4 modalities of periodontal treatment compared over 5 years

The purpose of the present study was to assess in a clinical trial over 5 years the results following 4 different modalities of periodontal therapy (pocket elimination or reduction surgery, modified Widman flap surgery, subgingival curettage, and scaling and rool planing). 90 patients were treated. The treatment methods were applied on a random basis to each of the 4 quadrants of the dentition. The patients were given professional tooth cleaning and oral hygiene instructions every 3 months. Pocket depth and attachment levels were scored once a year. 72 patients completed the 5 years of observation. Both patient means for pocket depth and attachment level as well as % distribution of sites with loss of attachment greater than or equal to 2 mm and greater than or equal to 3 mm were compared. For 1-3 mm probing depth, scaling and root planing, as well as subgingival curettage led to significantly less attachment loss than pocket elimination and modified Widman flap surgery. For 4-6 mm pockets, scaling and root planing and curettage had better attachment results than pocket elimination surgery. For the 7-12 mm pockets, there was no statistically significant difference among the results following the various procedures.     

Longitudinal therapeutic effects on the periodontal attachment level and pocketdepth in beagle dogs

Thirteen healthy Beagles, 3 1/2–5 years of age with moderate to advanced periodontal discase received a thorough scaling and prophylasis followed by four weeks of daily tooth cleaning. After one month, each of the fourposterior quadrants of each dog was subjected to one of the following treatments: 1) subgingival curettage, 2) modified Widman flap surgery with root planing, 3) apically repositioned flap and bone surgery for pocket elimination and 4) scaling and root planing as a control. Toothbrushings was carried out daily. In addition, every 14 days the dogs received a rubber cup and pumice prophylaxis throughout the entire length of the study. At the baseline, 1, 6, 12, 24 and 36 months following treatment, oral hygiene and gingival health were scored and the level of periodontal attachment and pocket depth were measured. The results at one Month suggested an increase in attachment levels which was grater after scaling or subgingival curettage than after flap procedures. Up to 36 months, the established attachment levels were maintained for all treatment groups and no significant difference was found between any of the treatments and the scaled controls. However, in advanced periodontal lesion attachment levels were not maintaned with scaling alone.
The present study has shown that the more conservative approaches to the treatment of periodontal disease such as subgingival curettage and Widman flap surgery may be as effective in maintaining clincal attachment levels as elaborate surgical procedures involving osteoectomy.     

Suppression of the periodontopathic microflora in localized juvenile periodontitis by systemic tetracycline

Abstract. Since recent studies have implicated Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis, this investigation determined the effectiveness of subgingival debridement, topical Betadine Solution®, and systemic tetiacycline in suppressing subgingival A. actinomycetemcomitans and other microorganisms. A total of 20 deep periodontal pockets and 10 normal periodontal sites of 6 localized juvenile periodontitis patients was included in the study. Each patient was treated in 3 stages over a period of 22 weeks, and the result of treatment was monitored for an additional 38 weeks. The first stage of treatment included plaque control, as well as thorough scaling and root planing, composed of at least 6 h of debridement. No concomitant periodontal surgery was performed. In the second stage, Betadine saturated cotton gauze was inserted into the periodontal pockets for 10 min. Stage 3 involved systemic tetracycline therapy (1 g/day) for J4 days. The subgingival microflora was determined at frequent intervals by selective culturing of A. actinomycetemcomitans and Capnocytophaga and by direct microscopic examination. The clinical effect was assessed by measuring changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic alveolar bone mass, and other relevant clinical parameters. Scaling and root planing reduced the total subgingival bacterial counts and the proportions of certain Gram-negative bacteria, but no periodontal pocket became free of A actinomycetemcomitans. Betadine application had little or no effect on the subgingival microflora. In contrast, tetracycline administered via the systemic route suppressed. A actinomycetemcomitans, Capnocytophaga, and spirochetes to low or undetectable levels in all test periodontal pockets. A, actinomycetemcomitans reappeared in 9 of the deep periodontal pockets after the administration of tetracycline. Most of these 9 pockets became free of detectable A. actinomycetemcomitans during the second week of tetracycline administration, whereas pockets which yielded no A. actinomycetemcomitans after tetracycline therapy became free of the organisms during the first week of tetracycline treatment. This data suggests that systemic tetracycline therapy of localized juvenile periodontitis should, as a practical rate, be continued for 3 weeks. Periodontal destruction continued in 4 deep pockets which all showed high posttetracycline A, actinomycetemcomitans counts. All 6 pockets which demonstrated a marked gain in periodontal attachment yielded no cultivable A. actinomycetemcomitans. No association was found between periodontal disease status and subgingival Capnocytophaga, spirochetes or motile rods. The present study indicates that A. actinomycetemcomitans is an important etiologic agent in localized juvenile periodontitis. Also, this study demonstrates that the effectiveness of therapy can be monitored by subgingival A. actinomycetemcomitans counts, and that periodontal A, actinomycetemcomitans infections cannot be resolved by root surface debridement alone but can be cured by systemic tetracycline therapy.     

