Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.     

Clinical and antimicrobial effects of a single episode of subgingival irrigation with tetracycline HCI or chlorhexidine in deep periodontal pockets

Abstract. 15 adults, each providing 4 non-adjacent untreated periodontal pockets with a probing depth (PD) exceeding 6 mm. volunteered for a randomized, split-mouth, double-blind, clinical study evaluating subgingival irrigation with chlorhexidine (CHX) or tetracycline HCl (TTC). The study protocol included oral hygiene instructions followed by scaling and root planing. Experimental and immediately adjacent teeth did not receive instrumentation. The 4 deep periodontal pockets in each patient were assigned to be irrigated with 150 ml CHX (0.12%). TTC (10 or 50 mg/ml; TTC10, TTC50), or sterile saline (control) in a single episode. Post-irrigation mechanical plaque control was supported by 2× daily CHX rinses throughout the 12-week observation interval. Recordings of oral hygiene (PlI), gingival health (GI). bleeding on probing (BoP). probing depth (PD), clinical attachment level (CAL), and microbial morphotypes from subgingival paper point samples were performed pre-irrigation. and at 1, 2, 4, 6, 8, 10, and 12 weeks post-irrigation. Mean post-irrigation PlI was low, fluctuating between 0.0 and 0.4, without significant differences between experimental groups. Mean pre-irrigation GI approximated 1.4 and reached 0.8 at the exit of study without significant differences between experimental groups. All experimental sites exhibited BoP pre-irrigation. BoP was significantly reduced in TTC50 compared to TTC10, CHX and control sites from week 8 post-irrigation. PDs were reduced for the experimental groups with TTC50 exhibiting the strongest reduction. CALs remained unaltered from pre-irrigation for TTC10. CHX and control sites over the 12-week observation interval, whereas TTC50 sites consistently improved to significantly differ from all other groups at week 10 and 12 post-irrigation. The distribution of bacterial morphotypes was significantly altered towards one of periodontal health for all experimental groups with a profound effect for TTC50 sites. Our results suggest that subgingival irrigation with TTC solutions at high concentrations may have a rôle in the management of adult periodontitis.     

Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate

Recent interest in the local delivery of antimicrobial and anti-inflammatory agents has stimulated interest in the efficacy of various treatment regimens. Chlorhexidine gluconate (CHX) delivered daily by home-applied marginal irrigation as a 0.04% solution in combination with a single professional irrigation of 0.12% CHX was tested over a 3-month period. Sixty periodontal maintenance patients each having at least 2 pockets greater than or equal to 4 mm probing depth, and bleeding on probing were assigned to either Group 1: one professional subgingival 0.12% CHX (Peridex) irrigation (Perio Pik) followed by adjunctive daily home marginal 0.04% CHX irrigation (Pik Pocket); Group 2: one professional subgingival 0.12% CHX irrigation followed by adjunctive daily home marginal water irrigation; Group 3: one professional subgingival water irrigation followed by adjunctive daily home marginal water irrigation; or Group 4: control. At baseline and 3 month visits, subgingival plaque samples were taken from 2 sites per patient. Cultural microbiological analysis was performed using non-selective and selective media. Plaque Index, Gingival Index, pocket probing depths, and gingival recession were assessed. Scaling and root planing (supportive periodontal treatment) was provided for each patient followed by subgingival irrigation as outlined above. At 3 months the Gingival Index and pocket probing depths were both significantly reduced (P less than .05) in all irrigation groups compared to baseline. There were no significant changes in clinical parameters in the control group from baseline to 3 months. In Group 1 the GI was significantly reduced (P less than .05) compared to Group 4 at 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Povidone-iodine as a periodontal pocket disinfectant

OBJECTIVES AND BACKGROUND: Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus. METHODS: Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests. RESULTS: At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups. CONCLUSIONS: The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.     

