Periodontal attachment loss over 14 years in cleft lip,alveolus and palate (CLAP,CL, CP) subjects not enrolled in a supportive periodontal therapy program

OBJECTIVES: (i) To assess the overall and (ii) cleft-associated rate of periodontal disease (PD) progression in subjects with cleft lip, alveolus and palate (CLAP) and (iii) to compare these rates with those of subjects with cleft lip (CL) and cleft palate (CP). MATERIAL AND METHODS: Twenty-six subjects not enrolled in a supportive periodontal therapy (SPT) program were examined in 1979, 1987 and 1993. PD progression was assessed as increase in pocket probing depth (PPD in mm) and probing attachment loss (PAL in mm). RESULTS: Extensive plaque accumulation and high frequencies of gingival units bleeding on probing were observed at all three examinations. A statistically significant increase in mean PPD of 0.57+/-0.21 mm (SD) in both groups as well as a statistically significant loss of PAL of 1.85+/-0.23 mm (SD) in the CLAP group and of 1.72+/-0.21 mm (SD) in the CL/CP group occurred over the observation period (p<0.05). In subjects with CLAP, statistically significant increases in PPD and loss of PAL were recorded over time at sites adjacent to the cleft as well as at control sites (p<0.05). Over 14 years, however, PPD increased 1.72+/-1.08 mm (SD) at cleft sites versus 0.72+/-1.14 mm (SD) at control sites (p<0.05), and PAL amounted to 3.19+/-1.35 mm (SD) at cleft sites versus 2.41+/-1.52 mm (SD) at control sites (p<0.05). CONCLUSION: Both the CLAP and the CL/CP subjects are at high risk for PD progression if no SPT program is provided. This also suggests that alveolar cleft sites in subjects with high plaque and gingival inflammation scores underwent more periodontal tissue destruction than control sites over a 14-year period.     

One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial

Background: Single photodynamic therapy (PDT) has been effective in initial periodontal therapy, but only improved bleeding on probing (BoP) in maintenance patients after a single use. Repeated PDT has not been addressed.
Objectives: To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance.
Material and Methods: Ten maintenance patients with 70 residual pockets [probing pocket depth (PPD)5 mm] were randomly assigned for treatment five times in 2 weeks (Days 0, 1, 2, 7, 14) with PDT (test) or non-activated laser (control) following debridement. The primary outcome variable was PPD, and the secondary variables were clinical attachment level (CAL) and BoP. These were assessed at 3, 6 and 12 months following the interventions.
Results: Greater PPD reductions were observed in the test (−0.67 ± 0.34; p =0.01) compared with the control patients (−0.04 ± 0.33; NS) after 6 months. Significant CAL gain (+0.52 ± 0.31; p =0.01) was noted for the test, but not in the control (−0.27 ± 0.52; NS) patients after 6 months. BoP percentages dcreased significantly in test (97–64%, 67%, 77%), but not control patients after 3, 6 and 12 months.
Conclusions: Repeated (five times) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients. The effects were best documented after 6 months.     

Periodontal status of teeth with crown–root fractures: results two years after adhesive fragment reattachment

Aim: This series of case reports evaluated the impact of adhesive crown–root fragment reattachment in periodontally healthy teeth suffering from crown–root fractures on various parameters of periodontal health over a time course of 2 years.
Material and Methods: A total of 20 teeth with crown–root fractures in 18 periodontally healthy subjects were evaluated. After open-flap access, crown–root fragments were adhesively reattached to the root stub. In all cases, the vertical difference between the alveolar bone crest and the fracture line was 1 mm, i.e. violating the biological width. Subsequently, clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BoP) and gingival index (GI) scores were recorded at 6, 12 and 24 months postoperatively for the restored teeth as well as plaque index (PlI) and periodontal screening index (PSI) values for the whole dentition.
Results: Two years after therapy, recorded CAL, PPD, BoP, GI, PlI and PSI scores revealed healthy periodontal conditions in 18 out of 20 treated teeth. Two teeth had suffered again from fragment fracture due to new traumata.
Conclusions: Adhesive fragment reattachment in periodontally healthy teeth affected by crown–root fractures had no detrimental impact on periodontal health over a time course of 2 years.     

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.     

