Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet.

OBJECTIVES: To assess the efficacy of subgingival glycine powder air polishing (GPAP) during supportive periodontal therapy (SPT). METHODS: Each quadrant of 25 subjects was randomly assigned to the following treatments: subgingival scaling with hand instruments (SRP), GPAP, subgingival ultrasonic debridement (UD) and no subgingival treatment (NT). Clinical recordings included the following: probing pocket depth (PPD), gingival recession (RE), clinical attachment level (CAL), Gingival and Plaque Index. Subgingival plaque samples were taken from two sites >4 mm per quadrant. Therapy, recordings and microbial sampling were performed at baseline, 3 and 6 months, while at 1 month only clinical recordings and sampling were performed. Subgingival samples were analysed using 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Tannerrella forsythia and Treponema denticola. RESULTS: All groups were homogeneous at baseline for the clinical parameters assessed. The GPAP group displayed statistically significant higher PPD compared to SRP and UD at 1, 3 and 6 months and no statistical differences with the 'no treatment' group at all time points. At 1 month, the GPAP group displayed statistically significantly higher levels of CAL compared to SRP, while at 3 and 6 months statistically significant differences were observed with groups assigned to SRP and UD. No differences were observed among groups for RE, PI, GI and numbers of the investigated bacteria at any time point. CONCLUSIONS: On the basis of clinical and microbiological data, this study does not support the superiority of GPAP as sole treatment over SRP or subgingival ultrasonic scaling.

The influence of sex hormones on proinflammatory cytokines in gingiva of periodontally healthy premenopausal women.

BACKGROUND AND OBJECTIVE: The aim of this work was to investigate any correlation between the fluctuation of levels of specific proinflammatory cytokines in gingival crevicular fluid and the fluctuation of sex hormones in peripheral blood at ovulation and progesterone peak. MATERIAL AND METHODS: Eighteen premenopausal women with normal and consistent menstrual cycles and healthy periodontium were included in this study. The exclusion criteria were as follows: (i) pregnancy; (ii) use of oral contraceptives; (iii) metabolic or systemic disease that might affect the periodontium; (iv) use of antimicrobial or nonsteroidal anti-inflammatory drugs during the past 6 mo; and (v) smoking. The measurements were performed at two specific time points for each participant [(i) on the day of ovulation; and (ii) on the day of the progesterone peak) and included the following: (i) plaque index; (ii) bleeding on probing; and (iii) the gingival crevicular fluid levels of interleukin (IL)-1ß, IL-6, IL-8 and tumor necrosis factor-α (TNF-α). RESULTS: During the menstrual cycle, plaque index values remained unchanged (0.71 ± 0.07 at ovulation; 0.73 ± 0.08 at progesterone peak; p > 0.05), as did bleeding on probing (0.35 ± 0.07 at ovulation; 0.41 ± 0.07 at progesterone peak; p > 0.05). At ovulation, mean gingival crevicular fluid levels were as follows: IL-1ß, 13.3 pg/sample; IL-6, 5.9 pg/sample; IL-8, 18.7 pg/sample; and TNF-α, 25.9 pg/sample. The corresponding values at progesterone peak were as follows: 14.1, 10.1, 19.5 and 26.3 pg/sample. Only IL-6 gingival crevicular fluid levels were significantly different between ovulation and progesterone peak (p < 0.05). This could reflect sensitivity to subclinical amounts of plaque and biofilm constituents. CONCLUSION: The subclinical increase of IL-6 at progesterone peak is not accompanied by clinical changes in the periodontium.

A review on peri-implant crevicular fluid assays potential in monitoring and predicting peri-implant tissue responses.

The early and reliable detection of any adverse peri-implant tissue reaction is a prerequisite for treatment planning in patients treated with endosseous dental implants. However, traditional periodontal markers allow only the documentation of the severity of the preexisting destruction. Thus, simple and reliable clinical tests for monitoring peri-implant tissue condition are needed. As the peri-implant crevicular fluid (PICF) is an osmotically mediated inflammatory exudate, changes in flow rate and profile occur according to the condition of the peri-implant tissues. Consequently, peri-implant crevicular fluid analysis may help in detecting early metabolic and biochemical lesions not readily discernible, as well as in monitoring the osseointegration process and the bone response to occlusal loading, thereby improving the long-term success of implants. The purpose of this paper was to review current information on PICF flow rate and profile changes under various clinical conditions and investigate whether specific PICF assays could be useful in the assessment, monitoring and prediction of peri-implant tissue responses.

