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The purpose of this retrospective study was to assess if dental invagination is a risk factor for root resorption during orthodontic treatment. The sample consisted of 91 patients (32 males, 59 females) with a mean age of 13.1 years (range 9.3-32.1 years) with complete orthodontic records, including periapical radiographs of the maxillary incisors before and after treatment. Forty-nine patients had at least one maxillary incisor invaginated, whilst the remaining 42 patients were free of dental invaginations. Variables recorded for each patient included gender, age, Angle classification, extraction or non-extraction therapy, ANB angle, overjet, overbite, trauma, habits, agenesis, tooth exfoliation, treatment duration, Class II elastics, body-build, general factors, impacted canines, and root form deviation. Crown and root length of the maxillary incisors were measured on pre- and post-treatment long cone periapical radiographs corrected for image distortion. The percentage of root shortening and root length loss in millimetres was then calculated. Most of the invaginated teeth were minor type 1. Statistical analysis revealed no significant difference in the severity of apical root resorption between invaginated and non-invaginated incisors in patients without dental invaginations, nor was the extent of dental invagination related to the severity of apical root resorption. However, invaginated teeth had malformed roots more often than non-invaginated teeth. Dental invagination, and particularly type 1, cannot be considered a risk factor for apical root resorption during orthodontic tooth movement.

The aim of the present study was to investigate the effect of systemic administration of low-dose doxycycline (DC) on orthodontic root resorption. The effect on alveolar bone, the cell population involved, and the amount of tooth movement were also evaluated.Fifty-six 40-50-day-old male Wistar rats were used. Six animals served as untreated controls. Six animals were only administered DC for 7 days, by means of a mini-osmotic pump implanted subcutaneously. In 44 animals the maxillary first molar was mesialized by a fixed orthodontic appliance exerting 50 g force upon insertion. In 28 of these animals DC was administered at the time of appliance insertion and throughout the experiment. The animals were sacrificed 7, 10 or 14 days after force application and block sections processed for analysis. An area including the mesial aspect of the distopalatal root and the adjacent inter-radicular alveolar bone was histomorphometrically evaluated. The root resorption area, absolute alveolar bone area, distance between first and second molars, number of odontoclasts, osteoclasts, mononuclear cells on the root, tartrate-resistant acid phosphatase (TRAP)-positive cells on the root, bone, and in the periodontal ligament (PDL) were compared between DC-treated and non-DC-treated animals. The results revealed a significant reduction in root resorption, the number of odontoclasts, osteoclasts, mononuclear cells on the root surface, and TRAP-positive cells on the root and bone for the DC-administered group. The absolute alveolar bone area was greater, whereas the distance between the first and second molars did not differ between groups. In conclusion, systemic administration of low-dose DC in rats may have an inhibitory effect on orthodontically induced resorptive activity.

Background: In the oral cavity, sutures are placed within tissues of high vascularity in a moist environment with infectious potential. The objective of this study was to evaluate tissue reactions at silk and expanded polytetrafluoroethylene (ePTFE) sutures in the presence and absence of anti-infective therapy (AT)., Methods: Thirty-six sutures were placed within the mandibular keratinized gingiva in six Beagle dogs. Each animal received one braided silk (4-0) and one ePTFE (CV-5) suture in contra-lateral jaw quadrants at 14, 7, and 3 days prior to biopsy. Three animals received daily AT including topical 2% chlorhexidine solution and a systemic broad-spectrum antibiotic. Biopsy specimens allowed histometric analysis of tissue reactions along the central part of the suture loop including the area of perisutural epithelium, ratio inflammatory cells (ICs)/epithelial cells and IC/fibroblasts, and presence/absence of bacterial plaque in the suture track., Results: A perisutural epithelial sheath was forming within 3 days. The cross-sectional area of the epithelium increased with time for both suture materials (p=0.003) but was particularly pronounced for the silk sutures in the absence of AT. Clusters of IC were present in the perisutural connective tissue and epithelium. Over time, a more prominent increase in IC/fibroblasts was evident for the silk sutures in the absence of AT. The pooled material revealed a significantly higher IC/fibroblast ratio for silk compared with ePTFE sutures (p=0.017). Bacterial plaque influx was detected in 6/9 silk and 0/9 ePTFE suture channels in the presence, and 6/6 and 3/6 suture channels, respectively, in the absence of AT., Conclusions: AT may reduce biofilm formation and inflammation along the suture track. Braided silk, however, elicits more severe tissue reactions than ePTFE regardless of infection control., ((c) Blackwell Munksgaard, 2005.)

Background: Wound closure by suturing is a critical and significant event in general as well as in oral surgery. Information regarding tissue reactions to different suture materials appears incomplete and inconsistent, particularly in humans. Thus, the purpose of the present study was to evaluate clinically and histologically tissue reactions to silk and expanded polytetrafluoroethylene (ePTFE) suture materials placed in human oral tissues., Methods: Twelve patients undergoing periodontal treatment, who had bilateral periodontal defects in the maxillary premolar and molar region scheduled for resective surgery, were included. In each patient, one single interrupted ePTFE suture (CV-5) and one single interrupted silk suture (4-0) were inserted in gingival tissues in contralateral jaw quadrants 10 days prior to scheduled surgery and a second set of sutures was inserted at 7 days prior to surgery. After placement, the length of the suture embedded in the tissue as well as the slack of the suture loop were measured and tabulated. The measurements were repeated on the day of surgery. At this time biopsy specimens, including the suture loop and surrounding tissue, were harvested and processed for histologic analysis. The inflammatory response was evaluated by measuring the thickness of the perisutural epithelium and the diameter of the connective tissue infiltrate, by estimating the proportion of inflammatory cells to epithelial cells, and by recording the presence or absence of bacterial plaque along the suture track., Results: At 7 days, silk sutures showed a significantly higher degree of slack of the suture loop than did ePTFE sutures (P= 0.02), while the difference was not significant at 10 days (P= 0.21). The mean change of "tissue bite" was greater for silk compared to ePTFE at 7 as well as at 10 days. However, none of the differences were statistically significant (P= 0.43). The thickness of the perisutural epithelium increased significantly from 7 to 10 days for both suture materials, while the difference in proportion of inflammatory cells to epithelial cells was not significant (P= 0.43). An overall significantly greater diameter of connective tissue infiltrate was present around the silk sutures. Bacterial plaque was detected in 10 of 11 silk and four of 11 ePTFE suture channels at 7 days, and eight of 10 and four of 11 suture channels at 10 days., Conclusions: The results revealed that placement of sutures in gingival tissues elicits an inflammatory reaction and that the magnitude of this reaction may vary with the suture material used. Braided silk sutures apparently cause a more extensive inflammatory tissue reaction in an environment characterized by moisture and infectious potential.

