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This study quantitatively assessed radiographic changes in alveolar bone density by computer-assisted densitometric image analysis (CADIA) in periodontal defects that were treated with decalcified freeze dried bone allograft (DFDBA) alone or in combination with interproximal expanded polytetrafluroethylene membranes (ePTFE). The radiographic changes where then analyzed for correlation with the clinically assessed changes. The radiographic changes were evaluated on standardized radiographs of treated sites treated prior to, 1 week after surgery, and 6 months post-operatively. 15 patients with one pair of bilateral interproximal periodontal defects of similar morphology and > or = 6 mm in pocket depth participated. Analysis of the changes 6 months after treatment showed that the increases in density in the defect areas that received the graft were significantly greater than the adjacent areas (p < 0.001). These adjacent areas, in contrast, demonstrated significantly larger loss in radiographic density than the defect area (p < 0.001). The placement of DFDBA into the defects produced in itself significant increases in radiographic density, as illustrated by the results of one week which remained at six months. Utilization of ePTFE addition to DFDBA did not lead to additional radiographic gains in the defect area. While at one week the analysis suggested increased resorption by the combined treatment over grafting alone, such differences did not persist at 6 months post-surgery. Analysis comparing CADIA derived values for change with those of the clinical assessment revealed some associations.(ABSTRACT TRUNCATED AT 250 WORDS)

This study clinically evaluates the use of decalcified freeze-dried bone allograft (DFDBA) in conjunction with an expanded polytetrafluoroethylene (ePTFE) membrane specifically designed for the treatment of interproximal intraosseous defects. It also examines by SEM, plaque contaminated membranes retrieved from patients. 15 advanced periodontitis patients with two bilateral interproximal probing depths of > or = 6 mm participated. After hygiene phase, measurements were made to determined soft tissue recession, pocket depth, clinical attachment levels and amount of keratinized tissue. Defects from each pair were randomly treated with ePTFE plus DFDBA (experimental) or DFDBA alone (control). Measurements were made during the surgery to determine crestal resorption, defect resolution and defect fill. Membranes were removed at 4 to 6 weeks and analyzed by SEM. Each site was surgically reentered and measurements repeated at six months. Both groups showed clinical and statistically significant changes when compared to baseline (P < 0.01), but no difference between groups. The experimental group showed increased soft tissue recession vs control group, 0.9 versus 0.4 mm, and loss of keratinized tissue 1.6 versus 0.1 mm (P < 0.0001). Control sites showed a 58% bone fill while experimental sites had 70% bone fill. There were no clear patterns of microbial colonization or cell adherences in either side of the membrane. It was concluded that the presence of plaque on the membranes did not compromise the initial clinical healing during the first 4-6 weeks. Results suggest a beneficial effect with the use of either technique for the treatment of intraosseous defects.

Bisphosphonates have been shown to increase bone mass in estrogen-deficient patients by inhibiting osteoclast activity. The purpose of this study was to measure clinical and radiographic effects of a bisphosphonate on periodontitis development in monkeys. Twenty-seven (27) adult cynomolgus monkeys were studied. After quarantine, baseline data were obtained including plaque index, gingival index, clinical probing depth measurements, and intraoral radiographs. Standardized radiographs were analyzed for quantitative changes in bone density using a computer assisted densitometric (CADIA) system. Animals were divided into 3 groups to receive 1 of the 3 treatment agents; these agents consisted of two levels of the test drug (alendronate) and a saline placebo. Agents were injected in the saphenous vein of the lower leg every 2 weeks for 16 weeks. One week after the initiation of treatment agent injections, mandibular right molars and premolars were ligated with 3-0 silk sutures to induce periodontitis. Ligated teeth were also inoculated with Porphyromonas gingivalis to insure a significant etiologic challenge. Nonligated homologous teeth served as controls. Clinical measurements and radiographs were repeated at 8 and 16 weeks after ligation. The bisphosphonate at a concentration of 0.05 mg/kg significantly retarded the progression of periodontitis as measured by bone density changes. The higher level dose of the test drug did not differ from placebo with respect to loss of bone density. Clinical indices were not affected significantly by the test drugs. Drugs that alter bone metabolism may offer a new approach to the treatment of periodontal disease.

