Natural distribution of oral Actinobacillus actinomycetemcomitans in young men with minimal periodontal disease

A total of 1005 subgingival and extracrevicular samples from 201 male recruits, 18–25 yr old, were selectively cultivated for Actinobacillus actinomycetemcomitans. The organism was isolated in 55 subjects (27%); 9.5% of pooled subgingival plaque samples from first molars, 14% cheek mucosa, 20% dorsum of tongue and 20% saliva samples were culture-positive. In order to divide the study population into distinct clinical categories, cluster analysis was performed, based on previous caries experience, probing pocket depth categories, bleeding scores, visible plaque and calculus. Two clusters (n=86 and n=92, respectively) were identified with no or minimal periodontal disease (mean±standard deviation % of periodontal probing depth 1–2 mm 78.7±10.4% and 57.4±12.6%, respectively; virtually no periodontal probing/depth in excess of 4 mm) and a relatively low DMF-S (22±13). A third cluster (n=22) had, in contrast, a high DMF-S (47.7±173) and a relatively high % of periodontal pockets of ≥5 mm (5.9 ±5.2%). Prevalence of A. actinomycetemcomitans in this cluster was 41%, while the organism was found in 23% and 27% in the minimally diseased populations (p<0.15). Whereas no heterogeneity of associations between subgingival and extracrevicular occurrence of the organism could be ascertained in different clusters, the organism was significantly more often identified in extracrevicular material, especially dorsum of tongue samples, compared with subgingival plaque (McNemar's X²=12.45, p<0.001). Multiple linear regression analysis revealed the number of A. actino-mycetemcomitans positive samples as well as the % of sites bleeding on probing being positively associated with the % of sites with a probing pocket depth of ≥5 mm (R2=0.345, p≤0.0001). The present large-scale investigation points to the wide distribution of this putative periodontopathogen in young individuals with minimal periodontal disease.     

Simultaneous isolation of Actinobacillus actinomycetemcomitans from subgingival and extracrevicular locations of the mouth

Abstract In the present study, a total of 619 subgingival and extracrevicular samples from 66 early-onset periodontitis, 42 adult periodontitis/gingivitis and 36 treated Actinobacillus actinomycetemcomitans-associated periodontitis patients were selectively cultivated for presence of A. actinomycetemcomitans. The organism was recovered from 68% cases with early-onset periodontitis, 24% cases with adult periodontitis/gingivitis and 50% of treated patients. Associations between recovery from pooled subgingival plaque and samples from extracrevicular locations as well as between different extracrevicular samples, were not heterogeneous with regard to different groups with the exception for cheek/saliva comparisons (odds ratios: early-onset periodontitis 825; adult periodontitis 8.1; treated patients 117; 0.05<p<0.1). For associations between recovery of A. actinomycetemcomitans from pooled subgingival plaque/extracrevicular samples, Mantel-Haenszel's odds ratios of between 12.2 and 21.6 were calculated (p<0.0001). The organism was isolated from 17 cheek mucosa samples of 18 patients identified as still harboring the organism after therapy. Present results point to the considerable value of cheek mucosa samples especially in treated patients to diagnose persistent A. actinomycetemcomitans colonization of the oral cavity.     

Postoperative bleeding tendency as a risk factor in Actinobacillus actinomycetemcomitans-associated periodontitis

