Periodontal response after tooth movement into intrabony defects

The present study was undertaken since conflicting evidence exists regarding the effect of such tooth movement on levels of connective tissue attachment. Localized intrabony pockets were produced around isolated incisors in four rhesus monkeys. The root surfaces were planned to the level of the bone at the base of the angular bony defects. An oral hygiene regime was begun and continued for the remainder of the study. The experimental teeth were moved orthodontically into, and through, the original area of the intrabony defect. Two months after cessation of active tooth movement, block specimens were removed for histologic analysis. Control specimens comprised those teeth with induced periodontal defects, but without tooth movement. In specimens not subjected to tooth movement, angular bony defects were present and epithelium lined the root surface to the apical extent of instrumentation. The alveolar bone adjacent to the orthodontically moved teeth no longer had angular defect morphology. On the pressure side, epithelium lined the root surface, was interposed between root surface and bone and terminated at the apical limit of root instrumentation. On the tension side, the crest of the bone was located apical to the level of root planing, and epithelium lined the instrumented portion of the root surface. It was concluded that orthodontic tooth movement into intrabony periodontal defects was without effect upon the levels of connective tissue attachment.     

Regeneration of alveolar bone following surgical and non-surgical periodontal treatment

The purpose of this investigation was to examine the regeneration of alveolar bone following surgical and non-surgical periodontal treatment. A total of 16 patients who had advanced periodontitis and demonstrated angular bony defects on radiographs participated in the study. After the initial examination, they received instruction in oral hygiene and had their teeth thoroughly scaled. When the individual patient at 2 succeeding appointments had plaque on less than 20% of the tooth surfaces, one maxillary and one mandibular quadrant was treated with the modified Widman flap procedure while one of the remaining quadrants was treated with the reverse bevel flap procedure. The last quadrant was treated with root planing under local anesthesia. None of these procedures included bone contouring. Following treatment, the patients were recalled every 2 weeks for professional tooth cleaning. Radiographs taken 12 months following treatment revealed that only minor changes in the bone level had occurred in areas with horizontal bone loss following the various treatment modalities. Following the modified Widman flap procedure, however, a statistically significant coronal regrowth of bone (0.5 mm) had occurred in angular bony defects. The majority of the angular bony defects persisted following all 3 treatment modalities.     

The healing potential of the periodontal tissues following different techniques of periodontal surgery in plaque-free dentitions

A clinical trial was undertaken to study the healing capacity of the periodontal tissues following different modes of periodontal surgery in patients whose oral hygiene was professionally maintained at an optimal level. Fifty patients, distributed into five groups, participated in the study. Following an initial examination and presurgical treatment, the various patient groups were subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects, 2) the apically repositioned flap operation including curettage of the bony defects but without removal of bone, 3) the "Widman flap" technique including elimination of bony defects, 4) the "Widman flap" technique including curettage of the bony defects but without removal of bone, 5) gingivectomy including curettage of the bony defects but without removal of bone. After surgery, all patients received oral hygiene instruction and professional cleaning of the teeth once every 2 weeks during a 2-year period. The results showed that periodontal disease can be cured and further destruction of the periodontal tissues avoided irrespective of the surgical technique utilized for pocket elimination. Different surgical techniques, however, promoted varying degrees of regeneration of the supporting tissues. The most favourable healing was obtained when resection of bone was avoided and when complete coverage of the alveolar bone was ensured.     

Healing following surgical treatment and root demineralization in monkeys with periodontal disease