Healing following surgical non-surgical treatment of periodontal disease

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

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.     

Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery

This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy.     

Effectiveness of scaling and root planing versus modified Widman flap on nitric oxide synthase and arginase activity in patients with chronic periodontitis

BACKGROUND: Nitric oxide (NO) is synthesized from the conversion of L-arginine to L-citrulline by NO synthase (NOS). Arginase, which is an arginine-depleting enzyme, can compete with NOS for the common substrate L-arginine and thus inhibit NO production. OBJECTIVES: In the present study, we aimed to examine the correlation between the arginase and NOS activity in patients with chronic periodontitis and to compare the effects of scaling and root planing and modified Widman flap procedures on enzyme activity. MATERIAL AND METHODS: The study included 13 patients diagnosed with chronic periodontitis. Using a split-mouth design, the defects showing>or=7 mm of attachment loss were treated either with scaling and root planing or with modified Widman flap. Gingival biopsies from both sites were obtained at baseline and 2 months after periodontal treatment. Immunohistochemical staining was performed for evaluating NOS expression and specific arginase activity was determined spectrophotometrically. RESULTS: Although inflamed periodontal tissues demonstrated a strong inducible NOS (iNOS) expression at baseline, immunostaining decreased after periodontal treatment. iNOS expression intensity and the number of inflammatory cells showing iNOS expression were found to be higher in the scaling and root planing group compared to the modified Widman flap group. The specific activity of arginase was measured as 0.18+/-0.07 IU/mg protein in the modified Widman flap group and 0.25+/-0.11 IU/mg protein in the scaling and root planing group at baseline. After periodontal therapy, the enzyme level was increased to 0.68+/-0.14 IU/mg protein in the modified Widman flap and to 1.10+/-0.23 IU/mg protein in the scaling and root planing group. CONCLUSION: This study was the first report of evaluating the involvement of the arginine-NO pathway in chronic periodontitis and this might be considered to be of value in understanding the periodontal disease mechanisms.     

Comparison of surgical and nonsurgical treatment of periodontal disease A review of current studies and additional results after 6 1/2 years

Abstract. Many well designed clinical studies have established the effectiveness of periodontal therapy. Surgical procedures have been shown to be effective in treating periodontitis when followed by appropriate maintenance care. Scaling and root planing alone have recently been compared to scaling and root planing plus soft tissue surgery in several longitudinal trials. A review of the literature indicates several important findings including a loss of clinical attachment following flap procedures for shallow (1–3 mm) pockets and no clinically significant loss after scaling and root planing. These studies also generally report either a gain or maintenance of attachment level for both procedures in deeper pockets (≥4 mm). For these pockets, neither procedure has been shown to be uniformly superior with respect to attachment gain. All reports indicate that both treatment methods result in pocket reduction. However, the literature also indicates that scaling and root planing combined with a flap procedure results in greater initial pocket reduction than does scaling and root planing alone. This difference in degree of pocket reduction between procedures tends to decrease beyond 1–2 years. It has been shown that both treatment methods result in sustained decreases in gingivitis, plaque and calculus and neither procedure appears to be superior with respect to these parameters. Additional data from the study at the University of Minnesota indicate that similar results are maintained up to 6 1/2 years following active therapy. Pocket depth did not change for shallow (1–3 mm) pockets treated by either scaling and root planing alone or scaling and root planing followed by a modified Widman flap. For pockets 4–6 mm, both treatment procedures resulted in equally effective sustained pocket reduction. Deep pockets (≥ 7 mm) were initially reduced more by the flap procedure. After 2 years, no consistent difference between treatment methods was found in degree of pocket reduction. However, as compared to baseline, pocket reduction was sustained to 6 1/2 years with the flap and only 3 years with scaling and root planing alone. After 6 1/2 years, sustained attachment loss in shallow (1–3 mm) pockets was found after the modified Widman flap. Scaling and root planing alone in these shallow pockets did not result in sustained attachment loss. For pockets initially 4–6 mm in depth, attachment level was maintained by both procedures but scaling and root planing resulted in greater gain in attachment as compared to the flap’at all time intervals. Treatment of pockets ≥ 7 mm in depth by either procedure resulted in a sustained gain in attachment with no difference between procedures. The results of these studies indicate that both scaling and root planing as well as scaling and root planing combined with a flap procedure are effective in treating periodontitis over time up to 6 1/2 years. Individual variations among patients were noted. Decisions for or against soft tissue surgery must be made on the basis of individual patient considerations.     