The purpose of the study was to characterize root surface alterations in orthodontically moved teeth. Thirty-six 40-50-day-old male Wistar rats were used. The maxillary right first molar was mesialized by means of a fixed appliance, exerting 50 g of force upon insertion. One, 2 and 4 days after force application the animals were sacrificed (nine animals per observation period) and block sections processed for analysis. Nine animals served as untreated controls. In total, 20 specimens were prepared for examination of the mesial aspect of the mesiobuccal root by scanning electron microscopy (SEM). The remaining specimens were processed for light microscopy. Three morphologically distinct types of resorption defect were observed: isolated small lacunae, wide shallow resorption bays, and deep resorption lacunae. The area occupied by each resorption type varied significantly (P < 0.05) with time. Isolated small lacunae were the earliest to be observed, sometimes found in continuity with wide shallow resorption bays. Mononucleated macrophage-like cells were associated with both resorption types. Deeper lacunae extending into the dentine were found at the 4 day observation period. These always occurred within shallow resorption bays and appeared to be created by multinucleated cells. From the sequence of the different root surface defects and associated cell types observed during the development of orthodontically induced root resorption, it may be concluded that different cell types, with different resorptive potential but functionally interrelated, are involved in the successive phases of the process, and that each cell type leaves a characteristic resorption pattern on the root surface.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) technologies have been shown to enhance alveolar bone formation significantly. Biomaterial (carrier) limitations, however, have restricted their biologic potential for indications where compressive forces may limit the volume of bone formed. The objective of this proof-of-principle study was to evaluate the potential of a space-providing, macroporous ePTFE device to define rhBMP-2-induced alveolar bone formation using a discriminating onlay defect model., Methods: Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the third and fourth mandibular premolar teeth in four young adult Hound Labrador mongrel dogs. All jaw quadrants received rhBMP-2 (0.4 mg) in an absorbable collagen sponge (ACS) carrier. Contralateral jaw quadrants in subsequent animals were randomly assigned to receive additionally the dome-shaped, macroporous ePTFE device over the rhBMP-2/ACS implant or no additional treatment. The gingival flaps were advanced to cover the ePTFE device and teeth, and sutured. Animals were scheduled for euthanasia to provide for histologic observations of healing at 8 weeks postsurgery., Results: Healing was uneventful without device exposures. New bone formation averaged (+/-SD) 4.7+/-0.2 mm (98%) and 4.5+/-0.4 mm (94%) of the defect height, respectively, for jaw quadrants receiving rhBMP-2/ACS with the ePTFE device or rhBMP-2/ACS alone (p>0.05). In contrast, the regenerated bone area was significantly enhanced in jaw quadrants receiving rhBMP-2/ACS with the ePTFE device compared to rhBMP-2/ACS alone (9.3+/-2.7 versus 5.1+/-1.1 mm2; p<0.05). Cementum formation was similar for both treatment groups. Ankylosis compromised periodontal regeneration in all sites., Conclusions: The results suggest that the novel space-providing, macroporous ePTFE device appears suitable as a template to define rhBMP-2/ACS-induced alveolar bone formation.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to support the regeneration of alveolar bone and periodontal attachment in surgically created periodontal defects and in defects with a history of dental plaque and calculus exposure. Periodontal regeneration has also been shown following guided tissue regeneration using space-providing expanded polytetrafluoroethylene (ePTFE) devices. The objective of this study was to evaluate the influence of rhBMP-2 on regeneration of alveolar bone and periodontal attachment used in conjunction with a space-providing ePTFE device., Methods: Routine, critical-size, 5-6 mm, supra-alveolar, periodontal defects were created around the third and fourth mandibular premolar teeth in four young adult Hound Labrador mongrel dogs. rhBMP-2 (0.2 mg/ml) in an absorbable collagen sponge (rhBMP-2/ACS) or buffer/ACS (control) implants were randomly assigned to be placed around the premolar teeth in the left and right jaw quadrants in subsequent animals. Space-providing ePTFE devices with 300-microm laser-drilled pores, 0.8 mm apart, were used to cover the rhBMP-2 and control implants. The gingival flaps were advanced for primary wound closure. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analyses., Results: Bone regeneration and ankylosis were significantly increased in jaw quadrants receiving rhBMP-2/ACS compared to control (bone height 4.8+/-0.3 versus 2.0+/-0.2 mm, p=0.001; bone area 10.9+/-1.3 versus 1.4+/-0.1 mm2; p=0.009, and ankylosis 2.2+/-0.2 versus 0.04+/-0.7 mm; p=0.01). No differences between groups were found for cementum regeneration and root resorption., Conclusions: rhBMP-2 significantly enhances regeneration of alveolar bone in conjunction with a space-providing, macroporous ePTFE device for GTR.

Background: Crohn's disease is a chronic inflammatory bowel disease characterized by uncertainty in etiology and pathogenesis occasionally with manifestations in oral mucous membranes. This report reviews the literature on Crohn's disease and presents a patient with Crohn's disease on continuous anti-inflammatory and immunosuppressive medication who showed adverse healing response following surgical treatment of gingival recession type defects., Methods: A 28-year-old male in generally good health apart from his bowel disease requested treatment of multiple maxillary gingival recessions due to esthetic concerns and root sensitivity. Following oral hygiene instruction, 3 coronally advanced flap procedures were performed in the maxillary anterior region to cover the defects. In 2 of the surgical areas, the exposed root surfaces were treated by ethylenediaminetetraacetic acid (EDTA) in combination with enamel matrix derivative (EMD) before coronally positioning the buccal flap. Postoperatively, chlorhexidine gluconate was used for oral hygiene control., Results: The first surgical procedure, performed as a coronally advanced flap, showed delayed and altered healing. Two weeks postoperatively, the flapped tissue remained intensely red and swollen. In the following 2 surgical sites where EDTA and EMD were applied the healing was uneventful. Differences in immediate tissue response, however, did not influence the 3-month treatment outcome with respect to root coverage., Conclusions: Patients with Crohn's disease on recommended systemic medications may show a delayed and altered wound healing indicating that periodontal surgery must be closely monitored. Treatment planning should take into account the potential wound healing promoting effects of enamel matrix derivative as well as adverse healing effects of chlorhexidine gluconate administration.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable sponge (ACS) carrier is currently being evaluated as candidate therapy for periodontal regeneration. The objective of this study was to characterize, in some detail, tissue reactions following surgical implantation of rhBMP-2/ACS into periodontal defects., Methods: Four young adult, male beagle dogs with surgically induced, bilateral, critical size, supra-alveolar, mandibular premolar defects sequentially received rhBMP-2/ACS (rhBMP-2 at 0.2 mg/ml) in right and left jaw quadrants. After 4 or 8 weeks of healing, experimental teeth with surrounding tissues were harvested and processed for light and transmission electron microscopy., Results: Surgical implantation of rhBMP-2/ACS into large supra-alveolar periodontal defects resulted in a variable tissue response without marked difference between 4- and 8-week observations. New bone, exceeding the volume of the normal alveolar process, had formed within 4 weeks. The regenerated bone tissue consisted of finely trabeculated woven bone. Marrow spaces exhibited a continuous lining of osteoblasts, osteoclasts, and resting cells. The marrow spaces contained numerous large, thin-walled vessels but were almost devoid of collagen fibrils or fibroblasts. Large voids (seromas) encountered in the newly formed bone were free of structured elements except for occasional aggregates of effete erythrocytes. A variety of tissue reactions were observed along the root surface including areas of resorption, areas of hard tissue deposition, and areas without resorptive or appositional activity. Ankylosis was a frequent observation, although areas showing characteristics of a periodontal ligament with a fine layer of acellular fiber cementum and occasional inserting Sharpey's fibers were also observed. Osteoblasts facing the root surface often appeared to be in a highly active state judged by their cuboidal shape, well-developed endoplasmic reticulum and numerous mitochondria, and the presence of an adjacent layer of preosteoblasts. Conspicuous bundles of wide collagen fibrils near the dentin surface as well as within the marrow spaces were considered to represent remnants of the ACS. These fibrils were associated with areas of mineralization as verified by examination of undecalcified specimens., Conclusions: rhBMP-2/ACS elicits a rapid osteoinductive process throughout the implant as well as along and onto the instrumented adjacent root surface. Lamellated trabecular bone was the predominant regenerated tissue. A typical cementum-periodontal ligament-alveolar bone relationship was a rare observation. The great variability in histological tissue response along the instrumented root surface indicates that the stimulus to hard tissue formation resided primarily in the rhBMP-2/ACS implant rather than in the root surface.