超声龈下刮治同步药物冲洗对龈下微生物的影响

目的 :比较Master 40 0超声龈下刮治同步药物冲洗系统与传统超声龈下刮治 +药物冲洗对龈下微生物的影响及临床疗效。方法 :选取慢性成人牙周炎患牙 2 0个 ,随机分入实验组 (超声龈下刮治同步药物冲洗 )和对照组 (传统超声龈下刮治 +药物冲洗 )。记录治疗前、后 0、7、14d的探诊出血 (BOP)、探诊深度 (PD) ,并采集龈下菌斑样本培养 ,观察比较总菌落形成单位 (CFU)和牙周可疑致病菌检出率及检出量的变化。结果 :治疗后两组PD、BOP、CFU和牙周可疑致病菌数量均显著减少 (P <0 .0 5 ) ;实验组牙龈卟啉单胞菌 (P <0 .0 1)和二氧化碳噬纤维菌 (P <0 .0 5 )明显少于对照组。结论 :Master 40 0超声龈下刮治同步药物冲洗系统比传统超声龈下刮治 +药物冲洗能更有效地减少龈下致病微生物的数量     

Periodic subgingival antimicrobial irrigation of periodontal pockets

The present investigation was undertaken to study the clinical effect of professionally performed periodic subgingival irrigation per se and as an adjunct to scaling and root planing. 10 patients suffering from moderate-severe periodontal disease participated in the study. Following an initial 3-month period of supervised supragingival plaque control, a total of 102 periodontal sites with probing pocket depth greater than or equal to 6 mm and "bleeding on probing" were selected and subjected to a Baseline examination comprising assessments of oral hygiene and gingival conditions, probing depths and probing attachment levels. The pockets in the various jaw quadrants were randomly assigned to one of the following treatment groups: (1) periodic subgingival irrigation with hydrogen peroxide, (2) periodic subgingival irrigation with chlorhexidine, (3) periodic subgingival irrigation with saline and (4) no subgingival treatment. During the first part of the study (baseline-32 weeks), no mechanical debridement of the subgingival area was performed. The irrigation treatment was carried out by the operator 3 times per week during weeks 1 + 2 and 5 + 6 of the trial. In the 2nd part of the trial (32-52 weeks), the sites were subjected to scaling and root planing combined with professional irrigation during weeks 32-38. The previously non-irrigated control sites were not subjected to adjunctive irrigation when mechanically debrided. During the entire study, the patients were recalled for professional tooth cleaning once every 4 weeks. Re-examinations were carried out at 4, 6, 32, 40 and 52 weeks. The results revealed that repeated professional irrigation of unscaled periodontal pockets with chlorhexidine or hydrogen peroxide resulted in a temporarily reduced frequency of bleeding sites, but not in any clinically significant changes in probing assessments. A similar improvement of bleeding scores was observed in the saline-irrigated control group. Scaling and root planing, in combination with an optimal supragingival plaque control, resulted in a marked resolution of the clinical symptoms of periodontal disease. Adjunctive irrigation with chlorhexidine or hydrogen peroxide did not improve the healing result above and beyond that obtained after mechanical debridement alone or in combination with saline irrigation. Hence, the study failed to demonstrate that professionally performed periodic subgingival irrigation with chlorhexidine or hydrogen peroxide, used alone or in combination with thorough mechanical debridement, has a significant therapeutic effect.     

The adjunctive use of a controlled-release chlorhexidine chip following treatment with a new ultrasonic device in supportive periodontal therapy: a prospective, controlled clinical study