Aspartate aminotransferase levels in gingival crevicular fluid before and after initial periodontal treatment.

The present study investigates the presence of the enzyme aspartate aminotransferase (AST) in the gingival crevicular fluid (GCF) of untreated periodontal patients and determines the alterations in enzyme activity after the initial phase of periodontal treatment. From 12 patients suffering from advanced periodontitis, 54 pockets exhibiting severe attachment loss and depth > 4 mm were selected. Measurements of pocket depth (PD), attachment level (AL) and bleeding upon probing (BOP) were undertaken. For the GCF collection, sterile strips were gently placed at the previously isolated gingival crevice for 30 seconds and afterwards the GCF volume was determined with a Periotron 6000. The AST measurements were based on the establishment absorbency coefficient of NADH. The rate of decrease in the concentration of NADH is directly proportional to the AST activity in the sample. Four weeks after completion of the initial treatment, the patients were re-examined and the same clinical and laboratory measurements were performed. The parameters obtained were statistically analysed. The clinical parameters showed a statistically significant improvement, while the laboratory data expressed a statistically significant decrease of GCF volume as expected. Further, the sites were divided in two groups--pathological (pi) and physiological (phi)--according to Persson and Page (1991). After treatment a marked improvement concerning these values was noticed and it was noteworthy that these alterations occured regardless of initial AST presence.

Experiences with guided tissue regeneration in the treatment of advanced periodontal disease. A clinical re-entry study. Part I. Vertical, horizontal and horizontal periodontal defects.

The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE-membranes (Gore-Tex) in the treatment of advanced periodontal disease. The study presents long-term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL') and the tissue level (TL), a new parameter between cemento-enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re-entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL-Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re-entry (BL-BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at re-entry. The decreased amount of mineralized tissue at re-entry in relation to the tissue gain at membrane removal might be due to formation of a so-called long connective tissue attachment or to mineralization-induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.

Gingival health and salivary function in head and neck-irradiated patients. A five-year follow-up.

Gingival health and salivary gland function were evaluated for a period of 5 years in 14 patients who received head and neck irradiation for nasopharyngeal carcinoma (seven patients; total dose greater than 60 Gy, nasopharyngeal field) and Hodgkin's lymphoma (seven patients; total dose less than 50 Gy, "mantle" field). Plaque index (PII), bleeding index (BI), gingival recession (GR), whole saliva flow rate (WSFR), left parotid sialographic morphology, and salivary gland radioisotopic activity were assessed immediately before radiotherapy and annually thereafter. The nasopharyngeal group had perfect correlation between postradiation depression of WSFR and the sialographic and scintigraphic scores (R = -1.00 and -0.96, respectively). The degree of gland dysfunction correlated negatively with BI and the BI/PII ratio (r = -0.497) and with GR (r = 0.681). The same correlations were noted in the group with Hodgkin's lymphoma during the first 3 years of follow-up. However, recovery of parotid gland function (WSFR and scintigraphic scores) and morphology (sialographic scores) and return to the preradiation relation between WSFR and both BI/PII ratio (r = 0.75) and GR (r = -0.71) were noted in the fourth year. The differences between the nasopharyngeal and Hodgkin's lymphoma groups are attributable to the delineation of the radiation field employed in each group.

[Changes in the physical properties of Gingivamoll flexible gingival epithesis]. / Veränderungen physikalischer Eigenschaften von Gingivaepithesen aus Gingivamoll.

It was the purpose of this study to investigate variations in weight, volume, hardness, material density, adjustment and colour of Gingivamoll flexible gingival masks during a period of twelve months. Additionally, patients were inspected for potential infections of Candida albicans. Thirty-three gingival masks of nine patients were selected for the study. One third was placed into patients' mouths, one third was placed on stone models under room conditions and a third group was submerged under water. At baseline all gingival masks were examined and measured. For the first half of the year, measurements were recorded monthly and in the second half of the year at two months' intervals. Results showed a constant Shore-A hardness, volume and density. Gingival masks submerged under water kept their weight. The other masks, i. e. those placed into patients' mouths and those placed on plaster models, lost weight. Adjustment deteriorated at distal sites. Colour stability was not satisfactory. Tests for Candida albicans remained negative. It can be concluded that Gingivamoll flexible gingival masks can be used without serious problems for a period of twelve months.

