Epidemiology of periodontal status in dentate adults in France, 2002-2003.

BACKGROUND AND OBJECTIVE: Few recent nationwide studies of the periodontal landscape in European countries have been developed from the point of view of attachment loss and pocket depth. Decision makers are not always in a position to estimate the burden of periodontal disease. The purpose of this study was to investigate the prevalence and the oral distribution of periodontal status among dentate adults in the general population of France. MATERIAL AND METHODS: In 2002-2003, a National Periodontal and Systemic Examination Survey was organized to a stratified quota sample of 2144 adults, aged 35-64 years, nationwide. Participants with six or more teeth were selected from the Health Examination Centers of the National Health Insurance. Measurement of periodontal health was assessed by clinical attachment level and probing depth. RESULTS: A total of 95.40% and 82.23% of adults were found to have clinical attachment loss and periodontal pockets, respectively. Population prevalence estimates indicated that loss of attachment > or = 5 mm is 46.68% and probing depth (> 5 mm) is 10.21%. However, clinical attachment loss of > or = 5 mm occurred in only 0.88 sites in an individual. Periodontal depth pocket generalized forms were as follows: 78% slight, 18% moderate and 4% severe. Multiple logistic regression analyses showed significant differences of attachment loss values between types of tooth (molar, incisors, canines, or premolars). CONCLUSION: Based on the International Classification of Periodontal Diseases, approximately 50% of adults in France may suffer from a severe attachment loss problem. Periodontal pockets are an uncommon condition in France. Significant differences in the prevalence of loss of attachment and probing depth with respect to location of attack have implications in the purchase and development of screening and treatment services.

Type 2 diabetes and periodontal indicators: epidemiology in France 2002-2003.

BACKGROUND AND OBJECTIVE: Diabetes and periodontal disease have been associated in the literature. In the present study, the periodontal heath of noninsulin-dependent diabetic adults was compared with that of a general population of nondiabetic patients. MATERIAL AND METHODS: In France, 2144 adults (age: 35-65 years) were examined for life habits (tobacco, alcohol), biological diagnosis (type II diabetes, arterial hypertension), biometry (weight, size) and biochemistry. Dental and periodontal data included plaque index, gingival index, probing depth, and clinical attachment loss. RESULTS: Descriptive and multifactorial analysis evidenced a more severe periodontal disease in diabetic patients. Moreover, when the plaque index was held constant, the gingival index was more elevated in diabetics. In nondiabetics, age, gender, glycemia, alcohol, and tobacco smoking were identified as significant risk factors for periodontal disease. In contrast, in diabetic subjects, only tobacco smoking was a significant risk factor. CONCLUSION: In type II diabetics, the diabetes factor is probably more significant than periodontal risk factors, age, and gender.

Conditions for success in guided bone regeneration: retrospective study on 376 implant sites.

BACKGROUND: Used alone or in association with bone, guided bone regeneration is a clinically accepted method to increase the volume of bone during implant placement. Concerns about appropriate surgical techniques and the predictability of the results questions still exist. The aim of this study was to assess the conditions for success. METHODS: Three-hundred-seventy-six implants were placed in association with 214 non-resorbable membranes. In 109 implants, the membrane was secured on a blood clot; for 213 implants, membrane was placed with autogenous bone; and for 54 implants it was placed with allogenic bone. The surgical procedure, the primary closure, the timing of re-entry, and the density of regenerated tissue were studied. RESULTS: In 19 membranes, barrier exposure occurred before 3 months in these instances, the regenerated tissue was removed; another 7 membranes were exposed between 3 and 6 months. The 188 non-exposed membranes were removed between 6 and 12 months. In cases of exposure before 3 months, the regenerated tissue was soft and then removed. After closure for 6 months or more, the regenerated tissue was dense and resistant to probe pressure. The best results were obtained when the membranes were placed with autogenous bone. CONCLUSIONS: If all the clinical steps are appropriately followed, guided bone regeneration using an autogenous bone graft and implant placement is a predictable technique for increasing bone volume.

Clinical evaluation of a bioabsorbable regenerative material in mandibular class II furcation therapy.

30 periodontally compromised adult subjects with mandibular buccal class II furcation defects were recruited for this study. All selected defects were treated according to the biological principles of guided tissue regeneration. The subjects were randomly assigned to 2 parallel groups. The test group (n=15) received a bioabsorbable polyglycolic-polylactic membrane (PGA/PLA group); the control group (n=15) received a non-resorbable expanded polytetrafluoroethylene membrane (ePTFE group). After initial therapy, baseline measurements were recorded including plaque index, gingival index, vertical and horizontal probing depths, clinical attachment level and depth of the recession. Recall visits were made at 1, 2, 4, 6, 8, 12, and 24 weeks. At 12 months, all baseline clinical parameters were again measured. The data analysis did not demonstrate a significant difference between the 2 groups. The vertical probing depth and attachment level changes were statistically significant in each group. The postoperative recession was 0.6 mm in the ePTFE group (p<0.05) and 0.8 mm (p<0.05) in the PGA/PLA group. Compared to the initial measurements, the mean changes in horizontal probing depth were 2.7 mm and 2.5 mm (p<0.001), corresponding to mean reductions of 41.5% and 40.9% for the ePTFE and the PGA/PLA groups respectively. The results of this study suggest that 12 months after initial surgery, similar clinical improvements can be obtained in GTR therapy of buccal class II furcation lesions, regardless of whether bioabsorbable PGA/PLA membranes or non-resorbable ePTFE membranes are used.

