摘要:

The purpose of this studywas to evaluate the use of autogenous gingival grafts as barriers for endosseous implants placed directly into fresh extraction sockets. This study consisted of four patients who presented with hopeless teeth due to endodontic pathology, caries, or root resorption. In all cases, the teeth in question were extracted at the Stage 1 surgery. An endosseous root form implant was immediately placed into the extraction socket in each case. As a consequence of immediate placement, there was a lack of primary closure over the fixture and a large space was present between the fixture and the remaining alveolus. An autogenous gingival graft was sutured in place to cover the fixture and act as a physical barrier to epithelium, food debris, and possibly bacteria. At the Stage 2 surgery, all implants achieved complete osseointegration clinically and radiographically. The results at 16 to 24 months reveal continued success in all four cases. This report demonstrates the potential of autogenous gingival grafts in immediate implant placement. A clinical trial to fully assess the potential of this procedure is recommended.J Periodontol 1994;65:201–210.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.201

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Microorganisms can adhere and colonizeon an exposed guided tissue regeneration (GTR) membrane thus developing a nidus of infection. The purpose of this study was to compare early bacterial adhesion to three different GTR membranes. Expanded polytetrafluoroethylene, polyglactin 910, and collagen were used as the test membranes. In part I of this study 15 different oral microbes were used to compare their relative ability to adhere to the membranes. Six of the most strongly adherent bacteria (Actinomyces viscosus, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, Fusobacterium nucleatum, andSelenomonas sputigena) were selected for part II of this study. The membranes were placed in tubes containing broth cultures containing identical concentrations (1 × 108cells/ml) of these bacteria at 37°C. Membranes were placed in tubes of media without bacteria as controls. At 4, 6, 12, and 24 hours, the bacterial cultures were decanted and the membranes in the tubes were agitated gently in reduced transfer fluid (RTF) 4 times to remove non‐adherent bacteria. Each tube was then sonicated for 30 seconds in 10 ml RTF to detach adherent bacteria. The detached adherent bacteria were counted using a Petroff‐Hausser chamber. Data were analyzed by using the SAS program. Analysis of variance was used to test for differences between multiple means. Results showedS. mutanshad the strongest adherence at all time points except forP. gingivaliswhich exhibited the strongest attachment to the collagen membrane at 4 and 6 hours.Selenomonas sputigenahad the lowest adherence capability to all test membranes. Polyglactin 910 had significantly (P<0.05) lowerS. mutansadherence than either the ePTFE or the collagen membrane at 4 and 6 hours. The collagen membrane had significantly higher values ofS. mutansadherence at 12 and 24 hours when compared to the other two membranes. No significant differences onA. actinomycetemcomitans, A. viscosus, F. nucleatum, andSelenomonas sputigenawere observed when different membranes were compared. This pilot study indicated that certain bacteria adhere to GTR membranes and thatS. mutansandP. gingivalishave the strongest adherence affinity of those microbes tested.J Periodontol 1994;65:211–218.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.211

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

HLAproteins are genetically determined, and account in part for individual immune response. Several studies have been performed seeking an association between HLA antigens and various forms of periodontitis with no conclusive results. The aim of the present study was to determine the frequency of HLA antigens of patients suffering from the localized (LJP) and the generalized (SGP) forms of early‐onset periodontitis (EOP). Twenty‐six EOP patients from the same ethnic group were studied in comparison to 113 race‐matched controls. The EOP group included 11 LJP and 15 SGP patients. HLA‐A9 and B15 antigens were found to be significantly elevated in the patient group. These differences were found to be due to the high frequency of A9 and B15 antigens in the SGP patients, with the LJP patient group showing no significant difference from the control group. The results are in agreement with previous studies in which A9 and B15 were found to be associated with EOP. However, previous studies did not differentiate between the localized and the generalized form of EOP. These results support the hypothesis that the generalized and the localized forms of EOP are under different genetic control.J Periodontol 1994;65:219–223.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.219

