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In ANCA?associated vasculitis (AAV), the autoantigens proteinase 3 (PR3) and myeloperoxidase (MPO) are exclusively expressed by neutrophils and monocytes. Cathepsin C (CatC), which activates the proteolytic function of neutrophil serine proteases (NSPs), provides a potential novel treatment target by controlling NSPs in both human neutrophils and monocytes. The authors show that genetic deficiency of CatC in humans and pharmacologic inhibition of CatC in a human stem cell model effectively downregulate NSPs, including PR3. Consequently, these neutrophils showed a diminished activation response to PR3-ANCA but not to MPO-ANCA. Moreover, both genetic and pharmacologic NSP depletion resulted in less neutrophil-induced injury of glomerular microvascular endothelial cells. These findings may offer encouragement for pursuing clinical studies with adjunctive CatC inhibitor administration in patients with PR3-AAV.

Predictive models and assessment tools for disease susceptibility and progression are necessary to enhance personalized medicine. The aim of this study is to assess the predictive accuracy of using the 2018 classification to predict likelihood of tooth loss. A total of 134 patients were screened 10 years after periodontal therapy. Data were extracted from 82 patients’ records and periodontal diagnoses were assigned according to the 1999 and 2018 classifications at baseline, whereas patient‐ and tooth‐related parameters were documented at baseline and at reexamination. Statistical analysis included descriptive statistics, hurdle regression with a zero and count model as well as logistic regression. Significantly more teeth were lost during SPT in patients with Stage IV or Grade C (P< 0.05). Patients’ adherence seems to have an impact on the predictability of the 2018 classification (P< 0.001). In comparison, neither classification system alone (1999 vs 2018) showed a high predictive value for tooth loss (area under the curve [AUC] = 59.2% vs 58.2%). Class III and IV/Grade C of the 2018 classification of periodontal diseases show similar predictive accuracy for tooth loss as severe cases in the former classification. Patients adherence seems to influence the prognostic value of the classification.

Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth‐related factors affecting TL. Patients were re‐examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth‐related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model. Ninety‐seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P<0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P<0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth‐related prognostic factors (P<0.05). During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well‐established treatment concept. Well‐known tooth‐related prognostic factors were confirmed.

Evaluation of clinical long‐term results 20 years after connective tissue grafting (CTG) or guided tissue regeneration (GTR) using bioabsorbable barriers for root coverage therapy. Initially, 15 patients with 38 Miller Class I and II recession defects underwent CTG or GTR according to random assignment. At baseline, 3, 120 ± 12, and 240 ± 12 months after surgery, data on probing depth, clinical attachment level, recession depth and width, amount of keratinized tissue, and bleeding on probing were obtained. Additionally, patients’ smoking habits and participation in supportive periodontal therapy were investigated. Eight patients contributing 23 recessions were available at the 240 ± 12 months follow‐up. Three and 120 ± 12 months after therapy with CTG, significantly better root coverage was observed compared with baseline (3 months: 3.01 ± 1.74 mm; P= 0.003; 120 ± 12 months: 2.11 ± 1.86 mm; P< 0.024). GTR resulted in significantly better root coverage compared with baseline after 3 months (2.25 ± 1.89 mm; P< 0.012). Although there were no significant changes in the recession depth between 3 and 240 ± 12 months in both groups (CTG: P= 0.097; GTR: P= 0.190), 1.57 ± 2.12 mm (CTG) and 1.19 ± 2.31 mm (GTR) of the achieved coverage after 3 months were lost. CTG showed significantly better relative root coverage percentage than GTR after 3 (P= 0.026) and 120 (P= 0.038) months. This study failed to detect a significant difference in the stability of root coverage after 240 ± 12 months between CTG and GTR (P= 0.448) and patients’ assessments of their treatment outcomes (P= 0.503). Long‐term stability of root coverage and patient‐perceived esthetic outcomes failed to show significant differences between CTG and GTR at 20 years post‐surgery.

To assess oral health‐related quality of life (OHRQoL) after long‐term (20 years) periodontal treatment in patients with chronic periodontitis (ChP) and to compare it with the current clinical outcome and oral health status. Twenty years after therapy, 63 patients were reexamined. The dental and periodontal status and OHRQoL using the Oral Health Impact Profile‐G49 (OHIP‐G49) were assessed. Descriptive statistics, correlation analysis, and tests for differences were calculated. Up to 75% of patients showed no probing depths > 5mm, bleeding on probing (BOP) ≤25%, no pain and satisfactory function. A comparatively low perceived oral impact of ChP was represented by an OHIP‐G49 overall score of 18.89 ± 21.66. The most common reported impairment was physical pain followed by “functional limitation.” A correlation between oral quality standard and the OHIP‐G49 was limited to the physical pain subdomain. Satisfaction with oral status was perceived high by most patients treated for chronic periodontitis. A comparably high OHRQoL can be achieved and retained long‐term after periodontal treatment. The objective and subjective evaluation of oral health only correlated in the subscale “physical pain.”

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.

Background:This study aims to evaluate long‐term stability of attachment achieved in infrabony defects (IBDs) by regenerative treatment. Methods:All patients who had received regenerative treatment for at least one IBD between 2004 and 2010 were screened for this retrospective case series. If complete examinations (plaque/gingival index, probing depth [PD], vertical clinical attachment level [CAL‐V]) were available for patients at baseline and 12 months after surgery, they were invited for reexamination 60 ± 12 months after surgery. Reexamination involved testing for interleukin (IL)‐1 polymorphism and counting number of supportive periodontal treatment (SPT) visits. Forty‐one patients (24 males and 17 females; age, median: 62.0 years, lower/upper quartile: 49.8/68.3 years; six smokers, and 9 IL‐1 positive) were included for analysis, each contributing one IBD. Results:Regenerative therapy resulted in significant attachment gain after 1 (median: −3 mm, lower/upper quartile: −1.5/−4 mm; P<0.001) and 5 (median: −3 mm, lower/upper quartile: −1.9/4.5 mm; P<0.001) years. The study failed to detect median change of CAL‐V from 1 to 5 years after surgery (median: 0 mm; lower/upper quartile: −1/1.5 mm; P= 0.84). Multiple regression analysis identified that number of SPT visits is correlated with CAL‐V gain from 1 to 5 years after surgery. IL‐1 polymorphism and percentage of sites with PD >6 mm at 5‐year reexamination are correlated with CAL‐V loss from 1 to 5 years after surgery. Conclusions:CAL‐V achieved by regenerative therapy in IBDs may have retained stability over 5 years. Frequent SPT is associated with stability. IL‐1 polymorphism and generalized reinfection are associated with less stability.

