摘要:

While the efficacy of oral irrigationswith antimicrobial agents on the clinical and microbial parameters of gingivitis is well established, the study of the efficacy of intrapocket irrigants on periodontitis has yielded conflicting and inconclusive results regarding both clinical and microbiological parameters. The overall goal of this review paper is to summarize the available information on the efficacy of intrapocket irrigation in the treatment of patients with Periodontitis. The following topics are addressed: 1) the penetrability of the irrigant; 2) pocket irrigation without scaling and root planing; 3) professional pocket irrigation following scaling and root planing; 4) irrigations between recalls; and 5) safety of intrapocket irrigation. Single irrigation of periodontal pockets for short periods of time before or after scaling and root planing has limited effects on periodontal healing. However, continuous irrigation of the periodontal lesion with agents such as povidone iodine during thorough scaling and root planing, such as that carried out under local anesthesia, has promise as an antimicrobial adjunct in periodontal therapy.J Periodontol 1993; 64:835–843.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.835

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Various particle sizesof demineralized freeze‐dried bone allograft (DFDBA) are currently used to treat patients with periodontal osseous defects. However, the effect of particle size on the healing of human intrabony periodontal defects is unknown since there have been no direct clinical comparisons. The purpose of this study was to compare the bony defect resolution obtained using two different particle size ranges of DFDBA. Cortical bone from a single donor was processed and ground to final particle sizes of 250μ to 500μ or 850μ to 1,000μ using an analytic mill. Paired interproximal intrabony periodontal defects in 11 patients were grafted with DFDBA. Soft and hard tissue measurements were made using an electronic constant‐force probe at the initial and reentry surgeries. Treated sites in 10 patients were reevaluated by reentry approximately 6 months postoperatively. Mean bony defect fill was 1.66 mm for the large particle group and 1.32 mm for the small particle group. There was no statistically significant difference in bony fill between defects grafted with the different particle sizes of DFDBA when used in humans.J Periodontol 1993; 64:844–847.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.844

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Aprevious multi‐center study examiningpatients diagnosed as having at least four periodontally diseased teeth showed that when BANA (N‐Benzoyl‐DL‐Arginine‐Naphthylamide) hydrolysis by periodontal pathogens such asTreponema denticela, Porphyromonas gingivalis, andBacteroides forsythuswas evaluated versus clinical parameters such as clinical judgment of disease, bleeding on probing, and pocket depth, the sensitivity of the test was 84%, 82%, and 87%, respectively, while the specificity was only 42%, 41%, and 32%, respectively. The purpose of the present investigation was to improve the specificity of the test while retaining a high level of sensitivity in both gingivally healthy and periodontally diseased groups. One hundred forty‐nine patients participated in this study providing 3,497 interproximal plaque samples. Gingival health was measured using the papillary bleeding score and this was compared with the presence or absence of detectable trypsin‐like activity, as determined by the BANA hydrolysis of interproximal plaque samples, using a commercially‐available test. Sensitivity and specificity were measured by varying the incubation time and temperature of the enzymatic assay. Using the correlated binomial model to analyze site‐specific data within a patient, the specificity was highest at 35°C and 5 minutes incubation (94%), and lowest at 45°C and 15 minutes incubation (33%). Sensitivity was highest at 45°C or 55°C and 15 minutes incubation (90%) and lowest at 35°C and 5 minutes incubation (47%). When the sensitivity and specificity of the test run at 35°C for 5 minutes were used in a model for a diagnostic test proposed by Douglass and Fox, the test has utility when used on older general dental patients and for periodontal patients.J Periodontol 1993; 64:848–852.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.848

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The purposes of this study were to1) characterize the demographics, oral health behavior, and periodontal status of a health maintenance organization sample; 2) investigate the relationship between the location of posterior proximal measurement sites and prevalence estimates for periodontal disease; and 3) compare the prevalence of persons with pockets ≥ 4 mm in the present sample to the 1985 NIDR Survey of Oral Health. The sample consisted of 1,090 adults attending a large health maintenance organization. All proximal sites in one randomly selected posterior dental sextant were examined for probing depth using a constant force probe. Demographic, medical, and behavioral factors were determined by questionnaire. Results indicated that the sample consisted primarily of medically and periodontally‐healthy middle‐aged adults with good oral hygiene habits. Overall, the mean probing depth was 2.95 mm with 10.1% of sites/subject ≥ 4 mm. A larger percent of subjects had probing depths with pockets ≥ 4 mm at lingual proximal sites than buccal proximal sites. Prevalence of subjects with pockets ≥ 4 mm at mesio‐buccal sites in the present study was similar to NIDR Region III data (15.3% vs. 17.4% respectively). However, when data from all posterior sites were included, the overall prevalence rate in the present sample increased to 36.8%. These findings indicate that disease prevalence is dependent on the location of surfaces measured and conservatively indicate that NIDR survey data may have underestimated the prevalence of persons with periodontal pockets ≥ 4 mm by at least 20%.J Periodontol 1993; 64:853–858.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.853