The purpose of the study was to investigate root lengthening during orthodontic treatment in relation to the age of the patient, the developmental stage of the root, and the anticipated growth. Specifically, the potential benefit of treating young teeth was addressed. The sample consisted of 80 patients with Angle Class II division 1 malocclusions, treated with extraction of at least two maxillary first premolars, and edgewise technique with 0.018-inch slot brackets. Additionally, a cross-sectional control group of 66 untreated individuals matched to gender, and pre- and post-treatment age of the experimental group was included. Crown and root lengths of the maxillary incisors were measured on peri-apical radiographs before and after treatment, and corrected for image distortion. The stage of root development before treatment was recorded. Root elongation during treatment was found for 50 out of the 280 examined teeth. Age at treatment start was significantly higher among the patients showing root shortening of the lateral incisors during treatment than among those showing root elongation (P < 0.05). The stage of root development was significantly related to the direction of root length change, i.e. shortening or elongation. Roots elongated during treatment did not differ in length from untreated teeth of similarly aged individuals. There was no significant difference in the extent of root lengthening between the roots elongated during treatment and the normal root lengthening in age-matched untreated individuals. Post-treatment root length was significantly related to pre-treatment age. Roots that were incompletely developed before treatment reached a significantly greater length than those that were fully developed at the start of treatment. The results of this study show a definite advantage for younger teeth with regard to post-treatment root length. This finding may influence treatment planning strategy.

This investigation was undertaken to assess bacterial plaque accumulation adjacent to orthodontic brackets. Experiments were carried out on 11 subjects who were scheduled for orthodontic treatment including extraction of two or four premolars. Metal brackets were bonded to the premolars to be extracted using macro-filled bonding composite. A conventional elastomeric ring was placed around one bracket and a steel ligature wire around the bracket on the contralateral tooth. The subjects were told to continue their normal oral hygiene regimen. Teeth were extracted at 1, 2, or 3 weeks after bracket bonding. Scanning electron microscopic (SEM) examination of brackets, excess composite, and buccal enamel revealed that mature plaque was present on excess composite at 2 and 3 weeks after bonding, whereas plaque on the gingival enamel surface was still at an early stage of development. The results demonstrate that excess composite around the bracket base is the critical site for plaque accumulation due to its rough surface and the presence of a distinct gap at the composite-enamel interface. The method of ligation does not appear to influence the bacterial morphotypes on both composite and enamel surfaces.

The objective of this study was to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) concentration on regeneration of alveolar bone and cementum, and on associated root resorption and ankylosis. Contralateral, critical size, supra-alveolar, periodontal defects were surgically produced and immediately implanted with rhBMP-2 in an absorbable collagen sponge (ACS) carrier in 8, young adult, male, beagle dogs. 6 animals received rhBMP-2/ACS (rhBMP-2 at 0.05, 0.10, or 0.20 mg/mL; total construct volume/defect approximately 4.0 mL) in contralateral defects following an incomplete block design. 2 animals received rhBMP-2/ACS (rhBMP-2 at 0 and 0.10 mg/mL) in contralateral defects (controls). The animals were euthanised at 8 weeks post-surgery and block sections of the defects were collected for histologic and histometric analysis. Supra-alveolar periodontal defects receiving rhBMP-2 at 0.05, 0.10, or 0.20 mg/ml exhibited extensive alveolar regeneration comprising 86%, 96%, and 88% of the defect height, respectively. Cementum regeneration encompassed 8%, 6%, and 8% of the defect height, respectively. Root resorption was observed for all rhBMP-2 concentrations. Ankylosis was observed in almost all teeth receiving rhBMP-2. Control defects without rhBMP-2 exhibited limited, if any, evidence of alveolar bone and cementum regeneration, root resorption, or ankylosis. Within the selected rhBMP-2 concentration and observation interval, there appear to be no meaningful differences in regeneration of alveolar bone and cementum. There also appear to be no significant differences in the incidence and extent of root resorption and ankylosis, though there may be a positive correlation with rhBMP-2 concentration.

The rat incisor is a commonly used model in studies of tooth eruption, amelogenesis and effects of mechanical loading on the dental and periodontal tissues. The purpose of this study was to assess the three-dimensional architecture of the microvascular bed of the rat incisor enamel organ, to describe the direction of blood flow, and to provide a histometric assessment of the vascular categories that can be statistically analyzed. Vascular corrosion casts were prepared and examined by scanning electron microscopy. The microvasculature of the labial periodontal space was arranged in three distinct layers. The inner layer in direct relation to the enamel organ consisted of a capillary network which was drained by short venules at the cemento-enamel junction. The intermediate layer consisted of arterioles oriented parallel to the long axis of the incisor mainly mid-labially, branching off smaller arterioles to the capillary network. The outer layer was formed by flattened sinusoid vessels of larger caliber. Blood supply was from the anterior superior alveolar artery branches through the arterioles into the capillary network. Drainage was postero-laterally along the cemento-enamel junction via short venules which emptied into the sinusoid vessels, finally to flow through Volkmann's canals into the alveolar bone via small venules. The findings demonstrate that the microvasculature of the rat incisor enamel organ has an exceptionally high level of physiologically-adapted structural organization.

