摘要:

The present study was undertakento compare the efficacy of two antibiotics, spiramycin and tetracycline, with a placebo when used adjunctively with scaling and root planing in the treatment of advanced adult chronic Periodontitis. This was a double‐blind, parallel, randomized trial with one factor (drug) at three levels. Ninety–six patients (mean age 46 ± 1) were randomly assigned into one of three groups. All groups were scaled and root planed with each respective group receiving either spiramycin, tetracycline, or a placebo for 2 weeks. Two sites with probing depth of at least 7 mm were evaluated and the following clinical parameters were measured at baseline, 2, 8, 12, and 24 weeks: plaque index, bleeding on probing, crevicular fluid, probing depth, and change in the attachment level. The changes in the subgingival bacteria were monitored also using a differential staining technique. Seventy–nine patients completed the study. At the end of 24 weeks, although all three groups had shown clinical improvement when compared to the baseline data, there were no significant intergroup differences in any of the clinical parameters measured. While the proportion of spirochetes were significantly decreased (P<0.05) at 2‐ and 8‐week intervals in both tetracycline and spiramycin groups (26% to 0.04% and 28% to 0.04%, respectively), compared to the placebo group (30% to 7%), only in the spiramycin group was the proportion of spirochetes significantly lower than the placebo group at the 24–week interval (3% and 11%, respectively). At week 24, the proportion of spirochetes in the tetracycline group had rebounded to 7%, which was not significantly different from the placebo group. We concluded that mechanical debridement with or without adjunctive spiramycin was effective in improving clinical parameters. Although the adjunctive use of antibiotics aided in preventing recolonization of spirochetes, the data did not support any short‐term clinical benefit since no statistical intergroup differences existed. (J Periodontol1989;60:533–539)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.533

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

Gingival neutrophils, testedin the chemotaxis–under–agarose assay, were examined with the scanning electron microscope. Non–motile cells were round with narrow surface ridges. In response to the chemoattractant, zymosan–activated serum, the cells elongated and became polarized with an anterior lamellipodium and a posterior uropod. Cells flattened as they emigrated beneath the agarose. These studies show that gingival crevicular neutrophils from healthy subjects are capable of responding vigorously to external stimuli and hence may participate in the pathophysiology of periodontal disease. {J Periodontol1989;60:540– 543)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.540

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

Six patients who participatedin a clinical study comparing the response of periodontal osseous defects to either grafting with Periograf (durapatite) hydroxylapatite (HA) ceramic or debridement alone (DEBR) were followed under an active maintenance program for 5 years. Mean values for gingival recession and attachment levels remained essentially stable following either treatment over the 5 year period. However, mean probeable pocket depths shifted from being significantly (P<0.05) shallower for DEBR sites at 6 months and 1 year to being significantly shallower for HA sites at 5 years. The probing pocket depth change for grafted sites was steady and the change from presurgical values was significantly greater than the change for DEBR areas, which became about 1.5 mm deeper over the 5 year postsurgical period. Intrapatient comparisons showed that recession, attachment gain, and pocket depth decrease were most frequently greater for the Periograf‐treated sites. Assessment of the pattern of clinical changes during the 5 year postsurgical period demonstrated that the attachment level of grafted sites improved or stayed the same 86% of the time compared to only 62% stability or improvement in the DEBR only sites. In fact, 38% of the DEBR sites were worse at 5 years than at the time of surgery, a 3 times greater failure rate than that found in the HA‐grafted sites. Pocket depth measurements showed that 98% of the Periograf‐treated sites were better or the same as presurgically (2% worse), while only 80% of DEBR sites showed positive results and 20% had deeper pockets than at the time of surgery. These findings suggest that Periograf–treated sites were stable for 5 years following surgery and resulted in a high frequency of clinical improvement, while areas treated by open flap debridement alone were not stable and regressed at a rate 3 to 5 times that of the grafted sites. It is probable that other grafting materials would demonstrate similar comparative results to debridement alone. (J Periodontol1989;60:544–551)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.544

