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The healing of a new attachment procedure was evaluated in monkeys. Standard pedicle wounds similar to reverse bevel flaps were made in previously created periodontal pockets. The diseased root surfaces were treated with sodium deoxycholate (2%) and human plasma fraction Cohn IV1 (5%), applied to experimental sites for 1 minute each. Control surfaces were similarly treated with phosphate buffered physiological saline. The healing from the first to the 21st day was described (1) clinically, (2) histologically, (3) by rupture strength, and (4) by collagen production assays. All control sites healed with a dentogingival junction comprised only of junctional epithelium. Most experimental sites healed by means of junctional epithelium and some connective tissue new attachment at the apical extent of the wounds.

There is a preponderance of evidence in the literature that periodontal and other oral diseases, such as caries, can be treated and controlled by thorough mechanical plaque removal by the patient, the use of antimicrobial agents and antibiotics when necessary, and participation with the therapist in a well monitored, long-range program of supportive periodontal therapy. Recent evidence suggests that the control and prevention of oral disease, especially periodontitis, is especially important for patients with various systemic conditions that can be impacted by oral infections. It is far better for patients and therapists to practice primary and even secondary prevention with effective plaque control and regular, consistent supportive periodontal therapy, than having to rely on tertiary prevention for disease that has progressed to a level that requires costly treatment, is time-consuming and carries a greater risk of morbidity.

The dynamics of bone turnover in the furcations of teeth treated with expanded polytetrafluoroethylene (ePTFE) membranes were evaluated using multiple fluorochrome labels in 6 male beagle dogs. Loss of attachment involving the furcation area was induced in the second, third, and fourth premolar teeth using silk ligatures. The resulting defects were treated with the use of mucoperiosteal flaps for access, debridement of the defects, and placement of ePTFE membranes covering the furcations of the second and fourth premolars (experimental teeth) while the third premolar received only debridement without membrane placement (control tooth). Five fluorochrome labels were administered intravenously at timed intervals to act as markers of the osseous response. Membranes were removed at 4 weeks and all animals were terminated at 12 weeks post-membrane placement. One side of the mandible was decalcified, sectioned at 7 microns, and stained with either hematoxylin and eosin or Gomori's tri-chrome. The opposite side provided non-decalcified tissue processed as 100 microns ground sections. Using fluorescent light and point-hit evaluation, tissue in the coronal half of each specimen was classified as either labelled bone, unlabelled bone, or resorption space. In addition, microradiographs were prepared of each ground section and specimens classified as either woven bone, old lamellar bone, or new lamellar bone. No significant differences in attachment levels, or level of junctional epithelium, were observed in decalcified sections although greater remodeling activity was noted in the experimental specimens. Comparison of ground sections revealed significant differences (P < 0.05) in all categories with both methods of evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

This study compared the relative amounts of Actinobacillus actinomycetemcomitans (Aa), Eikenella corrodens (Ec), and black-pigmented anaerobic rods, and the proportions of coccoid forms, nonmotile rods, motile rods, spirochetes, and total motile organisms in subgingival plaque samples from 2 groups of young adults with generalized moderate to severe periodontitis. Two groups of 12 untreated patients were selected based on the relative amounts of subgingival calculus detected. Subgingival plaque samples (2 sites/patient) were taken with a sterile curet, dispersed, and plated under anaerobic conditions on ETSA, ETSA-kanamycin, ETSA-clindamycin, and TSBV agar. Appropriate biochemical tests were performed to confirm suspected microorganisms. Phase-contrast microscopy also was used to count the relative numbers of coccoid forms, nonmotile rods, motile rods, and spirochetes in each of the samples. Patients with no clinically detectable subgingival calculus harbored significantly greater proportions (%) of coccoid forms and Aa and greater amounts (CFU/mg) of Aa than did patients with obvious amounts of subgingival calculus. Subjects with clearly detectable subgingival calculus possessed greater proportions of motile rods, total motile organisms, and black-pigmented anaerobic rods than did subjects with little or no subgingival calculus. Young adult patients with generalized moderate to severe disease and little or no detectable subgingival calculus may possess a subgingival microbiota with relatively higher numbers of Aa and coccoid forms, and a lower percentage of BPB, motile rods, and total motile organisms as compared to similar patients with greater amounts of subgingival calculus.

