Periodontal bone loss of teeth with metal posts

Abstract Periodontal bone loss was compared in teeth with metal posts and contralateral teeth without metal posts by means of intraoral radiographs. 250 subjects with a high standard of dental awareness and a great number of teeth retained were included in the study. The periodontal bone loss was calculated from the ratio of the distance from bone margin to apex (bone height) and the distance from crown tip to apex (tooth length). Intra-individual differences between experimental and control teeth were statistically analyzed with the Student paired t-test. 96 subjects (38%) had 1 teeth with root posts. In all, 172 teeth with posts were found, i.e., on average 1.8 teeth per subject. The means ± SEM of the ratio bone height to tooth length in experimental and control teeth were 0.52 ± 0.007 and 0.56 ± 0.006, respectively. The difference was statistically highly significant (P < 0.001). Statistically significant differences were found for incisors, premolars and molars. Regression analysis indicated more severe bone loss for teeth with longer posts. The results suggest that the periodontal bone support of teeth with metal posts is inferior to that of teeth without metal posts.     

The loss of the remaining natural teeth

A survey was carried out of 453 people who had their remaining teeth extracted in a dental teaching hospital between January 1980 and June 1983. Seventy-two individuals at risk to endocarditis formed a Cardiac group, of which 57 per cent were women. The remaining 381 formed a Normal group which had a higher proportion of men (67 per cent). The mean age at clearance of the 453 individuals was 53·6 ± 13 years (men 53·4 years, women 53·8 years). The Cardiac group mean age was 54·4 years and that of the Normal group 53·4 years. The mean number of teeth extracted was 15·6 ± 2·9, however, there was great variation at all ages. Comparisons with studies of British groups carried out during the past 15 years support the conclusions that the mean age at which people become edentulous has increased, particularly in women. There was little difference between the pattern of clearance in men and women.     

Comparison of radiographic and clinical signs of early periodontal disease

abstract — The purpose of the study was to examine the justification of the common assumption that early periodontal disease can be diagnosed on the basis of qualitative radiographic changes in the alveolar bone margin. The material comprised 100 bite wing radiographs of quantitatively intact interdental septa between the mandibular first and second premolars of 65 males aged 19–22 years. The width of the periodontal space, the continuity of the crestal cortical bone layer, and the pattern of trabeculation of each septum were used as criteria for classifying the septa as either healthy or probably or positively diseased. The study revealed that no relationship exists between the Gingival Index score and the presently studied qualitative radiographic findings. It was concluded that the constant interplay between physiologic constructive and destructive phases within the alveolar bone efficiently masks the minute qualitative radiographic changes pertaining to early periodontal disease.     

Periodontal bone loss in the aging beagle dog A radiographic study

Studies in the beagle dog have clearly established the usefulness of this breed in periodontal disease research. However, little is known about the progressive nature of the disease with advancing age. It is the purpose of this paper to describe frequency and distribution of radiographically detectable lesions in an aging population of 166 colony dogs. 3 grades of alveolar bone loss were determined on high-quality postmortem radiographs. The number of teeth involved was similar in male and female and was age-dependent. Disease was more frequent in the maxillary arcades, with the 2nd upper premolar most frequently involved. Most extensive bone loss was noted around the 3rd and 4th upper premolars, and 1st and 2nd lower molars. It is felt that by the study of such a large group of older colony dogs, a better understanding can be gained of the expected alveolar bone loss with age as determined radiographically.     

Periodontal conditions, remaining teeth and oral hygiene habits in a group of Vietnamese refugees in Norway

Since 1975, about 3500 Vietnamese refugees have come to Norway. The purpose of the present study was to report on remaining teeth and periodontal conditions in a population of 200 adolescent and adult Vietnamese refugees. The mean number of remaining teeth ranged from 27.8 in the youngest age group to 24.6 in the oldest. This number of teeth is slightly lower than reported from Norwegian populations, but similar to other Asian populations. Almost all index teeth showed dental plaque, and subgingival calculus was observed in 9 of 10 teeth after the age of 20. Gingival bleeding was seen on all index sites of 26.5% of the subjects and all subjects above the age of 40 had gingivitis adjacent to one or more index teeth. There was a progression of probeable pocket depths with increasing age. In the oldest age group, 72.7% had pockets between 3.5 mm and 5.5 mm. The data indicated that if optimal conditions should be obtained, substantial resources would be required. In populations with limited resources and with relatively few subjects with severe periodontal breakdown, it is suggested that an identification of subjects "at risk" to be dentally handicapped through loss of teeth, should be a priority.     

