Search

Αbstract Background/Aim: The aim of this study was to investigate healing responses to demineralized freeze-dried bone powder allografts in standardized periodontal fenestration defects, compared with subcutaneous wounds in a dog model. Methods: Circular periodontal fenestration defects were created buccally at all four canines in 14 mongrel dogs. Each site received one of the following underneath a barrier membrane: (a) ethylene oxide (EO)-sterilized demineralized freeze-dried bone allografts (DFDBA), (b) heat-treated DFDBA, (c) non-sterilized DFDBA and (d) ungrafted control. Twelve of the 14 dogs had three subcutaneous chest wall pouches created and one of the three DFDBA materials placed in each. The animals were necropsied at 4 weeks. Histologic sections were prepared through the center of the fenestration sites in an apico-coronal direction. Quantitative analysis using computer-assisted imaging technique was performed. Subcutaneous implants were evaluated histologically and quantified for associated inflammatory cell infiltrate. Results: Fenestration defects healed by partial osseous fill and cementum regeneration with formation of a periodontal ligament. The graft particles generally appeared isolated from the site of osteogenesis and covered by cementum-like substance. Graft particles incorporated into newly formed bone at a distance from the root surface was the exception. No statistically significant differences in new bone formation were observed between treatment groups within animals, but significant inter-animal variation was found (p

Background This article is a follow-up on a 1998 article in JADA. The blood pressure, or BP, of 23 of 24 normotensive patients was monitored at 15-minute intervals for a total of nine days, in three consecutive sessions of four, two and three days, respectively, separated by a few weeks. Methods Twelve patients were reached by phone seven years after the prior chrono-biologically interpreted monitoring to ascertain their cardiovascular status since the initial monitoring. Results Only two of the 12 patients reached in follow-up had abnormalities in all three sessions, and only these two patients reported having experienced an adverse vascular event (one a myocardial infarction, the other coronary artery bypass graft surgery). The difference in outcome between the patients with chronobiological abnormality in all three sessions vs. the pool of those with abnormality in only two, one or none of the sessions is statistically significant. Conclusions Even a five-day (and sometimes a longer) profile, while greatly preferred to single measurements, may not suffice for a definitive diagnosis of certain patients. Retrospectively, the 864 measurements, on the average, on each person in our study could have served for a recommendation to each person. Chronobiologically interpreted BP and heart rate monitoring for a week or longer as a start detects high-risk states that may be missed by conventional casual measurements that are rarely accompanied by one-day profiles. Clinical Implications The dentist has an important opportunity for conveying the importance of monitoring BP and heart rate for a week to detect an abnormal variability, and for implementing this monitoring. Dentists can educate patients regarding the need for screening and for interpreting the results for variability, and contribute to their overall health by referring them to their physicians when treatment is indicated.

Population densities (PD) of capillaries (C) and endotheliocytes (E) were determined in pinnal dermis of C57BL mice before and after trauma. Moving (and overall) least-squares spectra before trauma detected in EPD (versus CPD) pronounced 3.5-day (circasemiseptan) and 8-h oscillations corresponding to components of the endothelin-1 chronome in human blood plasma reported earlier. Circadians were more pronounced in CPD. After trauma, circasemiseptan oscillations appeared also in CPD; their period gradually shortened and in two weeks split into about 2.5- and about 4.5-day oscillations; and circadian components became very pronounced. The pre-traumatic chronome was not restored within three weeks following trauma.

Concerns about local anesthetics and dental treatment stress are still prevalent in today's medical and dental communities. The authors conducted 24-hour monitoring of heart rate and blood pressure for 23 patients undergoing two root planing procedures and a single periodontal surgical procedure. Chronobiologic analysis of circadian blood pressure and heart rate rhythms revealed that neither epinephrine vasoconstrictor in anesthetics nor increased invasiveness of the procedure resulted in statistically significant deviations from regular, individualized blood pressure rhythms. For surgical appointments, time of day had the greatest effect on cardiovascular variables, with the greatest elevations in blood pressure seen for surgery at 8 a.m. and the largest blood pressure decreases seen for surgery at 2 p.m.

Healing of extraction sockets where the buccal plate of bone has been destroyed often results in localized ridge deformities. This is most likely due to the ingrowth of extraskeletal connective tissue into the space originally occupied by the tooth which then fills with a combination of bone and soft tissue. Techniques for managing these defects have been described, but it would be preferable to prevent them from occuring at all. Using the principles of guided tissue regeneration, a surgical technique is described that can be applied to post-extraction sites that are deficient in alveolar bone thereby preventing localized ridge deformities. Representative cases are presented illustrating the technique. J Periodontol 1994;65:17–24.

