bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative longitudinal study of 2 methods of scheduling maintenance visits; 2‐year data
Authors: Listgarten M. A. , Levin S. , Schifter C. C. , Sullivan P. , Evian C. I. , Rosenberg E. S. , Laster L.
Published: December 2005

Abstract This report compares the clinical and microbiological status of 2 groups of subjects with treated periodontitis on different maintenance schedules. 43 control (C) subjects were given prophylaxes every 3 months. 40 test (T) subjects were given this service on a flexible schedule according to the proportions of spirochetes and/or motile rods in fresh smears of subgingival scrapings. Both groups were examined every 6 months clinically and microbiologically. This report presents base line, 1‐ and 2‐year data. Generally, mean values for both groups did not differ significantly from one another. Both groups exhibited comparable increases in GI and PLI scores during the first 2 years of this study. No change in probing depth was noted between base line and the 2‐year examination. However, a slight increase in attachment level, as determined by probing, was noted in both groups. Both groups also exhibited similar proportions of bacterial morphotypes at base line and subsequent examinations.

Disease recurrence, defined as an increase in probing depth of 3 mm or more from base line on any tooth surface during the 2‐year period, tended to be more prevalent in the C than in the T group (15/43 C and 9/40 T subjects). However, the proportional difference between the groups was not statistically significant. Subjects with disease recurrence in the T group had greater proportions of spirochetes at base line than subjects in the same group without disease recurrence (20.2% versus 9.8%, P < 0.01). This difference in proportions persisted if both groups were examined jointly, but was only of borderline significance (16.0% versus 10.5%, p= 0.05). The difference did not reach statistical significance when C subjects alone were examined. The difference between groups with respect to correlation of spirochete % at base line and future disease recurrence may be due to differences in the recall schedule, with regular tri‐monthly prophylaxes more likely to interfere with the expected tissue response to the resident subgingival microbiota. After 2 years, although both groups averaged about 7 recall visits, the time elapsed since the last prophylaxis averaged 2.4 months for the C versus 13.7 months for the T group. No other criteria examined at base line were significantly correlated with disease recurrence.
The effectiveness of citric acid as an adjunct to surgical re‐attachment procedures in humans
Authors: Smith Billy A. , Mason William E. , Morrison Edith C. , Caffesse Raul G.
Published: December 2005

Abstract The purpose of this study was to clinically evaluate the effect of citric acid on re‐attachment and re‐adaptation in conjunction with periodontal surgery. A split‐mouth design was used in 10 patients involving 30 quadrants of surgery. A total of 120 teeth were treated. Each quadrant consisted of at least 2 teeth from cuspid to second molar. One quadrant was treated with a modified Widman flap alone while the root surfaces of the contralateral side were also treated with a 3 min application of citric acid.

Immediately following hygienic phase and at 3 and 6 months postsurgically, the following measurements were taken in this sequence: gingival index, gingival crevicular fluid flow, plaque index, furcation involvement, level of attachment and probing depth. All the data were statistically analyzed using the paired t‐test, X2 and Fisher exact probability test.

The biometric results showed that both surgical techniques resulted in a loss of attachment in shallow pockets and a gain in deeper pockets. Both techniques resulted in similar amounts of recession and probing depth reduction at 6 months. Gingival index, plaque index and furcation values decreased at 3 and 6 months postsurgically. The gingival crevicular fluid values remained essentially the same up to 6 months postsurgically.
Treatment of juvenile periodontitis without antibiotics
Authors: Saxén Leena , Asikainen Sirkka , Sandholm Leena , Kari Kirsti
Published: December 2005

Abstract 20 patients with juvenile periodontitis (JP) were treated with oral hygiene instruction, scaling and rootplaning, possibly with flap surgery but with no antibiotics. The patients were monitored after 6 to 12 years. Re‐examination revealed that no probing depth of 7 mm or more existed any longer, and that sites with probing depth of 4 to 6 mm had decreased from 237 to 46. The bone loss scores had changed from 18% (range 2.0 to 48.1) to 14% (range 0 to 44.4) and the bleeding on probing scores from 39% (range 0 to 100) to 10% (range 0 to 40). Actinobacillus actinomycetemcomitans (A.a.) had neither been cultivated nor serologically tested at the initial examination. At the re‐examination, it was found in 2 patients out of 20 at 5 sites. 7 patients, the 2 with positive cultures included, had elevated titers to A.a. strain Y4 in whole or parotid saliva or both.

