Rinsing with alcohol-free or alcohol-based chlorhexidine solutions after periodontal surgery. A double-blind, randomized, cross-over, pilot study.

The aim of this randomized, double-blind, cross-over pilot study was to evaluate the effect on plaque formation and patient experience of rinsing after periodontal surgery using chlorhexidine solution with or without alcohol. Twenty patients refrained from tooth brushing after surgery and used two mouth rinses.Ten patients used alcohol-based (AB) 0.1% and another ten used alcohol-free (AF) 0.12% chlorhexidine (CHX). Sutures were removed after 2 weeks and teeth were cleaned; thereafter, the two groups shifted solution. Plaque at operated teeth was recorded at 2 and 4 weeks (Quigley-Hein Index). Patient experience was assessed with a visual analogue scale (0-10). Mean (SD) plaque indices at 2 and 4 weeks were 1.0 (0.8) and 1.1 (1.0) for AB CHX and 1.1 (0.7) and 0.8 (0.7) for AF CHX, respectively (no significant differences between solutions). At 2 weeks, between-group differences in taste experience of the solutions differed non-significantly: 6.1 (2.8) for AB and 6.0 (2.3) for AF. At 4 weeks, values were 4.6 (2.5) for AB and 6.9 (3.3) for AF-patients tended to prefer AF (p = 0.050). Taste change over the study period was equal for both groups: -37 (3.3) for AB and 3.4 (2.3) for AF at 2 weeks and slightly higher at 4 weeks 4.9 (2.8) and 4.5 (2.5) for AB and AF, respectively. Smarting was low in both groups: 2.2 (3.2) and 1.3 (2.2) for AB and 1.0 (1.5) and 1.9 (2.0) for AF at 2 and 4 weeks, respectively. To conclude, alcohol-free and alcohol-based chlorhexidine showed the same plaque inhibitory effect in periodontal patients after periodontal surgery. Both rinses were well tolerated by the patients.

A randomized study of open-flap surgery of 32 intrabony defects with and without adjunct bovine bone mineral treatment.

BACKGROUND: Bovine bone mineral (BBM) is extensively used as a filler material in periodontal reconstructive surgery of intrabony defects. Data are mostly available on the combined use of BBM with other biomaterials. The aim of this study is to evaluate healing after open-flap debridement (OF) of intrabony periodontal defects alone or with adjunct treatment with BBM. METHODS: After initial treatment, 32 patients with 32 intrabony periodontal defects participated in the study. Full-thickness flaps were raised and root surfaces and defects were debrided. Patients were then randomly assigned to treatment groups, either OF alone or combined with defect fill with BBM, and followed in a strict postoperative maintenance care program for 12 months. RESULTS: At 12 months, a mean ± SE gingival recession of 1.1 ± 0.3 mm in OF and 0.9 ± 0.4 mm in BBM occurred. Probing depth reduction was 4.0 ± 0.5 mm in OF and 3.2 ± 0.7 mm in BBM. Gain in clinical attachment level was 2.8 ± 0.6 mm in OF and 2.3 ± 0.8 mm in BBM. Probing bone level was reduced by 2.7 ± 0.7 mm in OF and 1.8 ± 1.1 mm in BBM. None of the above parameters showed significant intergroup differences. In contrast, radiographic defect depth change was significantly greater in BBM (3.4 ± 2.3 mm) than in OF (1.9 ± 1.7 mm). CONCLUSIONS: Both treatments resulted in improved periodontal conditions. The adjunctive use of BBM in this study did not enhance the clinical result compared to OF alone.

Full-mouth versus quadrant-wise scaling--clinical outcome, efficiency and treatment discomfort.