Abstract The aim of the present investigation was to study the potential for new attachment to root surfaces which 1) had become devoid of attachment either by mechanical removal or in conjunction with experimental periodontal tissue breakdown and 2) subsequently had been conditioned with citric acid. Three adult monkeys (Macaca cynomolgus) were used. Periodontal pockets were produced during a 2–6-month period around the maxillary central incisors and first and second premolars and around the mandibular central incisors by the placement of orthodontic elastics. Surgical treatment of the pockets was carried out with the use of a flap procedure. During surgery, the roots of the premolars on the right side of the jaws were first scaled and planed and subsequently treated with citric acid. Citric acid conditioning was not performed on the premolars of the left side. In the front tooth regions the surgical treatment included citric acid conditioning of the mandibular central incisors in two animals and of the maxillary central incisors in one animal. Surgical procedures were also carried out around the mandibular second premolars and first molars which had not been exposed to periodontal tissue breakdown. Folio wing flap elevation, the buccal bone plate was mechanically removed within an area corresponding to that of bone loss produced by the experimental periodontitis model in the maxillary premolars. The cementum layer of the surgically denuded portion of the roots was removed by root planing. In all treated teeth, a notch was prepared in the buccal root surfaces at the level of the alveolar bone crest. Six months following treatment the animals were sacrificed and histologic sections prepared. Linear measurements were made along the root surface from the apical border of the prepared notch to the apical termination of the junctional epithelium and to the crest of the alveolar bone. The results demonstrated that cementum formation and new connective tissue attachment did not occur on root surfaces previously exposed to periodontal pockets and subsequently subjected to scaling and root planing or on root surfaces surgically deprived of their supporting bone and previously “non-exposed” cementum layer. Cementum formation and new connective tissue attachment also failed to occur following citric acid conditioning of root dentin surfaces. In all sections representing all three treatment groups, the attachment between the gingiva and the root was established by epithelium.     

Periodontal surgery in plaque-infected dentitions

A clinical trial was performed to study the result of periodontal treatment following different modes of periodontal surgery in patients not recalled for maintenance care. The material consisted of 25 patients distributed into 5 groups. Following an initial examination, all patients underwent presurgical treatment including case presentation and instruction in oral hygiene measures. This instruction was given once. The various patient groups were then subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects 2) the apically repositioned flap operation including curettage of bony defects but without removal of bone 3) the "Widman flap" technique including elimination of bony defects 4) the "Widman flap" technique including curettage of bony defects but without removal of bone 5) gingivectomy including curettage of bony defects but without removal of bone. Six, 12 and 24 months after completion of the treatment, the patients were recalled for assessment of their oral hygiene standard and periodontal conditions. The results showed that case presentation and oral hygiene instruction given once, only temporarily improved the patient's oral hygiene habits. Renewed accumulation of plaque in the operated areas resulted in recurrence of periodontal disease including a significant further loss of attachment. All five different techniques for surgical pocket elimination were equally ineffective in preventing recurrence of destructive periodontitis.     

Porous hydroxyapatite grafts in chronic subcrestal periodontal defects in rhesus monkeys: a histological investigation

The purpose of this investigation was to evaluate the histologic response to replamineform (porous) hydroxyapatite grafts in chronically inflamed, surgically created, periodontal pockets in Rhesus monkeys. Forty-eight subcrestal defects were surgically created in 8 Rhesus monkeys. Orthodontic wires were adapted to the base of the defects and left in place for 8 weeks. The defects were randomly assigned a treatment modality so that 8 granular porous and 8 block porous hydroxyapatite grafts were done. Eight sites were left as unoperated controls. Twenty-four contralateral sham-operated sites were treated by open curettage. Histometric measurements of the length of regenerated connective tissue attachment were recorded. Block hydroxyapatite, granular hydroxyapatite, and sham-operated sites exhibited similar amounts of regenerated connective tissue attachment, which was significantly greater than that which occurred in unoperated controls. Newly formed bone was observed within the porous channels of the hydroxyapatite grafts as well as in direct apposition on the surface of implant particles. New bone, cementum, and periodontal ligament was observed in grafted sites and in defects treated by open curettage. In some instances healing occurred by means of a long junctional epithelium. Histology confirmed that unoperated defects remained as unhealed, inflamed periodontal pockets. The results of this study suggest that porous hydroxyapatite grafts have the potential to regenerate the attachment apparatus in primates.     

