Search

Many diseases seem to affect each other. This is particularly true of periodontal diseases that relate to many systemic diseases. For this reason, this study investigated the relationship between obesity and gingivitis in children by focusing on plasma and salivary metabolomic biochemicals. Whole saliva and plasma samples were taken from each of sixty‐eight 11‐year‐old children afflicted by different degrees of both gingivitis and obesity. Gingivitis was evaluated as the percent of sites considered erythematous. Obesity was determined by waist circumference. Untargeted metabolomic analysis defined 29 biochemicals significantly correlated between saliva and plasma, which included the collagen breakdown amino acid hydroxyproline (Hyp). Two‐sided t‐tests and regression analysis were performed to compare these data from children with obesity alone, gingivitis alone, both, and neither. Obese children exhibited signs of increased collagen turnover by being taller (14.4 cm) and having more permanent teeth (5.7). Analysis indicated a significant impact of obesity on gingivitis. Children with both diseases had 41.02% of gingival sites red whereas children with only obesity had 5.2% and children with only gingivitis had 19.16%. Hyp was increased in saliva by the combined presence of both diseases. The effects of gingivitis on obesity were in the same direction but generally not statistically significant. Obesity clearly augments gingivitis. Data suggest that interaction between gingivitis and obesity may exhibit disease reciprocity in which activated neutrophils are mutually shared to create collagen destruction and Hyp release into both saliva and plasma.

Poor sleep behavior appears to have adverse effects on health by metabolic disruption and immunity suppression. Sleep disturbance is strongly associated with diabetes, cardiovascular diseases, and some cancers. This study aimed to evaluate the association between sleep duration and periodontal disease in a national US population study in a National Health and Nutrition Examination Survey (NHANES). The data were collected from individuals aged ≥30 years and included 3,624 participants in the United States NHANES 2013 to 2014. A weighted multivariable logistic regression modeling quantified the association between sleep and severe periodontal disease. We tested for diabetes as an effect modifier, adjusting for potential confounders such as smoking status, sex, age, education level, and dental visit. Individuals who sleep >7 hours/night with no trouble sleeping are 40% less likely to have severe periodontal disease (odds ratio [OR] = 0.6, P< 0.05), adjusting for age, sex, smoking status, FPL, education level, and dental visit. Additionally, diabetes was a significant positive effect modifier of the relationship between sleep and severe periodontal disease (OR = 4.8, P< 0.05). Findings of this cross‐sectional representative study of an adult US population revealed a statistically significant association between sleep duration and severe periodontitis. In this study, individuals who slept >7 hours/night were less likely to exhibit severe periodontal disease. It also seems that this relationship was stronger among individuals with diabetes compared with individuals without diabetes.

Background:Oral docosahexaenoic acid (DHA) + aspirin therapy has been shown to reduce periodontal probing depth (PD) and local inflammatory mediators in gingival crevicular fluid (GCF) among patients with untreated chronic periodontal disease. Whether DHA + aspirin therapy influences specific bacterial burden in this setting is unknown. Thus, the aim of this study is to evaluate the impact of DHA with low‐dose aspirin therapy on periodontal bacterial profile in patients with periodontitis. Methods:Fifty‐five adults with moderate‐to‐severe periodontitis were enrolled in a randomized, 3‐month double‐masked, placebo‐controlled trial of daily 2 g DHA or placebo capsules enriched with 81 mg aspirin; 46 enrollees completed the trial. In addition to clinical measurements and GCF sampling, subgingival plaque samples were collected from four posterior sites in all participants and analyzed by the checkerboard DNA–DNA hybridization technique. Presence of 40 periodontal bacterial species at baseline and 3 months was semiquantitatively estimated. Results:Despite broad improvements in clinical parameters, total bacteria and individual species counts in dental plaque did not differ significantly between baseline and 3 months in either group (P>0.1 for all). A modest effect of DHA + aspirin on Porphyromonas gingivaliscounts was associated with 14% (95% confidence interval: 3% to 35%) of the observed benefit of DHA on PD. DHA + aspirin had no significant effect on individual plaque bacterial counts in unadjusted models or those adjusted for age, sex, and race (P>0.1 for all). Conclusions:This pilot randomized, controlled trial suggests that DHA + aspirin therapy improves periodontitis largely by modulating host inflammatory response. Changes in individual species levels in subgingival plaque microbiota were not detectable; however, a small portion of the benefit appears to stem from changes in P. gingivalislevels in the DHA + aspirin treatment group. Whether this change in P. gingivalislevels leads to biofilm alteration with reversal of dysbiosis requires further longitudinal and more specific investigations.