OBJECTIVE: The aim of this randomised, split-mouth, controlled clinical trial was to evaluate the effectiveness of a controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP) with a newly developed ultrasonic device in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Twenty patients with moderate-to-severe chronic periodontitis, displaying at least four sites with probing depth (PD) > or = 5 mm and persistent bleeding on probing (BOP), were recruited for the study. The target sites were randomly treated with either a newly developed piezo-driven ultrasonic device Vector--or ultrasonic system (VUS) + CHX chip or VUS alone without adjunctive antimicrobial treatment. The clinical parameters, plaque index (PI), gingival index (GI), BOP, PD and clinical attachment level (CAL) were recorded at baseline and after 1, 3 and 6 months. RESULTS: At baseline, there were no significant differences between test and control sites for any of the investigated parameters. The average reduction of PD and improvement in CAL was greater in the VUS + CHX chip sites than in sites treated with the VUS alone at 1, 3 and 6 months (P < 0.05). The mean reductions on PD and CAL were 0.7 and 0.6 mm for the control sites and 2.2 and 1.9 mm for the test sites, respectively. Also, the mean reduction in BOP scores were higher in the VUS + CHX chip sites compared to VUS alone at 1, 3 and 6 months (P < 0.05). PI scores were not significantly different between VUS + CHX chip sites and VUS alone sites at any visit. CONCLUSION: These data suggest that CHX chip application following SRP with the tested ultrasonic device is beneficial in improving periodontal parameters in patients on SPT.     

Effect of scaling and root planing on the composition of the human subgingival microbial flora

The effect of a single session of scaling and root planing on the subgingival periodontal flora of 14 adult human subjects was investigated by darkfield microscopy. At baseline, one randomly selected periodontally diseased site in each subject was assessed for GI and P1I scores, probing depth and the percentage distribution in subgingival debris of coccoid cells, spirochetes, motile cells and other microorganisms. Following a single full mouth scaling and root planing session, these criteria were reevaluated at other initially diseased sites, one per subject and time interval. The intervals tested were days 3, 7, 14, 21, 28, 35, 42, 49, 56, 70 and 90.
The P1I and GI scores tended to decrease during the first 14 days, returning to baseline around days 21–28. After another transient decline around 35–42 days the values stabilized around baseline levels till the end of the experiment. Probing depth decreased below baseline during the first 7 days and with the exception of day 28, remained below baseline level till the end of the experiment. Coccoid cells increased from 25.1 % at baseline to 76.1 % on day 3. Return to the baseline level occurred by day 21. Spirochetes did not return to baseline until day 42. The percentage of motile cells decreased significantly from baseline on day 3 only (14.8 % to 3.8 %).
The results indicated that a single session of scaling and root planing is capable of disturbing the proportions of certain bacterial forms in the subgingival periodontal flora, and that it may require approximately 42 days for the proportions to return to baseline levels. Probing depth was significantly decreased by the debridement throughout most of the 90-day experimental period. The proportion of coccoid cells was negatively correlated with both GI and P1I scores, while the percentage of spirochetes was positively correlated with GI and P1I scores as well as probing depth measurements.     

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.     

Scaling and granulation tissue removal in periodontal therapy

The present clinical trial was performed to study whether subgingival scaling is a method of therapy which is equally effective as "access" flaps in reducing gingivitis and probing depths and in improving probing attachment levels. The study was also designed to assess whether granulation tissue removal is a determining factor for proper healing in the treatment of periodontal disease. 15 patients with advanced periodontal disease were included in the study. Each patient had at least 4 sites in each quadrant of the jaws with probing depths exceeding 6 mm. A baseline examination was performed to assess the following parameters: the oral hygiene status, the gingival conditions, the probing pocket depths and the probing attachment levels. In addition, in each quadrant, 3 approximal sites were selected for analysis of the subgingival microbiota. All of these sites showed signs of gingivitis. One site had a probing depth of less than 4 mm, another a probing depth between 4 and 6 mm and the third site had a probing depth exceeding 6 mm. The subgingival bacterial samples were studied by dark-field microscopy and the % of spirochetes and motile rods was assessed. By random selection the 4 jaw quadrants in each patient were treated for periodontal disease by the use of (1) the modified Widman flap procedure, (2) the modified Kirkland flap procedure or by (3) nonsurgical scaling and root planing. In all, 20 quadrants were treated with each of the 3 procedures. After the termination of active periodontal treatment, all patients were recalled for professional tooth cleaning once every 2 weeks during a 12-week period. Subsequently, they were recalled for prophylaxis every 3 months. The patients were examined 6 and 12 months after treatment using the same parameters as used at baseline. The data from the examinations demonstrated that subgingival scaling is an effective measure in the treatment of periodontal disease. Both in terms of average gingivitis resolution and average probing depth reduction, non-surgical therapy appeared to be equally effective as a surgical approach to treatment. It was also observed, however, that following non-surgical treatment, a larger number of sites with pockets exceeding 6 mm remained than following surgical therapy. Most of these deep pockets in non-surgically treated quadrants bled on probing to the base of the pocket. In addition, the subgingival microbiota of such sites were found to harbor more than 20% spirochetes and motile rods.(ABSTRACT TRUNCATED AT 400 WORDS)     

