Long-term effect of the combined use of powered toothbrush and triclosan dentifrice in periodontal maintenance patients

Aim: To test the hypothesis of a superior clinical and microbiological effect of the combined use of powered toothbrush+triclosan‐containing dentifrice compared with manual toothbrush+regular fluoride‐containing dentifrice in periodontal maintenance patients. Material and Methods: A total of 128 periodontitis subjects involved in recall programmes were randomized to use either powered toothbrush with triclosan‐dentifrice (test) or manual toothbrush and standard dentifrice (control). Supportive periodontal treatment was provided at baseline and every 6 months. Plaque, bleeding on probing (BoP), probing pocket depth (PPD) and relative attachment level (RAL) were scored at baseline, 1, 2 and 3 years. Subgingival plaque samples were taken and analysed for their content of 40 bacterial species at each examination interval. All analyses were performed by “intention‐to‐treat” protocol. Results: Both groups showed significant reduction in BoP, PPD and in mean total counts of the 40 bacterial species between baseline and 3 years, while plaque score and RAL remained almost unchanged. No significant differences between the two prevention programmes were found for any of the clinical outcome variables or in mean counts of the various bacterial species. Conclusions: The study failed to demonstrate superior clinical and microbiological effects of powered toothbrush+triclosan dentifrice compared with manual toothbrush+standard fluoride‐dentifrice in periodontitis‐susceptible patients on regular maintenance therapy.     

Periodontal disease progression in subjects with orofacial clefts over a 25-year follow-up period

Aims: To assess rates of periodontal disease progression in subjects with cleft lip, alveolus and palate (CLAP) over a 25-year period without regular maintenance care in a specialist setting and to compare those with those of subjects without alveolar clefts, i.e. cleft lip (CL) or cleft palate (CP).
Material and Methods: Ten subjects with CLAP and 10 subjects with CL/CP were examined in 1979, 1987, 1993 and 2004. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP) and plaque control record (PCR) scores were recorded in all 20 subjects.
Results: High plaque and BoP scores were recorded at all examinations in both groups. Over 25 years, a statistically significant loss of mean full-mouth CAL of 1.52 ± 0.12 mm (SD) and 1.66 ± 0.15 mm occurred in the CLAP and CL/CP group respectively ( p <0.05). A statistically significant increase ( p <0.05) in mean full-mouth PPD of 0.35 ± 0.12 mm was observed in the CL/CP group, whereas only a trend for a mean full-mouth increase in PPD of 0.09 ± 0.11 mm was observed in the CLAP group. In subjects with CLAP, a statistically significant increase ( p <0.05) in PPD of 0.92 ± 1.13 mm at cleft sites was observed compared with that of 0.17 ± 0.76 mm at control sites. With respect to CAL, the loss at the corresponding sites amounted to 2.71 ± 1.46 and to 2.27 ± 1.62 mm, respectively ( p =0.36).
Conclusions: When stringent and well-defined supportive periodontal therapy was not provided, subjects with orofacial clefts were at high risk for periodontal disease progression. Over 25 years, alveolar cleft sites tended to have more periodontal tissue destruction compared with control sites.     

Effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy

The purpose of the present study was to evaluate clinically the effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy. A total of 19 patients with chronic periodontitis were enrolled in the study. Each subject had three sites in each of two contra-lateral jaw quadrants with a probing pocket depth (PPD) of ≥5 mm and bleeding on probing (BoP+). All teeth received scaling and root planing under local anesthesia followed by irrigation with sterile saline. An oily calcium hydroxide suspension (Osteoinductal) was applied subgingivally to the test sites at random. All sites were reexamined after 1, 2 [gingival index (GI) and BoP], and 3 weeks (GI, BoP, and PPD). Treatment success was defined as no signs of GI (GI=0), no BoP (BoP−), and pocket closure (PPD≤4 mm). At all three different points in time, there were improvements in both GI and BoP at the control and test sites, which were in favor of the test therapy (p<0.05). For PPD change, no differences were found between the test and the control sites. The results of the study suggest that the topical application of an oily calcium hydroxide suspension (Osteoinductal), after nonsurgical periodontal therapy, improves early periodontal wound healing.     

