Clinical and microbiological features of subjects with adult periodontitis who responded poorly to scaling and root planing

Abstract In a previous report, it was shown that scaling and root planing (SRP) decreased mean pocket depth and attachment level in subjects with adult periodontitis, as well as the levels and prevalence of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola. However, a subset of subjects in that study exhibited mean loss of attachment following SRP. The purpose of the present investigation was to seek clinical and microbiological differences between subjects who responded well or poorly to SRP. 57 subjects with adult periodontitis were treated by full-mouth SRP under local anaesthetic. Clinical assessments of plaque, redness, suppuration, BOP, pocket depth and attachment level were made at 6 sites per tooth prior to and 3 months post-SRP. Attachment level measurements were repeated at each visit and differences in means between visits used to assess change. 18 subjects showed mean attachment loss 3 months post-SRP (poor response group), while 39 showed mean attachment level gain (good response group). The prevalence and levels of 40 subgingival taxa in subgingival plaque samples from the mesiobuccal site of each tooth (maximum 28 sites) in each subject prior to and 3 months post-SRP were assessed using checkerboard DNA-DNA hybridization. The prevalence of each species was computed for each subject and averaged across subjects in the 2 treatment-response groups at each visit. Differences between groups were sought using the Mann-Whitney test. There were no statistically significant differences between the 2 response groups in any clinical parameter prior to therapy. Subjects in the good response group showed more attachment level gain at sites with baseline pocket depths of < 4 mm, 4–6 and > 6 mm than poor response subjects. Of 40 species evaluated. A. naeslundii genospecies 2 (A. viscosus), T. denticola, C. gracilis and C. rectus were significantly higher and more prevalent pre-therapy in the good response subjects. Mean attachment level change post SRP could be predicted using multiple linear regression with A. naeslundii genospecies 2 (A. viscosus) and T. denticola as the predictor variables (r²=0.373, p < 0.00001). Sites that gained ≥ 2 mm of attachment post therapy showed a significant decrease in the counts of P. gingivalis (7.5±3.5 to 0.2±0.2×10⁵), T. denticola (8.2±3.5 to 1.8±1.1×10⁵) and B. forsythus (11.1 ± 5.7 to 0.3±0.2×10⁵). The data of the present investigation indicate that SRP is most effective in subjects and sites with high levels of the subgingival species that this therapy affects.     

Partial- and full-mouth scaling and root planing in type 2 diabetic subjects: a 12-mo follow-up of clinical parameters and levels of cytokines and osteoclastogenesis-related factors

Santos VR, Ribeiro FV, Lima JA, Miranda TS, Feres M, Bastos MF, Duarte PM. Partial‐ and full‐mouth scaling and root planing in type 2 diabetic subjects: a 12‐mo follow‐up of clinical parameters and levels of cytokines and osteoclastogenesis‐related factors. J Periodont Res 2012; 47: 45–54. © 2011 John Wiley & Sons A/S Background and Objective: The aim of this study was to evaluate the effects of full‐mouth scaling and root planing (FMSRP) and partial‐mouth scaling and root planing (PMSRP), up to 12 mo after treatment, on clinical parameters, and levels of cytokines and osteoclastogenesis‐related factors in type 2 diabetic subjects with chronic periodontitis. Material and Methods: Thirty‐four subjects received FMSRP (n = 17) or PMSRP (n = 17) within 24 h or in multiple sessions, respectively. Clinical parameters and local levels of tumor necrosis factor‐α (TNF‐α), interferon‐γ (IFN‐γ), interleukin (IL)‐17, IL‐23, IL‐4, receptor activator of NF‐β ligand and osteoprotegerin were assessed at baseline, and 3, 6 and 12 mo after therapies. Results: Clinical parameters improved after both therapies (p < 0.05), and no between‐group differences were observed at any time‐point (p > 0.05). Overall, there were no considerable differences in the local levels of the biomarkers studied between groups (p > 0.05). The IL‐23 concentration and total amount of IFN‐γ increased in the FMSRP group and decreased in the PMSRP group from baseline to 3 mo and from baseline to 6 mo, respectively (p < 0.05). Conclusion: Both PMSRP and FMSRP promoted benefits in clinical parameters and showed a similar modulation of cytokines and osteoclastogenesis‐related factors at 12 mo in type 2 diabetic subjects.     