The combined effects of plaque and physical stress on periodontal tissues

Experiments have been performed in beagle dogs in attempts to evaluate the effect of orthodontic- and jiggling-type trauma on the supporting structures of premolars. The results reported have unanimously demonstrated that in situations where orthodontic or jiggling forces were inflicted on teeth with a normal periodontium, or on teeth with overt signs of gingivitis, the periodontal ligament tissue reacted by transitory signs of inflammation. These phenomena occurred without a concomitant loss of connective tissue attachment and development of pathologically deepened periodontal pockets. If the jiggling trauma was inflicted on teeth with an ongoing plaque-associated, destructive periodontitis, the resulting inflammatory reactions caused enhanced loss of attachment and angular bony defects. Furthermore, orthodontic tilting movements of teeth (intrusion) in a plaque-infected dentition may shift a supragingivally located plaque into a subgingival position resulting in periodontal tissue breakdown.     

Short term results of three modalities of periodontal treatment.

Short term data were obtained from 74 patients who recieved comprehensive periodontal treatment using a split mouth approach to test three variables; subgingival curettage, pocket elimination surgery, and modified Widman flap procedure. The patients initially had an average interproximal loss of attachment of 3.2 mm and an average interproximal pocket depth of 3.9 mm. Evaluation of the data indicate that after 4 to 6 weeks: 1. All three surgical procedures reduce pocket depths. In order of effectiveness they are: pocket elimination surgery, modified Widman flap, and subgingival curettage. 2. Pocket elimination surgery reduces pockets more than subgingival curettage on the buccal, lingual and interproximal, and more than the modified Widman flap on the lingual. The modified Widman flap procedure reduces pockets more interproximally than subgingival curettage. 3. Subgingival curettage results in a gain of attachment interproximally, and on the lingual side, while the modified Widman flap resulted in a gain of attachment interproximally only. 4 Pocket elimination surgery resulted in a loss of attachment buccally. 5 Subgingival curettage results in a more favorable postoperative attachment level on all surfaces than did pocket elimination surgery.     

Periodontal response to long-term abuse of the gingival attachment by supracrestal amalgam restorations

The combined length of the supracrestal connective tissue attachment and the junctional epithelium is referred to as the "biologic width". The long-term (1-year) effect of complete violation of the supracrestal connective tissue attachment was examined in beagle dogs. Full thickness periodontal flaps were elevated, exposing the buccal bony crests of the maxillary and mandibular canines of 3 beagle dogs. The roots of the experimental teeth were planed and class V cavities were prepared. The apical border of each cavity was located at the alveolar bone crest. The cavities were restored with amalgam and the flaps were repositioned and sutured. In the control sites, a notch was prepared at the CEJ and the distance between the notch and the bony crest was measured. The dogs were sacrificed 57 weeks after the operation and the experimental and control sites prepared for histologic analysis. Every 5th section was examined and measurements were taken of the amount of gingival and bone recession, the length of the connective tissue and the epithelial attachment. Control sites healed uneventfully. Gingival recession averaged only 0.5 mm; bone loss was minimal and averaged 0.15 mm. The combined length of the supracrestal connective tissue and epithelial attachment measured 4.47 mm. In experimental sites, the gingiva receded 3.16 mm on average. Moderate bone loss (mean = 1.17 mm) was noted, but no signs of bone resorption were seen at the time of sacrifice. After bone loss, root surfaces which were previously attached to alveolar bone by periodontal ligament were mainly (0.90 mm) attached to connective tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improved periodontal conditions following therapy