Healing following surgical and non-surgical treatment of juvenile periodontitis

The patient sample used in the present study comprised 16 young individuals who were referred for treatment of advanced periodontal disease. Based upon the age of the patients and the location of the diseased sites, the patients were divided into 2 groups; a juvenile periodontitis group (JP) and a post-juvenile periodontitis group (post-JP). The patients in the JP group had periodontal lesions only at first molars and incisors. All 16 subjects were in excellent general health and none had been treated with antibiotics during a period of at least 12 months prior to the 1st examination. At a baseline examination and 6, 24 and 60 months after active therapy, the diseased sites were examined regarding plaque, gingivitis, probing pocket depths, probing attachment level, recession of the gingival margin and marginal alveolar bone level. Following a case presentation and instruction in proper oral hygiene measures, the 16 subjects were subjected to periodontal treatment, utilizing a split mouth design. By random selection, the diseased sites in one side of the jaws were treated by scaling and root planing in conjunction with a "modified Widman flap" procedure, while in the contralateral jaw quadrants treatment was restricted to scaling and root planing. During the 1st 6 months following active therapy, the patients were subjected to professional tooth cleaning once every 4 weeks. Subsequently, the interval between the recall appointment was 3 months. 2 years after treatment, this maintenance care program was terminated. A final examination was performed 5 years after therapy. None of the patients involved in the trial received antibiotic treatment during the 5 years of observation. The findings of the present study revealed that the response of the periodontal tissues to therapy, both in the JP and the post-JP group of patients, was almost identical to that found for similar types of treatment in patients with adult periodontitis. The re-examinations performed after 6, 24 and 60 months following active therapy of JP and post-JP lesions revealed that excision of the granulation tissue in conjunction with flap elevation did not enhance the degree of probing pocket depth reduction, probing attachment gain and bone fill that occurred following meticulous root surface instrumentation.     

"Critical probing depths" in periodontal therapy

Abstract The present investigation was carried out on 15 individuals who were referred for treatment of moderately advanced periodontal disease. All patients were first subjected to a Baseline examination comprising assessment of oral hygiene and gingival conditions, probing depths and attachment levels. Following case presentation and instructions in oral hygiene measures, the patients were given periodontal treatment utilizing a split mouth design. In one side of the jaw scaling and root planing were performed in conjunction with a modified Widman flap procedure while in the contralateral jaw quadrants the treatment was restricted to scaling and root planing only. The period from initial treatment to 6 months after treatment was considered to be the Healing phase and from 6–24 months after treatment the maintenance phase. During the healing phase the patients were recalled for professional tooth cleaning once every 2 weeks. During the maintenance phase the interval between the recall appointments was extended to 3 months. Reexaminations were carried out 6, 12 and 24 months after the completion of active treatment. The results revealed that treatment resulted in loss of clinical attachment in sites with initially shallow pockets, while sites with initially deep pockets gained clinical attachment. With the use of regression analysis “critical probing depths” were calculated for the two methods of treatment used. It was found that the critical probing depth value for scaling and root planing was significantly smaller than the corresponding value for scaling and root planing used in combination with modified Widman flap surgery (2.9 vs 4.2 mm). In addition, the surgical modality of therapy resulted in more attachment loss than the non-surgical approach when used in sites with initially shallow pockets. On the other hand, in sites with initial probing depths above the critical probing depth value more gain of clinical attachment occurred following Widman flap surgery than following scaling and root planing. The data obtained from the reexaminations 12 and 24 months after active treatment demonstrated that the probing depths and the attachment levels obtained following active therapy and healing were maintained more or less unchanged during a maintenance care period which involved careful prophylaxis once every 3 months. However, the data also disclosed that the level of oral hygiene maintained by the patients during healing and maintenance was more critical for the resulting probing depths and attachment levels than the mode of initial therapy used. Thus, sites which during the maintenance period were found to be free from supragingival plaque were associated with shallow pockets and maintained attachment levels. In contrast, sites which harboured plaque exhibited increasing probing depths and further attachment loss.     