This split-mouth study was designed to evaluate regeneration of alveolar bone and periodontal attachment following implantation of allogeneic, freeze-dried, demineralized bone matrix (DBM). Buccal fenestration defects (6x4 mm) were created on the maxillary canine teeth in 6 beagle dogs. DBM was implanted into one randomly selected defect in each animal. The contralateral defect served as surgical control. Tissue blocks were harvested following a 4-week healing interval and prepared for histometric analysis. DBM was discernible in all implanted defects with limited evidence of bone metabolic activity. The DBM particles appeared invested within a dense connective tissue, often in close contact to the instrumented root. Fenestration defect height averaged 3.8+/-0.1 and 3.7+/-0.3 mm, total bone regeneration 0.9+/-0.9 and 0.4+/-1.2 mm, and total cementum regeneration 2.3+/-1.5 and 0.6+/-0.7 mm for DBM and control defects, respectively. Differences with regards to cementum regeneration were statistically significant (p=0.03). In summary, the results of this study suggest that DBM implants may enhance cementum regeneration in this defect model, and that they have no apparent effect on alveolar bone regeneration. Enhanced cementum regeneration may be possibly be explained by provisions for guided tissue regeneration from the implant suppressing a significant influence of the gingival connective tissue on the healing process. Moreover, a 4-week healing interval appears insufficient for turnover of DBM.

Tissue reactions to natural and synthetic braided and monofilament suture materials in gingiva and oral mucosa were studied. A total of 138 sutures made of four commonly used materials were placed in the edentulous ridges and vestibular mucosa of eight beagle dogs. Biopsy specimens including the suture loop and surrounding tissues were obtained after 3, 7, and 14 days and processed for histologic analysis. The inflammatory reaction was more rapid and intense than the reaction that has been reported after suture placement in skin. Bacterial invasion of the suture track was a common sequela regardless of the material used, but it was particularly prominent for silk. The formation of a perisutural epithelial sleeve was well under way at 3 days and in some instances included the entire suture track within 7 days. Connective tissue reactions consisted of several well-defined, concentric perisutural zones. At 14 days, these zones were partly replaced by granulation tissue surrounded by a fibrous capsule. The synthetic monofilament suture elicited a mild inflammatory tissue response. The results showed that sutures placed in gingiva and oral mucosa produce a prolonged tissue response that is most likely a result of the continual influx of microbial contamination along the suture channel, which may be a lesser problem when sutures are placed in other surgical compartments. The results indicate that chromic gut sutures are rapidly and unpredictably absorbed when used in an environment characterized by moisture and infectious potential.

This randomized, split-mouth study was designed to evaluate the adjunctive effect of allogenic, freeze-dried, demineralized bone matrix (DBM) to guided tissue regeneration (GTR). Contralateral fenestration defects (6 x 4 mm) were created 6 mm apical to the buccal alveolar crest on maxillary canine teeth in 6 beagle dogs. DBM was implanted into one randomly selected fenestration defect. Expanded polytetrafluoroethylene (ePTFE) membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four-week healing interval and prepared for histometric analysis. Differences between GTR+DBM and GTR defects were evaluated using a paired t-test (N = 6). DBM was discernible in all GTR+DBM defects with limited, if any, evidence of bone metabolic activity. Rather, the DBM particles appeared solidified within a dense connective tissue matrix, often in close contact to the instrumented root. There were no statistically significant differences between the GTR+DBM versus the GTR condition for any histometric parameter examined. Fenestration defect height averaged 3.7+/-0.3 and 3.9+/-0.3 mm, total bone regeneration 0.8+/-0.6 and 1.5+/-0.8 mm, and total cementum regeneration 2.0+/-1.3 and 1.6+/-1.7 mm for GTR+DBM and GTR defects, respectively. The histologic and histometric observations, in concert, suggest that allogenic freeze-dried DBM has no adjunctive effect to GTR in periodontal fenestration defects over a four-week healing interval. The critical findings were 1) the DBM particles remained, embedded in dense connective tissue without evidence of bone metabolic activity; and 2) limited and similar amounts of bone and cementum regeneration were observed for both the GTR+DBM and GTR defects.

This study evaluated site-by-site the relations between subgingival microbial colonization and gingival tissue reactions. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained, rotating diamond point, or by a sharp curet. Following a 10-day postsurgical healing period, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed and tissue blocks of the experimental sites including teeth and periodontal tissues were secured. The buccal gingiva was removed and processed for histomorphometric analysis while the teeth were prepared for scanning electron microscopic evaluation of the extent of subgingival microbial colonization. The results revealed that inflammatory cell density in the junctional epithelium and in the connective tissue were positively correlated to subgingival microbial colonization (P < 0.01). Furthermore, the degree of significance decreased with increasing distance from the plaque. The present study demonstrates that a close relation may exist between the extent of subgingival microbial colonization and inflammatory gingival tissue reactions.

Groundwater may contain high concentrations of fluoride. In most countries, however, information on the fluoride content is scarce and anecdotal. The aim of the present study was to make a comprehensive assessment of F- in the groundwater of a representative area of Norway, thereby establishing a more solid basis for appropriate health counseling. Relevant technical information was collected, together with water samples from 1063 underground water sources in 31 municipalities in the county of Hordaland. One thousand and two water samples were analyzed for F- and pH with an F(-)-selective electrode and a pH electrode, respectively. Mean F- was 0.30 mg/l (range, < 0.02-9.48). Fourteen per cent of the wells contained water with F- levels > or = 0.50 mg/l. In three municipalities well water had a mean F- concentration > 0.07 mg/l; in one instance the mean was as high as 1.45 mg/l. In 10 municipalities maximum F- values were > 1.50 mg/l. F- values showed a positive correlation with the pH of the water and the depth of the wells (P < 0.01) and a negative correlation with the age of the well (P < 0.05). The results indicated that low-capacity wells deliver water with a higher F- value than high-capacity wells. This trend, however, was not statistically significant. The results show that high-F groundwater is prevalent and emphasize that information on domestic water supply must be available before supplementary fluoride is prescribed for caries prophylactic purpose.

The purpose of this study was to examine possible tissue-dependent differences in rate of healing after mucogingival flap surgery. After intrasulcular incision and a vertical-releasing incision distal to the maxillary and mandibular cuspids, buccal, full-thickness mucogingival flaps were raised in four quadrants of 10 adult cats. The triangular flaps were left open for 30 min and then repositioned and sutured. Tissue reactions were studied histologically after 1, 3, 7, 14, and 28 days of healing. Although new collagen occasionally was observed in the wound space in the free gingiva at 3 days, collagenous union between the cut dentogingival fibers and the flap seemed well established at 7 days. Flap reattachment to the denuded cortical bone was seen at 14 days in the region of the attached gingiva. In the region of the alveolar mucosa, however, residual coagulum and inflammatory reaction was present as late as at 28 days in several specimens. These observations indicate a marked difference in rate of healing among the different interfaces involved. These variations seem to be related to variations in size of the resulting wound space when a full-thickness mucoperiosteal flap is readapted over cervical root surfaces, alveolar bone crest, and denuded cortical bone, respectively.

