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BACKGROUND Coronally advanced flap (CAF) has been considered as one of the most predictable and versatile root coverage procedures. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following CAF in the treatment of gingival recession (GR); and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 5, 10, and 20 years after surgery. METHODS Ninety-four patients with 97 GR (73 Miller`s Class I and 24 Miller's Class III) were treated with CAF in a private practice between 1984 and 1996. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1 year, 5 years, 10 years, 15 years and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study RESULTS: A total of 72 patients with 72 GR were available for analysis at the 20-year follow-up examination (final patients' dropout rate = 23.4%). Statistically significant improvements were found for RD in all evaluations (P

Periodontal regeneration can be defined as complete restoration of lost periodontal tissues to their original architecture and function. A variety of treatment modalities have been proposed to achieve it. Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors that promotes restoration of lost periodontal tissues. The objective of the present study is to assess the effect of PRGF associated with guided tissue regeneration (GTR) versus GTR only in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP).Patients with CP (n = 14) with 42 contralateral 2- and 3-walled defects were randomly assigned to test (PRGF+GTR) and control (GTR alone) treatment groups. Clinical and radiographic assessments performed at baseline and after 6 months were: 1) gingival index (GI), 2) probing depth (PD), 3) clinical attachment level (CAL), 4) radiologic defect depth, and 5) bone fill.Comparison of parameters measured at baseline and after 6 months showed mean PD reduction of 3.37 ± 1.62 mm in the control group (P0.001) and 4.13 ± 1.59 mm in the test group (P0.001). There was a significant difference in mean change in CAL (P0.001) in the control group (5.42 ± 1.99) and the test group (5.99 ± 1.77). Mean change in GI was 1.89 ± 0.32 and 1.68 ± 0.58 in the control group and test group, respectively, and the difference was statistically significant (P0.001). When compared between groups, clinical parameters did not show any statistically significant variations. Mean radiographic bone fill was 1.06 ± 0.81 and 1.0 ± 0.97 in the control group and test group, respectively. However, the difference was not statistically significant.PRGF with GTR, as well as GTR alone, was effective in improving clinical and radiographic parameters of patients with CP at the 6-month follow-up. There was no additive effect of PRGF when used along with GTR in the treatment of IBDs in patients with CP in terms of both clinical and radiologic outcomes.

Studies on periodontal wound healing have resulted in the development of the treatment modality known as "guided tissue regeneration" (GTR) based on a principle of guiding the proliferation of the various periodontal tissue components during healing following periodontal surgery. The first report of a human tooth treated according to the principle of GTR was presented 10 years ago by Nyman et al. Since then numerous clinical studies and animal experiments have been performed bringing the concept of GTR to a clinical reality. We also know that the results obtained through GTR therapy can be maintained on a long-term basis. The first generation of GTR devices has been non-resorbable, which calls for a second surgical procedure. This is avoided when bioresorbable devices become available. This paper suggests some demands regarding safety and efficacy criteria for both non-resorbable and bioresorbable devices. Results from recent animal experiments and clinical studies following the use of a bioresorbable device in GTR therapy are presented. J Periodontol 1993; 64:1157-1165.

Human dedifferentiated fat cells (HDFATs) may be a new cell type suitable for regenerative therapies. The aim of this study is to assess the potential of HDFATs for vascular regeneration of periodontal tissue. To do this, HDFATs and human gingival endothelial cells (HGECs) were cocultivated, and vascular regeneration was examined in vitro.HDFATs were isolated from subcutaneous adipose tissue, and HGECs were isolated from gingival cells using anti-cluster of differentiation 31 antibody-coated magnetic beads. HDFATs were cocultured with HGECs in microvascular endothelial cell growth medium-2 (EGM-2MV) for 7 days. Expression of endothelial cell (EC) markers, the formation of capillary-like tubes, and the expression of pericyte markers were determined.HDFATs, cultured in EGM-2MV or cocultured with HGECs, expressed EC markers. HDFATs in both conditions initiated tube formation within 5 hours of seeding and formed extensive capillary-like structures within 12 hours. These structures disintegrated within 24 hours when cells were cultured in EGM-2MV alone, whereas cocultured HDFATs maintained tubes for24 hours. Cocultured HDFATs significantly increased expression of pericyte markers, a cell type associated with microvasculature.HDFATs possess the ability to express EC markers, and coculture with HGECs promotes differentiation into pericytes involved in the maturation and stabilization of the microvasculature.

Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy.Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole-paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking-cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow-up was required for inclusion.Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta-analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) ≥3 mm during a 6-year period was approximately three times higher among smokers than quitters (P0.001). Two studies (10 and 20 years of follow-up) observed a decrease in radiographic bone loss of ≈30% among quitters when compared with smokers. Among individuals receiving non-surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P0.05) than non-quitters/oscillators. No differences in AL were observed.Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.

During the past two decades, dentists and microbiologists have relied on periodontal antibiotic therapy in the management of periodontitis. This association has accumulated and strengthened exponentially. Macrolides attain high therapeutic concentrations in infected tissue, so they are potentially a good choice for inhibiting invasive periodontal pathogens. Clarithromycin accumulates in phagocytes, monocytes, fibroblasts, polymorphonuclear cells, macrophages, and lymphocytes. These cells are more numerous at inflamed sites, so it is reasonable to expect clarithromycin levels to be higher in periodontally diseased sites. This study determines the distribution profile of clarithromycin in the gingiva of patients with periodontitis compared to serum after systemic administration of clarithromycin.Twenty patients (14 males and six females, aged 25 to 45 years) with chronic periodontitis were enrolled in the study. Gingival index and plaque index were recorded at baseline and 3 days after administration of 500 mg clarithromycin, twice daily, for 3 days. Intravenous blood and biopsy of periodontal tissue samples were taken on the third day. These samples were analyzed for detection of clarithromycin concentration using high-performance liquid chromatography.Approximately 6 hours after the last dose of clarithromycin, mean clarithromycin concentrations in serum and periodontal tissue were 0.465 μg/mL and 2.61 μg/g, respectively, and the difference was statistically significant.Clarithromycin can attain higher levels in gingiva than serum of patients with periodontitis. This distribution profile of clarithromycin can thus be advantageous in the management of periodontal lesions.