Periodontal status of teeth with crown–root fractures: results two years after adhesive fragment reattachment

Aim: This series of case reports evaluated the impact of adhesive crown–root fragment reattachment in periodontally healthy teeth suffering from crown–root fractures on various parameters of periodontal health over a time course of 2 years.
Material and Methods: A total of 20 teeth with crown–root fractures in 18 periodontally healthy subjects were evaluated. After open-flap access, crown–root fragments were adhesively reattached to the root stub. In all cases, the vertical difference between the alveolar bone crest and the fracture line was 1 mm, i.e. violating the biological width. Subsequently, clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BoP) and gingival index (GI) scores were recorded at 6, 12 and 24 months postoperatively for the restored teeth as well as plaque index (PlI) and periodontal screening index (PSI) values for the whole dentition.
Results: Two years after therapy, recorded CAL, PPD, BoP, GI, PlI and PSI scores revealed healthy periodontal conditions in 18 out of 20 treated teeth. Two teeth had suffered again from fragment fracture due to new traumata.
Conclusions: Adhesive fragment reattachment in periodontally healthy teeth affected by crown–root fractures had no detrimental impact on periodontal health over a time course of 2 years.     

Full-mouth ultrasonic debridement and risk of disease recurrence: a 1-year follow-up

AIM: To evaluate the incidence of disease recurrence following a full-mouth pocket/root debridement approach with ultrasonic instrumentation versus that following a traditional approach of quadrant-wise scaling and root planing (Q-SRP) performed with hand instrumentation. METHODS: Thirty-seven patients were re-examined 1 year after the completion of a 6-month clinical trial comparing two different treatment protocols: a 1-h session of full-mouth ultrasonic debridement (UD--19 patients) or four sessions of Q-SRP with hand instruments (Q-SRP--18 patients). At 3 months, re-instrumentation was performed of pockets showing a remaining probing pocket depth (PPD) of > or =5 mm using the same type of instruments as used during the initial treatment phase. The clinical examinations comprised assessments of plaque, bleeding on probing (BoP) and PPD. The primary outcome variable was the incidence of recurrent diseased sites (i.e., sites showing PPD > or =5 mm and BoP+) between the post-treatment and 1-year follow-up examinations. All sites that were healed (PPD < or =4 mm and BoP(-)) at the post-treatment examination were included in the study sample, with a mean number of sites per patient of 23.5. RESULTS: In the UD group, 29 (7%) out of 430 initially healed sites showed disease recurrence at the 1-year follow-up examination compared with 47 (11%) of 440 sites in the Q-SRP group (p>0.05). Twelve patients (63%) in the UD group presented recurrent diseased pockets, compared with 14 patients (78%) in the Q-SRP group. Two or more recurrent, diseased pockets were observed in nine patients in the UD group versus 11 in the Q-SRP group. All but one of the smokers belonged to the group of patients presenting recurrences. A tendency towards a higher mean plaque score was observed for the patients with recurrent sites. CONCLUSION: The study revealed no significant difference in the incidence of recurrence of diseased periodontal pockets between the full-mouth UD approach and the traditional approach of Q-SRP.     

Surgical guided tissue regeneration treatment of advanced periodontal defects: a 5-year follow-up study

OBJECTIVES: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects. MATERIAL AND METHODS: In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years. RESULTS: Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination. CONCLUSION: Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.     