Background:The collection of subgingival plaque samples with paper points is time‐consuming and accident‐sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control). Methods:In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens. Results:Detection frequency of Aggregatibacter actinomycetemcomitans(MT4/MSP: 42%/36%), Porphyromonas gingivalis(78%/66%), Tannerella forsythia(98%/84%), Treponema denticola(94%/74%), Parvimonas micra(86%/62%), Campylobacter rectus(90%/76%), Eubacterium nodatum(64%/30%), Prevotella intermedia(58%/54%), and Eikenella corrodens(90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum(100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophagaspecies (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum. Conclusions:There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatumshow statistically higher detection frequencies with MT4.

Oral bleeding is a frequently reported symptom of von Willebrand disease (VWD) and evaluated by several VWD bleeding scores. Gingival bleeding is also known to be a leading symptom of plaque-induced gingivitis and untreated periodontal disease. This study evaluates whether mild type 1 VWD is associated with an increased susceptibility to gingival bleeding. In this case–control study, 50 patients and 40 matched controls were periodontally examined, answered a questionnaire, and underwent professional teeth cleaning. Compared with the controls, the VWD patients more frequently reported periodontal symptoms, such as bleeding (34 vs. 20%, P = 0.141) and swelling (54 vs. 32.5%, P = 0.538) of the gingiva, and these patients had their teeth professionally cleaned less often (58 vs. 77.5%, P = 0.051). However, there was less gingival bleeding, as determined by the gingival bleeding index, in the VWD patients compared with the controls (10 vs. 12.2%, P = 0.047); the amount of bleeding on probing was similar between the VWD patients and the controls (17 vs. 17.2%, P = 0.723). Gingival bleeding in VWD patients may be triggered by gingival inflammation, but it is not a genuine symptom of mild type 1 VWD.

Genetic studies demonstrated the presence of risk alleles in the genes ANRILand CAMTA1VAMP3that are shared between coronary artery disease (CAD) and periodontitis. We aimed to identify further shared genetic risk factors to better understand conjoint disease mechanisms.

Background:This aim of this study is to compare regenerative therapy of infrabony defects with and without administration of post‐surgical systemic doxycycline (DOXY) 12 and 24 months after therapy. Methods:In each of 57 patients, one infrabony defect (depth ≥4 mm) was treated regeneratively using enamel matrix derivative at two centers (Frankfurt am Main and Heidelberg). By random assignment, patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Twelve and 24 months after surgery, clinical parameters (probing depths [PDs] and vertical clinical attachment level [CAL‐V]) and standardized radiographs were obtained. Missing data were managed according to the last observation carried forward. Results:Data of 57 patients (DOXY: 28; PLAC: 29) were analyzed (26 males and 31 females; mean age: 52 ± 10.2 years; 13 smokers). In both groups, significant (P<0.01) PD reduction (DOXY: 3.7 ± 2.2 mm; PLAC: 3.4 ± 1.7 mm), CAL‐V gain (DOXY: 2.7 ± 1.9 mm; PLAC: 3.0 ± 1.9 mm), and bone fill (DOXY: 1.6 ± 2.7 mm; PLAC: 1.8 ± 3.0 mm) were observed 24 months after surgery. However, the differences between both groups failed to be statistically significant (PD: P= 0.574; CAL‐V: P= 0.696; bone fill: P= 0.318). Conclusions:Systemic DOXY, 200 mg/day for 7 days, after regenerative therapy of infrabony defects did not result in better PD reduction, CAL‐V gain, or radiographic bone fill compared with PLAC 12 and 24 months after surgery, which may be attributable to low power and, thus, random chance.

Background:This case report describes the clinical and microbiologic long‐term outcome 5 years after periodontal therapy of two siblings diagnosed with Papillon‐Lefèvre syndrome (PLS) and tinea capitis. Methods:In 2005, two brothers diagnosed with PLS and tinea capitis began periodontal treatment. Both of them showed premature mobility of the primary dentition, markedly increased probing depths, and subgingival Aggregatibacter actinomycetemcomitans(previously Actinobacillus actinomycetemcomitans; Aa). Initial therapy consisted of scaling and root planing based on the concept of full‐mouth disinfection, extraction of periodontally hopeless deciduous teeth, and systemic antibiotics. Reevaluation of clinical parameters revealed a dramatic improvement. After that, the patients were enrolled in a stringent maintenance program. Microbiologic monitoring was performed 1 and 5 years after treatment. Results:Five years after initial treatment, the periodontal situation was stable in both patients. Residual deciduous teeth, with the exception of one tooth, could be retained and no further teeth were lost. Further disease progression on the previously involved teeth was controlled, and development of periodontitis on erupting teeth was prevented for a period of 5 years. Conclusions:Even periodontally affected deciduous teeth can be treated successfully in patients with PLS. Suppression of Aaand a stringent maintenance program are of high importance.

Aim: A comparison of the detection frequency and number of periodontal pathogens in patients with aggressive or generalized, severe chronic periodontitis using a gene‐probe analysis.

Background:Hemophilia A and B and von Willebrand disease (VWD) belong to the most frequent congenital coagulation disorders and are a significant problem in patients who require periodontal therapy or tooth extraction. These patients need specialist management because even minor invasive procedures can precipitate a prolonged bleeding episode. However, although dental care presents major challenges in these patients, only a few studies are available. Methods:In this case series, the comprehensive periodontal treatment of four patients with hemorrhagic disorders (VWD type I and mild hemophilia B) is described. There was a close collaboration between the periodontist and the hematologist: all patients were scheduled for premedication with desmopressin and other pharmaceuticals at the hematologist's office. After one session of scaling and root planing was performed in all patients, local agents such as tranexamic acid were used. In the course of periodontal therapy, access‐flap surgery was performed in one of the four patients. Results:Before treatment, the rates of probing depths (PDs) of 4 to 6 mm (20% to 57%) or ≥7 mm (2% to 20%) were high. Three months after treatment, the rates of PDs of 4 to 6 mm (5% to 42%) or ≥7 mm (0% to 2%) decreased significantly in all patients. Attachment gains were also observed. A secondary hemorrhage did not occur in any of the patients, and wound healing proceeded without any complications. Conclusion:Effective periodontal treatment can be provided to patients with hemorrhagic disorders with the combined efforts of the periodontist and hematologist.