Background: The aim of the present study was to evaluate the clinical and histological healing of deep intrabony defects treated with guided tissue regeneration (GTR) with a collagen membrane from bovine pericardium and implantation of granular bovine bone biomaterial. Methods: Thirty patients with one deep combined 1- / 2 - wall intrabony defect exhibiting a probing depth ≥ 6 mm and an associated intrabony defect ≥ 3 mm were treated with GTR with a bioresorbable collagen membrane from bovine pericardium and adjunct implantation of a granular bovine bone biomaterial. The clinical results were evaluated 1- and 3-years following surgery. In addition, five teeth fulfilling the inclusion criteria but scheduled for extraction due to advanced periodontitis and/or restorative considerations were treated similarly and then extracted along with a potion of their surrounding periodontal tissues for histological evaluation six months after surgery. Results: Healing was uneventful in all patients. Significant clinical improvements were observed at 1- and 3 years post operatively (p

Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm. Methods: Fifty-four periodontally healthy patients were assigned as follows: group 1 (N = 18), root exposure (RE) without non-carious cervical lesions (NCCL) treated with coronally positioned flap (CPF); group 2 (N = 18), RE with NCCL treated RMGI restorations plus CPF; group 3 (N = 18), RE with NCCL treated with MC restorations plus CPF. Probing depth (PD), visible local plaque score (PL), and local bleeding on probing (BOP) were assessed at baseline and 6 months after surgeries. Restored and non-restored root recoverage (RR) was assessed at 6 months. Each experimental tooth was subgingivally sampled (baseline and 6 months) and analyzed by checkerboard DNA-DNA hybridization. Results: Clinical results showed no significant differences among the groups regarding PL, BOP, and PD at baseline and 6 months. The RR means were similar among the groups at 6 months. Intragroup analyses revealed that the proportions of 10 periodontopathogens decreased at 6 months for the control group. For the RMGI group, there was a significant decrease in the proportions of nine periodontopathogens. For the MC group, there was a significant increase in the proportions of Fusobacterium nucleatum polymorphum and Gemella morbillorum and a decrease in five periodontopathogens. Intergroup analyses showed an increase in the proportion of F. nucleatum polymorphum for the MC group. Conclusions: In a 6-month evaluation, well-finished RMGI or MC subgingival restorations did not negatively affect periodontal health. Furthermore, RMGI seems to exert more positive effects on the subgingival biofilm composition than MC. J Periodontol 2007;78:1522-1528.

Guided tissue regeneration (GTR) is an accepted approach in the correction of periodontal bone loss. Nonetheless, the deficiencies of commonly applied absorbable membrane, such as flexibility and limited osteoconductive and osteoinductive capability, still leave much room for improvement. Thus, the feasibility of applying demineralized dentin tissue to improve the therapeutic effect of GTR in periodontal regeneration was explored.Demineralized dentin was harvested after acid treatment, and its physiochemical properties were assessed in terms of mineralization density, contact angle, three-point test, and cell attachment. Because of its similar characteristics with bone tissue, dentin that had been acid-treated for 6 hours was chosen to repair a periodontal defect using an induced-periodontitis canine model. Histologic measurements were taken to compare its therapeutic effects to an absorbable membrane group and an untreated group.The demineralized dentin displayed continually decreased hardness and density as the acid etching time was prolonged. Enhanced attachment and spreading of bone marrow mesenchymal stem cells were observed on the 6-hour processed dentin. Furthermore, in the demineralized dentin group, more periodontal tissues were newly formed compared with the biomembrane and untreated groups.Acid etching represents an easy and promising approach to obtain demineralized dentin with desirable properties, similar to bone, for clinical application to promote periodontal tissue regeneration.

Previous surgical crown lengthening studies have investigated positional changes of the free gingival margin but not the biological width. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biological width. However, very little work has been done in humans. Therefore, the purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown lengthening in human subjects.Twenty-three (23) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent teeth with adjacent and non-adjacent sites: plaque and gingival indexes, free gingival margin, probing depth, attachment level, bone level, direct bone level, and biological width. During surgery, the bone level was reduced based on the future prosthetic margin and predetermined biological width; flaps were placed at the bony crest. Patients were examined at baseline and at 3 and 6 months postoperatively.Eighteen patients completed the study. Overall, the amount of bone resected was 1 to 5 mm. At 90% of treated sites,or = 3 mm of bone was removed. At 3 months, the apical displacement of the free gingival margin at non-adjacent, adjacent, and treated sites was 2.46 +/- 0.25 mm, 2.68 +/- 0.20 mm, and 3.07 +/- 0.16 mm, respectively. There was no significant change in the position of the free gingival margin from 3 to 6 months. The biological width at all sites was smaller at 3 and 6 months compared to baseline (P0.05) except for the treated sites, which were not significantly different from baseline at 6 months.During surgical crown lengthening, the bone level was lowered for placement of the prosthetic margin and reestablishment of the biological width. The biological width, at treated sites, was reestablished to its original vertical dimension by 6 months. In addition, a consistent 3 mm gain of coronal tooth structure was observed at the 3- and 6-month examinations.