Full-mouth treatment concepts for chronic periodontitis: a systematic review

Objectives: To systematically review the effectiveness of full-mouth treatment concepts for chronic periodontitis.
Material and Methods: A search was conducted for randomized, controlled clinical trials including full-mouth scaling with (FMD) or without (FMS) the use of antiseptics and quadrant scaling (control). Data sources included COHG, CENTRAL, MEDLINE and EMBASE. Reviewers independently conducted data abstraction and quality assessment. The primary outcome was tooth loss; secondary outcomes were the reductions of PPD and BOP and a gain of CAL.
Results: Of 216 identified abstracts, seven trials were included. Meta-analysis revealed a weighted mean difference (WMD) for the reduction of PPD between FMD and control of 0.53 mm [95% confidence interval (CI) (0.28, 0.77), p <0.0001] in moderately deep pockets of single-rooted teeth. The WMD for gain in CAL was 0.33 mm [95% CI (0.04, 0.63), p =0.03] in moderately deep pockets of single- and multi-rooted teeth. Comparing FMD and FMS, the WMD for the reduction of CAL amounted to 0.74 mm [95% CI (0.17, 1.31), p =0.01] in deep pockets of multi-rooted teeth in favour of FMS. For BOP a WMD –18.0% [95% CI (−34.30, −1.70), p =0.03] was calculated in deep pockets of single-rooted teeth in favour of FMD.
Conclusions: In adults with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies.     

Cleft lip and cleft palate in Santo Domingo

The purpose of this study was to analyze the occurrence of isolated cleft lip (CL), cleft lip with cleft palate (CL + CP) and isolated cleft palate (CP) and their distribution according to sex and laterality in Santo Domingo, Dominican Republic, located in the Caribbean Archipelago. The sample consisted of 439 hospital records (204 males and 235 females) of patients attending a children's public hospital in Santo Domingo over the period of May 1973 to December 1976. Of all facial clefts, the highest percentage (36.4%) was presented by CL, followed by CP (32.1%) and CL + CP (31.4%). Of all facial clefts, males presented the highest percentage (53.5%). For both sexes, there was an equal number of cases with CL (17.54 %) but more males had CL + CP (0.20 > P0.10) and more females presented CP (P < 0.001). The left-sided defects were almost twice as common as the right-sided defects. The ratio of unilateral clefts-to-bilateral clefts was 5.4:1.     

Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration

Background: Surgery utilizing an enamel matrix protein derivative (EMD) or guided tissue regeneration (GTR) has been shown to promote periodontal regeneration.
Aim: To evaluate the 10-year results following treatment with EMD, GTR, EMD+GTR, and open flap debridement (OFD).
Material and Methods: Thirty-eight patients out of an initial group of 56 participants were treated with one of the four modalities. Results were evaluated before surgery, at 1 year, and at 10 years. Primary outcome variable was CAL change.
Results: Treatment with EMD yielded a mean CAL gain of 3.4±1.0 mm ( p <0.001) and 2.9±1.4 mm ( p <0.001) at 1 and 10 years, respectively. GTR resulted in a mean CAL gain of 3.2±1.4 ( p <0.001) at 1 year and 2.8±1.2 mm ( p <0.001) at 10 years. Mean CAL gain in the EMD+GTR group was of 3.3±1.1 mm ( p <0.001) and 2.9±1.2 mm ( p <0.001) at 1 and 10 years, respectively. Treatment with OFD demonstrated a mean CAL gain of 2.0±1.2 mm ( p <0.01) at 1 year and 1.8±1.1 mm ( p <0.01) at 10 years. Compared with OFD, the three regenerative treatments resulted in statistically significant ( p <0.05) higher CAL gain, at both 1 and 10 years. The CAL change between 1 and 10 years did not present statistically significant differences in any of the four groups.
Conclusion: The present results indicate that the clinical outcomes obtained with all four approaches can be maintained over a period of 10 years.     

Clinical and genetic study on 356 Brazilian patients with a distinct phenotype of cleft lip and palate without alveolar ridge involvement

Oral clefts include cleft lip (CL), cleft lip with cleft palate (CLP) and cleft palate (CP), with wide variations in clinical presentation and degree of severity. We described a sample of individuals with CL and CP without alveolar arch involvement (CL + CP) to verify if the characteristics of this group are distinct from those with CL with or without CP (CL/P) described in literature. The sample was composed of 356 patients with CL + CP, registered at HRCA-USP, Bauru-SP-Brazil. The following characteristics were investigated: sex ratio, parental age at the time of conception, parental consanguinity, familial recurrence, laterality of the cleft and associated anomalies. A subgroup of 30 individuals with microforms of CL and CP were taken from the sample and compared with the remaining cases. Statistical differences were found between this CL + CP sample and the literature data for groups with CL/P regarding laterality, sex ratio, consanguinity, familial recurrence, and the presence of associated anomalies. The microform sample showed a statistical difference in paternal age. In most evaluated aspects, this sample presents similar characteristics to the consulted literature data for CL/P; as do the group of microform cleft cases when compared with the remaining CL + CP sample in this study. Microforms of cleft can represent a target group for investigation into the embryogenetic mechanisms of oral clefts and their phenotypic variability.     