Frequent bleeding on probing (BOP) has been considered a risk factor for recurrence of periodontitis. In the present study, 29 patients with Actinobacillus actinomycetemcomirans-associated periodontitis were enrolled in a carefully performed recall system. At 6 sites per tooth, periodontal probing depth (PPD), gingival index (GI), plaque index (PII) and BOP was assessed 6 weeks, 6 months, 1 and 2 years after comprehensive therapy. Professional toothcleaning and subgingival scaling at sites with PPD ≥ 5 mm and BOP was carried out every 2nd or 3rd month. Subgingival samples from 2 sites, a pooled subgingival sample, check mucosa, saliva and tongue samples were selectively cultivated for A. actinomycetemcomitans after 2 years. Following active therapy, 8 % sites had a PPD of ≥ 4 mm, whereas 21 % sites bled on probing. After 2 years, respective figures were 12 and 27 %. During maintenance, frequent BOP (≥3 times at 4 visits) had a predictive value of 0.133 to indicate an increase in PPD of ≥ 2 mm and a negative predictive value of 0.947. The predictive value of no bleeding to indicate a stable site was 0.972, the negative predictive value 0.078. There was evidence for heterogeneity of associations between increase in PPD of ≥ 2 mm and ≥ 3 times BOP among patients (X²₍₂₈₎ = 41.45, p < 0.05). Significant sources for the variation of weighted In-transformed estimates of individual odds ratios (range -0.83 to 6.21, median 1.52) were relative numbers of A. actinomycetemcomitans-positive samples 2 years after therapy, age, and mean % of PII 2 (R² =0.439, p<0.001). No association between increase in PPD and BOP was found in patients where A. actinomycetemcomitans was not recovered from any sample (X²_MH = 1.96), but A. actinomycetemcomitans-positive subjects still had inconsistent associations (X²_MH = 37.65. p < 0.01). Ignoring patient characteristics may be misleading in the search for risk factors for recurrence of the disease.     

Potential diagnostic value of sampling oral mucosal surfaces for Actinobacillus actinomycetemcomitans in young adults*

Actinobacillus actinomycetemcomitans has been implicated in the pathogenesis of several forms of early onset and refractory adult periodontitis. Early diagnosis of colonization of the oral cavity might be of importance in order to initiate preventive measures. The aim of the present study was to determine the potential diagnostic value of oral mucosal and salivary tests to identify, among healthy young men with no or minor periodontal disease, individuals colonized by A. actinomycetemcomitans. Two hundred and one male recruits. 18–25 yr of age, took part in the present study. Mean values of periodontal parameters suggested only minor periodontal disease. Of the sites, 64.8±17.6% (mean ± SD) had a periodonta) probing depth (PPD) of 1 or 2 mm. only 1.6±2.9% deep sites of 5 mm were detected. More than 1000 subgingival and extracrevicular samples were selectively cultivated for A. actinomycetemcomitans. The organism was isolated in 55 subjects (21%). The odds for presence of at least 1 deep site of 5 mm was increased by a factor 1.99 if A. actinomycetemcomitans could be recovered. In identifying subjects colonized by A. actinomycetemcomitans. diagnostic test parameters sensitivity and predictive value for a negative test were 74.5±5.9% and 91.1±2.3%', respectively, for both saliva and dorsum of tongue samples. In contrast, pooled subgingival plaque from mesial surfaces of 1st molars was only 34.5±6.4% sensitive: the negative predictive value was 80.2±3.0%. The results point to a high diagnostic value of oral mucosal and especially saliva samples to identify young adult individuals colonized by A. actinomycetemcomitans.     

Microbial ecology of Actinobacillus actinomycetemcomitans, Eikenella corrodens and Capnocytophaga spp. in adult periodontitis