Regeneration of periodontal tissues requires orchestration of several cell types. Two cell types, gingival fibroblastic cells (gingival fibroblasts) and cells from the periodontal ligament (PDL cells), were studied to compare the effects of supplemental addition of TGF-beta 1 and PDGF on proliferation. Cells obtained from healthy donors were cultured in 10% FBS supplemented with either 10 ng/ml TGF-beta 1, 20 ng/ml PDGF, or both. Thymidine incorporation was measured after 24, 48, or 72 hours. Data from PDL (analyzed by ANOVA) showed the following relations: at 24 hours TGF beta 1/PDGF = PDGFTGF-beta 1 = control; at 48 hours TGF beta 1/PDGFTGF-beta 1PDGFcontrol; at 72 hours TGF beta 1/PDGFTGF-beta 1PDGF = control. Gingival fibroblast cultures showed the following relations: at 24 and 48 hours TGF beta 1/PDGF = PDGFTGF-beta 1 = control; at 72 hours, TGF beta 1/PDGF = PDGFcontrol with TGF beta 1 not different from control or factor combinations. Both TGF-beta 1 and TGF-beta 1/PDGF showed a significantly greater increase in proliferation of PDL cells than in gingival fibroblasts at 48 and 72 hours (Student t test P0.05). In contrast, PDGF stimulated proliferation of gingival fibroblasts was significantly greater than PDL cells at 72 hours (P0.05). Thus, supplementation of complete cultures (containing 10% FBS) with TGF-beta 1 alone or combined with PDGF stimulates proliferation of PDL cells to a significantly greater extent than proliferation of gingival fibroblasts.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal pathogenic microorganisms produce volatile sulfur compounds (VSCs), such as hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. VSCs are toxic to periodontal tissue. Therefore, there is a relationship between periodontitis and the VSC level of mouth air. However, the association between VSC and periodontal disease progression has not been investigated in a longitudinal study. The purpose of this study is to evaluate the association between VSCs in mouth air and periodontal disease progression among elderly dentulous non-smokers.Two hundred forty-one dentulous non-smokers (103 males and 138 females; all 70 years old) had their VSC levels examined with a portable sulfide monitor, and their periodontal status was assessed. Periodontal examinations were performed at baseline and once a year for 3 years to investigate the clinical attachment levels of all teeth. Participants were classified by membership in tertile groups (lowest, middle, and highest) according to the value of baseline VSC measurements.In negative binomial regression analysis, the number of teeth with periodontal disease progression for participants in the highest tertile of VSC measurement was greater (incidence rate ratio of 1.33, P = 0.011) than for the reference group (lowest tertile of VSC measurement) after simultaneously adjusting for sex, number of remaining teeth, and maximum clinical attachment level.VSC measurements were significantly associated with periodontal disease progression in a non-smoking dentulous elderly population. This suggests that VSC measurements are useful for the diagnosis of periodontal disease progression.

Background: Among the newly emerging diagnostic approaches for periodontitis, optical spectroscopy is a promising complementary diagnostic tool. The objective of this study is to verify the reproducibility of this method at a geographically distinct location (Suzhou, China) to a broader patient population using similar instrumentation to that in a previous report. Methods: Using a portable optical near-infrared spectrometer, optical spectra were obtained, processed, and evaluated from healthy (n = 62), gingivitis (n = 98), and periodontitis (n = 47) sites from a total of 51 patients. A modified Beer-Lambert unmixing model that incorporates a non-parametric scattering loss function was used to determine the relative contribution of oxyhemoglobin and deoxyhemoglobin to the overall spectrum. The balance between tissue oxygen delivery and oxygen use in periodontal tissues was then assessed. Results: Tissue oxygenation decreased significantly from healthy sites to sites with gingivitis (P

This split-mouth, single-masked, randomized, controlled clinical trial compares the short-term outcomes of a combined treatment with scaling and root planing (SRP) and neodymium-doped:yttrium, aluminum, and garnet (Nd:YAG)-laser irradiation with treatment with SRP alone.Thirty patients were recruited. The mandibular left or right side was randomly assigned as the test side (SRP with laser treatment) or control side (SRP alone). The water-cooled Nd:YAG laser was used at 4 W, 80 mJ/pulse, 50 Hz, and with a pulse width of 350 micros. At baseline, gingival crevicular fluid (GCF) samples were taken from the test and control sides, and levels of matrix metalloproteinase (MMP)-8 and interleukin (IL)-1beta, -4, -6, and -8 were measured using standard techniques. The plaque index (PI), gingival index (GI), and probing depth (PD) were measured by calibrated examiners.At the 1-week follow-up, PD (P0.001), PI (P0.05), and GCF volume (P0.001) showed significant improvement on test sides compared to control sides. At the 3-month follow-up, PD (P0.01), PI (P0.01), GI (P0.01), and GCF volume (P0.05) also showed significant improvement on test sides compared to control sides. At the 1-week follow up, IL-1beta and MMP-8 levels were significantly reduced on test sides compared to control sides. The 3-month follow-up confirmed that the improvements on test sites had been sustained compared to the treatment outcomes of control sites.In the short-term, SRP in combination with a single application of a water-cooled Nd:YAG laser significantly improves clinical signs associated with periodontal inflammation compared to treatment with SRP alone.