The significance of alveolar bone in periodontal disease

The periodontal conditions in 19 patients with unilateral cleft lip, alveolus and palate (CLAP) and in 6 patients with bilateral CLAP, were evaluated in 1979 and re-examined in 1987. During these 8 years, these patients were not subjected to any professionally supervised maintenance care program. Pronounced plaque accumulation and high frequency of gingival units exhibiting bleeding on probing were noted in the majority of the patients both in 1979 and 1987, documenting inadequate oral hygiene standards with resulting inflammatory reactions of the periodontal tissues. Progression of periodontal disease over time was assessed as loss of clinical attachment and loss of alveolar bone height. The periodontal destruction was not found to be more severe at cleft sites with a long connective tissue attachment than at control sites not affected by cleft defects. It was concluded that sites with a long supracrestal connective tissue attachment do not seem to be more prone to periodontal destruction, induced by bacterial infection, than sites with a normal length of the supraalveolar fibrous attachment. The results also show that the alveolar bone height, as visualized in radiographs at sites with alveolar defects, is of limited value for the diagnosis of the degree of periodontal destruction at such sites.     

Undetected anomalies in foetuses with a prenatal diagnosis of isolated cleft

The aim of this study was to determine the rate of undetected additional anomalies following a prenatal diagnosis of isolated oral cleft. Data of all infants with a prenatal diagnosis of isolated oral cleft born between 2000 and 2015 were studied retrospectively. Additional anomalies detected after birth were categorized as minor or major and included structural and chromosomal anomalies. Isolated clefts of the lip (CL), lip and alveolus (CLA) and lip, alveolus, and palate (CLAP) were diagnosed prenatally in 176 live-born infants. The type of cleft was more extensive after birth in 34/176 (19.3%) and less extensive in 16/176 (9.1%) newborns. Additional anomalies were diagnosed in 24 infants (13.6%), of which 12 (6.8%) were categorized as major. The latter included two submicroscopic chromosome anomalies and two gene mutations. Postnatal additional anomalies occurred more frequently in CLA and CLAP than in CL, and more in bilateral than in unilateral clefts. Major anomalies are still found in infants with a prenatal diagnosis of an isolated oral cleft. The prevalence of additional anomalies seems to be related to the type and bilaterality of the cleft, and this should be considered during prenatal counselling.     

Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapy

OBJECTIVES: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing - SRP). MATERIAL AND METHODS: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths >/=5 mm and with radiographic angular bone defects >3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t-tests) was used to compare response to treatment in control versus experimental sites. RESULTS: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3+/-0.5 mm for control sites and 2.0+/-0.3 mm for experimental sites. The mean CAL gain was 1.8+/-0.4 mm for control sites, and 1.4+/-0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p>0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months. CONCLUSION: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP.     

Enamel matrix proteins in the regenerative therapy of deep intrabony defects

AIM: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). MATERIAL AND METHODS: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of > or =3mm. Heavy smokers (> or =20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up. RESULTS: At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1+/-1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm. Pocket reduction was also significantly higher in the test group (3.9+/-1.7 mm) when compared to the controls (3.3+/-1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains > or =4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm). CONCLUSIONS: The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.     

Resolution of periodontal inflammation does not guarantee improved glycemic control in type 1 diabetic subjects

Objective: The aim of this study was to find out if periodontal therapy has any effect on glycemic control of type 1 diabetes mellitus (DM).
Subjects and Methods: The periodontal health status of 65 type 1 diabetic subjects was assessed at the baseline and 8 weeks after completion of periodontal therapy. Glycemic control was assessed on both visits by measuring the percentage of glycosylated haemoglobin (GHbA1c). The change in HbA1c (ΔHbA1c) was assessed by using both a positive or negative change 0.5% and any change in HbA1c.
Results: The mean HbA1c level (±SD) of the whole study group was 8.6% (±1.5) at the baseline and 8.5% (±1.5) after treatment. Glycemic control improved during the study period in 23 subjects (35%) and worsened in 18 subjects (28%). Approximately 78% of the bleeding sites and 87% of the sites with probing depth 4 mm presented healing. ΔHbA1c associated significantly with baseline HbA1c but not with baseline periodontal health status or periodontal healing.
Conclusion: Regardless of a significant resolution of periodontal infection, a great majority of the subjects did not present any improvement in their glycemic control.     