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

In order to evaluate the effectivenessof a counter‐rotational powered brush (CRPB) during the supportive periodontal therapy (SPT) phase of periodontal treatment, 40 treated patients in SPT but with insufficient plaque control were randomly divided into equal experimental or control groups. All subjects used the same toothpaste, but the CRPB group did not use any interproximal aids. Gingivitis (MGI), plaque, and bleeding on probing (BOP) were scored at baseline and 1, 3, and 6 months prior to prophylaxis in conjunction with regular SPT visits. While both groups improved from baseline, CRPB use achieved significantly lower mean plaque scores and BOP at 6 months as analyzed by repeated measures ANOVA. The CRPB also showed consistent statistically superior percentage changes from baseline resulting in a general 50% improvement in clinical conditions compared to a 20 to 25% improvement for control oral hygiene methods. CRPB use resulted in at least a 50% improvement from baseline twice as often as did the control. The results of this study demonstrate more substantial and consistent improvement in periodontal conditions and plaque control effectiveness with the CRPB than the control methods that included interproximal hygiene aids. It appears that the CRPB may be a useful adjunct in maintaining reduced plaque levels and favorable gingival conditions in patients in the SPT phase of periodontal therapy.J Periodontol 1993; 64:859–864.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.859

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The purpose of the present studywas to determine the levels of osteocalcin, a bone specific matrix protein, in gingival crevicular fluid (GCF) from periodontal disease patients and to investigate the relationship between GCF osteocalcin levels and clinical parameters. Nineteen initial visit patients, 5 patients with gingivitis and 14 patients with adult Periodontitis, participated in this study. The clinical parameters including probing depth, attachment level, gingival index, and tooth mobility were recorded following careful sampling of GCF with a filter paper strip harvested for 3 minutes. Osteocalcin adsorbed on a strip was extracted in a plastic tube containing 150μ1 of 10 mM sodium phosphate buffer (pH 6.5). GCF osteocalcin was determined by a newly‐developed, high sensitive enzyme immunoassay which could recognize the N‐terminal 20 residue peptide. In gingivitis patients, no significant amounts of osteocalcin were detected. In Periodontitis patients, on the other hand, osteocalcin levels were detected, ranging between 0 and 540 pg/tube and positively correlated with these clinical parameters (P<0.01). Moreover, in several sites in GI = 3 group, extremely higher levels of GCF osteocalcin were detected. These results strongly suggest that in addition to the presence of GCF osteocalcin the levels of osteocalcin may reflect the degree of the periodontal inflammation at the sampled sites.J Periodontol 1993; 64:865–869.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.865

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Tryptase‐like activity has previously been identifiedbiochemically in gingival homogenates and gingival crevicular fluid (GCF) using substrates linked to the 7‐amino4‐trifluoromethyl coumarin (AFC) leaving group. In the present study, activity was demonstrated histochemically in tissue sections with analogous 4‐methoxy‐2‐naphthylamide (MNA) substrates. Z‐Ala‐Ala‐Lys‐MNA and D‐Val‐Leu‐Arg‐MNA were the most sensitive substrates. Comparison of staining patterns with the MNA substrates and toluidine blue indicated that enzyme activity was localized to mast cell secretory granules. Most stained cells were in the lamina propria, but a few were in the epithelium. The number of stained cells was somewhat greater in inflamed tissue from chronic Periodontitis patients than in healthy tissue from controls. However, hardly any staining was seen in inflamed granulomatous tissue. Using high‐salt buffer containing heparin, it was possible to extract enzyme activity from tissue sections for biochemical analysis with corresponding AFC substrates. Inhibitors gave similar results in the biochemistry and histochemistry. The inhibitor response and pH profile of the enzyme were the same as that found earlier with gingival homogenates and GCF and were again consistent with mast cell tryptase. The enzyme may have a role in the pathology of chronic Periodontitis.J Periodontol 1993; 64:870–877.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.870