For decades there has been an ongoing search for clinically acceptable methods for the accurate, non-invasive diagnosis and prognosis of periodontitis. There are several well-known inherent drawbacks with current clinical procedures. The purpose of this review is to summarize some of the newly emerging diagnostic approaches, namely, infrared spectroscopy, optical coherence tomography (OCT), and ultrasound. The history and attractive features of these new approaches are briefly illustrated, and the interesting and significant inventions related to dental applications are discussed. The particularly attractive aspects for the dental community are that some of these methods are totally non-invasive, do not impose any discomforts to the patients during the procedure, and require no tissue to be extracted. For instance, multiple inflammatory indices withdrawn from near infrared spectra have the potential to identify early signs of inflammation leading to tissue breakdown. Morphologically, some other non-invasive imaging modalities, such as OCT and ultrasound, could be employed to accurately measure probing depths and assess the status of periodontal attachment, the front-line of disease progression. Given that these methods reflect a completely different assessment of periodontal inflammation, if clinically validated, these methods could either replace traditional clinical examinations for the diagnosis of periodontitis or at least serve as attractive complementary diagnostic tools. However, the potential of these techniques should be interpreted more cautiously given the multifactorial character of periodontal disease. In addition to these novel tools in the field of periodontal inflammatory diseases, other alternative modalities like microbiologic and genetic approaches are only briefly mentioned in this review because they have been thoroughly discussed in other comprehensive reviews.

This review discusses the rationale for using guided tissue regeneration therapy. The review not only attempts to clarify the concept of selective tissue regeneration using non-resorbable and resorbable barriers, but to discuss differences in healing events after treatment with the two types of barriers together with their significance in periodontal therapy. At present, barrier membranes have potential clinical use in promoting periodontal tissue regeneration if patients to be so treated are selected appropriately. Research is still necessary to determine the critical period for guiding the ingrowth of new attachment forming cells and also to further clarify the concept of GTR involving the "wrong cell type" which inhibits periodontal tissue regeneration.

Some scientists say, ‘‘Forget about bacteria; treat, or even better yet, prevent inflammation.’’ We understand that periodontal diseases originate as bacterial assaults, but some two-thirds of the destruction comes from the inflammatory response to the bacterial invasion. There is growing evidence that inflammation can be transferred from the oral cavity to other parts of the body (and vice versa), explaining the possible association between periodontitis and other chronic inflammatory conditions. As a clinician, I find this intellectually interesting, but when I ask myself whether or not this shift from an infection model to an inflammation model changes the way I treat my patients, the answer is, ‘‘not really.’’ But should it? Have I been so busy in my daily practice that I missed something important? Although I may not understand inflammation on the molecular level, I do know when my patients have inflammation, and when I do what I have been trained to do as a diagnostician and a clinician to eliminate it, most of my patients end up with a good clinical outcome. My job as a clinician is to translate what is going on in research and incorporate it into my practice to provide the best possible patient care. What I offer you in this commentary are the results of my journey to discover how or if our new emphasis on inflammation should affect how I care for my patients. My conclusion at this time is that I should err on the side of aggressive control of periodontal inflammation, since, until proven otherwise, the consequences of undertreatment could be more than the loss of a few teeth. It is your job to decide how this information influences the treatment of your patients. J Periodontol 2008;79:20162020.

Mechanoreceptors situated in the periodontal ligament provide detailed information about intensive and spatial aspects of tooth loads, which support the neural control of masticatory forces. We asked whether a reduced periodontal ligament due to periodontitis, and, thus, an altered mechanoreceptive innervation of the teeth, would affect masticatory behavior when subjects used incisors to hold and split food.We tested 11 subjects with reduced periodontal tissue support that rendered 30% to 70% alveolar bone loss for at least one pair of opposing anterior incisors. Forces were recorded when subjects used their affected incisors to hold half of a peanut for approximately 4 seconds and then split it. Age- and gender-matched healthy subjects served as the control group. None of the participants showed acute oral symptoms or massive periodontal inflammation.The test group used greater force when holding food between the teeth (1.1+/-0.4 N [ mean+/-1 SD]) compared to the control group (0.4+/-0.2 N). Hold forces used by subjects in the test group were also more variable, both within and between trials. The increase in bite force applied to split the peanut was slower and more hesitant for subjects in the test group compared to the control group.Reduced periodontal tissue support accompanies impaired regulation of masticatory forces. Faulty mechanoreceptive innervation of the periodontal ligament explains the elevated hold force, whereas a change in biting strategy due to the weakened support of the teeth may account for the more defensive food-splitting behavior.

During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress is an acute inflammatory one. This study uses a longitudinal design to examine lactate dehydrogenase (LDH) activity in gingival crevicular fluid (GCF) to determine if GCF LDH can be used as a diagnostic aid in monitoring tooth movement and tissue response during orthodontic treatment.Seventeen patients (mean age: 16.1 years) participated in the study. Each patient was undergoing treatment for distal movement, and an upper first molar served as the test tooth (TT), while the contralateral (CT) and antagonist (AT) teeth were used as controls. The CT was included in the orthodontic appliance, but was not subjected to the distal movement; the AT was free from any orthodontic appliance. The GCF around the experimental teeth was harvested from both mesial and distal tooth sites immediately before appliance activation, and on days 7, 14, and 21. Clinical gingival conditions were also recorded.Gingival crevicular fluid LDH activity was significantly elevated in all sites of the TT and CT, as compared to the AT, where LDH activity remained at the baseline level throughout the study. Enzyme activity levels were also greater in the TT than in the CT, and in the compression sites.Our results suggest that GCF LDH levels reflect the biological activity that takes place in the periodontium during orthodontic movement, and therefore they can be used as a diagnostic tool for monitoring for correct orthodontic tooth movement in clinical practice.

