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The uptake of 99Tcm-DP in normal facial bones was not changed by irradiation of malignant tumors. The intensity of the pathologic uptake into regions with active parodontitis in a few patients increased during irradiation. The uptake of 99Tcm-DP in bone with neoplastic growth varied during the period of treatment, probably depending on the tumor reaction to irradiation.

12 patients suffering from advanced periodontitis with probing depths of 4 mm or more, were selected to assess the efficiency of an oral antibiotic during a period of 15 days in the treatment of periodontal disease. Our double-blind test, shows a decrease of gingival inflammation involving a comparison of clinical and histological parameters. thus highlighting the indisputable therapeutic role of antibiotic therapy. By means of a "t" test of Student a significant decrease in the plaque index, the gingival index and the bleeding index was noted between day 0 and day 15 as well as a significant increase in the recessions. However, no significant difference was obtained in the probing depths and the attachment level. These clinical results were correlated with histological parameters, namely a significant drop in the volumetric density of the infiltrated connective tissue, of the non collagenases structures, the blood vessels and the number of plasma cells, in addition to a significant increase in the volumetric density of the noninfiltrated connective tissue, in the collagenous structures and the number of fibroblasts.

A case of severe periodontitis in a young man suffering from cyclic neutropenia is reported. The periodontal status as evaluated from oral radiographs at the age of 13 reveals advanced periodontal breakdown around the molars and the incisors in both jaws. At the age of 21, when clinical examination was performed, all teeth were found to be periodontally involved. The treatment was divided into three phases: (1) a causative treatment phase (oral hygiene phase) aimed at achieving the highest possible level of oral cleanliness, (2) a corrective phase including periodontal surgery and prosthetic rehabilitation and (3) a maintenance phase aimed at prevention of recurrence of periodontal disease. The oral hygiene phase was markedly extended both in time (2 years) and intensity. Several reexaminations were carried out during the course of this phase to evaluate the patient's ability to exercise proper plaque control and the response of the tissues to treatment. The progression of the periodontal disease could be arrested and the prosthetic treatment indicated was successfully performed. Following the corrective treatment phase a maintenance care program was designed including frequent recall appointments in order to prevent disease recurrence. Four years after active treatment no further periodontal breakdown could be observed as evaluated from pocket depth, attachment level and bone height measurements. The result of the treatment of this patient shows that treatment, designed to eliminate plaque infection, is effective also in an individual with defective host defense against bacterial infections, but the demand on the patient's cooperation must be extraordinary high as well as the demand on the effectiveness of the maintenance care program.

27 patients with periodontal lesions were examined by Panorex layered film and 14 intra-oral dental X-ray films (Updegrave's long tube right angle technique). The result of this enquiry shows that the two radiological methods do not compete with one another. Each has advantages over the other which derive from fundamentally different exposure techniques. The dental status films with right angle technique are superior in showing clear periodontal structures and hard dental tissue whilst the Panorex method gives X-ray surveillance over the whole mastication organ and neighbouring structures which cannot be visualised in its entirety by the intra-oral method.

The objective of this study was to determine the effect of crevicular application of a collagen stabilizer on ligature-induced periodontal disease in beagle dogs. Fourteen male and female dogs, 15 months of age, were studied. The mandibular first molars and third and fourth premolars were ligated for 6 months and moderate periodontitis resulted. Ligatures were removed for 2 months and then replaced for an additional 3 months to experimentally mimic the episodic changes seen in human periodontal disease. Following this phase, ligatures were removed and the animals were assigned to a placebo or treatment group. Medications were then applied intracrevicularly, three times a week over 5 months using an IMAX irrigator. Clinical indices measured were plaque index (PI), gingival index (GI), gingival crevicular fluid flow (GCF), attachment level (AL), pocket depth (PD) and standardized radiographic analysis of alveolar bone height. While overall changes in PI, GI and GCF were not significant, the results showed that alveolar bone regeneration was increased approximately twice as much in the treatment group as compared to the placebo group, PD improved by 20% vs. 12.5% (P less than 0.001) and AL improved by 8.8% vs. 4.5% (P less than 0.001). The data were also evaluated in terms of the response in more severe sites as compared to those less severe. The results of these evaluations showed the more severe sites to be significantly more responsive to treatment than the less severe sites.(ABSTRACT TRUNCATED AT 250 WORDS)

There has recently been a substantial change in our concept of periodontal disease and particular attention is now focused on that small proportion of the population who appear susceptible to its more aggressive forms rather than the majority in whom bone loss progresses very slowly. It is also apparent that the presently available clinical parameters are of little value in predicting future destructive activity. Under these circumstances, the aim of this paper is to review the contribution of radiography to the diagnosis of chronic periodontitis as traditionally perceived and then reassess its status in the light of these newer concepts. Panoramic radiography, followed by the appropriate periapical radiographs (taken with the paralleling technique), is proposed as an alternative to complete mouth intra-oral surveys on grounds of both diagnostic yield and radiation thrift. The five areas to which radiography, despite its limitations, can make a significant contribution are in the assessment of bone loss, mobility, occlusal trauma, calculus and marginal overhangs and crown-root ratio. The validity of the three criteria that have been proposed for the radiographic assessment of early periodontitis, loss of crestal bone height, marginal widening of the periodontal ligament and crestal irregularity, is evaluated in detail and it is concluded that only the first is of any diagnostic worth, providing at least two sequential radiographs are available. While there is an urgent need to develop techniques of greater sensitivity for the early identification of periodontal bone loss, there must be some doubt as to the value of any bone imaging technique in predicting the susceptible patient. Follow-up radiography should be limited to these sites showing clinical evidence of further disease activity.

