Reproducibility of Manual Periodontal Probing Following a Comprehensive Standardization and Calibration Training Program.

Background: Clinical standardization and calibration training is recommended to increase the reproducibility of periodontal probing, but its impact on manual periodontal probing outcomes has received little attention. This study examined the reproducibility of manual periodontal probing performed by a periodontist after completion of a comprehensive standardization and calibration training program. Methods: A newly-educated periodontist was subjected to an individualized periodontal probing standardization and calibration training program involving approximately 24 total hours of lecture, bench-top, and clinical instruction/evaluation. Satisfactory completion of each portion of the training program required ≥ 95% intra-examiner agreement within 1 mm between initial and repeat measurements, and a ≥ 90% level of exact agreement with measurements by a "gold standard" examiner. The periodontist then evaluated bleeding on probing (BOP) and performed duplicate measurements of probing depth (PD) and the distance between the cementoenamel junction and gingival margin (CEJ-GM) with a manual periodontal probe on 567 periodontal sites exhibiting ≥ 5 mm PD with BOP in 39 adults. Clinical periodontal attachment level (CAL) was calculated for each site as (PD) - (CEJ-GM). Results: Intra-examiner measurement error (the standard deviation for a single measurement) was found to be 0.21 mm for PD, 0.15 mm for CEJ-GM, and 0.26 mm for CAL. Replicate assessments of PD and CAL yielded excellent exact agreement kappa scores of 0.86 and 0.87, respectively. Greater intra-examiner measurement error was found at periodontal sites with more gingival inflammation as measured by higher BOP index scores. Conclusion: These findings demonstrate that a rigorous periodontal probing standardization and calibration training program facilitates acquisition of highly reproducible PD and CAL assessments in moderate to deep inflamed periodontal pockets with a manual periodontal probe. Similar formal hands-on training should be incorporated into dental education programs and clinical research studies to improve the diagnostic performance of manual periodontal probing of the periodontium.

IL-1B(3954) polymorphism and red complex bacteria increase IL-1ß (GCF) levels in periodontitis.

OBJECTIVE: The aim of this study was to compare IL-1ß levels in gingival crevicular fluid (GCF) from healthy and periodontitis sites of IL-1B(3954)-Single Nucleotide Polymorphism (SNP) positive and IL-1B(3954)-SNP negative periodontitis subjects in association with their bacterial profiles. BACKGROUND: Susceptibility to periodontitis has been associated with several risk factors, including allelic variants at multiple gene loci. Variations in the IL-1 gene cluster have been linked with increased risk for periodontitis. IL-1B(3954)-SNP has been previously associated with increased levels of IL-1ß in GCF or periodontal tissues in chronic periodontitis patients, as well as higher levels of specific periodontal pathogens. There is insufficient evidence to conclude if IL-1B gene polymorphisms affect the susceptibility to periodontitis by ultimately modulating the levels of IL-1ß in GCF, the subgingival microbial profile or both. MATERIALS AND METHODS: GCF, subgingival plaque, and buccal epithelial cells were collected from 32 individuals with periodontitis. GCF IL-1ß levels were measured by an enzyme-linked immunosorbent assay (ELISA). Bacterial plaque samples were analyzed for 11 periodontal pathogens using polymerase chain reaction (PCR) analysis with specific primers for the 16SrRNA gene of each bacterium. IL-1B(3954)-SNP status was determined by identifying the carriers of the polymorphic T allele. RESULTS: A significant association was shown between IL-1B(3954)-SNP and IL-1ß GCF levels (amount and concentration). The concomitant presence of two or three red complex bacterial species was associated with increased IL-1ß GCF levels in periodontitis sites (site-level analysis). The concurrent presence of all three red complex periodontal pathogens and IL-1B(3954)-SNP was associated with the highest IL-1ß GCF levels in periodontitis sites. CONCLUSIONS: Our results indicate an independent association of both IL-1B(3954)-SNP and red complex bacterial species with increased IL-1ß levels in GCF of periodontitis sites. A better understanding of the interaction between genetics, bacteria, and inflammation is essential to develop more effective diagnostic, prognostic, and therapeutic tools for periodontitis.

The root coverage esthetic score: Intra-examiner reliability among dental students and dental faculty.

