摘要:

Increased blood supply, vital bone marrow cells, and minimal mobility may play a significant role in the success of osseous grafts, and are characteristics of the bone swaging grafting technique. As in all autogenous grafts, the risk of disease transmission is minimal. Previous reports of clinical success raise questions as to the type of tissue response to this procedure. This case report examines 8 months radiographic and histologic results of a clinically successful bone swaging graft.J Periodontol 1993; 64:66– 71.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.1.66

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The purpose of this studyis to demonstrate the potential of using a barrier in the treatment of palato‐gingival groove defects. The study group consisted of 10 patients. Prior to treatment, the palato‐gingival groove on maxillary lateral incisors was measured with calibrated periodontal probe from the cemento‐enamel junction (CEJ) to the free gingival margin (FGM) and from the FGM to the base of the pocket (BP). Probing depth (PD) was calculated and bleeding on probing indicated. Surgical procedures consisted of flap reflection, removal of granulation tissue, and scaling and root planing of the groove. An expanded polytetrafluoroethylene membrane was sutured over the palato‐gingival groove. Six months postsurgery, all measurements were repeated. Statistical analysis compared results using means, standard deviations, and paired t tests. Results showed an improvement in clinical attachment gain, probing depth reduction, and decreased bleeding on probing. This study demonstrates the potential of guided tissue regeneration in the treatment of palato‐gingival groove defects. A random blinded clinical trial is necessary, however, to fully assess the potential of this procedure in treatment of palato‐gingival groove defects.J Periodontol 1993; 64:72–74.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.1.72

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

An increasing body of evidencesupports the concept that host‐produced PGE2mediates much of the tissue destruction that occurs in periodontal disease. PGE2levels within the crevicular fluid can serve as a static assessment of ongoing disease activity; i.e., rate of attachment loss and bone resorption. New insights into the mechanisms that regulate PGE2synthesis provide an altered paradigm of periodontal disease which places the emphasis on host response, rather than the bacterial etiology, as the principal determinant of disease expression. We describe a PGE2host response model as a hypothetical framework to discuss new, possible explanations for host susceptibility to periodontal disease.J Periodontol1993;64:432–444.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.5s.432

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Matrix metalloproteinases(MMP)are a familyof proteolytic enzymes that mediate the degradation of extracellular matrix macromolecules, including interstitial and basement membrane collagens, fibronectin, laminin, and proteoglycan core protein. The enzymes are secreted or released in latent form and become activated in the pericellular environment by disruption of a Zn++‐cysteine bond which blocks the reactivity of the active site. The major cell types in inflamed and healthy periodontal tissues (fibroblasts, keratinocytes, endothelial cells, and macrophages) are capable of responding to growth factors and cytokines, as well as to products released from the microbial flora by induction of transcription of 1 or more MMP genes. Cytokines that are likely to regulate expression of MMP genes in periodontal tissues include IL‐1, TNF‐α, and TGF‐α. In addition, triggered PMN leukocytes which express only 2 MMP (PMN‐CL and Mr 92K GL) release these enzymes from specific granule storage sites in response to a number of stimuli. The evidence that MMP are involved in tissue destruction in human periodontal diseases is still indirect and circumstantial. Cells isolated from normal and inflamed gingiva are capable of expressing a wide complement of MMP in culture and several MMP can be detected in cells of human gingiva in vivo. In addition, PMN‐CL and Mr 92K GL are readily detected in gingival crevicular fluid from gingivitis and Periodontitis patients. Osteoclastic bone resorption does not appear to directly involve MMP, but a body of evidence suggests that bone resorption is initiated by removal of the osteoid layer by osteoblasts by means of a collagenase‐dependent process.J Periodontol 1993; 64:474–484.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.5s.474

