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New attachment procedures were performed in 80 three-wall intrabony defects produced adjacent to incisors and canines in monkeys. Following a reverse bevel incision, mucoperiosteal flaps were raised on the buccal and lingual aspect of 40 intrabony defects. All soft tissue was removed from the defects and following transplantation of autogenous bone grafts. the tissue flaps were replaced and sutured. On the buccal and lingual aspect of another 40 intrabony defects a split flap procedure was performed. Granulation tissue was removed from the defects and following transplantation of autogenous hone grafts, the defects were covered with free palatal grafts. The animals were sacrificed to yield observation periods from 0 to 42 days. After decalcification of the specimens and embedding in paraffin, 8-μm serial sections were cut and stained. The epithelium on the full thickness flap seemed almost unaffected by the surgical procedure and had migrated between 0.2 mm and 2.0 mm along the root surface during the first week of healing. The epithelium on the transplants degenerated almost completely within the first week after surgery and epithelial migration along the root surface was not observed until after 10-12 days. These results indicate that the migration of epithelium during the postoperative phase of new attachment attempts can be retarded by covering the defects with free palatal grafts instead of full thickness flaps. [ABSTRACT FROM AUTHOR]

The plasma cell population in gingival biopsies from 3 groups of patients with adult, juvenile, and rapidly progressive periodontitis was characterized with respect to the distribution of individual immunoglobulin isotypes, including IgA subclasses, by paired immunofluorescence staining. The median ratios of IgG:IgA plasma cells in gingival connective tissue from the 3 groups were 2.7 (range 2.0-6.5), 3.0 (1.4-6.2), and 2.0 (1.2-4.0), respectively. Cells staining for intracellular IgM were found in low numbers in all biopsies (range 0.3-6.3% of all plasma cells). No statistically significant differences were observed between the 3 patient groups. In all 3 groups, the IgA plasma cell population was predominantly of the IgA1 isotype. One function of IgA seems to be to dampen inflammatory side-effects of other immune effector systems. The demonstrated predominance of IgA1 plasma cells indicates that the majority of IgA produced locally in gingivae of patients with periodontal diseases is susceptible to the IgA1- specific proteases excreted by important members of the disease-associated subgingival microflora. This may be an important factor in the apparently uncontrolled inflammation and tissue degradation taking place in the marginal periodontium during active periodontal disease. [ABSTRACT FROM AUTHOR]

The aim of the present investigation was to study the effect of daily plaque removal on gingival inflammation and the occurrence of oral mucosal ulcers in granulocytopenic patients with acute myeloid leukemia. Eleven patients were analyzed prospectively and consecutively during a period of 28 days, in which the patients were treated with antineoplastic drugs. The patients had their teeth scaled, and plaque was removed daily. On Day 1 all had gingival inflammation, and two had profound periodontitis with pocket depths and loss of attachment greater than 5 mm. During the treatment period plaque scores were reduced in all patients and a corresponding decrease in gingival inflammation was seen. It was possible to obtain healthy gingiva during treatment with cytotoxic drugs. In addition, the development of oral mucosal lesions was low compared with other studies. This study demonstrates that daily plaque removal from the teeth resolves gingival inflammation also in severely granulocytopenic patients. [ABSTRACT FROM AUTHOR]

