A case of systemic arterial supply to the normal left basal segments with no symptoms

STATEMENT OF PROBLEM: The surgical and restorative procedures at the posterior region of the maxilla and the mandible present a complex task in the treatment of partially edentulous patients. PURPOSE: The purpose of this study was to investigate the applicability of short hydroxylapatite-coated dental implants to the posterior mandible of partially edentulous patients. MATERIAL AND METHODS: Eight and 11 mm implants were evaluated as to their cumulative survival rate, clinical status (plaque index, gingival index, probing depth), and marginal bone loss over a 5-year period. RESULTS AND CONCLUSIONS: The verified overall cumulative survival rate was 94% for implants and 91% for prostheses. These results suggest predictable success for the application of short implants to the posterior mandible.     

Distribution of Porphyromonas gingivalis in adult periodontitis patients

Porphyromonas gingivalis (P. gingivalis) is considered to be a pathogenic factor in adult or rapidly progressive periodontitis. The purpose of this study was to evaluate the distribution of P. gingivalis in the dentition of adult periodontitis patients using a nonradioactive DNA probe, and to compare the presence of P. gingivalis with clinical parameters. Twelve adult periodontitis patients were examined. Subgingival plaque samples were taken from 4 sites of all the remaining teeth using a paper point. At the same time, probing depth and bleeding on probing (BOP) were also recorded. Plaque samples were investigated using a whole genomic DNA probe from P. gingivalis (ATCC 33277) modified with bisulfite. The detection, percentage and amounts of P. gingivalis present were statistically compared with probing depth and BOP in each patient. P. gingivalis was detected in all patients examined. The detection percentage was 35% of all sample sites. When the probing depth was over 4 mm or BOP was positive, the detection percentage of P. gingivalis significantly increased (P < 0.01). As more P. gingivalis was identified, the percentage of sites with deep probing depth or that were BOP positive increased significantly (P < 0.01). However, P. gingivalis was also detected in clinically healthy sites, and P. gingivalis negative sites with deep probing depth or that were BOP positive existed in the same patient. These results indicate that P. gingivalis play an important role, but is not the only microorganism responsible for adult periodontitis.     

Role of intestinal transit in the pathogenesis of gallbladder stones

The aim of the study was to compare the occurrence and levels of A. actinomycetemcomitans, P. gingivalis, and P. intermedia in the subgingival plaque from sites with and without early periodontitis in adolescents using an ELISA. 47, 15- to 16-year-old adolescents (39 Indo-Pakistani, 8 white Caucasian) were examined for clinical attachment level, probing depth, supragingival plaque, subgingival calculus and bleeding on probing on the mesio-buccal and disto-buccal aspects of the 1st molars and the incisors. Based on the clinical data, 2 sites per subject were selected for subgingival plaque sampling 3 weeks later: in 32 subjects with loss of attachment > or = 1 mm, a diseased site (D) and a healthy comparison control site (C) were sampled; in 15 subjects in whom loss of attachment had not yet developed, 1 of the upper molar sites was selected, called the at-risk site (R), together with a C site. The presence and levels of A. actinomycetemcomitans, P. gingivalis, and P. intermedia were determined using an ELISA. The loss of attachment subgroup had significantly more pockets > or = 4 mm, subgingival calculus and bleeding on probing (p < 0.05). Significantly more of the D than C sites had P. gingivalis both at detectable and at measurable levels (p < 0.05). In subjects who had no loss in clinical attachment levels, fewer sampled sites harboured any of the suspected periodontopathogens investigated, and no significant differences were found between the R or C sites (p > 0.05). Although there was a significantly higher prevalence and extent of loss of attachment > or = 1 mm in the Indo-Pakistani subjects compared with the Caucasians (p < 0.05), no differences could be identified in the distribution of the bacteria. It is concluded that monitoring of the subgingival plaque may be useful in studies of early periodontitis in adolescents, and the role of P. gingivalis needs to be elucidated in prospective longitudinal investigations.     