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The purpose of this studywas to determine the effect of daily water irrigation versus regular oral hygiene alone on gingival and periodontal health in periodontitis patients receiving supportive periodontal treatment. The study also sought to determine if there are enhanced benefits from using an antiplaque zinc sulfate rinse as an irrigant. One hundred fifty‐five patients who have had periodontitis and had been treated either surgically or non‐surgically completed the 6‐month multi‐center multi‐national study. Patients with at least two 5 mm sites demonstrating bleeding on probing were assigned to 3 equal groups by balanced randomization. In all centers Group A (n = 57) performed regular oral hygiene only, and Group B (n = 58) irrigated with 500 ml water once daily after regular oral hygiene. Group C (n = 40) patients irrigated with a total of 500 ml once daily; following irrigation with 300 ml water, the patients then irrigated with an additional 200 ml with a zinc sulfate solution. The irrigants were diluted to provide the manufacturer's recommended daily dosage. The supragingival irrigation was performed with a commercially available oral irrigator. Bacterial measurements at baseline, 3 months, and 6 months were taken to determine the effect of irrigation on the target organisms and will be reported elsewhere. Gingival index: irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) and irrigation with zinc sulfate (Group C) (P<0.05) in reducing gingival inflammation. Bleeding on probing: significant reductions in bleeding on probing occurred for water (Group B) compared to normal oral hygiene (Group A) (P30% sites), irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) in reducing bleeding on probing and gingival inflammation (P<0.01); and water irrigation was significantly better than zinc sulfate irrigation (P<0.05) for reducing gingival inflammation. Probing depth: irrigation with water (Group B) demonstrated clinically small, but statistically significant, reduction (P<0.05) in probing depth compared to Group A and Group C. Plaque index: there were no significant differences observed. This study demonstrates that adjunctive supragingival irrigation with water can provide meaningful clinical outcomes for patients with periodontitis who are being treated in the maintenance phase of periodontal therapy.J Periodontol 1994; 65:224–229.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.224

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

This study was undertaken in an effortto understand the role of cytokines on human gingival fibroblasts and T lymphocyte trafficing into inflamed gingival tissue. Using flow cytometry we examined gingival fibroblasts to determine the level of cell surface expression and the percentage of cells positive for intercellular adhesion molecule 1 (ICAM‐1), the HLA‐DR antigen, lymphocyte function‐associated antigen 3 (LFA‐3), and the CD44 molecule, which are involved in antigen presentation. The following cytokines were used: interleukin‐1β (IL‐1β), tumor necrosis factor‐α (TNF‐γ), interferon‐γ (IFN‐γ), IL‐6, and IL‐8. The levels of ICAM‐1 expression were enhanced in a dose‐ and time‐dependent manner by IL‐1β, TNF‐α, or IFN‐γ, but not by IL‐6 or IL‐8. HLA‐DR surface expression was induced only by IFN‐γ in a dose‐ and time‐dependent manner, but not by the other cytokines tested. In contrast, the expression of LFA‐3 and the CD44 molecule could be detected without the stimulation of any cytokine, but the levels of their expression were not significantly changed by any cytokines. The enhanced ICAM‐1 expression by cytokines was reduced in a time‐dependent manner following the removal of cytokines from the reaction mixture, while IFN‐γ‐induced HLA‐DR expression was maintained even 7 days after the removal of IFN‐γ. These data support an interactive role for inflammatory cytokines and the expression of adhesion molecules on gingival fibroblasts in the pathogenesis of gingival inflammation in periodontal disease.J Periodontol 1994;65:230–235.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.230

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Objective, reliable, and valid diagnosticcriteria are required for studies of HIV‐associated periodontal conditions. A set of diagnostic criteria were devised based on a literature review and the clinical experience of the authors. Validity was assessed by comparison with clinical photographs and the criteria were evaluated and refined for ease of use and objectivity. To assess the reliability of the criteria, 9 experienced examiners were shown 20 clinical photographs accompanied by brief vignettes of clinical information. Each examiner was asked to identify signs evident in a particular area of the photograph and to record a diagnosis. Five examiners were then trained and calibrated in the use of the criteria. Finally, all 9 examiners were shown the original 20 photographs and asked to identify signs and record diagnoses. The examiners showed only fair reliability in the recognition of clinical signs, made diagnoses intuitively, and had only fair agreement on the diagnosis of periodontal diseases. The inter‐examiner reliability of examiners trained and calibrated in the use of the criteria increased and was greater than among untrained examiners. Rigid diagnostic criteria are essential in epidemiologic studies. Inter‐examiner reliability will be increased if examiners are trained in their use and calibrated in the recognition of clinical signs. Diagnostic criteria should be modified as understanding of the diseases they classify increases. The proposed criteria will enhance the value of studies of HIV‐associated periodontal changes and will contribute to that understanding.J Periodontol 1994; 65:236–243.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.236

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The purpose of this studywas to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze‐dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non‐surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full‐thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ‐AC) and vertical (CEJ‐BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(−)/gain PAL= −0.2, 0.8; decreased CEJ‐BDF = 3.8, 5.0; increased CEJ‐AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE + DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ‐BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ‐AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.J Periodontol 1994;65:244–254.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.244