Detailed quantitative studies of phagocytosis were performed on purified blood neutrophils isolated from 12 young and 10 adult patients with advanced periodontitis and from 22 age and sex matched controls without periodontitis. Chemotaxis was significantly reduced only in the young patients whereas no difference could be demonstrated between young and adult patients or controls in uptake of opsonized zymosan particles, in the concentration and consumption rate of ATP, in the rate of oxygen consumption and superoxide liberation, or in the exocytosis of &glucuronidase and lysozyme during phagocytosis. Serum opsonization was equally effective in the 3 groups. It is concluded that defective chemotaxis in juvenile periodontitis does not originate from defective mobilization of energy in the neutrophils during active movements. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was, to compare the histological features of Kielbone and autogenous jaw bone following transplantation into periodontal interradicular lesions in monkeys. Bifurcation defects were produced on mandibular molars and premolars. Kielbone was transplanted into 40 bifurcations while another 30 bifurcations received fresh autogenous cancellous jaw bone. The animals were sacrificed according to a schedule yielding observation periods up to 16 weeks. Before sacrifice the animals were perfused with a mixture of india ink and serum (3:1) by cannulization of the carotid arteries. The specimens were decalcified in a formic acid/sodium citrate solution. Cleared specimens 100μ of thickness were prepared from one half of each specimen. The other half of the specimen was cut into serial sections 8μ thick and stained with hematoxylin and eosin or Mallory's connective tissue stain. During healing of the treated defects Kielbone grafts and grafts of fresh autogenous bone from the jaws displayed similar histological features. In the bifurcation defects, Kielbone as well as autogenous bone grafts occurred as isolated bone particles surrounded by a cementum-like substance. It is suggested that Kielbone may constitute a suitable substitute for autogenous bone grafts in the treatment of periodontal intrabony defects. However, it should be emphasized that neither autogenous jaw bone nor Kielbone did favour bone regeneration in the bifurcation defects. [ABSTRACT FROM AUTHOR]

In four patients with juvenile periodontitis (group A), five adults with advanced periodontitis (group B), and in four controls (group C) the concentration of serum immunoglobulins, serum complement (C3, C4, and C5), T and B lymphocyte ratio, leukocyte migration inhibition and lymphocyte transformation responses to dental plaque bacteria (A. viscosus, B. melaninogenicus, F. nucleatum, and V. parvula) and PPD or PHA, and lymphocyte ATP-ase activity were assessed before and during development of experimental gingivitis. All the patients in group A and B had completed extensive periodontal treatment, and at the time of the experiment the periodontal conditions were excellent. Plaque accumulation and gingival inflammation were assessed and blood samples were drawn: at day 0; after plaque accumulation for 14 d (no oral hygiene) (period 1); after 14 d with optimal oral hygiene (period II); after plaque accumulation for 14 d (no oral hygiene) and concomitant immunostimulatory treatment with levamisole (period III); after 14 d with optimal oral hygiene. After period I, gingival inflammation and increased gingival fluid flow developed in all groups; however, in group C some of the clinical and immunological responses were slightly enhanced as compared with group A and group B. On the other hand, after period III (plaque accumulation - livamisole) more pronounced clinical and immunological changes were recorded in group A and B than in group C, including a significant rise in gingival fluid flow. LIF production, and lymphocyte ATP-ase activity. The present study has supported the assumption that a state of immunodeficiency can be as underlying, predisposing factor for juvenile periodontitis. The results, however, give only vague information on the nature of this deficiency. [ABSTRACT FROM AUTHOR]

Thirty-six two-wall periodontal intrabony defects were produced adjacent to incisors and canines in 12 monkeys. Following a reverse bevel incision mucoperiostal flaps were raised on the buccal and lingual aspect of the defects, After removal of all soft tissue, fresh iliac bone marrow grafts were transplanted into eighteen of the defects., The remaining eighteen defects on contralateral teeth, were treated in the same way except that cancel- bus bone grafts from an edentulous area of the maxillary jaw were placed against the root surface prior to the transplantation of iliac bone marrow. After transplantation the tissue flaps were repositioned and sutured., The animals were treated and sacrificed to yield observation periods from 3 to 24 weeks. After decalcification and embedding in paraffin, serial sections were cut at 8 microns and stained with hematoxylin and cosin. Ankylosis and active resorption of the root surface was found in the majority of the defects grafted with fresh iliac bone marrow. In defects treated with the composite grafts ankylosis and root resorption occured with considerably less frequency. These results suggest that ankylosis and root resorption can be minimized if iliac bone marrow grafts are effectively separated from the root surface. [ABSTRACT FROM AUTHOR]