Porous coralline hydroxyapatite blocks were implanted in the anterior region of several patients to improve the pontic/ridge relationship for a fixed prosthesis, thereby improving esthetic appearance and oral hygiene performance. A beveled incision on the palate was used to displace the flap coronofacially without leaving an area of denuded bone or graft. Flap margins were sutured to the adjacent palatal tissues. At the 2 1/2- and 3-year postgrafting follow-up, the implant area was healthy and ridge contours have been maintained. The permanent fixed partial denture is functional, and radiographic evaluation indicates the continued presence of the porous coralline hydroxyapatite implant. Three-year results have been promising enough to warrant continuing the procedure in patients requiring localized ridge augmentation.

P-72 1. Halberg F, Cornelissen G, Halberg J, Fink H, Chen C-H, Otsuka K, Watanabe Y, Kumagai Y, Syutkina EV, Kawasaki T, Uezono K, Zhao ZY, Schwartzkopff O. Circadian Hyper-Amplitude-Tension, CHAT: a disease risk syndrome of anti-aging medicine. J Anti-Aging Med 1998; 1: 239-259. (Editor s Note by Fossel M, p. 239.) Key Words: Circadian Variations, Blood Pressure, Emotions

The purpose of this investigation was to evaluate the histologic response to replamineform (porous) hydroxyapatite grafts in chronically inflamed, surgically created, periodontal pockets in Rhesus monkeys. Forty-eight subcrestal defects were surgically created in 8 Rhesus monkeys. Orthodontic wires were adapted to the base of the defects and left in place for 8 weeks. The defects were randomly assigned a treatment modality so that 8 granular porous and 8 block porous hydroxyapatite grafts were done. Eight sites were left as unoperated controls. Twenty-four contralateral sham-operated sites were treated by open curettage. Histometric measurements of the length of regenerated connective tissue attachment were recorded. Block hydroxyapatite, granular hydroxyapatite, and sham-operated sites exhibited similar amounts of regenerated connective tissue attachment, which was significantly greater than that which occurred in unoperated controls. Newly formed bone was observed within the porous channels of the hydroxyapatite grafts as well as in direct apposition on the surface of implant particles. New bone, cementum, and periodontal ligament was observed in grafted sites and in defects treated by open curettage. In some instances healing occurred by means of a long junctional epithelium. Histology confirmed that unoperated defects remained as unhealed, inflamed periodontal pockets. The results of this study suggest that porous hydroxyapatite grafts have the potential to regenerate the attachment apparatus in primates.

This investigation included a cross-sectional component (284, 20-40-year-old subjects/568 sites) and a longitudinal component (19 subjects with moderate to advanced periodontitis/76 sites). Subgingival plaque samples and clinical data were obtained from all upper second bicuspids and first molars in the longitudinal subjects and from both upper first molars in the cross-sectional subjects. The purpose was to: determine/confirm changes in proportions of selected subgingival microorganisms following root planning combined with conventional oral hygiene procedures in the longitudinal subjects, evaluate those changes in terms of an estimate of the naturally occurring distribution of subgingival microorganisms based on data obtained from the cross-sectional subjects and relate shifts in the subgingival microorganisms to changes in clinical measurements. Changes following treatment at sites with pre-instrumentation probing depths greater than or equal to 4.5 mm included cocci, 18.3 to 46.9%; spirochetes, 20.9 to 3.1%; total motile organisms, 28.5 to 5.9%; Fusobacterium spp., 10.2 to 2.2%; and dark-pigmented Bacteroides spp., 14.0 to 9.7%. Translating proportions of microorganisms in samples from subjects in the longitudinal treatment study to equivalent percentile ranks within the large cross-sectional data base demonstrated that at probing depths greater than or equal to 4.5 mm cocci moved from below the 50th percentile in our estimate of the naturally occurring distribution of subgingival microorganisms to above, and spirochetes, total motile organisms and Fusobacterium spp. moved from above the 50th percentile to below. The microbiological findings were consistent with statistically significant improvements in clinical measurements. Statistically significant changes also occurred in microorganisms at sites with initial probing depths less than 4.5 mm.

