Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-centre, triple-blind, split-mouth, randomized, controlled clinical study. Part 2 - evaluation of the interdental soft tissue.

To date, there have been many studies clinically evaluating periodontal regenerative procedures by the help of routinely used hard and soft tissue parameters; however, these parameters are not capable of assessing interdental soft tissue located above the regenerative periodontal surgery area. The purpose of this study was to assess interproximal soft tissue changes following application of (i) particulate form demineralized bone matrix (DBM), (ii) putty form DBM and (ii) open flap debridement (OFD, control), using modified curtain technique in the treatment of interproximal suprabony (horizontal) defects located in anterior maxillary region, as previously reported. Twenty-five chronic periodontitis patients with 125 interproximal surgery sites (radiologically >or=4 mm horizontal bone defect) were also participate in this second stage of the triple-blind, split mouth, randomized, controlled clinical trial. Surgery sites were assessed by (i) plaque index (PI), (ii) gingival index (GI), (iii) the presence of interdental soft tissue clefts or craters and (iv) the loss of interdental papilla height by using papilla presence index (PPI), during the healing period. At the baseline and 3, 6, 9 and 12 months after the operations, these measurements were repeated. In all groups, there is a significant increase in the prevalence of soft tissue cleft and crater formation (P < 0.01), with increase in PI and GI scores at interdental soft tissue defect areas (P < 0.001), 3 months after the operations. There was also an increase in PPI scores after the operations in all treatment groups (P < 0.01). Three procedures affected the interproximal soft tissues similarly. There was no significant difference among groups in terms of all parameters (P > 0.05). Particulate DBM, putty DBM and OFD demostrated similar interproximal soft tissue changes especially increasing interproximal PI and GI scores in 3 months follow-up.

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-center, triple-blind, split-mouth, randomized, controlled clinical study. Part 1 - clinical and radiographic evaluation.

Putty form graft materials may have additional favourable effects when compared with particulate ones in periodontal bone defects. The purpose of this study was to assess clinical and also radiographic changes following application of (i) putty form demineralized bone matrix (DBM), (ii) particulate form DBM and (iii) open flap debridement (control), using modified curtain suturing technique in the treatment of interproximal suprabony (horizontal) defects. Twenty-five chronic periodontitis patients with 125 sites (radiologically >or=4 mm horizontal bone defect) were selected to participate in this triple-blind, split mouth, randomized, controlled clinical trial. Putty and particulate form DBM grafts were placed at experimental sites. Clinical measurements included probing depth (PD), relative attachment level (RAL), gingival recession and bone probing depth (BPD) were made at baseline and repeated 12 months after the operations. Standardized digital radiographs were also taken to measure radiographic bone level (RBL) at baseline and 12 months later to be compared in a software. Probing depth reductions and RAL gains were significantly improved in all treatment groups (P < 0.001). No significant differences in soft tissue parameters were found among three groups (P > 0.05). Bone probing depth measurements indicated comparable significant bone gain in graft applied groups (P < 0.01) and a significant bone resorption in open flap debridement group (P < 0.01). Radiographic evaluation did not show any significant bone gain or resorption in all treatment groups (P > 0.05). The results of this study indicate that either putty or particulate DBM demonstrates similar enhancements in soft and hard tissue parameters. Applying putty or particulate form DBM results with slight bone formation when compared with open flap debridement in horizontal bone defects at 1-year post-operative examination according to BPD measurements.

Generalized aggressive periodontitis in a prepubertal patient: a case report.

A 10-year-old boy presented with generalized gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and radiographic examination supplemented by microbiologic investigation led to a diagnosis of classically termed prepubertal periodontitis (now known as generalized aggressive periodontitis). Other than severe periodontitis, the child was systemically healthy. Neither unusual infections nor abnormalities in neutrophil functions were detected. Microbiologic examinations by culture revealed the presence of the periodontal pathogen Actinobacillus actinomycetemcomitans. Treatment consisted of extraction of mobile teeth, supragingival and subgingival debridement, subgingival curettage, and root planing combined with a 1-week prescription of a combination of metronidazole and amoxicillin. Scanning electron microscopy of extracted teeth revealed hypoplastic and aplastic cementum at the periodontally exposed and intact surfaces. Clinical and microbiologic follow-up was continued over a 1-year period. No periodontal lesions have been detected, and A actinomycetemcomitans could not be isolated from the subgingival areas of the remaining teeth at the end of the first year. Since A actinomycetemcomitans was the main pathogen present in the subgingival microflora of the patient, it might play a key role in the etiology of prepubertal periodontitis.