The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results

BACKGROUND/AIMS: Previously, we reported that SRP resulted in a decrease in mean pocket depth and attachment level and reduced prevalence and levels of Bacteroidesforsythus, Porphyromonas gingivalis, and Treponema denticola at 3 and 6 months post-SRP in 57 subjects with adult periodontitis. 32 of the 57 subjects were monitored at 9 and 12 months. Thus, the purpose of the present investigation was to evaluate the microbial and clinical effects of SRP in 32 (mean age 48+/-11) subjects over a 12-month period. METHOD: Clinical assessments of plaque, gingival redness, suppuration, bleeding on probing, pocket depth and attachment level were made prior to SRP and at 3, 6, 9, and 12 months post-therapy. Subgingival plaque samples were taken at each visit and analyzed using the checkerboard DNA-DNA hybridization technique for the presence and levels of 40 subgingival species. Each subject also received maintenance scaling at each of the subsequent monitoring visits. Differences in clinical parameters and prevalence and levels of bacterial species were analyzed pre- and post-therapy using the Wilcoxon signed ranks test. The Quade test for related samples was used for analysis of multiple visits. RESULTS: Mean pocket depth (mm+/-SEM) decreased from 3.2+/-0.3 at baseline to 2.9+/-0.3 at 12 months (p<0.01). Mean attachment level showed significant reduction at 6 months, but did not diminish further. Bleeding on probing and plaque were significantly reduced at 12 months (p<0.001, p<0.05, respectively). P. gingivalis, B. forsythus and T. denticola decreased in prevalence and levels up to the 6-month visit and remained at these lower levels at 9 and 12 months. Significant increases in levels and prevalence were noted at 12 months for Actinomyces naeslundii genospecies 2, Actinomyces odontolyticus, Fusobacterium nucleatum ss polymorphum, Streptococcus mitis, Capnocytophaga sp, and Veillonella parvula. CONCLUSIONS: The data suggest that the maintenance phase of therapy may be essential in consolidating clinical and microbiological improvements achieved as a result of initial therapy.     

Alveolar bone loss in type 1 diabetic subjects

AIM, BACKGROUND: The aim of this study was to assess the degree of marginal alveolar bone loss in a group of young subjects with type 1 diabetes mellitus (DM) (n=35, age range 24-36 years) and age-matched non-diabetic control subjects (n=10). METHOD: The diabetic group was divided into 3 subgroups (D1, D2, D3) according to the severity of the diabetic state. The level of alveolar bone was measured on panoramic radiographs of maxillary and mandibular molars as the % of the distance between the cemento-enamel junction (CEJ) and the bone crest along the total length of the root. All mesial and distal sites with a distance of > 15% (BL>15%) were picked, and calculations were performed using the individual %s of sites with BL> 15%. RESULTS: Based on the present findings, we conclude that type 1 DM has a modifying effect on marginal loss of alveolar bone. A clear trend towards increased marginal bone loss was seen in the subjects with complicated DM (D3). The subjects with good metabolic control and no complications of DM (D1) are no more susceptible to marginal bone loss than non-diabetic controls of the same age. CONCLUSIONS: The present findings confirm our previous results on increased loss of periodontal support in subjects with complicated DM already at an early age.     

全口一次龈下刮治与分区段龈下刮治的疗效分析

目的：比较一次全口龈下刮治与分区段龈下刮治的临床疗效。方法：选择需进行牙周洁治的慢性牙周炎患者50例,分为实验组25例和对照组25例,实验组一次全口龈下刮治,对照组分四个区段进行龈下刮治,观察3个月内治疗前后PD、BI、PI的变化,并记录患者对治疗的主观感觉和治疗后是否有发热症状。结果：实验组和对照组龈下刮治后3个月,PD、BI均显著降低,两组间无统计学差异（P〈0.05）;与对照组相比,实验组1个月时P（I1.09±0.57）和VAS值（0.37±0.26）显著降低,差异有统计学意义（P〈0.05）。两组患者均无治疗后发热症状。结论：全口一次龈下刮治与分区段龈下刮治都可获得良好的治疗效果,全口一次龈下刮治更利于菌斑控制和短期消除治疗不适。     

龈下刮治和根面平整术后牙本质过敏的临床评价

目的 评价龈下刮治和根而平整术后牙本质过敏的发生率和敏感程度.方法 分别在手术前以及手术后5 min、1周和4周对38例接受龈下刮治及根面平整术的慢性牙周炎患者行温度试验,采用视觉疼痛模拟评分(VAS)对其牙的敏感程度进行评估,比较术前术后牙本质过敏的发生率和敏感程度.结果 术后1周,牙本质过敏的发生率(52.6%)显著高于术前(28.9%),过敏牙的VAS(4.1±1.7)也显著高于术前(2.9±1.7),差异均有统计学意义(P<0.05);术后4周,牙本质过敏的发生率和VAS显著下降,与术前相比较差异无统计学意义(P>0.05).结论 龈下刮治和根面平整术是牙本质过敏的一个诱发因素.     