Background:This study compares the changes to the subgingival microbiota of individuals with “refractory” periodontitis (RP) or treatable periodontitis (good responders [GR]) before and after periodontal therapy by using the Human Oral Microbe Identification Microarray (HOMIM) analysis. Methods:Individuals with chronic periodontitis were classified as RP (n = 17) based on mean attachment loss (AL) and/or >3 sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GR (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Subgingival plaque samples were taken at baseline and 15 months after treatment and analyzed for the presence of 300 species by HOMIM analysis. Significant differences in taxa before and post‐therapy were sought using the Wilcoxon test. Results:The majority of species evaluated decreased in prevalence in both groups after treatment; however, only a small subset of organisms was significantly affected. Species that increased or persisted in high frequency in RP but were significantly reduced in GR included Bacteroidetessp., Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotellaspp., Tannerella forsythia, Dialisterspp., Selenomonasspp., Catonella morbi, Eubacteriumspp., Filifactor alocis, Parvimonas micra, Peptostreptococcussp. OT113, Fusobacteriumsp. OT203, Pseudoramibacter alactolyticus, Streptococcus intermediusor Streptococcus constellatus, and Shuttlesworthia satelles.In contrast, Capnocytophaga sputigena, Cardiobacterium hominis, Gemella haemolysans, Haemophilus parainfluenzae, Kingella oralis, Lautropia mirabilis, Neisseria elongata, Rothia dentocariosa, Streptococcus australis, and Veillonellaspp. were more associated with therapeutic success. Conclusion:Persistence of putative and novel periodontal pathogens, as well as low prevalence of beneficial species was associated with chronic refractory periodontitis.

Background:This study compared the subgingival microbiota of subjects with refractory periodontitis (RP) to those in subjects with treatable periodontitis (GRs = good responders) or periodontal health (PH) using the Human Oral Microbe Identification Microarray (HOMIM). Methods:At baseline, subgingival plaque samples were taken from 47 subjects with periodontitis and 20 individuals with PH and analyzed for the presence of 300 species by HOMIM. The subjects with periodontitis were classified as having RP (n = 17) based on mean attachment loss (AL) and/or more than three sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GRs (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Significant differences in taxa among the groups were sought using the Kruskal‐Wallis and χ2tests. Results:More species were detected in patients with disease (GR or RP) than in those without disease (PH). Subjects with RP were distinguished from GRs or those with PH by a significantly higher frequency of putative periodontal pathogens, such as Parvimonas micra(previously Peptostreptococcus microsor Micromonas micros), Campylobacter gracilis, Eubacterium nodatum, Selenomonas noxia, Tannerella forsythia(previously T. forsythensis), Porphyromonas gingivalis, Prevotellaspp., Treponemaspp., and Eikenella corrodens, as well as unusual species (Pseudoramibacter alactolyticus, TM7 spp. oral taxon [OT] 346/356, Bacteroidetessp. OT 272/274, Solobacterium moorei, Desulfobulbussp. OT 041, Brevundimonas diminuta, Sphaerocytophagasp. OT 337, Shuttleworthia satelles, Filifactor alocis, Dialister invisus/pneumosintes, Granulicatella adiacens, Mogibacterium timidum, Veillonella atypica, Mycoplasma salivarium, Synergistessp. cluster II, and Acidaminococcaceae[G‐1] sp. OT 132/150/155/148/135) (P<0.05). Species that were more prevalent in subjects with PH than in patients with periodontitis included Actinomycessp. OT 170, Actinomycesspp. cluster I, Capnocytophaga sputigena, Cardiobacterium hominis, Haemophilus parainfluenzae, Lautropia mirabilis, Propionibacterium propionicum, Rothia dentocariosa/mucilaginosa, and Streptococcus sanguinis(P<0.05). Conclusion:As determined by HOMIM, patients with RP presented a distinct microbial profile compared to patients in the GR and PH groups.

