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Objective: The aim of this cross-sectional study was to assess the bias in estimating the prevalence of periodontitis due to partial-mouth periodontal examination protocols (PMPE) and to relate the severity and extent of periodontal damage to periodontitis misclassification when applying case definitions by Centres of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP)., Materials and Methods: A full-mouth periodontal examination (FMPE) was performed in 721 adults living in North Italy to identify moderate and severe periodontitis. These results were compared with those obtained with two PMPE protocols analyzing two interproximal sites on all teeth (fMB-DL) or four interproximal sites in two random diagonal quadrants (pMDB-MDL)., Results: Both PMPE systems estimated the prevalence of moderate periodontitis with limited bias (-2.79% for pMDB-MDL and -3.49% for fMB-DL), whereas produced larger relative biases for severe periodontitis (-28.74% versus - 14.55%). The percentage of under-recognition of existing periodontal disease was 8.9% under fMB-DL and 15.5% under pMDB-MDL. The diagnosis of moderate and severe periodontal disease was correctly assigned to individuals with on average 8% and 30% of pathological sites, respectively., Conclusion: These findings suggest that PMPE systems provide high level of bias when using CDC/AAP case definitions.

This study investigated differences in periodontal health variables between buccally impacted maxillary canines (BIMC) and palatally impacted maxillary canines (PIMC) after surgical-orthodontic treatment with open technique. Nineteen patients were enrolled: 10 with unilateral BIMC (5 men, 5 women; mean age 18.50 ± 1.96 years) and 9 with unilateral PIMC (4 men, 5 women; mean age 19.44 ± 2.40 years). Probing depth and keratinized tissue were recorded 12 months after surgical-orthodontic treatment, and the differences between the 2 sides were analyzed as primary outcomes. In addition, data for BIMC and PIMC were directly compared. In the BIMC group, probing depths were significantly higher for lateral incisors than for the untreated side (P = 0.044), and keratinized tissue values were significantly lower for canines than for the untreated side (P = 0.006). No significant differences were observed in the PIMC group. In BIMC, surgical-orthodontic treatment with open technique resulted in loss of periodontal keratinized tissue in the treated tooth and periodontal attachment loss in adjacent lateral incisors. However, the periodontal status of PIMC was not affected by surgical-orthodontic treatment with open technique.

Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE, Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: "overdenture AND attachment OR overdenture AND bar OR overdenture splinted." The PICO question "Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?" was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow-up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta-analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P = .39; MD: -0.11; 95% CI: -0.37 to 0.14), complications (P = .31; RR: 1.26; CI: 0.80-1.99) and implant survival rate (P = .14; RR: 0.37% CI: 0.10-1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate., (© 2018 John Wiley & Sons Ltd.)

Purpose: The aim of this systematic review was to assess the gingival retraction methods in terms of the amount of gingival retraction achieved and changes observed in various clinical parameters: gingival index (GI), plaque index (PI), probing depth (PD), and attachment loss (AL)., Methods: Data sources included three major databases, PubMed, CINAHL plus (Ebsco), and Cochrane, along with hand search. Search was made using the key terms in different permutations of gingival retraction* AND displacement method* OR technique* OR agents OR material* OR medicament*., Results: The initial search results yielded 145 articles which were narrowed down to 10 articles using a strict eligibility criteria of including clinical trials or experimental studies on gingival retraction methods with the amount of tooth structure gained and assessment of clinical parameters as the outcomes conducted on human permanent teeth only. Gingival retraction was measured in 6/10 studies whereas the clinical parameters were assessed in 5/10 studies., Conclusions: The total number of teeth assessed in the 10 included studies was 400. The most common method used for gingival retraction was chemomechanical. The results were heterogeneous with regards to the outcome variables. No method seemed to be significantly superior to the other in terms of gingival retraction achieved. Clinical parameters were not significantly affected by the gingival retraction method., (© 2016 by the American College of Prosthodontists.)

Background and Objective: Aggregatibacter actinomycetemcomitans is involved in oral and systemic infections, and is associated with, eg aggressive forms of periodontitis and with endocarditis. The cagE gene encodes a ≈39 kDa putative exotoxin expressed by A. actinomycetemcomitans. The level of conservation of cagE, and its possible significance in periodontal disease, has not yet been thoroughly investigated. In the present study, the role of the cagE gene as a diagnostic marker has been investigated., Material and Methods: We have used conventional polymerase chain reaction (PCR), quantitative PCR and whole genome sequencing data to determine the prevalence of cagE in A. actinomycetemcomitans based on analysis of: (i) 249 isolates, collected and cultivated in a Ghanaian longitudinal cohort study; (ii) a serotype b collection of 19 strains; and (iii) the 36 A. actinomycetemcomitans genomes available in the NCBI database., Results: Whereas cagE was absent in the other serotypes, our data support that this gene sequence is linked to a virulent and highly leukotoxic group of serotype b strains, including both JP2 and non-JP2 genotypes of A. actinomycetemcomitans., Conclusion: We propose that cagE has the potential to be used as a PCR-based gene marker for the identification of a virulent and highly leukotoxic group of serotype b strains, including both JP2 and non-JP2 genotypes. This finding might be of importance in the risk assessment of the development of periodontal attachment loss in young individuals and hence suggested to be a relevant discovery in future development of new diagnostic tools and/or treatment strategies., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A normality assumption is typically adopted for the random effects in a clustered or longitudinal data analysis using a linear mixed model. However, such an assumption is not always realistic, and it may lead to potential biases of the estimates, especially when variable selection is taken into account. Furthermore, flexibility of nonparametric assumptions (e.g., Dirichlet process) on these random effects may potentially cause centering problems, leading to difficulty of interpretation of fixed effects and variable selection. Motivated by these problems, we proposed a Bayesian method for fixed and random effects selection in nonparametric random effects models. We modeled the regression coefficients via centered latent variables which are distributed as probit stick-breaking scale mixtures. By using the mixture priors for centered latent variables along with covariance decomposition, we could avoid the aforementioned problems and allow efficient selection of fixed and random effects from the model. We demonstrated the advantages of our proposed approach over other competing alternatives through a simulated example and also via an illustrative application to a data set from a periodontal disease study. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