Rhesus monkeys receiving an oral hygiene program which included brushing, interdental cleansing and topical applications of chlorhexidine gluconate demonstrated a clinically normal gingiva for periods of up to 3 months. Wide fluctuations within individual dental units were noted with respect to histological sulcus depth, degree of connective tissue infiltration with lymphocytes and plasma cells, and total leukocyte or polymorphonuclear leukocyte (PMN) counts in the junctional epithelium, even when the plaque and gingivitis index scores were 0. Of 1 8 clinically normal dental units sampled, only 6 appeared free of connective tissue inflammation. However, more than half of the tissue blocks obtained from dental units with a gingivitis and plaque index of 0 also showed scores of 0 with respect to the connective tissue inflammation (CTI) score and the number of PMNs in the junctional epithelium. Within three days following discontinuation of oral hygiene procedures, rhesus monkeys developed a clinically noticeable gingivitis which began in the interdental papillae. Increases in CTI scores and number of leukocytes in the junctional epithelium were evident after 2 days without oral hygiene. These values tended to increase further during the experimental period. A slight, but significant increase in sulcus depth was also noted during this time period. Regardless of the clinical state of the gingiva, a positive correlation was established between CTl scores and the number of PMNs and leukocytes in the junctional epithelium. In early gingivitis, the plasma cells did not appear to outnumber lymphocytes, as has been reported for chronic gingivitis of longer duration. [ABSTRACT FROM AUTHOR]

Following scaling, the gingiva of rhesus monkeys was maintained in a stat of clinical normalcy by single daily intra-oral swabs with 2% chlorhexidine gluconate, supplemented by toothbrushing and interdental cleansing with toothpicks three times per week. Chance findings in 2 animals, one maintained for 3 months on this regimen, the other for only 3 weeks followed by a period of 12 days without oral hygiene, revealed that under these circumstances, the junctional epithelium is able to form an attachment to a calculus mass which contained morphologically recognizable bacterial cells. Electron microscopy revealed that this attachment was mediated through a dental cuticle, a basement lamina and hemidesmosomes. The ultrastructure of the epithelial attachment to calculus was indistinguishable from that which exists between junctional epithelium and various tooth surfaces, These results may be due to the inhibiting effect of chlorhexidine gluconate on plaque formation and possibly a concomitant lowering of the toxicity of calculus. [ABSTRACT FROM AUTHOR]

This study reports the results of implant therapy involving a sinus membrane lift and of conventional implant therapy in 68 periodontally compromised patients treated between June 1990 and June 2002. Patients had at least two implants inserted, one of which was placed in the maxillary sinus region following fenestration of the lateral sinus wall and lifting of the sinus membrane. Two implant systems were used: a two-stage system (Astra) and a one-stage system (ITI). Annual follow-up visits included recording of plaque, probing pocket depth and measurement of the radiographic distance in millimeter from the implant shoulder to the alveolar crest. Survival analysis showed that the proportion of implants that had not been explanted after 5 years ranged between 88.7% for ITI sinus implants and 97% for ASTRA conventional implants. After 10 years, the proportion of implants remaining in situ ranged between 59% for ITI conventional implants and 97% for ASTRA conventional implants. Cox regression analyses showed that the factors influential for implant explantation were implant type (HR(ITI) = 2.8), implant length (HR(< or = 10 mm) = 3.1), patient being a smoker (HR(smoking) = 2.2) and patient having at least 20 natural teeth (HR(> or = 20 teeth) = 3.8). Our results demonstrate that sinus implants may be inserted with the same success as conventional implants in periodontally compromised patients.

The prevalence of heart failure increases with age. Although the benefit of cardiac rehabilitation has been well demonstrated, in particular for what concerns improved effort tolerance, data in the geriatric population is scarce. A supervised inpatient cardiac rehabilitation program has started in September 2004 at the Hôpital de gériatrie in Geneva. By March 2005, 34 out of 50 participants (mean age of 87 years) had completed the program. The results showed a significant increase in the distance walked at the 6-minute test (+ 68,5 m, P<0,001) and a decreased level of anxiety that facilitated the return home. It will be necessary to evaluate the impact of these encouraging results on the readmission rate and on the longterm functional capacity.