Background:Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis. Methods:A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis. Results:MM + SRP reduced red‐complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P<0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P<0.05). Conclusions:SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Background:The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug‐delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis. Methods:Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red‐complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia(formally T. forsythensis), and Treponema denticolarelative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject. Results:MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 × 105. The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 × 105, respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved. Conclusion:These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Background:The objective of this double‐masked, randomized, multicenter crossover study was to compare the efficacy of 4% articaine HCl with 1:100,000 epinephrine (A100) to 4% articaine HCl with 1:200,000 epinephrine (A200) for providing effective local anesthesia and hemostasis for periodontal surgery. Methods:Anesthetic efficacy was based on patient self‐report and lack of need for reinjection during the surgical procedures. Hemostatic properties of the formulations were compared using ratings of the surgeons’ ability to visualize the surgical field and expectation for bleeding. The volume of blood collected during each surgical session also was measured and compared. Results:Forty‐two adult subjects (26 males and 16 females, mean age 46.3 ± 9.7 years) diagnosed with moderate to severe periodontal disease requiring local anesthesia for matched bilateral periodontal surgery were enrolled and completed the study. Subjects reported satisfactory surgical anesthesia following the A100 and A200 formulations; no supplemental local anesthesia was administered. Significant differences between the A100 and A200 treatments were found for the surgeons’ ability to visualize the surgical field (rated as clear 83.3% of the time with A100 and 59.5% of the time with A200; P= 0.008), bleeding expectation (rated as equal to or better than expected 85.7% of the time with A100 and 71.4% of the time with A200; P= 0.034), and volume of blood loss (54.9 ± 36.0 ml for A100 and 70.2 ± 53.0 ml for A200; P= 0.018). Sixteen patients experienced 27 mild or moderate adverse events; the most common were postoperative pain (nine patients) and swelling (eight patients). Six adverse events may have been related to treatment. The frequency of adverse events did not vary between formulations. Conclusions:For patients undergoing periodontal surgery, 4% articaine anesthetic formulations containing epinephrine (1:100,000 or 1:200,000) provided excellent surgical pain control. For patients who can tolerate higher amounts of epinephrine, the 4% articaine 1:100,000 epinephrine formulation had the additional therapeutic advantage of providing better visualization of the surgical field and less bleeding.

Background:The hypothesis that nifedipine‐induced gingival enlargement in periodontitis patients can be treated with the adjunctive use of tetracycline (TCN) fibers was tested in this study. Methods:Ten patients (mean age 66 ± 4 years) with chronic periodontitis combined with nifedipine‐induced gingival enlargement participated. Full mouth recordings of clinical parameters (probing depth, clinical attachment level, bleeding on probing, presence or absence of plaque) were assessed at baseline and gingival enlargement was estimated from casts. Participants were instructed in proper oral hygiene and received supragingival scaling before being reassessed 1 month later. They subsequently received full‐mouth scaling and root planing followed by the immediate placement of TCN fibers in all pockets >5 mm. Clinical parameters were reassessed at 3, 6, and 12 months after completion of treatment. Results:TCN fiber placement was well tolerated by patients. All clinical parameters recorded displayed significant improvements after treatment, and they were preserved for the 12‐month experimental period. A significant reduction of the percentage of pockets >5 mm was noticed after treatment. The reduction of enlargement was still observed at 12 months despite patients not achieving optimal oral hygiene. Conclusion:Placement of tetracycline fibers as an adjunct to mechanical treatment is an option for the non‐invasive therapy of nifedipine‐induced gingival enlargement in periodontitis patients whose general medical condition and concomitant ailments do not favor a surgical approach.J Periodontol 2005;76:1034‐1039.

