Trauma from occlusion. Periodontal concerns.

Application of the chronic disease model to IPD suggests that to be most effective, programs of prevention and treatment include measures to address as many of the identified risk factors as is possible. It remains to be determined if TO is involved in the initiation of IPD, for example, if individuals with TO are at greater risk for the development of IPD. There is evidence that TO is a risk factor in the progression of IPD. Tooth mobility is associated with and is a risk factor for increased attachment loss and increased bone loss in patients with periodontitis. Tooth mobility can be reduced by occlusal treatment. Clinical trials involving patients with periodontitis clearly establish that a better clinical periodontal attachment level response to treatment is obtained when occlusal adjustment is included as part of the treatment plan. Patients with advanced periodontal involvement benefit from occlusal treatment in terms of increased stability for the teeth and also in terms of oral comfort. Finally, There is no evidence that without occlusal treatment, periodontal patients who are in careful maintenance programs are more likely to suffer recurrence of IPD.

The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss.

The purpose of this study was to determine the influence of furcation involvement (FI) and mobility (MO) on change in probing periodontal attachment level (AL) on molar teeth. Twenty-four patients were selected from The University of Michigan longitudinal periodontal clinical trial. The patients who met the entry criteria received a baseline examination and were treated by periodontal scaling and root planing followed by different periodontal surgical approaches in a split-mouth design. Patients were placed on a 3-month interval for maintenance prophylaxis and had yearly periodontal scorings for a period of 8 years. The scorings included determination of AL, FI, MO, and tooth loss (TL). Data for molar teeth from three different time periods (at entry (A) and at 1 (B) and 8 (C) years) were analyzed. The results demonstrated that teeth with FI were 2.54 times more likely to be lost when compared to teeth without FI during the maintenance period. By using paired t test approach to the probing attachment level data, molars with FI had significantly more loss between times B and C but not between A and B or A and C. Teeth with increased MO demonstrated significantly more AL between times A and C and B and C. When the interaction between MO and FI was analyzed, teeth with both FI and MO had significantly more attachment loss during the maintenance period (B to C). No statistically significant difference was found among the three different therapeutic approaches (pocket elimination, curettage, and modified Widman flap) during any of the time periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of ferric oxalate as an agent for use during surgery to prevent post-operative root hypersensitivity.

The aim of this study was to evaluate the effectiveness of a 6% ferric oxalate solution applied during periodontal surgery to prevent post-operative tooth hypersensitivity. Twenty-five adult patients with similar bilateral periodontal defects participated in this study. Data were collected at baseline (1 week prior to surgery) and 1, 2, 4, and 6 weeks following surgery. Sensitivity level was determined using the visual analog scale (VAS) with the following stimuli: 1) mechanical stimulation with a No. 23 dental explorer; 2) water at 50 degrees C; 3) ice; and 4) electric pulp tester (EPT). Teeth were randomly assigned to either test (6% ferric oxalate in 0.9% saline) or control (0.9% saline) groups. Solutions were applied to the exposed root surfaces for 1 minute during surgery. Data were analyzed by repeated measures ANOVA, paired t-test, and Pearson's correlation test. Results from this study demonstrated statistically significant reduction in the responses to thermal stimuli, especially cold, between groups treated with ferric oxalate as compared to those treated with saline. For the cold test the difference increased with time from baseline to 6 weeks. Statistically significant (P < 0.05) differences in sensitivity to heat between groups were also observed, but only at 2 and 4 weeks following surgery. There were no differences at any time period between the test and control groups when tactile or EPT techniques were used. In addition, there was no correlation between sensitivity and other clinical parameters. It was concluded from this study that 6% ferric oxalate was effective in reducing post-surgical cold sensitivity when applied during periodontal surgical procedures.

The relationship between restoration and furcation involvement on molar teeth.

The purpose of this cross-sectional study was to examine the correlation between the presence of a crown (CR) or a proximal restoration (RE) and furcation involvement (FI) on molar teeth. Data were collected from 134 periodontal maintenance patients who had restored and non-restored molars present both with and without FI. A majority of the restorations that were present in these patients had been in place for at least 5 years prior to the study. First and second molars were examined clinically using the following criteria: CR, RE, FI, mobility (MO), and probing periodontal attachment level (AL). Data were analyzed with a statistical program utilizing Pearson chi-square and the pair-difference t test. The results indicated that molars with CR or RE had a significantly (P < 0.01) higher percentage of FI but no greater mobility when compared to molars without restorations. Mean probing periodontal attachment loss was greater for restored than non-restored molars but only with marginal significance (P = 0.051). There was a greater difference in mean AL between restored versus non-restored maxillary molars than for mandibular molars. This cross-sectional study provides evidence that molars with crowns or restorations involving the proximal tooth surfaces had a higher prevalence of FI and greater AL than molars without restorations.