The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths. The material consisted of 16 patients, 35-65 years of age. Following a Baseline examination including assessments of oral hygiene status, gingival conditions, probing pocket depths and probing attachment levels, the patients were subjected to periodontal treatment. A "split-mouth" design approach of therapy was used and the jaw quadrants were randomly selected for the following different treatment procedures: (1) scaling and root planning, (2) scaling and root planing in conjunction with a gingivectomy procedure, (3) scaling and root planing in conjunction with an apically repositioned flap procedure without bone recontouring, (4) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring, (5) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and (6) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks during a 6-month period of healing, after which a final examination was performed. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in a low frequency of gingival sites which bled on probing, a high frequency of sites with shallow pockets (less than 4 mm) and the disappearance of pockets with a probing depth of greater than 6 mm. Between the Baseline examination and the 6-month re-examination, the probing attachment level for initially shallow pockets remained basically unaltered, but with a tendency of a minor apical shift. This occurred in all 6 treatment groups. For sites with initial probing depths of 4-6 mm and greater than 6 mm, there was in all groups some gain of probing attachment. This gain was most pronounced in the initially deeper (greater than 6 mm) pockets. With the use of regression analysis, the "critical probing depth" (CPD) value (i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level resulted) was calculated for each of the 6 methods of treatment used. A comparison of the CPD-values between the 6 treatment groups did not reveal any major differences.     

New periodontal attachment procedure based on retardation of epithelial migration

Abstract A new attachment procedure based on retardation of epithelial downgrowth was used for the surgical treatment of 88 intrabony periodontal defects. Split flaps were made at the vestibular and oral aspect of the intrabony defect leaving a layer of connective tissue on the bone and corresponding to the missing bony walls. Granulation tissue was removed from the defect and the root surface planed. After transplantation of autogenous cancellous bone grafts from edentulous ridges, the defect was covered with a free palatal graft which was sutured to the adjacent, attached gingiva and underlying periosteum. The grafted area was covered with telfa and Coe pack was applied for 1–2 weeks. This procedure and a modification of it resulted in a markedly greater zone of new attachment when compared with traditional flap surgery. Residual pockets deeper than 3 mm were found in only 10 per cent of the defects treated by the soft tissue grafting technique.     

Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results

BACKGROUND: The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure. METHODS: A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study. In each patient, left or right maxillary single-rooted teeth were assigned randomly to one of two groups: group A (Er:YAG laser) and group B (modified Widman flap surgery). Er:YAG laser was used to debride the bone pockets, scale the root surface, and trim the periodontal flap. Recession, probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were recorded at baseline and at 3, 6, 12, 24, 36, 48, and 60 months. RESULTS: Both treatments resulted in decreases in PD, PI, GI, and BOP, increases in gingival recession, and gains in CAL. PD reduction in group A versus group B was statistically significant at 6, 12, 24, and 36 months (P < 0.05). Gains in CAL were significantly greater in group A versus group B at 6, 12, 24, and 36 months. BOP scores were significantly lower in group A versus group B at 3 and 6 months (P < 0.05). All other differences between treatment groups were not statistically significant. CONCLUSIONS: Surgical treatment of single-rooted teeth with chronic periodontitis using the Er:YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery. The short-term results obtained with both treatments can be maintained over 5 years.     

Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing

The present investigation was designed to evaluate the potential for reformation of connective tissue attachment on exposed and planed root surfaces by preventing the dentogingival epithelium and the gingival connective tissue from interfering with healing following periodontal surgery. Following the elevation of soft tissue flaps, the buccal and proximal alveolar bone of 24 teeth (48 roots) was removed to mid-root level in 6 monkeys and the exposed root surfaces were carefully planed in order to remove the root cementum. Before the flaps were repositioned and sutured, a membrane (Millipore® filter) was placed over the denuded part of the root surfaces of 16 teeth (test teeth) in order to prevent the epithelium and the gingival connective tissue from interfering with healing. The membrane was adjusted to cover the tooth surfaces from midcrown level to approximately l mm apical to the bone crest. No membranes were placed around the remaining 8 teeth (control teeth) before flap repositioning. The animals were sacrificed 6 months after surgery. The jaws were removed and histological sections of test and control teeth including their buccal periodontal tissues were produced. Nine of the test teeth had to be excluded from examination due to technical failures in the surgical procedure or tissue preparation. New cementum with inserting collagen fibers was observed on all remaining 14 test roots. The length of this newly formed fibrous attachment corresponded to approximately 50% of the distance from the apical extension of root planing to the cemento-enamel junction. In the majority of the control teeth no new attachment had formed but a “long” junctional epithelium was lining the root surfaces to the apical extension of root planing. In 3 control roots a small amount of new cementum with inserting collagen fibers was found in the most apical area of root planing. The results showed that the reformation of a connective tissue attachment was considerably favored by the placement of membranes which prevented the dentogingival epithelium and the gingival connective tissue from interfering with healing.     