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

The purpose of this studywas to evaluate the duration of therapeutic effect after administration of the collagen film immobilized tetracycline (TC film). TC film or tetracycline non–immobilized placebo film was applied one time to the periodontal pocket (≧ 4 mm) of five Periodontitis patients (20 teeth). The clinical and microbiological effects are summarized as follows: The group that received TC film continued to show significantly low values for bleeding upon probing the pocket depth for 3 and 4 weeks, respectively, after administration, but there was no significant difference in the plaque index or gingival index when compared with the group that received a placebo film. In the TC film group, the density of microorganisms and the proportion of motile rods and spirochetes were also significantly decreased 3 weeks after administration. These findings suggest that topically administered TC film remains both clinically and bacteriologically effective for 2 to 3 weeks. (J Periodontol1989;60:552–556)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.552

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

Clinical and laboratory data were comparedin 72 patients with localized Periodontitis (LP) and 103 patients with generalized Periodontitis (GP). Significantly more LP than GP cases had decreased neutrophil Chemotaxis (CTX), and were seropositive forActinobacillus actinomycetemcomitans(Aa). Significantly, more GP cases were seropositive forBacteroides gingivalis(Bg). All clinical indices were similar on affected teeth in LP and GP, but the attachment loss was greater on clinically unaffected teeth in GP when compared with LP. LP cases with CTX defects had a significantly lower mean age, were more often seropositive for Aa antibodies, and were more often female than LP patients with normal CTX. Significantly more GP cases with CTX defects were seropositive for Aa antibody. GP patients with normal CTX had a higher plaque index on both affected and unaffected teeth than did GP patients with a CTX defect. Our data suggest that Chemotaxis and/or specific bacteria may be contributory, but not always necessary, factors in these disorders. The overlap in clinical and laboratory profiles of LP and GP continues to cloud the distinction of these early onset forms of Periodontitis. {J Periodontol1989;60:557–563)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.557

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

There is a growing body of scientific evidenceto support the concept that the use of tobacco products significantly contributes to the progression of periodontal disease or is detrimental to healing following periodontal therapy. Several studies have shown toxic effects of nicotine on peripheral circulation and the immune response. The purpose of the present study was to identify and compare the quantity of nicotine present on root planed and non– root planed surfaces of teeth from smokers. Twenty–nine single–rooted teeth from 11 smokers were extracted, brushed clean, and the roots sectioned longitudinally. The respective halves were either left untreated (Group A) or thoroughly root planed (Group B). Pulpal tissue was removed and the individual root sections weighed. Each half was extracted for nicotine using a methylene chloride technique. Quantification was performed using high pressure liquid chromatography (HPLC) and the sections compared on a nicotine per root weight basis. Results showed a greater amount of nicotine present on non–root planed sections than on treated sections, although some treated specimens revealed small amounts of the substance. These findings suggest that nicotine is present on the root surface but is largely removed by thorough root planing. Its presence is not surprising in light of the recent finding that nicotine and cotinine, the major metabolite of nicotine, are found in gingival crevicular fluid. Recent studies have shown a particularly harmful effect of nicotine on fibroblasts. Its presence on root surfaces may, therefore, impair wound healing and alter the host response in periodontal disease. The use of tobacco products in conjunction with periodontal therapy may interfere with optimal healing and/or lead to further periodontal breakdown. {J Periodontol1989;60:564–569)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.564

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

Previous studies have demonstratedthe potential beneficial effects of post‐surgical rinsing with 0.2% Chlorhexidine. In the present investigation a new chlorhexidine formulation (Peridex) (CHx) and concentration (0.12%) was evaluated clinically to determine if similar effects could be detected from the use of the new product and treatment regimen. A double blind, randomized, placebo–controlled study was carried out in 40 patients during a 6 week period. Patients who had moderate periodontitis (AAP Class III) received osseous periodontal surgery in one quadrant. Each surgical site received periodontal dressing and patients were given a placebo or CHx mouthrinse to be used twice each day. Compared to placebo, CHx significantly reduced plaque at all examinations (54.4% reduction over placebo at 6 weeks,P2) in the CHx group was reduced by 99% over the placebo group at 6 weeks and at 4 weeks post‐surgical, gingival inflammation scores were significantly lower in the CHx group (17% reduction over the placebo at 4 weeks,P2) were significantly lower in the CHx group at 4 and 6 weeks (41 % and 40% reduction over the placebo group,P<0.05). Probing pocket depth and attachment level changes were not significantly different between both groups. Epithelialization rates and pain assessment demonstrated consistently better results in the CHx group, although differences were not statistically significant. Use of 0.12% chlorhexidine immediately following periodontal surgery, for 6 weeks, has been shown to be a clinically effective adjunct providing enhancement of the post–surgical management of periodontal surgical patients. (J Periodontol1989;60:570–576)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.570

