Changes in alveolar bone height and width following ridge augmentation using bone graft and membranes.

BACKGROUND: Clinical observation suggests the amount of bone height and width created during guided bone regeneration (GBR) to augment alveolar ridges is not retained during healing. A study was designed to determine: 1) whether the amount of osseous structure 4 months postoperatively after GBR was significantly less than the amount surgically created; and 2) if this change was uniform over the area treated. METHODS: Nineteen extraction sites (10 patients) were treated with GBR prior to placing endosseous implants. Allograft (DMFDB) and a bioabsorbable membrane were employed. Standardized measurements were taken of alveolar height and width 1) prior to augmentation; 2) after placement of graft and membrane; and 3) following 4 months of healing. Width measurements were taken 3 mm, 5 mm, and 10 mm from the crest at 3 intervals: the mesio-distal midpoint of the edentulous area and 3 mm mesial and distal to the midpoint. Height measurements were recorded at the mesio-distal midpoint and points 3 mm mesial and distal to the midpoint. RESULTS: Loss in width of supplemented bone after 4 months of healing ranged from 52.1% to 58.0% 3 mm from the crest, 47.6% to 67.4% 5 mm from the crest, and 39.1 % to 46.7% 10 mm from the crest. Loss of augmented height averaged 14. 7% in the center of the edentulous area but ranged from 60.5% to 76.3% 3 mm mesial and distal to the midpoint. CONCLUSIONS: The results indicate significant non-uniform loss of augmented alveolar height and width during GBR healing. The implications of these findings impact preoperative augmentation planning for endosseous implantology.

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.

Effect of an enzymatic rinse on salivary levels of Streptococcus mutans and lactobacilli in periodontally treated patients.

Root surface caries is prevalent in patients with both treated and untreated periodontal disease. The major etiologic factor has been identified as microbial plaque. In periodontally treated patients, significantly higher root caries prevalence and incidence have been found in patients with high levels of Streptococcus mutans and Lactobacilli in saliva. Reducing the levels of S. mutans and Lactobacilli in saliva may lower the risk of root caries development. The purpose of this investigation was to determine the effect of an oral enzymatic rinse on the salivary counts of S. mutans and Lactobacilli in periodontally treated patients. Fifteen adult subjects participated in a double-blind, cross-over designed clinical trial. Each subject had previously undergone comprehensive periodontal therapy and had been maintained on a regular program of supportive periodontal therapy. Paraffin-stimulated whole saliva was collected from each participant. Each subject was then randomly given either the enzymatic rinse product or a control rinse and instructed to rinse with one tablespoonful twice a day for 2 weeks, after which saliva samples were taken. After a washout period, salivary samples were again taken, and the subjects received the alternate rinse product. Two weeks later, final salivary samples were taken. The salivary samples were serially diluted and incubated aerobically on selective culture media. S. mutans and Lactobacilli were counted on the basis of colonial morphology. Pretreatment and posttreatment salivary counts of S. mutans and Lactobacilli were analyzed using the Wilcoxon matched-pairs signed-rank test at the 5% level of significance. Analysis of data revealed that neither the test nor the control rinse significantly lowered salivary counts of either species in the sample population.

Clinical plaque removal performance of two manual toothbrushes.

A single-blind, cross-over design clinical study was conducted to compare the plaque removal efficacy of the Colgate Precision Full Head soft and the Crest Complete soft toothbrushes. A total of 72 adult male and female subjects who met the inclusion/exclusion criteria completed the study. Each subject refrained from brushing for 24 hours, and was screened for dental plaque on the facial and lingual surfaces of all natural teeth using the Rustogi, et al. refinement of the Modified Navy Plaque Index (Rustogi, et al. Index). Subjects were then stratified according to the MPI and randomly assigned to one of two groups. Subjects returned one week later having abstained from all oral hygiene procedures for a 24-hour period. At this visit, each subject was evaluated for plaque, then brushed with his/her assigned toothbrush for 60 seconds, and again scored for plaque after brushing. Subjects were instructed to resume their normal routine and return to the clinical site one week later. At this time, the alternate toothbrush was assigned to each group in a cross-over design. Plaque evaluations and toothbrushing procedures were again performed. Data were statistically analyzed, and the Colgate Precision toothbrush was demonstrated to be significantly more effective (p < 0.01) in removing whole mouth, gumline, and interproximal area plaque.