Comparison of some subgingival microflora from juvenile periodontitis before and after scaling and root planing

Actinobacillus actinomycetemcomitans and Capnocytophaga are subgingival bacteria that have correlation with juvenile periodontitis. Studies were carried out in a group of 20 patients with juvenile periodontitis before, after treatment by scaling, root planing, oral hygiene instruction and 20 patients with healthy gingiva as a control group. Gingival index, plaque index, pocket depth were measured. Subgingival bacteria were counted on selective media and compared by phase contrast microscopy. Before treatment all measurements in the patients and the control group were significantly different (P less than 0.05). In the patients before and after treatment all clinical measurements were significantly different (P less than 0.05) but the amount of A.actinomycetemcomitans and Capnocytophaga were not significantly different (P greater than 0.05). These results indicate that treatment of juvenile periodontitis by scaling, root planing and oral hygiene instruction improve the clinical measurements but are not effective in reducing proportions of subgingival bacteria.     

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.     

Clinical and microbiologic effects of single-dose metronidazole or scaling and root planing in treatment of adult periodontitis

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.     

Metronidazole plus amoxycillin in the treatment of Actinobacillus associated periodontitis

The potential use of an adjunctive therapy of metronidazole plus amoxycillin for the subgingival elimination of Actinobacillus actinomycetemcomitans in periodontitis patients was investigated. 22 patients participated in this study, 11 with localized juvenile periodontitis (LJP) and 11 with rapidly progressive periodontitis (RPP). 14 patients had received periodontal treatment in the past. All patients were subgingivally infected with A. actinomycetemcomitans. After mechanical subgingival debridement in combination with the antibiotic treatment, elimination of A. actinomycetemcomitans was achieved in all patients but one. With this one exception, clinical improvements were observed in all patients, resulting in reduced pocket probing depths as well as in a significant reduction in bleeding on probing. Re-examination of 16 patients after 9-11 months revealed that A. actinomycetemcomitans was still undetectable and further clinical improvement was observed. It was concluded that the combination of metronidazole plus amoxycillin is a valuable adjunct to mechanical therapy in A. actinomycetemcomitans associated periodontal infections.     

Treatment of localized juvenile periodontitis

Abstract The present investigation was performed to study the effect on localized juvenile periodontitis (LJP) of a treatment program which included tetracycline administration, surgical elimination of inflamed tissues, scaling and root planing, and careful plaque control during healing. Treatment of LJP lesions was carried out on 16 individuals aged 14 to 18 years (JP group). Lesions in first molars and incisors in a group of patients with adult periodontal disease (AP) were treated in an identical manner and served as controls. The presence of angular bony defects adjacent to first molars and incisors was first documented in all patients. Thereafter, a clinical examination was carried out, including assessments of oral hygiene status, gingival conditions, probing depths and attachment levels. The patients were subjected to a treatment program involving administration of tetracycline (250 mg 4 times per day for 2 weeks), removal of granulation tissue after flap elevation, and root curettage. After surgery, the patients were instructed to rinse the mouth with 0.2% chlorhexidine for 2min twice a day during the first 2 postsurgical weeks. Professional tooth cleaning was carried out once every 3 months during a 5-year period. At 6, 12, 24 and 60 months after surgical treatment, the patients were re-examined regarding oral hygiene, gingival conditions, probing depths and attachment levels. Treatment of LJP lesions resulted in resolution of gingival inflammation, gain of clinical attachment, and refill of bone in angular bony defects. The healing of the lesions of this patient sample was similar to healing observed in patients with AP.     

The effectiveness of scaling and root planing with adjunctive time-release minocycline using an open and closed approach for the treatment of periodontitis