The effects of attachment factors on initial attachment of human periodontal ligament fibroblasts on different root surfaces: a light and scanning electron microscopic study.

This study was aimed to test the effect of fibronectin (FN), vitronectin (VN) and a fibronectin analog (fibronectin-like engineered protein) on the attachment of periodontal ligament cells to mechanically-treated and mechanically non-treated periodontally involved and non-diseased root surfaces in vitro. Periodontal ligament fibroblasts were incubated with a total of 44 periodontally diseased and non-diseased root slices which had been treated in the following manner: 1) FN applied to mechanically-treated and non-treated root slices, 2) VN applied to mechanically-treated and non-treated root slices, 3) FN-like engineered protein applied to mechanically-treated and non-treated root slices, and 4) mechanically-treated and non-treated root slices. After the 1 hour incubation period in a humidified atmosphere of 95% air and 5% CO2 at 37 degrees C, the adherence of the fibroblasts was determined using light microscopy with an ocular grid system and orientation was evaluated by scanning electron microscopy. The results indicated that the number of attached cells to non-diseased cementum sites was significantly greater than the number of attached cells to diseased cementum sites for all of the groups (p < 0.05). Likewise, the number of attached cells to mechanically-treated diseased cementum sites was significantly greater than the number of attached cells to mechanically-non-treated diseased cementum sites (p < 0.05). Our findings suggest that these attachment factors cannot promote cell attachment to different cementum sites.

The effect of a collagen membrane in regenerative therapy of two-wall intrabony defects in dogs.

Guided tissue regeneration that supports the periodontal ligament and bone cells in achieving healthy attachment between teeth and alveolar bone following periodontal therapy has been repeatedly described in the literature. The aim of the present study was to assess the effect of an absorbable collagen membrane used in guided tissue regeneration procedures in two-wall intrabony defects. For this purpose, periodontal defects were surgically created around mandibular teeth in nine dogs. In a randomly chosen quadrant in each dog, a collagen membrane was shaped to cover the interproximal bone defect and adjacent root surface. No collagen membrane was placed over the control defects. Block biopsies of test and control sites were obtained from three dogs at 30 days, three dogs at 60 days, and three dogs at 90 days after the procedures. Histomorphologic and histometric evaluations were performed. We observed that both collagen membrane treated and control defects demonstrated similar amounts of new attachment and bone. However, gingival recession and postoperative keratinized tissue loss were observed in most of the sites. Although there was a tendency towards new attachment in both groups, the gingival tissue loss due to recession led to limited regeneration.

IL-6 levels in gingival crevicular fluid (GCF) from patients with non-insulin dependent diabetes mellitus (NIDDM), adult periodontitis and healthy subjects.

Cytokines play an important role in the pathology associated with chronic inflammatory diseases. One of these cytokines, interleukin 6 (IL-6) is a major mediator of the host response to tissue injury, infection and bone resorption. In the present study, gingival crevicular fluid (GCF) level of IL-6 was determined in patients with non-insulin dependent diabetes mellitus (NIDDM) with periodontitis, adult periodontitis, and healthy controls by use of an enzyme linked immunosorbent assay (ELISA). Twenty-four NIDDM patients with periodontitis, twenty-four adult periodontitis and twenty-four healthy controls were selected for the study. GCF sampling was performed on the vestibular aspects of maxillary incisors and canine teeth. Plaque index (PI), gingival index (GI), gingival bleeding time index (GBTI), probing depth (PD) and probing attachment levels (PAL) were recorded from each sampling area and also the entire dentition. NIDDM and adult periodontitis patients had numerous sites with radiographic evidence of alveolar bone resorption, loss of attachment and pocket depth greater than 3 mm. The mean GCF IL-6 level was 2.43 +/- 0.97 ng/ml in NIDDM patients, 1.31 +/- 0.92 ng/ml in adult periodontitis and 0.62 +/- 0.58 ng/ml in healthy subjects, respectively (p < 0.05). GCF IL-6 levels were markedly higher in NIDDM and adult periodontitis groups compared to the healthy controls. No correlation was found between GCF IL-6 levels and all clinical parameters. These findings suggested that GCF IL-6 levels were significantly higher in the area of inflammation and periodontal destruction locally. The high IL-6 levels in NIDDM patients might be due to different microbial flora in periodontal pockets and altered immune system. Future studies are needed to evaluate the complex interaction among IL-6 GCF levels, host response and local microbial environment in the NIDDM patients.