Microbial colonization patterns predict the outcomes of surgical treatment of intrabony defects

AIM: To explore the impact of bacterial load and microbial colonization patterns on the clinical outcomes of periodontal surgery at deep intrabony defects. MATERIALS AND METHODS: One hundred and twenty-two patients with advanced chronic periodontitis and at least one intrabony defect of >3 mm were recruited in 10 centres. Before recruitment, the infection control phase of periodontal therapy was completed. After surgical access and debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. Microbial colonization of the defect-associated pocket was assessed using a DNA-DNA checkerboard analysis. RESULTS: Total bacterial load and counts of red complex bacteria were negatively associated with CAL gains 1 year following treatment. The probability of achieving above median CAL gains (>3 mm) was significantly decreased by higher total bacterial counts, higher red complex and T. forsythensis counts immediately before surgery. CONCLUSIONS: Presence of high bacterial load and specific periodontal pathogen complexes in deep periodontal pockets associated with intrabony defects had a significant negative impact on the 1 year outcome of surgical/regenerative treatment.     

Periodontal infection as a possible severity factor for rheumatoid arthritis

OBJECTIVE: Clinical effects of periodontal treatment on biochemical and clinical markers of disease severity in rheumatoid arthritis (RA) patients with periodontal disease were evaluated. METHODS: Forty-two patients were assigned to two groups, G1 (n=16) and G2 (n=26). G1 patients were submitted to oral hygiene instruction and professional tooth cleaning and G2 patients additionally had full-mouth scaling and root planing (SRP). Clinical periodontal measurements were obtained at baseline and 3 months after periodontal treatment. A Health Assessment Questionnaire (HAQ) was used to evaluate their performance on daily living. Rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and drug therapy were assessed. RESULTS: Both groups presented a full-mouth improvement in all periodontal clinical parameters (p<0.05), with the exception of clinical attachment level (CAL) and probing pocket depth (PPD) >6 mm for G1. G2 showed greater mean reductions on PPD >4 mm than G1 (p<0.001). HAQ analyses showed a reduction on the degree of disability of G2, but not statistically significant. ESR was significantly reduced for G2 after SRP although RF did not show statistical reductions. CONCLUSION: The data suggest that periodontal treatment with SRP might have an effect on the ESR reduction.     

Relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects

Objective:  The purpose of this study was to evaluate the relation of bone turnover markers such as bone formation and resorption to periodontal disease and jaw bone morphology in elderly Japanese subjects.
Subjects and methods:  We selected 148 subjects for participation in this study. All subjects were aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). Biochemical parameters of bone turnover measured included urinary deoxypyridinoline, serum osteocalcin (S-OC), and serum bone-specific alkaline phosphatase. In addition, to evaluate the jawbone, we used the mandibular inferior cortex classification (MIC).
Results:  Serum osteocalcin had significantly higher (males: P  =   0.038, females: P  =   0.041) tendency for MIC Class (ANOVA). Multiple linear regression results showed that the number of remaining teeth and S-OC were negatively associated with the percentage of sites with ≥6 mm CAL ( R ² = 0.322, P  < 0.001). Coefficients and betas were −0.71, −0.46 ( P  <   0.001) and −1.11, −0.28 ( P  =   0.002), respectively.
Conclusion:  In conclusion, this study suggests that there is a significant relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects.     

Effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy

The purpose of the present study was to evaluate clinically the effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy. A total of 19 patients with chronic periodontitis were enrolled in the study. Each subject had three sites in each of two contra-lateral jaw quadrants with a probing pocket depth (PPD) of ≥5 mm and bleeding on probing (BoP+). All teeth received scaling and root planing under local anesthesia followed by irrigation with sterile saline. An oily calcium hydroxide suspension (Osteoinductal) was applied subgingivally to the test sites at random. All sites were reexamined after 1, 2 [gingival index (GI) and BoP], and 3 weeks (GI, BoP, and PPD). Treatment success was defined as no signs of GI (GI=0), no BoP (BoP−), and pocket closure (PPD≤4 mm). At all three different points in time, there were improvements in both GI and BoP at the control and test sites, which were in favor of the test therapy (p<0.05). For PPD change, no differences were found between the test and the control sites. The results of the study suggest that the topical application of an oily calcium hydroxide suspension (Osteoinductal), after nonsurgical periodontal therapy, improves early periodontal wound healing.     

