Adult periodontitis treated with a new device for subgingival lavage-a randomized controlled clinical trial using a split-mouth design.

OBJECTIVES: To evaluate in patients with untreated adult periodontitis, the effect of treatment with a novel pocket irrigator/evacuator device (IED) compared to conventional subgingival debridement (CPT), both provided during the initial phase of active periodontal therapy. METHODS: This study was an examiner-blind, randomized controlled clinical trial using a split-mouth design. Systemically healthy patients with adult periodontitis were selected. Full-mouth probing pocket depth (PPD), gingival bleeding on pocket probing scores (BOPP), gingival recession (REC) and dental plaque (PI) were assessed at baseline. All participants received oral hygiene instructions and supragingival prophylaxis including polishing. In 2 randomly assigned contra-lateral quadrants, approximal sites were irrigated with the IED, whereas in the other quadrants, CPT was provided. The CPT consisted of subgingival debridement using ultrasonic devices followed by the use of hand instruments. At 3 months post-treatment, the clinical parameters were re-assessed. RESULTS: Twenty-five patients met the inclusion criteria and were willing to participate. At 3 months post-treatment, the PPD and BOPP had significantly improved for both treatment modalities. Pockets of ≥5 mm reduced by 0.64 mm in the IED group (P < .001), compared to a reduction of 0.82 mm for the CPT group (P < .001). With respect to the primary outcome parameter (PPD) and BI, the results with the IED were less pronounced. Between the test and control groups, no significant differences were observed for REC and PI. CONCLUSIONS: Oral hygiene instructions, supragingival prophylaxis and subgingival lavage with the IED resulted in a significant reduction in PPD and BOPP. However, the effect does not reach the results of CPT which included the subgingival use of ultrasonic and hand instruments.

[Dissertations 25 years after date 4. Periodontal surgery an important component of periodontal treatment]. / Proefschriften 25 jaar na dato 4. Parodontale chirurgie, een belangrijk onderdeel van de parodontale behandeling.

The aim of periodontal treatment is to make and keep the periodontal tissues healthy. A proper diagnosis including the assessment of the different risk factors is essential before successful treatment can be carried out. Oral hygiene instruction together with supra- and subgingival cleaning is a basic part of the treatment. Antibiotic treatment and smoking cessation programs also contribute to a good clinical result. Until the seventies, when almost nothing was known about riskfactors and antibiotic therapy, no study was performed to assess the long-term effect of periodontal surgery being part of the treatment. Therefore a study was performed to assess clinically, radiographically and histologically the effect of periodontal surgery and oral hygiene on artificial periodontal defects. The results were reported in the thesis 'Surgery and oral hygiene on artificial periodontal defects in beagle dogs'. This study established that periodontal surgery can contribute to a healthy periodontium. A good oral hygiene is a prerequisite. These results have been confirmed by a long-term study in private practice. Pocketdepths of 5 mm and more after initial treatment is a good criterion in the decision making for periodontal surgery.

[How threatening is periodontitis? Effects of periodontitis on the human body]. / Hoe levensbedreigend is parodontitis? Effecten van parodontitis op het menselijk lichaam.

Periodontitis is a chronic inflammatory process which is not only threatening for the dentition. Bacteriae and their substances can enter the bloodstream by eating, toothcleaning or dental treatment and harm the body. Known are heart-valve infections by S. sanguis, but also pneumonia is seen more in patients with periodontitis. Recently it appears that periodontitis is probably the main course of preterm low birthweight babies. It has also been shown that there exists a close association between periodontitis and cardiovascular diseases. Investigations even suggest that this might be a causal relation.

[Risk factors in adult periodontitis: polymorphism in the interleukin-1 gene family]. / Risicofactoren voor adulte parodontitis: polymorfismen in de interleukine-1 genfamilie.

