The subepithelial connective tissue graft for root coverage in periodontal therapy--rationale and technique.

Gingival recessions are frequently of esthetic concern to patients and dental practitioners. Advances in periodontal surgical techniques allow the dentist to choose between several treatment modalities. Treatment aims, indications and limitations of different procedures for root coverage are outlined. Root defects with wide or deep-wide gingival recessions can be successfully treated with a subepithelial connective tissue graft. A description of the subepithelial connective tissue graft technique for root coverage of denuded root surfaces is presented and the rationale is discussed.

The effects of spiramycin and/or scaling on advanced periodontitis in humans.

It has long been questioned whether antibiotics, used as a supplement to traditional therapy, provide any lasting benefit in the treatment of chronic periodontitis. This study was designed to evaluate Spiramycin as an adjunct to scaling and root planing in the treatment of advanced chronic periodontitis. In total, 193 patients with advanced periodontitis were recruited in seven centres using selection criteria previously described. After undergoing thorough scaling and root planing, all patients randomly received either Spiramycin, 1,500,000 international units, twice per day (IU, bid) for 14 days (96 patients), or a visually-identical placebo capsule (97 patients). The clinical parameters measured were plaque index, crevicular fluid level, probing depths, bleeding on probing and attachment level changes. Data was recorded at baseline, two-, eight-, 12- and 24-weeks visits. A total of 189 patients completed the study (96 placebo, 93 Spiramycin). Statistically significant differences in probing depth, favoring Spiramycin, were seen at two weeks (p < 0.0125), eight weeks (p < 0.0020), 12 weeks (p < 0.0032) and 24 weeks (p < 0.0075). Spiramycin also produced a significant improvement in attachment level at 12 weeks (p < 0.0146). All other clinical parameters showed no difference between drug and placebo. This study shows that Spiramycin, as an adjunct to thorough scaling and root planing, provides a statistically significant improvement in probing depths for up to 24 weeks when compared with scaling and root planing alone. Both longer studies and microbiologic evaluations are necessary to determine whether a more lasting benefit is possible.

The endo-perio problem in dental practice: diagnosis and prognosis.

The relationships between endodontics and periodontics are explored. Diagnosis, prognosis, and treatment planning are discussed for the primary endodontic lesion and the primary endodontic lesion with secondary periodontal involvement. These endodontic lesions are compared with primary periodontal lesions and primary periodontal lesions with secondary endodontic participation. The "true" combined lesion is also reviewed. Clinical photographs and radiographs are used to illustrate specific aspects.

Detection of three-walled infrabony defects by subtraction radiography.

An in vitro investigation was undertaken to establish the sensitivity of subtraction radiography for three-walled infrabony defect detection. After the creation of defects of controlled sizes in the interproximal regions of a dried mandible, subsequent radiographs were taken with the help of an occlusal stent. The radiographs were then digitized, and the images were enhanced by frame summation and averaging to reduce electronic noise. Further standardization was facilitated by the use of a step wedge on each radiograph and a computer program to correct variations in processing and exposure. The results show that defect resolution depended not only on the diameter of the defect but also on the mass of the adjacent bone. The smallest detectable lesion was 0.5 mm in diameter in the interproximal region of the premolars. In addition, a change in depth of 1 mm could be detected at the base of three-walled infrabony defects.

Observations on temperature and temperature patterns of the gingiva. I. The effect of arch, region and health.

The purpose of this investigation was to study the pattern and constancy of temperatures recorded in the gingival crevices and some factors affecting them. The temperatures of the interproximal crevices in the maxillary and mandibular arch of 16 female dental hygiene students were evaluated at the time of examination, immediately afterwards and following a 14-day interval. The temperature difference between each site and the subject's sublingual temperature were calculated. In the analysis, a comparison of sites with a confirmed status of bleeding tendency and pocket depth was carried out. The results show temperature differences between arches (mandible vs maxilla) and regions (posterior vs anterior). The differences are independent of the health status. Inflamed gingiva generally has a higher temperature than clinically healthy gingiva. There is an indication that healthy tissue, more than inflamed tissue, reacts to an outside stimulus with an increase in temperature. It is necessary that environmental and stimulative factors are strictly controlled if temperature gradients are to be applied for diagnostic purposes in periodontics.

Observations on temperature and temperature patterns of the gingiva. II. Estimations of the error in measurement.

The diagnostician may expect an error associated with the measurements of clinical parameters. It is important to know how precise these measurements are. The purpose of this study was to make an estimation of the measurement error by comparing repeated measures of the same site. Six dental hygiene students were examined for gingival and were recorded twice. The maximum error associated with 95% of the temperature data and the average error were calculated as 1.3 degrees C and 0.65 degrees C, respectively. The probabilities of making a correct assessment of pocket depth and of sulcular bleeding were computed to be 0.864 and 0.840, respectively. The need for repeated measures was statistically analyzed. It can be concluded from our data that the thermocouple thermometer used in this study is a suitable instrument for measuring the gingival temperature. However, it is necessary to acquire a higher level of precision for the assessment of pocket depth and sulcular bleeding. This can be accomplished by increasing the number of clinical measures on each point.

The relationship between gingival tissue temperatures and various indicators of gingival inflammation.

IN PERIODONTICS there is a need for objective measurements in monitoring disease processes and in assessing the effectiveness of treatment. The purpose of this study was to compare gingival temperatures with indicators of gingival inflammation in order to examine the application of temperature as a diagnostic aid. In six patients the temperature of interproximal sulcular tissue was measured and compared with bleeding upon probing, crevicular fluid flow, pocket depth, plaque accumulation and calculus formation. The results show significantly higher temperatures with bleeding upon probing and with the presence of dental plaque and calculus. Temperature increase correlated with increase in crevicular fluid flow, but a relationship to pocket depth is not clear. The thermocouple microprobe is a very sensitive instrument. The method used is noninvasive, safe and efficient. It can be concluded from our data that differences in gingival temperature reflect not only a regional tissue variability but also can indicate an inflammatory state.