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Lasers are being used for soft tissue removal, caries removal, and treatment of root surface sensitivity. One concern for laser safety is that the heat produced at the irradiated root surface may diffuse to the pulp causing irreversible pulpal damage. To test this heat diffusion, copper‐constantan thermocouples were inserted into the radicular pulp canals of extracted teeth. Simulating direct exposure which might occur during gingival excision, superficial caries removal, and modification of the dentin surface for treatment of root surface sensitivity, a 2 mm2area of the external root surface was uniformly irradiated with a pulsed Nd:YAG laser using a 320 μm diameter fiber optic contact probe. Power was varied from 0.3 to 3.0 W with frequencies of 10 and 20 Hz. Temperature changes during cavity preparations using a high speed handpiece with air coolant were also recorded. Repeated measures ANOVA (P≤0.05) indicated that intrapulpal temperatures increased as a function of power, frequency, and time. Intrapulpal temperatures decreased as remaining dentin thickness (0.2 to 2.0 mm) increased for each laser parameter. Irradiation of dentin using a Nd:YAG pulsed laser, within the treatment times, powers, and frequencies with adequate remaining dentin thickness, as outlined in this paper, should not cause devitalizing intrapulpal temperature rises.J Periodontol 1994;65:255–259.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.255

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Specific risk indicators associatedwith either susceptibility or resistance to severe forms of periodontal disease were evaluated in a cross‐section of 1,426 subjects, 25 to 74 years of age, mostly metropolitan dwellers, residing in Erie County, New York, and surrounding areas. The study sample exhibited a wide range of periodontal disease experience defined by different levels of attachment loss. Therefore, it was possible to accurately assess associations between the extent of periodontal disease and patient characteristics including age, smoking, systemic diseases, exposure to occupational hazards, and subgingival microbial flora. Age was the factor most strongly associated with attachment loss, with odds ratios for subjects 35 to 44 years old ranging from 1.72 (95% CI: 1.18 to 2.49) to 9.01 (5.86 to 13.89) for subjects 65 to 74 years old. Diabetes mellitus was the only systemic disease positively associated with attachment loss with an odds ratio of 2.32 (95% CI: 1.17–4.60). Smoking had relative risks ranging from 2.05 (95% CI: 1.47–2.87) for light smokers increasing to 4.75 (95% CI: 3.28–6.91) for heavy smokers. The presence of two bacteria,Porphyromonas gingivalis and Bacteroides forsythus, in the subgingival flora represented risks of 1.59 (95% CI: 1.11–2.25) and 2.45 (95% CI: 1.87–3.24), respectively. Our results show that age, smoking, diabetes mellitus, and the presence of subgingival P. gingivalis andB. forsythusare risk indicators for attachment loss. These associations remain valid after controlling for gender, socioeconomic status, income, education, and oral hygiene status expressed in terms of supragingival plaque accumulation and subgingival calculus. Longitudinal, intervention, and etiology‐focused studies will establish whether these indicators are true risk factors.J Periodontol 1994;65:260–267.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.260

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

This study evaluated the effect ofperiodontal therapy on clinical and microbiological parameters in 23 subjects with severe generalized early onset periodontitis. Therapy consisted of oral hygiene instruction and root planing and scaling, followed 3 months later by open flap debridement. Subjects were monitored for both clinical measures and levels ofActinobacillus actinomycetemcomitansandPorphyromas gingivalisas identified by indirect immunofluoresence. Clinical and microbiological evaluations were done at the start of the study, 3 months after the completion of root planing and scaling and 3 months after open flap debridement. Mean probing depth was reduced by both root planing and scaling and open flap debridement and the level of reduction demonstrated by both phases of therapy was similar to reductions found in studies that utilized subjects with chronic adult periodontitis. In contrast, reductions in attachment level due to the two phases of therapy, demonstrated in previous studies of subjects with adult periodontitis, were not found in the young adult subjects with severe periodontal disease utilized in this study. Levels ofA. actinomycetemcomitanswere not significantly affected by root planing and scaling, but were reduced by open flap debridement.P. gingivaliswas virtually eliminated by root planing and scaling, demonstrating that the two bacterial types respond differently to periodontal therapy. These changes in microbiological parameters were similar to those found in studies of localized juvenile periodontitis subjects, where surgery or antibiotics have been shown to be necessary to reduce levels of A. actinomycetemcomitans.J Periodontol 1994; 65:268–273.

ISSN:1049-8885    

DOI:10.1902/jop.1994.65.3.268

出版商:Wiley    

年代:1994

数据来源: WILEY