Attempts to stimulate periodontal regeneration in the past have focused on either filling the defect with some type of material or providing a space for host cells to repopulate the site and elicit new tissue. In some cases, these approaches have been combined with the assumption that the filler material will help maintain the space necessary for the host cells to invade the area. Growth stimulating substances such as growth factors and other proteins have also been used to encourage periodontal tissue regeneration and histological evaluation supports the use of these substances. Thus, the role for and the necessity of a certain amount of space maintenance for periodontal regeneration is not exactly understood. In addition, it is not known if there is some critical size required for space maintenance or for exactly how long the space must be maintained in order for the host cells to stimulate new cementum, periodontal ligament, and bone. The goal of this study was to evaluate periodontal regeneration in intrabony defects of various sizes treated with a combination of enamel matrix proteins and autogenous bone graft.Periodontal defects ranging in size from 1 to 6 mm were randomized and created bilaterally beside three teeth in the mandibles of baboons. Plaque was allowed to accumulate around wire ligatures placed into the defects. After 2 months, the wire ligatures were removed, the teeth and roots scaled and root planed, and a notch was placed with a chisel at the base of the defect. On one side of the mandible, neutral ethylene diamine tetracetic acid and enamel matrix derivative (EMD) were first used to treat the defect. Autogenous bone taken from the same surgical site was treated with enamel matrix derivative in a dampen dish and then added to the EMD-treated defects. The other side of the mandible served as control with neutral ethylene diamine tetracetic acid and scaling and root planing. Flaps were sutured and the animals were allowed to heal without oral hygiene procedures. After 5 months, the animals were sacrificed and the teeth were processed for histological evaluation.The results revealed new cementum, periodontal ligament with Sharpey's fibers, and new bone tissue similar to native periodontal tissues. Remnants of the autogenous bone chips were still present at this 5-month post-healing period. Thus periodontal regeneration occurred in all sizes of the periodontal defects. In general, EMD plus autogenous graft treatment resulted in greater tissue formation than controls. In fact, in many cases, very dramatic tissue formation occurred far coronal to the base of the defects in the EMD plus autogenous graft-treated lesions. In addition, horizontal bone fill occurred in the defects and was prominent in the 4 or 6 mm wide lesions. When evaluating the combined 1 and 2 mm defects, the height of new cementum with EMD plus graft was 3.88 mm versus 2.03 mm in the controls, a statistically significant (P0.005) difference. In the wider (4 and 6 mm) lesions, this difference was not significant and was much less between treated and control lesions with 2.78 and 2.57 mm of new cementum respectively. In the case of new bone height, in the smaller lesions EMD plus graft resulted in 4.00 mm new bone versus 2.22 mm in the controls, again a statistically significant (P0.005) difference. In the larger lesions, EMD plus autogenous bone graft had 3.24 mm new bone height compared to 2.71 mm in the controls, a difference that was not statistically significant. Additionally, in the smaller lesions, new cementum width at the level of the notch was twice as great (statistically significant, P0.015) in the EMD plus graft sites compared to control. The width of the periodontal ligament at the coronal aspect of the new bone tissue was similar in the smaller lesions between treated and control sites. The results from the wider defects must be interpreted cautiously as the interproximal bone heights were remodeled adjacent to the wider defects and likely limited the potential for regeneration.The combination of enamel matrix derivative plus autogenous bone graft stimulated statistically significant periodontal regeneration in the more narrow 1 and 2 mm lesions. No statistically significant difference was observed in the wider 4 and 6 mm lesions. In many cases, dramatic amounts of new cementum, Sharpey's fibers, periodontal ligament, and bone tissue were formed far above the notch placed at the base of the contaminated defects. This was especially significant considering the width of some of the defects and the fact that no oral hygiene was performed over the 5-month healing period. This periodontal regeneration occurred in the absence of exogenous growth factors or barrier membranes. In summary, the combination of enamel matrix derivative and autogenous bone represents a therapeutic combination that can be highly effective in stimulating significant amounts of periodontal regeneration.

Non-steroidal anti-inflammatory drugs and antibiotics are important in the prevention of infections and pain associated with periodontal surgery as well as in the adjunctive therapy of periodontal disease. In this study, patients undergoing oral surgery were treated with piroxicam and azithromycin to examine the interactions of these drugs on periodontal tissues.Sixty-six patients were assigned to 3 groups and treated for 3 days as follows: 1) piroxicam 20 mg/day; 2) azithromycin 500 mg/day; or 3) piroxicam 20 mg/day plus azithromycin 500 mg/day. Samples of blood, saliva, gingiva, and alveolar bone were collected during surgery and at days 0.5, 2.5, 4.5, and 6.5 after last dose. Piroxicam concentrations were assayed by high-performance liquid chromatography and azithromycin concentrations by microbiological assay.In patients treated with piroxicam alone, the highest drug concentrations were found in plasma at each time point, but consistent piroxicam levels were also detected in gingival samples up to 4.5 days. The combined treatment with piroxicam plus azithromycin was associated with a reduction of piroxicam concentrations in periodontal tissues. In patients receiving azithromycin alone, high drug levels were measured in periodontal tissues up to 6.5 days. This distribution pattern did not vary in patients treated with piroxicam plus azithromycin.Treatment with piroxicam or azithromycin alone ensures a favorable distribution of these drugs into periodontal tissues. However, upon combined administration, azithromycin interferes negatively with the periodontal disposition of piroxicam. This interaction might depend on the displacement of piroxicam from acceptor sites at the level of periodontal tissues.