It is concluded that there is a marked improvement in the periodontal condition of these patients, and that good periodontal health in patients with JP can be reached without antibiotics.
A review and proposal for the etiology of acute necrotizing gingivitis
Authors: Sabiston Charles B.
Published: December 2005

Abstract There are numerous correlations between features of acute necrotizing gingivitis (ANG) and virus infections, notably cytomegalovirus (CMV) infections. The age range of occurrence of seroconversions to CMV positive and occurrence of ANG correlate both in industrialized countries (young adults) and in underdeveloped countries (young children). A depression in cell‐mediated immunity, as evidenced by a decrease in T‐lymphocyte helper/suppressor ratio and decreased responsiveness to the mitogen ConA, has been shown to occur in both CMV infection and ANG. There is a higher incidence of both CMV infection and ANG in young male homosexuals. These and other correlations, taken together, argue for a fundamental role for virus in ANG etiology.
Gingival inflammation at deciduous and permanent teeth An intra‐individual comparison
Authors: Matsson Lars , Goldberg Per
Published: December 2005

Abstract Previous studies showed that the tendency to develop gingivitis differed between pre‐school children with deciduous dentition and adults. A similar difference was noted between juvenile dogs with deciduous teeth and adult dogs with permanent teeth. The juvenile dogs showed morphologic characteristics which might interfere with the permeability of the junctional epithelium, thus protecting the underlying tissues from bacterial irritation. An indirect way to test whether structural differences of clinical importance exist in humans between the gingiva at deciduous and that at permanent teeth is to study the gingival reaction to a controlled amount of plaque in children with mixed dentition. The present paper reports an intra‐individual comparison of the gingival reaction at deciduous teeth with that at permanent teeth.

30 children, 7–9 years of age. took part in the study. The amount of plaque was assessed in terms of the plaque index and the degree of gingival inflammation by applying the gingival index. The mean distribution of gingival index scores did not differ significantly between deciduous and permanent teeth, but a higher % of plaque index score 2 + 3 was found in permanent teeth. In the comparison based on areas of similar plaque irritation, a tendency toward a higher degree of gingivitis was found at the deciduous teeth. The results indicate that structural differences, if any. between the gingiva at deciduous teeth and that at permanent teeth have no impact of clinical significance on the gingivitis reaction.
Long‐term evaluation of root surface caries in periodontally treated patients
Authors: Ravald Nils , Hamp Sven‐Erik , Birkhed Dowen
Published: December 2005

Abstract Caries development on exposed root surfaces was evaluated in 31 patients who had been subjected to surgical and/or nonsurgical periodontal treatment 8 years earlier due to advanced chronic periodontitis. Besides assessments for evaluation of the periodontal treatment, a number of examinations and tests were carried out in order to assess variables presumed to influence the root surface caries development. Both statistical and graphical analyses were carried out to test differences between groups of subjects and to evaluate the variables studied as possible risk factors for root surface caries. The variables studied were: salivary lactobacillus count, salivary Streptococcus mutans count, plaque score, salivary secretion rate, salivary buffer effect, oral sugar clearance time, dietary habits and the age of the subject. The final results support previous findings from an initial 4‐year period that root surface caries occurs, though to a minor extent, in this patient category demonstrating good or excellent periodontal conditions after periodontal treatment. A positive correlation was found between the baseline and final root surface caries scores. After the second 4‐year period, the salivary counts of S. mutans and lactobacilli, the plaque score and the dietary habits differed significantly between groups of subjects who had developed 0 or > 5 new DPS %. Root surface caries was far more prevalent when risk values of the variables studied were present than when they were absent. The important variables in this respect differed considerably between the subjects. No single variable was found to be discriminative in all subjects.
Bleeding/plaque ratio and the development of gingival inflammation
Authors: Abbas F. , Van der Velden U. , Hart A. A. M. , Moorer W. R. , Vroom Th. M. , Scholte G.
Published: December 2005

Abstract In a recent publication, it was hypothesized that the ratio between bleeding and plaque scores may act as a prognostic indicator for periodontal breakdown. Furthermore, it was found that the rate of development of gingival inflammation in terms of bleeding on probing during experimental gingivitis is more rapid in patients susceptible to periodontal breakdown than in subjects insusceptible to periodontal breakdown. The purpose of the present investigation was to compare the gingival reaction to dental plaque in an experimental gingivitis study in individuals without periodontal breakdown, having either a low or a high bleeding/plaque ratio. A group of 8 volunteers (18–23 years) with a low bleeding/plaque ratio and 7 volunteers (19–22 years) with a high bleeding/ plaque ratio were selected. In both groups, an experimental gingivitis study of 23 days duration was carried out. Results showed that individuals with a high bleeding/plaque ratio developed significantly more clinical inflammation in terms of bleeding and swelling of the gingiva than individuals with a low bleeding/plaque ratio. After 23 days of plaque accumulation, gingival biopsies as well as supragingival plaque samples were taken from both groups. Phase‐contrast microscopy of the plaque samples showed no significant differences between the 2 groups. Low %s of spirochetes and motile rods were found. Stereologic point‐counting procedures snowed equal amounts of infiltrated connective tissue in both groups. However, significant differences in composition of the infiltrate appeared to be present. The high ratio group showed more IgA producing plasma cells and complement activation than the low ratio group. The results of the present study suggest that the bleeding/plaque ratio of an individual may be regarded as a prognostic indicator for the degree of experimentally induced gingival inflammation in terms of bleeding and swelling of the gingiva as well as complement activation and IgA‐plasma cell activity.
Clinical and microbiological effects of sustained release chlorhexidine in periodontal pockets
Authors: Stabholz Ayala , Sela Michael N. , Friedman Michael , Golomb Gershon , Soskolne Aubrey
Published: December 2005