The significance of alveolar bone in periodontal disease

The present experiment was designed to study if a gingival unit with a long supraalveolar connective tissue attachment provides less resistance against progression of periodontal disease than a unit with a supraalveolar connective tissue attachment of normal length. A long supraalveolar connective tissue attachment was established at the buccal aspect of mandibular premolars and molars in dogs by surgical removal of the marginal portion of the buccal alveolar bone after elevation of a muco-periosteal flap. Attempts were made to minimize mechanical injury to the root cementum and the supraalveolar fibrous attachment during the surgical procedure. Contralateral, non-operated teeth with a supraalveolar connective tissue attachment of normal length were used as controls. Following surgery, plaque control was initiated and maintained for 3 months by topical application of 0.2% chlorhexidine digluconate solution twice daily. During the following 6 months, the oral hygiene measures were abandoned and plaque was allowed to accumulate on both groups of teeth. In order to enhance plaque formation and to promote the development of subgingival plaque, cotton floss ligatures were placed at the entrance of the gingival sulci. The dogs were sacrificed 6 months after the initiation of the plaque accumulation period. The jaws were removed and histological sections prepared of test and control teeth including their surrounding periodontal tissues. The histological analysis revealed that the plaque induced inflammatory lesion in the gingival connective tissue did not extend more apically in sites with a long supraalveolar connective tissue attachment than in sites with a supraalveolar fibrous attachment of normal length. A small but statistically significant loss of connective tissue attachment had occurred in both groups of teeth. This attachment loss, however, was similar in sites with a long supraalveolar connective tissue attachment and in sites with a supraalveolar fibrous attachment of normal length. These findings suggest that the loss of attachment in periodontal disease is unrelated to the presence or absence of the bony component of the periodontium.     

The effect of root planing as compared to that of surgical treatment

Abstract This study was undertaken in order to evaluate the effect of root planing as compared to that of surgical periodontal treatment in patients with advanced periodontal disease. 17 patients with advanced periodontal disease participated in the study. After the initial examination, the teeth were scaled and the patients were given instruction in performing proper oral hygiene. The hygienic phase for the individual patient was continued until less than 20% of the tooth surfaces demonstrated plaque at 2 succeeding appointments. After re-assessment of the periodontal status, 1 side in both the maxilla and mandible was treated with modified Widman flap surgery. In I of the remaining quadrants, in the maxilla or mandible, reverse bevel flap surgery was used. Bone contouring was not performed in any of the surgical procedures. The last quadrant was subjected to meticulous root planing under local anesthesia. Subsequently, the patients were recalled every second week for professional tooth cleaning. The periodontal status of each patient was assessed 3 and 6 months following treatment. Root planing resulted in considerable reduction in pocket depth, although more shallow pockets were obtained following modified Widman flap and reverse bevel flap surgery. Clinical gain of attachment was obtained following all 3 modalities, but root planing resulted in slightly more gain of attachment than the 2 surgical procedures.     

The histologic evaluation of new attachment in periodontally diseased human roots treated with tetracycline-hydrochloride and fibronectin

The purpose of this study was to determine how the treatment of human tooth roots with tetracycline-HCl and fibronectin during periodontal surgery influences the attachment of the gingiva to the root surface. Mucoperiosteal flap surgery was performed on 22 teeth with periodontal disease. Teeth were assigned to three groups. Group one received surgery with degranulation and root planing. Group two received surgery with treatment of roots with tetracycline-HCl. Group three received surgery with treatment of roots with tetracycline-HCl and fibronectin. At 90 days, block sections were taken and teeth, gingiva, alveolar bone, and periodontal ligament were evaluated histologically. Controls healed with a long junctional epithelial attachment. Tetracycline and tetracycline with fibronectin groups demonstrated some reattachment, but only within the notches placed in the root at the original level of the bone. There was a trend for greater connective tissue attachment following tetracycline-HCl treatment of roots. The additional application of fibronectin to tetracycline treated roots appeared to partially negate the enhanced connective tissue attachment observed with tetracycline treatment alone.     