The objective of this retrospective study was to evaluate the influence of cemental tear as a risk factor in periodontal attachment loss. Seventeen extracted, single-rooted teeth showing loss of attachment and having one cemental tear surface and one opposite intact surface were examined. The teeth were stained in 0.1% toluidine blue to visualize attached periodontal ligament remnants and examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the periodontal ligament on intact as well as on defect surfaces. Cemental tear surfaces demonstrated a significantly greater loss of attachment than opposite intact surfaces (P < 0.0001). In one specimen, the cemental tear fragment was partially attached to the root after the extraction procedure. This specimen was processed for light microscopy to determine the location of the cemental tear fracture. Histological examination clearly revealed that the split between the root and the fragment had occurred along the cemento-dentinal border. The results indicate that cemental tear should be considered as a possible etiologic entity in localized rapid periodontal breakdown.

A paramolar mesial to the mandibular second molar would be predicted from the atavistic theory on phylogenetic evolution of the human dentition. The actual finding of this feature, however, appears to have been reported only once. A 4 mm long tooth was found mesial to the right mandibular second molar in a 54-yr-old Japanese female. The tooth had a ball-shaped crown, a relatively normal crown/root length ratio, and a tapering root located entirely in the gingival soft tissue.

Histological studies have demonstrated a relationship between the amount of subgingival plaque and the magnitude and extension of gingival tissue reactions. The objective of the present study was to evaluate inflammatory reactions in the gingival tissues facing plaque accumulation at a diamond and curet-instrumented root surfaces. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained. rotating diamond point, or by a sharp curet. Next, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed, and tissue blocks of the experimental sites including teeth, alveolar bone, and gingival tissues were secured. The gingival soft tissue was processed for histomorphometric analyses at 3 levels. Epithelium and connective tissue area measurements showed no differences between the two instrumentations. Junctional epithelium (JE) cell point counts exhibited a higher proportion of inflammatory cells (IC)in specimens facing diamond compared to curet-instrumented defects. A higher proportion of IC was present within the coronal compared to the apical aspect of the JE for both instrumentations (P < 0.05). A significant difference in IC density between instrumentations was detected for non-infiltrated (P < 0.05), as well as for infiltrated (P < 0.01) connective tissue. The infiltrated connective tissue (ICT) inflammatory cell density was significantly (P < 0.01) and positively correlated to the JE inflammatory cell density (r = 0.75), and to area measurements of ICT (r = 0.55). The overall results demonstrate that the character of subgingival root instrumentations significantly affects gingival inflammatory reactions, most likely by influencing subgingival plaque formation.

Effects of topical citric acid application on tissue maturation was studied in standardized periodontal defects in 6 beagle dogs. Following elevation of facial mucoperiosteal flaps, fenestration defects, 3 mm in diameter, were made through the cortical bone and recessed 0.5 mm into the dentin of maxillary canines. 1 defect in each dog was conditioned with a saturated solution of citric acid for 3 min and then rinsed with saline. Control defects in contralateral teeth were treated with saline only for the same length of time. The defects were covered with an expanded polytetrafluoroethylene membrane and the flaps repositioned and sutured. 14 days postsurgery, healing appeared more advanced along the defect walls and floor than in the center of the defect in all instances. Histometrically, citric acid-conditioned defects exhibited a higher density of collagen fibers along the defect walls and floor and adjacent to the barrier membrane as well as more advanced resolution of the residual blood clot than the surgical controls. Differences in fibroblast density within specimen pairs were non-significant. All control defects but none of the acid-conditioned defects showed an artifactual split between the dentin walls and the granulation tissue. This study failed to support the contention that topical application of citric acid to root surfaces may delay healing following periodontal surgery.

The profuse gingival microvasculature surrounding natural teeth has a unique architecture that contributes to the biologic seal and the anti-infective defense in the sulcular region. This study tested the hypothesis that this characteristic vascular arrangement is not replicated when gingival tissues adapt to a transmucosal implant. In 20 4-week-old Wistar rats, the upper first molar was extracted bilaterally and the gingiva at this site excised. Four weeks later, a 5-mm-long titanium screw was implanted at the extraction site on one side. After another 4 weeks, the rats were injected with liquid plastic resin through the carotid arteries and vascular casts prepared for scanning electron microscopy. The results showed that within 4 weeks after implant insertion, the microvasculature of the regenerated soft tissues immediately surrounding the implant had formed a characteristic arrangement that consisted of a dense subepithelial network as well as an orderly array of vertically oriented capillary loops. The density and diameter of the capillaries varied within a wide range, possibly related to the extent of healing and/or inflammatory conditions. On the contralateral, edentulous side, the capillaries formed a flattened meshwork showing a conspicuous absence of capillary loops. This study indicates that, when a transmucosal implant is inserted in an edentulous area, the mucosal microvasculature adapts and forms an arrangement very similar to that surrounding natural teeth.

Histologic studies of periodontal reconstructive therapies have repeatedly shown a zone of nondescript connective tissue adaptation, or collagen adhesion, to the root surface between the apical extension of the junctional epithelium and the coronal extension of identifiable regenerated cementum. To clarify the nature of this zone, supra-alveolar periodontal defects were created bilaterally in the mandibular premolar region in three beagle dogs, and exposed roots were instrumented to remove the cementum. Flaps were then coronally advanced and sutured. Histologic analysis after 12 weeks of healing showed instrumented root dentin not associated with junctional epithelium, new cementum, root resorption, or ankylosis in 27 of 60 root surfaces. In 10 of these specimens subsequently examined by transmission electron microscopy, collagen fibrils were generally oriented parallel to and in close proximity to the root. A mechanism of collagen attachment was, in fact, functioning at sites of collagen adhesion; these areas may validly be included in the histologic attachment level reported in studies of periodontal reconstructive therapy.

This study evaluated intra- and inter-examiner reproducibility for a conventional manual probe versus a computer-interfaced force-controlled periodontal probe. 2 examiners recorded probing depths (PD) and relative attachment levels (AL) at 1128 sites in 15 periodontal maintenance patients. Each site was evaluated 2x, 7 to 10 days apart by both examiners. Probing force for the electronic probe was 15 g. PD intra-examiner reproducibility (within +/- 1.0 mm) for shallow sites (PD < or = 3 mm) was 98.6% versus 91.5% for the conventional versus the electronic probe for examiner 1 and 98.5% versus 88.7% for examiner 2. Corresponding values for deeper sites (PD > 3 mm) were 96.4% versus 85.9% for examiner 1 and 95.1% versus 77.0% for examiner 2. Generally, AL intra-examiner reproducibility was 1 to 3% lower than for PD. PD inter-examiner reproducibility (within +/- 1.0 mm) was 99.2% versus 90.7% for the conventional versus the electronic probe, respectively, for shallow sites and 95.4% versus 76.9% for deeper sites. AL inter-examiner reproducibility (within +/- 1.0 mm) was 1 to 5% lower than for PD. Both intra- and inter-examiner reproducibility was higher for anterior than for posterior sites. Mean PD and AL were similar for both examiners. However, the electronic probe consistently recorded 0.1 to 0.2 mm higher values than the conventional probe. Standard deviations indicated a greater variability for electronic than for manual probing. The results suggest that intra- and inter-examiner reproducibility may not necessarily be higher with an electronic, force-controlled periodontal probe than with a conventional manual probe.