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.743

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Prior to the1950s, periodontitis was treatedmostly by tooth exfoliation or extraction, and that is still the predominant treatment for most of the world's populations today. Debridement of the root surface by scaling and root planing came into relatively common use in the first half of the present century and has become the central feature held in common by all currently‐used forms of periodontal therapy. Until the 1980s, the most commonly‐used treatment consisted of scaling and root planing, followed by resective surgery aimed at achieving zero pocket depth. During the 1980s, data were obtained demonstrating that the thoroughness of root debridement and subgingival infection control, not the presence or absence or periodontal pockets, is the major determinant of successful periodontal therapy, and non‐surgical therapy became a commonlyused treatment. Neither resective surgery nor non‐surgical therapy results in significant regeneration of periodontal attachment. With the realization that periodontitis is an infectious process, the use of antibiotics and other anti‐infective agents came into common use as adjuncts to other standard therapies. An understanding of the pathways by which the soft and calcified tissues of the periodontium are destroyed has led to the likelihood of widespread future use of the non‐steroidal, anti‐inflammatory family of drugs to suppress alveolar bone destruction by blocking prostaglandin production, and to the use of chemically‐modified tetracyclines that chelate divalent cations and thereby block tissue destruction by the metalloproteinases. Recent data clearly show that regeneration of the previously‐destroyed periodontal attachment tissues is biologically possible, and regeneration has become the goal of therapy for the 1990s. Use of osteoconductive and osteoinductive graft materials can, under favorable conditions, induce roughly 60% to 70% regeneration of bone lesion height or volume with concomitant improvement in the clinical conditions. Regeneration by grafting may be further enhanced by use of barrier membranes that exclude gingival fibroblasts and epithelium from the healing site. Still further enhancement seems to be possible by local application of various growth factors, although studies in this important area are now only in their infancy. The future of periodontal therapy is exceedingly bright. It seems likely that we may be able to achieve nearly complete regeneration of periodontal attachment at many, although not all, sites through the use of root debridement and anti‐infective and anti‐inflammatory drugs and agents that inhibit metalloproteinases to arrest progress of disease and resolve the inflammatory process, followed by the combined use of graft material, barrier membranes, and growth factors to induce regeneration of periodontal attachment tissues.J Periodontol 1993; 64:744–753.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.744

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Periodontal disease progression requiresthe simultaneous presence of high numbers of pathogens, low numbers of compatible or beneficial species, a conducive local environment, and a susceptible host. Effective therapy acts by altering one or more of these factors. Data from an ongoing study were used to examine the biological basis of treatment success or failure. Seventeen subjects showing disease progression were treated by Widman flap surgery at deep sites, scaling at shallow sites, and 1 of 4 randomlyassigned, systemically‐administered adjunctive agents including amoxicillin/clavulanate potassium (Au) (n = 3), ibuprofen (n = 3), tetracycline (n = 9), or a placebo (n = 2). Clinical measurements and microbiological samples (enumerated using DNA probes) taken from the mesial aspect of each tooth pre‐treatment and 12 months post‐treatment were compared and 418 pre‐ and 418 post‐therapy plaque samples were enumerated. Overall, the 4 treatments resulted in pocket depth reduction and “gain” in attachment. After therapy, the percentage of sites colonized byPorphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, andBacteroides forsythuswas decreased and counts>106were less frequent. Large attachment level gains were accompanied by major decreases in these species and were more frequent in subjects receiving antibiotics. A small number of sites in each treatment group became deeper and/or lost attachment. More than half of these sites were detected in 2 subjects who were older (65 vs. 44), had higher serum antibody to Actinobacillus actinomycetemcomitans serotype a (506 vs. 125 ELISA units),A. actinomycetemcomitansserotype b (518 vs. 130), andCampylobacter rectus(39 vs. 18). They also had the lowest mean total viable subgingival counts (1.1 vs. 12.3 × 106) and the lowest counts of each species pre‐therapy. In the total subject group, increased mean counts ofP. gingivalisandB. forsythuswere seen at sites showing attachment loss>1 mm after therapy, while counts decreased at sites showing no attachment change or “gain”>1 mm.J Periodontol 1993; 64:754–759.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.754

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The recognition that periodontal diseasesare primarily caused by specific microorganisms has led researchers to explore the possibility that antibiotics may enhance the effect of mechanical debridement procedures such as scaling and surgery. For some selected periodontal diseases, this has proven to be true. This paper will review systemically‐administered antibiotics and the clinical studies and case reports supporting their use. In periodontal therapy, the tetracyclines are the most commonly‐used antibiotics in the United States. Tetracycline hydrochloride, minocycline, and doxycycline have been shown to inhibit in vitro most putative periodontal pathogens. Several studies support the use of tetracyclines in the treatment of localized juvenile periodontitis. Penicillins such as amoxicillin are effective in vitro against most periodontal pathogens but have limited efficacy due to the presence of beta‐lactamases in gingival fluid. Amoxicillin/ clavulanate potassium (Au) has proven effective in treating adult refractory periodontitis characterized by a Gram‐positive flora. Metronidazole is an effective adjunct in adult periodontitis associated with high numbers of “black‐pigmentedBacteroides” and spirochetes. A combination of metronidazole and amoxicillin produces a synergistic effect againstA. actinomycetemcomitansand has been shown to be effective at eliminating this organism. Clindamycin is an effective adjunct in the treatment of adult refractory periodontitis associated with a predominantly Gram‐negative flora.The use of macrolides, quinolones, and combinations of antibiotics is discussed. Clinical studies do not support the use of systemically‐administered antibiotics in routine adult periodontitis. Clinical studies do, however, support the use of antibiotics in the treatment of specific periodontal diseases.J Periodontol 1993; 64:760–771.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.760