Interleukin (IL)-1 alpha, IL-1 beta and IL-1 receptor antagonist (ra) play a major role in regulation of the inflammatory response in periodontal tissues. The aim of this study was to investigate the distribution of genetic variation in the IL-1 gene family among periodontitis patients and controls, taking into account smoking and microbiology as additional variables. There were 53 non-smoking and 52 smoking patients with severe adult periodontitis and 53 periodontal healthy controls genotyped for genetic variation in the IL-1 gene family. The presence of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was established by culture techniques. A higher frequency of genotype+ (IL-1A*2 + IL-1B*2 + IL-1RN*2) was found in non-smoking periodontitis patients in whom P. gingivalis and A. actinomycetemcomitans could not be detected (42.1% vs. 11.3% in controls; p = 0.0068; or 5.7, 95% ci: 1.6-19.8). This data provide evidence that polymorphisms in genes of the IL-1 family are associated with severe adult periodontitis and may be a risk factor for severe periodontitis.

Polymorphisms of the interleukin-1 gene family, oral microbial pathogens, and smoking in adult periodontitis.

Interleukin (IL)-1alpha, IL-1beta, and IL-1ra contribute to regulation of the inflammatory response in periodontal tissues. We aimed to investigate the distribution of polymorphisms in the IL-1 gene family among periodontitis patients and controls, taking into account smoking and microbiology as additional variables. Fifty-three non-smoking and 52 smoking patients with severe adult periodontitis and 53 controls were genotyped for bi-allelic IL-1A(-889), IL-1B(-3954), and a penta-allelic 86-bp VNTR IL-1RN gene polymorphisms. The presence of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was established by culture techniques. We found a higher frequency of allele 2 carriage in IL-1A, IL-1B, and IL-1RN in periodontitis patients who were non-smokers and in whom P. gingivalis and A. actinomycetemcomitans could not be detected (42.1% vs. 11.3% in controls; P = 0.0068; OR 5.7, 95% CI: 1.6-19.8). Our results provide evidence that polymorphisms in genes of the IL-1 family are associated with severe adult periodontitis in the absence of other risk factors tested in this patient population.

[Long-term results of traditional periodontal therapy]. / Langetermijnresultaten van traditionele parodontale therapie.

OBJECTIVE: To evaluate the long-term results of traditional therapy consisting of initial preparation followed by mucogingival surgery including bone recontouring and regular maintenance treatments. DESIGN: 125 patients between 25 and 70 with a generalised periodontitis of the type adult and rapidly progressing periodontitis were selected. These patients were treated according to a fixed protocol by a periodontist and a dental hygienist. SETTING: The Practice for Periodontology in Groningen. METHODS: Patients were treated in a practice limited to periodontology. Before and 5 years after treatment the following data were assessed: plaque- and bleeding-score, probing pocket-depth, mobility and furcation involvement. Furthermore the reason for extraction was established. RESULTS: In general a great reduction in plaque- and bleeding-score and probing pocket-depth was much better in case of good oral hygiene. Within 5 years after treatment only 1.1% of the teeth were extracted. Furcations with through and through involvement in combination with deep residual pockets were mostly the reason for this. CONCLUSION: It is concluded that with traditional periodontal therapy following a strict protocol including regular maintenance treatments excellent treatment results can be achieved.

[Periodontal aftercare. Prudence after after traditional surgical therapy and after guided tissue regeneration]. / Parodontale nazorg. Beleid na traditionele chirurgische therapie en na geleide weefselregeneratie.

The system of maintenance determines the long term success of periodontal therapy. Guided tissue regeneration enables us to regenerate lost periodontal supporting tissues. Likewise a good maintenance system is very important. Since regeneration of periodontal tissue is a relatively slow process, the direct post-operative care differs somewhat from the traditional treatment. Prevention of infection and trauma is of the utmost importance.

Cell-seeding of periodontal ligament fibroblasts. A novel technique to create new attachment. A pilot study.