Background: Aim of this randomized controlled parallel-designed study was to evaluate the effects of diode laser as an adjunct to mechanical periodontal treatment on clinical parameters and gingival crevicular fluid (GCF) volume of the residual pockets diagnosed following initial periodontal treatment in chronic periodontitis (CP) patients., Materials and Methods: A total of 84 residual pockets on single-rooted teeth in 11 CP patients were included and randomly assigned into three groups. Residual pockets were treated either only by mechanical treatment (Group M) (n = 28) or only by diode laser disinfection (Group L) (n = 28) or by a combination of these techniques (Group M + L) (n = 28). Plaque index, gingival index (GI), bleeding on probing (BoP), probing depth (PD), clinical attachment level and gingival recession were assessed at baseline and 8 weeks after treatment of residual pockets. GCF samples were collected at baseline, 1 and 8 weeks after treatment., Results: All treatment modalities resulted in significant reductions in PD and attachment gain. GI and BoP showed a greater reduction in both Group M and Group M + L than Group L (P < 0.001), but there was no difference between the Groups M and M + L (P > 0.05). No difference was also found among groups for other clinical parameters. GCF volume decreased significantly in the Groups M and M + L (P < 0.05) but there was no difference among the groups (P > 0.05)., Conclusion: Results demonstrated clinical improvements on residual pockets in CP patients treated with all three modalities. Moreover, our findings suggest that application of diode laser as an adjunct to mechanical periodontal treatment doesn't demonstrate any additional clinical effect on the residual pockets.

Objective: To establish a profile of periodontal conditions in chronic kidney disease patients on hemodialysis and their periodontal risk., Methods: We included 115 patients on hemodialysis. Clinical periodontal parameters assessed were: plaque index, gingival index, probing depth and clinical attachment level. Patients were classified according to presence/absence and severity of periodontal disease and periodontal risk., Results: In 107 dentate patients (93%) the plaque index was 1.53±0.78, the gingival index was 0.95±0.85, the probing depth was 2.2±0.6mm and the clinical attachment level was 3.18±1.75mm. We observed that 1 patient (0.94%) did not have periodontal disease, 55 patients (51.40%) had slight, 28 (26.17%) moderate and 23 (21.49%) severe periodontal disease. Among 107 patients, 37 (34.58%) had low risk, 35 (32.71%) moderate risk and 35 (32.71%) high risk. Patients with severe periodontal disease showed 104.5 more chance of high risk compared with low risk individuals (odds ratio: 104.5; 95%CI: 10.7-1017.2; p<0.0001)., Conclusion: Most of patients with chronic renal disease presented periodontal disease, indicating the presence of chronic inflammatory and infection process that may influence in systemic conditions. A prevention and interventionist approach in this population is needed, especially to emphasize the importance of oral health. The periodontal risk assessment is a useful tool to create individualized periodontal therapies and to improve general health condition., Objetivo: Traçar um perfil das condições periodontais de pacientes com doença renal crônica em hemodiálise e seu risco periodontal., Métodos: Foram incluídos no estudo 115 pacientes em hemodiálise. Os parâmetros clínicos periodontais avaliados foram: índice de placa, índice gengival, profundidade de sondagem e perda de nível de inserção clínico. Os pacientes foram classificados de acordo com a presença e a gravidade da doença periodontal, bem como de acordo com o risco periodontal., Resultados: Quanto aos parâmetros clínicos, 107 pacientes dentados (93%) apresentaram média de índice de placa de 1,53±0,78 e gengival de 0,95±0,85, profundidade de sondagem de 2,2±0,6mm e nível de inserção clínica de 3,18±1,75mm. Em relação à doença periodontal, 1 (0,94%) era saudável, 55 (51,40%) apresentavam periodontite leve, 28 (26,17%) moderada e 23 (21,49%) avançada. Com relação ao risco, dos 107 pacientes, 37 apresentavam risco baixo, 35 moderado e 35 alto. Os pacientes com doença periodontal avançada apresentaram 104,5 vezes mais chance de ter alto risco comparado ao baixo (odds ratio: 104,5; IC95%: 10,7-1017,2; p<0,0001)., Conclusão: A maioria dos pacientes com doença renal crônica apresentou doença periodontal, indicando um processo infeccioso e inflamatório crônico, que pode influenciar na condição sistêmica. Evidencia-se a necessidade de uma abordagem preventiva e intervencionista nesta população, enfatizando a importância da saúde bucal. A avaliação do risco periodontal seria uma ferramenta na elaboração de terapias periodontais individualizadas para uma melhor condição de saúde geral.

Objective: This observational study aimed to compare the estimation of clinical attachment loss (CAL) as measured by direct (CALD ) and indirect (CALI ) methods., Methods: Periodontitis patients (n = 75; mean age: 50.9 ± 8.02 years; 72.2% women; 50.6% smokers) received a periodontal examination (six sites/tooth) to determine the presence of visible plaque and calculus, the gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), CALD and gingival recession (GR). CALI values resulted from the sum of PPD and GR values. Statistical analysis considered only data from sites with visible GR (e.g. the gingival margin apical to the cemento-enamel junction; n = 4,757 sites) and determined the mean difference between CALI and CALD measurements. Based on the mean difference, univariate and multivariate analyses were also performed., Results: Mean CALD and CALI values were 3.96 ± 2.07 mm and 4.47 ± 2.03 mm, respectively. The indirect method overestimated CAL compared with the direct method (mean difference: 0.51 ± 1.23 mm; P < 0.001). On uni- and multivariate analyses, absence of GBI and BOP, PPD and proximal site location had significant influences on the overestimation of CAL by the indirect method (all P ≤ 0.01). The indirect method increased the CAL value by 0.38 mm for each additional 1 mm in PPD., Conclusions: To decrease the number of probing errors in daily practice it is suggested that direct examination is more appropriate than the indirect method for estimating CAL., (© 2016 FDI World Dental Federation.)

Demineralized freeze-dried bone allograft (DFDBA) has been used extensively in periodontal therapy. Questions have been raised however, about the osteogenic potential of the variety of grafts available. In India the cost factor is another important consideration. The aim of this study therefore was to evaluate the clinical efficiency of the low priced, indigenously prepared DFDBA obtained from the Tata Memorial Hospital (TMH) Tissue Bank, in periodontal regeneration in infrabony periodontal defects, as compared to DFDBA obtained from the Pacific Coast Tissue Bank (DEMBONE). The latter was used as the control. 16 patients with bilaterally similar periodontal infrabony defects were selected, and randomly allotted to the test and control groups. At baseline, using standardized protocol, recession, probing depths (PD), and clinical attachment levels (CAL) were measured, following which periodontal surgery was carried out, with placement of the respective graft materials. Patients were recalled after 6 months for re-assessment. Statistically significant improvement was obtained for PD reduction and CAL gain for both groups (p < 0.05). However, no significant difference was observed between the test and control groups. It was therefore concluded that both the materials from different tissue banks are equally effective clinically, with the test material being additionally cost effective.