A randomized trial of occlusal adjustment in the treatment of periodontitis patients.

The purpose of the randomized clinical trial was to test; (1) the influence of occlusal adjustment (OA) in association with periodontal therapy on attachment levels, pocket depth, and tooth mobility, (2) whether OA was of greater significance in non-surgically treated periodontal defects, and (3) whether initial tooth mobility or disease severity had an affect on post-treatment attachment levels following OA. After hygienic-phase therapy, 50 patients received OA/No OA according to random assignment; 22 patients received an OA and 28 were not adjusted. 2 months after OA, either modified Widman flap surgery or scaling and root planing by a periodontist were done according to random assignment within each patient in a split-mouth design. Following active treatment patients were maintained with prophylaxis done every 3 months and scored annually. For the analysis of this two-year data, a repeated measures analysis of variance was performed using attachment level change and pocket depths as outcome indicators. There was significantly greater gain of clinical periodontal attachment in patients who received an OA compared to those who did not. Both the surgically and non-surgically treated sides of the mouth responded similarly to OA. There was no affect of OA on the response in pocket depth, nor did initial tooth mobility or initial periodontal disease severity influence the response to OA.

Oral hygiene and maintenance of periodontal support.

The role of personal plaque control in periodontal maintenance care was studied in 78 patients who had undergone periodontal therapy and were on 3-month recall for prophylaxis over 8 years. Variations in pocket depth and attachment levels were related to individuals with plaque scores above and below the median. The results also were analyzed by comparing the 25% of the sample having the lowest plaque scores with the 25% having the highest scores over 7 years of maintenance care. Students t test was used. It was found that personal oral hygiene as expressed in plaque scores was not critical for maintenance of post-treatment pocket depth and attachment levels in patients with professional tooth cleaning every 3 months. The initial post-treatment reductions in pocket depth and variations in attachment levels were more favorable in patients with good than with poor oral hygiene, but, these differences were not significant after 3 to 4 years of maintenance care.

Tooth mobility and periodontal therapy.

Data collected as part of an 8-year longitudinal study on periodontal therapy involving 82 patients and 1974 teeth were analyzed to determine if tooth mobility influenced the result of treatment. For each patient, pocket depth, attachment level and tooth mobility were scored clinically at the initial appointment, and once a year for 8 years following periodontal therapy. The treatment consisted of scaling, oral hygiene instruction, occlusal adjustment, periodontal surgery (curettage, modified Widman or pocket elimination), followed by recall prophylaxes every 3 months. Tooth mobility data on a scale of 0--3 were related to changes in attachment levels for three grades of severity of periodontal disease, based on initial pocket depth (1--3 mm, 4--6 mm, and 7 + mm). Mean patient attachment changes were calculated from teeth in the same severity category for each patient. The data were analyzed by one-way analysis of variance and Scheffe's multiple comparison procedure to test the hypothesis of equal effects of tooth mobility on the results of the treatment for the three severity groups over 8 years. The results indicate that there is a statistically significant relationship between original tooth mobility and the change in level of attachment following treatment. Pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same initial disease severity.

Results of periodontal therapy related to tooth type.

Certain teeth or groups of teeth are prone to develop more severe periodontal destruction than other teeth in the same individuals. A test was made to assess if these same teeth or groups of teeth also respond less favorably to periodontal therapy than other teeth. Data from a longitudinal study of periodontal therapy for 78 patients over 8 years were analyzed with regard to effect of tooth types on treatment results. The response to periodontal treatment was only marginally related to tooth type with the most favorable responses in the maxillary and mandibular anterior teeth and the least favorable responses in the maxillary molars and bicuspids. Although a number of these differences were significant statistically, the actual values were too small to be of appreciable clinical significance. The overall prognosis for treatment of periodontal pockets apparently is good for all tooth types and this observation applies to moderate as well as to deep pockets.

Short term results of three modalities of periodontal treatment.