Information on intraoral distribution of putative periodontal pathogens might be essential for controlling different forms of periodontal disease. Colonization may be either promoted or impeded by other bacteria competing in the subgingival ecosystem. In recent investigations microbial associations between dental organisms have been determined in a multitude of subgingival plaque samples within multiple patients and described by odds ratios, in most circumstances without taking into account the correlated structure of the observations within a single individual. The present investigation had 3 major objectives: (i) to describe the intraoral distribution of some facultatively anaerobic, Gram-negative rods, i.e. Actinobacillus actinomycetemcomitans, Eikenella corrodens-like organisms and Capnocytophaga spp., in a multitude of subgingival and extracrevicular samples of 10 adult subjects with A. actinomycetemcomitans-associated periodontitis; (ii) to analyse possible inconsistencies of microbial associations between these periodontal organisms; and (iii) to determine factors increasing the likelihood of isolating these bacteria in a given subgingival site by employing Generalized Estimation Equation (GEE) methods. Clinical examinations were carried out at 6 sites of every tooth present. In each subject, 13 extracrevicular (2 cheek mucosa, 3 tongue, 4 gingival, 2 tonsillar samples, 1 palatinal, 1 saliva sample) and between 22 and 44 subgingival samples from deepest sites of every tooth present (n=296) were selectively cultivated for A. actinomycetemcomitans, E. corrodens and Capnocytophaga spp. In extracrevicular material, A. actinomycetemcomitans, Capnocytophaga spp. and E. corrodens were isolated in 9, 10 and 6 patients, and from 65, 82 and 15% samples, respectively. The organisms were recovered from 51, 62 and 27% subgingival plaque samples, respectively. Heterogeneity tests did not reveal significant inconsistencies of microbial associations between bacteria in subgingival plaque. Mantel-Haenszel's odds ratios ranged between 2.0 for A. actinomycetemcomitans and Capnocytophaga spp. and 18.7 for Capnocytophaga spp. and E. corrodens. An exchangeable working dependence structure was employed in the GEE approach. The odds of isolating A. actinomycetemcomitans was increased by factor 3.7 in 4–6 mm deep pockets, and 9.5 in ≥ 7 mm deep pockets. The odds of presence of E. corrodens was increased by factor 10.8 in the case of presence of Capnocytophaga spp. and 2.1 in the case of presence of A. actinomycetemcomitans. Capnocytophaga spp. were associated with bleeding on probing and molar sites. Presence of E. corrodens was associated with clinical attachment loss but not periodontal probing depth. Results of the present study indicated an association of A. actinomycetemcoinitans with periodontal pathology. Whereas this organism and Capizocytopliagae were widely distributed in extracrevicular ecosystems of the mouth, E. corrodens only occasionally appeared in saliva or on mucous membranes of the oral cavity. In general, GEE methods seem to allow to determine factors associated with the presence of periodontal organisms in a multivariate approach and considering the correlated structure of the data.     

Failure of adjunctive minocycline-HCI to eliminate oral Actinobacillus actinomycetemcomitans

Abstract Considerable problems have been reported in the eradication of Actinobacillus actinomycetemcomitans from periodontal sites. The present communication describes the 2-year results of a comprehensive combined mechanical/surgical and adjunctive rainocycline (200 mg/day for 3 and another 2 weeks) treatment regimen in 28 patients with A. actinomycetemcomitans-associated periodontitis. Elimination of A. actinomycetemcomitans at periodontal sites was a prerequisite for gain of clinical attachment of ≥2 mm or decrease of probing depth to ≥4 mm after subgingival scaling plus minocycline (p<0.01). Whereas 2 years after active treatment A. actinomycetemcomitans could not be detected at monitored sites in 23 patients, the organism was found on buccal mucosa and in saliva in 17 and 12 cases, respectively. One or 2 years after periodontal surgery, there was a significant association between log₁₀-numbers of A. actinomycetemcomitans in buccal samples and numbers of residual pockets of ≥7 mm as well as gingival sites with overt gingivitis (R²= 0.687, p<0.001). Present results indicate failure of an even prolonged administration of adjunctive minocycline to eliminate oral A. actinomycetemcomitans in most cases of A. actmomycetemcomitans-associated periodontitis.     