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

Bacterial plaque accumulationfollowing periodontal surgery has been directly associated with delayed and altered surgical wound healing. Successful antimicrobial treatment following periodontal surgery depends upon the elimination and suppression of wound associated microorganisms. Highly effective antimicrobials should also prevent recolonization of periodontopathogens. In this investigation, the antimicrobial effect of a 0.12% Chlorhexidine gluconate mouthrinse (Peridex) on bacterial recolonization after periodontal surgery was determined. A double–blind, randomized, placebo‐controlled study was carried out on 40 patients for 6 weeks. Patients with moderate Periodontitis (AAP Class III) underwent osseous periodontal flap surgery in one quadrant. Subgingival and marginal plaque samples from the surgery area were taken prior to surgery and 2 and 6 weeks postoperatively. General descriptive bacteriological cultural analysis and assays for specific microbial populations were carried out. During the 6 weeks of mouthrinse use, patients using Chlorhexidine had significant reductions over placebo (P<0.05) in the number of total Gram–positive facultative cocci, streptococci (85.8%); Gram–positive facultative rods, primarilyActinomyces(91.7%);Capnocytophaga(97.6%) and Gram–negative anaerobic rods (94.5%). Few black pigmentedBacteriodesorActinobacillus actinomycetemcomitanswere found prior to surgery or any time postoperatively. In the Chlorhexidine group, 6 weeks post surgery, streptococci were the predominant bacterial group in the sampled plaque. Quantitatively, the distribution of bacteria, after 2 and 6 weeks of mouthrinse use, was consistent with a young, less mature plaque. A previous study demonstrated that this plaque was associated with clinical health. (J Periodontol1989; 60:577–581)

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.577

出版商:Wiley    

年代:1989

数据来源: WILEY

摘要:

The purpose of this study was to evaluatethe clinical and histological effects of high concentration doxycycline on osseous regeneration in adult beagle dogs. Four 5 mm two– wall periodontal osseous defects were created in the premolar and molar area of each quadrant yielding a total of 48 defects in the three dogs. Ligature‐induced Periodontitis was maintained for 6 weeks. Two weeks following ligature removal, one of the following graft procedures was randomly assigned to each defect: 1) doxycycline alone (DOX); 2) tricalcium phosphate alone (TCP); 3) a combined graft of DOX plus TCP, or 4). surgically debrided control. All areas received thorough scaling and root planing at the time of surgery. Clinical parameters evaluated at 4, 12, and 20 weeks after the surgical treatment included the gingival index and probing depths. Crevicular fluid was examined at 3, 10, and 28 days postoperatively for tetracycline fluorescence. Direct clinical measurements from the CEJ to a notch placed at the base of the defect and from the CEJ to the alveolar crest were made at the time of surgical treatment and reentry. The reentry procedures were performed at 4, 12, and 20 weeks postoperatively. Immediately following reentry block sections were obtained from each quadrant and prepared for examination with the light microscope. The gingival index and probing depth measurements showed greater improvement in the DOX and DOX + TCP groups. Increased regeneration (new bone, cementum, and periodontal ligament) and reduced alveolar crest resorption were observed more frequently in DOX and DOX + TCP defects, while healing by long junctional epithelium was more common in defects not treated with doxycycline. Epithelial migration tended to halt just coronal to root–bound doxycycline. Root–bound doxycycline was observed both histologically and with a UV light for up to 20 weeks. When TCP grafts were combined with DOX, the TCP was more rapidly enclosed by bone than when TCP alone was used. The high concentration of doxycycline used in the present study tended to provoke a pronounced inflammatory response that diminished over time. A limitation of the present study was the number (3) of dogs available. Within the limitations of this sample size the following observations were made: 1) Defects treated with high concentration doxycycline tended to have more regenerative healing and less crestal resorption; 2) root bound doxycycline served as a barrier to the downgrowth of junctional epithelium; and 3) the combination of doxycycline plus tricalcium phosphate resulted in more bone formation and less crestal resorption than either doxycycline alone or tricalcium phosphate alone.

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.582

出版商:Wiley    

年代:1989

数据来源: WILEY

ISSN:1049-8885    

DOI:10.1902/jop.1989.60.10.591

出版商:Wiley    

年代:1989

数据来源: WILEY