Collagenase activity and protein content of sulcular fluid after scaling and occlusal adjustment of teeth with deep periodontal pockets

Three teeth from each of 14 adult patients with advanced periodontitis were included in this study. The Test Tooth was an incisor or canine with increased mobility associated with an occlusal interference and a ≥ 5 mm deep pathologic pocket. The Infected Control Tooth was a non-mobile incisor or canine with a ≥ 5 mm pocket. A non-mobile incisor or canine with pockets ≤3 mm served as the Healthy Control Tooth. At least 7 d prior to Day 0 the patients were taught an effective oral hygiene regimen and received a supragingival prophylaxis. At Day 0, sulcular fluid for assay of protein content and Collagenase activity was collected from each chosen pocket. Immediately thereafter the Test Teeth of 7 subjects were scaled and root planed and the Test Teeth of 7 subjects occlusally adjusted. At Day 14, the treatments were reversed for the two groups. Sulcular fluid for the assays was again collected at Days 14 and 28. The protein content and collagenase activity in deep pockets was elevated during periodontitis in both mobile and immobile teeth. After establishment of a supragingivally clean oral environment, a rapid decrease of the collagenase activity took place following scaling and root planing of the root surfaces within the periodontal pockets (p≤0.05). Also, occlusal adjustment of the hypermobile teeth with deep pathological pockets reduced the protein content and collagenase activity in sulcular fluid (p ≤ 0.02). There was a further reduction of collagenase activity when occlu-sally adjusted teeth were scaled and root planed (p≤0.02). No change in the protein content or collagenase activity was observed in the deep pockets of the untreated Control Teeth in the same patients.     

A 7-month study of sulcular fluid flow in the assessment of healing after debridement of deep pockets

The purpose of this investigation was to assess the value of sulcular fluid flow (SFF) measurements in evaluation of the healing of deep periodontal pockets after scaling and root planing. Fourteen adult patients with advanced periodontal disease received supragingival prophylaxis and instructions in oral hygiene. Immediately after baseline examination, meticulous scaling and root planing were performed. One to five selected pockets per patient were monitored on Days 0, 30, 120 and 210. Subgingival microbial proportions, sulcular fluid flow, probing depth, Gingival Index and bleeding after probing were assessed and recorded. The subgingival microbial proportions were determined with darkfield microscopy. The periodontal conditions were markedly improved by Day 210 as depicted by the microbial proportions. The proportion of motile micro-organisms was reduced from 51% at baseline to 9% on Day 30. This result was sustained until Day 210. Healing was also evident from the changes in Gingival Index scores and bleeding after probing. Probing depth was reduced from a mean of 8.3 to 4.5 mm. Correlations between the individual means recorded for the clinical parameters and bacterial proportions were calculated for the pooled data of all four examinations. Sulcular fluid flow did not correlate with the clinical parameters. Gingival Index, bleeding after probing or probing depth. The latter three parameters correlated significantly with the microbial proportions and each other. When the pooled tooth surface recordings of Days 30, 120 and 210 were divided into two groups according to the proportion of motile bacteria (the groups with less than 18% of spirochetes and motile rods and the groups with greater than 18% of spirochetes and motile rods), a significant difference in the mean amount of sulcular fluid flow (P less than 0.01) and mean probing depth (P less than 0.001) could be demonstrated between the two groups.     

Clinical attachment loss produced by curettes and periodontal files

The aim of this study was to clinically evaluate the effect of immediate trauma from instrumentation after scaling and root planing with different instruments. Ten subjects with moderate chronic periodontitis, presenting probing depths of 3.5-6.5mm on anterior teeth, maxillary and/or mandibular, were selected. Teeth were randomly assigned to one of the following groups: PF group - scaled and planed with Hirschfeld periodontal files; CC group - scaled and planed with Gracey conventional curettes. The selected teeth were probed with a computerised electronic probe, guided by an occlusal stent and subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered as trauma from instrumentation. Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (1.28 +/- 1.13 for PF group; and 0.83 +/- 0.41 for CC group - p<0.05). However, inter-group analysis did not show statistically significant difference in trauma from instrumentation caused by the different instruments (p=0.063). Within the limits of this study, it was concluded that root instrumentation causes a mean immediate attachment loss of 1.06mm, with no differences between instrumentation with periodontal curettes or periodontal files.     