Background:This study clinically evaluates the 10‐year results of connective tissue graft (CTG) and guided tissue regeneration (GTR) therapies using bioabsorbable barriers for root coverage (i.e., the reduction of recession depth). Methods:In 15 patients, 38 Miller Class I and II recessions were treated. Recession defects received a CTG or GTR by random assignment. At baseline (immediately prior to surgery) and 6 and 120 ± 12 months after surgery, clinical parameters were obtained. Results:Nine patients, who contributed 24 recession defects, were available for re‐examination at 120 ± 12 months. Six and 120 ± 12 months after receiving a CTG, statistically significant (P<0.05) root coverage was observed compared to baseline root coverage (6 months: 3.07 ± 1.74 mm; 120 ± 12 months: 2.07 ± 1.89 mm). The GTR therapy resulted in statistically significant root coverage compared to baseline root coverage only after 6 months (2.28 ± 1.77 mm; P<0.05). Both groups experienced a statistically significant loss of coverage from 6 to 120 ± 12 months (CTG: −1.0 ± 0.78 mm; GTR: −2.03 ± 2.24 mm). At 120 ± 12 months after CTG surgery, the stability of root coverage was statistically significantly better than 120 ± 12 months after GTR surgery (P= 0.002). The CTG caused more post‐surgical discomfort (P<0.05), but it resulted in a better treatment outcome (P<0.05) than GTR as perceived by patients. Conclusion:The long‐term stability of root coverage (i.e., the reduction of recession depth) and esthetic results perceived by patients were significantly better 10 years after CTG surgery, statistically, than after GTR surgery using bioabsorbable barriers.

Background:The identification of Aggregatibacter actinomycetemcomitans(previously Actinobacillus actinomycetemcomitans) serotypes may add some important information to the understanding of the pathogenetic background of severe periodontal infections. This study compared serotypes of A. actinomycetemcomitansin two groups of periodontal patients with different ethnic backgrounds. Methods:A total of 194 patients (96 Germans and 98 Koreans) with aggressive or severe chronic periodontitis participated in the study. Microbiologic analysis of pooled samples from subgingival plaque was performed by using a real‐time polymerase chain reaction (PCR) test for A. actinomycetemcomitans. In patients who tested positive for A. actinomycetemcomitans, serotypes (a through f) were determined by nucleic acid‐based methods. Results:The prevalence of patients who tested positive for A. actinomycetemcomitanswith the real‐time PCR was comparable in both groups (Germans: 27.0%; Koreans: 22.2%). In German patients, the serotypes detected most frequently were b (33.3%), c (25.0%), and a (20.8%), whereas in Korean patients, the serotype distribution was different, with serotypes c (61.9%) and d (19.0%) accounting for >80% of the complete serotype spectrum. Conclusion:Even if the percentage of patients who tested positive for A. actinomycetemcomitanswas identical in patients with generalized aggressive and severe chronic periodontitis and different ethnic backgrounds, the distribution of A. actinomycetemcomitansserotypes may exhibit marked differences.

Background:A 10‐year follow‐up study was conducted to clinically evaluate the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using non‐resorbable and bioabsorbable barriers. Methods:Twelve pairs of contralateral infrabony defects were treated in 12 subjects with advanced periodontitis. Within each subject, one defect received a non‐resorbable barrier and the other received a bioabsorbable barrier by random assignment. Clinical parameters were obtained at baseline and at 12 and 120 ± 6 months after surgery. Results:Eight of 12 subjects were available for the examination at 120 ± 6 months. Twelve and 120 ± 6 months after GTR therapy statistically significant (P<0.05) vertical clinical attachment level (CAL‐V) gain was observed in both groups (3.4 ± 1.0 mm and 1.5 ± 1.2 mm for the control group at 12 and 120 months, respectively, and 3.3 ± 1.6 mm and 3.5 ± 2.5 mm for the test group at 12 and 120 months, respectively). However, 120 ± 6 months after GTR therapy, three infrabony defects (two controls and one test) had lost >2 mm of the attachment that had been gained 12 months after GTR therapy, and a statistically significant mean CAL‐V loss of 1.7 ± 1.3 mm was observed from 12 to 120 ± 6 months in the control group. One tooth in the control group was lost between 60 and 120 ± 6 months. The case series failed to show statistically significant differences between test and control regarding CAL‐V gain 120 ± 6 months after surgery. Conclusion:CAL‐V gain achieved 12 months after GTR therapy in infrabony defects using non‐resorbable and bioabsorbable barriers was stable after 10 years in 12 of 16 defects.

Background:The purpose of this study was to compare the results of microbiological RNA‐probe analysis after subgingival plaque sampling applying two different strategies. Methods:In 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti‐infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola(Td) with a commercially available RNA‐probe test. Results:For all tested pathogens, log‐transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P≤0.01). However, for Tdonly, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately. Conclusions:Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td.

Background:The aim of this 5‐year follow‐up study was to evaluate clinically and radiographically the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using non‐resorbable and bioabsorbable barriers. Methods:Thirty‐one patients with periodontitis and 50 infrabony defects that had been treated using GTR were recruited. Eleven defects were treated with non‐resorbable expanded polytetrafluoroethylene membranes and 39 defects with bioabsorbable barriers. At baseline and 6 and 60 ± 3 months after surgery, clinical parameters and standardized radiographs were obtained. During surgery and 60 ± 3 months thereafter, the distance from the cemento‐enamel junction to the base of the bony defect (vertical probing bone level [PBL‐V]) was measured. Bone gain was evaluated using digital subtraction radiography. Results:At 6 and 60 ± 3 months after GTR, there was a statistically significant (P<0.001) reduction of probing depth (6 months: 4.31 ± 1.76 mm; 60 months: 3.95 ± 1.62 mm) and vertical clinical attachment level gains (CAL‐V) (6 months: 3.34 ± 1.66 mm; 60 months: 2.97 ± 1.53 mm). From 6 to 60 months after GTR, three infrabony defects exhibited CAL‐V loss >2 mm, and a small, statistically not significant mean CAL‐V loss of 0.39 ± 1.60 mm was observed. From baseline to 60 ± 3 months, a significant PBL‐V gain of 1.78 ± 2.67 mm (P<0.001) and increase in bone density were observed (P= 0.003). Conclusion:The CAL‐V gain achieved after GTR in infrabony defects using both non‐resorbable and bioabsorbable barriers was stable after 5 years in 47 of 50 defects.