The various methods for regeneration of periodontal tissue that have been developed can be classified into guided tissue regeneration and bone implantation. Since the implantation materials have shown both deficiencies and merits, dentists have begun exploring the bioactive glass first used in plastic surgery. This paper examines the effectiveness of this new material on periodontal intrabony defects.Clinical effects of bioactive glass implantation in intrabony periodontal defects were evaluated 6 months after surgery in 38 intrabony defects from 38 patients with chronic periodontitis. Twenty-one experimental defects received bioactive glass implantation (test group), while 17 control defects were treated with a flap procedure only (control group). The criteria for comparative observation were preoperative and postoperative probing depth (PD), clinical attachment level (CAL), bone probing depth (BPD), and gingival recession.Reductions in PD were observed in both groups (P0.01). The reduction in PD was significantly greater in the test group when preoperative PD exceeded 7 mm (P0.01). Improvements in CAL were also observed in both groups (P0.01), with the test group showing significantly greater gains (P0.05). In those cases where preoperative CAL was less than 7 mm, there was no statistically significant difference between the two groups. Reduction in BPD was observed in both groups, with the test group showing significantly greater reduction (P0.01). There was no significant difference in BPD change, however, when preoperative BPD wasor =7 mm. Significantly greater reduction of BPD in the test group was observed when intrabony defect depth was4 mm (P0.05). Significant improvements in PD, CAL, and BPD were noted in the test group when the crestal involvement exceeded 100 degrees. Correlation test between various clinical parameters indicated that greater changes in PD and CAL in the test group were observed when preoperative CAL was large (P0.001), and greater changes in PD (P0.05), CAL (P0.01), and BPD (P0.05) were noted when preoperative BPD was large. Correlation between crestal involvement and CAL change was noted only in the control group (P0.01). High correlations were observed between PD changes and CAL changes and between CAL changes and BPD changes in both groups.Use of a bone substitute in a flap operation resulted in significantly greater improvements in CAL and BPD over flap operation alone and seemed to have positive effects in postoperative PD, CAL, and BPD in those cases with more severe preoperative CAL and BPD.

Aspartate aminotransferase (AST), an enzyme released from necrotic cells, has been identified in gingival crevicular fluid (GCF), and elevated levels are associated with periodontal tissue destruction. The aim of this study was to examine the relationship between elevated GCF levels of AST and periodontal disease progression.Over a 12-month period, 8 to 10 interproximal sites in 41 periodontitis subjects (PS) and 15 healthy subjects (HS) were monitored. Clinical measurements included relative attachment level (RAL), probing depth, and bleeding on probing (BOP). Semiquantitative levels of GCF AST (800 microIU,or = 800 microIU, andor = 1,200 microIU) were determined using a chairside assay. At the 6- and 12-month visits, scaling and root planing and prophylaxis were performed in the PS and HS, respectively. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for 2 diagnostic criteria (ASTor = 800 microIU, ASTor = 1,200 microIU) utilizing 4 thresholds of disease progression as determined by 2 methods (absolute change in relative attachment level and cumulative sum [CUSUM]).The percentage of sites exhibiting ASTor = 800 microIU, ASTor = 1,200 microIU, and BOP in the PS was significantly (P0.02) lower at 6 and 12 months compared to baseline. The use of crevicular AST activity to monitor periodontal disease progression was associated with many false-positive results. Overall, low specificities, PPV, and odds ratios were demonstrated by the assay when using 2 diagnostic criteria and 4 thresholds of disease progression. The high NPV suggest that a negative AST test result was indicative of a periodontally stable site.These results demonstrate that elevated levels of AST were present at sites that did not subsequently exhibit disease progression. The high prevalence of AST-positive sites due to gingival inflammation diminished the test's ability to discriminate between progressive and stable, but inflamed, sites.

The ability to objectively assess periodontal disease activity can significantly affect periodontal therapy. Aspartate aminotransferase (AST) is released extracellularly upon tissue destruction which suggests its potential as a key index in a quantitative assay for evaluating periodontal disease activity. The purpose of the present research was to assess the origin of AST in gingival crevicular fluid (GCF) in vitro. An experimental kit was used for the measurement of AST level in human gingival epithelial cells (HGEs), human gingival fibroblasts (HGFs), human periodontal ligament fibroblasts (HPLFs), polymorphonuclear leukocytes (PMNs), and plasma in peripheral blood. AST activity levels were observed in all of the periodontally derived cells, PMNs, and plasma. A significantly high level of AST activity was observed in HGEs (104.93 +/- 8.13 KU/1000 cells). The level of AST activity in HPLFs was 18.09 +/- 3.73 KU/1000 cells. AST activity in PMNs was significantly low, approximately 2% of that observed in HPLFs. These findings may suggest that AST level in GCF is correlated with the destruction of periodontal tissue.

This paper describes a case of benign mucous membrane pemphigoid which affected the periodontal tissues and complicated ocular prosthesis placement. The clinical findings, diagnostic criteria, and therapeutic management of this disorder are reviewed.

The concentration of interleukin-1β is elevated in inflamed gingival tissue. Therefore a method for the measurement of interleukin-1β (Il-1β) in gingival crevicular fluid (GCF) using a commercially available Il-1β ELISA was developed. GCF was collected with periopaper strips and 4 protocols of sampling using filter paper strips were tested; the method with a recovery rate of 111.9% (SD: ± 14.5%) was chosen for subsequent analysis of all samples. Il-1β concentration in GCF of periodontitis patients and a healthy control group was determined. Patients (n = 19, mean age: 29.3 years) had not been treated. The healthy control group (n = 14, mean age: 22.8 years) showed, after a hygiene regimen of 2 weeks, no clinical signs of gingival/periodontal inflammation. Probing depth, clinical attachment level, bleeding upon probing, and a modified plaque index were recorded. Il-1β could be detected in all GCF samples. The concentration ranged between 22.8 ng/ml and 150 ng/ml in the healthy control group and between 85.8 ng/ml and 882.2 ng/ml in the periodontitis patients. No sex-related differences were noted. According to our present results the determination of GCF Il-1β concentration is possible using commercially available test kits if the principle of sample preparation is adapted to the specific requirements of GCF analysis. J Periodontol 1994; 65:423-428.