牙周基础治疗对慢性牙周炎伴继发性咬合创伤牙位龈沟液中IL-1β、RANKL-OPG系统的影响

目的 评价不同程序牙周基础治疗对慢性牙周炎伴继发性咬合创伤牙位龈沟液（GCF）中白细胞介素-1β（IL-1β）、核因子-κb受体活化因子配体（RANKL）-骨保护蛋白（OPG）系统的影响。方法 收集2012年7月至2013年10月在海军总医院口腔科就诊的中、重度慢性牙周炎合并继发性咬合创伤患者21例纳入研究,分层区组随机分为A、B两组。研究结束时18例患者纳入分析：其中A组9例,咬合创伤牙位共计18颗,包括9颗前牙及9颗前磨牙;B组9例,咬合创伤牙位共计18颗,包括7颗前牙及11颗前磨牙。基线时,A组先实施全口龈下刮治术+根面平整（SRP）治疗,B组实施咬合创伤牙位咬合调整治疗;第28天,A组接受咬合创伤牙位咬合调整治疗,B组接受全口SRP治疗。其中,咬合调整治疗在T-ScanⅢ型咬合分析系统指导下完成。采用ELISA法检测两组基线、第28天和第56天咬合创伤牙位GCF中IL-1β、RANKL、OPG水平。两组组内SRP治疗前后、咬合调整前后咬合创伤牙位GCF中IL-1β、RANKL、OPG水平变化比较采用配对t检验;两组咬合创伤牙位GCF中IL-1β水平在第28、56天时比较采用协方差分析。结果 SRP治疗后两组咬合创伤牙位GCF中IL-1β水平降低,RANKL/OPG比值升高,与SRP治疗前相比差异有统计学意义（P＜0.05）;咬合调整治疗后两组咬合创伤牙位GCF中IL-1β水平、RANKL/OPG比值降低,与咬合调整治疗前相比差异有统计学意义（P＜0.05）。结论 咬合调整治疗可降低慢性牙周炎伴继发性咬合创伤牙位GCF中IL-1β水平及RANKL/OPG比值,提示咬合调整治疗可能有助于抑制牙周骨组织破坏。     

The influence of trauma from occlusion on reduced but healthy periodontal tissues in dogs

The experiments were performed in five dogs fed a soft diet which allowed dental plaque accumulation. Experimental periodontal breakdown was introduced on Day 0. After 180 days trauma from occlusion was produced in 4P and P4 i.e. the mandibular fourth premolars, in the manner described by Svanberg & Lindhe (1973). On day 280 the periodontal pockets around 4P and P4 were eliminated. A notch was prepared in the root at the level of the bottom of the surgically eradicated pocket. In addition, the occlusal trauma in the 4P region was deleted. From Day 280 to Day 370 the teeth of the animals were brushed twice a day. The animals were then sacrificed, radiographs of the premolar regions were taken, and tissue sections comprising 3P4P1M (and P3P4M1) were produced and subjected to microscopic analysis. The results indicate that jiggling type occlusal trauma and tooth hypermobility are not factors which detrimentally affect healing following periodontal surgery.     