A clinical comparison of plaque removal performance of three manual toothbrushes.

A clinical study was performed to evaluate and compare the plaque-removal performance of a recently introduced, computer-designed manual toothbrush with that of two commercially available products; the Oral-B 40 and the Reach Full-Head soft toothbrushes. Seventy-five adult male and female subjects participated, each refraining from toothbrushing for twenty-four hours. Plaque was scored according to the Rustogi, et al. refinement of the Modified Navy Plaque Index. Following screening, the subjects were divided into three balanced groups on the basis of initial plaque scores. Each group, in an alternate weekly cross-over design, used each of the three toothbrushes. At Visit 1, each group, having refrained from toothbrushing for twenty-four hours, was evaluated for plaque before brushing for sixty seconds with the assigned toothbrush, after which plaque was again scored. At Visit 2 one week later, the same procedure was followed except for the assignment of a different toothbrush. The same procedure was employed for Visit 3. On completion of the study, the data were subjected to statistical analyses which indicated that the Colgate Precision Full Head soft toothbrush removed significantly more plaque than either of the other two toothbrushes.

Reconstruction of the severely atrophic maxilla with autogenous iliac bone graft and hydroxylapatite/decalcified freeze-dried bone allograft in the same patient: a preliminary report.

Procedures to augment the severely atrophic maxilla using sinus lift techniques have been increasingly used for endosseous implant placement. A case report is presented in which a patient had a severely resorbed maxilla bilaterally. A situation developed during the course of treatment which created a unique opportunity to compare an autogenous iliac graft on one side with a hydroxylapatite/freeze-dried bone allograft on the other.

Antiplaque efficacy of a triclosan/copolymer prebrush rinse: a plaque prevention clinical study.

A 5-day, double-blind parallel clinical study was conducted to determine the antiplaque efficacy of a pre-brush rinse containing 0.03% triclosan and 0.125% of a copolymer of polyvinyl methyl ether maleic acid as compared to a matching matching placebo pre-brush rinse. A total of 114 subjects were stratified into two balanced groups according to baseline Quigley-Hein Plaque Index scores. Each group was randomly assigned to use either the triclosan/copolymer pre-brush rinse or the placebo pre-brush rinse. All subjects received a thorough oral prophylaxis at the start of the study. They rinsed their mouths twice daily (mornings and evenings) for 1 minute with 15 cc of their assigned pre-brush rinse. Immediately after rinsing, subjects brushed their teeth for 30 seconds with a commercially-available dentifrice containing 0.76% sodium monofluorophosphate and a soft-bristled toothbrush. The morning rinsing/brushing procedure was done under supervision at the clinical facility. The evening rinsing/brushing procedure was done at home. After 5 days' use of their assigned pre-brush rinse, subjects were evaluated for plaque formation using the modified Quigley-Hein Plaque Index scoring system. As compared to the matching placebo pre-brush rinse, the results showed: 1) The triclosan/copolymer pre-brush rinse provided a 28.15% reduction in plaque formation on all surfaces of the teeth. This reduction was statistically significant (P less than 0.001); 2) The triclosan/copolymer pre-brush rinse provided a 50% reduction in plaque formation on the "more difficult to brush" surfaces of the teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a dentifrice containing triclosan and a copolymer on plaque formation and gingivitis.