The goal of this study was to investigate the relationship between probing depth, total microscopic counts, and specific microbial forms in subgingival plaque from young adults. Subgingival plaque samples were collected and probing depth recorded from 415 mesial surfaces of maxillary first molars in 266 individuals aged 20–40. Using dark field microscopy in a Petroff-Hausser chamber, total organisms in each sample were estimated, as well as proportions of spirochetes, motile and non-motile rods, cocci, and total motile organisms. Limits for decile ranks based on total organisms were determined and the mean percentage of each microbial form within each decile rank was calculated. Correlation coefficients (r) were computed between the dependent variables of microbial forms and the independent variables of total organisms, probing depth, and the combination of total organisms and probing depth. The percentage variability of microbial forms that could be explained by the regression of each dependent variable on each independent variable or combination of independent variables was estimated by r2. The results indicate: (1) differences in bacterial composition of subgingival plaque are associated with differences in total subgingival microorganisms and in probing depths, (2) approximately 15–20% of the variability in the proportions of microbial forms in subgingival plaque can be explained by differences in total subgingival microorganisms, (3) two to four times more variability in the proportions of microbial forms in subgingival plaque can be explained by differences in total subgingival microorganisms than can be explained by differences in probing depths, and (4) considerable variability in proportions of microbial forms in subgingival plaque remains that cannot be explained by either differences in total subgingival microorganisms or by differences in probing depths.

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.

This study was designed to examine human subgingival plaque for the presence of dark-pigmented Bacteroides (DPB) species in a large adult population that had been following a rigorous oral hygiene and recall program for 2 years. Subjects received scaling and root planing and oral hygiene instructions at the time of entry and then a prophylaxis and/or oral hygiene instructions at frequent intervals. Clinical measurements were determined and microbial flora identified in subgingival plaque. The DPB species were found in 63% of the subjects and 47% of the total sites. The N-acetyl-B-glucosaminidase-positive DPB species (B. melaninogenicus, B. denticola or B. loescheii), B. intermedius, B. gingivalis and strains of unclassified pigmenting Bacteroides were found in 25, 50, 3 and 40% of the subjects, respectively, and at 15, 35, 2 and 25% of the sites, respectively. Plaque and bleeding indices, probing depth and mean proportions of motile rods and spirochetes were higher at sites with DPB as compared to sites without DPB species. Sites with B. intermedius had higher plaque and gingival indices and greater loss of probing attachment than sites with DPB other than B. intermedius. The prevalence of B. intermedius and other DPB species was high even though subjects were on a rigorous oral hygiene and recall program.

Ideally, the new attachment operation should be confined to subcrestal pockets. The objective of the new attachment operation is to raise the attachment coronally to eliminate the periodontal pocket and to refill the subcrestal defect with new bone. The step-by-step procedure has been described. A partial gingivectomy will remove the marginal epithelium and reduce part of the pocket, namely, a portion of the soft tissue coronal to the alveolar crest. The most common reasons for failure are (1) the lack of complete and thorough root curettage, (2) mobility of the tooth, and (3) leaving some of the soft tissue in the subcrestal defect. If the operation should fail to eliminate the pocket, repetition of the procedures will result in success in the majority of cases. When the alveolar bone refills the subcrestal defect, a new functional periodontal membrane will be formed. This operation, rather than ostectomy or extraction, is the treatment of choice. The new attachment operation can be done successfully by the general practitioner as well as by the periodontist.

The purposes of this 2-year longitudinal study were to: compare the clinical effectiveness of patient applied sodium bicarbonate, hydrogen peroxide, and sodium chloride (S/P) to the use of conventional oral hygiene methods and to investigate the motivational effect of using phase-contrast microscopy in teaching effective oral hygiene. Initially, 972 subjects were screened for signs of periodontitis. From these, 347 with early to moderate periodontitis were selected and each was randomly assigned to one of four home treatment regimens after scaling and root planing. The four treatment regimens included: conventional oral hygiene procedures, conventional oral hygiene procedures plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation, S/P oral hygiene, and S/P oral hygiene plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation. Plaque, bleeding, gingival inflammation, probing depth, and clinical attachment level were recorded at baseline, 8, 16, and 24 months. Subjects were recalled for reinforcement of oral hygiene and periodontal prophylaxis at various intervals. Data were analyzed based on disease severity, location of index sites and compliance. The results indicated that both conventional oral hygiene procedures and the S/P regimen were effective in reducing clinical signs of disease when combined with professional care. There were no differences between the two regimens in clinical effectiveness and trends favoring microscopic viewing of subgingival plaque for motivational purposes were not statistically significant.

This study of 171 subjects compared the effectiveness of a patient-applied salt and peroxide oral hygiene regimen with the use of conventional oral hygiene methods on clinical measures of periodontal disease, and determined patient compliance with and acceptance of using these two oral hygiene regimens. Results indicated that both regimens, when combined with professional care, were effective in changing clinical measures of periodontal disease to a state favoring periodontal health.