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目的评价不同程序牙周基础治疗对慢性牙周炎伴继发性咬合创伤牙位龈沟液（GCF）中白细胞介素-1β（IL-1β）、核因子-κb受体活化因子配体（RANKL）-骨保护蛋白（OPG）系统的影响。方法收集2012年7月至2013年10月在海军总医院口腔科就诊的中、重度慢性牙周炎合并继发性咬合创伤患者21例纳入研究,分层区组随机分为A、B两组。研究结束时18例患者纳入分析：其中A组9例,咬合创伤牙位共计18颗,包括9颗前牙及9颗前磨牙;B组9例,咬合创伤牙位共计18颗,包括7颗前牙及11颗前磨牙。基线时,A组先实施全口龈下刮治术＋根面平整（SRP）治疗,B组实施咬合创伤牙位咬合调整治疗;第28天,A组接受咬合创伤牙位咬合调整治疗,B组接受全口SRP治疗。其中,咬合调整治疗在T-ScanⅢ型咬合分析系统指导下完成。采用ELISA法检测两组基线、第28天和第56天咬合创伤牙位GCF中IL-1β、RANKL、OPG水平。两组组内SRP治疗前后、咬合调整前后咬合创伤牙位GCF中IL-1β、RANKL、OPG水平变化比较采用配对t检验;两组咬合创伤牙位GCF中IL-1β水平在第28、56天时比较采用协方差分析。结果 SRP治疗后两组咬合创伤牙位GCF中IL-1β水平降低,RANKL/OPG比值升高,与SRP治疗前相比差异有统计学意义（P〈0.05）;咬合调整治疗后两组咬合创伤牙位GCF中IL-1β水平、RANKL/OPG比值降低,与咬合调整治疗前相比差异有统计学意义（P〈0.05）。结论咬合调整治疗可降低慢性牙周炎伴继发性咬合创伤牙位GCF中IL-1β水平及RANKL/OPG比值,提示咬合调整治疗可能有助于抑制牙周骨组织破坏。     

3种方法根面平整对牙根表面形态影响的扫描电镜观察

目的：本文用扫描电镜观察比较Gracey刮治器、Vector超声治疗仪和Er：YAG激光根面平整引起牙根表面形态学改变。方法：24颗因重度牙周炎拔除牙齿随机分为3组。A组,Gracey刮治器组,B组Vector超声治疗仪组,c组Er：YAG激光组。扫描电镜观察牙根表面形态。结果：A组牙根表面可见不规则的深沟和空洞样缺损。B组牙根表面清洁光滑,未见工作尖的痕迹,颗粒状结构覆盖于牙骨质层。c组牙根表面形态几乎没有改变,高倍镜下表层组织熔融呈火山状。结论：Er：YAG激光和Vector超声治疗仪都能有效地去除龈下牙石,而且与Gracey刮治器相比能更好的保存牙根表面健康组织。     

Er:YAG laser in defocused mode for scaling of periodontally involved root surfaces: an in vitro pilot study

BACKGROUND: The Er:YAG laser may be used on periodontally involved teeth in combination with conventional periodontal therapy in order to improve the efficacy of root instrumentation. The aim of this study was to compare the effect of hand instrumentation on root surfaces of periodontally involved teeth with Er:YAG laser application. METHODS: Thirty freshly extracted, non-carious, single-rooted, periodontally diseased human teeth from adult humans with advanced periodontal disease were used in this study. The teeth were divided into three groups of 10 specimens each. Group A was treated with scaling and root planing (SRP) with curets only (control). In group B, the root surfaces were scaled with curets and then lased with an Er:YAG laser (wavelength 2.94 microm). A handpiece with a water spray was used in non-contact mode (defocused) at a distance of 1 cm from root surface. Laser parameters were set at energy of 100 to 200 mJ/pulse, with 10 Hz of frequency. In group C, the root surfaces were lased only with power settings 250 to 300 mJ/pulse and 10 Hz frequency. An epon-araldite plastic embedding technique was used for light microscopic investigation. RESULTS: Histologic findings showed significant differences between the test and control sites. In control sites, after hand instrumentation, the surface was smooth, without a cementum layer, and the dentin layer presented opened tubules. Defects on the dentin layer were also present along root surfaces. In the test sites (B, C) root surfaces revealed no thermal damage; no cracking or tissue carbonization were observed. The superficial layers of lased surfaces appeared smooth and melted without alterations. CONCLUSION: Based on these findings, it appears that it may be feasible to use the Er:YAG laser for root instrumentation without prior root planing if the proper parameters are followed.     

Attachment loss after scaling and root planing with different instruments. A clinical study

OBJECTIVES: The aim of this study was to evaluate clinically the immediate effect of trauma from instrumentation after scaling and root planing with different instruments. MATERIAL AND METHODS: Ten subjects with moderate chronic periodontitis, presenting probing depths ranging from 3.5 to 6.5 mm on anterior teeth, upper and/or lower, were selected. Teeth were randomly assigned to one of the following groups: MC group--scaled and planed with Gracey mini-curettes (MiniFive); CC group--scaled and planed with Gracey conventional curettes. The selected teeth were probed with a computerized electronic probe, guided by an occlusal stent, and then subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered as trauma from instrumentation. RESULTS: Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (0.68 +/- 0.32 for MC group; and 0.83 +/- 0.41 for CC group--p < 0.05). However, inter-group analysis did not show a statistically significant difference in trauma from instrumentation caused by the different instruments. CONCLUSIONS: Within the limits of this study, it was concluded that root instrumentation causes an average trauma from instrumentation of 0.76 mm with no differences between the tested instruments.     

