being involved in the periodontal destruction, in which the polymorphonuclear neutrophilic granulocytes appear to have a major share. Depending on the age of the patient, progress of the disease, and the composition of the subgingival plaque, endeavours are made to classify the periodontal diseases into four subgroups. In recent years, however, doubt has increased as to whether gingivitis and even the periodontitides can be considered as comprising a single disease. However, this does not affect therapeutic concepts developed on the basis of opinions to date and which, as a rule, are successful, so that, for the time being, there is no reason for a change in this sphere.

Root debridement of molars with furcation involvement using diamond-coated sonic scaler inserts during flap surgery -- a pilot study.

In our laboratory, we modified sonic scaler inserts to increase effectivity of root surface instrumentation of molars with furcation involvement during flap surgery. The working end of conventional sonic scaler inserts was thickened ellipsoidally and diamond coated. Inserts with variously angled shafts were designed in order to facilitate insertion into the furcation. A clinical, split-mouth study examined the debridement of molars with furcation involvement during flap surgery using either hand instruments or diamond-coated sonic scaler inserts with 15 patients. Average treatment time was cut by ca. 50%, using diamond-coated inserts as compared to hand instruments for root surface debridement during surgery. 2 years after surgery, the clinical parameters had not been influenced by type of instrument used.

Root debridement of single-rooted teeth with a diamond-coated sonic scaler insert during flap surgery. A pilot study.

In our laboratory, we modified inserts of a sonic scaler to increase effectivity of root surface instrumentation during flap surgery. The present clinical study investigates whether use of this diamond-coated, thickened insert facilitates more rapid root debridement compared to hand instruments and whether clinical wound healing is influenced by the type of instrument used. In 13 patients with moderate to advanced periodontal destructions, flap surgery was carried out on single rooted teeth with probing depth of > or =6 mm. The mean amount of time saved by root debridement with the diamond-coated insert was 60% over curets. Regardless of the used instrumentation method probing depths and attachment level changes were altered and remained unchanged for 2 years after surgery. In conclusion the newly-developed, diamond-coated sonic scaler insert facilitates more rapid root debridement during flap surgery than hand instruments without disadvantageously affecting clinical healing.

[Psychological aspects on the treatment with periodontal surgery]. / Einige psychologische Aspekte zum Ablauf der parodontalchirurgischen Behandlung.

In a pilot study on psychological aspects of periodontal treatment more than 90% of 95 patients gave a positive rating of our approach of periodontal surgery by quadrants in cases of profound periodontitis. On the basis of their own experience with this course of surgery more than 90% of patients would recommend periodontal treatment to others. The results of our questionnaire survey confirm that their is no reason for doing periodontal surgery at one appointment. About half of the patient showed a reduction of their anxiety level in the course of surgical periodontal treatment. With increasing interval (1 year) a minor part of the patients partly modified their opinion on some of the questions asked.

A study on the imaging of complex furcation forms in upper and lower molars.

BACKGROUND, AIMS: The form of the molar roots and their furcated region influence both the pathogenesis of periodontal destruction and therapeutic attempts. METHOD: Using a specially-constructed measuring device, 359 1st and 2nd molars, both upper and lower, were analysed 3-dimensionally. The parameters measured were horizontal furcation concavity, height of root trunk, degree of root taper, the distance between the root prominences adjacent to the furcation entrances and the angle of root separation. RESULTS: The mean horizontal furcation concavity in lower molars was 0.5 mm at a distance of 1 mm apical to the cemento-enamel-junction (CEJ) and 3 mm at the distance of 4 mm apical to the CEJ. The angle of root separation was between 16 degrees (lower jaw molars lingual) and 29 degrees (upper jaw molars distal). The vertical distance from root separation to CEJ averaged 3.3 mm in lower jaw molars and 4.8 mm in upper jaw molars. CONCLUSIONS: Our findings underline the variability of furcation morphology.

[Interproximal tooth cleansing of abutment teeth and pontic design]. / Interdentalraumhygiene an Bruckenpfeilern und Gestaltung des Zwischengliedes.

This clinical study was an attempt to find out if a patient's home care plaque control at his or her abutment tooth is more effectively enhanced by a modified ridge lap or a hygienic pontic design. Oral hygiene was performed either with a tooth brush alone or in combination with an interdental brush. We found that the effectivity of interproximal toothcleaning was not influenced by the pontic design and that only interdental brushes permit a good plaque control at the proximal area of the abutment tooth. This implies that "self cleansing" is non-existent in these tooth areas.

Instrumentation of furcation with modified sonic scaler inserts: study on manikins, part I.