Aim: To compare the effectiveness of treatment of peri-implantitis with a novel ultrasonic device, the Vector system, with that of subgingival debridement with carbon fiber curettes., Material and Methods: The study, comprising 11 patients with at least two screw type implants with bleeding on probing (BOP), probing pocket depth (PPD) > or =5 mm, and at least 1.5 mm radiographic bone loss and exposed implant threads, was carried out as a single blind randomized clinical trial. At baseline one randomly chosen implant in each patient was treated by the Vector system (test) while the other implant (control) was treated by submucosal debridement with a carbon fiber curette. After 3 months, the same treatments were repeated. Plaque, BOP, and PPD were recorded on all implant surfaces at baseline, and after 3 and 6 months. Bone levels were recorded on radiographs taken prior to the start of the study, and after 6 months., Results: Oral hygiene around both test and control implants was improved at 3 and 6 months compared with baseline. At 6 months, four of the Vector-treated sites, and only one site treated with curettes, had stopped to bleed. In neither the test nor the control group, were there any differences between baseline and 6 months regarding PPD and bone levels., Conclusion: Although there was a greater reduction in the number of sites with BOP following treatment with the Vector system than following instrumentation with carbon fiber curettes, there was no significant difference between the two methods.

Background: Relatively little is known on the long-term prognosis of implants inserted in partially edentulous, periodontally compromised patients., Methods: A total of 258 conventional implants, 57 two-stage and 201 one-stage implants, which were inserted in 32 and 108 patients, respectively, between June 1988 and June 2002 were followed with respect to their survival, as well as the periodontal parameters bone loss, probing depth, and bleeding on probing. All patients were periodontally compromised who had undergone periodontal surgery and were considered able to maintain a high standard of oral hygiene., Results: The 5-year survival rates were 97% and 94%, respectively, for the two- and the one-stage implants. The 10-year survival rate remained high at 97% for the two-stage implants, but had dropped to 78% for the one-stage implants. Smoking, short implant length, and insertion during the later period (1995-2002) were found to be associated with an increased failure rate., Conclusions: Implants placed in patients with a history of periodontitis have a 5-year survival similar to that observed for implants installed in non-diseased persons. Although the 10-year survival of the one-stage implants was somewhat lower than has been observed for non-diseased patients, implant placement remains a good treatment alternative also for periodontally compromised patients.

This study reports the results of implant therapy involving a sinus membrane lift as well as conventional implant therapy in 24 periodontally compromised patients who were treated during the period between June 1990 and May 1995. Patients were included on the basis of being in need of at least 2 implants, 1 of which was to be placed in the maxillary sinus region, and at least 3 mm bone height was required in the sinus region. Following fenestration of the lateral sinus wall and lifting of the sinus membrane sinus implants were inserted as described for conventional implants. Annual follow-up visits included recording of plaque, probing pocket depth and bleeding on probing, and recording of the radiographic distance from the implant shoulder to the alveolar crest in mm. The Astra, Astra sinus, ITI, and ITI sinus were observed for an average of 30.8, 29.9, 29.4 and 25.3 months, respectively. Of the 80 implants inserted 1 Astra and 2 ITI had failed at 11-12 months and 1 ITI had failed at 42 months. The Kaplan-Meier estimate of the proportion of non-failed implants at 36 months were 100%, 95%, 91%, and 86% for the Astra, Astra sinus, ITI, and ITI sinus implants, respectively. Of the Astra, Astra sinus, and ITI implants, 71-82% remained free from bone-loss > or = 1.5 mm at 36 months, whereas this was the case for only 29% of the ITI sinus implants. About 80-90% of the implants remained free from plaque; 65-86% remained free from bleeding; and 44-80% remained free from pockets > or = 4 mm. These results indicate that the sinus lift technique can be used successfully in periodontally compromised patients.

The purpose of the study was to evaluate the effect of a mouthrinse regimen comprising both chemical plaque control and mechanical plaque removal. 20 adult patients with acute myeloid leukaemia were assigned to one of the following 2 regimens: (1) (group 1) mouthrinse twice daily with a 0.1% chlorhexidine solution; or (2) (group 2) the same regimen, but preceded by mechanical removal of plaque and calculus on day 1. All patients were followed for 28 days from the initiation of remission-induction therapy. In group 2, the plaque scores remained lower than those of group 1 throughout the study, although only 3 patients remained completely free of plaque after 28 days. Gingival inflammation as judged by bleeding scores remained unchanged in group 1, whereas in group 2, the degree of inflammation was reduced from 52% (median value) on day 1 to 31% (median value) on day 28. The bleeding scores were also lower in group 2 (31%) than in group 1 (60%) on day 28. No differences were found between the 2 groups with respect to the occurrence of other oral infections. It is concluded that chemical plaque control with chlorhexidine should be preceded by mechanical removal of plaque and calculus, when used in patients with acute myeloid leukaemia and thrombocytopenia.