A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial

Background: We aimed to analyze clinical, microbiologic, and serologic effects of chlorhexidine (CHX) chips used as a subgingival controlled‐release delivery device before and immediately after scaling and root planing (SRP). Methods: Twenty‐four patients presenting with ≥12 teeth with probing depth (PD) ≥5 mm and bleeding on probing were assigned in test or control groups. After prophylaxis, CHX chips (test) or placebo chips (control) were placed in pockets with PD ≥5 mm. Ten days later, SRP was performed in all teeth with PD ≥4 mm in a single appointment. Immediately after SRP, new chips were inserted in all pockets with PD ≥5 mm. Parameters were assessed at baseline; beginning of SRP; and 1, 3, and 6 months after treatment. Subgingival samples were obtained at baseline; beginning of SRP; and at 1 month after treatment. Periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were analyzed. Serum levels of high sensitive C‐reactive and lipopolysaccharide‐binding proteins were measured. The changes of the parameters between and within the groups were tested by Mann‐Whitney U test (P <0.05). Results: All clinical and serologic parameters improved in both groups over time. There was a significant difference in clinical attachment level (CAL) gain from baseline to 6 months between groups (1.17 mm in the test group versus 0.79 mm in the placebo group) (P <0.05). The treatment with CHX chips showed a greater reduction of the microorganisms of the “red complex” after 1 month (P = 0.02). Conclusion: The use of CHX chips before and immediately after SRP improved CAL and reduced the subgingival microorganisms of the red complex in the treatment of chronic periodontitis.     

Comparative analysis of the effect of 4MATRIX with and without PRF on regeneration of infrabony periodontal pockets

AimThe aim was to compare the effect in improvement of periodontal pocket depth (PPD) and clinical attachment level (CAL) between application of 4MATRIX and 4 MATRIX combined with PRF in advanced periodontal disease during follow-up of 6, 12 and 18 months.MethodsThirty patients of both genders aged 25–50 years were included. The patients were clinically and radiologically diagnosed with generalized advanced chronic periodontitis with the presence of periodontal pockets with a depth of ≥ 5 mm bilaterally in the upper jaw. Both sides were treated with a flap intervention in all patients. On one side a bone substitute 4MATRIX was applied, and the other side was treated with an application 4MATRIX and PRF. The clinical assessment and measurements were performed in four stages, immediately before the intervention, and then 6, 12 and 18 months after the intervention. PPD and CAL were determined in all four timepoints.ResultsPPD was the highest at zero time before the surgery for both groups and was 5.56 ± 0.28 mm. In the postoperative follow-up period, the PPD value decreased gradually with the lowest average value of 5.10 ± 0.18 mm after 18 months in Group I and 4.67 ± 0.13 mm in Group II (p < 0.001, respectively). Moreover, comparing the values of PPD at 6, 12 and 18 months after the surgery, a significant difference was found between the patients from the 4MATRIX vs 4MATRIX + PRF (p < 0.001 respectively). The postoperative follow-up period showed a decrease in CAL value with the lowest value after 18 months. A significant difference in CAL was found between the four measurement times (p < 0.001, respectively). The average level of CAL was the highest before surgical treatment in both groups. The intergroup analysis of CAL after 18 months in group I (4MATRIX) was 5.27 ± 0.17 mm and in group II 4.10 ± 0.14 mm (p < 0.001).ConclusionTreatment of adult patients with advanced chronic periodontitis with periodontal pockets of ≥ 5 mm bilaterally in the upper jaw using 4MATRIX and 4MATRIX + PRF showed improvement of PPD and lower CAL loss after 18 months of the treatment. In the group treated with 4MATRIX + PRF patients showed the highest improvement in PPD and CAL loss. The analysis of treatment with 4MATRIX and 4MATRIX + PRF showed the lowest values after 18 months of the treatment.     

Clinical and microbiologic results 12 months after scaling and root planing with different irrigation solutions in patients with moderate chronic periodontitis: a pilot randomized trial