The established correlation between diabetes and periodontal diseases and the increasing prevalence of Type II diabetes in the general population indicate that dental practitioners will probably treat an increasing number of diabetic patients. Despite the fact that there is little scientific evidence to support the concept, it has been generally accepted that treatment for periodontal disease in diabetic patients may reduce insulin requirements and improve metabolic balance. However, to date no one has evaluated the effects of periodontal therapy on the metabolic state of the poorly-controlled diabetic patient. The purpose of this pilot study was to evaluate the effect of controlling gingival inflammation on blood glucose levels as determined by glycosylation of hemoglobin and albumin.

A group of cases is presented in which dramatic repair and regeneration of periodontal tissues lost as a result of periodontitis have occurred following systemic administration of tetracycline either alone or in combination with other forms of periodontal therapy. The nature and extent of regeneration demonstrated in these patients appears to be more dramatic than what has been shown previously when more conventional forms of periodontal therapy were utilized, even including bone grafting and guided tissue regeneration. The type of repair described has been shown in many instances to be long standing and is probably not totally related to the antibacterial characteristics of tetracycline. It is suggested that the ability of this drug to inhibit collagenolytic enzymes (collagenases) may have influenced the favorable clinical results achieved. The anti-collagenolytic properties of tetracycline are being considered with increasing frequency in the treatment of other systemic diseases characterized by collagen breakdown such as corneal ulcers, rheumatoid arthritis, diabetes, and dystrophic epidermolysis bullosa. Given the highly collagenous nature of the tissues of the periodontium, this report suggests that tetracycline could be of considerable value in the treatment of some types of periodontitis.

Since plaque plays a major role in the development of periodontal inflammation, special attention is paid to its composition and quantity. Several indices have been designed for the quantification of the supragingival plaque. The aim of the present study was to compare the utility and discriminating power of five such plaque indices. In 14 subjects, three teeth were selected randomly on which the undisturbed plaque formation was studied over a period of 96 hours. This examination was performed twice, the first time after induction of gingivitis and a second time starting with a healthy gingiva. It is known that in the presence of gingival inflammation, the plaque growth rate slightly increases. Plaque formation was estimated at several visits with the following indices: Harrap index, Quigley and Hein index, Navy index modified by Clemmer and Barbano, Navy index modified by Hancock and Wirthlin, and a planimetrical plaque scoring system. The path of the plaque growth curve was found to depend on the selected plaque index, going from an exponential curve (planimetry) over an sigmoidal curve (Harrap index, Navy index modified by Hancock and Wirthlin) to a nearly linear relation (Quigley and Hein, Navy index modified by Clemmer and Barbano). By comparing the plaque scores on patients with healthy gingiva with those from patients with inflamed gingiva, it was found that the planimetrical plaque index had a clearly higher discriminating power. It was concluded that the choice of an index for the measurement of the plaque extension depends on the goals of the study.

Palatal groove is a rare morphological defect of upper incisors, frequently associated with localized destruction of periodontal tissue with endodontic complications. In this study, a sample of 1, 081 male, young adult subjects, aged 20 to 22, palatal grooving was recorded in 11 (1.01%) subjects, affecting 15 incisors. Among 634 adult subjects, aged 35 to 50, with periodontal disease, palatal groove was found in 5 (0.79%) incisors. Second incisors were more frequently (75%) associated with this anomaly. In the young adults, the mean probing pocket depth in the groove region and around other teeth of the intercanine area was 3.8 mm and 1.2 mm, respectively. In the group of periodontal patients, the mean probing pocket depth was significantly greater at the site of palatal groove (8.8 mm vs. 4.0 mm).

Although the chemotaxis and efflux of functionally normal polymorphonuclear leukocytes (PMN) into the periodontal sulcus may have a protective role in periodontitis, these cells are also associated with periodontal tissue destruction. The immunomodulating agent, levamisole hydrochloride, is known to enhance PMN chemotaxis. The present study was designed to evaluate the effects of enhanced PMN chemotaxis on the tissue destruction associated with an experimental periodontitis. Levamisole was administered by oro-gastric intubation to 4 squirrel monkeys (experimental) at 3 mg/kg/bw every 2 days for 18 days. After 2 doses of levamisole, marginal periodontitis was induced around maxillary and mandibular bicuspids and the maxillary first molars by tying plaque-retentive ligatures at the gingival margins. Periodontitis was induced around corresponding teeth in 4 animals (control) which had not received levamisole. All animals were killed 2 weeks after induction of periodontitis. Clinically, gingival inflammation was more pronounced in experimental animals at both 7 and 14 days after periodontitis induction. The progression of periodontitis was evaluated histometrically and alterations in the cell populations characterized using step serial sections. The results were analyzed statistically. No significant differences were observed between the groups with respect to areas of infiltrated supracrestal connective tissue and total numbers of cells present, loss of connective tissue attachment and loss of coronal alveolar bone. However, in experimental specimens, a much denser band of inflammatory cells was evident between the apical extent of the bacterial plaque and the gingival sulcular tissues the connective tissue of which contained significantly fewer inflammatory cells and demonstrated more pronounced fibrogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence and distribution of gingivitis and gingival recession were studied in 820 Nigerians aged 15, 19, 20 and 21 years sampled from Lagos educational establishments. The prevalence of gingivitis was relatively high at all ages. There was a high degree of correlation between the prevalence of gingivitis affecting mouths, papillae and margins. It therefore would appear that in those mouths with gingivitis, the proportion of affected papillae or margins to those not affected varies only within narrow limits. Although the peak prevalance of gingivitis was observed in the 15-year olds, the prevalence of gingival recession was higher in the 21-year-old students than in those aged 15 years. Gingival recession may be a sequel of gingivitis resulting from apical proliferation of the epithelial attachment with destruction of the subjacent periodontal tissues. Hence gingivitis should be distinguished from gingival recession in its prevalence and distribution.