Background: The development of self-reported measures of periodontal disease would be of great benefit to facilitate epidemiological studies of periodontal disease on a larger scale, and to allow for surveillance of the periodontal condition of populations over time., Objectives: To develop a culturally adapted self-reported measure of periodontal disease, test its predictive and discriminative validity and establish a cut-off value for this measure to diagnose periodontal disease., Methods: A total of 288 Jordanian adults completed the questionnaire assessing self-reported periodontal health (18 questions) and underwent periodontal examination. Of the 18 questions, six were significantly associated with at least one clinical definition of periodontitis and were used to constitute the self-reported periodontal disease measure. Receiver-operating characteristics (ROC) curve analyses were used to examine the overall discriminatory power, sensitivity and specificity, and corresponding cut-off points of the self-reported periodontal disease measure., Results: ROC analysis showed that the self-reported periodontal disease measure had an excellent performance to discriminate between those with and without periodontal disease, regardless of the clinical definition used. A score of 2, on a scale of 0 to 6, had the highest sensitivity and specificity to detect periodontal disease when defined by all study criteria. Significant associations were observed between self-reported periodontal disease measures and all clinical definitions in the regression analysis (the odds ratio ranged from 8.31 to 18.96), according to the clinical definition to be predicted., Conclusion: Self-reported periodontal disease measures have excellent predictive and discriminative validity when tested against clinical definitions, and severity and extent of periodontal disease., (© 2015 FDI World Dental Federation.)

Aggressive periodontitis is a destructive disease characterized by the following: the involvement of multiple teeth with a distinctive pattern of periodontal tissue loss; a high rate of disease progression; an early age of onset; and the absence of systemic diseases. In some patients periodontal tissue loss may commence before puberty, whereas in most patients the age of onset is during or somewhat after the circumpubertal period. Besides infection with specific microorganisms, a host predisposition seems to play a key role in the pathogenesis of aggressive periodontitis, as evidenced by the familial aggregation of the disease. In this article we review the historical background of the diagnostic criteria of aggressive periodontitis, present a contemporary case definition and describe the clinical parameters of the disease. At present, the diagnosis of aggressive periodontitis is achieved using case history, clinical examination and radiographic evaluation. The data gathered using these methods are prone to relatively high measurement errors. Besides, this diagnostic approach measures past disease history and may not reliably measure existing disease activity or accurately predict future tissue loss. A diagnosis is often made years after the onset of the disease, partly because current assessment methods detect established disease more readily and reliably than they detect incipient or initial lesions where the tissue loss is minimal and usually below the detection threshold of present examination methods. Future advancements in understanding the pathogenesis of this disease may contribute to an earlier diagnosis. Insofar, future case definitions may involve the identification of key etiologic and risk factors, combined with high-precision methodologies that enable the early detection of initial lesions. This may significantly enhance the predictive value of these tests and detect cases of aggressive periodontitis before significant tissue loss develops., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To identify the diagnostic accuracy of gingival crevicular fluid (GCF) candidate biomarkers to discriminate periodontitis from the inflamed and healthy sites, and to compare the performance of two independent matrix metalloproteinase (MMP)-8 immunoassays., Materials and Methods: Cross sectional study. GCF (N = 58 sites) was collected from healthy, gingivitis and chronic periodontitis volunteers and analysed for levels of azurocidin, chemokine ligand 5, MPO, TIMP-1 MMP-13 and MMP-14 by ELISA or activity assays. MMP-8 was assayed by immunofluorometric assay (IFMA) and ELISA. Statistical analysis was performed using linear mixed-effects models and Bayesian statistics in R and Stata V11., Results: MMP-8, MPO, azurocidin and total MMP-13 and MMP-14 were higher in periodontitis compared to gingivitis and healthy sites (p < 0.05). A very high correlation between MPO and MMP-8 was evident in the periodontitis group (r = 0.95, p < 0.0001). MPO, azurocidin and total levels of MMP-8, MMP-13 and MMP-14 showed high diagnostic accuracy (≥0.90), but only MMP-8 and MPO were significantly higher in the periodontitis versus gingivitis sites. MMP-8 determined by IFMA correlated more strongly with periodontal status and showed higher diagnostic accuracy than ELISA., Conclusions: MPO and collagenolytic MMPs are highly discriminatory biomarkers for site-specific diagnosis of periodontitis. The comparison of two quantitative MMP-8 methods demonstrated IFMA to be more accurate than ELISA., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of this study was to evaluate the relationship between the severity of periodontitis and the extent and degree of coronary artery stenosis in a Chinese population., Methods: Patients (n = 853) with coronary artery stenosis confirmed by coronary angiography were eligible to take part in the study. Only subjects that were ≥60 years old, had ≥50% stenosis in at least one coronary artery, and did not have diabetes or a history of smoking were included (n = 115). After periodontal examination, including bleeding index, probing depth calculus index, plaque index and periodontal attachment loss, four groups were defined based on the severity of periodontitis: no periodontitis/gingivitis (M0, n = 19); mild periodontitis (M1, n = 27); moderate periodontitis (M2, n = 31); and severe periodontitis (M3, n = 38). The extent and degree of coronary artery stenosis was obtained by calculating the Gensini score (GS)., Results: The GS was significantly greater in the M3 group compared with the M0 group. Multiple linear regression analysis revealed that probing depth and plaque index were significantly correlated with the GS., Conclusions: The extent and severity of coronary artery stenosis in Chinese patients ≥60 years old is positively correlated with the severity of periodontitis., (© 2013 Australian Dental Association.)

Background: Cyclic neutropenia (CN) is a rare congenital disease that can present with recurrent oral ulcers and periodontitis. CN can easily be misdiagnosed as major recurrent aphthous stomatitis (MaRAS) or aggressive periodontitis (AP) in dental clinics. We describe the case of an 8-year-old boy with CN, and compare the oral manifestations of CN with those of MaRAS and AP., Case Report: An 8-year-old boy presented with a history of recurrent oral ulcers, periodontal destruction, pharyngitis and otitis media since the age of 3 months. Repeated, routine blood tests showed 1-week-long neutropenic periods that occurred at intervals of 2 weeks. A bone marrow cytology test during a neutropenic period demonstrated a decrease in granulocyte count. During a 2-year follow-up, his symptoms were well controlled by regular administration of granulocyte colony-stimulating factor and periodontal maintenance., Conclusion: Several clinical features help to differentiate CN from MaRAS and AP Early recognition of the systemic cause of oral symptoms is important.