BACKGROUND: The root coverage esthetic score (RES) was published in 2009 as an esthetic scoring system to measure visible final outcomes of root coverage procedures performed on Miller I and II recession defects. The aim of this study was to evaluate the intra-examiner, intra-group, and inter-examiner reliability of the RES when used among periodontal faculty, post-graduate students in periodontology, and pre-doctoral DMD students when using the RES at Tufts University School of Dental Medicine (TUSDM). METHODS: Thirty-three participants (12 second-year DMD students, 11 periodontal residents, and 10 faculty members) were assembled to evaluate 25 baseline and 6-month post-treatment outcomes of mucogingival surgeries using the RES. Each projection was shown for 30 seconds during which the participants were asked to use the RES scoring system to evaluate the surgical outcomes. The results were then recorded on a standardized worksheet grid. To test intra-examiner reliability, seven of the 25 projections were shown twice. Intra-examiner reliability and inter-examiner reliability were assessed using intraclass correlation coefficient using a two-way mixed effect model, and stratified by education level. RESULTS: Post-graduate (PG) residents had the highest tendency to agree with each other with an interclass correlation (ICC) of 0.53 (95% confidence interval [CI] 0.36 to 0.74). DMD students had an ICC: 0.51 (95% CI: 0.33 to 0.75), and PG faculty members produced an ICC: 0.41 (95% CI: 0.24 to 0.64). There was no statistically significant difference in ICC among the three groups of participants (Kruskal-Wallis test, P = 0.2440). When the data for each RES element were then combined, the mean ICC for the total inter-rater agreement for RES was 0.48 (95% CI: 0.32 to 0.71). This corresponds to an overall moderate agreement among all participants using the RES to evaluate the 25 surgical outcomes. The intra-examiner reliability within each of the three groups was quite high. The highest mean ICC was produced by PG faculty (0.908). The mean ICCs for PG residents was 0.867, and the mean ICC for DMD students was 0.855. The Kruskal-Wallis test (P = 0.46) failed to find any statistical difference in intra-examiner reliability among the three groups of participants. CONCLUSIONS: The RES is a "moderately" reliable scoring system for mucogingival treatments in a dental school setting and can be used even by operators with different levels of periodontal experience. This scoring system can be repeated by the same examiner to obtain reliable results.

Guided Tissue Regeneration Involving Piercing-Induced Lingual Recession: A Case Report.

Recession on the lingual aspect of mandibular incisors may occur in patients with history of tongue piercing and other factitious traumatic habits. Treatment of these areas is challenging due to the site-specific anatomical features of the region. This case report presents a novel approach for a specific type of mandibular lingual defect caused by tongue piercing. A nonresorbable titanium-reinforced barrier membrane combined with an allograft and enamel matrix derivatives was used to promote regeneration of periodontal attachment. Reentry surgery for membrane removal was performed at 8 weeks. The time from initial surgery to final follow-up was 18 months.

Prospective Clinical and Radiographic Study of Alveolar Ridge Preservation Combining Freeze-Dried Bone Allograft With Two Xenogeneic Collagen Matrices.

BACKGROUND: Tooth extractions are followed by significant dimensional changes in the alveolar crest that may preclude implant placement. This randomized, controlled, prospective compares the preservation of soft and hard tissue dimensional changes after alveolar ridge preservation (ARP) using two membranes consisting of collagen matrix (CM) or extracellular matrix (ECM) as barriers over freeze-dried bone allograft (FDBA). METHODS: Standardized clinical and radiographic measurements of soft and hard tissues were recorded by means of a stent before and 4 months after ARP. The surgery entailed sulcular incisions with minimal flap elevation and repositioning without advancement. RESULTS: Of 11 patients in the CM group and 12 in the ECM group who completed the study, gingival thickness (GT) increased from 0.1 to 0.2 mm for both groups along with a 0.5-mm decrease in the width of keratinized tissue after healing. Reductions in ridge width were most pronounced on the coronal aspect, 1.8 mm for CM and 2.0 mm for ECM, whereas vertical reduction was most pronounced on the buccal aspect, 0.7 to 1.0 mm. Differences between groups were not statistically significant. However, significant correlation for changes in GT (P = 0.001) and crestal bone width (P = 0.002) with preoperative buccal plate thickness (BPT) was observed. CONCLUSIONS: Both xenogeneic collagen matrices combined with FDBA were effective in maintaining soft tissues and minimizing ridge resorption in all dimensions after ARP. BPT was an important determinant for amount of change in crestal GT and ridge width.

Centipeda periodontii in human periodontitis.