The difference in proximal alveolar bone height between 1970 and 1980, the 'ABD index', has been measured longitudinally in radiographs from an unselected material. The group constitutes 406 individuals born in 1904-1952 in the county of Stockholm. Thirteen of 18 predictors determined in 1970 were significantly related to the ABD index in the simple correlation analyses. The predictor 'the alveolar bone loss 1970' ('ABL index 1970') had the strongest correlation to the ABD index. In the stepwise multiple regression analysis the predictor ABL index 1970 and three other predictors reached significant levels. These were age, number of lost teeth, and Russell's Periodontal Index.

In a total of 20 patients (of these 8 without parodontopathy and 12 with parodontitis marginalis profunda), a quantitative scintigraphy of the jaw bones was carried out after application of 99mTc-methylene diphosphonate with a gamma camera computer system. In 8 patients without parodontopathies, approximately the same metabolic activity in the bone was found in the os occipitale as well as in the mandible and maxilla. The 12 patients with parodontitis marginalis profunda showed in contrast to this an appreciable raised bone metabolism in the region of the affected jaw bone. This finding was in agreement with corresponding alterations in the X-ray of the jaw. The use of bone scintigraphy in marginal parodontopathies thus provides in addition to the radiological finding information on processes of bone transformation and degradation which can be registered quantitatively. Digital analysis enables control of the course of therapie.

In Sweden people in all age groups now have more remaining teeth than previously. An investigation has been made to identify some predictors of alveolar bone loss in a 10-year period in subjects with at least 20 remaining teeth. The material consisted of 349 individuals, examined radiographically, clinically, and by interview in 1970 and in 1980. These subjects, born in 1904-1952, constituted a subgroup, with regard to remaining teeth, of an unselected sample of the population of the old county of Stockholm. In the unselected sample statistically significant predictors of alveolar bone loss found in a stepwise multiple regression analysis were alveolar bone loss in 1970, age, number of lost teeth, and Russell's Periodontal Index (PI). In the subgroup the predictors were in the order Russell's PI and smoking. The prediction values (R2) of further variables were marginal. The analyses showed that there was an interaction between PI and smoking, implying that the effect of smoking on alveolar bone loss was increased in individuals with high PI values. Furthermore, a tendency was found for a dose-response effect of tobacco consumption. This tendency almost disappeared when controlling for PI.

The prevalence of periodontitis was studied in a population of insulin-dependent diabetes mellitus (IDDM) patients, aged 10-18, with a variety of disease durations and levels of control. The sample included a number of patients with poorly controlled IDDM of long duration. None of the patients had radiographic signs of periodontitis. When considered in conjunction with previously reported studies, the findings suggest that populations of IDDM patients may differ in susceptibility to the periodontal diseases; thus, generalizations concerning prevalence based on only a few studies may be inappropriate.

The composition of subgingival plaque, from healthy and periodontally diseased regions, as well as the clinical periodontal condition of 6 patients, 17 to 24-years-old suffering from juvenile periodontitis were examined. 6 older patients with rapidly progressive periodontitis served as a control. Samples of subgingival plaque were taken from first molars and central incisors and were analysed morphologically by dark-field microscopy. In the control group in healthy regions the ratio between non-motile and motile bacteria was 27:1 and about 1:1 in deep pockets. In the juvenile periodontitis group in diseased regions, motile bacteria made up only 1/4 of the bacteria present. The results clearly show that our relatively old patients with juvenile periodontitis had a completely different microflora in their periodontally diseased regions than patients with common periodontitis. As regards our observations by dark-field microscopy, one can assume, however, that with increasing age, there might be a shift of the flora associated with juvenile periodontitis lesions from a rather simple composition to a more complex composition very similar to the flora seen in rapidly progressive adult periodontitis lesions.

1. The placement of cotton floss ligatures in a position apical to the gingival margin of premolars and molars in young dogs induced an acute inflammatory reaction in the periodontal tissues resulting in loss of connective tissue attachment and alveolar bone. 2. Bone resorption could be observed histologically within 7 days, and radiographically within 2 to 3 weeks after ligature placement. 3. Daily administration of indomethacin interfered with the periodontal tissue response to ligature placement. Indomethacin was shown to (i) delay the onset and to suppress the magnitude of the acute inflammatory reaction, and (ii) decrease the degree of alveolar bone resorption.