Background:Bleeding indices are used as a screen for periodontal disease activity, a measure of disease prevalence, and a measure of effectiveness in clinical trials. Bleeding on probing (BOP) is widely interpreted as a sign of disease activity whereas its absence is interpreted as both a sign and predictor of health. Aspirin use has become increasingly common in the prevention of cerebrovascular and cardiovascular diseases. Because of its anti‐platelet activity, aspirin is a non‐disease factor that has the potential to affect the appearance of BOP. The hypothesis being tested is that short‐term aspirin use in doses of 81 mg and 325 mg will increase the number of bleeding sites in a population with gingivitis. Methods:Fifty‐four subjects were screened initially, those subjects with 20% to 30% whole mouth BOP were randomly assigned to one of three arms: placebo group, 81 mg aspirin group, or 325 mg aspirin group. Before and after exposure to the respective regimens, clinical parameters were measured on all the teeth: the plaque index was recorded at four sites per tooth, and probing depth and BOP were evaluated at six sites per tooth using an automated pressure‐sensitive probe. Results:The data obtained in this clinical trial were analyzed utilizing a linear regression analysis to control for confounding variables. The primary measure of interest was BOP in patients clinically demonstrating naturally occurring gingivitis. The results of this study indicate that while controlling for age, gender, and plaque, “low dose” 81 mg and “regular dose” 325 mg of aspirin demonstrated a statistically significant 5.30 (P= 0.001) and 4.13 (P= 0.010) increase from baseline, respectively, in percent BOP. Conclusion:Failure to consider the effects of aspirin on BOP could impair proper diagnosis and treatment planning for clinicians and introduce a significant confounding variable in research situations. J Periodontol 2004;75:679‐684.

Background: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non‐disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double‐blind placebo‐controlled randomized clinical trial was to study the effect of short‐term daily aspirin ingestion on the clinical parameter BOP. Methods: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low‐dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure‐sensitive probe. Measurements were recorded before and after 7‐day exposure to placebo and aspirin regimens. Results: A statistically significant difference in BOP was found in patients with ≥20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure. Conclusion: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had ≥20% BOP sites. J Periodontol 2002;73:871‐876.

Background:Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP. Methods:After initial therapy and full‐mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD ≥5 mm (SRP + TCF group). Results:In both treatment groups, PD decreased significantly from BL to week 54 (6.2 ± 1.5 mm to 4.7 ± 1.4 mm for SRP + TCF and 6.5 ± 1.4 mm to 4.2 ± 0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0 ± 1.8 mm to 11.3 ± 1.8 mm for SRP + TCF and 12.3 ± 1.5 mm to 11.2 ± 1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P<0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG). Conclusions:These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9‐month observation period. J Periodontol 2001;72:1241‐1245.

The literature relating tocurrent methods of periodontal diagnosis is reviewed. There exists a future need for objective diagnostic techniques which reflect the dynamics of periodontal disease activity.

In a12‐month multi‐center study of116 adult periodontitis subjects, six putative periodontal pathogens were monitored by DNA probe methods in a subset of 31 subjects. Monitored species included Porphyromonas gingivalis(Pg), Prevotella intermedia(Pi), Fusobacterium nucleatum(Fn), Eikenella corrodens(Ec), Campylobacter rectus(Cr), and Actinobacillus actinomycetemcomitans(Aa) with an average detection limit of 1.8 × 104bacterial colony forming units/sample. The microbiological response to four periodontal treatments was studied, one treatment in each quadrant: scaling and root planing (S), scaling and root planing with tetracycline (TC) fiber (SF), a single application of TC fiber (F) and two serial applications of TC fiber (FF). Generally two sites were sampled in each quadrant, however, in some quadrants only one site was selected. These treatments were evaluated at baseline; immediately following therapy; and post‐treatment at 1, 3, 6, and 12 months. The study was conducted with a split‐mouth design with no maintenance therapy over a 12‐month period. At baseline, 70.8% of sites had detectable Fn; 42.9% Pg; 63.5% Pi; 29.7% Ec; 28.3% Cr; and 5.5% Aa. No significant differences were seen in baseline proportions of these species between centers. Numbers and proportions of detectable pathogens (with the exception of Pg) exhibited a triphasic temporal response: a precipitous initial decrease immediately following therapy; a rise in proportions in the 1‐ to 3‐month post‐therapy period; and a spontaneous decline in the absence of therapy over the 3‐ to 12‐month period. This response was particularly prominent with Ec, where numbers of sites with detected organisms at 1 month were approximately equal to or greater than numbers of positive sites at baseline, suggesting an opportunistic characteristic. The immediate post‐treatment levels of Piwere substantially greater than other species, suggesting the relative difficulty in eliminating this species. Detected numbers of sites with Aawere too low to provide data for meaningful analysis. In general all treatments reduced the numbers of sites positive for each of the species tested throughout the 1‐year monitoring period, although exceptions were observed. At 12 months, however, differences in microbiological presence related to initial therapy of each of the pathogens were small and statistically insignificant. Numerically elevated post‐therapy levels of Crwere associated with sites that lost ≥ 1 mm between the 3‐ to 12‐month post‐treatment period. However, statistically this increase was not significant. Certain differences in detectable microbial presence between treatments were noted. Sites treated by TC fiber (F, FF, SF) exhibited lower post‐therapy percentages of detectable Fn, Pg, Pi, and Crin 56 out of 60 comparisons with scaling and root planing (S) over the monitoring period. Though each individual comparison was not generally statistically significant, the probability of this repeated observation occurring by chance alone is extremely low. Similarly, when compared with scaling and root planing (S) alone, the adjunctive use of TC fiber (SF) consistently resulted in a lower percentage of sites with detectable levels of Fn, Pg, Pi, and Cr. J Periodontol 1995;66:700–707.