This study assessed the subgingival occurrence of the flagellated, Gram-negative, anaerobic rod Centipeda periodontii in chronic periodontitis and periodontal health/gingivitis with species-specific nucleic acid probes, and evaluated the in vitro resistance of subgingival isolates to therapeutic levels of amoxicillin, metronidazole, and doxycycline. Subgingival plaque biofilm specimens from 307 adults with chronic periodontitis, and 48 adults with periodontal health/localized gingivitis, were evaluated with digoxigenin-labeled, whole-chromosomal, DNA probes to C. periodontii ATCC 35019 possessing a 10(4) cell detection threshold. Fifty-two C. periodontii subgingival culture isolates were assessed on antibiotic-supplemented enriched Brucella blood agar for in vitro resistance to either amoxicillin at 2 µg/ml, metronidazole at 4 µg/ml, or doxycycline at 2 µg/ml. A significantly greater subgingival occurrence of C. periodontii was found in chronic periodontitis subjects as compared to individuals with periodontal health/gingivitis (13.4 vs. 0 %, P < 0.003), although high subgingival counts of the organism (≥ 10(6) cells) were rarely detected (1.3 % of chronic periodontitis subjects). In vitro resistance was not found to amoxicillin or metronidazole, and to doxycycline in only 2 (3.9 %) of the 52 C. periodontii clinical isolates studied. These findings indicate that C. periodontii is not a major constituent of the subgingival microbiome in chronic periodontitis or periodontal health/gingivitis. The potential contribution of C. periodontii to periodontal breakdown in the few chronic periodontitis subjects who yielded high subgingival levels of the organism remains to be delineated. C. periodontii clinical isolates were susceptible in vitro to therapeutic concentrations of three antibiotics frequently used in treatment of human periodontitis.

Restoration of gingival and esthetic deformities following flap advancement: the physiologically pigmented gingival graft--a case report.

The coronal advancement of surgical flaps and subsequent shift of the mucogingival junction during bone augmentation procedures are common. These mucogingival alterations may become a challenge to manage in the maxillary anterior region among patients with a high lip line upon smiling or high esthetic demands. To further complicate matters, the presence of physiologic gingival pigmentation in the esthetic zone creates challenges of its own. In this case, a free gingival graft from the buccal gingiva of the maxillary molars was used to correct the mucogingival deformity created from a guided bone regeneration procedure.

Early bone healing around 2 different experimental, HA grit-blasted, and dual acid-etched titanium implant surfaces. A pilot study in rabbits.

PURPOSE: To compare early bone healing around different experimental titanium implant surfaces and to evaluate the role of a calcium phosphate-coated implant surface because it relates to bone-implant contact (BIC). METHODS: An experimental hydroxyapatite (HA) grit-blasted and dual acid-etched titanium surface (BAE-1) was compared to an experimental HA grit-blasted and dual acid-etched surface treated with nanometer-scale crystals of HA (BAE-2). Both experimental implant surfaces were implanted onto the tibias of 4 New Zealand white rabbits. The animals were killed at 1,6, 21, and 90 days after the implant surgery. Descriptive histology was performed at the healing responses of both implant surfaces. Quantitative morphology assessment provided measurements of BIC, number of bone multicellular units (BMUs), average penetration of BMUs, and maximum penetration of BMUs that were manually made using imaging computer software. RESULT: The overall BIC for the BAE-2 implant was higher than that for the BAE-1 implant at 21 days of healing. However, there was no significant difference at 90 days of healing. CONCLUSION: It is concluded from this animal pilot study that the bioactive BAE-2 implant surface provided a better BIC with healthy bone remodeling at 21 days of healing.

The single-tooth implant: a viable alternative for single-tooth replacement.

BACKGROUND: The use of dental implants for single-tooth replacement cases introduces a challenge to the performance of these restorations. Clinical data suggest that single-tooth implant restorations do not benefit from lateral support from the surrounding dentition as do bridged implants, and that these restorations are subjected to greater masticatory forces. Therefore, single-tooth implants are exposed to an increased risk of failure. This prospective clinical trial was designed to evaluate the cumulative success rate of dual acid-etched single-tooth replacement implants in two clinical centers. METHODS: The study protocol included 59 patients between 19 and 73 years. Implants were evaluated for mobility, infection, and crestal bone loss from 30.9 to 60 months. RESULTS: Seventy-one (71) implants were placed in 59 patients, 20 male and 39 female. Forty-seven (47) were placed in the maxilla and 24 in the mandible. The percentages of anterior and posterior implants were 45.1% and 54.9%, respectively. A total of 13 (18.4%) implants were placed in soft, poor quality (Type IV) bone. Beginning 1 month post-implant placement, cases were followed for 30.9 to 60 months with a mean follow-up of 45.9 months. One implant failed (peri-implant infection) yielding an overall success rate of 98.6%. CONCLUSIONS: This success rate for single-tooth replacement dual acid-etched implants compares favorably with bridged implants and with success rates of other single-tooth implant studies. Dual acid-etched implants performed well even under conditions of poor quality bone, where concomitant bone augmentation was performed, and when used for immediate replacement of extracted teeth.