Periodontal status in relation to age and tooth type

The purpose of the present study was to assess by radiographic means the pattern of destructive periodontal disease within the dentition of individuals of different ages. Full-mouth series of intra-oral radiographs from 531 dentate individuals aged 25-75 years were examined with respect to number and type of remaining teeth, location of the alveolar bone in relation to the cemento-enamel junction and presence of angular bony defects. The assessments of alveolar bone levels and angular bony defects were performed at the approximal surfaces of all teeth present. The results showed that although most individuals had experienced a reduction in alveolar bone height with age, only a small number of subjects had developed advanced breakdown of the periodontium. Hence, pronounced bone loss was observed in only 11% of the subjects and was non-existent in ages below 35 years. 23% of the individuals accounted for 3/4 of the total number of sites with bone level values (bone loss) of greater than or equal to 6 mm. Out of the total number of tooth sites examined, 28% showed no bone loss, while 13% demonstrated pronounced periodontal tissue breakdown. Angular bony defects were found at 8% of all teeth examined and were most frequent at the maxillary first premolars. Teeth in the incisor regions consistently showed the highest frequency of advanced alveolar bone loss and the lowest frequency of normal tissue support, while corresponding figures for teeth in the molar regions were found to be the opposite. However, molars were the most frequently missing teeth.     

Effect of citric acid and lyophilized autologous plasma on healing following periodontal flap surgery in monkeys

The purpose of this histologic, histometric, and autoradiographic study was to examine the effect of citric acid conditioning and lyophilized autologous plasma (LAP) application on healing following periodontal flap surgery. Mucoperiosteal flaps were elevated in six rhesus monkeys using the modified Widman flap procedure. A total of 24 quadrants were treated, each included the first and second premolar and first and second molar teeth. Cementum was removed from the exposed root surfaces, and reference notches were inscribed into the roots at the alveolar bone margin. Two treatment modalities were employed: (1) surgery plus citric acid conditioning, to serve as control and (2) surgery plus citric acid followed by LAP application (400 mg/ml saline). Flaps were returned to their preoperative positions and sutured. Animal sacrifices were scheduled to provide observations 3, 7, 14, 21, 28, and 45 days after surgery. Each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm of body weight, 1 hour before it was killed. Tissue specimens were processed for evaluation following standard procedures. Histologically, tissue sections were examined for: (1) proliferation and attachment of epithelium, (2) organization and maturation of periodontal fibers, (3) inflammatory cell types, (4) presence or absence of new cementum deposition, and (5) degree of vascularity of the tissues. For histometric evaluation, the radicular notches were used as reference points. The distances examined histometrically were: (1) from the root surface notch to the alveolar bone crest, (2) from the root surface notch to the apical extent of the junctional epithelium, and (3) from the free gingival margin to the apical extent of the junctional epithelium. For autoradiographic evaluation labeled cells were counted in five spatial compartments at 400 X magnification: (1) oral epithelium, (2) crevicular area, (3) supracrestal connective tissue, (4) coronal periodontal membrane, and (5) coronal bone marrow. For each the histometric and autoradiographic evaluation involved a total of 36 tissue sections per quadrant (9 sections per tooth). Tooth and quadrant means were obtained for each monkey. The plasma-treated and control quadrants were compared at each time point by the paired t test. N = 2 monkeys were used for each comparison. Histologic results showed that in teeth that were acid-conditioned after root planing, the epithelium often migrated apically reaching the radicular notch. Those teeth that were conditioned and subsequently treated with LAP demonstrated fiber attachment to the planed root surface and little or no epithelial downgrowth.(ABSTRACT TRUNCATED AT 400 WORDS)     