In recent years evidence in the literature has indicated that the immune response may play an important role in the initiation and progression of the periodontal diseases. A study was initiated to determine the IgA, IgG, and IgM concentrations in the granulation tissue removed from deep infrabony pockets of patients with periodontosis and advanced periodontitis. Comparison of mean immunoglobulin levels between the periodontosis and periodontitis groups revealed a statistically significant increase (P less than 0.05) for IgG in the granulation tissue from the periodontosis group. The possible implications of these findings are discussed.

A case with a facially positioned, unerupted maxillary incisor is presented as an illustration of the potential of the periodontal tissues to establish a zone of gingiva following surgical intervention. Despite the fact that the tooth had an erupting position entirely within the area of the alveolar mucosa, a zone of keratinized gingiva developed following surgical exposure of the crown of the tooth. This healing potential should be considered when selecting the treatment for facially positioned, unerupted teeth.

Extracts of corn and some nuts were found to ubiquitously stimulate both adult and newborn cord blood lymphocytes to transform and produce a factor chemotactic for monocytes. This indicates that corn and nuts contain a mitogen and are potential stimulators of the cellular immune response. The exposure of lymphocytes to this mitogen in vivo might trigger a destructive inflammatory reaction in the surrounding tissues. These findings, therefore, suggest that foods such as corn and nuts may be responsible for some periodontal abscesses and may be contributing factors to the development of intrabony alveolar lesions and chronic periodontitis.

1. Gingival fluid from severely inflamed periodontal tissue represents a 15 to 30% dilution of serum with respect to the proteins studied, with the exception of C3 and in some subjects, C4. 2. A marked decrease in C3 levels is found in most, if not all, gingival fluids, and a marked decrease of C4 levels is found in some gingival fluids. This suggests that complement might be activated during periodontal inflammation. 3. The concentrations of proteins in the gingival fluid are not related to their molecular weight.

THIS STUDY investigated the relationship between the degree of periodontal destruction present in advanced periodontal lesions and consistently associated infiltrates of lymphocytes and/or plasma cells. A total of 385 biopsy specimens were obtained from the depths of pockets during routine periodontal surgery. The selected lesions were in "established" or "advanced" stages and were classified according to pocket depth as Class I (4-6 mm) or Class II (7-10 mm). The infiltrates attached to the cementum, bone, or lining the pocket soft tissue wall were classified in five types according to the distribution of lymphocytes, plasmocytes, and neutrophils. Statistical evaluation of the findings demonstrates a strong, significant relationship (P less than 0.001) between the degree of destruction of supporting periodontal tissues (Class II) and the predominance of plasma cells in the infiltrate (Type a). A weaker significant correlation (P less than 0.02) was found between predominant lymphocytic populations (Type b) and Class I lesions. The assumption was made that local, specific, cellular infiltrates reflecting immunologic mechanisms are associated with the degree of periodontal destruction in humans.

Durapatite particles were employed along with autogenous bone chips to treat an extensive periodontal defect on a mandibular first molar which involved the bifurcation area and the distal root. Nine weeks after treatment the tooth was found to be cracked and was extracted along with tissue containing the grafted sites. The histologic specimen demonstrated that the ceramic graft particles were compatible with the periodontal tissues and showed no evidence of rejection or extrusion. They appeared completely encapsulated by connective tissue fibers while active osteogenesis was noted on the bone fragments implanted with them. Cementogenesis and connective tissue attachment to the root were seen adjacent to the durapatite particles. This healing was believed to be related to the earlier surgical denudation of this portion of the root during treatment and was unrelated to the placement of the graft.

This report reviews the literature concerning the periodontal considerations involved in nonextraction management of impacted teeth. Further, it describes the clinical and radiographic features of periodontal tissue response to an 18-mm extrusion and 160 degree simultaneous rotation of a horizontally impacted maxillary central incisor in a 22-year-old female patient. Following surgical exposure of the unerupted incisor, an elastic thread traction was used to orthodontically move the tooth to the line of occlusion. Posttreatment evaluation of the periodontal and gingival response to a tooth movement of this complexity and magnitude was very favorable from the esthetic and functional aspects.

The aim of the present investigation in dogs was to analyze the effect on periodontal disease induced by a combination of ligatures and jiggling trauma, when the jiggling forces are eliminated. The experiment was performed in six dogs. On Day 0 a phase of periodontal tissue breakdown was initiated around the mandibular fourth premolars (4P; P4) by placing plaque retention ligatures around the necks of the teeth. The ligatures were changed once a month during a 90-day period. On Day 90 the ligatures were removed. On Day 0 trauma from occlusion (jiggling) was also produced in the 4P and P4 region. On Day 90 the jiggling trauma was removed from the 4P-region (test) while it was maintained in the P4-region (control). Tooth mobility measurements and radiographic examinations were carried out on experimental Days 0, 30, 60, 90, 180, and 360. One dog was sacrificed on Day 90 and the remaining five on day 360. Following sacrifice, tissue sections comprising 1M, 4P, 3P, P3, P4, M1 were obtained and subjected to microscopic analysis. Removal of the jiggling trauma from the test teeth resulted in a markedly decreased tooth mobility, but the loss of connective tissue attachment on Day 360 was similar in the test and control sites. This means that although the control teeth had an increased mobility and a widened periodontal ligament space, the height of the remaining periodontal tissue support was similar in the test and control tooth regions.

THE PERIODONTAL Disease Index is a clinician's modification of Russell's PI index for epidemiological surveys of periodontal disease. The PDI index is primarily concerned with an accurate assessment of the periodontal status of the individual person. Emphasis is placed on recording of the attachment level of the periodontal tissues relative to the C-E junction. Such accurate measurable assessments are essential for longitudinal studies of periodontal disease and as a scientific basis for clinical trials in Periodontology.