Experimental animal and clinical studies have increased understanding of the biology of healing following periodontal regenerative therapy and factors that may influence the outcome. Formation of a new connective tissue attachment rather than a long junctional epithelium at the tooth-gingival flap interface is dependent upon the completion of a series of interactions among the root surface, plasma and tissue factors, and the connective tissue of the gingival flap. First, plasma proteins must adsorb to and remain in undisturbed contact with a generally noncompromised root surface. Next, adhesion of the established fibrin clot to the root surface must remain intact. Within days, a cellular and fibrous attachment will form; however, the tooth-gingival flap interface will still be vulnerable to wound-rupturing forces. Within two weeks the interface may have gained sufficient mechanical strength to offset such forces, at least in limited periodontal defects. Eventually, maturation of the fibrous attachment, including bone and cementum formation, will occur, particularly following adequate space provision by barrier membranes (guided tissue regeneration). A novel research focus involves how advances in molecular biology can translate to periodontal regenerative therapy. Bone morphogenetic proteins (BMPs) have been shown to support healing in a variety of skeletal sites. Recent research has demonstrated clinically significant alveolar bone and cementum regeneration with the use of a recombinant human BMP-2 implant. Such data suggest that growth-promoting substances, such as rhBMP-2, may significantly enhance periodontal regeneration and that use of such substances may radically recast current periodontal regenerative therapy.

The study of corrosion casts by scanning electron microscope is an established means of investigating three-dimensional microvascular architecture. However, concern has been raised that the volume of the vasculature is affected by the perfusion procedure. Ten rats (group A) were standard perfusion fixed, while 10 rats (group B) were perfused with acrylic resin after fixation. Vascular volume was assessed by computer-aided analysis of thin sections of tongue lamina propria. The results showed that vascular volume in lamina propria of rat tongue is 13.6 +/- 4.1% (mean +/- SD). No significant differences in vascular volume were found between group A and group B specimens. It can be concluded that plastic-perfused specimens may be as reliable as histologic sections in obtaining a true image of vascular systems. Thus, corrosion casts are suitable for histometric analysis of the microvasculature.

The purpose of this study was to examine microvascular regeneration associated with gingival wound healing. A full-thickness piece of gingiva and oral mucosa was excised along the palatal aspect of the right maxillary first and second molars in 20 young Wistar rats. The contralateral side served as unoperated control. After 2, 4, 7, 10 or 20 days of healing, microvascular corrosion casts were produced and examined by scanning electron microscopy. At 2 days, vessels surrounding the wound were dilated and impressions representing sites of leukocyte margination were prominent in the walls of venules. Capillary buds were emerging from venules and capillaries. At 4 days, the vessel buds had lengthened and connected in pairs to produce capillary loops. At 7 days, new vessels extended deeply into the wound space, mainly from the medical side, in a palisade-like pattern. At 10 days, the denuded bone surface was still not completely revascularized and Volkman's canals opening to the wound area were empty. At 20 days, the bone surface was covered by large, irregular vessels which originated mainly from the palatal mucosa. The periodontal ligament was less important in the tissue repair process, while the bony vasculature contributed little or not at all to revascularization of the healing gingiva and palatal mucosa.

A total of 1,128 sites in 15 periodontal maintenance patients were examined twice, 7 to 10 days apart, to evaluate reproducibility of periodontal probing by a conventional manual and an automated force-controlled electronic probe. Probing depths (PD) and relative attachment levels (AL) were recorded to the nearest 0.5 mm with both instruments. At each visit, all sites were probed first with the conventional and then with the electronic probe. Reproducibility of PD at shallow sites (PD < or = 3 mm) by the manual probe was 59.1% for exact agreement and 98.6% within +/- 1.0 mm variation. For the electronic probe, corresponding values were 41.3% and 91.5%, respectively. Reproducibility of PD measurements at deeper sites (PD > 3 mm), was 33.0% for exact match and 96.4% within +/- 1.0 mm for the manual and, correspondingly, 31.7% and 85.9% for the electronic probe. Reproducibility of AL followed a similar pattern, but was consistently lower than for PD. Reproducibility was consistently higher for anterior than for posterior sites and, for some comparisons, higher in the maxilla than in the mandible. These differences were smaller for the manual than for the electronic probe. Time required to complete the probing was longer for the conventional probe than for the electronic instrument. Under the prevailing study conditions, the automated force-controlled electronic probe failed to offer significant advantages over the conventional manual probe.

Experimentation in animal models has created a basis for highly improved therapeutic procedures in reconstructive periodontal surgery. This symposium has discussed several animal models currently used; additional models have been described in recent literature. The presentations by Drs. Caton, Wikesjö, and Lynch illustrated the need for further discussion of some of the problems inherent in animal experimentation, including: standardization of periodontal defect configuration; adequate recording of preoperative attachment level; minimizing the effect of biological variability; use of surgically-created versus naturally-developed periodontal lesions; choice of observation period; and regenerative potential of the model chosen.

Excessive fluoride (F) in drinking water should be removed, but simple, inexpensive methods of fluoride removal are not readily available. This study examines the F(-)-binding capacity of clay and clayware, especially the effect of the firing temperature on the F(-)-binding process. A series of pots were made from ordinary potter's clay and fired at 500-1000 degrees C. Likewise, small clay bricks were fired and then crushed and sieved. NaF solutions containing 10 mg/l F- (10 ppm F-) were prepared. Suitable aliquots of the solutions were poured into clay pots or exposed to powdered clayware. Samples were taken at storage periods of 30 min to 20 days and analyzed for F- by ion-selective electrodes. The rate and capacity of F(-)-binding in the clayware varied with the firing temperature. Clay fired at approximately 600 degrees C was most effective. Temperatures over 700 degrees C caused a decline in F(-)-binding, and pottery fired at 900 degrees C and above seemed unable to remove F- from water. Pots fired at 500 degrees C or less cracked in water. The findings indicate that clayware, fired at an optimal temperature, may be of practical value for partial defluoridation of drinking water.