Clinical evaluation of guided bone regeneration at exposed parts of Brånemark dental implants with and without bone allograft.

This investigation evaluated guided bone regeneration with a polytetrafluoroethylene barrier membrane at exposed parts of Brånemark dental implants with and without concomitant use of decalcified freeze-dried bone allograft. Density of the regenerated tissue was also determined using a No. 23 probe at a pressure of 25 g and was graded from 1 to 5. The higher index was associated with a higher resistance of newly formed tissue to the pressure of the probe. In 19 patients, 23 defects were treated by barrier membrane alone and 11 defects by bone allograft with barrier membrane. The width and the depth of the defects were determined at the time of the implant placement and at the second-stage implant surgery. When success was defined as 0 mm of residual defect, the mean success rate was 68% for the membrane group and 90% for the membrane group with bone allograft, with no statistically significant difference between the two treatment groups. The two groups did not demonstrate a significant difference in median density index. There was a significant positive relationship between time of membrane coverage and density index. A density index of 4 was only recorded after 7 months of membrane coverage. The present findings suggest beneficial clinical effect with the use of membrane alone and freeze-dried bone allograft with membrane for guided bone regeneration. This study proposed the use of a novel density index for clinical evaluation of regenerated tissue.

[Impairment of neutrophil functions: study of a family with a case of juvenile periodontitis]. / Alteration de la fonction des neutrophiles: etude d'une famille avec un cas de parodontite juvenile.

Neutrophil function was assessed in family in which only one member suffered from Juvenile Periodontitis (JP). Directed mobility (fMet-Leu-Phe and zymosan-activated plasma) was decreased in all siblings without involving a seric inhibitor. Adhesion was studied by a new method which allows for the evaluation of both adhesive rate and binding strengths. The latter parameters were decreased in the parents neutrophils, but remained increased in a set of twin sisters. The specific receptor induced phagocytosis was altered in all members of the family (FC receptor: IgG-SCR, C3b and mannosylfucosyl receptor: zymosan). The superoxide generation in response to fMet-Leu-Phe was decreased while the PMA response was almost normal. These results suggest an overall abnormality of ligand-receptor interactions (C5a, fMet-Leu-Phe, Fc and C4b receptors), this defect seems to involve some membrane characteristics and underlines the absence of correlation between PMN deficiency and the clinical expression of J.P.

[Function of polynuclear neutrophils in patients with juvenile periodontitis and rapidly progressing periodontitis]. / Fonction des polynucléaires neutrophiles chez des patients atteints de parodontite juvénile et de parodontite à progression rapide.

It is generally assumed that early onset forms of periodontal disease (including Juvenile and Rapidly Progressive Periodontitis) are associated with a defect in neutrophil behaviour. We have investigated neutrophil functions in patients with Juvenile (J.P.) and Rapidly Progressive Periodontitis (R.P.P.). In the group of J.P. patients the directed mobility (FMLP and zymosan activated plasma) is significantly decreased. The superoxide generation in response to FMLP decreases while the PMA response is normal. In the group of R.P.P. patients no significant abnormality has been reported.

[Guided tissue regeneration: clinical and microscopic study]. / Régénération tissulaire guidée: étude clinique et microscopique.

A case of furcation involvement of a maxillary molar is reported. The treatment consisted in applying the concept of Controlled Tissue Regeneration using a Goretex membrane. After removal of the membrane the result is satisfactory. The membrane is then examined under transmission electronic microscope. The lateral aspect of the membrane (in contact with the proliferating epithelial tissue) show a marked bacterial proliferation.

[Cellular competition and healing]. / Compétition cellulaire et cicatrisation.

Different therapeutic solutions have been tried to obtain a new attachment. Several animal experiments have studied cellular colonization of radicular surfaces exposed to the disease then planed. Only the cells from the periodontal ligament seem to be able to form a new attachment. The interposition of a membrane seem to prevent gingival and osseous tissues to interfere with the periodontal ligament. The periodontal ligament cells colonize then the radicular surface.

[Current therapy of gingival recession]. / Thérapeutique actuelle des récessions gingivales.

The muco-gingival surgery represents one of the facet of periodontal surgery. The gingival recessions, characterized by a total attachmentless uncovering the root surface, become an esthetic and painful problem for our patients. The recessions can be treated by different surgical procedures. After a review of the etiologic factors and of the different type of wound healing, the authors describe and illustrate respectively the gingival graft for root coverage and the laterally positioned flap.