Background:The aim of this 10‐year follow‐up was to evaluate the long‐term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non‐resorbable and bioabsorbable barriers clinically. Methods:In nine patients with advanced periodontitis, nine pairs of contralateral Class II furcation defects were treated. Within each patient, one defect received a non‐resorbable expanded polytetrafluoroethylene barrier (ePTFE; C) and the other a bioabsorbable (polyglactin 910; T) barrier by random assignment. At baseline and 12 and 120 ± 6 months after surgery, clinical parameters were obtained. Results:Twelve and 120 months after GTR therapy, statistically significant (P<0.05) horizontal clinical attachment level (CAL‐H) gain was observed in both groups (C12: 1.9 ± 0.5 mm; C120: 1.1 ± 1.3 mm; T12: 1.9 ± 0.8 mm; T120: 1.7 ± 1.4 mm). However, one patient with furcations that had been assessed as Class I 12 months after GTR therapy had lost two teeth after 10 years, and another patient had lost more than 2 mm CAL‐H at one furcation from 12 to 120 ± 6 months post‐surgery 10 years after implantation of an ePTFE barrier. Horizontal bone sounding revealed similar bone gain in both groups 120 ± 6 months post‐surgery (C120: 0.8 ± 1.0 mm; T120: 1.1 ± 1.1 mm). Conclusions:CAL‐H gain achieved after GTR therapy in Class II furcations was stable after 10 years in 15 of 18 defects (83%). The study failed to show a statistically significant difference in stability of CAL‐H gain between group C and T 10 years after GTR therapy.

Background:Report of a combined periodontal and orthodontic treatment in a patient with Papillon‐Lefèvre Syndrome (PLS). Methods:A patient with PLS was treated orthodontically 26 months after the start of a combined mechanical and antibiotic therapy. Clinical periodontal parameters were obtained 26 (t1), 60 (t2), and 79 (t3) months after anti‐infective therapy. The deepest site of each tooth was sampled for microbiological analysis at 26 and 60 months. Periodontal maintenance therapy was provided every 6 weeks. After a stable periodontal situation was achieved, orthodontic treatment, consisting of space opening for the upper canines with a multibracket appliance and coil springs, was carried out. In the lower jaw, crowding was resolved by an orthodontic mesialization of the canines. Results:Twenty‐six months (t1) after the beginning of the combined mechanical and antibiotic therapy, 6% of the sites exhibited 4 mm probing depth (PD) with bleeding on probing (BOP) or PD ≥5 mm. Sixty months (t2) after therapy the number of sites with 4 mm PD with BOP or PD ≥5 mm had increased to 17%, and 79 months after therapy (t3) 13% of all sites were similarly affected. From 26 to 60 months, a slight mean clinical attachment level (CAL) gain was observed, whereas the mean PD increased. From 60 to 79 months, there was a mean PD reduction. However, a significant mean attachment loss was also noted. After 26 months (t1), RNA probes failed to detect A. actinomycetemcomitans, P. gingivalis, or T. forsythensis from any site. Thirty‐four months later (t2), subgingival recolonization was observed. A. actinomycetemcomitans was detected by RNA probes at three sites. At 26 and 60 months (t1, t2), trypticase‐soy with serum, bacitracin, and vancomycin (TSBV) culture failed to detect A. actinomycetemcomitans at any of the sampled sites. Eighty‐two months after the beginning of therapy (t4), none of the applied methods could detect A. actinomycetemcomitans from the pooled samples from the deepest pockets of each quadrant or the oral mucosa. In the present case, concomitant orthodontic treatment with a fixed appliance could be performed without further pronounced periodontal deterioration. Space for eruption of the canines and premolars was created, in addition to an alignment of the teeth. Conclusion:After a successful combined mechanical and antibiotic periodontal therapy of the PLS periodontitis, moderate orthodontic tooth movements may be possible within a complex interdisciplinary treatment regimen. J Periodontol 2005;76:642‐650.

Background:Topical application of active substances offers an additional option in periodontal therapy. The aim of this study was to examine the influence of the administration of a novel, biodegradable 14% doxycycline gel on microbiological findings, in connection with scaling and root planing. Methods:One hundred ten patients in three centers (Frankfurt and Heidelberg, Germany; Nijmegen, The Netherlands) with moderate to advanced periodontitis were evaluated in this randomized, double‐masked, split‐mouth clinical trial. In each patient, three test teeth were randomly assigned to one of three treatment modalities: 1) scaling and root planing (SRP) alone; 2) SRP with subgingival placebo gel (VEH); or 3) SRP and 14% doxycycline gel (DOX). Subgingival plaque samples were analyzed at baseline and 3 and 6 months after therapy for Actinobacillus actinomycetemcomitans (A.a.), Tannerella forsythensis (T.f.), Porphyromonas gingivalis (P.g.), and Treponema denticola (T.d.)using a RNA probe. Samples from 10 patients were tested for resistance against doxycycline, amoxicillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole using agar diffusion testing. Results:The largest decrease in pathogens was found after 3 months, with the most pronounced differences between DOX and SRP (P<0.05). At 6 months, pathogens were still reduced markedly in all groups. Treatment results were consolidated for VEH and DOX, with a slight deterioration for SRP (DOX versus SRP: P<0.001). Resistance was observed to amoxycillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole (four isolates) but not to doxycycline. Conclusion:The addition of subgingival instillation of a 14% doxycycline gel resulted in pronounced reduction of periodontal pathogens after 3 months and stabilizing results up to 6 months after therapy. Resistance to doxycycline was not induced. J Periodontol 2005;76:66‐74.

Background:The aim of this 5‐year randomized controlled clinical trial was to evaluate the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using two bioabsorbable barriers. Methods:Fifteen pairs of contralateral infrabony defects in 15 patients with moderate to severe periodontitis were treated. Each patient received one polydioxanon (test: T) and one polylactide acetyltributyl citrate (control: C) barrier by random assignment. At baseline, 12, and 60 ± 3 months after surgery clinical parameters and standardized radiographs were obtained. Vertical bone levels (PBL‐V) were measured during surgery and 60 ± 3 months later by transgingival bone sounding. Results:Thirteen patients were available for the 60‐month examinations. Twelve and 60 ± 3 months after GTR, statistically significant (P≤0.001) vertical attachment (CAL‐V) gain was found in both groups (T12: 3.5 ± 1.5 mm; T60: 2.2 ± 1.8 mm; C12: 4.0 ± 0.9 mm; C60: 2.4 ± 1.0 mm). However, from 12 to 60 months after therapy both groups experienced significant CAL‐V loss (P<0.05): two defects in the test group and three in the control group had CAL‐V loss >2 mm compared to the 12‐month reexamination. Twelve and 60 ± 3 months after surgery, statistically significant (P<0.05) radiographic bony fill was found in both groups (T12: 1.2 ± 1.3 mm; T60: 1.5 ± 2.2 mm; C12: 0.9 ± 1.4 mm; C60: 1.0 ± 1.6 mm). Further, 60 months after surgery significant (P<0.05) PBL‐V gain was found in both groups (test: 1.8 ± 2.3 mm; control: 2.2 ± 1.8 mm). The study failed to show statistically significant differences between test and control regarding CAL‐V and PBL‐V gain 60 months after surgery. Conclusion:CAL‐V gain achieved after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 5 years in 21 of 26 defects (81%). J Periodontol 2004;75:957‐965.