The purpose of this study was to determine the suitability of different scaling instruments for the debridement of furcations. 12 upper and 12 lower replicated molars with through-and-through furcations were instrumented 3x with 5 different types of instruments: (i) hand instruments; (ii) hand instruments in conjunction with diamond burrs; (iii) a conventional ultrasonic scaler insert; (iv) a conventional sonic scaler insert; (v) a set of 2 modified diamond coated sonic scaler inserts with different angulated shafts. The plastic replicas were fixed in a manikin head without replicated soft tissues. Following debridement, weight loss and % of instrumented furcation area were assessed. In the case of lower molars, it made little difference whether they were treated with hand instruments, hand instruments combined with diamond burrs, or diamond-coated sonic scaler inserts. On upper molars, however, significantly more area was instrumented with the diamond-coated inserts than with the other instruments. Substance removal was greater with diamond-coated inserts than with the other devices. In conclusion, an effective debridement of the furcation seems possible only with an odontoplasty, in which a furcation is fitted to the instrument by means of intensive instrumentation, thus leading to substance loss. To improve results with these instruments, further research is necessary.

Instrumentation of furcation with modified sonic scaler inserts: a study on manikins (II).

We developed a sonic scaler tip with an ellipsoid diamond-coated bud and contra-angulated shafts to overcome problems resulting from furcation anatomy. In this study, extracted molars were instrumented in a dummy model without any replicated soft tissues using 3 different instrumentation methods (i) curettes, (ii) diamond-coated sonic scaler tips with normal handle and (iii) diamond-coated sonic scaler tips in 2 handles with varying power levels. 15 extracted upper and lower molars were instrumented using each of the 3 instrumentation types. Following debridement, loss of substance and % of furcation area instrumented were assessed. In both upper and lower molars, significantly more surface area was instrumented in one instrumentation run with diamond-coated tips than with curettes. Substance loss was greater with diamond-coated tips than with hand instruments. In conclusion, an effective debridement of the furcation roof seems only possible with odontoplasty. Clinical evaluation of this approach to root debridement is needed.

[Periodontal treatment of furcally involved teeth: with or without root resection?]. / Parodontalbehandlung furkationsbefallener Zähne: Mit oder ohne Radektomie?

A retrospective radiographical and clinical evaluation of 275 molars (59 patients) with different classes of furcation involvement was assessed. Flap operations with and without root resections had been performed and the patients were enrolled in a regular maintenance program for at least 4 years (up to 8 years). The life expectancy of molars with root resection was compared to molars conventionally treated by flap operation. Probing depth was reduced significantly on molars of the lower jaw even with class III involvement, progression of periodontal disease could be arrested. The progression of bone loss (mean 1.4 mm) in molars of the upper jaw with a class III involvement could be stopped only by root resection. During the observation period 12 teeth had to be extracted. 8 for nonperiodontal reasons. The long-term prognosis of class III furcations only treated by flap operation with or without tunnel preparations was as good as that of root resected molars.

[Assessment of the acceptance of modern periodontal treatment]. / Untersuchungen zur Akzeptanz einer modernen Parodontalbehandlung.

In a retrospective study we assessed the acceptance of necessary modern periodontal treatment by more than 2200 patients in the years 1981-1987. 50% of the patients withdrew from treatment in the presurgical phase and 42% in the postsurgical maintenance phase; particularly during the first year the drop out rate was high (64%). One of the reasons could be a certain lack of health awareness and fading willingness of the patients for permanent cooperation as known from longstanding chronic diseases in general medicine. Therefore it remains necessary to enhance periodontal health awareness and to promote information on the cause and treatment of periodontitis and the subsequent maintenance care.

[Guided tissue regeneration for the treatment of different periodontal defects. A clinical study]. / Gesteuerte Geweberegeneration (GTR-Technik) bei unterschiedlichen parodontalen Defekten. Eine klinische Studie.

In 31 patients we implanted a teflon membrane (Gore-Tex) during flap operation for a duration of 6 weeks. The periodontal situation was assessed clinically and radiographically 1-1.5 years after surgery. The study comprised 18 upper and lower molars with furcation involvement and 15 single-rooted teeth with a 2-wall-, 3-wall- or combined bony defect. Clinical gain of attachment only occurred in furcation class II lesions (upper molars + 2.3 mm, lower molars + 2.5 mm), whereas the attachment level was unchanged in "through and through" furcation defects in the upper jaw and loss of attachment was observed at lower molars with class III furcations. In single-rooted teeth the gain of attachment varied between 0.5 and 8.5 mm, depending on the proportions of the defect and the number of the surrounding bony walls.