The correlation of gingival crevicular fluid interleukin-8 levels and periodontal status in localized juvenile periodontitis.

Localized juvenile periodontitis (LJP) is an early-onset periodontal disease characterized by progressive bone loss involving the permanent first molar and incisor teeth. Approximately 70% to 75% of LJP patients have impaired neutrophil chemotaxis towards a number of chemoattractants including N-formyl-methionyl-leucyl-phenyl-alanine, complement fragment C5a, leukotriene B4, and interleukin 8 (IL-8). The aim of the present study was to observe the role of IL-8 in the pathogenesis of LJP. Fourteen individuals who were systemically and periodontally healthy and 24 systemically healthy individuals diagnosed with LJP (based on the results of clinical periodontal assessments and radiographic examination) were recruited for this study. Gingival crevicular fluid (GCF) samples were obtained from anterior teeth in each subject before treatment. After evaluation of GCF amount from paper strips, enzyme-linked immunoabsorbent assay was employed to determine the amount of IL-8 in GCF. The amount and concentration of IL-8 measured was 894.5 +/- 435 pg, and 445.3 +/- 468 pg/microl for the experimental group and 747.3 +/- 543 pg and 684.7 +/- 548 pg/microl, for the control group. The correlation among the levels of cytokine and clinical parameters was assessed. It was observed that the concentration of IL-8 demonstrated a negative correlation with gingival index in the LJP group. In addition, no significant correlation was found among the total amount and concentration of IL-8, GCF volume, and clinical parameters in the control group. IL-8 is thought to enhance host defense mechanisms against gram-negative bacteria, thus providing protection against periodontal infections. Our data demonstrate that, when both the total amount and concentration of IL-8 are taken into consideration, no significant difference between LJP and healthy subjects is shown. This may indicate a less active IL-8 production compared with healthy subjects in spite of the dense Gram bacterial stimulation in LJP.

Combined use of root conditioning, fibrin-fibronectin system and a collagen membrane to treat a localized gingival recession: a 10-case report.

The purpose of this research was to evaluate the effectiveness of combined root surface conditioning with tetracycline HCI, fibrin sealing system, guided tissue regeneration procedure and coronal sliding flap application in the treatment of localized gingival recessions. The present study was conducted on 10 patients with localized facial recessions of at least 3mm. A trapezium-shaped flap was elevated apically to the margin of the bone dehiscence and the root surface was thoroughly scaled by hand instruments and burs. Tetracycline HCI (pH 1.9) solution was then topically applied for 5 minutes and the root surface thoroughly rinsed with sterile saline. A collagen membrane was trimmed and shaped to cover the entire root surface and later removed and a fibrin sealing system injected onto the root surface. Immediately membrane was placed again on the root surface without applying any pressure. The flap was sutured in the coronal position to completely cover the root surface and membrane. Control group patients were treated with only coronal sliding flap operation. Sutures were removed 10 days after surgery. Patients were clinically reevaluated 6 months postoperatively. The mean amount of root surface coverage obtained was similar in the test and control groups (test = 71.7%; control = 68.55%) but the clinical attachment gain (test = 4.21mm; control = 2.86mm) and pocket depth variations (test = 1.14mm reduction; control = 0.07mm reduction) differed significantly (P < 0.001). This study found promising healing of localized gingival recessions to result from a combined use of tetracycline HCI root demineralization, fibrin sealing system application, guided tissue regeneration procedure and coronal sliding flap operation.

Serum antibodies to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in juvenile periodontitis and adult periodontitis (part I).