Effect of occlusal trauma on healing of periapical pathoses: report of two cases

AIM: To present two clinical cases and demonstrate that occlusal trauma may affect healing of periapical pathoses. SUMMARY: Two teeth with periradicular disease did not respond successfully to conventional root canal treatment or endodontic surgery. Occlusal adjustment was finally performed on both cases. After occlusal adjustment, uncomplicated healing and periapical repair occurred in both cases. The findings in these two cases suggest that occlusal trauma may play a role in the healing of periapical pathoses. KEY LEARNING POINTS: Occlusal trauma is positively correlated with changes in periodontal tissues. Although experiments in animals have shown that application of forces to teeth will not induce further periodontal destruction, we believe that some failures of root canal treatment may be due to the presence of occlusal trauma modulating the responses of inflamed periapical tissues or apical pathoses with persistent infection.     

Does temporary splinting before non-surgical therapy eliminate scaling and root planing-induced trauma to the mobile teeth?

The objective of this study was to determine whether temporary splinting of periodontitis-affected mobile teeth, prior to non-surgical mechanical therapy, affects treatment outcome by eliminating scaling and root planing-induced trauma to the teeth. Mandibular anterior teeth of 29 patients (15 females; 14 males; age range 30 to 48 years) with adult periodontitis were evaluated. Clinical measurements were performed at 4 sites per tooth including mesial, distal, buccal and lingual aspects at baseline, 3 and 6 months after treatment. The following clinical parameters were analyzed: plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), probing attachment level (PAL), gingival margin level (GML) and tooth mobility (TM). Patients were randomly divided into 3 groups: i) group 1 (n = 8) received scaling and root planing (SRP) only, ii) group 2 (n = 10) received scaling and root planing before splinting and iii) group 3 (n = 11) received scaling and root planing after splinting. Statistical analysis revealed that there were no significant differences among the groups for either bleeding on probing or probing attachment level values at any of the time intervals. At the end of the study, the greatest decrease in pocket depth was noted in group 2 (1.24+/-0.10 mm) which was thought to be the result of gingival recession (0.73+/-0.07 mm). Group 1 was the only group that showed reduction in tooth mobility at 3 months compared to baseline (1.67+/-0.55 PTV units). Group 3 displayed the least reduction in tooth mobility during the entire study period (0.26+/-0.44 PTV units). In conclusion, splinting of mobile teeth before SRP, and thereby elimination of potential SRP-induced trauma to the mobile teeth, did not show any adjunctive effect on healing when compared to splinting after SRP. Thorough debridement of root surfaces, even performed in the presence of increased mobility, resulted in improvements in clinical parameters, i.e. mechanical manipulation of mobile teeth during periodontal treatment did not affect clinical outcome negatively.     

The effect of metronidazole on human periodontal disease. A clinical and bacteriological study

Fifteen female subjects undergoing treatment for nonspecific vaginitis with metronidazole 250 mg q.i.d. for 7 days were studied. Clinical and microbiological evaluations were carried out initially and at 2 and 4 weeks. The following parameters were measured in two quadrants: plaque index, sulcular bleeding index, pocket depth, attachment level and amount of gingival fluid. Dark field microscopy was used to quantitate the plaque constituents. One quadrant was subjected to root planing at the initial visit; the other quadrant received no therapy. No oral hygiene instructions were given. All the clinical parameters were significantly reduced in all areas. Gingival fluid, sulcular bleeding index and pocket depth showed greater improvement in the root-planed quadrant compared to the nonroot-planed quadrant. Dark field microscopy showed decreases in fusiforms, curved rods and spirochetes in all areas with a concomitant increase in cocci. The root-planed quadrant showed no significant differences in microbiological aspects when compared to the nonplaned quadrant. Clinically, metronidazole therapy resulted in improvement of periodontal status with some additional but small enhancement due to root planing. Microbiologically, metronidazole dramatically changed the quality of plaque with no supplemental effect when root planing was added.     

Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp

Experimental breakdown of the periodontal attachment apparatus was produced in six young adult monkeys to study the effect on the tissue of the dental pulp by (1) periodontitis, (2) scaling and plaque accumulation on exposed root dentin. Periodontal tissue breakdown was induced by the placement of ligatures around the neck of 92 permanent teeth. Subsequent plaque formation caused marked loss of periodontal tissue support, which after a period of 5--7 months amounted to 30--40% of the root length. One group of teeth received no further treatment. Other teeth were subjected to scaling and root planing. Following treatment, plaque was allowed to accumulate for 2, 10, and 30 days on the freshly planed root dentin surfaces. Histologic examination revealed that in comparison to teeth with normal periodontal conditions, 57% of the teeth exposed to periodontitis exhibited pathologic pulp tissue alterations. Secondary dentin formation and/or inflammatory cell infiltrates were observed within localized areas of the pulp subjacent to root surfaces exposed to periodontal tissue destruction. The changes within the pulp were of "mild" nature and only one tooth displayed signs of total pulp necrosis. Lateral canals communicating with both the pulp cavity and the exposed root surface were never detected. Teeth subjected to scaling and subsequent plaque accumulation in comparison with teeth with periodontitis alone exhibited no obvious aggravation or increased incidence of pathologic pulp reactions. The findings show that in the monkey (1) periodontal destruction limited to the cervical half of the root and (2) plaque accumulation on exposed root dentin does not cause severe alteration in the pulp of the roots involved.     

松牙固定时机对下颌前牙牙周治疗结果的影响

目的探讨松牙固定时机对中国人群牙周治疗结果的影响。方法 27例中重度牙周炎患者,给予龈上洁治和口腔卫生宣教后随机分成两组。常规组14例,龈下刮治和根面平整完成后行百强固位纤维带粘接固定松动的下颌前牙;试验组13例,完成纤维带粘接固定后行龈下刮治和根面平整。基线、治疗后3个月和治疗后6个月分别评估简化口腔卫生指数、龈沟出血指数、探诊深度、牙周附着丧失4项临床参数,并对数据进行统计学分析。结果常规组和试验组自身前后比较,各组治疗后3个月牙周临床参数与基线时比较有明显改善（P〈0.01）,各组3个月与6个月临床参数变化不明显（P〉0.05）。两组间比较,基线到治疗后3个月和基线到治疗后6个月临床参数的变化,差异均无统计学意义（P〉0.05）。结论龈下刮治和根面平整前或后行松牙固定对中国人群牙周治疗预后没有明显影响。     

Tooth movement and repositioning of the mandible without appliances

Reactive positioning refers to the movement of either the teeth or the mandible to a more favorable position after appropriate treatment. This tooth movement is achieved without the use of appliances. The treatment of the patients in this report included supra- and subgingival scaling, coronal reshaping, root planing, light curettage, instruction in home care, and various techniques of periodontal surgery, but no osseous surgery.Reactive positioning of teeth has been reported in the following situations: Interproximal contacts of both anterior and posterior teeth were closed; cross-bite occlusion between one or two maxillary teeth and the opposing mandibular teeth was corrected; a cusp-to-fossa relation, with one or two mandibular posterior teeth completely lingual to their opposing teeth, was corrected; the positions of the teeth on the ridge were changed.Reactive positioning of the mandible can occur after deflective occlusal contacts from the retruded contact position to the intercuspal position are eliminated. In patients with acquired mesiocclusion, the mandible can be repositioned to an edge-to-edge anterior tooth position.     