The bitewing radiographs of 1,731 English and Danish schoolchildren aged 13--15 years were examined to assess the prevalence of chronic periodontitis. Only one child (0.06%) was found to be affected in comparison with the high prevalence of 51.5% reported by Hull et al. (1975). Minute qualitative changes in the radiographic appearance of the alveolar crest, or changes in the visual representation of the width of the periodontal ligament space are not reliable or valid criteria for assessing chronic periodontitis. Horizontal bone loss observed on radiographs, which can be accurately measured using the cemento-enamel junction as a reference point, is a useful diagnostic criterion for the measurement of chronic periodontitis.

From a series of about 200 facial bone scintigraphies, 32 patients were selected to demonstrate the uptake of 99Tcm-diphosphonate in various inflammatory and neoplastic diseases in the sinuses and oral cavity. The method was found of value in separating patients with inflammatory involvement of the bone from those without, as well as in assessing possible bone involvement in malignant lesions.

The potential diagnostic usefulness of subtraction radiology in dentistry was evaluated by means of an experimental model of marginal periodontitis in cynomolgus monkeys. Beam-guiding, field-limiting, intraoral radiographic instruments were modified to allow construction of appliances which yielded repeatable superimposable radiographic images during the course of a 16-week study. Marginal periodontitis was induced in monkeys by means of circumferential silk sutures tied around mandibular second molar and second premolar cementoenamel junctions, and serial radiographs were taken at weekly intervals for 16 weeks. Control subtraction masks were made from pretreatment radiographs, and bone loss was evaluated by means of elapsed-time films to give the subtraction prints. The subtraction films clearly showed increasing bone loss with time and were produced easily with size O dental films. This technique appears to have considerable potential usefulness in the evaluation of bone-density changes in experimental models of dental diseases as well as in the clinical setting.

A retrospective analysis was carried out to determine the frequency and onset of endodontic complications occurring in 52 patients treated for advanced periodontal disease. Comparisons were made between teeth which, following periodontal treatment, were used as abutments in fixed prosthetic reconstructions and nonabutment teeth. The study included 672 teeth with initially vital pulps (255 abutment teeth and 417 nonabutment teeth). The observation period varied from 4 to 13 years with a mean of 8.7 years. Pulpal necrosis including periapical lesions developed with a significantly higher frequency in abutment teeth than in nonabutment teeth (15% vs. 3%). The majority of these lesions did not appear until several years following the completion of active treatment. Conceivable reasons for the development of pulpal necrosis in teeth subjected to combined periodontal and prosthetic treatment are discussed.

The progression of proximal alveolar bone loss (ABD index) in an unselected material comprising 406 individuals was analysed by a longitudinal investigation over a period of ten years. In order to minimize the number of measurements and the drop-out of measurements of the difference in alveolar bone height between the two examinations a partial recording system was constructed. A partial index including five sites (12 m, 11 m, 33 d, 31 d, 41 m) gave high correlation to a total recording (r = 0.96). The best alternative in periapical radiographs to measuring the alveolar bone height in relation to the root length was to measure it in relation to the tooth length. This second method does not necessitate identification of the cemento-enamel junction. The mean alveolar bone difference was 5.5 per cent of the mean root length, which corresponds to an average bone loss of 0.09 mm per year. Eighteen variables were analysed as predictors in stepwise multiple regression analyses. The dependent variable was the "ABD index". Four predictors reached significance at 1 per cent level in the multivariate analysis, the alveolar bone loss 1970 ("ABL index 1970"), "Age", "Number of lost teeth" and "Russell's Periodontal Index" ("PI"). The coefficient of determination (R2) was 0.40. In a selected part of the material, consisting of individuals with at least 20 remaining teeth, the stepwise multiple regression analysis was repeated with the same 18 predictors. On this occasion two predictors reached significance at 1 per cent level, "PI" and "Smoking", and these two factors showed an interaction.

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.

Radiographic, gross, and histologic evidence is provided to demonstrate the development of caries and periodontal disease over a 5-year period in an unerupted tooth. The authors speculate on the pathogenesis of these disease processes.

A clinical trial was undertaken to test the hypothesis that periodontitis can be cured and that bone regeneration occurs in infrabony pockets in patients maintained on an optimal standard of oral hygiene. The material comprised 24 patients with advanced periodontal disease. After an initial examination, the patients were randomly distributed into one test group and one control group. All the patients were given instruction and practice in a proper oral hygiene technique, and then subjected to periodontal surgery using the modified Widman flap procedure. Following treatment, during a 2-year period the patients of the test group were recalled once every second week for professional tooth cleaning. The control patients were recalled once every 12 months for prophylaxis. The results showed that all osseous defects of the patients of the test group were refilled with bone. The control patients, on the other hand, could not maintain a high standard of oral hygiene, and exhibited a progressive deterioration of the periodontal tissues during the postsurgical observation time.