Questionnaires were sent to 22 dental practitioners. Each dentist was sent two types of questionnaires, one to be completed by the hygienist and the other one by the patients. The sampling was done by selecting at random approximately every sixth clinic employing a dental hygienist. Of 1100 questionnaires 710 were completed and returned. The investigation illustrates the patients opinion on different aspects of the dental hygienist's technical and social skills and of the cost of care. There was an overwhelming consumer satisfaction regarding the quality, as well as the cost, of dental care performed by a hygienist. Therefore, a broad use of well qualified dental hygienists as an auxilliary to a dentist is one way to lower the cost of dental health care in the future.

The prevalence of alveolar bone loss was investigated in 2813, 15- and 16-year-old Danish schoolchildren using bitewing radiographs. The interproximal spaces of the mesial and distal aspects of the first molar teeth were examined. Only defects with depths of more than 2 mm were considered periodontal bone loss. Radiographic evidence of bone resorption was found in 48 children. When evaluated clinically, 42 out of the 48 children with radiographic signs of bone loss demonstrated clinical loss of attachment. Only four children (0.1%) had the characteristic radiographic features of juvenile periodontitis. Loss of attachment of more than 2 mm was observed in these children.

The purpose of this study was to determine the prevalence of periodontal disease in teenagers. The survey was conducted on 325 children aged 14, 15 and 16 years, living in Aarhus, Denmark. Pocket depth and loss of attachment was measured in mm at the maxillary and mandibular first molars and incisors. Plaque, calculus and gingival bleeding on probing were recorded. A total of 221 children (68%) had 4-5 mm deep pockets and 19 children (5.8%) had pockets deeper than 5 mm on at least one tooth. Approximately 11% of the subjects showed loss of attachment on at least one tooth. The frequency of surfaces with plaque and gingivitis was high in all three age groups. Plaque, gingivitis, deepened pockets and loss of attachment were most frequently observed on interproximal surfaces. No significant differences were observed between the sexes with regard to periodontal disease.

New attachment of periodontal tissues can be obtained following surgical treatment of intrabony pockets. To day flap procedures with complete surgical opening to the defect and removal of all soft material from the intrabony lesion often followed by bone transplantation constitute the accepted approach to obtain a new connective tissue attachment. However, since the epithelium of elevated full thickness flaps are well preserved, the placement of these flaps adjacent to the treated areas facilitate the migration of epithelium into the defects. In a search for means to retard epithelial proliferation into the defects, disintegration of epithelium of free gingival grafts within the first days following transplantation might possibly be utilized in new attachment attempts. It has been demonstrated in three-wall intrabony defects in monkeys and in humans, that if the intrabony defect is covered with a free transplantat following a split flap procedure the epithelial migration into the defect will be delayed. This procedure resulted in a greater amount of new attachment when compared with traditional flap surgery and less residual pockets. The succes of new attachment procedures is directly related to the abscense of plaque in the area where regeneration takes place. Without absolute plaque control a further loss of attachment can be seen.

The fate of vital and devitalized grafts of mature concellous bone from the jaws were studied in interradicular lesions in monkeys. 98 bifurcation defects were produced in premolars and molars and maintained by periodontal dressing inserted for four weeks. Ten to 15 weeks later fresh cancellous bone was transplanted into 32 defects. Other cancellous bone grafts were divitalized by boiling and transplanted into 34 bifurcations. The remaining 32 defects received no grafts. The animals were sacrificed to yield observation periods from 0 to 90 days. After decalcification of the specimens and embedding in paraffin, serial sections were cut at 8 microns and stained. The fate of viable and dead transplants were similar during the healing of the interradicular lesions. Except for a few osteocytes which seemed to survive transplantation in the fresh cancellous bone, the osteocyte lacunae were devoid of cells in both types of transplants after 1 week. The deepest located bone grafts became incorporated in new bone developed from the interradicular septum. The more superficially located grafts were rejected or were surrounded by a cementum-like substans. The influence of the grafts on bone regeneration was small and based solely on their osteoconductive effect.