A total of one hundred twenty-one (121) adult male and female subjects completed a 6-month, double-blind clinical study comparing the effect on supragingival plaque formation and gingivitis of a dentifrice containing 0.3% Triclosan and 2.0% of a copolymer of methoxyethylene and maleic acid to a placebo dentifrice. Both the Triclosan/copolymer and placebo dentifrices contained 0.243% sodium fluoride in a silica base. Subjects were stratified into two balanced groups according to baseline plaque and gingivitis scores. They then received an oral prophylaxis and were assigned to use either the Triclosan/copolymer dentrifrice or the placebo dentifrice for the next 6 months. Subjects were evaluated for supragingival plaque formation and gingivitis after 3 and 6 months' use of the dentifrices. After 6 months, the Triclosan/copolymer dentifrice was shown to provide a 32.32% statistically significant reduction (99% level of confidence) in supragingival plaque formation, as compared to the placebo dentifrice. Also, after 6 months, the Triclosan/copolymer dentifrice was shown to provide a 25.64% statistically significant reduction (99% level of confidence) in gingivitis, as compared to the placebo dentifrice. It thus can be concluded from this clinical study that the twice daily use of the dentifrice containing 0.3% Triclosan and 2.0% of a copolymer in a 0.243% sodium fluoride/silica base provides statistically significant reductions in both supragingival plaque formation and gingivitis.

Localization of interleukin-1 beta in human periodontal tissue.

Interleukin-1 beta (IL-1 beta) is the predominant form of IL-1 produced by macrophages. IL-1 beta possesses numerous and diverse biological activities. Several of these activities, including fibroblast proliferation, potentiation of the immune response, and stimulation of bone resorption may be of relevance to the pathogenesis of periodontal disease. This study was designed to examine the presence of IL-1 beta in human periodontal tissue. An antiserum directed against the N-terminal segment (117-131) of human IL-1 beta was used to detect IL-1 beta using immunofluorescent staining techniques. IL-1 beta positive staining cells were observed in both normal and diseased tissue and were limited to the lamina propria. Brightly staining cells were increased by almost 3-fold in periodontally diseased tissue when compared to normal tissue. Low intensity staining cells were equally distributed in the normal and diseased specimens. We propose that IL-1 beta and IL-1 beta produced by cells in periodontal tissues may be related to the pathological processes associated with periodontal disease.

The effects of metronidazole administration on clinical and microbiologic parameters of periodontal disease.

The purpose of this study was to assay the concentration of metronidazole in gingival fluid, to correlate clinical and microbiologic parameters of periodontal disease to each other and to the gingival fluid concentration of the drug. Ten subjects with a minimum of two contralateral pairs of periodontal pockets of greater than or equal to 5 mm were utilized. One side of the mouth was selected to serve as the root-planed site while the other was left untreated. On day 0, plaque and bleeding-time indexes and probing depths were recorded. Subgingival plaque was analyzed using phase contrast microscopy. When root planing was completed, the subjects were prescribed either metronidazole or placebo three times daily for seven days. Within 24 hours of the last dose, and thereafter at intervals of 1, 2 and 3 weeks, fluid samples were assayed for metronidazole. Clinical and bacterial data were likewise recorded. The results indicate that root planing with metronidazole appears to be more effective in promoting periodontal health than root planing alone. Concentrations of metronidazole ranging from 5 to 20 micrograms/ml were detectable in fluid samples obtained within 24 hours of administration of the last dose. No discernible levels could be found in samples taken at the longer intervals.

Acute necrotizing ulcerative gingivitis associated with von Willebrand's disease: a case report.

Patients with hemorrhagic disorders are a concern to the dental profession because of their propensity for severe and prolonged intraoral bleeding following therapy, especially subgingival debridement and surgical procedures. One of the most common and perhaps least recognized hereditary coagulation disorder is von Willebrand's disease, also referred to as pseudohemophilia, vascular hemophilia, angiohemophilia, and idiopathic prolonged bleeding time. A case report of a patient with von Willebrand's disease who presented complaining of acute gingival pain and bleeding is presented.