Short term data were obtained from 74 patients who recieved comprehensive periodontal treatment using a split mouth approach to test three variables; subgingival curettage, pocket elimination surgery, and modified Widman flap procedure. The patients initially had an average interproximal loss of attachment of 3.2 mm and an average interproximal pocket depth of 3.9 mm. Evaluation of the data indicate that after 4 to 6 weeks: 1. All three surgical procedures reduce pocket depths. In order of effectiveness they are: pocket elimination surgery, modified Widman flap, and subgingival curettage. 2. Pocket elimination surgery reduces pockets more than subgingival curettage on the buccal, lingual and interproximal, and more than the modified Widman flap on the lingual. The modified Widman flap procedure reduces pockets more interproximally than subgingival curettage. 3. Subgingival curettage results in a gain of attachment interproximally, and on the lingual side, while the modified Widman flap resulted in a gain of attachment interproximally only. 4 Pocket elimination surgery resulted in a loss of attachment buccally. 5 Subgingival curettage results in a more favorable postoperative attachment level on all surfaces than did pocket elimination surgery.

Probing of pockets related to the attachment level.

Twenty immediate denture patients with periodontitis participated in a controlled study to determine the relationship between clinical probing of pocket depth and the connective tissue attachment. Maxillary and mandibular anterior teeth were probed clinically by one investigator to determine attachment levels. The mesial and distal facial line angles were probed from the cementoenamel junction and from a coronal bur groove, to the clinically determined attachment level. One hundred and sixteen teeth were measured. The teeth were extracted, rinsed, and stained with 4% methylene blue in 50% alcohol to demonstrate the remaining connective tissue attachment. A second investigator using the same probe as the first measured the distance from the coronal bur groove and cementoenamel junction to the most coronal extension of the connective tissue attachment. These measurements were repeated by the second investigator using a dividing caliper and a millimeter scale with a Vernier. The data were analyzed by an analysis of variance for grouped teeth, pairwise t statistic for all teeth, and an analysis of variance for all teeth. The results showed: the influence of the interaction between the patients and technique of measurement, bench and clinical, was negligible for the grouped teeth and for all teeth. The difference between the clinical and bench measurements was not significant for all the teeth as well. The null hypothesis that the difference between the clinical measurement and bench measurement is zero was satisified.

Results following three modalities of periodontal therapy.

Three methods for treatment of periodontal pockets (subgingival curettage, modified Widman flap surgery, and pocket elimination) were applied as a clinical trial to 82 patients. Follow up results over one to five years after the initial treatment are reported. The variations in attachment levels and pocket depth were analyzed statistically as related to methods of treatment and yearly time intervals following the initial treatment. The most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally. Subgingival curettage provided the greatest gain in attachment level up to three years postoperatively, but after four to five years there was no significant difference in results following the three methods. The most significant loss of attachment and return of pocket depth occurred on the buccal aspects of the teeth, and the results were not significantly different for the three methods except at the first year of follow up when the attachment level was maintained best after curettage.

Radiographs in clinical periodontal trials.

Fifty-eight patients were selected from an ongoing study of periodontal therapy at The University of Michigan. Pre-and post-treatment series of full mouth radiographs obtained by conventional paralleling long cone technique were available. Mesial and distal radiographic bone height was scored using the technique developed by Björn et al. A total of 1416 teeth were scored from the itial radiographs, and subsequently at one, two, three, and four years after the treatment. Radiographic bone height scores were compared with level of attachment and pocket depth scores for the same teeth at the same time. Statistical significance and correlation coefficients were derived using computer analysis of the data. The data were analyzed using three different data groupings: individual teeth, patient means, and half-mouth treatment methods. High positive correlations were found between initial measurements of radiographic bone height and attachment level as well as pocket depth. The correlations between changes in measurements of radiographic bone height and attachment level after treatment were markedly lower but are statistically significant. A highly significant correlation between radiographic bone heights and measurements of attachment level also appeared in follow-up data one to four years after treatment. The method of data grouping resulted in different correlation coefficients. Highest correlations were found if the data were pooled for patients. Lowest correlations were found if the data for individual teeth were analyzed. When the data were combined to produce patient scores, sample variation is reduced and correlations increase in magnitude. The generally high correlations between radiographic bone height and attachment level scores before and after treatment tend to confirm the fact that radiographic assessment of alveolar bone height using the method of Björn et al. can provide fairly accurate assessment of interproximal periodontal support.