Epidemiological and genetic study of 121 cases of oral clefts in Kuwait

Authors – S Al‐Bustan, M El‐Zawahri, A Al‐Adsani, R Bang, I Ghunaim, B Maher, S Weinberg, M Marazita Aim – The aim of the study was to ascertain some epidemiological factors such as sex and consanguinity that may be associated with cleft lip with or without cleft palate (CL ± CP) in Kuwait as well as to conduct genetic segregation analysis of these families. Setting and sample population – A total of 113 families ascertained through 121 CL ± CP and CP surgical probands in Kuwait. The frequencies of cleft types and the epidemiological variables were calculated using SPSS version 5.0 software. Chi‐square for goodness‐of‐fit test was used to test the significance of the associated epidemiological variables to facial clefts. Genetic segregation analysis was performed on 76 families with extended pedigrees and included only those with non‐syndromic CL ± CP (NS CL ± CP). Major locus segregation analysis was used to fit models to the observed family patterns under Class A regressive models as implemented by REGD routine in S.A.G.E. release 4.0. A test for heterogeneity was also conducted to complete data set in addition to two subsets: Arabs and nomads. Results – Of the 121 patients, 34(28.1%) had CP, 30(24.8%) had CL and 57 (47.1%) had CL + CP. The male to female ratio was 0.89 for CP, 1.14 for CL, 1.35 for CL + CP and 1.2 for all the clefts. The percentage of consanguineous families among those with a positive family history (60%) was not significantly different from that of the general population (54.3%), whereas for all the families with clefts the percent consanguineous was significantly lower (38%). No evidence of heterogeneity in the results between the Arab and nomad subsets was observed. The results for the major locus segregation analysis were inconclusive. Conclusion – No definite association was observed between consanguinity and the occurrence of facial clefts in Kuwait. General transmission models in the full data set showed no evidence of heterogeneity in the results between the Arab and nomad subsets.     

Effect of partial recording protocols on severity estimates of periodontal disease

Objectives: The study aim was to assess bias magnitudes of periodontal disease severity estimates for specific partial recording protocols (PRPs) in epidemiological studies.
Material and Methods: Estimates of mean clinical attachment loss (MCAL) and mean probing pocket depth (MPPD) were derived for 20 different PRPs using full-mouth periodontal data from 1437 dentate Brazilian subjects 14–103 years old having at least four teeth. Biases, relative biases and intra-class correlations for all PRPs were evaluated. Graphical methods were used to assess how well the PRP-based estimates agreed with full-mouth scores across levels of disease.
Results: Slightly higher levels of disease were evidenced on lingual than on buccal sites. Seven multi-site PRPs and the Ramfjörd PRP produced small biases in MPPD (−0.17 to 0.04 mm) and MCAL with relative biases under 8% and 4% in absolute value for MPPD and MCAL, respectively. Biases for full- and random half-mouth-based PRPs were similar. The three-site random half-mouth MB–B–DL and the Ramfjörd PRPs produced the smallest biases, with relative biases <3% in absolute value for MPPD and MCAL.
Conclusions: Bias for MPPD or MCAL estimates varies by site type, number of sites per tooth and number of quadrants included in the PRP.     

Dental age and asymmetry in the formation of mandibular teeth in twins concordant or discordant for oral clefts

Abstract – The aims of this investigation were: 1) to study the effects of zygosity and the type of cleft on dental age in pairs of twins concordant or discordant for oral clefts, 2) to compare dental age in the twins with that in a population of normal Finnish children, and 3) to study asymmetry in the formation of mandibular teeth with regard to zygosity and the type of cleft. Twenty-two pairs of twins (8 mono- and 14 dizygotic) and one set of monozygotic triplets concordant or discordant for cleft lip (CL), cleft palate (CP), or both (CLP) were investigated. Four of eight mono- and 12 of 14 dizygotic pairs were discordant for clefts. An orthopantomogram of both twins was taken on the same day. In 7 of the 8 monozygotic (88%) and in 4 of the 14 dizygotic (29%) pairs, the dental age was the same in both twins. Of the 12 pairs discordant for clefts, the dental age of the twin with cleft was delayed in 5, advanced in 3, and the same in 4 compared with that of the twin without a cleft. The means of chronologic age and dental age were counted separately for the cleft subgroups and the non-cleft (NONC) group. The dental age was advanced in the CL twins and in the NONC twins, and was the same as chronologic age in the CP twins, but it was delayed in the CLP twins. Asymmetric formation of the 14 mandibular teeth (mostly the second premolars) was encountered in 3 of 8 CLP, in 3 of 18 CP, in 1 of 16 NONC, and in none of 5 CL children. The great similarity in tooth formation among the monozygotic twins indicates strong genetic control of dental maturation in twins concordant and also discordant for cleft.