Classification, reproducibility and prevalence of root proximity in periodontal patients.

AIM: The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity. MATERIAL AND METHODS: In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts. A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ-BC for root proximity sites and contra-lateral sites were recorded. RESULTS: A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ-BC distance between the root proximity sites and their contra-lateral sites. CONCLUSION: We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ-BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

Root proximity as a risk marker for periodontal disease: a case-control study.

AIM: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. MATERIAL AND METHODS: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. RESULTS: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. CONCLUSION: Root proximity must be taken into consideration as a risk marker for periodontal disease.

Pocket elimination surgery with simultaneous connective tissue graft. A case report with 3-year follow-up.

BACKGROUND, AIMS: The purpose of the present case report was to present 2 ways of treating recession in a periodontal patient combined with regular pocket elimination surgery. The techniques used enabled the operator to reduce the number of surgical sessions and clinically evaluate the 3-year coverage of gingival recessions using a subpedicle connective tissue graft. METHODS: Surgery consisted of pocket elimination procedures to treat adult periodontitis as a way to harvest connective tissue to be placed in the areas of recession. The grafted tissue was covered by the primary flap or left uncovered in a pouch, according to 2 different techniques described in the literature. RESULTS: In this case, we observed that, with this approach, we were successful in reducing the number of surgical session as well as achieving objective and subjective goals of therapy in treated areas.

A possible association of alpha1-antitrypsin deficiency with the periodontal condition in adults.

Alpha1-antitrypsin (alpha1AT) is a serum inhibitor of several neutrophil-derived proteolytic enzymes, the serine proteinases. In certain individuals, a deficiency of this enzyme inhibitor is present, whereby only 10 to 20% of the normal concentration is present in the circulation. The purpose of this study was to evaluate the influence of this alpha1AT deficiency on the periodontal condition in a case control study. 10 patients aged 20-50 years with a mean age of 32 and showing a deficiency of alpha1AT were randomly selected from a national data bank, which contains persons known to be affected with the alpha1AT deficiency state. Control subjects were matched for age, gender and socio-economic status. Full periodontal charting on all subjects was performed on 6 sites per tooth, including probing attachment level, probing depth, bleeding on probing and a plaque score. Analysis of the data revealed no differences with regard to attachment loss between the two groups. The deficiency group showed 9.3% pockets > or =5 mm and the matched control group 5.9%. When these results were covariated with plaque scores, the deficiency group appeared to have a higher number of sites with probing depths > or =5 mm.

The prevalence of A. actinomycetemcomitans, P. gingivalis and P. intermedia in selected subjects with periodontitis.

The present study was carried out in a private periodontal practice. 8 clinical criteria were chosen to select patients for microbiological examination. These criteria characterize prominent features of disease which at the start, during, or in the maintenance phase of treatment suggest difficulties in the progress of the periodontal therapy. Based on these clinical characteristics, an inventory was made of the prevalence of the 3 putative periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia. Out of 320 referred patients 91 patients did meet > or = 1 of the clinical criteria and consequently were selected for microbiological examination. Results showed that young patients (19-30 years) with periodontitis demonstrated the presence of A. actinomycetemcomitans more often (69%: p < 0.005) compared to older age cohorts. A. actinomycetemcomitans was found more often when localized breakdown (in particular in the 1st molar and incisor region) was observed and in patient who responded poorly to scaling and rootplaning. P. gingivalis and P. intermedia were most frequently recovered in patients showing primarily a bone loss pattern of angular defects of > or = 5 mm. Retrospectively, these patients were further categorized, based on full mouth radiographs, in (1) patients with primarily horizontal bone loss and (2) patients with primarily angular bony defects. Results showed that A. actinomycetemcomitans occurred less frequently in patients showing horizontal bone loss (p < 0.05).

Lengthening clinical crowns--a solution for specific periodontal, restorative, and esthetic problems.

Crown-lengthening procedures can provide solutions for specific periodontal, restorative, or esthetic problems. Frequently, there is a distinct relationship between difficulties arising from periodontal anomalies and clinical problems associated with restorative or esthetic dentistry. The aim of crown lengthening, irrespective of the method employed, is to provide a healthy and stable dentogingival complex. To achieve this goal, it seems appropriate to take into consideration the dimensions of the "biologic width". The indications and treatment modalities for lengthening clinical crowns are discussed.

The importance of a coordinated restorative and maintenance program following periodontal therapy: a case report.

The problems arising during the maintenance phase of therapy following a combination of periodontal, orthodontic, and restorative treatment are illustrated by this case report. Emphasis is placed on the combined responsibility of the patient, general dental practitioner, and periodontist to recognize signs of recurrent disease at an early stage, thereby allowing corrective measures to be initiated promptly. By applying these principles, even when disease recurs during the maintenance phase, re-treatment is possible and a satisfactory result can be achieved.

Gingival inflammation and bone loss in periodontal disease.

Fifty subjects between 27 and 43 years of age were studied to determine the relationship between the severity of gingival inflammation, the amount of bone loss and the plaque score in interproximal sites. The results indicate moderately good correlations between Gingival Index or Plaque Index and percentage bone loss. However a low correlation was found between the amount of crevicular fluid and percentage loss. Gingival Index and Plaque Index were well correlated. It was also found that when patients were divided into two age groups, younger and older than 35 years, the older individuals studied had more bone loss interproximally compared with the younger despite comparable amounts of plaque or gingival inflammation. The data suggest that both severity and longevity of the inflammation may play a role in determining the rate of alveolar bone resorption.

An evaluation of proximal surface cleansing agents.

The effectiveness of the Interspace brush, Inter-Dens, and waxed dental floss as proximal surface cleansing agents was compared in 35 subjects. Each subject used all three methods of cleansing in random order of selection. Statistical analysis of the results showed that there was no difference in the effectiveness of any one of these three agents. However, proximal surfaces of anterior teeth where cleaned more effectively than posterior teeth. The coronal half of the proximal surfaces was cleaned more effectively than the apical half and the facial half more effectively than the lingual half when Inter-Dens was used. Comparison of cleansing effectiveness between facial and lingual halves of proximal surfaces for the Interspace brush and waxed dental floss showed no significant difference. Mesial and distal proximal surfaces were cleaned with similar effectiveness. Plaque control was only satisfactory on approximately half of the proximal surfaces, though a wide variation occurred. Significantly lower plaque scores were found 1 week after the initial instruction session, irrespective of the agent used. The majority of subjects preferred Inter-Dens whilst waxed dental floss was the least-liked method of cleansing.