The effectiveness of conically shaped compared with cylindrically shaped interdental brushes - a randomized controlled clinical trial.

AIM: The purpose of this study was to compare the effectiveness of conically shaped versus cylindrically shaped interdental brushes (IDB) in patients receiving supportive periodontal therapy. MATERIALS AND METHODS: Periodontal maintenance patients volunteered to be enrolled into this randomized controlled examiner-blind parallel study. At baseline and after 3 months, plaque scores, bleeding upon pocket probing scores and probing pocket depth (PPD) were assessed. The type of IDB (conical or cylindrical) was randomly assigned to each patient and individual instruction was provided regarding the method of use and the appropriate size. Only those approximal sites that had sufficient space for the IDB were eligible, and for those sites the data were analysed separately. Analyses were performed for all eligible approximal surfaces and a sub-analysis was performed for vestibular and lingual surfaces. RESULTS: In total, 51 participants attended the baseline and the 3-month clinical appointments. Overall, there was no difference between conical and cylindrical IDBs. However, the conical IDB showed significantly higher plaque and bleeding scores at the lingual approximal sites. The cause of this difference was an increase in plaque and bleeding scores compared with baseline. With respect to the PPD, no difference between the IDBs was observed. CONCLUSION: Within the limitations of this experiment, the conical IDBs are less effective than cylindrical IDBs with respect to lingual approximal plaque removal. Thus, in patients receiving supportive periodontal therapy, the cylindrical shape should be the first choice of IDB to obtain and maintain gingival health around natural teeth.

['Door de beugel': resorption at dental elements 2]. / Door de beugel: recessie bij gebitselementen 2.

A twenty-one-year-old man was referred to an orthodontist for orthodontic re-treatment of dental element 32 by his dentist and a periodontist. At the dental element a significant gingival resorption had occurred and the root of the element was located outside of the processus alveolaris buccally. This case was presented at the thematic tour 'Door de beugel: team up' on 27 October 2015, which was organised by the Nederlandse Vereniging van Tandartsen (Dutch Dentists' Society) and held at 4 different locations in the Netherlands. In this second part of the case the actual treatment of choice is described, considered and discussed.

[Autotransplants instead of implants? The secret of the periodontal ligament]. / Autotransplantaten in plaats van implantaten? Het geheim van het parodontale ligament.

Autotransplants are often applied in the Scandinavian countries. The indication for treatment concerns especially young patients for whom teeth with open apices are moved to areas with ageneses. The great advantage is the vital periodontal ligament, by means of which these teeth are able to grow along. In Rotterdam, during the past 11 years, transplants of teeth with fully developed apices have been carried out in cases with comparable indications. Over short and long periods of time, the results have been the same as those in the published findings in the literature. The fully developed apices appear to be just as successful as the open apices. The difference with the results in the research literature concerns the indications for transplantation in particular. These are not limited to the molar region. Within the same indication, the results are better by comparison with the implants, in both the transplants with open and with closed apices. On the basis of these results, autotransplants in dentistry have become an indication for every age group and when possible, a better treatment option than implants.

[Evidence-based clinical practice guidelines (CPGs) in oral care 1. Societal-, professional- and care-related perspective]. / Evidencebased klinische praktijkrichtlijnen in de mondzorg 1. Maatschappelijk, professioneel en zorginhoudelijk perspectief.

Some decades ago the need for clinical decision-making based on the best available evidence, and in that way providing accountability for professional services to society, was emerging in health care. The main purpose was to translate innovative knowledge from reliable resources into clinical practice to prevent inappropriate and unsafe care. In oral care it is also diserable to carry out improvements and to make treatment decisions more transparent. Evidence-based decision-making is not self-evident, and the development and the use of evidence-based clinical practice guidelines are in their infancy. Recently, national agreement has been reached among professional associations, scientific societies and educational institutions regarding the content of a national structure for the development of evidence-based guidelines within an independent institute for knowledge translation (KiMo).

A thin or thick probe handle: does it make a difference?

OBJECTIVES: The aim of the present study was to assess the probing force exerted when using two manual periodontal probes with different handle diameters in hands of different dental professionals. METHODS: For this study two periodontal probes with handle diameters of 54 and 92 mm were used. The 11 subjects responsible for the measurements were periodontists, postgraduate periodontal students and dental hygienists. Per measurement session, 20 measurements were performed by each subject. Each probe was used 10 times. After the first baseline measurement session, a second session was performed 1 week later and a last third session another 3 weeks later. Orders for using each probe were randomized for each subject and each session. RESULTS: The mean overall force with the thin probe was 55.2 g and with the thick probe 59.4 g. The difference of 4.2 g between the two probe types was found to be statistically significant (P = 0.041). CONCLUSION: The present study showed that the diameter of the probe handle also had an effect on the force exerted with a periodontal probe. However, the clinical relevance of this difference may be minor, when considering the interindividual variance of forces exerted when probing.

Comparison of two automated periodontal probes and two probes with a conventional readout in periodontal maintenance patients.