Periodontal diseases are considered some of the most prevalent diseases in the adult population, affecting as much as 80 percent of people. Diagnosis can be performed by measuring pocket depth and bleeding upon probing. These diseases can be easily addressed in their early stages, but many choose to ignore the signs and symptoms. Saliva has recently emerged as a potential tool to aid in the diagnosis of periodontal diseases and the prediction of treatment outcomes.

Objective: To assess the anatomical landmarks of the roots of bifurcated maxillary first premolars and study their effect on the diagnosis and management of periodontal disease., Methods: One hundred sixty-five maxillary first premolars were selected. The frequency of single-, two-rooted, and three-rooted premolars was assessed, but only the dual-rooted were used for the purpose of this study. For each tooth, the following measurements were obtained using a micrometer caliper: buccal and palatal root length, mesial and distal root trunk length, crown length, and width of the furcation entrance. The types of root trunk were classified according to the ratio of root trunk height to root length into types A, B and C. Root trunk types A, B and C are defined as root trunks involving the cervical third or less, up to half of the length of the root, or greater than the apical half of the root, respectively. The presence of any root grooves and concavities, as well as bifurational ridges, was assessed. The crown to root ratio was calculated., Results: Of the 165 maxillary first premolar teeth retrieved, 100 (60.6%) were two-rooted, 62 (37.57%) were single-rooted, and three (1.81%) were triple-rooted. Type A root trunks comprised only 7% of the examined teeth, while types B and C had more or less comparable results (46% and 47% respectively). Type B was more common in distal root trunks while type C was dominant in mesial root trunks. Bifurcation ridges were observed in 37% of the teeth; the mean root trunk length was greater in teeth with bifurcation ridges than in teeth without (7.41 mm vs. 5.96 mm). Root grooves and concavities were found in 96% of the mesial aspects of the root, and in 57% of the palatal aspect of the buccal root. The mean width of the furcation entrance was 0.89 +/- 0.19 mm (range 0.39-1.28). The average crown to root ratio was 0.69:1., Conclusion: Awareness of root surface anatomical variations may help the practitioner when assessing the diagnosis, treatment plan and prognosis of periodontally involved two-rooted maxillary premolars.

Objective: To detect the plasma leptin levels in patients with aggressive periodontitis (AgP) and to analyze the relationship between circulating leptin level and periodontal condition., Methods: A total of 97 patients with AgP and 44 healthy controls were recruited. Detailed clinical examinations were conducted and clinical parameters such as bleeding index (BI), probing depth (PD), attachment loss (AL) were recorded. Plasma leptin level was measured by enzyme-linked immunosorbent assay., Results: The plasma leptin level in AgP group was significantly higher than that of control subjects [(20.0 ± 4.3) µg/L vs. (7.5 ± 1.3) µg/L, P < 0.01)]. The plasma leptin level was positively related to BI, PD and AL, and the r values were 0.647, 0.596 and 0.632 respectively (P < 0.01)., Conclusions: Plasma leptin concentration in AgP patients was significantly elevated compared with healthy controls. Circulating leptin level was positively related to periodontal parameters including BI, PD and AL.

Aim: To quantify the digit preference effect for three manual periodontal probes and to calculate correction values to enable comparison of studies with equal recording protocols, but different periodontal probes., Material and Methods: A prospective in vivo crossover study was conducted with a six-sequence three-period design. Six examiners assessed attachment loss (AL), probing pocket depth (PD) and gingiva height (GH) at four surfaces, full-mouth, in six generally healthy subjects using three manual probes: PCP11 (3-3-3-2 mm increments), PCP2 (2 mm increments), and PCPUNC15 (1 mm increments)., Results: Distributions of AL, PD and GH differed between probes (p < 0.001). Compared with PCPUNC15, periodontal measurements coinciding with probe markings of PCP11 and PCP2, respectively, were preferentially named by examiners. Digit preference was most pronounced for PD, but less for AL and GH. In multilevel models, PD differed significantly between all three probes (p < 0.05); probe- and examiner-related effects were also observed for AL and GH. Correction values for pairwise combinations of probes were determined., Conclusions: We provided empirical evidence and quantified the effect of probe type on periodontal measurements. Differences in probe type should be considered when comparing periodontal data within and between epidemiological studies and appropriate corrections, provided here, should be applied., (© 2012 John Wiley & Sons A/S.)

Mauriac syndrome is a rare condition that affects people with uncontrolled diabetes. The case history of a 17-year-old female patient diagnosed with Mauriac syndrome and concurrently suffering from type 1 diabetes mellitus (T1DM), stunted growth, hepatomegaly, and severe periodontal disease is described. Non-surgical periodontal therapy was the treatment provided. Severe periodontal destruction was seen in conjunction with the unique features of this syndrome, such as hepatomegaly, dwarfism, moon-shaped face, cushingoid fat deposition, delayed puberty, and brittle diabetes. Treatment resulted in decreased plaque and gingival scores. A bi-directional relationship has been established between diabetes mellitus and periodontal disease and there is an increasing emphasis on perio-systemic interrelationships. Given the effect that such systemic disorders have on periodontal health, periodontists should be involved in the early diagnosis and treatment of such patients., (© 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Aim: The purpose of the present study was to assess the extent to which the three periodontitis case definition systems proposed by van der Velden, Tonetti & Claffey and Page & Eke identify the same cases in a population of never-treated adults with limited tradition for oral hygiene procedures., Material and Methods: Based on data on clinical attachment level (CAL), probing pocket depth (PD) and bleeding on probing (BOP) of four sites in all teeth present among 1,130 adult Kenyans we classified the population according to the three case definition systems, and according to the occurrence of the concomitant presence of CAL and BOP at the site level., Results: The case definitions by Tonetti & Claffey and by Page & Eke yielded similar results, which were also quite similar to the results of simply identifying a case of periodontitis as a person having at least one site showing both CAL ≥ 4 mm and BOP., Conclusions: The results indicate that it should be feasible for the periodontal community to reach an agreement over the distinction between a case and a non-case. The classification system proposed by van der Velden is better suited for providing clinicians with a clear image of the case., (© 2011 John Wiley & Sons A/S.)

