Auswirkungen von Bändern und Brackets auf das marginale Parodontium

Zusammenfassung Die Zähne von zwölf kieferorthopädischen Patienten wurden wechselweise bebändert und beklebt; nicht in die Behandlung einbezogene Zähne dienten als Kontrollzähne. Bei diesen Patienten wurden über mehr als ein Jahr folgende parodontologische Untersuchungen durchgeführt: Papillenblutungsindex, Gingival-index, Plaqueindex und Sondierungstiefe; hinzu kam eine mikrobiologische Prüfung der gingivalen Plaque mit Hilfe der Dunkelfeldmikroskopie. Dabei wurden folgende Ergebnisse gefunden: 1. Selbst vor Aufnahme der Behandlung ist die marginale Gingiva propria in der Regel nicht entzündungsfrei. 2. Durch Mundhygieneinstruktionen kann kurzfristig eine Verbesserung dieses Zustandes erzielt werden. 3. Im Laufe der kieferorthopädischen Behandlung nimmt der Entzündungsgrad der Gingiva kontinuierlich zu, besonders deutlich nach dem achten Monat. 4. Abgesehen vom Plaqueindex war der parodontale Zustand der bebänderten Zähne spätestens nach einem Jahr signifikant (p0,05) schlechter als der mit Adhäsivbrackets versehenen Zähne. 5. Fast regelmäßig ergab die Dunkelfeldmikroskopie signifikante Unterschiede für alle drei Zahnkategorien. Als Gesamtergebnis zeigte sich, daßunter parodontologischen Aspekten das Bekleben der Zähne einem Bebändern vorzuziehen ist.

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Summary The teeth of 12 orthodontically treated patients were alternately banded or bonded; teeth not included in active treatment served as control teeth. During a period of more than 1 year the periodontal conditions were assessed by the papilla-bleeding-index, the gingival-index, the plaque-index, and depth of the gingival sulcus. In addition a microbiological examination of the gingival plaque with darkfield microscopy was undertaken. The following results were obtained: 1. Even prior to the beginning of treatment the marginal gingiva propria is usually not free of inflammation. 2. Following oral hygiene instruction, improvement can be achieved, but only for a short period of time. 3. During the course of orthodontic treatment the degree of inflammation steadily increases and is particularly significant after the 8th month. 4. By the 12th month the periodontal status—beside the plaque-index—of the banded teeth was significantly (p0,05) worse than that of the bonded teeth. 5. Almost regularly the darkfield microscopy revealed significant differences in all three tooth categories. In conclusion, it is preferable from aperiodontal point of view, to place bonded brackets on teeth rather than bands.

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Résumé Les dents de 12 patients furent traitées alternativement à l'aide d'anneuax et de brackets collés; les dents non traitées servaient de contrôle. L'état de leur parodonte marginal fut régulièrement examiné pendant une année et plus (index de saignement papillaire, index gingival, index de plaque, profondeur de poche). La période d'observation se termina par un examen bactériologique avec un microscope à fond noir. Les résultats suivants furent trouvés: 1. Une inflammation gingivale fut pratiquement de règle avant le traitement. 2. Cet état put être amélioré transitoirement par des instructions d'hygiène orale. 3. Le degré d'inflammation gingivale augmenta continuellement au cours du traitement et ce particulièrement après le 8e mois. 4. Indépendamment de l'index de plaque, l'état parodontal des dents baguées fut significativement (p0,05) plus mauvais, au plus tard après 12 mois, par rapport aux dents munies de brackets collés. 5. Les résultats des examens bactériologiques à fond noir donnèrent presque toujours des différences significatives pour les trois catégories de dents. En conclusion il semble que du point de vue parodontal l'utilisation de brackets est préférable à celle d'anneaux.

     

Hematopoietic progenitor cell colony growth differentiates chronic myelomonocytic leukemia from reactive monocytosis

In the absence of a cytogenetic abnormality or overt dysplasia, chronic myelomonocytic leukemia (CMML) may be difficult to be distinguished from reactive monocytosis. We have previously described a typical growth pattern in CMML patients, i.e., 'pseudonormal' colonies resembling granulocytic colonies but consisting entirely of monocytic cells when stained. To study the utility of the colony forming unit cell assay (CFU-C) as a diagnostic tool in patients with monocytosis, we analyzed a cohort of 48 consecutive patients referred to our institution with peripheral blood monocytosis. Thirty-six patients fulfilled the WHO criteria for CMML; 12 were diagnosed with reactive monocytosis. Of the patients with CMML, 28 showed pseudonormal growth with or without leukemic cluster growth, another four showed exclusively leukemic growth. None of the patients with reactive monocytosis showed either leukemic or pseudonormal growth. With a specificity of 100% and a sensitivity of 89%, the CFU-C assay has a unique potential to distinguish CMML from reactive monocytosis.     

Observations on a new collagen barrier membrane in 16 consecutively treated patients. Clinical and histological findings.

BACKGROUND: Space-maintaining capacity, cell disclusive potential, and stability over time are crucial factors to achieving sufficient bone augmentation with membrane barriers. The case series presented here assessed a new collagen barrier used in bone augmentation. Clinically, the healing pattern, especially in cases of secondary healing, was studied. METHODS: Soft tissue healing was documented by photographs, and the size of the dehiscences calculated by image analysis. The measurements were performed on digitized photographs. During reentry, barrier remnants were dissected and histologically evaluated. RESULTS: The mean value for dehiscences was 35.5 mm2; all dehiscences healed within 4 weeks after the exposure became evident. The difference was statistically significant between the week 2 and week 6 visits (P = 0.008) for each previously exposed site. The histologic observation of barrier remnants revealed direct apposition of fibrous and bone tissues on the membrane surface. CONCLUSION: In cases of membrane exposure, gingival dehiscences always disappeared in the following weeks without affecting the healing process. Histologic results showed barrier stability over a 6-month period, promoting bone regeneration.     

