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Purpose: The aim of this literature review and case report was to point out the relationship between Cowden Syndrome (CS) and severe periodontitis. CS is a rare autosomal dominant disorder characterised by skin and oral hamartomas, and is associated with an increased risk of cancer development., Case Report: The case of a 43-year old male patient affected by Cowden syndrome and presenting severe periodontitis was reported., Results: It can be suggested that the specific gingival morphology of the patient with CS might be a risk factor for the development of periodontal disease, as described in the present case report., Conclusion: Early diagnosis is crucial in patients affected by CS. The dentist may be the first to notice any atypical changes in the oral cavity and refer the patient for further examinations. Moreover, the mucosal and skin changes have a tendency to appear prior to the malignancies associated with the syndrome. This highlights the responsibility of the dentist in the early diagnosis of this progressive pathological syndrome.

Objective: This retrospective study aimed to evaluate the long-term response of molars affected with severe periodontitis to periodontal treatment, to analyze the differences in response between molars with and without furcation involvement (FI) and to reevaluate the usefulness of the existing classification of FI in determining the prognosis., Method and Materials: A total of 402 patients from a single private practice were included. The observation period was 27 years (mean 16.5 years). The average frequency of the supportive periodontal therapy (SPT) visits was 1.76 ± 0.57 per year (median 1.95/ year). Inclusion criteria were: at least 10 years of periodontal follow-up, at least one tooth with probing depth ≥ 6 mm, level 4 of the Dutch Periodontal Screening Index (DPSI)., Results: Of the 2,559 molars present at the initial examination, 125 were extracted immediately. Degrees III or II FI were found in 37.2% molars, while 62.8% exhibited degree I or had no FI. The performed periodontal treatments were: nonsurgical therapy of scaling and root planing (77.6%), eventually repeated scaling and root planing (11.6%), access flap (7.8%), tunnellization (0.2%), and root resection (2.8%). The survival rate was 83.9% (77.5% molars with FI; 87.8% without FI). The presence or absence of FI did not exhibit a significant effect in any of the treatments provided., Conclusion: Simple treatments can successfully be applied to treat molars affected with severe periodontitis, even with FI, yielding good long-term survival rates. The classification of FI was not of great use in determining the prognosis except in case of degree III FI.

Objectives: The aim of this prospective, randomized, controlled clinical study was to compare the effectiveness of a newly developed ultrasonic device to that of scaling and root planing for non-surgical periodontal treatment., Material and Methods: Thirty-eight patients with moderate to advanced chronic periodontal disease were treated according to an "one-stage procedure" with either a newly developed ultrasonic device (VUS) (Vector-ultrasonic system) or scaling and root planing (SRP) using hand instruments. Clinical assessments by plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 6 months after treatment. Differences in clinical parameters were analyzed using the Wilcoxon signed ranks test and Mann and Whitney U-test., Results: No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the VUS group from 32% at baseline to 20% after 6 months (p<0.001) and in the SRP group from 30% at baseline to 18% after 6 months (p<0.001). The results have shown that at moderately deep sites (initial PD 4-5 mm) mean CAL changed in the test group from 4.6+/-1.2 to 4.2+/-1.6 mm (p< 0.001) and in the control group from 4.8+/-1.3 to 4.4+/-1.5 mm (p<0.001). At deep sites (initial PD>6 mm) mean CAL changed in the test group from 8.5+/-1.9 to 7.9+/-2.4 mm (p<0.001) and in the control group from 7.9+/-1.6 to 7.2+/-2.2 mm (p<0.001). No statistically significant differences in any of the investigated parameters were found between the two groups., Conclusion: Non-surgical periodontal therapy with the tested ultrasonic device may lead to clinical improvements comparable to those obtained with conventional hand instruments.

The expression of vimentin is well documented in the intact animal and human periodontal ligament (PDL), but there is limited information on the pattern of vimentin expression in the regenerated PDL. The aim of the present study was to investigate the pattern of vimentin expression in the regenerated and intact monkey and human PDL. A total of 12 chronic recession-type defects were created in three monkeys (Macaca fascicularis) and treated either with guided tissue regeneration (GTR), or with an enamel matrix protein derivative (EMD). After 5 months, the animals were sacrificed and specimens containing the defects and surrounding tissues were dissected free, decalcified in EDTA and embedded in paraffin. Sections were labelled immunohistochemically by using monoclonal antibody against vimentin (VIM 3B4). Twelve patients, each of whom displayed one deep intrabony defect scheduled for extraction were treated with GTR, EMD or combination of EMD+natural bone mineral (NBM). Following a healing period of 6 months, the teeth were extracted "en block" and immunohistochemically analysed according to the same protocol as described in monkeys. The results revealed that in both monkeys and humans the newly formed PDL was labelled similarly for vimentin to the intact (non-treated) PDL. In all specimens, the newly formed PDL was in continuation with the intact parts of PDL, thus suggesting that the mesenchymal cells capable of regenerating the attachment apparatus may have their origin in the intact PDL. In conclusion, the present findings indicate that (a) the reformed PDL displayed a similar expression of vimentin to the intact (original) PDL, and (b) the cells capable of regenerating new PDL and new cementum appear to be of mesenchymal origin and their source may be in the intact PDL.