The effect of 2% chlorhexidine digluconate irrigation on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets

Eight patients with moderate periodontitis volunteered to participate in a study to assess the effect of subgingival 2% chlorhexidine irrigation, with and without scaling and root planing, on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets. Each quadrant was required to have at least one site with a probing depth of 6 mm or greater and bleeding on probing. The patients were treated following a randomized four quadrant design: one quadrant received no treatment; a second quadrant received scaling and root planing only; a third quadrant received chlorhexidine irrigation only; the fourth quadrant received scaling and root planing, plus chlorhexidine irrigation. Sites to receive chlorhexidine were irrigated at 0, 1, 2, and 3 weeks. Clinical and microbiological indices were measured and recorded at 0, 5, 7, 11, and 15 weeks. The clinical parameters measured included; Plaque Index (PI), Gingival Index (GI), probing depth (PD), Bleeding Tendency (BT), and attachment level (AL). The attachment level was measured using an occlusal stint as a fixed reference point. The level of Bacteroides gingivalis was measured by labeling the plaque sample with a polyclonal fluorescent antibody. The plaque smear was then read using a fluorescent microscope at 1000 magnification. The Spearman Rank-Order Correlation was used to determine the relationship between parameters at baseline. The effects of the treatment groups were compared using the Neuman-Keuls Multiple Comparison Technique. The results showed that a positive correlation existed between B. gingivalis (rs = 0.68) and Bleeding Tendency and between P1I (rs = 0.77) and GI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Subgingival metronidazole in dialysis tubing and subgingival chlorhexidine irrigation in the control of chronic inflammatory periodontal disease

The present investigation compared subgingival metronidazole in dialysis tubing and subgingival chlorhexidine irrigation in the control of chronic inflammatory periodontal disease. 10 patients with 4 mm or deeper periodontal pockets were divided into 2 groups. Both received baseline scaling, root planing, subcontact area cleaning and instruction in the Bass technique of tooth brushing, but not in interdental cleaning. One group with 80 pockets received 0.2% chlorhexidine subgingival irrigation for 28 days and the other with 86 pockets received 0.5% metronidazole solution incorporated in subgingivally placed dialysis tubing. The tubings were replaced with freshly filled ones at days 7, 14 and 21. Active treatment ceased at day 28. Plaque Index, Sulcus Bleeding Index, pocket depth and gingival shrinkage were recorded at days 0, 7, 14, 21, 28, 56 and 84. Subgingival 0.5% metronidazole in dialysis tubing and 0.2% chlorhexidine irrigation were found to be equally effective in reducing chronic periodontitis. Metronidazole reduced Plaque Index less but pocket depth more than chlorhexidine. Improvements were maintained significantly below baseline levels for at least 8 weeks after the end of the 4-week treatment period.     