Abstract Previous studies have shown that a 3‐day exposure of the pocket flora to the sustained release of chlorhexidine significantly reduced the relative numbers of spirochetes and motile rods in periodontal pockets to negligible amounts. By 14 days post‐treatment, their numbers had returned to pre‐treatment levels. The present study extended the exposure time of the pocket flora to the sustatined release of chlorhexidine in an attempt to prolong the suppression of the microbial flora for a clinically significant period of time. Clinical parameters were also studied. Sustained release devices (SRD) were inserted into 13 pockets from 8 patients. Pocket depth ranged between 5 and 8 mm. The SRD's were replaced every 3 days to give a total exposure of 9 days. Plaque index (P1I). bleeding on probing and pocket depth were measured, and bacterial samples taken for dark field microscopy and anaerobic culture.

There was a marked decrease in the relative proportions of spirochetes and motile rods and the total anaerobic count post‐treatment. Pocket depth was reduced in all 13 pockets. These results indicate that a prolonged exposure to chlorhexidine suppresses the pocket flora to negligible amounts and reduces pocket depth for up to 11 weeks post‐treatment.
Speculations on periodontal attachment loss
Authors: Stahl S. Sigmund
Published: December 2005

Abstract A hypothesis is presented depicting patterns of human periodontal attachment loss. The patterns described occur rapidly, are site‐specific and take place in response to virulence and duration of local irritants. They appear to mirror current clinical observations regarding the nature and progress of site‐specific periodontal lesions.
Hemangioendothelioma of the gingiva
Authors: Ebo Chantal M. , de Boever Jan A. , Adriaens Patrick A. , Roels Hendrik
Published: December 2005

Abstract The hemangioendothelioma is a benign neoplasm, rarely observed in the mouth. In the literature, reports on the treatment and on the therapeutic results are lacking. This type of gingival neoplasm was observed in a young adult male. It was located in the attached gingiva in the upper and in the lower jaw, covering almost the entire coronal part of the anterior teeth.

An exhaustive internal and neurological examination revealed no associated general disease. The gingival biopsies displayed the typical characteristics of a hemangioendothelioma: proliferation of the blood vessels, with a reduced lumen surrounded by swollen endothelial cells. The treatment consisted of a meticulous mechanical plaque control, chlorhexidine rinses, gingivectomy procedures and a monthly professional prophylaxis. 3 years after the periodontal treatment, the gingival structures remained clinically healthy.

In the biopsies, only a small amount of inflammatory cells could be detected. This report shows a case of benign gingival neoplasms of unknown etiology in which meticulous plaque control, combined with extensive gingivectomies and repeated professional prophylaxis may have prevented or. at least, retarded the recurrence of the lesion.
Proteases and their inhibitors in chronic inflammatory periodontal disease
Authors: Sandholm Leena
Published: December 2005

Abstract This article reviews the current knowledge of the sources, function and interactions of proteolytic enzymes and their inhibitors in chronic inflammatory periodontal disease.

Proteolytic tissue degradation is a typical phenomenon in chronic inflammatory periodontal disease. The proteolytic enzymes can be both host‐ and bacteria‐derived. The proteases of the inflammatory cells are aimed for digestion of bacteria, enhanced locomotion through connective tissue, demarcation of the site of infection and tissue remodeling. Uncontrolled release of proteases in inflammation causes self‐digestion and tissue destruction. The potential of the bacterial proteases in degradation of connective tissue is not yet known. Biochemical and immunologic mediators of inflammation are released by proteolytic reactions. Immunoglobulin‐cleaving proteases present a specific mechanism in perturbation of host defenses.