Aim: : The purpose of the present study was to compare clinically the treatment of deep intrabony defects with a combination of a bovine-derived xenograft (BDX) and a bioresorbable collagen membrane to access flap surgery., Methods: : Twenty-eight patients suffering from chronic periodontitis, and each of whom displayed one intrabony defect, were randomly treated with BDX + collagen membrane (test) or with access flap surgery (control). Soft tissue measurements were made at baseline and at 1 year following therapy., Results: : No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.2+/-1.3 to 3.9+/-0.7 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.2+/-1.5 to 6.2+/-0.5 mm (p<0.0001). In the control group, the mean PD was reduced from 9.0+/-1.2 to 5.2+/-1.8 mm (p<0.001) and the mean CAL changed from 10.5+/-1.5 to 8.4+/-2.1 mm (p<0.01). The test treatment resulted in statistically higher PD reductions (p

The aim of this double-blind, 28-week study was to evaluate the plaque-inhibitory and antigingivitis efficacy of a fluoride toothpaste containing 0.3% triclosan and essential oil (Dental Kosmetik, Dresden, Germany) in comparison with a control toothpaste. One hundred twenty subjects previously treated for chronic periodontitis were included in the study. At baseline, 8, 18, and 28 weeks, plaque accumulation (PlI) and gingival status (GI) were assessed. Probing pocket depth (PD) and bleeding on probing (BOP) were measured at baseline and week 28 using a Florida probe. No professional hygiene was delivered during the study period. Mean plaque scores decreased between baseline and week 8 in both groups. At the end of the study, a significant increase of mean PlI compared to baseline could be observed in the test and in the control groups. Comparing the two groups, the PlI in the triclosan group was significantly lower than in the control group. Mean gingival scores decreased significantly during the first 8-week period in both groups. This reduction was followed by an increase of GI in the control, while the GI in the test group reached a significantly lower value than in controls after 28 weeks. Furthermore, at week 28, in both groups the PD were decreased as compared to the pre-study data. It is concluded that the triclosan/essential oil additive in a fluoride-containing dentifrice exhibited distinctive antigingivitis as well as plaque-inhibitory effects during a 28-week maintenance period in periodontitis patients.

A well known development of the chronic periodontal disease is reviewed. However, the histological picture of gingiva varies at a much lower speed than its clinical picture, and slower than previously described. In presence of periodontitis there may exist a zone of reversible disease of about 2 mm, which gives the possibility of obtaining a re-attachment of unknown magnitude. A new connective tissue attachment (on top of the re-attachment) seems only possible if the periodontal ligament cells are allowed to proliferate coronally.

The polymorphonuclear neutrophil (PMN) appears to be an important cell in the protection of the host from pathogenic periodontal micro-organisms. The purpose of the present histological studies was to observe the emigration of the PMN from the gingival vessels to the periodontal pocket during gingivitis and ligature-induced periodontitis in the cynomolgus monkey. 2 adult female monkeys were treated by application of a silk ligature around selected posterior teeth. After 9 weeks, the monkeys were perfused and block sections of both ligated (early periodontitis) and non-ligated (gingivitis) sites were obtained, cut into smaller blocks containing a single interdental area (N = 15 for periodontitis, N = 5 for gingivitis) and processed for light and electron microscopic observations. Morphologically, no differences in PMNs between gingivitis and periodontitis were observed and therefore the following description applies to both disease states. In the vessels, the endothelial cells appeared to be actively involved in PMN emigration, maintaining long processes which surrounded the PMNs. Within the connective tissue, the PMNs maintained their typical morphology which included polylobated nuclei and numerous lysosomal granules. Many intact PMNs were observed intercellularly within the connective tissue and the epithelium. Within the periodontal pocket, a multilayer of PMNs surrounded the plaque mass. Cells with numerous bacteria-containing phagolysosomes were observed with increasing frequency as they approached the plaque. Deeper within the bacterial deposit, PMNs were seen in varying stages of degeneration. These histologic studies, when interpreted in the light of reports of severe, rapidly-progressive periodontitis in patients with PMN disorders, suggest that the interaction of PMNs with bacterial plaque may serve to maintain a defensive boundary which protects the host tissues from irreversible destruction.

Histologic observations were made on the primate Macaca fascicularis in order to describe the features of both naturally-occurring gingivitis and gingivitis present at non-experimental sites when selected teeth were ligated to induce periodontitis. Semi-thin sections of glutaraldehyde-paraformaldehyde fixed, EDTA-decalcified, and epon-embedded specimens were used, supplemented by routine histologic methods. The microscopic picture of the interdental areas was identical for the two types of gingivitis specimens and consisted of a chronic inflammatory reaction resembling the established lesion in humans. The highly infiltrated gingival tissue exhibited a predominance of plasma cells. Leukocytes were seen in pathways from the connective tissue, through the epithelium and to the surface of the plaque, and many neutrophils were interposed between the plaque and soft-tissue. The apical extent of the junctional epithelium was at or slightly below the cemento-enamel junction. Although perivascular inflammation was observed in the transseptal fiber region, the alveolar crest exhibited only evidence of normal bone remodelling. [ABSTRACT FROM AUTHOR]

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