Some effects of enamel matrix proteins on wound healing in the dento-gingival region

OBJECTIVE: The aim of the present study was to evaluate by clinical means the effect of enamel matrix proteins on the healing of a soft tissue wound produced by periodontal pocket instrumentation. MATERIAL AND METHODS: The study was performed as an intra-individual, longitudinal trial of 3 weeks duration with a double-masked, split-mouth, placebo-controlled and randomized design. The patient material was comprised of 28 subjects with moderately advanced, chronic periodontitis. Each patient presented with 3 sites in each of 2 jaw quadrants with a probing pocket depth (PPD) of >or=5 mm and bleeding following pocket probing (BoP). Baseline examination, including assessments of plaque, gingival inflammation, PPD, BoP and root dentin sensitivity, was carried out one week after oral hygiene instruction and careful self-performed plaque control. All experimental sites were scaled and root planed, and the soft tissue wall of the pocket was curetted to remove the pocket epithelium and adjacent granulation tissue. The site was carefully irrigated with saline. When the bleeding from the pocket had ceased, a 24% EDTA gel was applied in the site and retained for 2 min. This was followed by careful irrigation with saline. Left and right jaw quadrants were then randomized to subgingival application of enamel matrix derivative (Emdogain) or vehicle-control. All sites were re-examined after 1, 2 and 3 weeks. In addition, a visual analogue scale (VAS) was used to score the degree of post-treatment discomfort. The primary endpoints of treatment success were defined as (i) pocket closure (PPD 相似文献   

Clinical characteristics at implants with a history of progressive bone loss

OBJECTIVE: The aim of the present study was to describe the clinical characteristics at implants with a history of progressive bone loss. MATERIAL AND METHODS: Eighty-two out of 184 previously identified subjects with a history of progressive bone loss volunteered for the study. Clinical assessments of plaque, bleeding on probing (BoP), probing pocket depth (PPD), suppuration following probing (Pus), presence of calculus on implants surfaces (Calc) and 'recession' i.e. the mucosal margin in level with or apical of the fixture/abutment junction were performed at the mesial, distal, buccal and lingual aspects of each implant and without removing the bridge constructions. RESULTS: It was demonstrated that the frequencies of BoP, Pus, 'recession' and PPD > or = 6 mm were higher at implants with than without 'progressive' bone loss. In addition, smokers had larger numbers of affected implants than non-smokers, and the proportion of affected implants that exhibited Pus and PPD > or = 6 mm was higher in smokers than in non-smokers. The logistic regression analysis revealed that the findings of Pus, 'recession' and PPD > or = 6 mm at an implant in a smoking subject had a 69% accuracy in identifying the history of progressive bone loss. CONCLUSION: The results from this study demonstrate an association between clinical signs of pathology and bone loss at implants. It is recommended to include clinical assessments in the evaluation of implant therapy.     

Periodontal conditions in patients requesting dental implant treatment

Periodontal disease is considered a risk factor in dental implant treatment. The purpose of this study was to investigate the periodontal conditions in patients requesting dental implant therapy. A total of 169 patients visiting Department of Oral and Maxillo-Facial Implantology at Tokyo Dental College Chiba Hospital were targeted. The following intraoral parameters were measured in each patient: Community Periodontal Index (CPI) score, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Prevalence of patients with periodontal pockets was high: 38% and 28% of patients had a CPI score of code 3 and 4, respectively. Prevalence of teeth with one or more sites with PPD≥4mm was 27%. Moreover, clinical signs suggestive of periodontitis (PPD, CAL≥4mm) were found in 10-15% of tooth sites. Prevalence rates at sites with severe periodontal breakdown (PPD, CAL≥7mm) were 2-5%. These results further emphasize the importance of thorough periodontal assessment in patients prior to dental implant treatment.     

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis

AIM: To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. Methods: Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. RESULTS: The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). CONCLUSION: The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.     

Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease

AIM: The aim of the study was to evaluate disease progression during supportive periodontal therapy in (i) a group of 225 subjects with "normal" (NG) and (ii) a group with high susceptibility (HSG; n= 109) to periodontal disease (based on their baseline disease status). MATERIAL AND METHODS: The following variables were recorded at the baseline examination (1 year after they received non-surgical periodontal therapy) and at the re-examination after 12 years of maintenance: number of teeth, plaque, probing pocket depth, probing attachment level, bone level in full mouth radiographs. All assessments were performed in a standardized manner and by well-trained and calibrated examiners. Supportive periodontal therapy was delivered 3-4 x per year and included repeated oral hygiene instruction and debridement. In addition, sites that bled on probing and had a PPD value of > or = 5 mm received subgingival instrumentation. RESULTS: A comparison between the findings at baseline and after 12 years revealed that in the NG, most subjects maintained their periodontal condition unchanged during the maintenance period; only a few subjects experienced tooth loss and the figures describing the mean amount of bone and attachment loss were small (0.5 mm and 0.3 mm respectively). The HSG patients experienced some tooth loss and also lost significant amounts of bone and attachment during the 12 years of SPT. Thus, in this group of subjects, the mean overall PAL loss amounted to 0.8 mm, i.e., 0.06 mm/tooth surface/year. In the NG, the overall attachment loss was significantly smaller: 0.5 mm, i.e. 0.04 mm/tooth surface/year. CONCLUSION: In subjects with a high susceptibility for periodontal disease who had been treated for this condition by non-surgical means, an SPT program including regularly repeated oral hygiene instruction and subgingival debridement, made it possible to maintain bone and attachment levels at a reasonably stable level over a 12-year period. A similar SPT provided to a group of subjects with normal susceptibility to periodontal disease, on the other hand, prevented almost entirely major tooth, bone and attachment loss.     

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.     

One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial

Background: Single photodynamic therapy (PDT) has been effective in initial periodontal therapy, but only improved bleeding on probing (BoP) in maintenance patients after a single use. Repeated PDT has not been addressed.
Objectives: To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance.
Material and Methods: Ten maintenance patients with 70 residual pockets [probing pocket depth (PPD)5 mm] were randomly assigned for treatment five times in 2 weeks (Days 0, 1, 2, 7, 14) with PDT (test) or non-activated laser (control) following debridement. The primary outcome variable was PPD, and the secondary variables were clinical attachment level (CAL) and BoP. These were assessed at 3, 6 and 12 months following the interventions.
Results: Greater PPD reductions were observed in the test (−0.67 ± 0.34; p =0.01) compared with the control patients (−0.04 ± 0.33; NS) after 6 months. Significant CAL gain (+0.52 ± 0.31; p =0.01) was noted for the test, but not in the control (−0.27 ± 0.52; NS) patients after 6 months. BoP percentages dcreased significantly in test (97–64%, 67%, 77%), but not control patients after 3, 6 and 12 months.
Conclusions: Repeated (five times) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients. The effects were best documented after 6 months.     

Periodontal attachment loss over 14 years in cleft lip,alveolus and palate (CLAP,CL, CP) subjects not enrolled in a supportive periodontal therapy program

OBJECTIVES: (i) To assess the overall and (ii) cleft-associated rate of periodontal disease (PD) progression in subjects with cleft lip, alveolus and palate (CLAP) and (iii) to compare these rates with those of subjects with cleft lip (CL) and cleft palate (CP). MATERIAL AND METHODS: Twenty-six subjects not enrolled in a supportive periodontal therapy (SPT) program were examined in 1979, 1987 and 1993. PD progression was assessed as increase in pocket probing depth (PPD in mm) and probing attachment loss (PAL in mm). RESULTS: Extensive plaque accumulation and high frequencies of gingival units bleeding on probing were observed at all three examinations. A statistically significant increase in mean PPD of 0.57+/-0.21 mm (SD) in both groups as well as a statistically significant loss of PAL of 1.85+/-0.23 mm (SD) in the CLAP group and of 1.72+/-0.21 mm (SD) in the CL/CP group occurred over the observation period (p<0.05). In subjects with CLAP, statistically significant increases in PPD and loss of PAL were recorded over time at sites adjacent to the cleft as well as at control sites (p<0.05). Over 14 years, however, PPD increased 1.72+/-1.08 mm (SD) at cleft sites versus 0.72+/-1.14 mm (SD) at control sites (p<0.05), and PAL amounted to 3.19+/-1.35 mm (SD) at cleft sites versus 2.41+/-1.52 mm (SD) at control sites (p<0.05). CONCLUSION: Both the CLAP and the CL/CP subjects are at high risk for PD progression if no SPT program is provided. This also suggests that alveolar cleft sites in subjects with high plaque and gingival inflammation scores underwent more periodontal tissue destruction than control sites over a 14-year period.     