The purpose of this investigationwas to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled‐release tetracycline fibers. One‐hundred‐twenty‐two (122) adult volunteers with at least one bleeding pocket ≥ 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12‐month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1,3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as ≥ 1 mm mean attachment loss at a site during the 3‐ to 12‐month period. Onehundred‐sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P< 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care. J Periodontol 1995;66:708–715.

The purpose of this investigationwas to evaluate the clinical efficacy of controlledrelease tetracycline fiber therapy in adult periodontitis patients. One hundred‐twentytwo (122) adult patients from 3 dental centers were enrolled at baseline for this study. Each patient provided at least one site in each of four quadrants that was ≥ 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10‐day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred‐sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy. J Periodontol 1995;66:692–699.

The concentration oftetracycline in gingival crevice fluid and blood was determined using a sensitive bioassay after oral administration of repeated doses of tetracycline. Crevicular fluid was sampled by an intracrevicular technique from four gingival sites in each individual and blood was obtained by finger puncture. Four volunteers received doses of 250 mg of tetracycline‐HCl either every 6 hours or every 12 hours and were sampled at hours 0 to 15, 21 to 36, 48 to 60 and 96 to 102. Volunteers given 250 mg every 6 hours had average crevicular fluid concentrations between 4 to 8 μg/ml and blood concentrations between 2 to 2.5 μg/ml after 48 hours. The levels in crevicular fluid and blood of volunteers who received 250 mg every 12 hours were 2 to 4 μg/ml and 0.3 to 1.4 μg/ml respectively after 48 hours. The results demonstrated that after repeated doses of tetracycline the crevicular fluid levels were typically 2 to 4 times the blood levels.

The interpretationof dental radiographs for the diagnosis of periodontal disease conditions poses several difficulties. These include the inability to adequately reproduce the projection geometry and optical density of the exposures. In order to improve the ability to extract accurate quantitative information from a radiographic survey of periodontal status, a method was developed which provided for consistent reproduction of both geometric and densitometric exposure parameters. This technique employed vertical bitewing projections in holders customized to individual segments of the dentition. a copper stepwedge was designed to provide densitometric standardization, and wire markers were included to permit measurement of angular variation. In a series of 53 paired radiographs, measurement of alveolar crest heights was found to be reproducible within approximately 0.1 mm. This method provided a full mouth radiographic survey using seven films, each complete with internal standards suitable for computer‐based image processing.