Gingival crevicular fluid levels of calprotectin and myeloperoxidase during therapy for generalized aggressive periodontitis

BACKGROUND: Levels of the inflammation marker calprotectin in gingival crevicular fluid correspond to clinical and biochemical parameters of periodontal inflammation. Neutrophil granulocytes (polymorphonuclear neutrophils: PMNs) are supposed to be the main source of calprotectin in gingival crevicular fluid, but evidence is still lacking. The influence of periodontal therapy on gingival crevicular fluid levels of calprotectin has not yet been determined. OBJECTIVES: Gingival crevicular fluid levels of calprotectin were monitored during therapy for generalized aggressive periodontitis. Interrelations between calprotectin and the PMN marker myeloperoxidase (MPO) were evaluated. MATERIAL AND METHODS: Gingival crevicular fluid samples were collected from 23 patients with generalized aggressive periodontitis before and 3 months after non-surgical therapy with an adjunctive antimicrobial medication. Clinical parameters were recorded with a pressure-calibrated electronic probe. Levels of calprotectin and MPO in gingival crevicular fluid were analysed by enzyme-linked immunosorbent assay (ELISA) procedures. RESULTS: At baseline, levels of calprotectin and MPO were highly correlated. Bleeding and suppurating sites showed significantly higher levels of calprotectin and MPO than non-bleeding, non-suppurating sites. Therapy significantly decreased levels of both biomarkers. These changes of calprotectin and MPO were highly correlated and also related to probing-depth reduction. Three months after therapy, the levels of both markers still showed significant correlations in initially deep sites, whereas in initially shallow sites no significant correlation was found. After therapy, levels of markers in bleeding and non-bleeding sites were comparable. CONCLUSION: The correlations between calprotectin and MPO indicate that PMNs are a major contributor to the calprotectin content in gingival crevicular fluid of severely affected sites. Calprotectin levels in gingival crevicular fluid and their changes reflect periodontal inflammation as well as the clinical treatment outcome. A prognostic potential of this marker substance remains to be determined.     

Obesity, inflammation, and periodontal disease

The prevalence of obesity has increased substantially over the past decades in most industrialized countries. Obesity is a systemic disease that predisposes to a variety of co-morbidities and complications that affect overall health. Cross-sectional studies suggest that obesity is also associated with oral diseases, particularly periodontal disease, and prospective studies suggest that periodontitis may be related to cardiovascular disease. The possible causal relationship between obesity and periodontitis and potential underlying biological mechanisms remain to be established; however, the adipose tissue actively secretes a variety of cytokines and hormones that are involved in inflammatory processes, pointing toward similar pathways involved in the pathophysiology of obesity, periodontitis, and related inflammatory diseases. We provide an overview of the definition and assessment of obesity and of related chronic diseases and complications that may be important in the periodontist's office. Studies that have examined the association between obesity and periodontitis are reviewed, and adipose-tissue-derived hormones and cytokines that are involved in inflammatory processes and their relationship to periodontitis are discussed. Our aim is to raise the periodontist's awareness when treating obese individuals.     

Apicomarginal defects in periradicular surgery: classification and diagnostic aspects

The prognosis of periradicular surgery is affected by the amount and location of bone loss. Apicomarginal defects are localized bony defects encompassing the total root length, and periradicular surgery on these teeth is associated with a lower success rate. This paper reviews the etiology, pathogenesis, and morphology of apicomarginal defects as encountered in periradicular surgery on the basis of a series of 24 consecutively treated patients. Periodontal data were recorded before surgery in all patients, and apicomarginal defects were diagnosed after flap reflection or, if applicable, apicoectomy. On the basis of the findings in these cases and on theoretic considerations, a classification system for apicomarginal defects with potential therapeutic and prognostic implications is presented and several criteria for differential diagnosis are discussed.     

Total IgA and Porphyromonas gingivalis-reactive IgA in the saliva of patients with generalised early-onset periodontitis

Generalised early-onset periodontitis (GEOP) is characterized by acute inflammatory bursts, resulting in rapid destruction of the periodontal apparatus in young adults. An impaired host defense seems to play an important role as etiological factor of periodontitis, especially in the development of GEOP. As the gram-negative Porphyromonas gingivalis has been identified as one of the causative anaerobic bacteria, the humoral immune response to this micro-organism is of particular interest in patients with GEOP. To evaluate the local immune status, we measured total and P. gingivalis-reactive salivary IgA in GEOP patients and in age- and gender-matched periodontally normal controls. We found a significantly lower concentration and secretion rate of total salivary IgA in the GEOP group. Although no differences were detected in the concentration or secretion of P. gingivalis-reactive IgA between groups, the specific fraction of P. gingivalis-reactive IgA of the total IgA was significantly higher in the GEOP group. These findings indicate an inhibition of total secretory IgA in GEOP, while the P. gingivalis-reactive humoral immune system in saliva is, however, activated. P. gingivalis seems to selectively activate IgA lymphocyte clones and induces a switch in the fraction of specific IgA.