Short-term effects of initial periodontal therapy (hygienic phase)

Abstract The aim of the present study was to evaluate the effect of non-surgical periodontal therapy on probing pocket depths and probing attachment levels using a patient group with moderate to advanced periodontitis. 68 patients with moderate to advanced periodontitis underwent hygienic phase therapy including oral hygiene instructions, scaling and root planing and elimination of plaque retentive factors. Assessments of the plaque control record (PCR), bleeding on probing (BoP), probing depths and probing attachment levels were performed at baseline examination and 3 to 5 months following active treatment. The measurements were obtained at 4 interproximal aspects of each tooth with a thin calibrated probe. Mean BoP values decreased from 63.2±21.9% at baseline to 16.6±7.3% after therapy, and mean PCR decreased from 78.6±16.4% to 12.7±7.1%, respectively. A reduction in mean probing pocket depth from 3.96±1.39 mm at baseline to 3.30±1.16 mm after therapy was noted. Sites with initial probing depths of 1–3 mm showed no change, sites with initial values of 4–6 mm revealed a reduction of 1.03±1.04 mm, while initial pockets of 7–9 mm decreased in depth by 2.28±1.62 mm. A gain in the mean probing attachment level from 4.16±1.80 mm to 3.74±1.71 mm was observed as a result of treatment. The group with the shallow initial probing depths of 1–3 mm showed no alteration in probing attachment level. Pockets with baseline values of 4–6 mm showed gain of clinical attachment of 0.69±1.43 mm. The greatest gain in clinical attachment of 1.51±1.75 mm was obtained in sites with initially deep pockets of 7–9 mm. From the results of this study, it can be concluded that non–surgical periodontal therapy is an effective means to reduce probing pocket depths and to improve clinical attachment levels in patients with moderate to advanced periodontitis.     

Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel

BACKGROUND, AIMS: Conventional treatment of chronic periodontitis involves mechanical debridement of periodontal pockets. Recently, subgingival antimicrobials have been used adjunctively following such debridement. This 2-centre study compared the clinical effects of subgingival scaling (SRP) with SRP plus subgingival application of 25% metronidazole gel, Elyzol (SRP+gel), in patients with chronic adult periodontitis. METHOD: Voluntary informed written consent was obtained from 45 subjects at the Eastman (mean age 46, range 34-63) and 43 subjects at RAF Halton (mean age 47, range 34-71) who participated in this blind, randomised split-mouth design study. All had at least 2 sites in each quadrant with probing pocket depth (PPD) > or = 5 mm. PPD, bleeding on probing (BOP), and clinical probing attachment levels (CAL) measured using a stent, were recorded at baseline and at 1, 3, 6 and 9 months post-therapy. After subgingival scaling of all quadrants, 2 quadrants were randomly selected to be treated with metronidazole gel. RESULTS: A paired t-test on baseline values showed no bias between groups. Both treatments effectively reduced the signs of periodontitis. At each follow-up visit, reduction in PPD, CAL and BOP after the combined treatment was greater than for SRP alone. Paired t-tests showed that the improvement in the SRP+gel group was statistically significantly better (p<0.001) than for SRP alone (mean 0.5 +/- 0.6 mm. 95% CI 0.4-0.6 mm.) Similarly, the % of sites which improved to a final pocket depth of < or = 3 mm and the % of sites which improved over the 9 months of the study by as much as > or = 2 mm were greater for SRP+gel than for SRP alone. CONCLUSIONS: At the end of the study, the mean reductions for PPD were 1.0 mm (SRP) compared to 1.5 mm (SRP+gel), and for CAL they were 0.4 mm (SRP) compared to 0.8 mm (SRP+gel), with mean difference for CAL between treatments of 0.4 +/- 0.6 mm (95% confidence intervals of 0.3-0.6 mm). The combination therapy of SRP+gel was superior to the conventional treatment of SRP alone, and these differences were maintained for 9 months.     