Background: The aim of this study is to determine in a randomized trial the impact on treatment outcome after 12 months of different subgingival irrigation solutions during scaling and root planing (SRP). Methods: Fifty‐one adult volunteers with generalized chronic periodontitis were treated by full‐mouth SRP using 0.9% sodium chloride, 0.12% chlorhexidine digluconate, or 7.5% povidone–iodine for subgingival irrigation during SRP. Before SRP and after 3 and 12 months, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. Subgingival plaque samples were analyzed for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Results: PD, CAL, and BOP were significantly improved in all groups after 12 months (P <0.001 to P = 0.044). No significant differences were seen among the groups for all sites and sites with 4 to 6 mm PD at baseline. The povidone–iodine group had the highest clinical improvements. The counts of A. actinomycetemcomitans and P. gingivalis were significantly reduced after 12 months (P = 0.045 and P = 0.002) using povidone–iodine. Significant differences between the groups were seen after 3 months for A. actinomycetemcomitans and P. gingivalis, and after 12 months for T. forsythia. Conclusions: No differences were seen among the groups in the clinical results after 12 months. Regarding the microbiologic results, a slight benefit seemed to derive from the use of povidone–iodine.     

Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis

Abstract. A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least I tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p= 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment. PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significant, but considered as clinically unimportant.     

Clinical effects of scaling and root planing in adults infected with<Emphasis Type="Italic"> Actinobacillus actinomycetemcomitans</Emphasis>

The periodontal pathogen Actinobacillus actinomycetemcomitans can frequently be isolated from subgingival plaque of adults with chronic inflammatory periodontal disease and individuals with plaque-induced gingivitis. Problems with the persistence of the organism after thorough debridement of root surfaces have been reported. In the present study clinical effects of the hygienic phase of periodontal therapy in ten adult patients with moderate or advanced periodontitis harbouring A. actinomycetemcomitans were analysed. Since proper analysis of highly correlated data within a given patient is crucial for appropriate interpretation, a major objective of this study was to compare the results of different models derived from logistic regression of clinical and microbiological factors on gain or loss of clinical attachment under different assumptions. Subgingival samples from every tooth present were obtained before and 6 weeks after thorough subgingival scaling, and selectively cultivated for the organism. A relevant gain of clinical attachment of 2 mm or more was observed at a total of 36% of periodontitis sites after scaling. Overall, loss of attachment of 2 mm or more was observed at 8% sites. Most loss occurred at sites with gingival enlargement (15%), whereas 3% periodontitis sites lost 2 mm or more. In multivariate analyses erroneously assuming either independence of data or correctly considering the correlated structure of observations attachment gain was mainly associated with deep probing depths at the outset. Presence or absence of A. actinomycetemcomitans before or after therapy was not included into the periodontitis models. Also, loss of attachment of 2 mm or more after subgingival scaling was not influenced by the organism. A direct comparison of the results obtained with both approaches of logistic regression may be helpful in the assessment of the influence of the magnitude of correlation of the data on the regression coefficients.     

Characterizing traditionally defined periodontal disease in HIV+ adults

Abstract – Background: Results have varied from previous studies examining the level and extent of periodontal disease (PD) in HIV‐1 infected (HIV+) adults. These studies used different methodologies to measure and define PD and examined cohorts with divergent characteristics. Inconsistent methodological approaches may have resulted in the underestimation of traditionally‐defined PD in HIV+ individuals. Objectives: To characterize the level, extent and predictors (i.e. immunologic, microbiologic, metabolic and behavioral) of PD in an HIV+ cohort during the era of highly active antiretroviral therapy (HAART). Study Design: Cross‐sectional study. Setting: HIV+ adults receiving outpatient care at three major medical clinics in Cleveland, OH. Subjects were seen from May, 2005 to January, 2008. Measurements: Full‐mouth periodontal examinations included periodontal probing depth (PPD), recession (REC) and clinical attachment level (CAL). Subgingival plaque was assessed for DNA levels of Porphyromonas gingivalis (Pg), Tannerella forsythia, and Treponema denticola by real‐time DNA PCR assays developed for each pathogen. Rather than using categories, we evaluated PD as three continuous variables based on the percent of teeth with ≥1 site per tooth with PPD ≥ 5mm, REC > 0 mm and CAL ≥ 4mm. Results: Participants included 112 HIV+ adults. Each subject had an average 38% (±24%) of their teeth with at least one site of PD ≥ 5 mm, 55% (±31%) of their teeth with at least one site of REC > 0 mm, and 50% (±32%) of their teeth with at least one site of CAL ≥ 4 mm. CD4+ T‐cell count <200 cells/mm³ was significantly associated with higher levels of REC and CAL, but not PPD. Greater levels of Pg DNA were associated with PPD, REC and CAL. By regression analysis, CD4+ T‐cell count <200 cells/mm³ had approximately twice the deleterious effect on CAL as did smoking (standardized β coefficient 0.306 versus 0.64). Annual dental visit compliance remained an independent predictor for lower levels of PD. Conclusions: The level and extent of PD were high in this cohort even though most patients were being treated with HAART. The definition of periodontal disease used and cohort characteristics examined can influence the level of periodontal disease reported in studies of persons with HIV. Traditional periodontal pathogens are associated with PD in this cohort. Those with CD4+ T‐cell counts <200 cells/mm³ are at greater risk for PD. Therefore, earlier HAART initiation may decrease exposure to immunosuppression and reduce PD morbidity. Continuity of dental care remains important for HIV+ patients even when they are being treated with HAART.     