Objective: The present prospective study aimed at evaluating the influence of orthognathic surgery on mucogingival tissues and the subgingival microflora., Patients and Methods: Fifteen consecutively-treated patients with a mean age of 24.9±7.7 years were included in this study. The surgical interventions comprised the Le Fort I osteotomy of the maxilla and/or sagittal split osteotomy of the mandible. The following periodontal and microbial parameters were measured preoperatively (T(0)) as well as 1 week (T(1)) and 6 weeks (T(2)) postoperatively: pocket probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), and changes in the subgingival microflora. Periodontal parameters were calculated for all sites as well as for buccal and oral sites separately. For statistical analysis, the general linear model and paired t test were applied (level of significance: p<0.05)., Results: PPD readings increased significantly on oral tooth sites when T(0) values were compared to T(1) (p=0.009) and T(2 )values (p=0.042). GR increased significantly on buccal sites from 0.10±0.16 mm at baseline to 0.21±0.23 mm at T(1) (p=0.013) and 0.31±0.31 mm at T(2) (p=0.001). Furthermore, we noted significant changes in the CAL (oral sites) and PI (buccal and oral sites). We observed no significant differences in BOP and periodontopathogenetic bacteria., Conclusion: Orthognathic surgery has a statistically significant effect on the development of gingival recessions. However, this effect may not necessarily clinically impair the esthetic appearance.

Introduction: Most clinical studies on the outcome of apical surgery concentrate on periapical healing based on radiographic and clinical characteristics (signs and symptoms). This study focuses on long-term changes in periodontal parameters after apical surgery., Methods: Periodontal parameters (ie, probing depth [PD], level of gingival margin [GM], and calculated clinical attachment level [CAL]) were collected at baseline and at 1 and 5 years after apical surgery. Changes in PD, GM, and CAL were calculated over time and were also evaluated in relation to patient-, tooth-, and treatment-related covariables., Results: One hundred eighty-six of 242 initially identified teeth could be evaluated. Significant changes in GM and CAL were observed at facial sites during the first year after surgery (mean recession of GM was 0.29 mm, mean CAL loss was 0.20 mm), but none of the periodontal parameters significantly changed between 1 and 5 years after apical surgery. With regard to covariables, the type of incision technique was found to be the major factor affecting changes in GM and CAL between baseline and 1 year after surgery. Age, smoking, and type of periapical healing were the variables influencing the periodontal parameters over the longer observation period of up to 5 years., Conclusions: Patients should be informed about possible changes in periodontal parameters (gingival recession and loss of attachment) after apical surgery. The surgery itself appears to account for changes observed during the first year, whereas patient- and healing-related factors seem to affect periodontal changes seen thereafter., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The study design of national surveys of periodontal disease often uses partial-mouth examination protocols to rationalize the need for resources so that the collection of data from a large number of subjects can be achieved within the available means without significantly sacrificing precision and validity. Studies show that surveys that use partial examination protocols underestimate the prevalence of periodontitis, and the amount of underestimation varies depending on the number and type of sites examined, the case-definition of periodontal disease, tooth loss, and prevalence and severity of the disease. If a survey uses a partial-mouth examination it is recommended that the amount of underestimation be assessed in the same sample. This could be achieved by performing a full-mouth examination on a randomly selected subsample. Inflation factors should be calculated and used to adjust for the underestimation in disease prevalence because of the use of partial examination. Based on the NHANES III (1988 to 1994) data and adjusting for the bias caused by the examination protocol, it is estimated that approximately half of the United States population aged ≥30 years has periodontitis.

Background: A major challenge in clinical periodontics is to find a reliable molecular marker of periodontal tissue destruction with high sensitivity, specificity and utility., Objectives: The aim of this systematic review is to evaluate available literature on 'the utility of molecular markers of soft and hard periodontal tissue destruction'., Materials and Methods: Based on the focused question, 'What is the utility of molecular markers of soft and hard periodontal tissue destruction', an electronic and manual search was conducted for human studies presenting clinical data for the potential of molecular markers of tissue destruction in biofluids; gingival crevicular fluid (GCF), saliva, and serum., Results: Papers fulfilling the inclusion criteria were selected. All relevant data from the selected papers were extracted and recorded in separate tables for molecules in GCF, saliva, and serum., Conclusion: Within the defined limits of the Problem/Population, Intervention, Comparison, Outcome, the present analysis reveals that (a) no single or combination of markers exists that can disclose periodontal tissue destruction adequately; (b) while the most fruitful source of biomarkers for periodontal destruction appears to be in molecules tightly related to bone and soft tissue destruction, this remains to be objectively demonstrated. Currently, clinical measurements are still the most reliable., (© 2011 John Wiley & Sons A/S.)

Background: In 2007, 17.9 million people in the United States had diagnosed diabetes, and 5.7 million had undiagnosed diabetes. The authors developed a clinical guideline to help dentists identify patients with undiagnosed diabetes., Methods: The authors used classification and regression tree (CART) methods to generate different prediction models using data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994) and data from NHANES 2003-2004 for external validation. They classified participants who answered "No" to the question "Have you ever been told by a physician that you have diabetes?" and who had a fasting plasma glucose level greater than or equal to 126 milligrams per deciliter as having undiagnosed diabetes. The authors used oral examination data regarding the presence or absence of periodontitis and waist circumference, as well as data on participants' self-reported oral health status, weight, age, family history and race or ethnicity. The authors chose the best prediction model by means of 10-fold cross-validation, as well as internal and external validation methods, which evaluated each prediction model by comparing sensitivity, specificity, area under the receiver operating characteristic curve and ease of use criteria (N = 7,545)., Results: The authors' final clinical guideline for predicting undiagnosed diabetes in dental patients had a sensitivity of 82.4 percent, a specificity of 52.8 percent and a receiver operating characteristic area under the curve of 0.72. They found that waist circumference, age, self-reported oral health status, self-reported race or ethnicity and self-reported weight information could be used to predict the risk of having undiagnosed diabetes (range, 0.1 to 9.1 percent)., Conclusion: Dental care providers should consider using a clinical guideline that includes the following predictors: waist circumference, age, self-reported oral health, self-reported weight and self-reported race or ethnicity, as well as any additional information on periodontal status and family history of diabetes., Clinical Implications: This clinical guideline could help dentists identify patients with undiagnosed diabetes, resulting in the early identification of dental patients who require treatment for diabetes and, thus, reduce morbidity and health care costs.

Background: Few studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City., Methods: The authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables., Results: More than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services., Conclusions: Having a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City., Clinical Implications: The study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.