Clinical and radiographic appearance of proximal carious lesions at the time of operative treatment in young permanent teeth

Clinical tissue changes were recorded during restorative treatment of proximal carious lesions of young premolars and molars. 60 proximal surfaces with radiolucencies in the inner half of the enamel or the outer half of the dentin were treated. The extent and character of the tissue changes were documented with photographs taken during drilling and evaluated after magnification. The maximum extent for each lesion was correlated to the extent of the radiographically observed lesion. The results showed that 70% of the restored surfaces were associated with a breakdown of the enamel surface. When the radiolucency did not extend deeper than into the inner half of the enamel, cavities were found in 61%; for lesions with a radiolucency extending into the outer half of the dentin the percentage was 78%. In the majority of cases the cavity was limited to the enamel. In all cases discoloration was observed in the enamel. The dentin was soft and discolored in 83%. Severe damage of tooth substance was found in 12% of the teeth.     

Periodontal diagnosis in the 1990s

Clinicians are usually inclined to reduce data obtained from diagnosis to a simpler form such as "yes or no" answers in order to obtain useful parameters for daily practice. It should be realized, however, that the diagnostic process very rarely exhibits "black and white" situations. Rather the evaluation of numerous "grey levels" is imperative. The diagnostic process, therefore, remains always incomplete and inaccurate, and it represents an evaluation of probabilities rather than certainties. For this reason, the diagnostician should realize and understand the mathematical relations between the information provided by diagnostic tests and the clinical situation actually present at the time of the test. This will allow one to convert diagnostic results into therapeutic procedures with a high degree of confidence. Since results from diagnostic tests are quite often used to decide on treatment, complex data are reduced to simple dichotomy, such as presence or absence of disease, normal or abnormal conditions, etc. In order to react to diagnostic tests in an ordinal, dichotomous manner, the clinician has to choose a particular level of a test at which he initiates treatment without having the assurance that this level represents the one and only standard at which treatment has to be initiated.     

Periodontal healing of extracted dogs' teeth air-dried for extended periods and soaked in various media

Abstract The aim of this study was to determine the periodontal healing of replanted dogs’ teeth which, after extended extra-oral dry times, had been soaked in various media before replantation. Incisors and premolars of beagle dogs were root canal treated, extracted and bench dried. The teeth were grouped according to dry times of 30, 45 and 60 minutes. Each group of teeth was soaked in one of three media, Hank's balanced salt solution, Via Span (Belzer UW-CSS, Dupont Pharmaceuticals), or Conditioned Medium (supernatant of confluent culture of human gingival fibroblasts) for 30 minutes before replantation. Controls consisted of teeth extracted and replanted without drying or soaking (negative control), and bench-dried teeth replanted without soaking in the media (positive control). The dogs were killed 6 months after replantation of the teeth, which were prepared for histologic evaluation. Five um cross-sections (every 70 Jim) of the root and surrounding tissue were evaluated for healing/resorption according to Andreasen's criteria. The best healing occurred for the roots which had been immediately replanted. Healing in the positive control groups decreased with increased dry time. For the 30–minute dry time groups, soaking in media had no beneficial effect on periodontal healing compared with the controls. Soaking in ViaSpan resulted in an increased healing incidence for both the 45- and 60- minute bench-dried groups while soaking in the other media had no consistent beneficial effect. It appears from this study that an avulsed tooth that has been left dry for 30 minutes should be replanted immediately without soaking. However, teeth that have been dry for 45 or 60 minutes would benefit from soaking for 30 minutes in ViaSpan.     

Periodontal inflammation and attachment loss: a critical problem for biological studies

BACKGROUND: In biological studies of periodontitis, there has been long-standing confusion between the ubiquitous phenomena of inflammation and the essential criterion of attachment loss. This is partly attributable to inadequate methods of clinical measurement, but seems also to be a consequence of an unproven and usually unstated assumption that the same biological processes underlie both inflammation and attachment loss. Developments in unidimensional clinical probing methods have helped in studies of periodontal treatment. However, such methods are intrinsically unsuitable in studies of periodontal diseases, and may have given them a false sense of security. The confusion has been compounded by inappropriate use of statistical techniques in an attempt to solve problems which do not arise from mathematical models but are intrinsic to measurement methods.
OBJECTIVE: This paper is a clinician's attempt to state the current difficulties and suggest some ways forward, including the development of three-dimensional measurement, non-invasive probing, and several objectives for biochemical, microbiological and immunolog-ical research.     