Physical measurements including the evaluationof probing depth, bleeding on probing, tooth mobility, and inflammation form the basis for most periodontal diagnostics in use today. The interpretation of these observations and the methods available for their measurement, however, have begun to change significantly. The episodic disease activity concept has done much to implement these changes. Observation of episodic attachment loss has been correlated with parallel radiographic changes, alteration in levels of probable pathogens, and changes in inflammatory mediator levels. The failure of pocket depth, suppuration, and bleeding on probing to predict episodic attachment loss has been given plausible explanations and enhanced meanings. Although attachment loss by a continuous process cannot be excluded in some disease conditions, the hypothesis of periodontal disease progression by episodic activity supplements and expands understanding of the disease process. Interest in periodontal diagnostics has accelerated in the last decade. As a parallel development, the technology of small computers has decreased in cost and increased in sophistication. The combination of these factors has created an environment for the development of intelligent diagnostic systems. Four commercially available systems and two systems under development are described. The systems, which measure pocket depth, pocket depth or attachment level, tooth mobility, and pocket temperature, all utilize computer processing of measurements. The result is to provide a simplified and more meaningful presentation of diagnostic information. As intelligent diagnostic systems prove themselves, some of these instruments are likely to become common to dental practice. The promise of more accurate identification of areas of the mouth that are diseased can increase both the efficiency and effectiveness of periodontal therapy. J Periodontol 1992; 63:373–382.

Three treatment regimens including localtetracycline delivery, systemic doxycycline and surgery plus systemic doxycycline were investigated in a localized juvenile periodontitis (LJP) population. Of the investigated treatments only surgery plus systemic doxycycline for 14 days was effective in eliminating or suppressing Actinobacillus actinomycetemcomitans, an organism strongly associated with LJP lesions. While surgery plus antibiotics was the superior treatment, it appears that the possibility of reinfection or incomplete elimination of the organism exists. Careful long‐term follow‐up, including clinical and microbiological monitoring, is highly recommended in this periodontal population.

The conduct of multicenter trialsto test agents for treatment of Periodontitis is conceptually similar to that of single center trials, but the requirement that centers ultimately be combined into a single result places much more stringent requirements on uniformity and control. Multicenter trials should be considered only if numbers of subjects or the ability to generalize to other treatment settings becomes a driving theme. General guidelines for the conduct of studies of this sort are suggested and problems that occur are discussed. Despite formidable difficulties that may occur, multicenter studies provide a convincing demonstration of an agent's therapeutic efficacy for the treatment of Periodontitis. J Periodontol 1992; 63:1058–1063.

For the purposeof developing controlled delivery devices for periodontal therapy which would release over several days, six fiber types made of tetracycline‐loaded biocompatible polymers were manufactured and tested. Polyethylene, polypropylene, polycaprolactone, polyurethane and cellulose acetate propionate all released their drug load within 1 day. Ethylene vinyl acetate fibers, however, provided in vitrosustained release for periods up to 9 days. A bioassay was designed to measure levels of tetracycline achieved by local delivery which used growth inhibition of Bacillus cereusas a measure of the amount of tetracycline in measured volumes of gingival sulcus fluid on filter paper strips. By this assay, fibers made from 25% loaded ethylene vinyl acetate established initial concentrations of approximately 500 μg/ml. The measurement of tetracycline concentration resulting from the placement of these fibers into deep periodontal pockets as a packing material provided indication that concentrations of > 50 μg/ml could be maintained for months by weekly to monthly replacement. These studies indicate that monolithic fibers made of tetracycline‐loaded ethylene vinyl acetate have characteristics which could prove useful as the basis of a tetracycline delivery system for the treatment of periodontal disease.

A 4‐quadrant, single‐blind studywas designed to test the efficacy of periodontal disease therapy by local drug delivery. A delivery system made of extruded ethylene vinyl acetate fibers loaded with 25% USP tetracycline hydrochloride was placed and maintained in periodontal pockets for 10 days. The clinical effects of this form of therapy were compared with treatment by periodontal scaling. In addition, the effect of treatment by combined local delivery and scaling was investigated. Untreated quadrants were included as control. Placement of tetracycline‐loaded ethylene vinyl acetate fibers into periodontal pockets established a drug concentration of approximately 0.06%. By covering the delivery system with a periodontal dressing, this concentration level was maintained throughout the 10‐day therapeutic period. The average tetracycline dose used was 2.4 mg/tooth treated. Following fiber therapy, treated sites improved clinically, as evidenced by a gain in periodontal attachment and a decrease in periodontal pocket depth. The rate of new lesion formation at fiber‐treated sites decreased from a pretreatment rate of 26.5% of sites/year to a posttreatment rate of 4.8% of sites/year. Periodontal scaling also produced clinical improvement, as indicated by significant attachment gain, pocket depth reduction and a decreased rate of new lesion formation. However, in no case were clinical results by scaling superior to results by local drug delivery, and by several measures local drug delivery was found to provide a better clinical response. Principal measures by which the clinical response using local drug delivery exceeded that by scaling were in early (3–6 months) attachment gain and in the degree of reduction of new lesion formation. The combination of fiber therapy with scaling reduced the rate of new lesion formation; however, attachment gain appeared delayed in comparison with either scaling alone or fiber therapy alone. This delay in healing was probably due to mechanical interference by the delivery system, which was packed into the periodontal pocket immediately following scaling. Although delayed, the final attachment gain was equal to that of other treatment modalities. Untreated sites exhibited clinical signs of significant improvement which appeared 6 to 12 months after the therapeutic period. Attachment level gains were consistently less than at periodontal sites which had been treated but were nevertheless significant when compared to pretreatment levels. It is suggested that host response mechanisms triggered by periodontal scaling may have been responsible for this effect.