Background: This position paper was commissioned by the European Association of Dental Public Health, which has established six working groups to investigate the current status of six topics related to oral public health. One of these areas is epidemiology of periodontal diseases., Methods: Two theses "A systematic review of definitions of periodontitis and the methods that have been used to identify periodontitis" 1 and "Factors affecting community oral health care needs and provision" 2 formed the starting point for this position paper. Additional relevant and more recent publications were retrieved through a MEDLINE search., Results: The literature reveals a distinct lack of consensus and uniformity in the definition of periodontitis within epidemiological studies. There are also numerous differences in the methods used. The consequence is that data from studies using differing case definitions and differing survey methods are not easily interpretable or comparable. The limitations of the widely used Community Periodontal Index of Treatment Need (CPITN) and its more recent derivatives are widely recognized. Against this background, this position paper reviews the current evidence base, outlines existing problems and suggests how epidemiology of periodontal diseases may be improved., Conclusions: The remit of this working group was to review and discuss the existing evidence base of epidemiology of periodontal diseases and to identify future areas of work to further enhance it.

Objective: To perform a systematic review and critical analysis of the definitions of periodontitis and the methods which have been used to identify and measure this disease., Material and Methods: Relevant publications were identified after searching MEDLINE, EMBASE, SCISEARCH and LILACS electronic databases. Screening of titles and abstracts and data extraction was conducted independently by two reviewers. To be included in the review, studies were required to define periodontitis and to indicate how it was measured. Studies that related purely to gingivitis, and/or intervention studies, and/or studies where prevalence or severity of periodontitis was not a principal outcome were excluded., Results: From a total of 34,72 titles and abstracts, 104 potentially relevant full text papers were identified. Of these, 15 met the criteria for inclusion in the final stage of the review. The survey revealed heterogeneity between the studies in the measurement tools used, particularly the types of probes and the sites and areas of the mouth that were assessed. There was also heterogeneity in the use of clinical attachment loss (CAL) and pocket probing depth (PPD) as criteria for periodontitis. In the 15 studies, the threshold for a diagnosis of periodontitis when CAL was the criterion ranged from 2 to > or =6 mm and when PPD was used, from 3 to > or =6 mm., Conclusions: This review has confirmed previous work which has suggested that epidemiological studies of periodontal diseases are complicated by the diversity of methodologies and definitions used. The studies that were reviewed utilized a minimum diagnostic threshold defining periodontitis, at a given site in terms of CAL of 2 mm and PPD of 3 mm.

Aim: The purpose of the present study was to test the accuracy and precision with which the cemento-enamel junction (CEJ) can be assessed using three commercially available periodontal probes with different tip endings in both deciduous and permanent teeth., Material and Methods: An "in vitro" model was developed, consisting of 70 extracted permanent and 30 deciduous human teeth mounted in plaster with an artificial gingiva made of silicone rubber. The probes tested were the Merritt-B probe, the ball-ended CPITN probe and the Vivacare TPS beveled-ball probe. With each probe, duplicate CEJ assessments were carried out at six sites per tooth by four examiners. Upon completion, the distance between the CEJ and the artificial gingival margin was determined using a stereomicroscope., Results: The mean difference between the microscopic assessment and the mean clinical probe measurements in permanent teeth was -0.05 mm with the Merritt-B, 0.11 mm for the CPITN and 0.19 mm with the TPS probe. In deciduous teeth, the differences were -0.02, 0.35 and 0.63 mm, respectively. In both permanent and deciduous teeth, only the Merritt-B did not differ from the microscopic assessment., Conclusions: Results showed that the use of the Meritt-B probe offered the most accurate location of the CEJ in both permanent and deciduous teeth.

Aim: To date probing of the furcation using sounding has been one of the reliable methods to assess horizontal component of furcation in multirooted teeth. A more precise and reliable measurement of this horizontal component of furcation involves using a fixed reference point providing stability and reproducibility of measurements. A custom stent is used to provide a fixed reference point and can be used pre- and post-surgically without re-entry. Therefore, the purposes of this study were to (1) assess the reliability of furcation measurements by direct probing (without stent) and with the use of a newly designed furcation stent and (2) to assess the furcation measurements in relation to gingival margin position pre- and post-operatively., Methods and Materials: Forty-three chronic periodontitis patients with buccal grade II furcation involvement in maxillary or mandibular molars were included. The furcation involvement was measured by direct probing using a UNC-15 calibrated probe with and without using a custom stent. The furcation involvement and gingival margin position were measured pre- and post-surgically., Results: There was a significant reduction in plaque (PI) and gingival inflammation (GI) during the study period. The reduction in plaque index and gingival index was observed from 1.75 +/- 0.35 to 0.92 +/- 0.30, 1.88 +/- 0.35 to 0.98 +/- 0.29, respectively. Complete agreement was found between the first and the second measurement for about 74% of sites without the custom stent, whereas 86% of the sites measured using the stent had complete agreement. The differences never exceeded 1 mm for any of the sites. There was significant (t = 2.49; p<0.05) difference observed at complete agreement level ('0' difference)., Conclusion: It may be concluded the clinical attachment level-H of the furcation involvement using a PCP UNC-15 probe and a custom designed stent provides reproducible information about the furcation depth in multirooted teeth., Clinical Significance: Use of a simple modified furcation stent has shown greater reproducibility of furcal depth measurements than direct probing without the stent. The furcation stent definitely addresses the problems of existing methods of horizontal furcal depth measurements reported in the literature. The major advantages of the newly designed stent are the simple construction and non-invasive application which translates to wide practical applications.

Objective: To assess the systemic bone mineral density (BMD) and the periodontal situation in postmenopausal women, to understand the possible role of osteoporosis as a risk factor for periodontal disease., Methods: The sample was comprised of 47 postmenopausal women, divided into 3 groups: 14 patients with normal bones (G1), 17 with osteopenia (G2) and 16 patients with osteoporosis (G3). Data was obtained using bone mineral density (BMD), obtained by dual energy x-ray absorptiometry (DXA) in the lumbar area (L1-L4). Periodontal condition was evaluated by Gingival Index (GI), Plaque Index (PI) and Clinical Attachment Level (CAL). Results were analyzed and submitted to statistical treatment, through the One Way ANOVA: (alpha=0.05) test and the Pearson's Correlation test (alpha=0.01)., Results: GI, PI and CAL variables did not disclose a significant difference in the periodontal situation of postmenopausal women A significant correlation between periodontal parameters GI, PI and CAL (p<0,001) was observed, however no significant correlation was detected between periodontal parameters (GI, PI and CAL) and systemic bone condition of postmenopausal women, evaluated by BMD (p>0.01)., Conclusion: The periodontal situation of postmenopausal women does not depend on the systemic bone mass and there is no significant correlation between BMD and periodontal parameters. However, further longitudinal surveys are required to understand osteoporosis as a risk factor of periodontal disease.