Currently PMMA is the polymer most commonly used as a bone cement for the fixation of total hip prostheses. Ideally, a bone cement material should be easy to handle, biologically compatible, nonsupporting of oral microbial growth, available in the particulate and molded forms, easy to obtain, nonallergenic, adaptable to a broad range of dental and medical applications, in possession of high compressive strength, and effective in guided tissue regenerative procedures. One of the problems associated with the conventional types of bone cement used is their unsatisfactory mechanical and exothermic reaction properties. The purpose of this in vitro study was to investigate and compare the mechanical properties (three-point bending strength, energy-to-break, and modulus of elasticity) and physical properties (setting time, water sorption, and exothermic heat) of HA/PMMA (HA group) and bovine-bone originated HA/PMMA (BB group) composites. Composites samples were fabricated by admixing method. It was found that the addition of HA and BB particles increased the water sorption. Generally 10 v/o 20 v/o HA and 0 v/o to 10 v/o BB ratio combinations had significant beneficial effects on the mechanical properties. The heat generated during polymerization was influenced by the different admixtures. More than 40 v/o HA and 40 v/o BB should be mixed into PMMA to reduce the peak temperature. Overall evaluation indicated that the BB group had better properties than the HA group.

Periodontal maintenance therapy is dependent both upon methods of disease control that are either patient or therapist applied as well as on compliance with regular recall schedules. Recent advances in the design and use of mechanical aids for plaque removal, electric toothbrush design, use of chemotherapeutic plaque control agents, and evaluations of the role of maintenance therapy in practice are included. Numerous studies indicate that compliance with recall intervals may be difficult to achieve but is essential to the success of periodontal therapy. Suggestions for approaches to effective periodontal maintenance therapy are provided.

The largest growing segment of our society is that of older Americans. The population explosion of older adults challenges both general practitioners and periodontists to provide the highest level of care available. More of our patients will have concurrent medical conditions that alter or modify the delivery and provision of periodontal care. This paper reviews some of the common conditions occurring in the older patient and suggests some modifications in periodontal therapy which may be beneficial. The therapist must be knowledgeable about the medications commonly used for treating the chronic diseases of the older population. Finally, the therapist must become adept in performing functional assessments of patients so that the types of therapy administered contribute to the quality of life desired by patients.

There is a preponderance of evidence in the literature that periodontal and other oral diseases, such as caries, can be treated and controlled by thorough mechanical plaque removal by the patient, the use of antimicrobial agents and antibiotics when necessary, and participation with the therapist in a well monitored, long-range program of supportive periodontal therapy. Recent evidence suggests that the control and prevention of oral disease, especially periodontitis, is especially important for patients with various systemic conditions that can be impacted by oral infections. It is far better for patients and therapists to practice primary and even secondary prevention with effective plaque control and regular, consistent supportive periodontal therapy, than having to rely on tertiary prevention for disease that has progressed to a level that requires costly treatment, is time-consuming and carries a greater risk of morbidity.

Nonabsorbable barriers are considered the material by which all other barriers are judged. They have a well-established record of safety and efficacy. They are not a panacea, however. Practitioners must take special care when selecting both patients and surgical sites for GTR. Extensive experience, superior surgical ability, and meticulous attention to detail are also required if one is to achieve predictably favorable results.

Antimicrobial agents provide an additional means of combating the infective agents encountered in the periodontal diseases. Delivery methods include oral rinses, dentifrices, irrigation, local delivery, and systemic administration. Agents and delivery methods should be selected with the following criteria in mind: 1. The agent must be effective against the organisms present. 2. The agent must reach the desired site of action in appropriate concentration. 3. The agent must remain at the site for a sufficient period of time. When combined with a careful patient assessment and a considered diagnosis, the use of antimicrobial agents may prove to be an important adjunct in total periodontal therapy.

Two interesting populations in periodontology have emerged this year. National and international reports have indicated that inflammatory periodontal disease is widespread in adolescents, although most of the cases of disease are considered to be in a reversible stage. Nevertheless, the attachment loss present portends serious future problems. The rapidly growing elderly population presents a unique problem of assessment. Current indices do not adequately evaluate recession. Thus, there is substantial underestimation of periodontal disease in the elderly. Further insight into the interrelationships between systemic diseases and local inflammatory periodontal diseases has been reported. Methods to improve statistical evaluation of site-specific periodontal data and address the shortcomings of currently available periodontal indices have been suggested. Finally, the major disadvantage of indices in treatment planning is the lack of specific treatment goals. Examples of the potentially misleading information that results from this lack were presented and the inclusion of treatment goals with treatment needs was suggested.