Background:The aim of the present study was to evaluate defect width and two different definitions of defect depth as prognostic factors of periodontal healing in infrabony defects treated by regenerative therapy 6 and 24 months after surgery. Methods:In 32 patients with moderate to advanced periodontitis, 50 infrabony defects were treated by the guided tissue regeneration (GTR) technique using non‐resorbable or bioabsorbable barriers. Clinical parameters were assessed, and 50 triplets of standardized radiographs were taken before surgery and 6 and 24 months after surgery. Using a computer‐assisted analysis, the distances cemento‐enamel junction (CEJ) to alveolar crest (AC), CEJ to bony defect (BD), horizontal projection of the most coronal extension of the bony wall to the root surface to BD, width, and angle of the bony defects were measured. Depth of the bony defect was 1) calculated as CEJ‐BD minus CEJ‐AC (INFRA1) and 2) measured as horizontal projection of the most coronal extension of the bony wall to the root surface to BD (INFRA2). Results:Whereas statistically significant vertical clinical attachment level gains (CAL‐V: 3.36 ± 1.59 mm/ 3.41 ± 1.72 mm; P<0.001) could be found both 6 and 24 months after surgery, bony fill (0.70 ± 2.52 mm; P= 0.056/1.21 ± 2.55 mm; P<0.005) was significant 24 months post‐surgically only. In a multilevel regression analysis, CAL‐V gain was predicted by bioabsorbable membrane (P= 0.005), baseline probing depths (PD) (P<0.001), and actual smoking (P<0.05). Bony fill could be predicted by baseline depth of the infrabony component as determined by INFRA2 (P<0.05), angulation of bony defect (P<0.005), and gingival index at baseline (P<0.001). In narrow (<37°) and deep (≥4 mm) infrabony defects, bony fill was more pronounced than in wide and shallow defects (P<0.001). Conclusions:Improvement achieved by GTR in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and are to some extent clinically more favorable to GTR therapy than are wide and shallow defects. The infrabony component of bony defects, as determined by the distance from the most coronal extension of the lateral bony wall to BD (INFRA2), is a better predictor of bony fill than that determined by AC‐BD (INFRA1). J Periodontol 2004;75:399‐407.

Background:With the help of so‐called controlled release delivery systems, the half‐life period of locally administered antibiotics in gingival crevicular fluid (GCF) can be extended significantly. The aim of this study was to characterize the delivery profile of a new one‐component 14% doxycycline free amine gel for local application. Pharmacokinetics of doxycycline (DOXY) were analyzed in GCF, saliva, and serum. Methods:Twenty patients with persisting or recurring pockets (probing depths ≥5 mm and bleeding on probing) after mechanical treatment (surgical or non‐surgical) took part in the study. In each patient 1 periodontal defect was treated with DOXY gel. Samples of GCF, saliva, and serum were obtained before application of DOXY gel; 15 minutes after application; at 2 and 5 hours; and at 1, 2, 3, 4, 7, 9, and 11 days after application. Separation and quantitative measurement of DOXY was performed with high performance liquid chromatography and UV detection at λ = 260 nm. Results:Coefficients of variation were lower than 2% (intraassay) and 4% (interassay), respectively. For concentrations between 50 to 1000 μg/ml, we found a linear relationship between expected and measured DOXY values (linear coefficient of correlation: r = 0.998). Within the first 5 hours after application, concentration of DOXY in GCF (maximum after 15 minutes 19.97 ± 5.85 mg/ml) and saliva (maximum after 15 minutes 17.83 ± 2.84 mg/ml) was similar. Then concentration fell to a lower level (28.90 ± 19.44 μg/ml) compared to GCF (577.41 ± 127.34 μg/ml) after 3 days. Up to 10 days after application, the concentration of DOXY in GCF was 34.24 μg/ml. With the exception of 1 patient, all serum samples were DOXY‐negative. Conclusions:1) After subgingival application of biodegradable 14% doxycycline gel, mean doxycycline levels in GCF that exceeded 16 μg/ml could be maintained for at least 12 days. Thus, the antimicrobial agent may be classified as a controlled release device. 2) The antibiotic effect was limited mainly to the subgingival sites of application of the doxycycline gel. 3) The doxycycline gel possesses the pharmacokinetic and clinical properties to deliver efficacious levels of antibiotics to the periodontal pocket and to maintain these levels for at least 1 week without the need of further drug retention by a periodontal dressing. J Periodontol 2002;73:1285‐1291.

Objective.The objective of the present study was to compare 2 different computer-assisted analysis systems with respect to the measurement of interproximal bone loss on radiographs. Study Design.In 14 patients with untreated advanced periodontal disease, 90 standardized radiographs were taken presurgically and during postoperative follow-up. During periodontal surgery for 30 vertical bone defects and 28 adjacent sites (22 vertical, 3 horizontal, and 3 without bone loss), the distances from the cementoenamel junction (CEJ) to the alveolar crest (AC) and from the CEJ to the bottom of bony defect (BD) were measured. In all radiographs, the linear distances from the CEJ to the AC and from the CEJ to BD were assessed by using 2 computer-assisted analysis devices: linear measurement (LMSRT) and FRIACOM (FRIADENT, Mannheim, Germany). A comparison between the radiographic and intrasurgical assessments was performed by using the paired ttest. Results.With respect to the linear distance from the CEJ to the BD, the study failed to detect statistically significant differences between the computer-assisted techniques and intrasurgical measurement as the gold standard (LMSRT,: 0.26 ± 2.16 mm [P>.05]; FRIACOM, 0.35 ± 2.5 mm [P>.05]). In terms of the distance from the CEJ to the BD and from the CEJ to the AC, the correlation between both computer-assisted methods was excellent (rs≥ 0.75) and there were no statistically significant differences detectable between LMSRT and FRIACOM for both distances. With regard to the distance from the CEJ to the AC, both techniques overestimated interproximal bone loss as compared with intrasurgical measurements (CEJ-AC, LMSRT: 1.63 ± 2.52 mm [P<.01]; FRIACOM: 2.00 ± 2.48 mm [P<.01]). The amount of overestimation of interproximal bone loss did not differ significantly in either computer-assisted technique (P>.05). For double measurements, both LMSRT and FRIACOM showed excellent reproducibility with coefficients of variation that ranged between 3.8% and 4.5% (CEJ-BD) and between 5.7% and 6.6% (CEJ-AC). There were no statistically significant differences between the reproducibilities of both computer-assisted techniques (P<.05). Conclusions.Both LMSRT and FRIACOM are reproducible methods to measure the distances from the CEJ to the BD and from the CEJ to the AC on radiographs and can be recommended for clinical use. With respect to the distance from the CEJ to the AC, it must be kept in mind that both computer-assisted methods tend to overestimate the real distance on an average of 1.5 to 2.0 mm. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:379-87)