The relationship of bone loss observed on panoramic radiographs with clinical periodontal screening

Abstract The aim of this study was to determine the relationship between bone levels observed on dental panoramic tomographs (DPT) and the WHO/FDI recommended periodontal screening technique: the community periodontal index of treatment needs (CPITN). Computer enhancement and digital analysis were used to improve accuracy and reliability. A total of 199 posterior sextants on DPT radiographs from 50 patients (29 female and 21 male) with a mean age of 42 were examined. A statistically significant relationship was found between CPITN and radiographic measurement from the cemento-enamel junction to the alveolar crestal bone margin (A). The relationship between A and CPITN was found to fit the following equation: √A=β_i+F, where, F is constant and β_i is the coefficient corresponding to the i th codes of CPITN. It was concluded that there was a close correlation between the CPITN screening codes and bone loss as measured on the DPT radiograph.     

Periodontal treatment needs in populations of high- and low-fluoride areas of Morocco

The purpose of this study was to determine the periodontal status and treatment needs, using the CPITN index, in a population aged 7 to 60 years residing in the fluorosis area of Khouribga and the non-fluorosis area of Beni-Mellal, Morocco. A total of 2378 subjects was studied. In the youngest age groups, more subjects and sextants from Khouribga than from Beni-Mellal were free of periodontal diseases. Conversely, in Beni-Mellal, subjects in the youngest age groups presented a higher mean number of sextants with calculus than those from Khouribga. In combining the 2 areas, 1.3% of the 2319 dentate subjects examined needed no treatment and 98.7% needed at least oral hygiene instructions (TN1). The present study, based on the CPITN index, demonstrated in both areas a high prevalence of gingivitis, and a relatively low prevalence of deep pocketing, occurring on the average in less than half a sextant in the total populations.     

Radiographic and clinical examination of periodontal status of first molars in 15–16-year-old Danish schoolchildren

Abstract – The prevalence of alveolar bone loss was investigated in 2813, 15- and 16-year-old Danish schoolchildren using bitewing radiographs. The interproximal spaces of the mesial and distal aspects of the first molar tech were examined. Inly defects with depths of more than 2 mm were considered periodontal bone loss. Radiographic evidence of bone resorption was found in 48 children. When evaluated clinically, 42 out of the 48 children with radiographic sings of bone loss demonstrated clinical loss of attachment. Only four children (0.1%) had the characteristic radiographic features of juvenile periodontitis. Loss of attachment of more than 2 mm was oberved in these children.     

Periodontal status and total tooth extraction in a medium-sized city in the Netherlands

A combined sociodental research project was started in the city of Groningen in 1982 aimed at gaining insight into the reasons for total tooth extraction. Patients showing up for total tooth extraction during 1982 participated in this study by filling out a questionnaire concerning the underlying reasons for their decision to have all their teeth extracted. The dentists in this city were asked to collect all the extracted teeth and to fill out a short questionnaire for each patient about the reason (diagnosis) for the total tooth extraction. The periodontal status of the extracted teeth was established afterwards by measuring the percentage of the loss of attachment (L.A.). It appeared that most surfaces in the molar region and the front teeth in the mandible were affected by periodontal disease. Advanced generalized periodontal disease was established in 17% of the patients, accounting for 64% of all teeth with an L.A. measurement of greater than 50%. Periodontal disease could not be identified as the main clinical condition requiring tooth extraction: even in the group of 55 yr of age and older advanced periodontal disease was found in only one third of the extracted teeth. Finally, the contribution of regular dental attendance to periodontal health is discussed.     

