Microbiological and immunohistological findings in a patient with Papillon-Lefèvre syndrome.

The following communication is a case history of an 11 year-old female patient suffering from Papillon-Lefèvre syndrome. Since a massive occurrence of A. actinomycetemcomitans had been found in the subgingival microflora of the periodontal pockets, the patient was treated with repeated subgingival scaling, with an adjunct Amoxicillin and Metronidazol treatment. A bacteriological examination of the girl's family proved that several brothers and sisters as well as one parent also carried. A. actinomycetemcomitans, showing 3 different strains of this bacterium within the family. An immunohistological examination of the gingival tissue showed a massive inflammatory infiltrate which was dominated by plasma cells. The histological investigation of the first molars did not show morphological abnormalities of the root cementum. Posttreatment clinical and radiographical improvement of the periodontal conditions is reported despite the recurrent finding of A. actinomycetemcomitans.

[Deviations of the central ray in standardized bite-wing radiographs]. / Abweichungen des Zentralstrahls bei standardisierten Bissflügelaufnahmen.

Interpretation of serial radiographs without sufficient information of projection geometry is hardly possible. We obtained 51 pairs of bite-wing radiographs in 12 patients by use of a modified filmholder (Duckworth et al. 1983). Two orthodontic wires of different profile, placed coaxially on the perpendicular, cast shadows on the film, which were differentiated by their respective shape. By placing each wire a known distance from the film plane, the angular difference between the perpendicular to the film and the actual direction of the central ray could be calculated. In 63% of pairs the angular deviation of the central rays between the serial exposures was below 0.9 degrees. The results of the present study show that utilization of this type of device can provide radiographs of sufficient quality to allow their use in image subtraction.

[Postsurgical findings after tunnel preparation in mandibular molars with Class III furcation involvement]. / Postoperative Befunde nach Tunnelierung furkationsbeteiligter Unterkiefermolaren (Grad III).

3 teeth developed carious lesions within the furcation. 9 tunnel preparations showed soft tissue closure. 5 teeth were extracted for various reasons.

Multiple periodontal abscesses after systemic antibiotic therapy.

Multiple periodontal abscesses were reported in medically compromised patients. We examined patients with a non-contributory medical history referred for the treatment of numerous periodontal abscesses. All patients had taken oral broad spectrum antibiotics 1 to 3 weeks prior to the outburst of the abscesses (8 patients: penicillin, 2 patients: tetracycline). The patients suffered from advanced periodontal disease, 82% of the examined sites showed probing depths greater than 3 mm, 56% attachment loss greater than 3 mm. Subgingival plaque samples were analysed from 2 different abscess sites. Bacteroides gingivalis (19/20), Fusobacterium nucleatum (13/20) and Streptococcus intermedius (13/20) were the most prevalent anaerobic microbiota. Strains resistant to the prescribed antibiotic were found in 55% (11/20) of the subgingival plaque samples. It was concluded that in patients with advanced periodontal disease, systemic antibiotic therapy without subgingival debridement may change the composition of the subgingival microbiota, thus favouring the outburst of multiple periodontal abscesses.

[Comparative studies on progressive and superficial marginal periodontitis]. / Vergleichende Untersuchungen bei fortgeschrittener und superfizieller marginaler Parodontitis.

It was the objective of the present study to investigate the local inflammatory and immune response in patients with superficial (SMP) and progressive marginal periodontitis (PMP). In a preliminary study the distribution of macrophage subpopulations was analysed during experimental gingivitis using monoclonal antibodies. A significant increase in the number of inflammatory macrophages was observed during acute gingivitis. In the second part of the study, the distribution of the macrophage subpopulations, T-helper and -suppressor cells, B-lymphocytes and plasma cells as well as the total anaerobic microflora were determined during periodontal therapy. Before periodontal surgery PMP-patients demonstrated significantly more inflammatory macrophages and plasma cells and a significantly higher prevalence of Bacteroides gingivalis, Peptococcus species and Actinobacillus actinomycetemcomitans. The different local immune responses in PMP-patients might be caused by a distinct subgingival microflora, since no differences were observed in the number of the immunocompetent cells and the subgingival flora after successful periodontal treatment.

[The effects of orthodontic treatment on periodontal findings in adults]. / Der Einfluss orthodontischer Massnahmen auf parodontale Befunde Erwachsener.