The association between Actinobacillus actinomycetemcomitans and periodontal disease in juveniles has been well documented. The purpose of this investigation was to determine the prevalence and proportions of A. actinomycetemcomitans in supragingival and subgingival plaque samples from the maxillary first molars of a large number of young adults. The study population included 284 adults, aged 20–40, ranging in periodontal disease status from healthy to moderate periodontitis but with the majority exhibiting early periodontal disease. The clinical characteristics of probing depth, attachment level, plaque index, and gingival index were measured. Supragingival and subgingival plaque samples were evaluated microscopically for microbial forms. They were also cultured on supplemented blood agar and various selective agar media including selective media for A. actinomycetemcomitans. The prevalence of A. actinomycetemcomitans in subgingival and supragingival plaque for individuals in the population was 13.0% (37/284) and 4.9% (14/284), respectively. Proportions of actinobacilli, based on total anaerobic counts, were found at or below 1% in 87% of 47 subgingival sites from 37 subjects. Supragingival and subgingival sites with actinobacilli were compared to sites without actinobacilli. Subgingival sites with A. actinomycetemcomitans had a significantly higher mean plaque index, with 79% of these sites having a plaque index greater than 1.0 compared to 30% of sites without actinobacilli. The mean gingival index, probing depth, and attachment level of sites with actinobacilli were also higher, but not significantly, than those without. Of the microbial forms enumerated, only spirochetes had a significantly higher mean proportion at subgingival sites when compared to sites without actinobacilli. Mean proportions of the cultivable microorganisms, Veillonella spp. and Streptococcus spp., were significantly lower at sites with A. actinomycetemcomitans. Differences in the mean proportions of certain microorganisms were compared between the 47 subgingival sites with actinobacilli divided into three groups by probing depth. Mean proportions of A. actinomycetemcomitans were significantly higher at intermediate probing depths between 3.0 and 5.0 mm compared to deeper sites with probing depths above 5.0 mm. On the other hand, dark-pigmented Bacteroides spp. mean proportions were significantly higher at deeper probing depths than at either intermediate or shallow, less than or equal to 3.0 mm, probing depths. There were no significant differences in the mean proportions of spirochetes between shallow, intermediate, or deeper probing depths of the 47 subgingival sites with actinobacilli.

The purpose of this study was to determine if a classification of subgingival plaque into distinct categories of microbial forms would be beneficial for detecting differences in the severity of periodontal disease. Three thousand and thirty-two subgingival plaque samples were collected and evaluated from three different populations having 284, 160, and 180 individuals. Plaque and gingival indices, probing depth, and attachment level were measured at each sampling site. Overall, the results indicated that mean plaque index, probing depth, and loss of attachment were successively higher at sites classified into four distinct microbial categories in the order (1) “Low Motile Organism - High Cocci,” (2) “Low Motile Organism - Low Cocci.” (3) “High Motile Organism - High Motile Rods,” and (4) “High Motile Organism - High Spirochetes.” The consistent pattern of differences in severity of periodontal disease between these microbial categories suggest that microscopic interpretation of plaque may be improved by this classification.

The periodontal status of maxillary first molars in 284 young adults demonstrating near-health to early disease was evaluated, and supragingival and subgingival plaque samples were collected. Plaque samples were processed anaerobically, enumerated microscopically for bacterial morphotypes, and cultivated on various media to enumerate the microflora. Although haemophili were ubiquitous (recovered in 98.5 and 96.2% of the supragingival and subgingival plaque samples, respectively), 50% of the respective samples had proportions of less than or equal to 1.5% and less than or equal to 0.33% total Haemophilus spp. based on total cultivable microflora. To study the distribution of Haemophilus spp., 377 colonies were identified from modified chocolate agar (selective for oral haemophili) from 14 supragingival and corresponding subgingival samples from 14 subjects. The most prevalent species, Haemophilus parainfluenzae, was found in significantly higher proportions, based on total haemophili on modified chocolate agar, in supragingival and subgingival samples from teeth with shallower probing depths (less than or equal to 3.0 mm) versus deeper probing depths (greater than or equal to 3.0 mm). Additional statistically significant findings included Haemophilus segnis in higher proportions in supragingival samples from deeper sites, Haemophilus aphrophilus in higher proportions in subgingival samples from deeper sites, and Haemophilus paraphrophilus in higher proportions in subgingival samples from shallower sites. Scatter diagrams illustrating the bivariate distributions of proportions of haemophili with proportions of dark-pigmented Bacteroides spp., spirochetes, and streptococci demonstrated that high proportions of haemophili were never recovered from sites with high proportions of Bacteroides spp. or spirochetes. All levels of haemophili, however, were recovered from sites with all levels of streptococci. Two potential systems for interpreting haemophili data were hypothesized for predicting periodontal probing depths. There was highly significant agreement between the two systems. Small but statistically significant correlations were found between the gingival index, probing depth, and attachment level, and proportions of total Haemophilus species in the respective samples.