Partial edentulism in 34 patients was consecutively treated using the Brånemark osseointegration technique. A total of 102 implants was tested for mobility, signs and symptoms of infection, and radiographic bone levels. All patients had at least a 6-month follow-up of prosthesis function (mean 22.5 months). An overall success rate of 88.2% was observed. Twenty-five of 28 maxillary implants and 65 of 74 mandibular implants were successfully placed and restored. Twelve failures were observed; 7 were not integrated at the time of stage 2 surgery while 5 occurred after prosthetic reconstruction. The results of this study suggest that the Brånemark osseointegration procedure can be used to treat partially edentulous patients with a high degree of success.

Suture granulomas mimic neoplasms in clinical appearance and may increase in frequency as dental implant therapy increases. This case report illustrates the clinical and histologic features of this sometimes perplexing postoperative complication.

This study was conducted to determine if erythrosine had any effect when placed in contact with alveolar bone and gingival connective tissue in dogs in conjunction with a periodontal surgical procedure. Periodontal surgery was performed on 15 dogs, with a mucoperiosteal flap affording access for introduction of erythrosine (test) or saline (control) solutions, and subsequent flap replacement. The dogs were sacrificed at 2, 7, 10, 14, 21, and 28 days. Autopsy specimens were prepared, stained, sectioned, and examined by light microscopy. The general amount, degree, and type of inflammatory infiltrate was evaluated and recorded. Erythrosine had no apparent effect on the clinical healing time, alveolar bone, or gingival connective tissue in regard to the general degree, type, and location of the inflammation infiltrate based on postsurgical observations.

Palato-gingival grooves are developmental anomalies of maxillary incisors which contribute to severe localized periodontitis and loss of anterior teeth. Because these grooves or their root extensions are covered by periodontal tissues, they are easy to overlook as etiologic factors. This article describes palato-gingival grooves and discusses their prevalence, diagnosis, and treatment.

Overhanging dental restorations (ODR) are a major dental health problem. An ODR is defined as an extension of restorative material beyond the confines of a cavity preparation. They have been strongly implicated as an etiologic factor in the progression of periodontal disease and are alarmingly prevalent. In addition to promoting plaque accumulation, they change a nondestructive subgingival flora to a destructive one. There is good documentation that bleeding, gingivitis, and bone loss increase in tissues adjacent to ODR as compared to homologous teeth. Removal of ODR enhances the effectiveness of the hygienic phase of periodontal therapy. Many ODR, however, are not detected on radiographs and are evident only by use of an explorer directed subgingivally. For this reason and others, many are not removed. This literature review summarizes research concerning the prevalence, significance and removal of ODR.

The purpose of this investigation was to determine the prevalence of the palato-gingival groove in maxillary incisor teeth and the health status of the lingual periodontal tissues adjacent to maxillary incisor teeth with and without the grooves. A total of 531 individuals aged 17 to 35 years were examined for the presence or absence of palato-gingival grooves in their maxillary incisor teeth. A Plaque Index (PII), Gingival Index (GI), and Periodontal Disease Index (PDI) were recorded for the lingual aspect of the four maxillary incisors. Tooth mobility was also recorded. The prevalence of the palato-gingival grooves in the 531 individuals examined was 8.5%. Of the 2,099 maxillary incisor teeth examined, 2.33% had a palato-gingival groove. Most of the palato-gingival grooves (93.8%) were in maxillary lateral incisor teeth. Statistical analyses revealed no differences in groove prevalence on the basis of sex or race. Results of the study also indicate that the palato-gingival groove is associated with poorer periodontal health as measured by the GI and PDI and more plaque accumulation as measured with the PII.

Gingival enlargement was studied and measured in ten patients before, and for 18 months after discontinuation of phenytoin therapy. A clinically evident decrease in gingival hyperplasia occurred after discontinuing phenytoin in all subjects; all subjects, however, had mild hyperplasia after 18 months. These results may encourage increased use of alternative antiseizure drugs.

Although periodontitis is a bacterial disease, its multidimensional nature and its bacterial complexity have made it difficult to definitively prove that specific microorganisms initiate the disease process. The successful implantation of a rifampin-resistant strain of the putative periodontal pathogen Bacteroides gingivalis into the periodontal microbiota of monkeys (Macaca fascicularis) resulted in an increase in the systemic levels of antibody to the microorganism and rapid and significant bone loss.

An internal mattress suture is described for suturing labial papillae to palatal flaps when using the "curtain technique." The suture is simple to perform and does not violate the intact labial sulci. It gives stability to both the labial papillae and palatal flap while maintaining maximum esthetic results.