[Preliminary results in periodontal treatment with guided tissue regeneration]. / Erfahrungen nach Parodontalbehandlung mit gesteuerter Geweberegeneration. (Vorläufige Ergebnisse).

The objective of the present clinical study was to evaluate the predictability of a treatment procedure (GTR) aimed at regenerating periodontal tissue. 34 patients and 103 teeth were selected for the investigation. All teeth included in the study exhibited advanced loss of periodontal attachment. The periodontal defects were associated with even and/or angular bone defects or, in the case of multirooted teeth, advanced loss of periodontal tissue support in the furcation area. The probing bone level (PBL) and the probing tissue level (PTL) of the diseased sites were recorded using a standardized procedure. Treatment included placement of a barrier membrane (e-PTFE, Gore-Tex) according to the GTR method. After a healing period of 4-6 weeks the membrane was removed in a second surgical procedure. The result of healing was evaluated immediately after membrane removal. A further measurement was carried out during a re-entry operation 9 months later. The measurements of the treated sites revealed that GTR therapy had resulted in a marked tissue gain of more than 60% (p less than 0.001). In 33 of a total of 34 furcation-involved molars treatment had resulted in complete closure of the furcation defect. In the light of the findings of the present clinical trial it may be suggested that GTR therapy is an effective and predictable means of improving prognosis for both single- and multirooted teeth. A definite evaluation, of course, will be possible with the results of the re-entry procedure.

[The etiopathogenesis of periodontal diseases: the role of microorganisms. A review]. / Atiopathogenese der Parodontalerkrankungen: die Rolle der Mikroorganismen. Eine Ubersicht.

The microbiology of periodontal diseases as well as associations between certain microorganisms and types/stages of periodontal diseases are discussed and the ecology and the composition of the subgingival plaque are included in this discussion, too. Furthermore, the possible role of microorganisms associated with periodontal diseases, their pathogenic mechanisms and their virulence factors are treated in the present article. Periodic upsets of the host-parasite equilibrium seem to be responsible for the bursts of disease progression. Several plaque hypotheses (specific, non-specific, opportunistic) have been proposed as likely models to explain the nature of periodontal infections and diseases. However, none of these theories is widely accepted at the moment. Therefore, we suggest that further investigations concerning the complex bacterial interactions and the manner in which the host responds to the mass and the composition of the dental plaque must be carried out in the future.

[Gingivectomy]. / Die Gingivektomie.

The gingivectomy is the oldest surgical approach in periodontal therapy. During the centuries, the technique has been modified. Just at the middle of our century, gingivectomy was the most important surgical method in periodontal treatment. Indication for performance of the gingivectomy is the complete elimination of the periodontal pocket (gingival overgrowth/e.g. hyperplasia, subgingival caries, subgingivally located crown margins. The physiologic design of the free gingival margin by surgical means, gingivoplasty, must be taken under consideration. Depending on the long and painful healing for the patient, gingivectomy should be preserved for the indications above. Wherever possible, is recommended a flap procedure like the apically repositioned flap.

[A latex agglutination test for the rapid identification of periodontally pathogenic microorganisms in subgingival plaque. The preliminary results]. / Der Latex-Agglutinationstest zur schnellen Identifizierung von parodontopathogenen Mikroorganismen in der subgingivalen Plaque. Vorläufige Ergebnisse.

Latex agglutination tests (LA) have been evaluated for identifying periodontal pathogens. This preliminary study compared LA tests with indirect immunofluorescence (IF) for the rapid identification of A. actinomycetemcomitans, B. gingivalis, and B. intermedius in clinical subgingival plaque samples. A total of 58 sites from 12 patients suffering from advanced periodontitis, exhibiting recent attachment loss were examined before and after initial periodontal treatment. The results of the two examinations were pooled and a total of 116 sites were statistically evaluated. The overall agreement between LA and IF was 75.8% for black pigmented Bacteroides (BPB) and 74.1% for Aa. These results demonstrate the feasibility of LA as a rapid, inexpensive, and reliable tool for monitoring periodontal disease offered to the general practitioner.