Effects of subgingival chlorhexidine irrigation in chronic moderate periodontitis

The clinical and microbiological effects of once daily subgingival irrigations with 1 ml of 0.2% chlorhexidine gluconate (CH) during 14 days were evaluated in 23 patients with 4 to 6 mm contralateral pockets. On Days 0, 14 and 28, evaluations were made of the plaque index, the gingival index, gingival bleeding on probing pocket depth and of microbiological variables (phase-contrast microscopy). Supragingival scaling was carried out but no oral hygiene instructions were given to patients at the start of the trial. Twenty-three test sites (subgingival CH) and 23 control sites (subgingival distilled water + supragingival CH) were studied. The clinical results showed a significant reduction of the gingival index (P less than 0.05) in the test group with respect to the control group on Day 14. No other clinically significant differences could be observed in the test group with respect to the control group. A significant reduction in the proportions of spirochetes (P less than 0.05) and a significant increase in the proportions of cocci (P less than 0.005) were observed in the test group on Day 14. CH irrigation as a subgingival monotherapy yielded transient microbiological and limited clinical effects.     

Clinical effects of pulsed oral irrigation with 0.2% chlorehexidine digluconate in patients with adult periodontitis

The aim of this study was to investigate the effects of using 0.2% Chlorhexidine digluconate in an pulsated jet irrigator by patients as part of their daily dental home-care measures. After initial assessment, 16 patients diagnosed as having adult periodontitis received scaling and polishing together with advice on the subgingival use of a pulsated jet oral irrigator with which they were supplied. 8 patients having 293 active sites with probing depths equal to or in excess of 4 mm used 0.2% chlorhexidine digluconate (CHX) in the oral irrigator, 2 x daily for 56 days. The other group of 8 patients with 253 active sites over 4 mm used a placebo as the irrigating solution. A modified dichotomous plaque index (MPI), gingival bleeding index (GBI) and probing pocket depths (PPD) were assessed on days 0, 28 and 56. Within-group comparisons showed that the CHX regime reduced MPI, GBI and PPD significantly but that the placebo group (PG) only achieved a significant reduction in the PPD. Between-group comparisons showed that the use of 0.2% CHX as an irrigant was significantly more effective than the placebo solution at reducing all the clinical parameters studied. The patients found the oral irrigator easy and pleasant to use, although all the CHX group developed staining to a varying extent. This double blind study demonstrated that 0.2% CHX used 2 x daily in an oral irrigator was effective at reducing plaque deposition, periodontal inflammation and probing pocket depths. The effects of using lower concentrations of chlorhexidine digluconate in this regime need to be investigated.     

氯己定薄片辅助牙周治疗的疗效观察

目的评价控释药氯己定薄片(chip)辅助牙周刮治(scaling and root planing, SRP)治疗牙周炎的疗效和安全性.方法 65例成人牙周炎患者经全口SRP后,左右侧象限均至少有一个牙位探诊深度(probing depth, PD)≥5 mm且探诊出血(bleeding on probing, BOP),选此种牙为受试牙,检查和记录其临床指标,并随机选择一侧的受试牙刮治后放药,另一侧受试牙刮治后不做处理,临床观察6个月.结果用药组在第6个月时的PD减少(1.32 mm)以及附着增加(0.91 mm)均显著高于对照组(0.77 mm,0.40 mm),差异有非常显著性(P<0.001),第6个月用药组的BOP阳性率(79.4%)明显低于对照组(92.4%)(P<0.001);两组的牙面着色指数无统计学差别.44.6%的患者反映用药部位不适,主要为牙龈轻度胀痛.结论 SRP+氯己定薄片组在减少PD、增加牙周附着和减轻牙周组织炎症方面优于单纯SRP组,是一种适于牙周维护治疗的有效且安全的局部用药.     

Clinical outcome observed in subjects with recurrent periodontal disease following local treatment with 25% metronidazole gel

BACKGROUND: The aim of this study was to evaluate the clinical outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel. METHODS: Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing, a total of 40 sites, 2 in each patient, with probing depth > or = 5 mm were selected. One site randomly selected was treated with metronidazole gel (test) and the other site with a placebo gel (control). Baseline and follow-up measurements included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). RESULTS: There were no statistically significant differences in PI, GI, BOP, PD, or CAL between test and control sites. CONCLUSION: This study showed that local treatment with 25% metronidazole gel did not seem to influence the clinical healing in this group of subjects with recurrent periodontal disease.     