The 2 main protease inhibitors in serum, alpha‐1‐antitrypsin and alpha‐2‐macroglobulin, are also present in the gingival tissue fluid guarding the function of proteases. It has been suggested, although not confirmed, that deficiency in serum protease inhibiting capacity could be correlated with susceptibility to periodontal disease. Mucous secretions contain local low molecular weight protease inhibitors, but their possible rôle in saliva is not known. Bacteria‐derived, antiproteolytic short peptides may prove to be useful in pharmacological control of tissue destruction at inflammatory sites.
Periodontal ligament areas and occlusal forces in dentitions restored with cross‐arch unilateral posterior two‐unit cantilever bridges
Authors: Laurell Lars , Lundgren Dan
Published: December 2005

Abstract This investigation was undertaken in order to analyse to what extent the magnitudes of chewing and biting forces in dentitions restored with cross‐arch unilateral posterior two‐unit cantilever bridges are correlated to the area of the periodontal tissue supporting the abutments.

12 subjects, whose dentitions were periodontally treated and prosthetically restored, participated in the study.

The chewing and biting forces, simultaneously measured in various parts of, as well as over the entire dentition, were correlated to the periodontal ligament areas of the abutments supporting the bridge constructions. A strong positive correlation (r= 0.83; P <0.01) was found between the total remaining periodontal ligament area and the mean total chewing force. A positive correlation (r= 0.57; P= 0.05) was also found between the local remaining periodontal ligament area of the posterior end abutment tooth and the local chewing force in that region. No positive correlation was found between the amount of periodontal tissue support and the magnitude of the forces developed during biting with maximal strength in habitual occlusion either totally or locally, although there was a strong tendency (r= 0.54; 0.6 > P >0.5) towards decreasing total maximal bite force with decreasing total remaining periodontal ligament area.

A strong positive correlation (r= 0.74; P < 0.01) was found on the end abutment side between the local remaining periodontal ligament area of the end abutment tooth and the local forces in that region during biting with maximal strength over a limited area at a time. The remaining periodontal ligament area of the abutment tooth adjoining the cantilever segment was not found to have any influence on the local chewing or biting forces over the distal cantilever segment. Clinical implications of the findings are discussed.
Depth of penetration in periodontal pockets with oral irrigation
Authors: Eakle W. Stephan , Ford Christine , Boyd Robert L.
Published: December 2005

Abstract The purpose of this study was to determine the effectiveness of the Water Pik® oral irrigator as a vehicle for delivering an aqueous solution into periodontal pockets. Plaque‐disclosing dye diluted with sterile saline solution was applied with the irrigator toward the gingival margins of teeth at 90° and at 45° prior to their extraction. The mean % penetration measured between a reference notch at the gingival crest and the periodontal ligament at the bottom of the pocket showed no statistical difference between the two angles of application. Penetration ranged from 44% to 71%, the lowest being into pockets 4–7 mm; higher mean penetration was noted in both subgroups 0–3 and >7 mm. No statistical difference was found between proximal and facial or lingual surfaces, maxilla and mandible, existence of tooth contact, and proximal tissue contour or consistency. The mean % penetration was independent of pocket depth (χ2 analysis). Correlation between pocket depth and mean penetration was low for all but one subgroup (90° application and pockets > 7 mm). The results suggest that the oral irrigator will deliver an aqueous solution into periodontal pockets and will penetrate on average to approximately half the depth of the pockets.
Toothbrush age and wear as it relates to plaque control*
Authors: Glaze Peter M. , Wade A. Bryan
Published: December 2005

Abstract An investigation was conducted to test the hypothesis that age and wear of toothbrushes do not affect plaque removal. 40 preclinical dental students between the ages of 19 and 26 years were assigned randomly to 2 groups. 1 group of 19 subjects used a toothbrush for 10 weeks while the 21 subjects in the other group were given new toothbrushes every 2 weeks for 10 weeks. A baseline of zero plaque and calculus was obtained on the first visit. On subsequent visits, 2 weeks apart, the gingival status of each group was evaluated using the gingival index, and plaque levels were scored using the patient hygiene performance index. The brushing surface area of the toothbrushes was measured with a caliper as well as being graded subjectively according to their condition (good, fair or poor). Results were statistically analysed at the end of the 10‐week period. It was found that after 10 weeks, the subjects using the same toothbrush for the whole period had significantly more plaque than those who replaced their brushes every 2 weeks. As brushes deteriorated, they became less effective. No differences in gingival state were detected. There was appreciable variation in toothbrush wear among subjects, some reducing their brush to a poor state in 2 weeks whereas with others the brush was rated as “good” after 10 weeks.
Treatment of localized gingival recessions with coronally displaced flaps and citric acid
Authors: Gottlow Jan , Nyman Sture , Karring Thorkild , Lindhe Jan
Published: December 2005

Abstract The present study was designed to examine the effect of citric acid conditioning on the result of healing following treatment of localized gingival recessions with coronally displaced flaps.