This trial tested the adjunctive effects of a 0.12% chlorhexidine rinse (Peridex) upon gingival healing following scaling and root planing. Assessments were made on reduction in plaque (Pl), gingivitis (GI), pocket depth and gingival bleeding as measures of treatment benefit. All subjects had Class II, III or IV periodontal conditions. Following baseline examinations, subjects received a gross supragingival scaling and polishing. Subjects were separated by sex and periodontal classification, arrayed by GI scores, and randomly assigned to either the chlorhexidine rinse or a placebo rinse. Subjects were instructed to rinse with 1/2 ounce of their assigned products for 30 seconds twice daily. Following two weeks of product use, the clinical examinations were repeated and two randomly selected, opposing contralateral quadrants were scaled and root planed. After two more weeks of product use (week 4), clinical examinations were repeated and the remaining quadrants were scaled and root planed. At week 6, final clinical examinations were conducted. Since half-mouths were treated at different times and exposed to the treatment rinses for different periods, the data were analyzed for the half-mouths independently 2 and 4 weeks after gross scaling, and 2 and 4 weeks after root planing. A total of 94 subjects (47 in each treatment group) completed all phases of the trial. Gingival healing following scaling and root planing in subjects using a chlorhexidine rinse (0.12%) was significantly better than subjects using the placebo rinse as evidenced by less gingivitis (29%), fewer GI bleeding sites (48%) and less plaque (54%).

The purpose of this study was to compare the effectiveness of a unituft brush in combination with a conventional brush for plaque removal and maintenance of gingival health. Thirty patients presenting for routine dental care were examined and scored for plaque deposits and gingival inflammation. All subjects received a dental prophylaxis consisting of removal of all supragingival and subgingival deposits and polishing of the clinical crowns. Subjects were subsequently evaluated at 1 week, 6 weeks and 12 weeks. The addition of a unituft brush to the patient's regimen of oral hygiene procedures resulted in significant reductions at 12 weeks in both plaque scores (p less than .05) and gingival inflammation (p less than .01) when compared to the use of the conventional brush alone.

Untreated periodontally-involved teeth contain cementum-bound endotoxin, that may prevent periodontal new attachment during healing after pocket therapy. The purpose of this study was to restore biocompatibility to diseased root surfaces by a non-invasive treatment. Untreated human teeth removed for severe chronic periodontal disease were split buccolingually, the level of connective tissue was scribed on the roots, the specimens cleaned of plaque and visible calculus, and autoclaved. Cementum removal was not attempted. One member of each pair was treated with phosphate-buffered saline as a control. Sodium desoxycholate (2%), Cohn plasma fraction IV1 (5%), or deoxycholate followed by plasma fraction were applied for one minute. Roots were incubated in a suspension of gingival fibroblasts for 48 hours, then rinsed, fixed, and stained. Counts were made of the number of attached cells at 40 x magnification using an ocular grid. There was a significant increase (p less than 0.01) of the combination treatment over controls. All treatments provided a biological surface for attachment of fibroblasts, in vitro, compared to untreated roots.

The determination of disease activity has a direct impact on therapeutic measures in periodontics. Evaluations that may indicate disease activity have been reviewed under the topics of traditional evaluations, gingival crevicular fluid contents, tissue changes, circulating factors, and sulcular microbiota. The traditional methods, such as probing, radiographs, and clinical indices, were static evaluations that had limited validity in determining disease activity. When used in longitudinal tests, these methods may be used retrospectively to detect disease activity. Evaluation of the contents of gingival crevicular fluid has promise as a noninvasive method of determining tissue changes in the periodontium. To date, none of the crevicular fluid constituents has been a reliable indicator of disease activity. Tissue changes in the periodontium are important in understanding the disease processes but have had limited value as indicators of disease activity. The ability to determine disease activity through identification of substances or changes in the systemic circulation would prove quite useful to the clinician. Although some reports found lymphocyte transformation indicative of active disease, others had conflicting results. Finally, examinations of sulcular microbiota provided evidence suggesting that active periodontal disease was associated with specific groups of pathogens and with elevated counts of motile organisms. The evaluation of such pathogens and motile organisms currently shows the most promise for determining periodontal disease activity. However, long-term assessments and further clinical trials are necessary before this type of evaluation can be widely accepted. It is hoped that such studies will enable the clinician to predict the natural history of active and inactive periodontal disease.

Standard wounds of simple incision and trauma were made in the gingivae of monkeys. The healing from the 1st to the 21st day was described clinically, his'tologically, physically and biochemically. There were no major clinical differences, but both atraumatic and traumatic wounds have reactions in the periodontium to be considered in postoperative care.