The effect of plaque control after scaling and root planing on the subgingival microflora in human periodontitis

The aim of the present study was to evaluate the effect of a strict supragingival plaque control regimen on bacterial repopulation following scaling and root planing. 7 patients with moderate to severe inflammatory periodontal disease received a full-mouth scaling and subgingival curettage. Using a split-mouth design, 2 sites of opposite quadrants were submitted to professional supragingival plaque control 3 X a week while the contralateral sites served as controls. Clinical and bacterial examination were performed on days 7, 14, 28, 49, 56, 63 and 70 following therapy. All clinical parameters (P1I, GI, probing depth, attachment levels) showed significant improvement after scaling and root planing. Shifts in the subgingival bacterial population observed by dark field were also noticed following curettage: there was a decrease in the proportions of spirochetes and motile rods and an increase in that of coccoid cells. However, bacterial distribution tended to return to base line values towards the end of the observation period. No difference in the pattern of bacterial recolonization of the subgingival area could be detected between the sites under strict supragingival plaque control and the control sites.     

Subgingival irrigation in the maintenance phase of periodontal therapy

The purpose of this study was to evaluate the effect of subgingival scaling versus subgingival pocket irrigation with 0.1% chlorhexidine or saline controls on the repopulation of subgingival periodontal sites with disease-associated micro-organisms following a single procedure of scaling and root planing. Additionally, pertinent clinical parameters (attachment level, plaque index, bleeding on probing) were also recorded. 375 sites in 30 individuals with previously untreated periodontal disease were thoroughly scaled and subsequently either rescaled, irrigated, or not treated at all for the following 6 months at 1-month intervals. The results show that the initial scaling and root planing procedure led to significant clinical and microbiological improvements in all experimental groups. These improvements were maintained in all but the untreated sites. Based on the observed clinical and microbiological changes, subgingival irrigation of periodontal pockets at 1-month intervals was equally effective as scaling and root planing performed at the same pace. 0.1% chlorhexidine however, being used as test irrigant, was not more effective than saline controls.     

Effect of subgingival irrigation with tetrapotassium peroxydiphosphate on scaled and untreated periodontal pockets

A total of 20 test and 20 control subjects completed an 8-week double blind clinical trial aimed at testing the therapeutic efficacy of a 7% tetrapotassium peroxydiphosphate (PDP) solution administered as a subgingival irrigant to scaled and untreated periodontal pockets. Each patient provided similar contralateral pockets with probing depths at base line of 5 mm or more (mean 6.25 mm). One pocket was selected at random for a thorough scaling, immediately following the base line examination (examination 1). The examination of each experimental site consisted of Plaque Index (P1I) and Gingival Index (GI) scores, probing depth (PD) and attachment level (AL) measurements (in mm), and a differential microscopic proportional count of certain subgingival bacterial morphotypes, namely coccoid cells, motile bacteria (not including spirochetes), spirochetes and all residual bacterial morphotypes. Test patients received coded irrigators containing the active ingredient PDP, while control patients received irrigators containing a placebo rinse similar to the test solution, but without PDP. The participants were instructed to irrigate the test sites twice a day. They were re-examined after four weeks (examination 2) and eight weeks (examination 3) from the base line examination. The results indicated that scaling and irrigation produced a significant decrease from the initial P1I and GI scores, and the PD and AL measurements. The proportions of coccoid cells were significantly increased, while the proportions of motile bacteria and spirochetes were significantly decreased. Irrigation of unscaled pockets resulted in a modest, but significant decrease in the P1I and GI scores.(ABSTRACT TRUNCATED AT 250 WORDS)