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Refractory periodontitis is consideredby many investigators to be a separate disease entity that is descriptive of a particular patient who has multiple sites, rather than a few individual sites, that do not respond to conventional periodontal treatment modalities. Such patients continue to demonstrate loss of attachment and alveolar bone despite frequent periodontal treatment which includes surgical intervention, scaling and root planing, and often systemically‐administered tetracycline. Controlled clinical studies have demonstrated that both clindamycin‐hydrochloride and amoxicillin/clavulanate potassium (Au) are beneficial when used in conjunction with periodontal scaling. Gordon et al. found improvements in attachment levels, inflammation, suppuration, and a decrease in pocket depths for up to 2 years following a 7‐day course of Clindamycin given in conjunction with a full‐mouth scaling. The incidence of disease activity decreased from an annual rate of 8% of all sites prior to antibiotic treatment to 0.5% after treatment. Magnusson, reporting on a similar group treated with a 14‐day course of Au, found an average loss of attachment of 2.2 mm and an increase in pocket depth of 1.5 mm in sites demonstrating disease progression prior to antibiotic treatment. At 3 months post‐antibiotic therapy, these sites had regained an average of 2 mm of attachment and pocket depths had decreased an equivalent amount. Both attachment levels and pocket depths remained relatively stable for up to 12 months post‐therapy. In an ongoing study, 30 subjects with refractory Periodontitis were treated with either Clindamycin or Au in conjunction with scaling or scaling plus a placebo. Prior to antibiotic treatment, but while being scaled at 3‐month intervals, sites with disease activity lost an average 2.4 mm of attachment. At 3 months post‐treatment, the clindamycin‐treated group showed an average gain of 2.1 mm, the Au‐treated group gained 1.9 mm, and the scaling group gained 1.4 mm in attachment. The clindamycin group remained relatively stable for up to 21 months and the Au group remained stable for about 15 months without additional treatment. Five of the 6 subjects treated with scaling alone required additional treatment within 9 months. Preliminary analyses have indicated that at least two patterns or rates of attachment loss may be associated with refractory periodontitis and that each pattern may be indicative of a different microflora. The pattern associated with a relatively rapid loss of attachment was characterized by a Gram‐negative flora which contained spirochetes,P. intermedia, andFusobacteriumspecies. A slow, continuous rate was associated with a predominantly Gram‐positive flora containing a high proportion ofS. intermediusand/or aS. intermedius‐like organism.J Periodontol 1993; 64:772–781.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.772

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

New knowledge about the microbial etiologyof periodontal diseases emerged in the 1970s and 1980s and led to widespread interest in the use of antimicrobial agents to treat periodontitis. The controlled‐release delivery of antimicrobials directly into the periodontal pocket has received great interest and appears to hold some promise in periodontal therapy. Some techniques for applying antimicrobials subgingivally, such as subgingival irrigation, involve local delivery but not controlled‐release. Controlled‐release local delivery systems, in which the antimicrobial is available at therapeutic levels for several days, have been evaluated in several forms and using different antimicrobials. Although most studies with such systems have focused on drug delivery kinetics and “proof of principle” evaluations, some controlled clinical trials have recently been reported. The most widely tested system, monolithic tetracycline‐containing fibers, has shown significant clinical benefit when used alone as compared to no subgingival therapy. Similarly, controlled trials involving chlorhexidine strips used subgingivally every 3 months in place of routine supportive periodontal therapy have shown significant clinical benefit for up to 2 years. Although these data are now emerging, many questions concerning the optimal use and role of this therapy in clinical practice remain. This review attempts to summarize and interpret current data and to outline key remaining questions that must be addressed as this technology is transferred into clinical practice.J Periodontol 1993; 64:782–791.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.8s.782

出版商:Wiley    

年代:1993

数据来源: WILEY