The periodontal probe is used clinically to measure pocket depth and the level of periodontal attachment. In order to be a more reliable, noninvasive method of assessment, it is necessary to investigate the position of the tip of the probe when at rest in the dentogingival junction. Probes were assessed for accuracy, and those closest to a standard millimeter scale were used to make pressure-cast, gold-coated, acrylic replicas. The replicas were placed in the gingival crevice of Rhesus monkeys with normal gingiva and with experimentally-induced gingivitis and periodontitis. Clinical, histologic, and histometric evaluations were made in block sections. In normal gingiva and in areas of gingivitis the probe tip stopped at the base of the crevice and was contained within epithelium. In periodontitis the probe sometimes penetrated the epithelium and stopped at the level of the connective tissue attachment. Even with gentle probing there was slight tearing and distortion of the gingiva at the base of the pocket. It was concluded that probing depth estimates indicated the level of a healthy dentogingival junction but did not differentiate between epithelial and connective tissue attachment.

Untreated periodontally-involved extracted human teeth were cleaned of plaque and calculus and then treated with chemicals having the potential to dissociate or degrade endotoxin. The count of attached gingival fibroblast cells after 48-hours of culturing was used as a measure of the biocompatibility of the diseased root surface. Paired specimens compared to their phosphate-buffered saline controls demonstrated no significant differences for the use of sodium lauryl sulfate and EDTA, plasma protein fraction, immune serum globulin, citric acid, or sodium deoxycholate followed by immune serum globulin.

Standard wounds of simple incision and partial excision of the dentogingival junction were made in miniature swine. The healing from the 1st to the 14th day were described clinically and histologically, and the standardization of the wounds permitted quantitative and statistical analysis. In wounds that are closely adapted to the tooth, the epithelium of the new dentogingival junction contributes primarily to early wound strength recovery. This functional achievement probably would not occur with thick clots or hematomas, or with any displacement of the gingiva away from the tooth.

Ninety-eight young adult patients were examined and scored according to the criteria of the Navy Periodontal Screening Examination. The population examined had a 98% incidence of inflammatory periodontal disease. The relationship of the Navy Periodontal Disease Index and the Navy Plaque Index total scores was determined to +0.55 (P 0.01). The relationship of the gingival score of the NPDI and the NPI was found to be +0.75 (P 0.01). The Navy Plaque Index, like others reported, has a better relationship to a reversible index of inflammatory periodontal disease. The use of the NPDI total is recommended as an aid in determining treatment recommendations.

The healing of a new attachment procedure was evaluated in monkeys. Standard pedicle wounds similar to reverse bevel flaps were made in previously created periodontal pockets. The diseased root surfaces were treated with sodium deoxycholate (2%) and human plasma fraction Cohn IV (5%), applied to experimental sites for 1 minute each. Control surfaces were similarly treated with phosphate buffered physiological saline. The healing from the first to the 21st day was described (1) clinically, (2) histologically, (3) by rupture strength, and (4) by collagen production assays. All control sites healed with a dentogingival junction comprised only of junctional epithelium. Most experimental sites healed by means of junctional epithelium and some connective tissue new attachment at the apical extent of the wounds.

A group of 40 healthy, young adult male naval recruits were examined and scored for gingival inflammation, plaque, food impaction, pocket depth, carious lesions, calculus, restorations and overhangs. The findings of this study support those previously reported in naval recruits, i.e. gingival inflammation is widespread involving almost every area examined. Naval recruits do not adequately remove deposits of interdental plaque, and at least one pocket with a depth of 4 mm or greater is present in three out of every four recruits. Additionally, it was found that the level of gingival inflammation was considered moderate or severe in more than 80% of the areas examined. Analysis revealed no significant relationship between contact type and Gingival Index or pocket depth. However, the significant relationship observed between food impaction and contact type, and between food impaction and pocket depth, reinforced clinical observations that food impaction contributes to periodontal pathosis. A high number of restorations had mechanical retentive areas for bacterial plaque accumulations. Thus, in addition to establishing adequate levels of interproximal surface plaque removal by the patient, the clinician should take great care in finishing the gingival margins of restorations and should eliminate those factors associated with food impaction early in treatment.

MICROFIBRILLARY COLLAGEN hemostat (MCH) is described in clinical use as a topical hemostatic agent for control of bleeding at the donor site of the free gingival graft procedures. On the basis of clinical trials, it is an excellent adjunct to periodontal surgical procedures.