Recent microbiological studies support the concept that specific gram negative bacteria play a major role in the etiology and pathogenesis of human chronic inflammatory periodontal disease. Actinobacillus actinomycetemcomitans has been isolated frequently from juvenile periodontitis and Porphyromonas gingivalis has been shown to be a prominent species in adult periodontitis in humans. The purpose of this study was to determine levels of the specific antibodies to A.actinomycetemcomitans and P.gingivalis in 17 patients with juvenile and 15 patients with adult periodontitis and 24 healthy subjects. IgG and IgM antibody titers against these antigens were determined by enzyme-linked immunosorbent assay (ELISA). The levels of antibodies against A.actinomycetemcomitans were significantly higher in the juvenile periodontitis compared to the adult periodontitis patients and controls. Anti-P.gingivalis antibodies were elevated in adult periodontitis compared to juvenile periodontitis patients and controls.

The effects of periodontal therapy on serum antibody levels to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis (part II).

Levels of IgG and IgM antibodies were estimated against Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were determined by enzyme linked immunosorbent assay (ELISA) in 17 patients with juvenile periodontitis, 15 with adult periodontitis and 24 healthy controls at the beginning of treatment and 3 to 8 months after periodontal therapy. After treatment, antibodies to A. actinomycetemcomitans and P.gingivalis had decreased in patients, but the levels were still significantly higher than in healthy controls. Whether or not an of antibody level against a specific bacteria changes after periodontal treatment is however, still debatable.

Comparison of the antibacterial effects on subgingival microflora of two different resorbable base materials containing doxycycline.

A study was conducted to evaluate the effects of local drug delivery on subgingival plaque flora using hydroxypropylmethylcellulose (HPMC) and methylcellulose (MC) base material containing 40% doxycycline (DOXY). Eleven patients who had at least four pockets exceeding 5 mm in depth associated with a single rooted tooth were selected from volunteers after an initial examination. Two of the pockets were chosen at random for insertion of the HPMC and MC strips twice a week for 6 w. One pocket received no treatment, and the other was debrided and root-planed only. Baseline and follow-up measurements at 0, 1, 3, 6, and 10w included probing depth, gingival shrinkage, bleeding on probing and crevicular fluid flow. Subgingival bacterial samples were also taken for dark-field microscopy. In vitro drug release from the HPMC strips was greater than that from MC. Significant improvements in many clinical parameters occurred in the pockets treated with HPMC or MC strips, or mechanical debridement. There was a marked decrease in the relative proportions of motile organisms during and after treatment.

Use of membranes containing 20% chlorhexidine and 40% doxycycline for treatment of chronic periodontal pockets.

A study was carried out to compare the effects of subgingival applications of resorbable hydroxypropylmethylcellulose (HPMC) membranes containing 20% chlorhexidine (CHx) and 40% doxycycline (DOXY) placed subgingivally in periodontal pockets greater than 5 mm in depth. Each of 11 patients had at least four pockets. HPMC strips containing CHx and DOXY were inserted into each pocket twice a week for 6 w. One pocket was kept as a control and the other received subgingival scaling and root planing at 0, 1, 3 and 6 w. The microbial flora of 44 pockets from the 11 patients was examined using dark-field microscopy at the baseline and at 1, 3, 6 and 10 w. Clinical parameters including probing depth, crevicular fluid flow, bleeding on probing and gingival shrinkage were also recorded. The CHx and DOXY-administered or root-planed pockets showed marked reduction of both pocket depth and the number of motile organisms. Less bleeding was also observed in CHx and DOXY-inserted pockets.

Blood flow to human gingiva measured by the 133Xe clearance technique.

Blood flow to the maxillary and mandibular gingivae was determined in 9 subjects under both normal conditions and in inflammation using the 133Xe clearance technique. A total of 36 sites (18 healthy and 18 inflamed) were selected for 133Xe injection. The clearance of radioactivity was monitored by a gamma camera. The calculated mean blood flows were 51.1 +/- 11.4 and 48.7 +/- 6.7 ml/100 g/min to the normal maxillary and mandibular gingivae, respectively. In inflamed gingiva, the corresponding mean blood flows were 55.0 +/- 13.0 and 54.7 +/- 11.7 ml/100 g/min, respectively. A statistical comparison of the healthy and diseased sites was done according to the paired t and Student's t tests. The difference between the sites was not significant (p > 0.05) in the maxilla, but significant (p < 0.05) in the mandible. There was no significant difference (p > 0.05) when the total healthy and diseased sites were compared.