Background: Osteocalcin levels have been postulated as a marker of inhibition of bone formation. The aim of the present study was to assess plasma, saliva and GCF levels of osteocalcin and correlate them with periodontal treatment outcome in postmenopausal women., Methods: Thirty-nine postmenopausal women (57.8 -/+8.5 years old) were recruited for the study. Periodontal examination of all women was carried out and plaque, bleeding on probing, probing depth (PD), and clinical attachment level (CAL) were recorded. Serum, saliva and gingival crevicular fluid osteocalcin were measured. Then, periodontal treatment was carried out. Six months after the first appointment a second periodontal examination was carried out., Results: Mean PD and mean CAL decreased significantly at second appointment in the group with serum osteocalcin concentration <10 ng/ml (15.8 -/+15.8% and 15.3 -/+ 21.2% respectively; p < 0.05). Mean PD decreased significantly at second appointment in the groups with saliva osteocalcin concentration < 3 ng/ml (17.1 -/+ 15.9%; p < 0.05) and 3-7 ng/ml (16.2 -/+18.1%; p < 0.05)., Conclusions: Low serum osteocalcin concentration is associated to a significantly higher percentage of decrease in PD and CAL after periodontal treatment in postmenopausal women. Low saliva osteocalcin concentrations are significantly associated to a higher percentage of decrease in PD.

Objective: The aim of the present study was to evaluate whether a stent should be used when assessing attachment level (AL) by an electronic probe (Florida Probe)., Methods: Twenty patients were recruited and individual stents were obtained to measure relative AL (RAL) with the Florida stent probe. Conventional AL (CAL) measurements were obtained by adding pocket depth and gingival recession recorded by the Florida pocket probe. Duplicate RAL and CAL measurements were taken one hour apart from each other on anterior teeth, at six sites per tooth, by one examiner. Patients were treated and reassessed with both probes after 45 days so that the gain in RAL and CAL could also be compared., Results: Pearson's correlation test showed that correlation was moderate (r = 0.57) and significant (p < 0.001) for duplicate CAL measurements. As for RAL values, correlation was higher (0.91) and significant (p < 0.001). The difference between RAL and CAL gain after 45 days was 0.04 mm (p = 0.85)., Conclusion: Since the correlation was higher for duplicate RAL measurements than for CAL measurements, the use of a stent should be considered in clinical trials to ensure better reproducibility of measurement of attachment level gains.

The objective of the present study was to compare the reliability of four partial-mouth protocols for assessing shallow, moderate, and deep sites for periodontal pocket depth and clinical attachment levels. Periodontal pocket depth and clinical attachment level measurements were recorded for 156 subjects (age > or = 30). The four models of partial-mouth protocols compared were: Model I: all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II: buccal sites in a full-mouth protocol, Model III: buccal sites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV: all sites per tooth using Community Periodontal Index teeth. In comparison with full mouth examination, Model I did not show significant differences for periodontal pocket depth and clinical attachment level parameters. Models II and III were different for some periodontal pocket depth means, and Model IV significantly overestimated all clinical parameters related to periodontal disease. Model I appears to be adequate to substitute for the full-mouth examination to assess the prevalence and severity of chronic periodontal disease in adults.

A nine-year-old boy presented with a serious periodontal lesion caused by a rubber band that had been used to close a medial diastema. Surgery was required to remove it. The impaction of a foreign body in the periodontal space should be suspected when a clinical attachment level is lost during childhood.

Introduction: Rubinstein-Taybi syndrome (RTS) is a rare disorder affecting 1 of 300,000 people, characterized by growth, mental and motor retardation, small stature, broad thumbs and toes, characteristic face, high-arched palate, and recurrent respiratory infections., Case Report: The present report describes the periodontal and immunological status of a 14-year-old female patient with RTS. Probing depth, clinical attachment level, bleeding on probing, and radiographic evaluation were performed. Periodontal examination revealed severe attachment loss in incisors and molars and generalized bleeding on probing. Periodontal treatment consisted of scaling and root planing and oral hygiene instructions. Periodontal treatment resulted in resolution of gingival inflammation and pocket depth reductions. The association of periodontal disease and RTS is previously undescribed., Conclusion: This case report underscores the importance of periodontal clinical diagnosis and the possibility of successful periodontal treatment in RTS patients.

Background: We present an approach to examiner calibration study design where the number of calibration subjects is based on a specified margin of error (half-width of the 95% confidence interval [CI]) of the percentage of agreement (exact and within 1 mm) for both intra- and interexaminer reliability assessments., Methods: An experienced standard examiner (S) trained three dental hygienists (A, B, and C) in correct procedures for obtaining a variety of periodontal measures. Duplicate measurements of probing depth (PD [mm]) and the free gingival margin to the cemento-enamel junction (CEJ-GM [mm]) were obtained in a pilot study to design a formal examiner calibration study, where sample sizes were adjusted for the effects of within-subject clustering of binary indices of agreement., Results: Within-subject clustering of agreement indices resulted in an approximate four-fold increase in the variance of the estimates of percentage of agreement with the standard. PD and CEJ-GM percentage of exact agreement measurements (95% CI) for each examiner-standard pair, respectively, were as follows: AS=55% (48%, 61%) and 70% (62%, 78%); BS=52% (45%, 59%) and 73% (63%, 82%); and CS=55% (50%, 61%) and 72% (65%, 79%). The corresponding 95% CIs unadjusted for the effects of clustering underestimated the margin of error associated with the estimates of exact agreement by as much as 57% for PD and 68% for CEJ-GM., Conclusion: Failure to account for dependence among site-level agreement indices results in a false sense of precision in the resulting reliability estimates and can lead to faulty inference.

Objective: The purpose of this study was to compare periodontal status of postmenopausal women with mild to moderate osteoporosis who use risedronate therapy with those who do not., Design: In this cross-sectional study, a total of 60 age-matched postmenopausal women with mild to moderate osteoporosis diagnosed by a bone density scan T score below -2.5 at either spine or hip were divided into two groups. Women in the experimental group had used systemic risedronate once weekly (35 mg) for at least 3 months. Women in the control group had never used bisphosphonate therapy. The periodontal status of each subject was evaluated through a clinical periodontal examination including evaluation of periodontal probing depth, gingival recession, gingival index, plaque score, attachment loss, and alveolar bone level. The significance in differences between the two groups was assessed using two-tailed paired t tests., Results: Significant differences (P < 0.05) were found between risedronate and control groups for periodontal probing depth (2.6 vs 2.9 mm), gingival index (0.37 vs 0.71), plaque score (56.2 vs 77.0), attachment loss (2.8 vs 3.2 mm), and alveolar bone level (3.1 and 4.0), respectively. Gingival recession parameters did not differ significantly. Five of six periodontal parameters evaluated show that postmenopausal women with mild to moderate osteoporosis using risedronate therapy have healthier periodontal status than those who do not use bisphosphonates., Conclusions: Women using risedronate therapy show significantly less plaque accumulation, less gingival inflammation, lower probing depths, less periodontal attachment loss, and greater alveolar bone levels. These observations suggest that risedronate therapy may play a beneficial role in periodontal status.