The purpose of this study was to examine the 3-dimensional architecture of the microvascular system of the rat periodontal ligament (PDL). Vascular corrosion casts were prepared and examined by scanning electron microscopy. Cervically, arterioles and venules communicated with the profuse capillary network of the gingiva. The mid-root segment of the PDL contained arterioles and venules that mainly coursed occluso-apically near the alveolar wall, as well as capillary loops located closer to the root surface. Arterioles entered the PDL through vascular canals from the bone marrow, then coursed coronally and branched into an interconnected network of capillaries. The capillaries formed hairpin loops pointing coronally. At the tip, the capillary loops were enlarged in diameter and had an irregular luminar surface. The capillaries then coursed apically, anastomosing freely, until entering a venule. Large venules mainly followed a coronal-apical path, giving the PDL vasculature a palisade-like appearance. These vessels either left the PDL through vascular canals in the alveolar wall or connected in an apical, venous cap with venules exiting through the apical foramen. The results show that the microvasculature forms a highly organized system presumably related to the specialized functions of the periodontium. Cervically, a dense capillary system may be required for antimicrobial defense and rapid tissue turnover. The vasculature in the middle segment supports the suspensory structures, while the venous cap in the apical region may be designed to cushion masticatory forces.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal health reflects a balance between harmful and protective elements in the gingival margin area. The total plaque mass, specific periodontopathogens, and local environmental factors may challenge this balance. The aim of this retrospective study was to evaluate the effect of proximal root grooves as a risk factor in periodontal attachment loss. One-hundred and three (103) extracted, formalin-stored, single-rooted teeth showing loss of attachment and having one non-grooved and one grooved proximal root surface were selected for the study. Following staining in 0.1% toluidine blue to visualize attached periodontal ligament remnants, the teeth were examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants on mesial as well as on distal surfaces. Incisors and premolars were grouped separately. For both groups, a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (P < 0.0001). Generally, there was a direct relationship between groove location and maximum loss of attachment. The results indicate that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

Effects of a topically applied growth factor combination on fibroblast migration, collagen fiber formation and bone regeneration were studied in standardized periodontal defects in 4 beagle dogs. Following elevation of facial mucoperiosteal flaps, fenestration defects, 3 mm in diameter, were made through the cortical bone and into the dentin of maxillary and mandibular teeth. Collagen sponges, impregnated with 200 ng insulin-like growth factor II, 20 ng basic fibroblast growth factor and 6 ng transforming growth factor beta 1 were fitted to defects randomly in right or left quadrants and the flaps repositioned and sutured. Contralateral control defects received the collagen with vehicle only. Experimental procedures were staggered to allow observations of healing 3, 7, 10, and 14 days after surgery. Histometric analysis showed no differences in fibroblast and collagen density between control and growth factor defects. Bone regeneration was significantly greater in control than in growth factor defects 10 and 14 days after surgery. The rate of healing generally appeared more affected by intra-dog variations or procedural variations than by the growth factor combination.

This study evaluated microbial colonization of periodontal pockets subjected to root instrumentation with a curet or a rotating diamond. Ten maxillary and 10 mandibular subgingival pockets were established in the canines of 5 beagle dogs. The subgingival root surface areas were debrided by a sharp curet or a flame-shaped, fine-grained, rotating diamond point. The dogs were fed a plaque-inducing diet for 70 days. Specimens from both instrumentation groups were then harvested and prepared for stereomicroscopic and scanning electron microscopic evaluation. Grading of the extent of subgingival colonization was performed in coded specimens directly on the fluorescent screen of the scanning electron microscope in a grid-counting system. Error of the method was assessed by duplicate counts. The subgingival root surface areas were divided into 3 zones: cervical, middle, and apical, and statistical differences between these zones as well as between the 2 instrumentation groups were calculated. The results revealed that curet-treated surfaces were smoother and promoted less subgingival colonization than diamond-treated surfaces. The difference in amount of bacterial colonization between the 2 groups was statistically significant (P < 0.05) in all zones. Bacterial colonization decreased in apical direction in both instrumentation groups. For the diamond-treated specimens, this decrease was significant (P < 0.05) between each of the 3 zones. In the curet-treated specimens, the decrease was significant only between the cervical and the apical zone (P < 0.05). The present study has demonstrated that subgingival instrumentation roughness significantly influences the subgingival microbial colonization.

The purpose of this study was to examine the microvascular system of the dorsum of the rat tongue in relation to the subepithelial connective tissue relief. Methylmethacrylate corrosion casts of the vasculature as well as specimens in which the epithelium had been removed were prepared and examined by scanning electron microscopy (SEM). The SEM images revealed four distinct layers in the vasculature of the lamina propria. Superficially, Layer 1 comprised the irregularly shaped ends of capillary loops. Layer 2 consisted of parallel ascending and descending capillaries. These two layers were drained by the subjacent Layer 3, a fish-net-like venous plexus. More deeply, Layer 4 contained arterioles ascending from the muscular layers of the tongue. The vessels of larger papillary structures formed cylindric networks supplied by several arterioles and drained through a single venule to the venous plexus in Layer 3. At their base, the capillary loops often showed a constriction, suggestive of a sphincter. Arteriovenous anastomoses were rare. The epithelium-connective tissue interface showed short conical papillae as well as larger papillary structures which corresponded in both distribution and size to the capillary loops found in the vascular casts. The results confirm that the tongue is highly vascularized and demonstrate that the vascular supply to the papillae, taste buds, and other surface structures forms a highly organized and specific system which is adapted to the specific functions of this organ in the rat.

Twenty-six proximal, intrabony periodontal defects with probing depths equal to or exceeding 6 mm in 23 patients were treated with gingival flap surgery supported by an expanded polytetrafluoroethylene barrier membrane. The material included 1, 2, and 3-wall defects with crestal involvement relative to the root circumference ranging between 90 degrees and 270 degrees. Healing was evaluated clinically 12 months after surgery. Deep defects exhibited greater probing depth reduction and attachment gain than shallower defects. Probing depth reduction, attachment gain, and bone fill were positively correlated to the depth of the 3-wall intrabony component of the defect. The extent of crestal involvement, and wall form in the fundus of the defect did not appear to influence the healing response. The treatment also affected the proximal surface of the defect-adjacent tooth, which showed some reduction in bone level as well as gingival recession. Thus, the overall healing pattern following barrier membrane-supported flap surgery appears similar to that generally observed for conventional reconstructive flap surgery in intrabony periodontal defects.

Sixteen intrabony defects in 12 patients were treated by gingival flap surgery including root surface debridement and placement of an expanded polytetrafluoroethylene (ePTFE) membrane. The membranes were removed after 4 to 6 weeks and examined by scanning electron microscopy (SEM) for bacterial contamination and adherent connective tissue elements. Twelve months postsurgery, the defect sites were reexamined for changes in probing attachment level and probing bone level. Comparison of ultrastructural findings and clinical observations revealed that extent of bacterial contamination of the membrane correlated inversely with clinical assessment of attachment gain. The results indicate that the extent of oral exposure and bacterial contamination of the ePTFE membrane at the time of removal may be an indicator of the long-term success or failure of the regenerative procedure.

The effect of citric acid conditioning of the root surface in conjunction with gingival flap surgery including barrier membranes (expanded polytetrafluoroethylene) was clinically evaluated in 26 intrabony periodontal defects in 23 patients. Control treatment included gingival flap surgery with barrier membranes alone. Twelve defects were treated with the experimental and 14 with the control protocol. Healing was evaluated 12 months after surgery. Initial probing depths approximated 6.9 mm and defect depths measured during surgery exceeded 4 mm. The patients exhibited good oral hygiene over the study interval as substantiated by low plaque and bleeding scores. Acid conditioning of the root surface did not enhance periodontal healing in this study, similar amounts of defect resolution were observed following either treatment protocol. Probing depth reduction generally approximated 1.8 mm; gain of clinical attachment, 0.8 mm; and defect bone fill, 1.2 mm. Under the prevailing conditions, the barrier membrane procedure apparently gave a healing result beyond which further improvement could not be achieved by root surface conditioning.