Effects of fibrin adhesive material (Tissucol) application on furcation defects in dogs.

A histological study was conducted to evaluate the effects of fibrin adhesive material (FAM) application on periodontal healing in seven experimental dogs. Bilateral class III furcation defects were surgically created at the second and third premolars, then orthodontic wires were placed around the teeth to induce periodontitis. Six weeks later, the wires were removed and the defects were treated by either surgery alone or surgery plus FAM application. A total of 21 specimens were obtained for histological and histometrical analysis on days 7, 21 and 42. The Mann-Whitney U test showed significantly more new attachment and bone regeneration in the FAM-treated group compared to the control (p less than 0.05). Surgery plus FAM application in the treatment of class III furcation defects seemed to be effective in promoting connective tissue attachment and bone regeneration.

The effects of various agents on root surfaces (a scanning electron microscopy study).

In periodontitis, root surface alterations have been observed in the cementum due to the presence of toxic substances mainly endotoxins of various microorganisms. Elimination of endotoxins from diseased root surfaces by root planing and demineralisation procedures seem to be essential for new attachment procedures. In this study the effects of citric acid and tetracycline HCl on periodontally involved root surfaces which had been scaled and root planed were evaluated by scanning electron microscopy. Our results showed that scaled, root planed and citric acid treated surfaces were relatively even with many dentinal tubules. The planed and tetracycline HCl treated root surfaces, however showed an irregular cemental surface with some debris, whilst the control surfaces found to be irregular with a considerable amount of debris.

Effects of various root surface treatments on initial clot formation: a scanning electron microscope study.

A study was conducted to evaluate using SEM the earliest events of initial blood clot formation on periodontally diseased root surfaces given various treatments. Six teeth with periodontal disease were extracted from six different subjects and were studied in two individual groups. In the first group the root surfaces were divided into three individual treatment areas: (a) intact periodontal ligament, (b) planed, (c) planed and also treated with 1% citric acid. The root surfaces in the second group were likewise divided into three treatment areas: (a) intact periodontal ligament, (b) planed, (c) planed and topically conditioned with tetracycline HCl. All the roots were reinserted into the original extraction sites, and then removed at either "zero" (less than 5 s), one or 3 min and prepared for SEM evaluation. It was observed that organized clot formation occurred more rapidly in the treatment areas where both root planing and topical conditioning with tetracycline HCl had been done.

[Alveolar cavitational osteopathosis--a case report]. / Alveoler kavite osteopatozu. Vaka raporu.

Alveolar cavitational osteopathosis is a rare disease of dental alveolus with an undefined origin. Clinically, the symptoms may vary widely; patients may complain dental sensitivity in those teeth which appear normal or pain remote from the craniofacial region. In this case report, present knowledge about alveolar cavitational osteopathosis and diagnostic and treatment process of our case was presented.

[Effects of various oral rinses on the pathogenities of bacterial plaque]. / Cesitli gargaralarin bakteri plagi patojenitesine etkileri.

For the chemical control of bacterial plaque, various oral rinses have been suggested. Oral rinses which have been used widely in dentistry for the treatment of periodontal disease were tested in this study. We investigated the effects of 4 national and 1 foreign commercially available oral rinses. Our study was headed to compare these oral rinses with CHx solution which has been accepted as a "+" control material. At the end of this study CHx was found to be the only effective solution. From those of tested, only Heksoral, a national brand, oral rinse and a foreign originated Veadent had very limited anti plaque effects.

[Investigation into the effect of citric and phosphoric acids on planed root surfaces using S.E.M]. / Küretaj uygulanmis kök yüzeylerinde sitrik ve fosforik asit etkisinin tarama elektron mikroskopta (SEM) incelenmesi.

The aim of the present study was to evaluate the effect of citric and phosphoric acid conditioning the diseased root surface on periodontally extracted teeth. Citric acid pH1 and 50 per cent phosphoric acid were topically applied to thoroughly scaled and planed root surfaces for one to three minutes. The specimens were then processed for scanning electron microscopy (S.E.M.) Root surfaces that had received acid treatment after root planing exhibited no smear layer and the overall surface appeared to have an undulating morphology. Whereas, examination of nonacid-treated specimens showed the presence of a smear layer. Furthermore, phosphoric acid treated surfaces demonstrated more irregularity with increasing application time.