The effect of a triclosan/copolymer dentifrice on healing after non-surgical treatment of recurrent periodontitis

The present study examined whether the daily use of a triclosan/copolymer dentifrice enhanced healing following non-surgical periodontal therapy at sites with progressive attachment loss in periodontitis-susceptible subjects: 60 subjects who had been (i) treated for advanced periodontal disease using nonsurgical means and (ii) had been enrolled, for at least 3-5 years, in a maintenance care program that called for prophylaxis once every 3 months. During the course of this maintenance period, all 60 subjects had suffered recurrent periodontitis at > or = 2 sites at several intervals. Following a baseline examination, all 60 subjects received, on an individual basis, detailed instruction in proper self-performed plaque control methods. They were stratified in 2 balanced groups (test and control groups). The members of the test group were assigned to use a triclosan/copolymer/fluoride-containing dentifrice, while the control group used a placebo dentifrice. During the following 3 years, all participants were recalled every 3 months for an evaluation of their oral hygiene standard. Re-examinations were performed after 6, 12, 24 and 36 months. In conjunction with the re-examinations, sites (loser sites) which exhibited additional probing attachment loss (> or = 2 mm) were identified. The loser sites were exposed to professional therapy. Thus, the site was anaesthetized and the surface carefully scaled and root planed (S/RP). Alterations regarding probing pocket depth (PPD), probing attachment level (PAL), and bleeding on probing (BoP) that occurred in the interval between S/RP and 36 months were analyzed. In the control group, 126 loser sites, 67 identified at the 12-month and 59 at the 24-month examinations, were subjected to S/RP. The corresponding number of loser sites in the test group was 85 (48 at 12 months and 37 at 24 months). At the time of S/RP, about 60% of the sites were BoP (+) in both groups. Following treatment, there was a reduction in the number of sites with gingivitis. While the reduction in the control group was modest (6.8%), in the test group, the improvement was more marked (27.5%). Following S/RP, there was also a reduction of the mean PPD in both groups. This decrease amounted to 1.7 mm in the test group and was significantly (p<0.05) smaller (0.6 mm) in the control. Finally in the interval between S/RP and 36 months, there was an improvement of the probing attachment level in both groups. The mean PAL gain was, however, significantly higher in the test than in the control group (1.8 mm versus 0.7 mm; p<0.01).     

Clinical and microbiologic changes associated with the combined use of a powered toothbrush and a triclosan/copolymer dentifrice: a 3-year prospective study

BACKGROUND: Different means are available for self-performed oral hygiene. The aim of this study was to evaluate the clinical and microbiologic effects of a preventive homecare program including the combined use of a powered toothbrush and a triclosan/copolymer-containing dentifrice. METHODS: A total of 160 adult subjects without signs of destructive periodontal disease were recruited for this 3-year randomized controlled trial. The subjects were assigned to a homecare program using an oscillating/rotating powered toothbrush and a triclosan/copolymer/fluoride-containing dentifrice (test) or a manual toothbrush and a standard fluoride-containing dentifrice (control). Supragingival polishing and reinforcement of homecare procedures were provided every 6 months. Plaque, bleeding on probing (BOP), and probing depth (PD) were scored at baseline and after 1, 2, and 3 years. Subgingival plaque samples were taken from the mesial aspect of each tooth at baseline and after 1, 2, and 3 years and were analyzed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization. All data analyses were based on "intention-to-treat" with the subject as the statistical unit. RESULTS: Compared to baseline, no significant changes in clinical parameters were observed during the 3 years, except for a reduction in the mean PD at the 2- and 3-year follow-up examinations (P <0.05). No significant differences were found between the two groups with regard to plaque, BOP, or PD or in the mean counts of the 40 species at any time point. CONCLUSION: The study failed to prove additional benefits of the combined use of a powered toothbrush and a triclosan/copolymer-containing dentifrice in adult subjects without signs of destructive periodontal disease.     