Objective: The main objective of this study was to determine the relationship between bleeding on probing (BOP) and periodontal disease progression in community-dwelling older adults., Methods: A 3-year longitudinal study was carried out in 229 non-smoking healthy older adults aged 70 years. Using pressure-controlled periodontal probes, BOP, pocket depth and attachment level at 13,289 sites were measured annually. Periodontal disease progression was defined as an increase in attachment loss of >or=3 mm from the baseline to the final examination. The backward stepwise logistic regression analysis was performed to assess the relationship between the total number of sites with BOP in the four examinations and periodontal progression., Results: Logistic regression analysis showed that the odds ratios of BOP frequency for periodontal disease progression ranged from 1.4 to 6.2 after controlling for pocket depth >or=4 mm at baseline, number of missing teeth, jaw type and tooth site., Conclusion: Increasing frequencies of bleeding might increase the probability of periodontal disease progression in community-dwelling older adults., (Copyright (c) Blackwell Munksgaard, 2005.)

Probing depth assessments are the backbone of a periodontal evaluation. However, they should be interpreted with respect to current information regarding their diagnostic and therapeutic implications. Controlled clinical trials and review papers that related probing depth determinations to diagnosing periodontal disease or assessments of therapy were selected for evaluation. The literature indicates that increased probing depths usually are related to loss of clinical attachment; however, they may not reflect periodontal disease or disease progression. When characteristics pertaining to deep and shallow sites are compared, deep sites have more bleeding on probing, elevated bacterial levels, reduced ability of oral hygiene to alter subgingival microflora, less effective root instrumentation, and a greater percentage of pockets that experience disease progression in treated and untreated sites. However, individual deep sites are not good predictors of disease progression. The preponderance of information indicates that it is preferable, but not always essential, to have shallow sites around teeth to attain and maintain periodontal health. Ultimately, therapeutic decisions based on probing depths are influenced by the medical and dental history of the patient, a practical interpretation of the literature, and clinical experience.

The aim of this study was to evaluate the reproducibility of a conventional manual probe (MP) and an electronic probe, the Florida Probe (FP). Twenty patients with chronic periodontitis were assessed for pocket depth (PD) and clinical attachment level (CAL) by one examiner. Replicate measurements were taken one hour apart with each probe, on anterior teeth, at six sites per tooth. Pearson's correlation test and Student's paired t-test were used for the statistical analysis. The results showed that there were no significant differences in PD between the replicate measurements of both FP and MP (p > 0.05), although the correlation value was higher for FP (r = 0.97, p < 0.01) than for MP (r = 0.54, p < 0.05). Considering CAL, no differences were found between replicate measurements for both FP and MP (p > 0.05) and correlation values were similar (0.57 and 0.64, respectively, p < 0.001). Although the FP showed higher correlation values for PD, no significant differences were found between duplicate measurements for both probes. Thus, both electronic and manual probing measurements seem to be reproducible when assessing periodontal disease.

Background: Successful treatment of molar furcation defects remains a challenge in clinical practice. Knowledge of anatomic factors facilitates predictable management of furcation involvement lesions. The degree of success in managing furcation involvement is inversely related to the horizontal probing depth. The depth of the horizontal component of attachment loss can vary depending on the external tooth-surface reference points used. However, the anatomical factors affecting horizontal component of attachment loss have not been previously assessed. Therefore, this study determined the bucco-lingual measurements of the cemento-enamel junction and the mesial and distal roots and at the level of root separation., Methods: One hundred extracted permanent human mandibular first (N = 50) and second (N = 50) molars were studied. Four horizontal bucco-lingual widths were measured with calibrated calipers: 1) furcation entrance/roof (FE); 2) cemento-enamel junction level (CEJ); 3) mesial root width (MRW); and 4) distal root width (DRW)., Results: The mean widths at FE, CEJ, MRW, and DRW were, respectively, 5.53 +/- 0.45 mm, 8.71 +/- 0.54 mm, 8.57 +/- 0.54 mm, and 7.97 +/- 0.65 mm in the first molars and 5.61 +/- 0.65 mm, 8.40 +/- 0.65 mm, 7.95 +/- 0.88 mm, and 7.16 +/- 0.84 mm in the second molars. Analysis of variance revealed significant differences between FE and the other variables tested. The results showed that the bucco-lingual width of the furcation roof is considerably shorter than the MRW and DRW. The difference in the mean bucco-lingual dimension between FE and the other measurements occurred in all teeth evaluated and varied between 0.7 and 4.30 mm., Conclusions: Our findings demonstrate that clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated. This has implications not only for clinical practice but also for clinical research studies evaluating treatment outcomes.

Objective: To observe two-year natural progression of chronic periodontitis in mild, moderate and advanced periodontitis patients., Methods: The periodontal status of 169 untreated chronic periodontitis patients aged from 22 to 64, were examined for two years. Periodontal measurements were performed on all teeth except the third molars and 6 sites examined for each tooth. Probing depth (PD), attachment loss (AL), and bleeding on probing (BOP) were measured at baseline, one year, and two year by a same experienced periodontist. Forty-five patients were diagnosed as having mild periodontitis, 87 with moderate, and 37 with advanced periodontitis. The changes of attachment level in these three group patients were analyzed. The site with change of AL greater than 3 mm (DeltaAL > or = 3 mm) were defined as periodontal disease activity (PDA) sites. The occurrence of PDA in three groups was compared., Results: (1) The average AL levels at 1 year and at 2 year were greater than that at baseline in mild, moderate and advanced periodontitis. (2) The percentage of sites with AL > or = 1 mm in three groups all increased from baseline to 1 year and to 2 year. (3) The occurrence of periodontal disease activity increased significantly from mild (0.14% at site level, 15.56% at subject level), moderate (0.39%, 29.89%) to advanced (0.73%, 43.24%) periodontitis patients. (4) The mean baseline AL and PD levels in active sites were greater than that in inactive sites (PD: 3.03 +/- 0.45 vs. 2.87 +/- 0.38, P < 0.05; AL: 2.25 +/- 0.93 vs. 1.77 +/- 0.90, P < 0.01)., Conclusion: Untreated advanced periodontitis patients were the risk population for further periodontal breakdown.