Treatment of recurrent periodontal disease by root planing and Ornidazole (Tiberal®)

The purpose of this study was to evaluate the use of Ornidazole as an adjunct to root planing in the therapy of patients suffering from recurrent periodontal disease. In 10 individuals who had previously been treated with scaling, root planing and periodontal surgery and who had followed a regular maintenance program including recall visits every 3-5 months for 1-7 years, 2 sites with recurrent periodontitis and 1 shallow site were selected. Reinfected sites had a record of losing clinical attachment of more than 3 mm since the completion of initial therapy, were bleeding upon probing and had a mean pocket probing depth of 7.85 +/- 1.31 mm. They had been reinstrumented several times by a registered dental hygienist, when clinical signs of recurrence of disease had appeared and the root surfaces were judged to be smooth and free of deposits. Clinical parameters were recorded and microbial samples were collected twice prior to retreatment. Then, 500 mg Ornidazole, to be taken twice a day for 10 days, was administered, and the whole dentition was thoroughly scaled and root planed. At day 10 as well as 2, 5, 8 and 11 months thereafter, samples were again obtained. At baseline, reinfected sites showed over 20% spirochetes, over 20% motile rods and over 9% fusiform organisms in darkfield preparations of subgingival plaque samples. Culturally, over 1/10 of organisms were identified as black pigmenting Bacteroides and in 18% of all baseline samples collected, B. gingivalis was found.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical effects of scaling and root planing on untreated teeth

OBJECTIVE: The aim of this report is to examine whether scaling and root planing (SRP) in one area of the mouth may affect periodontal improvement in untreated areas in the same patient, possibly through systemic effects of treatment. MATERIAL AND METHODS: Twenty patients diagnosed with generalized aggressive periodontitis were randomized into treatment (n=11) and no treatment (n=9) groups. Within the treatment group, three quadrants were treated by SRP at week 0, 3, 12, and 24, while a single experimental quadrant remained untreated throughout the study. The outcome for all teeth was assessed using clinical parameters, subtraction radiography, and pathogenic bacteria levels in the subgingival flora over the 24-week study period. RESULTS: Compared with sites in no treatment patients, the treated sites in the treated patients showed a 1 mm decrease in probing depth (PD) (p<0.01) and a 0.5 mm increase in bone height (p<0.01) by 24 weeks. In untreated sites within treated subjects, however, PDs tended to improve (p=0.09) but at a reduced rate compared with treated sites. The levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis (Bacteroides forsythus) remained unchanged in untreated sites while levels of Prevetolla intermedia and Treponema denticola tended to decrease as compared with controls but did not reach significance. CONCLUSIONS: This study indicates that untreated sites in treated periodontitis patients show a trend towards clinical improvement and exhibit reductions in some but not all periodontopathic bacterial species tested.     

One‐stage full‐mouth disinfection versus quadrant and full‐mouth root planing

Objective: The aim of this study was to test the hypothesis that the one‐stage full‐mouth disinfection (FMD) provides greater clinical and microbiological improvement compared with full‐mouth scaling and root planing (FM‐SRP) within 24 h and quadrant scaling and root planing (Q‐SRP) in patients with generalized chronic periodontitis. Material & Methods: Twenty‐eight patients were randomized into three groups. 25 patients completed the study and were the basis for analysis. The Q‐SRP group was scaled quadrant‐wise at 1‐week intervals. The other groups received a one‐stage full‐mouth scaling with (FMD) and without (FM‐SRP) chlorhexidine. At baseline, after 1, 2, 4 and 8 months clinical parameters were recorded and microbiological analysis was performed. Results: All three treatment modalities resulted in significant clinical improvement at any time. There were only group differences after 1 and 2 months: in the FM‐SRP group was a significantly higher reduction of probing depth and bleeding on probing compared with the other two groups. The bacteria could be reduced in every group although this reduction was only significant for Prevotella intermedia in the FMD group 8 months after treatment. Conclusion: All three treatment modalities lead to an improvement of the clinical and microbiological parameters, however, without significant group differences after 8 months.     

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

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