Regeneration of intrabony defects: comparing e-PTFE membrane vs. decalcified freeze dried bone allograft--a pilot study.

The purpose of this study was to compare the amount of clinical attachment gained when using an expanded polytetrafluoroethylene (e-PTFE) membrane versus the placement of a decalcified, freeze-dried bone allograft (DFDBA) in human deep intrabony defects. Ten 2- and 3-wall intrabony defects were treated with scaling and root planing followed by flap surgery and placement of either an e-PTFE membrane or a DFDBA. The clinical parameters, clinical attachment level (CAL), probing depth (PD) and recession, were evaluated at baseline, following oral hygiene instructions and scaling and root planing, and at 6 and 9 months post-operatively. The e-PTFE group demonstrated an increased CAL of 3.2 mm at 6 months and 3.4 mm at 9 months while the DFDBA group manifested a gain of 2.2 mm at 6 months and 2.6 mm at 9 months. The e-PTFE group had a 6.6 mm decrease in PD at 6 months and 6.2 mm at 9 months while the DFDBA group had a decrease of 4.0 mm and 4.4 mm at 6 and 9 months respectively. The amount of gingival recession was 1.6 mm for both groups at 6 months and slightly less for the PTFE group at 9 months. It was concluded that both treatment groups resulted in a clinically and statistically significant improvement over baseline measurements in clinical attachment gain and PD reduction. No statistical significance could be demonstrated between the two groups. The number of subjects and sites treated by the two treatment modalities--e-PTFE and DFDBA--was too small to conclude that the treatments gave comparable results. A larger sample size is necessary in order to establish whether or not a statistically significant difference exists between groups.

Osseous repair of a lateral periodontal cyst.

THE LATERAL PERIODONTAL CYSTS is a slow-growing radiolucent, developmental lesion occurring most frequently in males during the sixth decade. As part of the differential diagnosis, it must be distinguished from the collateral keratocyst and the gingival cyst of adults as well as other entities. Speculation remains as to the lateral periodontal cyst's developmental origin. Whether it is from reduced enamel epithelium, remnants of dental lamina, or cell rests of Malassez remains to be determined. The following longitudinal case report describes the review of literature and clinical and histologic findings as well as unusual treatment of a through-and-through perforating lateral periodontal cyst. Due to the large bony defect left after the cyst's removal, a decalcified freeze-dried bone graft was placed to close the defect. The repair of the lesion was followed for 30 months.

Irrigation with chlorhexidine to resolve naturally occurring gingivitis. A methodologic study.

This study compared oral irrigation and rinsing with chlorhexidine (CHX) and placebo in the treatment of naturally occurring chronic gingivitis. 44 subjects with at least 6 interproximal sites which bled on probing were randomly distributed on a double-blind basis into 4 treatment groups, placebo-rinse, CHX-rinse (0.12%), placebo-irrigation and CHX-irrigation (0.06%). A half-mouth was scaled 2 weeks prior to therapy in all groups. Rinses were performed 2 times daily and irrigation was performed once a day by means of an oral irrigator with the tip directed at a right angle to the tooth. Subjects continued with routine oral hygiene without instruction. The active treatment period was 2 months. Parameters were recorded at baseline and at 60 days. At the conclusion, marginal plaque was cultured for predominant microbial types. CHX-rinse (0.12%) and CHX-irrigation (0.06%) significantly reduced (p less than 0.05) plaque. Gingival bleeding decreased by 26% in both scaled and unscaled sites following CHX (0.12%) rinses and by 40% at both types of sites following CHX (0.06%) irrigation. Bleeding was reduced with CHX-irrigation greater (p less than 0.05) than with the placebo-irrigation. The mean log of colony-forming units of Actinomyces species was significantly lower (p less than 0.05) in the CHX (0.12%) rinse and CHX (0.06%) irrigator groups than in the placebo groups. These data therefore indicate that delivery of CHX (0.06%) by an oral irrigator is an effective means of treating naturally occurring gingivitis.

Antimicrobial agents in the prevention and treatment of periodontal diseases.

It has been estimated that there are more than 400 diseases affecting the oral cavity. In terms of prevalence, however, the major public health problems are caries and periodontal disease. Although these two destructive entities are completely different in many respects, they share a common denominator: the initial lesions are brought about by an aggregate of bacteria known as plaque. This article discusses chemical control of plaque in the treatment of gingivitis and antimicrobial control of subgingival plaque in the treatment of periodontitis. The authors address the use of antibiotics in the treatment of localized juvenile periodontitis, the ideal properties of antiplaque agents, and adjunctive subgingival application of antimicrobial agents.

Hydroxylapatite as an alloplastic graft in the treatment of human periodontal osseous defects.

Twelve patients, 32 to 60 years of age, received a polycrystalline ceramic form of pure dense hydroxylapatite as an alloplastic bone implant material in intrabony defects following reflection of full mucoperiosteal flaps, root planing and defect-curettement. The defects were measured from an acrylic stent, using an endodontic silver point which was placed to the base of the defect. Similarly, debrided and curetted defects in the same patients were not implanted and served as controls. Recalls for documentation and plaque control were at 1, 2, and 4 weeks, and at 3, 6 and 9 months. Measurements relating to changes in defect-depth were made upon reentry at 9 months. The twelve defects, serving as controls, showed very little difference between the pretherapy and 9-month measurements. The initial mean measurement from the base of the defect to the highest alveolar crest was 4.27 mm and the 9-month mean measurement after curettage only was 3.36 mm. In terms of resolution of the original defect this amounted to 19.49% reduction, but a 0.46-mm mean loss in height of the alveolar crest provided an actual percentage fill of the original defect of 9.91%. Of sixteen experimental defects, the same initial mean measurement from the base of the defect to the highest alveolar crest was 5.18 mm and the 9-month mean measurement after grafting was 2.43 mm. In terms of resolution of the original defect, this amounted to a 53.57% reduction, but in contradistinction to the curettage sites, a mean increase in height of the highest alveolar crest of 0.61 mm gave a true percentage fill of the original defect of 66.89%. At the 9-month reentry, the implanted mass seemed to be partially "calcified" and was resistant to penetration with a probe or removal with a curette. The data and clinical impression strongly suggest that hydroxylapatite has a potential as an alloplastic implant with clinically apparent acceptance by the soft and hard tissues.

The relationship between the mobility of human teeth and their supracrestal fiber support.

A method to study the relationship between the mobility of human teeth and their supracrestal fiber support was developed. The results of this study would indicate that: (1) The supracrestal fibers do not contribute significantly to the support of a normal premolar tooth. (2) As a human premolar tooth develops moderate to severe loss of osseous support, the relative contribution of the supracrestal fibers to the support of the tooth increases significantly.