Chemotherapy. A viable periodontal treatment modality?

Because bacterial plaque is composed chiefly of micro-organisms, use of chemotherapeutic agents directed against a susceptible flora would seem a conceptually valid therapeutic modality, in terms of inhibition of plaque, for the prevention and treatment of periodontal disease. The objective of treatment largely dictates the modality used. If, for example, the philosophy of treatment is elimination or reduction of pocket depth, chemotherapy against supragingival plaque may complement mechanical oral hygiene in the absence of a plaque-free environment. On the other hand, access to the subgingival flora can only be achieved through systemic administration of drugs or the use of controlled delivery systems. Notwithstanding their potential benefit as adjunctive therapy, in cases of refractory periodontitis and juvenile periodontitis in which elimination of Actinobacillus actinomycetemcomitans by mechanical debridement alone is extremely difficult, the potential for adverse reactions from the administration of antibiotics must be weighed and their use, in general, considered unwarranted. The dynamics of the inter-relationship between supragingival and subgingival plaque necessitates control of both for the successful treatment of periodontal disease. Although there are chemical agents that have been shown to be effective in the treatment of gingivitis, the evidence pertaining to their effectiveness in the treatment of periodontitis, either alone or in conjunction with conventional therapy, is inconclusive. If specific microbial floras are associated with different forms of periodontal disease, chemotherapeutic agents to which such micro-organisms are susceptible would have to be employed for their elimination. Until accurate predictors of disease activity--including definitive indicators of which particular sites are, at any one time, actively undergoing attachment loss--are available, the use of chemotherapeutic agents directed at the subgingival flora appears extremely limited and impractical. However, with the development of predictors of disease activity, including sophisticated methods of determining even small increments of attachment loss, new drugs, and a better understanding of subgingival ecologic systems, chemotherapy may yet play a significant role in the treatment of periodontal disease.

The gingival bleeding time index.

Recent studies have supported an emphasis on gingival bleeding indices for detection of inflammation. The purposes of the present study were: (1) to evaluate the relationships between the time necessary for stimulated gingival bleeding to occur and both gingival fluid flow and Löe's gingival index, and (2) to develop a clinical index based on gingival bleeding time. In the first part of the study, the elapsed time for gingival bleeding to first occur after sulcular stimulation was correlated with the gingival index and fluid flow on 150 gingival units. A high correlation was found between bleeding time with both the gingival index and exudate flow. A bleeding time index based on a scattergram of the data obtained in part I of the study was then formulated and evaluated in a similar fashion on an additional 172 gingival units. Results indicate a high correlation between the bleeding time index and the other indices. It is concluded that the bleeding time index may be used by itself as an accurate and objective clinical tool to evaluate gingival inflammation.

Familial benign chronic neutropenia associated with periodontal disease. A case report.

A rare case report of periodontal disease associated with familial benign chronic neutropenia is presented. The medical, dental and family histories as well as clinical and histologic observations are described and discussed.

Tooth staining effects of an alexidine mouthwash.

The primary purpose of this study was to determine the amount of tooth staining produced by an alexidine mouthrinse. One hundred and eighty subjects rinsed twice daily for 1 month with either 15 ml of alexidine (0.035%) or a placebo solution. Prior to the study, the subjects were classified according to their smoking, coffee and tea drinking habits and these factors were subsequently considered in the analysis of the stain scores. Additionally, the effects on staining of a prior prophylaxis and the use of a fluoridated toothpaste during the study were determined. Upon termination of the study, subjects utilizing the active mouthrinse manifested a greater degree of staining than placebo users. The amount and intensity of the stain due to alexidine were not influenced (increased) by smoking, tea or coffee drinking habits. A prior prophylaxis did not reduce the staining propensity of alexidine users. The method of scoring developed can be used to assess the degree of tooth staining induced by antiplaque agents.