Selection of the most accurate method of conventional radiography for the assessment of periodontal osseous destruction

Abstract The purpose of the present study was to compare the radiographic measurements of periodontal osseous destruction with the surgical measurements, which represent the true value of osseous destruction, and to select the most successful method of conventional radiography in detecting and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontitis were evaluated surgically during penodontal flap surgery and radiographically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radiographic detection ability of small osseous destruction (1–4 mm) was very low for both methods of assessment and became even lower for the initial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destruction, especially of the small destruction (4.7X). (3) Panoramic radiography underestimated the osseous destruction, whereas periapical radiography was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction assessment than panoramic, regardless of the location of the dental surfaces (jaw. tooth group, mesial or distal) and the degree of osseous destruction. (5) The deviation of the radiographic measurements of osseous destruction from the surgical measurements, as well as the difference between the two radiographic methods, depended on the jaw location, the tooth group and the degree of osseous destruction. (6) The radiographic assessment of osseous destruction underestimated the osseous destruction in initial periodontitis, it was relatively accurate in moderate periodontitis. But overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and most in that of severe osseous destruction. (7) The 2 radiographic methods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruction than the direct millimetric method of radiographic evaluation. (9) The osseous destruction as assessed from periapical radiographs by the Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study suggest that periapical radiography is more successful in detecting periodontal osseous destruction and more accurate in assessing it than panoramic radiography.     

Periodontal repair in dogs: evaluation of the natural disease model

Abstract Animal models are frequently consulted for histometric analysis of periodontal reconstructive therapy. Such models include surgical, periodontitis-simulating and natural disease defects in canines or non-human primates. Our studies suggest that homogeneity in defect height is critical for sensitivity of surgical and periodontitis-simulating supraalveolar defect models in discriminating treatment effects. We herein evaluate this model aspect for natural disease defects. Buccal-lingual histologic sections from the 2nd, 3rd, and 4th mandibular premolar teeth (P2, P3, P4) from 6 aged beagle dogs with advanced natural periodontal disease were used. Defect heights from the reduced alveolar bone to the cemento-enamel junction were recorded in central step-serial sections at the buccal and lingual surfaces of the mesial and distal roots for the premolar teeth. Mean defect height, standard deviation and coefficient of variation were calculated for tooth types and jaw quadrants, separately, and for all teeth. Confidence intervals were calculated for teeth in left and right jaw quadrants. Mean defect height and standard deviation for left and right jaw quadrants was 3.6±0.9 and 3.3±0.6 mm for P2. 3.3±.9 and 2.3±0.9 mm for P3, and 3.3±1.0 and 4.5±1.6 mm for P4. respectively. Coefficient of variation for defects for left and right jaw quadrants was 26 and 40%, respectively. Using confidence intervals for mean differences between jaw quadrants, it was determined that a mean treatment effect may be as large as 0.8, 1.1 and 1.9 mm for P2. P3 and P4, respectively, before being detected as statistically significant (p≤0.05, N=6). With the apparent variation in defect baseline, it is suggested that natural disease defects have limited potential in discriminating treatment effects following periodontal reconstructive therapy.     

Periodontal treatment needs of diabetic adults

AIM: The aim of this study was to investigate diabetes-related factors in relation to periodontal treatment needs. MATERIAL AND METHODS: A cross-sectional study was conducted among 299 dentate diabetics attending a diabetic clinic in Tehran, Iran. A self-administered questionnaire was administered during a dental appointment in order to gather information about year of birth, year of onset of diabetes, education and organ complications related to diabetes. Number of teeth, the Community Periodontal Index of Treatment Needs and visible plaque were recorded. RESULTS: None of the subjects had a healthy periodontium. Shallow periodontal pockets were the most prevalent finding. Periodontal pockets exceeding 5 mm and a higher number of missing teeth were associated with a low level of education. The sum of plaque scores [odds ratio (OR)=1.3; 95% confidence interval (CI) 1.1-1.5] was related to the presence of deepened pockets when controlling for other factors. Among diabetes-related factors, the only significant association with CPITN > or =3 was by HbA1c (OR=0.7; 95% CI 0.6-0.9); for CPITN=4, no associations with the diabetes-related factors appeared. CONCLUSIONS: The poor periodontal status of our diabetic patients indicates a need to establish a comprehensive oral health promotion programme for diabetics based on collaboration between dental and general health care professionals involved in diabetic care.     