This study was undertaken to test the hypothesis that seeded periodontal ligament cells are able to create new attachment. In one beagle dog, a premolar was removed and scrapings of the ligament were cultured. Artificial periodontal defects were made and the cultured ligament cells were seeded on the planed root surfaces and covered with muco-periosteal flaps. The opposite side served as control. After 4 months, the dog was sacrificed and histological and electron microscopical sections were prepared. The seeded root surfaces were almost completely covered with cementoblasts, whereas in controls, epithelial down-growth could be observed. We conclude that seeding of periodontal ligament cells could be a promising technique to create new connective tissue attachment.

Adhesion of stainable, calcium-rich deposits on substrata with different surface free energies. An in vivo study in beagle dogs.

Calculus plays an important role in chronic inflammatory periodontal disease and tooth loss. Patients can suffer from calculus formation despite good oral hygiene. The strength of adhesion between calculus and the enamel surface, though not determinant for the formation of calculus itself, determines whether calculus remains on the teeth during eating and toothbrushing. In this study, the amount and the strength of adhesion of calcium-rich deposits formed in vivo on different materials are related to substrate surface free energies (sfe). In 4 beagle dogs, fenestrated crowns were made on the upper fourth premolars. Smooth facings of glass (sfe 120 mJ.m-2), polished bovine enamel (sfe 85 mJ.m-2), polymethylmethacrylate (PMMA sfe 56 mJ.m-2) and polytetafluorethylene (PTFE sfe 20 mJ.m-2) were inserted in the crowns for 1, 3, 7, 14 or 28 days. The amount of deposit was evaluated both gravimetrically and planimetrically using Alizarin Red S for staining. Adhesion of calcium-rich deposits was evaluated planimetrically by studying their removal in a brushing machine. Dry weight increased linearly with time (approximately 0.18 mg.cm-2 per day) and was slightly less on PTFE than on the other materials. After 1 to 3 days, staining already revealed a 100% coverage by calcium-rich deposits. The number of strokes required to reduce the planimetric scores by 63% was extremely small on PTFE and PMMA and related with substrate surface free energies. This study shows that a possible way to reduce calculus formation in vivo is to decrease the surface free energy of the enamel using appropriate surfactants in, e.g., toothpastes.

Morphological aspects of the gingiva in children with Down's syndrome during experimental gingivitis.

In a previous investigation, children with Down's syndrome (DS) showed an earlier, more rapid and more extensive gingival inflammation than normal healthy control children. These differences in gingival inflammation may be the result of aberrant morphology of the gingiva related to the genetic disorder in DS children. The aims of the present study were (i) to describe the structural composition of "normal" gingiva in DS compared to control children, (ii) to analyse the histological changes in the gingiva during plaque development and (iii) to investigate whether the clinical findings could be supported by morphological observations. The study was carried out in 8 DS and 8 matched control children. Their ages ranged from 5-10 years. Gingival normality was guaranteed by strict oral hygiene procedures. During a period of 21 days in which oral hygiene was abolished, gingival biopsies were taken from buccal sites of deciduous teeth following a predetermined schedule on days 0, 7, 14 and 21. Results on day 0 showed no morphological differences between the DS and control children regarding oral epithelium, junctional epithelium or connective tissue. During the experimental phase of the study, the amount of plaque accumulation in the DS children gave rise to a more extensive gingival inflammation than in the control children. The gingival inflammation in the DS group started earlier and included: (1) an acute inflammatory response, (2) an increase of the junctional epithelium area, (3) an increase of the infiltrated connective tissue area (ICT) and (4) a decrease in collagen fibre density of about 35-40% compared to day 0. The same phenomena were not seen until 7 days later in the control group. Conversely, the development of a perivascular lymphocyte infiltrate (LI) in the DS children was delayed compared to the control group. This may be caused by the impaired delayed-type hypersensitivity response in DS children. The development of 2 separate infiltrates (ICT and LI) in this age group and the different temporal development of ICT (day 7 for the DS and day 14 for the control group) and LI (day 14 for the DS and day 7 for the control group) does suggest different immunological mechanisms for both areas and both groups.