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Contralateral periodontal fenestration defectsin seven beagle dogs were used to evaluate influence of a collagen matrix on periodontal wound healing. The defects (6 × 4 mm) were created through the buccal cortical plates of the maxillary canine teeth following elevation of mucoperiosteal flaps. The collagen was fitted to the defects on one side. Contralateral defects served as controls. Flaps were repositioned and sutured. Dogs were sacrificed 4 weeks after surgery and block sections including teeth and surrounding structures were prepared for histometric analysis. No meaningful differences in cementum and bone regeneration were observed between treatments. There was seemingly more bone regeneration in the apical than in the coronal aspect of the defects and significantly more cementum regeneration. Root resorption was observed in one collagen and one control defect. Ankylosis was not observed. The results suggest that the maxillary canine periodontal fenestration defect can be used as a model to evaluate factors that may enhance cementum and bone regeneration. The collagen matrix neither enhanced nor inhibited periodontal wound healing in this model.J Periodontol 1993; 64:878–882.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.878

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Awound stabilizing effect of expanded polytetrafluoroethylene(ePTFE) membranes was evaluated in supraalveolar periodontal defects in 5 beagle dogs. The defects, 5 to 6 mm in height, were surgically created around the 2nd, 3rd, and 4th mandibular premolar teeth in contralateral jaw quadrants. The root surfaces were conditioned with heparin, which, in this model, has been demonstrated to compromise periodontal healing and result in formation of a long junctional epithelium. Wound closure included application of ePTFE membranes around each premolar tooth in one jaw quadrant in each dog and flap positioning coronal to the cemento‐enamel junction in both jaw quadrants. Healing progressed uneventfully except for 3 teeth in 2 dogs, which experienced membrane exposure. The dogs were sacrificed after a 4‐week healing period and tissue blocks were prepared for histometric analysis. Connective tissue repair in heparin + membrane‐treated teeth averaged 98% of the defect height compared to 84% in control heparin‐treated teeth (P≤ 0.05). Junctional epithelium formation was smaller in membrane‐treated teeth than in control teeth (P≤0.05) and was usually terminated coronal to the membrane. Bone regeneration was enhanced in membrane‐treated teeth compared to controls (P≤0.01) and was strongly correlated to the area under the membrane in teeth without membrane exposure (r2= 0.993;P= 0.002). This correlation was reduced when teeth with membrane exposure were included in the analysis (P≤0.05). Cementum regeneration was minimal under both treatment conditions. Root resorption was increased in membrane‐treated compared to control teeth (P≤0.01). This study provides an alternative biologic rationale for membrane‐supported periodontal reconstructive surgery. The results suggest that: 1) connective tissue repair to the root surface is a function of wound stability; 2) bone regeneration is dependent on space provision; 3) exclusion of gingival connective tissue from the root surface does not prevent root resorption; 4) provisions for guided tissue regeneration do not necessarily support cementum regeneration; and 5) complete gingival coverage of the barrier membrane appears critical for optimal healing.J Periodontol 1993; 64:883–890.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.883

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Two groups of elderly chinese were selectedfrom a large epidemiological sample on the basis of a low (“best” group) or a high (“worst” group) number of sites with attachment loss levels ≥ 6 mm and/or pocket depth ≥ 4 mm and at least 16 teeth present. Six years later the patients were clinically reexamined and the subgingival microflora was assessed. This paper presents the clinical characteristics of destructive periodontal disease progression among the two subgroups. The “best” group lost an average of 1.8 teeth, contrasting the average loss of 5.3 teeth among the “worst” group. Virtually all teeth lost among the “worst” group had a baseline attachment loss level ≥ 4 mm, in contrast to 48% among the “best” group. While dental caries could be identified as a cause of tooth loss in both groups, the excess tooth loss among the “worst” group seems attributable to periodontal destruction. The average of 1.21 mm attachment/site lost among the “best” group was not statistically significantly different from the 1.36 mm/ site lost among the “worst” group during the 6 years. Individual mean losses of attachment ranged from a gain of 0.03 mm to a loss of 3.19 mm. An attachment loss ≥ 2 mm at a site was highly positively associated with a high initial attachment loss level (≥ 4 mm) at that site among the “best” group, whereas a highly negative association was seen among the “worst” group. This may indicate that progression in the “best” group mainly occurs in sites already “marked” for progression, whereas progression in the “worst” group continues to implicate new sites.J Periodontol 1993; 64:891–899.

ISSN:1049-8885    

DOI:10.1902/jop.1993.64.9.891

出版商:Wiley    

年代:1993

数据来源: WILEY