Proteoglycan expression by human trabecular meshworks

The aim of the present study was to clinically assess the peri-implant and periodontal conditions 1 year after placement of oral implants (ITI Dental Implant System) in partially edentulous patients. In all, 127 patients (median age 50 years, range 17 to 79) were examined. They were all treated according to a concept of comprehensive dental care and had received fixed partial dentures (FPD). Significant differences were observed between implants and contralateral control teeth with respect to mean pocket probing depth (PPD) (2.55 mm at implants/2.02 mm at teeth), mean probing attachment level (PAL) (2.97 mm/2.53 mm) and bleeding on probing (BOP) (24%/12%) (Wilcoxon matched pairs sign rank test, P < or = 0.01), whereas mean modified plaque index (0.22/0.30), mean modified bleeding index (0.35/0.44) and mean recession (-0.42 mm/-0.51 mm) did not significantly differ between implants and teeth. Compared to control teeth, the width of keratinized mucosa at implants was significantly smaller at lingual, but not at buccal aspects. Regression analyses showed no significant association between the amount of keratinized mucosa and degree of inflammation. Recession, PPD and PAL were slightly influenced by the amount of keratinized mucosa indicating greater resistance to probing. Grouping the implants according to various lengths, type of fixation of the FPD or combination with natural teeth did not result in statistically significant different clinical parameters, whereas grouping according to different localization within the oral cavity did. For example, the mean PAL in 83 anterior implants was 2.52 mm, whereas 175 posterior implants had a mean PAL of 3.18 mm (Mann-Whitney U-test, P < or = 0.01). Regression analyses between the mean PAL for all implants in each patient and the mean PAL of the corresponding dentition revealed an r2 of 0.23 (P < or = 0.01). Using multiple regression analysis, the mean PAL of the implants showed to be significantly influenced by the combined factors "fullmouth" PII, "fullmouth" BOP and mean PAL of all teeth. The results of this study suggest that in partially edentulous patients the overall periodontal condition may influence the clinical condition around implants and thus reinforces the importance of periodontal treatment prior to and supportive periodontal therapy after the incorporation of osseointegrated oral implants.     

Crevicular fluid enzymes from endosseous dental implants and natural teeth

Several neutrophil-derived enzymes that are present in the gingival crevicular fluid have been evaluated for use as risk markers for periodontal disease progression. However, very little information is available about the presence of these enzymes in peri-implant tissues. The purpose of this cross-sectional study was to compare levels of enzymes in gingival crevicular fluid between natural teeth and endosseous dental implants and between well-integrated and failing implants. Scores of plaque and gingivitis were recorded for 68 integrated implants, five failing implants, and 34 natural teeth in 12 completely edentulous and 18 partially edentulous subjects. Samples of gingival crevicular fluid were obtained from these sites using filter paper strips and were assayed for levels of neutral protease, neutrophil elastase, myeloperoxidase, and beta-glucuronidase. Neutral protease levels were higher (P = .066) at moderately to severely inflamed implant sites (Gingival Index of 2, 3) compared to mildly or noninflamed sites (Gingival Index of = 0, 1). Despite the small number (n = 5) of failing implants evaluated in this study, levels of neutrophil elastase, myeloperoxidase, and beta-glucuronidase were significantly higher (P < or = .001) around failing implants compared to successful implants. Neutral protease levels were also elevated around failing implants, but the difference was not statistically significant. Results of this study indicate that neutrophil elastase, myeloperoxidase, and beta-glucuronidase levels in GCF appear to be good candidates for study as risk markers of implant failure.     