Cellular aspects of and effects on the gingiva in children with Down's syndrome during experimental gingivitis.

In a previous experimental gingivitis study, it was shown that in children with Down's syndrome (DS), gingival inflammation started earlier, was more extensive and developed faster, than in normal healthy control children. In both groups, the start of the process was accompanied by an acute inflammatory response and an increase of the infiltrated connective tissue area (ICT). The purpose of the present study was to investigate how these facts were reflected at a cytological level. The study was carried out in 8 DS and 8 matched control children. Their ages ranged from 5-10 years. A "normal" healthy gingiva was attained after strict oral hygiene procedures. During a period of 21 days in which oral hygiene was abolished, gingival biopsies were taken on days 0, 7, 14, and 21. In both groups, junctional epithelium (JE) and ICT contained low numbers of polymorphonuclear leucocytes (PMNs). The start of the inflammation (day 7 for the DS and day 14 for the control children) was marked by a significant positive correlation between the numbers of PMNs in the JE and the ICT, and a significant increase of the numbers of PMNs in ICT. In ICT, a concomitant decrease in collagen fibre density was observed. In the control group, the decrease correlated with the numbers of PMNs in ICT, which suggests that this collagen breakdown is caused by PMN products. After the initial decrease, the collagen fibre density remained fairly constant in this group throughout the study. In the DS group, there was a tendency to a further decrease in the ICT3 area, correlated with the numbers of PMNs in ICT.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of oral hygiene on the results of periodontal surgery in beagle dogs with artificially created defects.

The effect of oral hygiene on periodontal surgery was evaluated clinically, radiographically and histologically during 24 months. In 13 beagle dogs artificial periodontal defects were created around the second, third and fourth premolars of the mandible. One week after removal of the plaque retention ligatures, periodontal surgery consisting of mucoperiosteal flaps and osseous recontouring was performed. Postoperatively, plaque accumulation was prevented by daily application of a 2% chlorhexidine solution for 2 weeks and daily toothbrushing for the next 2 weeks. Toothbrushing was continued in seven dogs; oral hygiene was discontinued in the other six. All dogs were scaled and polished at 1, 6, 12 and 18 months after surgery. Plaque accumulation in the nonbrushed dogs resulted in a heavy inflammation of the periodontium. Probing depths that had been reduced by the surgery increased and subsequently the clinical attachment level changed into a more apical level compared to the brushed dogs. Histometrically, however, no difference in attachment level could be recorded, indicating that oral hygiene did not affect the attachment level in the 2 years after surgery. It appears that oral hygiene stimulated bone formation and that the periodontal tissues had not matured in the 2 years after surgery.

Artificial periodontal defects in beagle dogs. A clinical evaluation during 24 months.

Artificial periodontal defects were evaluated clinically for 24 months in six beagle dogs. Defects were created bilaterally around the lower second, third and fourth premolars. The gingiva was separated from the teeth by intrasulcular incisions and copper bands were cemented around the teeth as far apically as possible. After 3 weeks the bands were replaced by cotton ligatures, which were kept in place deep subgingivally for 11 weeks. The dogs were placed on a soft diet, allowing plaque accumulation throughout the study. One week after removal of the ligatures, probing depths of around 4.5 mm were recorded. During the evaluation period of 24 months, plaque accumulation was abundant and subsequently the gingiva was heavily inflamed. However, a distinct healing tendency was evident clinically. Two years after removal of the ligatures, probing depth was reduced to approximately 3.5 mm and the attachment level as assessed clinically had changed in a coronal direction. Part of this recorded increase in periodontal attachment may have been the result of changes in composition and condition of the periodontal tissues resulting in differences in probing depths.