In 3 beagle dogs, localized gingival recessions were surgically created at the buccal surfaces of canines, premolars and molars. All experimental sites were allowed to accumulate plaque for a period of 6 months. Following preparation of notches in the buccal root surfaces at the level of the gingival margin, buccal and lingual mucoperiosteal flaps were raised. The exposed portion of the root surfaces was scaled and the cementum layer was removed. Another notch was prepared in the root surfaces at the level of the crest of the alveolar bone. Half the number of the roots were treated by topical application of citric acid while the remaining roots were used as non‐acid treated controls. The flaps were sutured in a coronally displaced position. After 3 months of healing, the dogs were sacrificed and the jaws removed and placed in fixative. After decalcification, histological sections of the experimental roots and their periodontal tissues were produced.

The 2 notches described above were used as reference points in the histological examination. The histological analysis disclosed that new attachment had formed on all test and control roots and extended in some specimens of both groups to a position coronal to the presurgical level of the gingival margin. The amount of new attachment was similar in the 2 categories of roots, demonstrating that citric acid conditioning did not produce additional new attachment.
Economic perspectives on diagnosis and treatment planning in periodontology
Authors: Pilot Taco
Published: December 2005

Abstract Economic factors in diagnosis and treatment planning in periodontology may be considered from several points of view. A first perspective is that of government responsibility. Because of the explosion in health care expenditure in the last decade, public funding of dental care programmes may become static or even reduced. Most governments try to curb the ever growing public health expenditure. Consequently, terms like effectiveness, efficiency and accountability are now becoming common words also in relation to periodontal health care. Moreover, private insurance companies, which have entered this area, may be individual patient who, explicitly or implicitly, would like to consider the services individual patient, who explicitly or implicitly, would like to consider the sendees rendered in periodontal therapy and prevention as cost‐effective. Features of supply of and demand for care on an individual basis should also be considered. Finally, the periodontist or general practitioner has to consider economic factors. In professional life, there should be a balance between good working conditions providing satisfactory care, and the demands and priorities of individual patients and the community at large.
The non‐specific theory in microbial etiology of inflammatory periodontal diseases
Authors: Theilade Else
Published: December 2005

Abstract In the absence of toothbrushing. the gingival crevice is colonized by a complex indigenous microflora causing gingivitis, a non‐specific inflammation. Subgingival plaque may develop by downgrowth into the inflamed pocket of those micro‐organisms from supragingival plaque which can multiply there. By direct microscopy, increased proportions of motile rods and spirochetes have been found in diseased pockets. Cultures on selective media have demonstrated increased prevalence of various gram‐negative rods. Cultures on non‐selective media have revealed the complexity and variability of the subgingival microflora. comprising more than 200 species. Destructive periodontitis is the result of subgingival colonization, which is favored by such ecological changes as plaque accumulation, gingivitis, and gingival exudate. These changes increase the numbers of micro‐organisms and alter their proportions, but no single species appears in active sites which is not also commonly present in inactive sites. The subgingival micro‐organisms have several virulence factors which promote colonization of the pockets, destroy host defense mechanisms, and provoke inflammation. It appears that different combinations of indigenous bacteria, rather than just a single species, can produce the pathogenic potential necessary to cause progression from gingivitis to destructive periodontitis.
Cellular and soluble mediator components of the local immune response to dental plaque
Authors: Dolby A. E.
Published: December 2005

Abstract The host immune response to dental plaque products leads to altered levels of activity by several types of cells involved in host defence. Cells of the periodontium which contribute to the supporting tissues of the teeth may be directly damaged by cellular attack, or their activity may be modulated by a range of soluble mediators released by host immune cells. These changes contribute to the modification of the tooth‐supporting tissue which is seen in chronic inflammtory periodontal disease.
Clinical uses of an enzyme‐containing dentifrice
Authors: Midda M. , Cooksey M. W.
Published: December 2005

Abstract Previous studies have shown that the inclusion of certain enzymes in mouthrinses and dentifrices will reduce plaque and gingivitis scores. The enzymes that are most effective clinically have, as their active ingredients, amyloglucosidase and glucose oxidase. These produce hydrogen peroxide from dietary fermentable carbohydrates which in turn converts thiocyanate to hypothiocyanite in the presence of salivary lactoperoxidase. The resultant hypothiocyanite acts as a bacterial inhibitor by interfering with cell metabolism; thus, there is a reduction in plaque accumulation and therefore in gingival inflammation. Pilot studies have compared over a short period the action of the trial dentifrice with enzymes and fluoride at 1100 ppm, using as controls the paste without enzymes but with fluoride and a commercial fluoride paste. There was an expected reduction in all scores with all products due to the mechanical removal of plaque, but a significantly greater reduction in gingivitis was noted in the paste with enzymes. This study is of longer duration with many more subjects. Baseline data include plaque and gingival indices and Periotron readings for crevicular fluid. The trial is of a double‐blind non‐crossover study design using a split‐mouth technique. One side of the mouth is given a prophylaxis and the subject given one of the 3 test pastes to use. Readings were repeated every 2 weeks for 3 months. The results show a significant reduction in gingivitis scores in the enzyme‐containing dentifrice group.
Modes of application of anti‐plaque chemicals
Authors: Newman H. N.
Published: December 2005