Subgingival microbiota in healthy, well-maintained elder and periodontitis subjects

This investigation compared the site prevalence of 40 subgingival species in 30 periodontally healthy (mean age 36+/-9 years), 35 elders with a well-maintained periodontium (mean age 77+/-5) and 138 adult periodontitis subjects (mean age 46+/-11). Subgingival plaque samples were taken from the mesial aspect of each tooth (up to 28 samples) in the 203 subjects at baseline. The presence and levels of 40 subgingival taxa were determined in 5003 plaque samples using whole genomic DNA probes and checkerboard DNA-DNA hybridization. Clinical assessments including dichotomous measures of gingival redness, bleeding on probing, plaque accumulation and suppuration, as well as duplicate measures of pocket depth and attachment level, were made at 6 sites per tooth. The % of sites colonized by each species (prevalence) was computed for each subject. Differences in prevalence and levels among groups were sought using the Kruskal-Wallis test. Commonly detected species, such as Actinomyces naeslundii genospecies 2, Streptococcus sanguis and Streptococcus oralis did not differ significantly among subject groups. After adjusting for multiple comparisons, 4 species were significantly elevated and at greater prevalence in the periodontitis group. Mean % of sites (+/-SEM) colonized by Bacteroides forsythus was 10+/-3, 12+/-2 and 40+/-2 (p<0.001) for healthy, elder and periodontitis groups respectively. The odds ratio was 14.4:1 that a subject had periodontitis when B. forsythus was detected at > or = 5% of sampled sites. Mean prevalence for Porphyromonas gingivalis in healthy, elder and periodontitis subjects was 4+/-2, 5+/-2 and 23+/-2 respectively (p<0.001); for Treponema denticola 12+/-4, 10+/-3 and 30+/-2 (p<0.001) and for Selenomonas noxia 6+/-2, 7+/-2 and 19+/-2 (p<0.01). Similar differences among subject groups were observed when only sites with PD 0-4 mm were analyzed. The data suggest an etiologic role for B. forsythus, P. gingivalis, T. denticola and S. noxia in adult periodontitis.     

Subgingival temperature: relation to gingival crevicular fluid enzymes, cytokines, and subgingival plaque micro-organisms

There have been no reports on the relationship of subgingival temperature to specific gingival crevicular fluid (GCF) components. Therefore, the purpose of this cross-sectional study was to determine whether there was any relationship between subgingival temperature and GCF levels of neutrophil elastase (NE), myeloperoxidase (MPO), beta-glucuronidase (BG), interleukin-1 alpha (IL-1), and interferon alpha (IFN). Furthermore, another objective was to confirm an association of subgingival temperature with clinical parameters and specific subgingival plaque micro-organisms as has been reported earlier. 27 human subjects each having healthy (n = 50), gingivitis (n = 59) and periodontitis (n = 53) sites were evaluated. The plaque index (PI), subgingival temperature, probing depth, attachment loss, bleeding index and gingival index were measured. GCF was sampled following the measurement of the PI and removal of the supragingival plaque. GCF samples were assayed for the enzymes NE, BG, MPO and the cytokines IFN-alpha and IL-1 alpha. A sterile Gracey curette was utilized at each sampled site to collect subgingival plaque. The plaque samples were evaluated using an immunoassay. Subgingival temperature was found to directly correlate with all clinical parameters (p < 0.001). Significant, albeit not large, correlations were found between subgingival temperature and NE (r = 0.35, p < 0.001), MPO (r = 0.26, p < 0.001) and BG (r = 0.23, p < 0.01). Temperature was found to correlate positively with E. corrodens (r = 0.33, p < 0.02) and F. nucleatum (r = 0.25, p < 0.05) but not with P. intermedia (r = 0.02, p = 0.9), P. gingivalis (r = 0.20, p = 0.1) and A. actinomycetemcomitans (r = 0.01, p > 0.9). In conclusion, subgingival temperature is correlated with the GCF enzymes, NE, MPO and BG as well as the clinical parameters and specific plaque micro-organisms associated with periodontal disease.     

Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier

THIS RANDOMIZED, CONTROLLED, CLINICAL STUDY was designed to evaluate outcome following surgical implantation of an allogeneic, freeze-dried, demineralized bone matrix-calcium sulfate (DBM+CS) composite with a CS barrier in intrabony periodontal defects. Twenty-six patients contributing 26 deep intrabony defects completed the study. Thirteen patients received the DBM+CS implant. Thirteen patients received gingival flap surgery alone (GFS; control). Clinical outcome was assessed at 6 and 12 months postsurgery. At 12 months postsurgery, probing depth (PD) reduction (mean +/-SD) for the DBM+CS and GFS group was to 4.3+/-0.5 and 3.0+/-1.3 mm; clinical attachment gain was to 2.9+/-0.8 and 1.7+/-1.5 mm; and probing bone level gain was to 2.9+/-1.4 and 1.2+/-1.2 mm, respectively. There were no apparent differences between evaluations at 6 and 12 months postsurgery. Clinical improvements were significantly different from presurgery for both groups at both observation intervals (P < 0.01). There were no significant differences between groups in PD reduction and clinical attachment gain. Probing bone level gain was significantly greater in the DBM+CS group compared to controls (P < 0.05). In summary, surgical implantation of DBM+CS with a CS barrier resulted in reduced PD and improved attachment levels comparable to that achieved by gingival flap surgery alone. However, gain in probing bone levels in deep intrabony periodontal pockets assessed by clinical parameters was greater than that observed by gingival flap surgery alone. These changes were noted at both 6 and 12 months after surgery. This regenerative technique needs further biologic evaluation before being generally accepted.     

Results of limited initial periodontal therapy in smokers and non-smokers

Eighty-seven adult patients (54 non-smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1-hour full-mouth subgingival scaling and root planing, with no maintenance recalls, during this 9-month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non-smokers was 5.46 +/- .46 mm and for smokers 5.70 +/- 0.66 mm. Data analysis (t test) revealed that both non-smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non-smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non-smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non-smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non-smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 +/- 0.45) than non-smokers (1.45 +/- 0.40). By 9 months only the gingival index of non-smokers decreased significantly compared to baseline (1.26 +/- 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 +/- 0.39) and non-smokers (0.78 +/- 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non-smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non-smokers responded similarly after 9 months to the limited amount of initial therapy provided.     

An autopsy case of ancient sarcoidosis associated with severe fibrosis in the liver and heart

The aim of the present trial was to study the effect of meticulous supragingival plaque control on (i) the subgingival microbiota, and (ii) the rate of progression of attachment loss in subjects with advanced periodontal disease. An intra-individual group of sites exposed to non-surgical periodontal therapy served as controls. 12 patients with advanced periodontal disease were subjected to a baseline examination (BL) including assessments of oral hygiene status, gingival condition (BoP), probing depth, clinical attachment level and subgingival microbiota from pooled samples from each quadrant. The assessments were repeated after 12, 24 and 36 months. Following BL, a split mouth study was initiated. The patients received oral hygiene instruction, supragingival scaling and case presentation. 2 quadrants in each patient were identified as "test" and the remaining 2 as "control" quadrants. Subgingival therapy was performed in all bleeding sites in the control quadrants. Oral hygiene instructions and plaque control exercises were repeated once every 2 weeks during the initial 3 months of the study. Thereafter the plaque control program was repeated once every 3 months for the duration of the 3 years. Sites demonstrating loss of clinical attachment > or =2 mm in the test quadrants were treated subgingivally. The results showed that in both test and control quadrants repeated oral hygiene instructions and supragingival plaque removal procedures resulted in low plaque scores throughout the study. The gingival bleeding scores and the frequency of periodontal pockets > or =4 mm was, however, significantly higher in the test quadrants than in the control quadrants. At the end of the 3 year study, the control quadrants showed significantly more reduced (> or =2 mm) pockets than the test quadrants, 265 versus 96. The number of sites in the test quadrants showing probing attachment loss > or =2 mm was more than 4x greater than in the control quadrants (59 versus 13). The microbiological findings indicate a more pronounced reduction only for P. gingivalis in the control quadrants. None of the other 4 marker bacteria consistently reflected or predicted the clinical parameters. The present study shows that only supragingival plaque control fails to prevent further periodontal tissue destruction in subjects with advanced periodontal disease.     