Background:The purpose of this study was to compare the clinical and radiographic parameters with the histometric findings following 2 different regenerative procedures in humans. Methods:Fourteen advanced intrabony defects at teeth scheduled for extraction were randomly treated as follows: 8 with guided tissue regeneration (GTR) using bioabsorbable barriers and 6 with an enamel matrix protein derivative (EMD). Standardized radiographs, probing depths (PD), and attachment levels (CAL) at baseline and 6 months after therapy were evaluated and compared to the histometric measurements made following the removal of teeth and surrounding tissues 6 months after the surgery. Results:Significant PD reductions (GTR: –5.62 mm; EMD: –5.00 mm) and CAL gains (GTR: 3.87 mm; EMD: 2.67 mm) were observed in both groups. Six months after surgery, minor resorptions of the alveolar crest (AC) (GTR: 0.40 mm; EMD: 0.33 mm) and bony gain at the bottom of the defects (GTR: 0.47 mm; EMD: 1.05 mm) were observed radiographically. No statistically significant differences in the change of clinical and radiographic parameters between the GTR and EMD groups were found. Histometrically, significant amounts of new connective tissue attachment (i.e., cementum with inserting collagen fibers) were observed in both groups (GTR: 2.29 mm; EMD: 1.81 mm). Bone regeneration was found to be significant only in the GTR group (GTR: 1.93 mm; EMD: 0.78 mm). However, the study lacked statistical power for determining equivalence between the groups. Conclusions:Within the limitations of the present study, it may be concluded that at 6 months after GTR or enamel matrix protein derivative therapy, formation of new cementum and bone may be histometrically demonstrated. Except for the formation of new bone, no statistically significant differences between both therapies could be seen for clinical, radiographic, and histometric results 6 months after surgery. J Periodontol 2002;73:409‐417.

Background:The aim of this 5‐year follow‐up case series was to clinically and radiographically evaluate the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using nonresorbable and bioabsorbable barriers. Methods:In 12 patients with advanced chronic periodontitis 12 pairs of contralateral infrabony defects were treated. Within each patient one defect received a non‐resorbable (expanded polytetrafluoroethylene [ePTFE]; control: C) and the other a bioabsorbable (polyglactin 910; test: T) barrier by random assignment. At baseline and at 6 and 60 ±3 months after surgery clinical parameters and standardized radiographs were obtained. Gain of bone density within infrabony defects was assessed using subtraction radiography. Results:Eight of 12 patients were available for the 60‐month reexaminations. Six and 60 ±3 months after GTR therapy statistically significant (P <0.05) vertical attachment (CAL‐V) gain was observed in both groups (C6: 2.6 ±1.4 mm; C60: 1.6 ± 1.5 mm; T6: 3.0 ±1.7 mm; T60: 3.0 ±0.7 mm). However at 60 months, 2 infrabony defects in the control group had lost all the attachment that had been gained 6 months after therapy and a clinically relevant but statistically insignificant mean CAL‐V loss of 1.0 ±2.1 mm was observed from 6 to 60 months. The case series failed to show statistically significant differences between test and control regarding CAL‐V gain 60 months after surgery. Also subtraction analysis failed to reveal statistically significant differences regarding density gain between both groups 6 and 60 months postsurgically (C6: 26.4 ± 54.2; C60 62.8 ±112.7; T6: 68.7 ±72.8; T60. 84.1 ±83.6). Conclusions:CAL‐V gain achieved after GTR therapy in infrabony defects using both non‐resorbable and bioabsorbable barriers was quite stable after 5 years in 14 of 16 defects.J Periodontol 2002;73:450‐459.

Background:The aims of the present study were to evaluate 1) defect depth and width as a prognostic factor and 2) change in defect width as a describing parameter of periodontal healing in infrabony defects treated by regenerative therapy after 6 and 24 months. Methods:In 24 patients with advanced periodontitis, 39 infrabony defects were treated by guided tissue regeneration (GTR) using expanded polytetrafluoroethylene (ePTFE) (n = 7) or bioabsorbable barriers (n = 32). Clinical parameters were assessed and 39 standardized radiographs (in triplicate) were taken before and 6 and 24 months after surgery. Using a computer‐assisted analysis, the depth, width, and angle of the bony defects were measured. Results: Statistically significant vertical clinical attachment gains (CAL‐V: 3.15 ± 1.63 mm to 3.31 ± 1.65 mm; P<0.001) and bony fill (1.30 ± 2.53 mm; P<0.01 to 1.54 ± 2.70 mm; P<0.005) were observed 6 and 24 months postsurgically. In a multilevel regression analysis CAL‐V gain was predicted by baseline CAL‐V (P<0.0001), actual smoking (P<0.05), and age (P<0.1). Bony fill could be predicted by baseline height of the infrabony component (P<0.0001), gingival index at baseline (P<0.05), and actual smoking (P<0.01). In narrow (<26°) and deep (≥3 mm) infrabony defects bony fill was more pronounced than in wide and shallow defects (P<0.05). Conclusions:Improvement achieved by guided tissue regeneration in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and to some extent clinically more favorably to GTR therapy than wide and shallow defects. However, depth of the infrabony component was a stronger prognostic parameter than defect angle. Actual smoking impairs the results of GTR therapy in infrabony defects. J Periodontol 2001;72:1639‐1646.

Background:Papillon Lefèvre syndrome (PLS) is rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS. Methods:A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens. Results:Prior to combined mechanical and antibiotic treatment, all teeth but one harbored Actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by DNA probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period. Conclusions:Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS.J Periodontol 2001;72:542‐549.