AIM: The aim of the present study was to test in periodontal maintenance patients whether the systems for pressure control that have been commercially developed contribute to more reproducible probing depth measurements as compared with a manual probe. MATERIAL AND METHODS: In 12 patients duplicate measurements were made at day 0 and 1 week later. In each patient four teeth with the deepest pockets were measured at six sites. In total 288 sites were available for comparisons. The Florida Probe (FP) (159 N/cm(2)), the Jonker Probe (JP) (153 N/cm(2)), the Brodontic probe (BP) (255 N/cm(2)) and the manual probe (MP) were used in a randomized scheme. RESULTS: Mean probing measurements showed for the FP and the JP lower recordings than for the BP and manual probe. The FP, the BP and the MP showed no differences between the duplicate measurements, except for the JP where the second measurement was deeper. Correlation coefficients between measurements at day 0 and 1 week show for the BP and the MP are 0.90 and 0.89, respectively, while for the FP and the JP they are 0.76 and 0.75, respectively. CONCLUSION: The BP and the MP appear to be reliable tools for reproducible pocket depth measurements in periodontal maintenance patients.

Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitis.

AIM: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. METHODS EXPERIMENT 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. RESULTS EXPERIMENT 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). METHODS EXPERIMENT 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). RESULTS EXPERIMENT 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. CONCLUSION: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.

[Root caries in patients in periodontal follow-up care. Prevalence and risk factors]. / Wortelcariës bij patiënten in parodontale nazorg. Prevalentie en risico-indicatoren.

The aim of this cross-sectional study was to investigate the prevalence and several risk indicators of root cariës in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffer capacity, S. mutans counts and Lactobacilli were also scored. From the total of 45 subjects, 37 patients (82%) showed root lesions (root caries and/or fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 lesions per patient (range 0-19) in the present study. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with > 106 S. mutans/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: root cariës can be regarded as a complication in periodontal maintenance patients, that the individual number of root lesions correlate with individual dental plaque score, that a high number of root lesions is associated with counts of salivary S. mutans, and that no relation between root cariës and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiëne instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Clinical and microbiological effects of initial periodontal therapy in conjunction with amoxicillin and clavulanic acid in patients with adult periodontitis. A randomised double-blind, placebo-controlled study.

The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months post-treatment. Approximately 6 weeks after initial periodontal treatment (3-6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) at baseline. At 12 months, all subjects had detectable subgingival Fn. 9 out of the 11 placebo and 8 of the 10 test patients remained positive for Pi. There were no differences in detection frequency of Peptostreptococcus micros (Pm) and Bacteroides forsythus (Bf) in both groups between baseline, 3, and 12 months post-treatment. The findings demonstrated that, in comparison to placebo, systemic amoxicillin plus clavulanic acid provided no additional clinical and microbiological effects in the treatment of adult periodontitis patients.

A cross-sectional study into the prevalence of root caries in periodontal maintenance patients.

The aim of this cross-sectional study was to investigate cross-sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0-19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites: 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >106 mutans streptococci/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Probe penetration in relation to the connective tissue attachment level: influence of tine shape and probing force.

Previous research has shown that probing force and probe tine shape influence the clinically assessed probing depth. The purpose of the present study was to investigate the effect of tine shape and probing force on probe penetration, in relation to the microscopically assessed attachment level in untreated periodontal disease. In 22 patients, scheduled for partial or full mouth tooth extraction and no history of periodontal treatment, 135 teeth were selected. At mesial and distal sites of the teeth reference marks were cut. Three probe tines, mounted in a modified Florida Probe handpiece, were tested: a tapered, a parallel and a ball-ended; tip-diameter 0.5 mm. The three tines were distributed at random over the sites. At each site increasing probing forces of 0.10 N, 0.15 N, 0.20 N, 0.25 N were used. After extraction, the teeth were cleaned and stained for connective tissue fiber attachment. The distance between the reference mark and the attachment level was determined using a stereomicroscope. The results showed that the parallel and ball-ended tine measured significantly beyond the microscopically assessed attachment level at all force levels; with increasing forces, the parallel tine measured 0.96 to 1.38 mm and the ball-ended tine 0.73 to 1.06 mm deeper. The tapered tine did not deviate significantly from the microscopic values at the forces of 0.15, 0.20 and 0.25 N. It can be concluded that for the optimal assessment of the attachment level in inflamed periodontal conditions, a tapered probe with a tip diameter of 0.5 mm and exerting a probing force of 0.25 N may be most suitable.

Clinical evaluation of tine shape of 3 periodontal probes using 2 probing forces.

The objective of this study was to evaluate the effect of the tine shape of 3 different periodontal probes. One tapered, one parallel-sided and one WHO-probe tine, each with a diameter of 0.5 mm at the tip, were mounted in hinged handles exerting a constant probing force (Brodontic). The handles were adjusted to either 0.25 N (127 N/cm2) or 0.5 N (255 N/cm2). 12 patients with moderate to severe periodontitis were measured after supra- and subgingival debridement, using all 6 possible tine/force combinations in 3 sessions. In each session one tine/force combination was used in the 1st and 3rd quadrants, and another tine/force combination in the 2nd and 4th quadrant. The measurements in the same quadrants could therefore be used for comparisons within the same site. The selection for the 2 quadrants in which a given tine/force combination was to be used, was randomised. Calculations of differences (mean per patient) between probing measurements show that the WHO tine yields deeper recording than the parallel/sided and tapered tines, both at 127 N/cm2 and 255 N/cm2. We conclude that in addition to probing force, the tine shape of a periodontal probe is of significant importance for the recorded probing depth.