Abstract Because interdental and subgingival sites are relatively inaccessible to mouthrinsing, they necessitate alternative methods of application of anti‐plaque chemicals. These include routine oral hygiene aids, surfactants to enhance uptake and retention of antimicrobials, gels and periodontal dressings. The principal modes of application that have received attention recently, apart from the systemic route, are syringe and pulsated jet irrigation and slow release compounds. Slow release devices currently receiving attention may be classified as membrane diffusion, solution of drug in polymer and solid drug dispersed in polymer matrix. The most widespread dental instance of a slow release device appears to be the use of varnishes and resins to carry fluoride. Recent attempts at devising improved methods of antimicrobial application include the testing of materials for their biodegradability or for their potential to adhere to mucosal surfaces. It is concluded that the potential exists for antimicrobials applied directly to the site of intended action to contribute significantly to dental health, particularly when employed as components of practical oral hygiene regimes.
The root surf ace and regeneration; present therapeutic limitations and future biologic potentials
Authors: Poison Alan M.
Published: December 2005

Abstract An ultimate goal of periodontal therapy is predictable regeneration of a periodontium at the site of a previous marginal periodontitis. Current clinical therapeutic techniques result in repair, and not regeneration with formation of a new connective tissue attachment. Studies have indicated that surface demineralization of dentin from root surfaces predisposes toward a new connective tissue attachment, and this attachment may take place in an environment lacking periodontal progenitor cell populations. The rôle of the root surface is considered regarding inhibition and facilitation of these various connective tissue responses.
The effect of artificial crown margins at the gingival margin on the periodontal conditions in a group of periodontally supervised patients treated with fixed bridges
Authors: Müller Hans‐Peter
Published: December 2005

Abstract The purpose of this investigation was to study whether or not artificial crown margins at the gingival margin are compatible with periodontal health. Periodontal conditions and the composition of subgingival plaque of 47 crowned teeth, 22 with crown margins at the gingival margin and 25 with a supragingival location of the margin, in 5 patients with extensive fixed bridgework has been examined 1 year after prosthetic treatment. Patients had been treated for periodontal disease and were recalled for prophylaxis sessions once every 2nd or 3rd month. Clinical data indicated little inflammation of the gingival tissues of crowned teeth with margins at the gingiva while at teeth with a supragingival location of the crown margin, gingival tissues showed minor or even no clinical signs of inflammation. In general, the composition of the subgingival plaque was similar to a flora regularly found to be associated with healthy conditions.
Prevalence of incipient juvenile periodontitis at age 16 years in Switzerland
Authors: Kronauer E. , Borsa G. , Lang N. P.
Published: December 2005

Abstract The present radiographic and clinical survey was performed to study the prevalence of “incipient juvenile periodontitis” in a population of 16‐year old adolescents in Switzerland. The subjects to be screened were selected on the basis of the population distribution in the year 1980 in the territory of Switzerland. 7% of all 16‐year old adolescents proportionally distributed into the different ethnic groups of Switzerland were incorporated in the study. From the school dental systems, a total of 7604 pairs of bite‐wing radiographs were obtained and evaluated for (i) fillings and iatrogenic factors, (ii) gross amounts of calculus, (iii) resorption of alveolar bone.

A diagnosis of “incipient juveline periodontitis” was given if the clinical criteria of this disorder proposed by Baer were met.

In 7142 pairs of bite‐wing radiographs, such a diagnosis was attributed to 7 female and 12 male patients. Subsequently, they were asked if they would be examined at the University of Berne School of Dental Medicine. On the basis of history, a complete periodontal chart and full mouth radiographs, the diagnosis was confirmed or refuted. 8 patients (4 female and 4 male) were definitely diagnosed as “incipient juvenile periodontitis”. This resulted in a prevalence of 0.1% with a ratio of female to male of 1:1 in the country of Switzerland at age 16. As in other industrialized countries, this prevalence seems not to be a major public health problem.
Lack of effect of citric acid treatment of root surfaces on the formation of new connective tissue attachment
Authors: Marks S. C. , Mehta N. R.
Published: December 2005

Abstract Previous reports have described an accelerated induction of new attachment and repair of furcations in dogs after treatment of roots surfaces with citric acid, but few controlled clinical studies have examined its usefulness in surgical treatments for periodontitis. This study compared the effects of a comprehensive surgical plaque control procedure with or without citric acid treatment for generalized and localized effects on gingival height, probing pocket depth and attachment level in 72 teeth in 3 patients who were treated surgically for moderate periodontitis and examined every 3 months for 1 year. No statistically significant differences in the effects of the 2 treatments were observed. These observations suggest that there is no clinical advantage of citric acid conditioning of the root surface during surgical treatment of periodontitis.
Microbial populations and active tissue destruction in experimental periodontitis*
Authors: Zappa Urs E. , Polson Alan M. , Eisenberg Arthur D. , Espeland Mark A.
Published: December 2005

Abstract Although specific subgingival microflora are being associated with active tissue destruction in periodontitis, little information exists on the relationship between subgingival flora and histological evidence of tissue destruction. The present study was undertaken to explore these relationships during experimental marginal periodontitis in squirrel monkeys.