Clinical Outcomes After Treatment of Non‐Contained Intrabony Defects With Enamel Matrix Derivative or Guided Tissue Regeneration: A 12‐Month Randomized Controlled Clinical Trial

Background: The purpose of this study is to compare the healing of deep, non‐contained intrabony defects (i.e., with a ≥80% 1‐wall component and a residual 2‐ to 3‐wall component in the most apical part) treated with either an enamel matrix derivative (EMD) or guided tissue regeneration (GTR) after 12 months. Methods: In this randomized, controlled clinical trial, 40 subjects with 40 defects affecting single‐rooted teeth were treated. The defects were treated with EMD alone or with a non‐resorbable titanium‐reinforced membrane. No grafting materials were used. At baseline and after 12 months, clinical parameters including probing depths (PDs) and clinical attachment levels (CAL) were recorded. The difference in CAL gain was the primary outcome. Results: At baseline, the intrabony component of the defects amounted to 8.5 ± 2.2 mm at EMD‐treated sites and 8.6 ± 1.7 mm at GTR‐treated sites (P = 0.47). The mean CAL gain at sites treated with GTR was significantly greater (P <0.001) than that at sites treated with EMD (4.1 ± 1.4 mm versus 2.4 ± 2.2 mm, respectively). GTR therapy, compared to EMD application alone, significantly (P = 0.01) increased the probability of CAL gain ≥4 mm (79.2% versus 11.3%, respectively) and significantly (P = 0.01) decreased the probability of residual PDs ≥6 mm (3% versus 79.3%, respectively). Conclusion: Although the outcomes of open‐flap debridement alone were not investigated, the application of EMD alone appeared to yield less PD reduction and CAL gain compared to GTR therapy in the treatment of deep, non‐contained intrabony defects.     

Five‐Year Results Evaluating the Effects of Platelet‐Rich Plasma on the Healing of Intrabony Defects Treated With Enamel Matrix Derivative and Natural Bone Mineral

Background: Regenerative periodontal surgery using the combination of enamel matrix derivative (EMD) and natural bone mineral (NBM) with and without addition of platelet‐rich plasma (PRP) has been shown to result in substantial clinical improvements, but the long‐term effects of this combination are unknown. Methods: The goal of this study was to evaluate the long‐term (5‐year) outcomes after regenerative surgery of deep intrabony defects with either EMD + NBM + PRP or EMD + NBM. Twenty‐four patients were included. In each patient, one intrabony defect was randomly treated with either EMD + NBM + PRP or EMD + NBM. Clinical parameters were evaluated at baseline and 1 and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL). Results: The sites treated with EMD + NBM + PRP demonstrated a mean CAL change from 10.5 ± 1.6 to 6.0 ± 1.7 mm (P <0.001) at 1 year and 6.2 ± 1.5 mm (P <0.001) at 5 years. EMD + NBM–treated defects showed a mean CAL change from 10.6 ± 1.7 to 6.1 ± 1.5 mm (P <0.001) at 1 year and 6.3 ± 1.4 mm (P <0.001) at 5 years. At 1 year, a CAL gain of ≥4 mm was measured in 83% (10 of 12) of the defects treated with EMD + NBM + PRP and in 100% (all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of ≥4 mm was measured in 75% (nine of 12 in each group) of the defects. Four sites in the EMD + PRP + NBM group lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group, one defect lost 2 mm and four other defects lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups. Conclusions: Within their limits, the present results indicate that: 1) the clinical outcomes obtained with both treatments can be maintained up to a period of 5 years; and 2) the use of PRP does not appear to improve the results obtained with EMD + NBM.     