Effects of CO2 laser treatment on fibroblast attachment to root surfaces. A scanning electron microscopy analysis

BACKGROUND: The aim of this study was to analyze the CO2 laser effects on root surfaces affected by periodontal disease in comparison to scaling and root planing for fibroblast attachment. METHODS: Thirty single-rooted human teeth extracted because of advanced periodontal disease were included in this study. A total of 60 specimens, obtained from all selected teeth, were randomly assigned to 3 groups: 1) control (untreated); 2) hand scaling and root planing (SRP); or 3) laser (CO2 defocused pulsed) and ultrasonic scaling. All the specimens were incubated in Petri dishes with fibroblast suspension, and then observed by scanning electron microscopy (SEM). RESULTS: The control group showed the lowest number of attached cells, with no tightly attached fibroblasts. The laser plus scaling group showed the highest number of attached fibroblasts, with the tightly attached fibroblast prevailing. The laser-treated and scaled root specimens did not show any damage or morphologic alteration of the root surfaces. CONCLUSION: CO2 laser treatment in defocused, pulsed mode with a low power of 2W combined with mechanical instrumentation constitutes a useful tool to condition the root surface and increase fibroblast attachment to root surfaces.     

Pulpal and root sensitivity rated to periodontal therapy

The purpose of this clinical investigation was to determine if periodontal treatment consisting of scaling, root planing, and periodontal surgery produced any change in pulpal or root sensitivity. Ten patients were tested, with a total of 84 observations. There were 42 periodontally treated teeth, with 42 contralateral teeth serving as control specimens. The teeth were evaluated with stimuli from an electric pulp tester, cold, and air. The electric pulp tester was found to be reliable in assessing the pulpal sensitivity. Neither the amount of periodontal destruction nor the extent of periodontal treatment had any effect on the pulp. Scaling and root planing had no significant effect on root sensitivity. Periodontal surgery was directly related to root sensitivity in terms of the extent of root surface exposure. An association was observed clinically between plaque accumulation after periodontal surgery and root sensitivity.     

牙周-正畸联合治疗牙周炎致前牙扇形移位疗效观察

目的：评价牙周-正畸联合治疔牙周炎致前牙扇形移位的临床效果。方法：对21例因牙周炎造成前牙扇形移位的患者,经牙周基础治疗,牙周炎症基本控制后,用方丝弓固定正畸方法内收并排齐扇形移位的前牙,同时配合牙周护理及凋精等措施,消除炎症及殆创伤,建立正常的咬合关系。共治疗74颗牙,治疗前后分别记录患牙牙周袋、牙槽骨吸收情况。所得数据采用Ridit分析及X^2检验。结果：经1～2a随访,40岁以下患者牙周袋情况有非常显著改善（P〈0．01）,牙槽骨吸收也有显著改善（P〈0．05）,治疗效果满意。结论：牙周-正畸联合治疗能有效控制牙周炎症．消除he创伤,排齐牙列,并使治疗效果达到长期稳定,但应注意患者年龄不宜超过40岁。     

A digital technique for splinting periodontally compromised mobile teeth in the mandibular anterior region

A digital technique for fabricating a periodontal splint is presented. The lingual surface of periodontally compromised mandibular anterior teeth is captured and registered to form the emergence profile of the periodontal splint. An accurate periodontal splint is fabricated for mandibular anterior teeth with increased mobility after scaling and root planing.     

Effects of gingival curettage when performed 1 month after root instrumentation

Abstract The purpose of the present study was to evaluate biometrically the periodontal response to gingival curettage. 15 subjects having suprabony pockets were selected. Gingival Index (GI) was initially determined for the selected teeth. Measurements of probing depth, and the distance from the free gingival margin to the cemento-enamel junction were also taken at that time, as well as immediately after scaling and root planing of the selected teeth. 4 weeks after scaling and root planing, the clinical parameters were recorded- A split mouth design was used to select 2 quadrants of the mouth in which gingival curettage was to be performed. Immediately after, experimental measurements were again recorded. 5 weeks after gingival curettage, gingival inflammation, probing depth and the location of the tree gingival margin were recorded for the last time. All data were analyzed statistically. It was shown that gingival inflammation, the distance from the free gingival margin to the cemento-enamel junction, and the probing depth were reduced after 4 and 9 weeks. The level of clinical attachment improved after 9 weeks. All these changes were statistically significant. These results were observed after scaling and root planing, as well as after scaling, root planing and gingival curettage. No differences were found between both treatment modalities in any of the parameters analyzed. Gingival curettage did not improve the condition of the periodontal tissues more significantly than scaling and root planing.