Background:The aim of this 5‐year follow‐up study was to clinically and radiographically evaluate the long‐term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non‐resorbable and bioabsorbable barriers. Methods:Nine pairs of contralateral Class II furcation defects were treated in 9 patients with advanced periodontitis. Within each patient, one defect received a non‐resorbable (expanded polytetrafluoroethylene [ePTFE]; control, C) barrier and the other a bioabsorbable (polyglactin 910; test, T) barrier by random assignment. At baseline, 6, and 60 ± 3 months after surgery, clinical parameters and standardized radiographs were obtained. Gain of bone density within furcation areas was assessed using subtraction radiography. Results:Six and 60 months after GTR therapy, statistically significant (P<0.05) horizontal attachment (CAL‐H) gain was observed in both groups (C6: 1.7 ± 0.8 mm; C60: 1.6 ± 1.2 mm; T6: 2.0 ± 0.7 mm; T60: 2.2 ± 0.9 mm). However, 1 furcation assessed as Class I six months after GTR therapy with a bioabsorbable barrier had progressed to Class III after 5 years, and in another patient, 5 years after placement of an ePTFE barrier, 1 furcation had lost all the CAL‐H gain that had been observed at 6 months. Subtraction analysis revealed similar area gain in both groups 6 and 60 months postsurgically (C6: 0.3 ± 0.5; C60 1.0 ± 1.7; T6: 0.4 ± 0.4; T60: 1.1 ± 1.7). Conclusions:CAL‐H gain achieved after GTR therapy in Class II furcations was stable after 5 years in 16 of 18 defects. The study failed to show a statistically significant difference in stability of CAL‐H gain between control and test groups 5 years after GTR therapy. J Periodontol 2001;72:35‐42.

Background:The aim of this study was to compare the effects of guided tissue regeneration (GTR) using 2 different bioabsorbable barriers (control: polylactide acetyltributyl citrate; test: polydioxanon). The polydioxanon barrier is an experimental membrane for GTR therapy that consists of a continuous occlusive barrier that has a layer of slings on the side that is meant to face the mucoperiosteal flap. Methods:In 21 patients with 22 pairs of similar contralateral defects (30 intrabony and 14 Class II furcation lesions), each defect was randomly assigned for treatment with either control (c) or test (t) devices. At baseline and 12 months after surgery, clinical measurements, plaque index (PI) gingival index (GI), probing depth (PD), and vertical and horizontal clinical attachment loss (CAL‐V; CAL‐H) and standardized radiographs were obtained. Results:Barrier exposure was commonly observed in both groups. Four weeks after surgery 61% of all barriers were exposed to some extent. However, both treatments revealed a significant GI reduction (P<0.005), PD reduction (–3.08 ± 2.29 mm [t]; –3.52 ± 2.67 mm [c]; P <0.001) and CAL‐V gain (2.44 ± 2.29 mm [t], 2.80 mm ± 2.21 [c]; P<0.001) 12 months after surgery in all defects. Within the intrabony defects significant bony fill (2.03 ± 1.70 mm [t]; 1.91 ± 1.20 mm [c]; P= 0.001), and within the furcations a significant but small CAL‐H gain (0.79 ± 0.68 mm [t]; 1.13 ± 1.44 mm [c]; P<0.05), was observed. Conclusions:Regarding GI and PD reduction as well as CALV and CAL‐H gain, this study failed to reveal statistically significant or clinically relevant differences between test and control 12 months postsurgically. Thus, the use of both bioabsorbable barriers in GTR therapy may be recommended. J Periodontol 2000;71:999‐1008.

Background:The aim of this study was to compare bone regeneration as assessed by subtraction radiography with clinical attachment measurements 24 months after regenerative surgery. Methods:In 24 patients with advanced periodontitis, 34 Class II and 10 Class III furcations were treated by guided tissue regeneration using expanded polytetrafluoroethylene (n = 18) or bioabsorbable barriers (n = 26). Clinical parameters were assessed and 40 pairs of standardized radiographs were taken before and 24 months after surgery. Bony gain within furcations was assessed using subtraction analysis. Results:In Class II furcations, statistically significant (P<0.001) vertical (CAL‐V: 1.06 ± 1.56 mm) and horizontal (CAL‐H: 2.05 ± 1.24 mm) attachment gain was observed 24 months postsurgically. Within Class III defects CAL‐V gain was assessed 1.78 ± 1.43 mm (P<0.005). CAL‐H gain in buccal and lingual Class II furcations was explained by the relative density gain, baseline CAL‐H, gingival index (GI) reduction, and individual patients (P<0.001) whereas, multiple regression analysis failed to show a relation between CAL‐H gain and any of the subtraction parameters for interproximal furcations. Vertical attachment gain in interproximal sites was explained by net bony area gain (subtraction), PD and GI reduction, baseline CAL‐V, defect type, smoking, and individual patients (P<0.001). Conclusions:There was a statistically significant correlation between clinical and radiographic improvements within furcation defects. However, this correlation was modulated by other factors such as baseline CAL‐V or CAL‐H, PD and GI reduction, or smoking. The relative density gain seemed to sufficiently describe bony changes related to clinical changes within buccal and lingual furcations, whereas bone area gain suitably described bony changes in interproximal Class II and III furcations. J Periodontol 1999;70:1490‐1500.

In16 patients with advanced periodontitis, 23 teeth exhibiting interproximal intrabony defects were treated by conventional periodontal surgery (n = 10, control) or guided tissue regeneration (GTR) technique using expanded polytetrafluoroethylene (ePTFE) barriers (n = 13, test), respectively. Clinical parameters were assessed before and 6 months after surgery. Presurgically and 3 and 6 months postsurgically standardized bite‐wing radiographs were taken. Using a loupe and a computer‐assisted system, respectively, the distances from the cemento‐enamel junction (CEJ) to alveolar crest (AC) and CEJ to the most apical extension of bony defect (BD) were measured. The average gain of attachment was assessed 2.33 mm in the control group and 3.17 mm in the test group. The bony fill was measured 0.97 mm and 0.97 mm in the control group and 0.93 mm and 1.68 mm in the test group after 3 and 6 months, respectively, using a loupe. Using a computer‐assisted system 0.83 mm and 1.82 mm of bone fill could be measured (control) and 0.76 mm and 1.79 mm (test) after 3 and 6 months, respectively. Compared to the gold standard of surgical measurements, the computer‐assisted analysis of radiographs underestimated bone loss significantly less than evaluation with a loupe (P< 0.002). Compared to conventional periodontal surgery, the GTR technique resulted in higher attachment gain and bony fill. However, the high variation of surgical results in the test group prevented the calculation of a statistically significant difference. J Periodontol 1996;67:379–385.