Periodontal health in a group of industrial employees

The aim of this study was to evaluate the dental health conditions of male employees in a large aluminum factory. The present report deals only with the periodontal findings. Five percent of the 181 examined subjects between 25 and 60 yr were edentulous, and all dentate individuals had some degree of periodontal disease. Surfaces harboring stainable plaque were high in all age groups, varying between 65 and 85%. Surfaces without retention factors were 31% and decreased with increasing age. The percentage of sites with bleeding increased from about 40% in the lowest to about 60% in the highest age group. Teeth with probing depths greater than or equal to 4 mm increased from about 30% in the age group 25-29 yr to about 45% in the age group 30-34 yr, after which it increased gradually with increasing age. The difference in bone scores (marginal bone loss) was the most extensive between the ages of 25 and 34 yr, but with a significant increase throughout the age groups. The administrators had a somewhat better oral hygiene, fewer retention factors, less bleeding, fewer pockets and some more marginal bone support than the workers. Still, the administrators had more missing teeth than the workers.     

Comparison of panoramic and intraoral radiography and pocket probing for the measurement of the marginal bone level

Panoramic, bitewing and periapical radiography and probing for measurement of the marginal bone level were compared. Altogether 237 sites of 23 patients were examined. Radiographs were taken with a splint containing steel balls to allow calculation of the enlargement of the radiographs. Probing was done before and during flap surgery using the same splint. The open bone measurement represented the true value. All radiographs were assessed by 5 observers. The mean enlargement of panoramic radiography was 27% in the upper and 26% in the lower arch. For bitewing and periapical radiography, it was 8% in the upper and 4-5% in the lower arch. All methods underestimated the bone loss. Probing bone level before surgery was most accurate, deviating at most 5% from the true value. Periapical radiography was more accurate than panoramic and bitewing radiography (p less than 0.001). Panoramic radiography presented a slightly lower mean accuracy than bitewing radiography (p less than 0.05). The underestimation of the bone loss ranged from 13 to 32% in orthopantomograms, 11-23% in bitewing and 9-20% in periapical radiographs. The interobserver variation of the radiographic methods was substantial.     

A comparison of WHO Periodontal Status Index with the Periodontal and Oral Hygiene Indices

Examination of 2,138 subjects, aged 15-65+ years, was carried out by calibrated examiners using mirrors and fibre optic illumination. Each subject was scored by the Periodontal Status Index, PSI (WHO Oral Health Surveys), Periodontal Index, PI (Russell) and the Oral Hygiene Index, OHI (Greene & Vermillion). For the PSI, PI and OHI all scores were age-dependent with the exception of soft deposits in PSI and OHI, which were age-independent. The advantages of the PSI system were considered to be the ease of scoring and the opportunity to assess treatment requirements, in terms of time, at the public health service level. Disadvantages were lack of quantitation, difficulties of diagnosis of intense gingivitis, and localized and general conditions. The PI and OHI systems provided a more objective, quantitative and sensitive basis of scoring than the PSI. Statistical tests showed the respective indices are associated and measuring the same kind of criteria. Examiner calibration and consistency were similar for both scoring systems.     

A panoramatomographic study of the teeth and jaws of Finnish university students

Abstract – A random sample of panoramic radiographs was taken of 1027 (386 male and 641 female) university students. All the students were born between 1965 and 1971. The following were examined: caries, apical radiolucencies, endodontically treated teeth, marginal and vertical bone loss, third molars, supernumerary, missing, and persisting teeth, bone structure, condyles, maxillary sinuses and soft tissue calcifications. In the inter- (of two examiners) and intra-examiner variation Kappa indices varied between 0.15 and 1.00, and agreement percentages from 52, to 100. Kappa index was poor (0.15) in evaluation of the bone structure. The mean DM FT index for the students was 8.4. A sound dentition was found in 6.6%, and 48.4% of the students were free of caries. The mean number of carious lesions was 1.1. There were 50 retained roots (49 from primary teeth). 76.6% of the students had one or more unerupted wisdom teeth and 22.7% had radioiogic changes typical of pericoronitis in the region of the mandibular third molars. 16.2% of the students had at least one missing wisdom tooth. Bone structure was normal in 92.4% of the students, idiopathic osteosclerosis being the most common divergence (3.5%). Arthrotic changes in the condyles were found in 9% of the students. In eight cases there was erosion of the condyles, which was diagnosed as arthritis. Styloid ligament calcifications were found in 21.5% of the students. In the maxillary sinuses, male students exhibited changes 1.7 times more often than female students (26.3% in males and 15.1% in females).