In a series of experiments, Golub et al. demonstrated that tetracyclines, but not other antibiotics, can inhibit mammalian collagenases and proposed that this property could be useful in treating diseases, such as periodontal disease (but also included certain medical conditions, e.g., corneal ulcers) characterized by excessive collagen degradation {JPeriodont Res1983, 1984 and 1985; Experientia1984; Cornea1984). One effect was the dramatic reduction of tissue collagenase activity within the gingival crevicular fluid (GCF) of periodontal pockets after administering a standard regimen of a tetracycline (e.g., 200 mg minocycline or 1000 mg tetracycline/day). The preliminary studies described below determined the effect of (1) low‐dose (LD; 40–80 mg/day) orally administered minocycline on GCF collagenase activity and on the subgingival microflora (Exp. I), and (2) tetracyclineloaded monolithic fibers (TF) on collagenase activity in vitro(Exp. II). In Exp. I, GCF collagenase activity was reduced by 45 to 80% 2 weeks after initiating LD minocycline therapy, an effect that lasted for at least several weeks after stopping drug treatment. No consistent change in the relative proportions of G(+), G(‐) and motile subgingival microorganisms was detected as a result of LD treatment suggesting that the reduction in GCF collagenase activity was a direct inhibition of the enzyme by the drug. In Exp. II, 3‐ and 6mm lengths of TF in vitroestablished tetracycline concentrations in 250 μl of 132 μg/ml, from 3‐mm lengths, and 265 μg/ml, from 6‐mm lengths, after an 18‐hour incubation. Although these concentrations were slightly lower than those established in the GCF of individual TF‐treated periodontal pockets in vivo(Goodson et al. 1983, J Periodontol), the released tetracycline from 3‐ and 6‐mm TFs inhibited rat polymorphonuclear leukocyte collagenase activity in vitroby 21 % and 45%, respectively (bacterial collagenase activity was also inhibited in vitro). These results indicate that TF placed into individual periodontal pockets could maintain a level of tetracycline in GCF that would effectively inhibit tissue (and perhaps also bacterial) collagenases at the lesion site.

The subgingival microbiologic compositionof diseased periodontal sites was evaluated by darkfield microscopy before and after scaling or local delivery of tetracycline. A standardized sampling and counting method using a crevicular washing technique was developed to determine both numbers and proportions of morphotypes using darkfield microscopy. Tetracycline‐loaded hollow fibers established an initial intrasulcular concentration of 200,000 μg/ml, which decreased exponentially to 15 μg/ml in 24 hours. Repetitive intrasulcular placement of these fibers at periodontitis sites produced an incremental reduction in bacterial counts over a 10‐day period. Monolithic fibers made of ethylene vinyl acetate loaded with 25% tetracycline hydrochloride provided sustained release for 10 days under in vitrotest conditions. Ten patients were treated in a study comparing the effects of these fibers with scaling. Fibers were placed subgingivally to fill pockets to their probable depth and covered with a periodontal dressing which was maintained for 10 days. The average intrasulcular tetracycline concentration measured at the end of the 10‐day period was 643 μg/ml. At these sites, total counts, spirochetes, motile rods and nonmotile rods were significantly reduced immediately following treatment. Total counts were depressed to levels near the detection limit of darkfield microscopy. In comparison, scaling produced much smaller alterations of darkfield counts which were not statistically significant.