Influence of orthognathic surgery on periodontal tissues

Objective

The present prospective study aimed at evaluating the influence of orthognathic surgery on mucogingival tissues and the subgingival microflora.

Patients and methods

Fifteen consecutively-treated patients with a mean age of 24.9±7.7?years were included in this study. The surgical interventions comprised the Le Fort?I osteotomy of the maxilla and/or sagittal split osteotomy of the mandible. The following periodontal and microbial parameters were measured preoperatively (T₀) as well as 1?week (T₁) and 6?weeks (T₂) postoperatively: pocket probing depth?(PPD), gingival recession?(GR), clinical attachment level?(CAL), bleeding on probing?(BOP), plaque index?(PI), and changes in the subgingival microflora. Periodontal parameters were calculated for all sites as well as for buccal and oral sites separately. For statistical analysis, the general linear model and paired t test were applied (level of significance: p<0.05).

Results

PPD readings increased significantly on oral tooth sites when T₀ values were compared to T₁ (p=0.009) and T₂ values (p=0.042). GR increased significantly on buccal sites from 0.10±0.16?mm at baseline to 0.21±0.23?mm at T₁ (p=0.013) and 0.31±0.31?mm at T₂ (p=0.001). Furthermore, we noted significant changes in the CAL (oral sites) and PI (buccal and oral sites). We observed no significant differences in BOP and periodontopathogenetic bacteria.

Conclusion

Orthognathic surgery has a statistically significant effect on the development of gingival recessions. However, this effect may not necessarily clinically impair the esthetic appearance.     

Presence of JP2 and Non‐JP2 Genotypes of Aggregatibacter actinomycetemcomitans and Attachment Loss in Adolescents in Ghana

Background: Limited data are reported concerning the presence of A. actinomycetemcomitans and attachment loss (AL) in sub‐Saharan countries. The authors investigate the carrier frequency of JP2 and non‐JP2 genotypes of A. actinomycetemcomitans and the presence of AL in Ghanaian adolescents and evaluate socioeconomic conditions and oral hygiene practices. Methods: Five hundred individuals (mean ± SD age: 13.2 ± 1.5 years) in public and private schools were interviewed about demographic characteristics and oral hygiene practices and were given a full‐mouth periodontal examination. Subgingival plaque samples were obtained from periodontal sites around permanent first molars and incisors. The carrier status of A. actinomycetemcomitans at the individual level was determined based on results obtained by cultivation and polymerase chain reaction. Results: The findings of this study show a relatively high carrier rate of JP2 and non‐JP2 genotypes of Aggregatibacter actinomycetemcomitans in the Ghanaian adolescent population and the presence of this bacterium is associated with the occurrence of AL. The overall carrier rate of A. actinomycetemcomitans was 54.4%, and the highly leukotoxic JP2 genotype was detected in 8.8% of the study population. A total of 107 (21.4%) individuals had ≥1 tooth with AL ≥3 mm. The majority of the individuals carrying A. actinomycetemcomitans (80.1%) (P <0.001) and of the periodontally diseased individuals (91.6%) (P <0.001) were found in public schools. Conclusions: A. actinomycetemcomitans and AL were frequently found in Ghanaian adolescents. The school type was the strongest predictor of both presence of A. actinomycetemcomitans and AL.     