In 4 squirrel monkeys, experimental periodontitis was induced around bicuspids and molars using silk ligatures. The buccal part of the subgingival ligature was removed for bacterial sampling 3, 7, and 14 days after ligature placement. Dark‐field microscopy was used to quantify motile forms, spirochetes, straight and curved rods, filaments, cocci and fusiforms. Subgingival plaque prior to periodontitis induction was dominated by cocci, but fusiforms and straight rods were also present. Spirochetes, filaments, curved rods and motile forms were absent. 3 days after induction of periodontitis, there were marked increases in spirochetes, motile forms, filaments, curved and straight rods. The proportions of coccoids and fusiforms decreased. The bacterial proportions stayed at approximately the same levels through 7 and 14 days. Histometric quantification of periodontal destruction showed loss of connective tissue attachment and crestal alveolar bone. A positive correlation was found between periodontal tissue destruction and both total number of subgingival bacteria and spirochetes.
Longitudinal observation of “unattached,” mobile gingival areas
Authors: Kisch Jenö , Badersten Anita , Egelberg Jan
Published: December 2005

Abstract Facial gingival surfaces over cuspids and bicuspids in 20 patients were monitored for 5 years to evaluate the importance of attached gingiva in the maintenance of a stable periodontium. 43 surfaces “at risk” were compared to 36 “non‐risk” surfaces within these patients. Surfaces “at risk” had to meet the following 3 criteria as established by both of 2 independent examiners: (1) width of keratinized gingiva < 1.0 mm; (2) absence of attached gingiva; (3) mobility of the gingival margin.

During the 5 years of observation, “non‐risk” surfaces showed a trend toward decrease in mean width of keratinized gingiva, while this measurement remained unchanged for the surfaces “at risk.” Probing depths remained unaltered for both groups. A trend toward gingival recession and loss of probing attachment was observed for both “risk” and “non‐risk” surfaces. Thus, this study failed to demonstrate that “unattached” and mobile facial gingival surfaces are more susceptible to periodontal breakdown than “attached” surfaces.
Artificial periodontal defects and frequency of tooth brushing in beagle dogs
Authors: Corba N. H. C. , Jansen J. , Pilot T.
Published: December 2005

Abstract This investigation was designed to determine the influence of different frequencies of tooth brushing on artificial periodontal defects in the beagle dog after a period of healing.

In 12 beagle dogs, periodontal defects were created using elastic bands placed in the sulci below the gingival margin after having cut the dento‐gingival fibres to the level of the alveolar bone crest. This active phase of creating defects lasted for 6 weeks. After removal of the elastic bands, the created defects were left undisturbed during the remainder of the pre‐experimental period (12 weeks). 6 premolars in the lower jaw were used (2P2, 3P3, 4P4).

After the pre‐experimental period, the 12 dogs were distributed into 3 groups of 4 dogs each. Each group was brushed with a certain frequency, i.e., 7 times, 3 times or once a week.

Registrations of plaque index, gingival index and probing depth using a constant force probe were carried out on approximal surfaces. The experiment lasted for 24 weeks. A brushing effect was calculated for each dog to include information on all within‐dog and between‐dog variations. It was shown in relation to artificially‐induced periodontal defects in beagle dogs that after a period of healing, brushing 7 times a week is superior to brushing 3 times a week in establishing and maintaining gingival health.
Scaling and root planing with and without periodontal flap surgery
Authors: Caffesse Raul G. , Sweeney Patrick L. , Smith B. A.
Published: December 2005