Microbiological and clinical effects of surgical treatment of localized juvenile periodontitis

Since Actinobacillus actinomycetemcomitans appears to be a key etiologic agent in localized juvenile periodontitis, this study determined the effectiveness of different treatment modalities in suppressing A. actinomycetemcomitans in localized juvenile periodontitis lesions. A total of 25 deep periodontal lesions from 7 patients with localized juvenile periodontitis were included in the study. The test periodontal lesions either received scaling and root planing alone, scaling and root planing together with soft tissue curettage, or modified Widman flap surgery. Subgingival A. actinomycetemcomitans were enumerated using selective culturing. Clinical measurements included changes in probing periodontal attachment level, probing periodontal pocket depth, gingival index, plaque index, and digital subtraction of standardized serial radiographs. The microbiological and clinical effects of treatment were monitored over a period of 16 weeks. All periodontal lesions studied demonstrated high numbers of A. actinomycetemcomitans prior to treatment. Scaling and root planing alone did not markedly change the subgingival A. actinomycetemcomitans counts, nor any of the clinical parameters studied. In contrast, soft tissue curettage as well as modified Widman flap surgery suppressed A. actinomycetemcomitans to undetectable levels immediately after therapy in more than 80% of the lesions studied. A total of 5 periodontal lesions exhibited gain of probing periodontal attachment after subgingival curettage or Widman flap treatment; 3 of these sites revealed no detectable A. actinomycetemcomitans, and the remaining 2 sites harbored only low levels of A. actinomycetemcomitans. 5 periodontal lesions which lost probing attachment after treatment all demonstrated high numbers of subgingival A. actinomycetemcomitans. Changes in alveolar bone, assessed by digital subtraction of serial radiographs, correlated with changes in probing periodontal attachment level, confirming the clinical results. The present study revealed a close relationship between post-treatment A. actinomycetemcomitans levels and the clinical response to treatment, which supports the concept that A. actinomycetemcomitans is an important organism in the etiology of localized juvenile periodontitis. This study also showed that a substantial suppression of subgingival A. actinomycetemcomitans cannot be achieved by periodontal scaling and root planing alone, but can be accomplished by surgical removal of periodontal tissues.(ABSTRACT TRUNCATED AT 400 WORDS)     

Healing following surgical non-surgical treatment of periodontal disease

Abstract A clinical trial was undertaken to study the effect of one surgical and one non-surgical treatment modality in patients with advanced periodontal disease. Fifteen patients were selected for the study. Following a Baseline examination comprising assessments of oral hygiene status, gingival conditions, probing depths and attachment levels, all participants were subjected to treatment. In each patient, scaling and root planing were carried out in conjunction with the modified Widman flap procedure in two jaw quadrants while in the contralateral quadrants the treatment was restricted to scaling and root planing. During the phase of active treatment, i.e. the period between the first and last operation, and for the subsequent 6 months of healing, the patients were subjected to “professional toothcleaning” once every 2 weeks. From this time until the end of the trial which was 24 months after active treatment, the patients were recalled for prophylaxis once every 3 months. Reexaminations were performed 6, 12 and 24 months after the completion of active treatment. The results demonstrated that scaling and root planing used alone were almost equally effective as their use in combination with the modified Widman flap procedure in establishing clinically healthy gingiva and in preventing further loss of attachment. Both treatment modalities prevented recurrence of periodontal disease for the 24 months of observation. The analysis of the probing depth data revealed that both methods of treatment resulted in a high frequency of probing depths of <4 mm. The probing depth reduction was more pronounced in initially deep than in initially shallow pockets and, for initially deep pockets, more marked in sites subjected to surgery than in sites exposed to scaling and root planing alone. The measurements also showed that sites with initially deep pockets exhibited more pronounced gain of clinical attachment than sites with initially shallow pockets. Significant loss of attachment did not occur in sites treated with scaling and root planing alone while attachment loss was found following Widman flap surgery in sites with initial probing depth of <4 mm.