The dentist's attitudes and their interaction with patient involvement in oral hygiene compliance.

The influence on patient compliance of the dentist's attitudes to his or her job and to his or her patient was studied in a sample of 82 patients. The dentist's attitudes were assessed at the beginning of dental treatment. Treatment consisted of cleaning, depuration and motivation. At follow-up examination after six months, attendance at follow-up and the development of plaque, calculus and gingivitis were significantly predicted by the dentist's attitudes. A causal model, which also included factors of patient involvement, was developed. The compliance-producing factors were, primarily, the establishment of sympathy and an informal relationship between dentist and patient. The patient's habit of regularly making visits to a dentist, in a complex way, also contributed to compliance.

The role of patient involvement in oral hygiene compliance.

Eighty-two dental patients were interviewed at the beginning of treatment in order to assess a number of psychosocial variables relevant to the prediction of compliance with treatment recommendations. Treatment consisted of cleaning, depuration and motivation. The patients were followed up after six months by measuring the development of plaque, calculus and gingivitis. In support of our hypothesis, it was found that variables that were related to patient involvement contributed strongly to the prediction of the oral health variables. The patient's visiting habits and initial attitudes were of particular prognostic value. The results with a set of variables conceptually unrelated to patient involvement were mixed and generally not as positive. Attendance at follow-up was predicted equally well by both kinds of variables, but generally not by the same variables as those that predicted oral health.

Role of "diseased" root cementum in healing following treatment of periodontal disease. A clinical study.

This clinical trial was undertaken to examine whether root debridement in the treatment of periodontal disease must include the removal of the exposed cementum in order to achieve periodontal health. The study included 11 adult patients with moderate to advanced periodontal disease. In a split-mouth design, the dentition of each patient was by random selection divided into test- and control quadrants comprising the incisors, canines and premolars. Following a baseline examination, all patients were given a case presentation and a detailed instruction in self-performed oral hygiene measures. The patients were then subjected to periodontal surgery. Following reverse bevel incisions, buccal and lingual mucoperiosteal flaps were elevated and all granulation tissue was removed. In 2 jaw quadrants (control quadrants) in each patient, the denuded root surfaces were carefully scaled and planed in order to remove soft and hard deposits as well as all cementum, using hand instruments and flame-formed diamond stones. In the contralateral quadrants (test quadrants) the roots were not scaled and planed but soft microbial deposits were removed by polishing the root surfaces with the but soft microbial deposits were removed by polishing the root surfaces with the use of rubber cups, interdental rubber tips and a polishing paste. Calculus in the test quadrants was removed by the use of a curette, but precaution was taken to avoid the removal of cementum. The flaps were repositioned to their original level and sutured. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks for a 3-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Healing after root reimplantation in the monkey.

The aim of the present investigation was to evaluate the regenerative potential of the periodontal tissues following tooth reimplantation using a model which excluded the dentogingival epithelium from the process of healing. Maxillary and mandibular incisors, premolars and molars of 5 monkeys were used. Following root filling of all experimental teeth, the teeth were divided into 3 experimental groups. In 1 group, the teeth were extracted following the elevation of full thickness flaps. The crowns were separated from the roots at the level of the buccal cemento-enamel junction and the roots immediately reimplanted into their sockets. The flaps were replaced and sutured to accomplish complete coverage of the roots. In a 2nd group, the teeth were subjected to the same experimental procedure, but in addition, the buccal alveolar bone was removed to about half its original height prior to root reimplantation. The teeth of the 3rd group were subjected to identical experimental procedures as for group II with the addition that the buccal root surfaces were planed to the level of the surgically created bone crest. The animals were sacrificed after 6 months of healing. The jaws were removed and histological specimens prepared for microscopic examination. The results showed that a complete fibrous re-attachment formed onto roots on which the original periodontal ligament tissue was preserved. This occurred irrespective of whether the roots were reimplanted into sockets with normal (group I) or reduced (group II) bone height. When the original periodontal ligament tissue was removed by root planing before reimplantation (group III), healing resulted in a significant amount of new connective tissue attachment. However, coronal to the newly formed fibrous attachment, the root surface frequently showed signs of resorption and particularly so in those roots which remained covered by the soft tissue during the entire course of healing. In the majority of the roots which perforated the covering soft tissue during the early phase of healing, the dentogingival epithelium had migrated apically into contact with the coronally generated fibrous attachment. In these cases, root resorption was never discernible. New bone formation occurred to a variable extent in the roots of groups II-III. No relationship was found, however, between the amount of connective tissue reattachment or new attachment and newly formed alveolar bone, which in turn indicates that bone tissue regrowth and periodontal ligament regeneration are unrelated phenomena.

Healing following reimplantation of teeth subjected to root planing and citric acid treatment.

The aim of the present study was to examine the effect of citric acid treatment on periodontal healing around teeth which were extracted, root planed and then reimplanted. Maxillary incisors and mandibular incisors, premolars and molars of 5 monkeys were used. The teeth were divided into 3 experimental groups. In 1 group, the teeth were extracted and immediately reimplanted into their own sockets. In a 2nd group, the teeth were extracted, root planed to a level corresponding to 50-75% of the root length and then reimplanted. In the 3rd group, periodontal breakdown extending to 50-75% of the root length was first induced by placing orthodontic elastic ligatures around the teeth. They were then extracted and root planed and transplanted into the sockets of the contralateral, periodontally healthy teeth which had just been extracted. Half the number of the teeth of groups 2 and 3 were treated with citric acid before reimplantation or transplantation. The animals were sacrificed after 6 months of healing. The jaws were removed and histological specimens prepared for microscopic examination. With the exception of a limited coronal regrowth of new cementum in the apical part of the planed portion of a few roots, connective tissue attachment failed to reform on most root surfaces deprived of their periodontal ligament tissue. Healing was most frequently characterized by root resorption and ankylosis. These were the most predominant features of healing both on root surfaces which had been deprived of the ligament tissue by mechanical means or during a course of experimentally-induced periodontal disease, and occurred in citric acid as well as non-citric acid treated roots. The findings imply that the result of healing following tooth reimplantation or transplantation is determined by the type of cells that repopulate the wound area adjacent to the denuded root surface.