Five-year results of guided tissue regeneration in combination with deproteinized bovine bone (Bio-Oss) in the treatment of intrabony periodontal defects: a case series report

The aim of this study was to report on the clinical and radiographic results 5 years following treatment of intrabony defects with guided tissue regeneration (GTR) in combination with deproteinized bovine bone (DBB) (Bio-Oss). Fifteen patients, with at least one intrabony periodontal defect with probing pocket depth (PPD)≥7 mm and radiographic presence of an intrabony component (IC)≥4 mm, were treated with a PLA/PGA bioabsorbable membrane. Prior to placement of the membrane, the defect was filled with DBB impregnated with gentamicin sulfate 2 mg/ml. Standardized intraoral radiographs were taken prior to treatment and at the control examinations after 1 and 5 years. At baseline, the average PPD was 9.2±1.1 mm, and the average probing attachment level (PAL) was 10.1±1.6 mm; the radiographic bone level (RBL) was 10.4±2.45 mm, and an IC of 6.2±2.3 mm was present. One year after membrane placement, treatment had resulted in a PAL gain of 3.8±1.8 mm, a residual PPD of 4.2±1.3 mm, an RBL gain of 4.7±2.0 mm, and a residual IC of 2.1±1.2 mm. At the 5-year examination, two patients did not show up, and two patients had lost the treated tooth. However, both teeth were endodontically treated, and progressive periodontal destruction might not necessarily have been the reason for extraction. At the 5-year control (11 patients), the PAL gain was 4.1±1.6 mm, and the residual PPD was 4.6±1.2 mm; an RBL gain of 4.9±2.7 mm and a residual IC of 1.8±0.8 mm were observed. Statistically significant clinical improvements had occurred between baseline and the 1- and 5-year controls, whereas there were no significant differences between the 1- and 5-year results. The results of GTR with bioabsorbable membranes in combination with Bio-Oss in the treatment of periodontal intrabony defects are basically stable on a long-term basis.     

Residual periodontal defects distal to the mandibular second molar 6-36 months after impacted third molar extraction

AIM: This retrospective study investigated the periodontal conditions distal to mandibular second molars 6-36 months after routine surgical extraction of adjacent impacted third molars. METHOD: Subjects were randomly selected by systematic sampling from computer records of 3211 surgical mandibular third molar extractions in the Hong Kong dental teaching hospital. Records and pre-extraction radiographs of the selected cases were retrieved. Selected subjects (n = 283) were invited for an interview followed by a clinical examination. Community Periodontal Index (CPI) protocol was used for the assessment of the general periodontal status (excluding the mandibular second molar of interest, i.e. the subject tooth) followed by a detailed periodontal examination of the subject tooth. RESULTS: In all, 158 subjects, aged 29 +/- 7 years, were examined with only 6% (nine subjects) having a highest CPI score of 4 (excluding the subject tooth), but local periodontal defects were prevalent at the distal surface of subject mandibular second molars: mean probing pocket depth (PPD) was 5.4 +/- 1.9 mm with 67% (106 subjects) exhibiting PPD >or= 5 mm and 23% (36 subjects) exhibiting PPD >or= 7 mm; mean recession was 0.8 +/- 1.0 mm; bleeding on probing 96% and suppuration on probing 5%. Multiple linear regression analysis was used to analyse the effects of 12 independent variables on the PPD at the distal surface of the involved mandibular second molar. Three possible risk indicators (P < 0.001, R2 = 0.27) associated with localised increased PPD at the distal surface of the mandibular second molars were identified: 1) third molar 'mesio-angular' impaction; 2) pre-extraction crestal radiolucency and 3) inadequate post-extraction local plaque control. CONCLUSION: The results suggest that periodontal breakdown initiated and established on the distal surface of a mandibular second molar in the vicinity of a 'mesio-angular' impacted third molar evidenced by pre-extraction crestal radiolucency in association with inadequate plaque control after extraction can predispose to a persistent localised periodontal problem.