Abstract Complete removal of calculus is a primary part of achieving a “biologically acceptable” tooth surface in the treatment of periodontitis. Rabbani et al. reported that a single episode of scaling did not completely remove subgingival calculus and that the deeper the periodontal pocket, the less complete the calculus removal. The purpose of the present study was to evaluate the effectiveness of scaling relative to calculus removal following reflection of a periodontal flap. Each of 21 patients who required multiple extractions had 2 teeth scaled, 2 teeth scaled following the reflection of a periodontal flap, and 2 teeth serve as controls. Local anesthesia was used. Following extraction, the % of subgingival tooth surfaces free of calculus was determined using the method described by Rabbani with a stereomicroscope. Results showed that while scaling only (SO) and scaling with a flap (SF) increased the % of root surface without calculus, scaling following the reflection of a flap aided calculus removal in pockets 4 mm and deeper. Comparison of SO versus SF at various pocket depths for % of tooth surfaces completely free of calculus showed 1 to 3 mm pockets to be 86% versus 86%, 4 to 6 mm pockets to be 43% versus 76% and >6 mm pockets to be 32% versus 50%. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. No differences were noted between anterior and posterior teeth or between different tooth surfaces.
In vitro effectiveness of dental floss in plaque removal
Authors: Smith B. A. , Collier Christopher M. , Caffesse Raul G.
Published: December 2005

Abstract This study was designed to determine whether there was any measurable difference in the effectiveness of bacterial plaque removal between 4 commercially available dental flosses. By means of a highly standardized and controlled in vitro experimental model technique utilizing 50 freshly extracted third molars, the possibility of intra‐ and inter‐individual variability was eliminated. Each tooth was individually mounted in a formatray block and the surface was finished to either a “planed” or “unplaned” surface configuration. The “planed” root surface (dentin) was achieved by using 600 grit wet‐sandpaper for tooth surface reduction while the “unplaned” root surface was achieved by using 600 grit wet‐sandpaper. The teeth were then individually processed to effect the growth of bacterial plaque (S. mutans) on the prepared surfaces. Each tooth was subsequently disclosed, flossed and photographed without interruption. The flossing was carried out on a flossing machine utilizing a controlled force of 50 g. A controlled direction of the stroke perpendicular to the long axis of the tooth, and a controlled frequency of flossing (2 strokes per trial) was used.

The results of the clinical trials were evaluated utilizing Ektachrome slides of the previously flossed and disclosed tooth surfaces. The photographs were projected, measured, and statistically analyzed (Student t‐test and paired t‐test) for the effectiveness of plaque removal of the 4 dental flosses and the effect of root surface roughness on the ability of the flosses to remove bacterial plaque. It was found that on smooth, “planed” root surfaces, there were no measurable difference among the 4 flosses. However, on rough, “unplaned” root surfaces, lightly waxed floss was found superior to the other three, relative to its effectiveness of plaque removal. With the exception of lightly waxed floss, which showed no difference, the remaining 3 flosses were found to be more effective in their ability to remove bacterial plaque from smooth, “planed” root surfaces than from rough, “unplaned” root surfaces.
The effects of a simplified oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on chronic inflammatory periodontal disease
Authors: Aziz‐Gandour I. A. , Newman H. N.
Published: December 2005

Abstract This study compared a simplified oral hygiene regime (scaling, root planing and Bass brushing) with this same regime plus 0.02% chlorhexidine (CH), 0.05% metronidazole (MD) and inactive control (PL) solutions delivered supra‐gingivally by a pulsating water jet irrigator.

22 patients were distributed randomly into 3 groups, 0.02% chlorhexidine (CH), 0.05% metronidazole (MD), and inactive control (PL). Approximal surfaces with associated pockets ≥ 4 mm were monitored at day 0, for plaque index (PII), gingival index (GI), sulcus bleeding index (SBI), baseline measurement for gingival shrinkage and probeable pocket depth. All monitored surfaces were then immediately scaled and root planed. All patients received identical oral hygiene instruction (Bass brushing), with a sodium fluoride toothpaste and a multituft toothbrush, and were shown how to use the oral irrigator. Proficiency in use of the oral irrigator was checked again at day 7. No interdental cleaning was taught. The active treatment period was 28 days. Patients were seen at days 7, 28, 56 and 84, and all parameters were recorded at each visit, but no further oral hygiene instruction was given.

Within procedure comparisons of the findings at days 28 (end of active treatment) 56 and 84 with those at day 0, showed statistically highly significant improvements in all parameters for all groups. Regarding between procedure comparisons, CH was better in reducing PlI at all times except at day 84, and on several occasions in reducing GI and SBI. Irrigated groups were always better than non‐irrigated groups. Although the differences were statistically highly significant, clinically the differences between groups were relatively small, except for CH effect on PlI. It was concluded that an oral hygiene regime of scaling, root planing and Bass brushing is statistically less effective in reducing PLI, GI and SBI than the same regime with once daily supragingival irrigation with a pulsating jet oral irrigator, especially using CH (0.02%).
The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque
Authors: Sanders P. C. , Linden G. J. , Newman H. N.
Published: December 2005

Abstract 23 patients with pockets ≥ 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned.

For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and “others” (non‐motile rods, filaments and fusiforms).

The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time‐points, the benefits were notstatistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels.

The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subging plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.