Previous studies have indicated that inflammatory resorption and ankylosis, which are frequent sequela after delayed tooth replantation, can be greatly reduced by treating the root surface with 1% solutions of stannous fluoride and tetracycline. However, the SnF2 conditioning leaves a long-standing inflammatory reaction in the periodontal ligament. To examine whether a more dilute SnF2 solution would reduce postoperative inflammation without jeopardizing any beneficial effects, anterior teeth in three young adult beagles were extracted and allowed to air-dry for 45 min. They were then immersed in 0.1% SnF2 for 5 min, rinsed in saline, immersed in 1% doxycycline HCl for 5 min, rinsed, and replanted. Control teeth were air-dried and replanted without further treatment. Block biopsies were harvested after 4 wk of healing and processed for histometric analysis. In experimental teeth, 85% of the root surface area showed normal healing, compared to 33% in control teeth. Conversely, resorption and ankylosis were more frequent in controls than in experimental teeth. A persisting inflammatory reaction either adjacent to or at a distance from the root surface was seen in limited areas in both experimental and control teeth. Compared to preceding studies, the findings indicate that reducing the strength of the SnF2 solution from 1% to 0.1% may result in less persistent inflammation, at the cost, however, of less complete prevention of inflammatory resorption and ankylosis.

Cemental tears have been described both in exposed and unexposed cementum. The phenomenon is believed to be elicited by overloading or acute trauma from occlusion. In this case report a patient, with a history of periodontal health, presented with an acute periodontal lesion on the distal aspect of a bridge abutment tooth. Periapical radiographs demonstrated an extensive vertical intrabony defect adjacent to the vital abutment tooth containing a radiopaque "foreign body." Histological examination of the surgically removed "foreign body" revealed a piece of dental cementum with some attached soft tissue. The lesion responded well to a surgical approach. Healing was uneventful and periodontal health was restored. This case illustrates that cemental tear should be considered as a differential diagnostic entity in isolated sites with rapid periodontal breakdown.

Wound healing in an incisional wound is a highly predictable process which has been studied extensively hour-by-hour and day-by-day. Healing in a periodontal defect following gingival flap surgery is, conceptually, a more complex process as one wound margin consists of calcified tissue, including the avascular and rigid root surface. Another complicating factor in this wound healing is the transgingival position of the tooth. Experimental studies, however, have indicated that healing at a dento-gingival interface under optimal conditions occurs at the same rate as in a skin wound. Generally, periodontal healing is characterized by maturation of gingival connective tissue, limited regeneration of alveolar bone and cementum, and the formation of a long junctional epithelium. Such observations have nurtured the hypothesis that the epithelium of the surgical flap needs to be prevented from early access to the root surface during the healing period to achieve connective tissue repair of the root surface-gingival flap interface. Recent experimental findings suggest, however, that connective tissue repair to the root surface following reconstructive periodontal surgery is a function of the establishment and maintenance of a root surface-adhering fibrin clot. Since fibrin adherence to the wound margins is a natural event, it is additionally suggested that apical migration of the gingival epithelium in periodontal surgical wounds may only follow interruption of the adherence of the fibrin clot to the root surface.

Cemental tears have been described both in exposed and unexposed cementum. The phenomenon is believed to be elicited by overloading or acute trauma from occlusion. In this case report a patient, with a history of periodontal health, presented with an acute periodontal lesion on the distal aspect of a bridge abutment tooth. Periapical radiographs demonstrated an extensive vertical intrabony defect adjacent to the vital abutment tooth containing a radiopaque "foreign body." Histological examination of the surgically removed "foreign body" revealed a piece of dental cementum with some attached soft tissue. The lesion responded well to a surgical approach. Healing was uneventful and periodontal health was restored. This case illustrates that cemental tear should be considered as a differential diagnostic entity in isolated sites with rapid periodontal breakdown. J Periodontol 1992;63:220-224., (© 1992 American Academy of Periodontology.)

Previous studies have indicated that TiF4 and SnF2 differ in their demineralizing effect when applied topically to root surfaces at the same acidity. The aim of this study was to examine in more detail the outermost layer of root surface specimens by transmission electron microscopy (TEM) after short-term exposure to these acidic fluoride solutions. Root surface specimens were exposed for 1 min and 4 min to equimolar (1.1 M F) solutions of a) TiF4, native pH 1.0; b) SnF2, acidified to pH 1.0; and c) SnF2, native pH 2.5. The specimens were then rinsed in saline and processed for TEM. Exposure to TiF4 resulted in a partly demineralized zone 8-10 microns deep after 1 min and 5-27 microns deep after 4 min of application. A 0.1-micron-thick, electron-dense coating was present in all TiF4-treated specimens. Acidified SnF2 resulted in a completely demineralized zone, 4-7 microns deep, when applied for 1 min and 4 min, whereas SnF2 at native pH produced a 0.5- to 1.0-micron-wide partially demineralized zone. Unevenly distributed crystalline deposits were a frequent finding on SnF2-treated surfaces. The results indicate that solutions of TiF4 and SnF2 at native pH will cause only slight demineralization when applied topically to root surfaces.

Regeneration of lost tooth support has been the illusive goal of periodontal surgery for more than 100 years. Important progress was made in the nineteen-seventies when it was found that (1) periodontally involved root surfaces can be detoxified by mechanical and chemical means, (2) demineralized bone and dentin matrices have an osteoinductive potential, and (3) application of citric acid or tetracycline to the root surface during reconstructive surgery enhances attachment of granulation tissue and new collagen fibers. While experimental studies in animals have reported 100% connective tissue regeneration, clinical results have been less spectacular. More recently, improvements have included the introduction of membrane materials to guide tissue regeneration. Currently, resorbable membrane materials, osteinductive graft materials, and a variety of biologic response modifiers are being examined for their potential as adjuncts to periodontal regenerative procedures.

Aqueous solutions of TiF4 cause a rapid uptake and a long-lasting retention of fluoride when applied to dentin. The aim of this study was therefore to investigate the pattern of fluoride release after TiF4 application in vitro, compared with SnF2 and NaF application. TiF4, SnF2, and NaF were applied for 4 min and 1 min to standardized areas of six groups of root surface specimens immersed in distilled water. Untreated specimens were used as controls. The water was changed daily for 30 days, and F concentrations measured by an ion-selective electrode. All test groups showed a rapid decline in F concentration. In the 4-min group F concentration more than double the detection limit of the F electrode could be registered the first 28 days for TiF4, 11 days for SnF2, and 7 days for NaF. In the 1-min group periods of F registration were shorter. Analysis of Sn by atomic absorption spectrophotometry showed decreasing concentrations in the first 12-day samples in the 1-min and 4-min groups. Traces of Ti were found in the first few samples, but no pattern of release could be observed.