Histological healing after nonsurgical periodontal treatment with enamel matrix derivatives in canine experimental periodontitis

The histological outcomes after nonsurgical periodontal treatment with enamel matrix derivatives (EMD) remain controversial. The present study evaluated periodontal wound healing after scaling and root planing (SRP) with subgingival application of EMD for treatment of experimental periodontitis. Periodontal breakdown was induced by applying silk ligatures around mandibular third and fourth premolars of six beagle dogs until radiographic bone loss progressed to approximately half of the root length. Probing pocket depth (PPD) and clinical attachment level (CAL) were proximally measured 2 weeks after ligature removal (baseline). Mesial and distal surfaces of the experimental teeth were subjected to SRP and randomized using a split-mouth design to subgingival application of EMD (test) or normal saline (control). PPD and CAL were re-evaluated at 11 weeks. Animals were sacrificed at 12 weeks for histological analyses. No significant differences were observed in PPD and CAL between both groups at baseline and at 11 weeks. Histologically, test sites exhibited a greater amount of new cementum than that did the control sites (p < 0.01). Moreover, the control sites revealed increased epithelial downgrowth compared with the test sites: (p < 0.05). On the other hand, no intergroup differences were detected in terms of bone position, connective tissue attachment, gingival recession, and planed root length. This study suggested that EMD has an increased potential to support formation of new cementum with decreased epithelial downgrowth when used as an adjunct to nonsurgical periodontal treatment.     

Change of Periodontal Disease Status During and After Pregnancy

Background: This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy. Methods: A follow‐up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty‐nine females who were previously enrolled in a case‐control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status. Results: Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy. Conclusions: Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.     

Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study

Oral Diseases (2011) 17 , 560–563 Objective: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. Study design: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non‐hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. Results: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). Conclusions: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.     

A longitudinal study of Actinobacillus actinomycetemcomitans in army recruits

During recruiting examinations 201 recruits, 18-25 yr old, were examined for subgingival and extracrevicular Actinobacillus actinomycetemcomitans. The organism was isolated in 55 subjects, most often at low levels. Cluster analysis revealed 3 clusters with no (A, n = 86) or minor (B, n = 92) periodontal disease and low DMF-S, as well as established periodontitis, increased DS and high DMF-S (C, n = 22). When leaving the 12-months' service, 105 recruits were re-examined (54 cluster A, 41 cluster B, 9 cluster C subjects, 1 recruit who was not clustered). An increase of periodontal probing depth (PPD) of 3 mm at 1 or more sites occurred in 33 subjects: 9 (17%) in cluster A, 16 (39%) in cluster B, 7 (78%) in cluster C and in the not-clustered recruit. Considerable variation in frequency distributions of PPD alterations was observed, therefore significant (p<0.1) mean increase (1-sample t-test) and skew g₁ (S-statistic) were additionally considered to define an “active” case. A total of 7 recruits (6.7%) met the criteria. Logistic regression analysis revealed a significant influence of self-reported smoking habits on activity status. Thus, heavy smokers (>20 cigarettes/d) had a 14-fold higher risk (p = 0.030) for developing or progressing periodontitis compared to non- or light smokers (< 10 cigarettes/d). In particular, cluster B recruits appeared to have a lower risk (p = 0.11) for developing periodontitis than cluster C recruits (established periodontitis, high DMF-S). A. actinomycetemcomitans was isolated in 29 recruits (27.6%) at baseline and 30 recruits (28.6%) after 12 months. Presence of the organism was not a risk factor for periodontitis. However, in active subjects, significantly more samples were only A. actinomycetemcomitans-positive at re-examination compared to inactive recruits. It was concluded that smoking is a significant risk factor for periodontitis. Subjects with established periodontitis tend to deteriorate further. A. actinomycetemcomitans seems not to increase the risk for developing or progressing periodontitis in this age group. Longer studies involving larger populations are needed to confirm these observations.