The aim of this randomized clinical study was to compare full-mouth scaling and root planing (FM-SRP) in two sessions within 24 hours with quadrant-wise scaling and root planing (Q-SRP) in four sessions within 4-6 weeks and evaluate (I) clinical outcome, (II) treatment efficiency, and (III) treatment discomfort of patients and therapists. Twenty individuals, aged 28-65 years, with severe chronic periodontitis were randomly assigned to treatment with FM-SRP or Q-SRP. At baseline and after 6 months, there were no between-group differences in clinical findings, treatment discomfort, or post-treatment body temperature. The therapists, however, felt that FM-SRP was more physically and psychologically demanding than Q-SRP. Mean effective scaling and root planing (SRP) time was 165.5 min during the two FM-SRP sessions and 202.1 min during the four Q-SRP sessions. FM-SRP's initial time savings of 36.6 min compared with Q-SRP diminished to 30.8 min at the 6-month follow-up due to rescaling needs. Total mean treatment time (comprising SRP and patient reinformation and reinstruction in oral hygiene) during the first 6 months post-treatment was 321.2 min for FM-SRP and 353.0 min for Q-SRP. Thus, mean savings in total treatment time with FM-SRP was 31.8 min compared with Q-SRP. In conclusion, this study found that both treatment modalities may be recommended for chronic periodontitis patients. Although time saving is possible with FM-SRP,the modality may compromise the therapist's well-being if practiced frequently due to the risk of musculoskeletal problems.

Surgical guided tissue regeneration treatment of advanced periodontal defects: a 5-year follow-up study.

OBJECTIVES: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects. MATERIAL AND METHODS: In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years. RESULTS: Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination. CONCLUSION: Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.

Effect of three different dental health preventive programmes on young adult individuals: a randomized, blinded, parallel group, controlled evaluation of oral hygiene behaviour on plaque and gingivitis.

AIM: To evaluate, in young adults, the effect of different preventive programmes on oral hygiene and to determine whether the variables investigated are predictors of gingival health. MATERIAL AND METHODS: This randomized, blinded, parallel, controlled clinical study examined the effectiveness of three dental health programmes. Four hundred subjects aged 20-27 years, 211 males and 189 females, participated in the study. They were recruited from a Public Dental Service clinic and from a private dental practice in Jönköping, Sweden. The effect of the programmes on plaque and gingivitis was evaluated over a 3-year period. The programmes included activities that were adapted for individuals as well as for groups. The plaque indices (PLI) and gingival indices (GI) were used to evaluate the programmes. RESULTS: All programmes resulted in a decrease in PLI and GI. The greatest decrease was found in the group that was followed-up every 2 months. Professional tooth cleaning was non-significant for the clinical result. Gingival health at baseline, participation in any of the test programmes, and knowledge of the dental diseases caries, gingivitis or periodontitis were significant predictors of good gingival health. CONCLUSIONS: The study confirms the efficacy of three different preventive programmes in reducing supragingival plaque and gingival inflammation. Professional tooth cleaning provided no clinical benefit beyond that derived from individual and group-based health education.

The effect of different dental health programmes on young adult individuals. A longitudinal evaluation of knowledge and behaviour including cost aspects.

The goal of this study was to report the long-term effect of different dental health programmes on young adult individuals' knowledge and behaviour relative to oral health. Over a 3 years period, the effect of three different dental health programmes on caries, gingivitis/periodontitis, and knowledge and behaviour concerning oral health in 400 Swedish young adults was evaluated. During the following 2 years, additional prophylactic measures--now based on the individual's symptoms and the prophylaxis previously received--were conducted and evaluated. Five years later still one follow-up was made. The evaluations were based on clinical and radiographic examinations and on a questionnaire survey whose purpose was to study the short- and long-term effects of the different preventive measures, including cost aspects. At the end of the 3 years period, the three test groups exhibited better knowledge and significantly improved behaviour compared with the control group concerning approximal cleaning, from approximately 50% of the individuals at the baseline examination to approximately 90% at the end of the period. Improvement was observed as early as the first year. There were no differences between the test groups. The intensified, individual-related prophylaxis carried out in the following 2 years did not significantly increase knowledge in the test groups; a significant increase in approximal cleaning, however, was found in the control group during this time. At the 10-year follow-up, the individuals' knowledge was undiminished while behaviour concerning approximal cleaning had sunk from 90% to approximately 70% of the individuals. A slight behavioural change concerning number of snacks was found in the course of the study with a shift towards fewer snacks per day. In conclusion, it can be said that simple prophylactic models have an effect on and maintain young adult individuals' knowledge and behaviour concerning oral health and that new knowledge is remembered for long periods of time while changes in behaviour are maintained less well. Moreover, it was found that the scope of the prophylactic programme measured in time and cost had little effect on the long-term result.