The purpose of this study was to determine the effectiveness of scaling and root planing using a closed and open approach (papilla reflection) with and without a locally delivered antibiotic (minocycline hydrochloride microspheres) in the treatment of moderate to advanced chronic periodontitis. Twenty-five periodontal recall patients with four or more probing depths of 5.0 to 9.0 mm and bleeding on probing (BOP) participated in this double-blind trial. Each of four sites per patient was randomly assigned a different treatment: scaling/root planing only; scaling/root planing followed by minocycline placement; gingival papilla reflection followed by scaling/root planing and flap closure; and gingival papilla reflection, scaling/root planing, minocycline placement, and flap closure. At baseline and each subsequent appointment, probing depth, BOP, and clinical crown length were recorded. Patients returned at three months for measurements and supportive periodontal therapy, and at six months for final measurements. Patients followed their usual oral hygiene regimens. Data were analyzed for significant differences using a repeated measure ANOVA and a Student t-test. All treatments resulted in reduction of probing depths (average of 1.76 mm) and a marked reduction in BOP at six months. While the papilla reflection plus minocycline showed the greatest reduction in probing depth (1.91 mm) and the greatest decrease in BOP (20% at three months and 28% at six months), the differences were not significant (p > 0.05). Clinical crown lengths did not change significantly in the treatment sites; therefore, improvements in probing depth can be attributed to improved clinical attachment levels (long junctional epithelium). The combination therapies did not differ significantly from scaling/root planing alone in decreasing probing depths and BOP.     

Long-term effect of surgical and non-surgical periodontal treatment. A 5-year clinical study

The aim of the present study was to evaluate the long-term (5 yr.) effect of surgical and non-surgical periodontal treatment. 16 patients with advanced periodontal disease participated in the study- All patients were subjected to initial treatment comprising supra- and subgingival scaling and instruction in performing proper oral hygiene. Modified Widman flap surgery was always employed in a quadrant in both the maxilla and mandible. Reverse bevel flap surgery or root planing under local anesthesia were used in the contralteral quadrants. During the 1st 2 wk after surgery or root planing the patients rinsed twice daily with 0.2% chlorhexidine digluconate They were then recalled for professional tooth cleaning once every 2nd wk for the 1st yr. every 3rd month during the 2nd yr, and every 6th month during the last 3 yr. Subgingival scaling was performed at each recall appointment during the last 4 yr.
Surgical as well as non-surgical treatment resulted in a considerable reduction in probing pocket depth which was maintained during the 5-yr observation period. A small gain of probing attachment (0.0-0.4 mm) was assessed 3 months after treatment for all procedures, but after 5 yr a small loss of attachment (0.0-0.2 mm) bad occurred in surgically treated areas, whereas a gain of 0.3 mm was maintained in the areas treated with root planing.
The changes in bone level were minute following both surgical and non-surgical treatment. Less than 5% of the tooth surfaces exhibited a loss of probing attachment of more than 2 mm or a loss of alveolar bone of 15% or more of the "normal" bone height alter 5 yr. The number of deteriorating sites in each individual did not correlate with the level of self-performed oral hygiene.     

Four types of periodontal treatment compared over two years

Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. Initial measurements of pocket depth and clinical attachment levels were compared with measurements obtained after the initial hygienic phase of the treatment and measurements of the same areas 1 and 2 years after four different types of periodontal treatment had been applied on a randomized basis to each of the four quadrants of the dentition. These treatments were: (1) surgical pocket elimination or reduction, (2) modified Widman flap surgery. (3) subgingival curettage, (4) scaling and root planing only. The patients were recalled for prophylaxis every 3 months, and rescored annually. One-way analysis of variance and Scheffe's method were used to test the hypothesis of equal treatment effects. The results were analyzed both with initial pocket depth as the baseline and with pocket depth at the hygienic phase as the baseline using a grouping of pockets 1 to 3 mm, 4 to 6 mm, and greater than or equal to 7 mm. For the 1 to 3 mm pockets there was a slight reduction in depth at the hygienic phase, with only minor changes after the various modalities of treatment over 2 years. However, significant losses of attachment after all modalities of periodontal therapy, including scaling alone, were observed at both the 1-year an 2-year intervals. For pockets 4 to 6 mm deep, the main reduction in pocket depth occurred at the hygienic phase, but the pockets also were reduced by further treatment, most by pocket elimination and modified Widman surgery. However, this reduction in pocket depth after surgery had no beneficial influence on maintenance of the attachment level, which actually was maintained best by scaling alone. For deep pockets greater than or equal to 7 mm, significant reduction in pocket depth occurred both at the hygienic phase and 1 to 2 years after treatment, with the greatest initial reduction after pocket elimination surgery. However, again there was no significant difference in attachment results among the four methods.     

A multidisciplinary approach to the diagnosis and treatment of early-onset periodontitis: a case report

BACKGROUND: The diagnosis and treatment of early-onset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP. METHODS: The 17-year-old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly. RESULTS: Using a non-surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2-year follow-up period. CONCLUSIONS: This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP.     

Short term results of three modalities of periodontal treatment.

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