After periodontal therapy 12 patients with advanced alveolar bone loss were orthodontically treated and recalled for approximately 51.1 months. Orthodontic tooth movement resulted in a mean overjet reduction of 1.7 mm, a mean overbite reduction of 1.3 mm and closure of the anterior spaces. No significant differences were observed in the probing depths and attachment levels between the test and control teeth. 31% of the treated teeth showed signs of root resorption. The results indicate that orthodontic therapy in patients with successfully treated advanced periodontal disease does not lead to further attachment loss if the patients are periodontally well maintained.

[Today's position on etiology and pathogenesis of periodontal diseases]. / Heutiger Stand der Atiologie und Pathogenese parodontaler Erkrankungen.

Page and Schroeder (1982) introduced a preliminary classification of the marginal periodontitis. Destructive forms like prepubertal, juvenile and rapidly progressive periodontitis seem to be associated with functionally defects of the leucocytes and monocytes. Some authors assign these different forms a specific subgingival microflora, although is seems to be too early, to name single microorganism as causative bacteria for different forms of marginal periodontitis. The destruction of the marginal periodontium during acute bursts might also be caused be an imbalance between the host response and the composition of the subgingival microflora.

[Diagnostic relevance of OPG and full-mouth X-ray and intraoperative findings]. / Die diagnostische Sicherheit von OPG und Röntgenstatus in bezug auf den intraoperativen Befund.

During surgery the distance between cemento-enamel junction and alveolar limbus as well to the lowest point of the bony defect was measured for 617 tooth surfaces with a periodontal millimeter probe to study the usefulness of OPG and full-mouth X-ray for the detection of periodontal bony defects. The results of different operators did not show any significant differences. Therefore the method of evaluation might be considered reproducible. The average difference between intraoperative measurement and OPG measurement was -0.6 mm and -1.4 mm for the full-mouth X-ray. 50.9% of measurements on the full-mouth X-ray and 59.7% of measurements on the OPG were within the limit of 1 mm. In correlation with the intraoperative measurements the OPG was slightly less reliable for the SZG value at 31 and 41. In the other areas OPG and full-mouth X-ray showed the same correlation with the intraoperative findings. However, on the OPG 13.9% of intraoperatively examined tooth surfaces could not be evaluated since the cemento-enamel junction was not visible. By comparison the failure rate for the X-rays was only 5%. One may therefore conclude that the OPG is of basic usefulness for periodontal X-ray diagnosis, but that additional individual images will be required, since in a considerable percentage of the images the periodontal bone loss is not clearly visible.

[Surface changes of enamel, root cementum and fillings after treatment with tooth cleaning instruments]. / Oberflächenveränderungen von Schmelz, Wurzelzement und Füllungen nach Einwirkung von Zahnreinigungsinstrumenten.

The effect of new, automatic tooth cleaning instruments on tooth surface and surfaces and margins of amalgam and composite fillings were studied by profilometric measurements and SEM and compared with each other. On the surfaces of teeth and fillings, in particular at the margins, ultrasound treatment resulted in the significantly highest maximum roughness values. These values were lower when turbin-operated scalers were used. Results demonstrate that during tooth cleaning direct contact between ultrasound and turbine-operated scalers and tooth and filling surfaces should be prevented.

Phenotypic dynamics of macrophage subpopulations during human experimental gingivitis.

The purpose of the present study was to investigate whether functionally different macrophages are present in clinically healthy gingiva and during human experimental gingivitis. Eight male probands were introduced to an oral hygiene program until all reached mean Plaque and Gingival Index scores approaching zero. During the following 19 days all oral hygiene was abandoned. At d -14, 0, 2, 4, 7, 11 and 19 clinical indices and gingival biopsies were taken. Cryostat sections were incubated with monoclonal antibodies against mature macrophages (25F9), inflammatory macrophages (27E10) and anti-inflammatory macrophages (RM 3/1). Positive cells were counted in the inflammatory infiltrate (IF) and the connective tissue (CT). At d -14 elevated numbers of 27E10-positive cells were observed which decreased significantly at d 0 (p less than 0.018) and increased again at d 19 (p less than 0.026). Significant differences in the number of RM 3/1-positive cells were found between d 0 and d -14, 2, 4 and 7 (p less than 0.05) while no differences in the number of 25F9-positive cells were observed throughout this study. It was concluded that experimental gingival inflammation is characterized by the appearance and disappearance of functionally different macrophage subpopulations.