The aim of this study was toinvestigate the reliability of the assessment of clinical furcation parameters (horizontal attachment levels [CAL‐H], class of furcation invasion). Replicate measurements of CAL‐H and furcation class were performed within 14 days in 420 molars of 105 patients with advanced periodontitis using a Nabers‐ (n = 50), a TPS‐ (n = 30) and a PCPUNC15‐probe (n = 25). Validity of clinical assessments was assessed by intrasurgical measurements. The standard deviation of single measurements (s) was calculated as a measure of the reproducibility of CAL‐H measurements and weighted kappa‐coefficients (kw) to estimate the agreement of furcation class assessments. The s ranged from 0.55 to 1.13 mm (Nabers), 0.55 to 1.02 mm (TPS), and 0.58 to 1.11 mm (PCPUNC 15). For all probes, a statistically significantly smaller measurement error was observed in buccal and lingual sites than in mesiolingual and distolingual furcations (P< 0.005). The kwranged from 0.59 to 0.89 (Nabers), 0.50 to 0.80 (TPS), and 0.53 to 0.72 (PCPUNC15). Multiple linear regression analysis identified distolingual location, probing depth (PD) and CAL‐H as factors influencing the variability of CAL‐H measurements. Whereas there was no statistically significant difference between pre‐ and intrasurgical CAL‐H measurements using the Nabers probe, the TPS and PCPUNC 15 probe underestimated CAL‐H for distolingual furcations (P< 0.025). Using the Nabers probe, no asymmetries between pre‐ and intrasurgically obtained class of furcation involvement were revealed, while the TPS and PCPUNC15 probe underestimated furcation degrees (P< 0.1). Multiple linear regression analysis identified distolingual location and height of furcation, as well as PD, vertical attachment level (CAL‐V) and type of probe, as factors influencing the validity of CAL‐H measurements. Clinical diagnosis of furcation lesions using the 3 mm incrementally marked Nabers probe provides reproducible and valid information about furcation invasion. J Periodontol 1998;69:328–336.

In21 patients with advanced periodontitis, 39 teeth exhibiting class II (n = 21) and class III (n = 18) furcations were treated by the guided tissue regeneration technique using expanded polytetrafluoroefhylene (ePTFE) membranes (n = 20) or bioabsorbable barriers (n = 19), respectively. Clinical parameters were assessed before and 6 months after surgery. Presurgically and 6 months postsurgically, 35 pairs of standardized bitewing radiographs were taken. Using subtraction radiography, gain of bone density within furcation areas was assessed. Eighteen radiographs showed sufficiently accurate geometry to be analyzed by subtraction. Within the defects suitable for subtraction, the average gain of vertical attachment assessed was 1.35±1.27 mm in the class II furcation group and 1.58±1.37 mm in the class III furcation group. The average horizontal attachment gain in the class II furcation group was 1.96±0.59 mm. No statistically significant differences were observed between results after GTR therapy using non‐resorbable and bioabsorbable barriers. Radiographic bone gain as assessed by subtraction analysis correlated with vertical (r = 0.458, P< 0.025) and horizontal (r = 0.734, P< 0.005) attachment gain. A statistically significant number of more radiographs for maxillary molars were not suitable for subtraction analysis than mandibular molars (P< 0.05). Further, statistically more radiographs that were taken with potentially unstable support of the filmholder were not suitable for subtraction analysis than those with stable support (P< 0.05). There is a statistically significant correlation between clinical improvements and bony fill within furcation defects. Only 18 of 35 pairs of radiographs were suitable for subtraction analysis. Subtraction analysis of maxillary molars seems to be more difficult than assessment of radiographic bone changes in mandibular molars. Potentially stable support of the filmholder seems to be a condition to provide radiographs suitable for subtraction analysis. J Periodontol 1997;68:636–644.

The furcation involvementof 200 molars in 50 patients suffering from advanced periodontitis was investigated. Presurgically, the horizontal probing attachment levels (CAL‐H) within the furcations of 4 molars per patient was assessed twice within 14 days. Within a subset of 11 patients duplicate measurements of clinical probing depths (PD) and vertical clinical attachment levels (CAL‐V) at the same molars were performed. To determine the measurement error of CAL‐H, PD and CAL‐V, respectively, the standard deviation of single measurements was calculated. The CAL‐II measurements were repeated intrasurgically and compared with presurgical assessments of furcation measurements. The overall standard deviation of single measurements was 0.759 mm. For Class 0, I, and II furcations, the standard deviations were 0.879 mm, 0.664 mm, 0.682 mm, respectively. The standard deviation of PD single measurements and CAL‐V single measurements varied from 0.393 mm to 0.993 mm (PD) and from 0.555 mm to 1.161 mm (CAL‐V), respectively. The agreement of replicate measurements of furcation degrees was moderate for furcation locations which showed a CAL‐H ≤ 3 mm and a CAL‐H > 3 mm, respectively (weighted k‐coefficients 0.500 and 0.691). At sites with furcation involvement Class 0 and II there was no statistically significant difference between presurgical and intrasurgical measurements. At sites with Class I furcations there was a statistically significant mean difference of 0.255 mm between presurgically and intrasurgically assessed CAL‐H. There was no statistically significant difference between furcation classes as assessed presurgically and intrasurgically (x2between 1.9 and 4.4). J Periodontol 1995;66:984–989.

The aim of the present studywas to clinically and radiographically compare guided tissue regeneration (GTR) therapy with bioabsorbable polyglactin 910 barriers and conventional periodontal surgery in intrabony defects. In 26 patients with advanced periodontitis, 29 teeth exhibiting interproximal intrabony defects were treated; 15 by conventional periodontal surgery (control) and 14 by GTR (test). Before and 12 months after surgery, clinical parameters were assessed and standardized radiographs were taken. On the radiographs the distances from the cemento‐enamel junction (CEJ) to the alveolar crest (AC), and the CEJ to the most apical extension of the bony defect (BD) were measured using a computer‐assisted analyzing device (LMSRT). Twelve months after surgery, 24 patients with 27 lesions were available for examination. For both methods statistically significant (P< 0.001) probing depth (PD) reduction (mean ± standard deviation) of −4.49 ± 1.94 mm (n = 13, test) and −3.22 ± 1.48 mm (n = 14, control), as well as clinical attachment gain (CAL‐V) of 3.41 ± 1.59 mm (test) and 2.07 ± 1.10 mm (control), was observed. Radiographic changes of the distance CEJ to AC of −0.95 ± 1.72 mm (n = 9, test), and −0.98 ± 1.53 mm (n = 11, control) were not significant. A significant bony fill (distance CEJ‐BD) of 1.05 ± 1.22 mm was observed for the test group (P< 0.01); the 0.68 ± 2.04 mm bony gain for the control group was not statistically significant. The PD reduction (P< 0.05) and attachment gain (P< 0.01) in the test group was statistically significantly more favorable than in the control group. Twelve months after surgery, statistically more favorable PD reduction and attachment gain was observed using polyglactin 910 barriers than compared to conventional flap surgery. Hence, the use of bioabsorbable barriers for therapy of intrabony defects may be recommended. J Periodontol 1998;69:1210–1217.