Factors affecting cyclosporine-induced gingival overgrowth in pediatric renal transplant recipients

The purpose of this research was to study the occurrence of gingival overgrowth (GO) in children after kidney transplantation and to investigate the relationship of GO to medical and dental parameters. Forty-nine kidney transplant patients taking the immunosuppressive drug cyclosporine A (CsA) were evaluated for plaque (PI), calculus (CI), gingival inflammation (GI), probing depth (PD), width of keratinized gingiva (GW), and gingival overgrowth (GO). Blood trough levels and oral dosages of CsA were obtained from medical charts on the day of examination. Most (77.5%) subjects exhibited GO, suggesting that GO is a frequent problem in children and adolescents ingesting CsA. GI, PD, and GW were found to be statistically significantly greater in subjects with GO than in those without GO. CsA dose/day was not significantly different between subjects with GO and those without GO. CsA dose/kg body weight and blood trough levels of CsA were significantly higher in subjects without GO, but the average length of time subjects without GO had been ingesting CsA was only 1.3 months, compared with an average 3.5 years for subjects with GO. The results indicate that in young subjects, duration of CsA ingestion may be the most critical factor related to eventual GO development.     

Local metronidazole application in maintenance patients. Clinical and microbiological evaluation

The purpose of this investigation was to evaluate the clinical and microbiological effect of local antibiotic therapy in comparison with subgingival scaling and root planing in a randomized semi-masked study. Forty-six recall patients who completed systematic periodontal therapy 6 to 24 months prior to the study were enrolled. The inclusion requirements were at least one site with probing depth > or = 5 mm in each quadrant, no scaling, and no antibiotic therapy during the last 6 months. After randomization each patient received 2 different treatments: in 2 quadrants metronidazole 25% dental gel was applied subgingivally to the pockets at day 0 and day 7; scaling and root planing was carried out in the 2 other quadrants, one at day 0 and in the remaining quadrant at day 7. Subgingival microbiological samples were taken from each patient before treatment and on days 21, 91, and 175 after the treatment. The analyses were carried out by indirect immunofluorescence assay. At all treated sites probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded on days 0, 21, 91, and 175. Both treatments resulted in PD reduction and CAL gain. PD reduction was statistically significant (P < 0.01) for both treatment modalities after 6 months. The CAL gain was not significant for either treatment. There was no statistical significance between scaling and antibiotic therapy. Treponema denticola, Porphyromonas gingivalis, and Prevotella intermedia were significantly reduced after therapy; however, there were no statistically significant differences between treatments. If Actinobacillus actinomycetemcomitans was present before therapy, it was also present after treatment in both groups. The conclusion is that, in recall patients, local application of metronidazole and scaling and root planing showed similar clinical and microbiological effects without statistically significant differences.     

Exulceratio simplex dieulafoy

Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E. = 1.36) BOP sites and 35.3% (S.E. = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with < 4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PD. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1-2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)     

The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus in humans 1 year after 4 randomized treatment modalities

The relationship between probing attachment changes in treated periodontal pockets and the prevalence of selected periodontal pathogens was assessed in 10 patients with adult periodontitis 1 year following randomized therapy. All patients had at least 1 tooth in each quadrant with an inflamed pocket of probing depth > or =5 mm and clinical attachment loss and harbored at least one of the following 3 major periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, or Bacteroides forsythus. The number of target organisms per site was determined preoperatively; at 1 week; and at 1, 3, 6, and 12 months postoperatively utilizing DNA probes. The following clinical parameters were measured and recorded preoperatively and at 1, 3, 6, and 12 months post-treatment: gingival fluid flow, gingival index, plaque index, probing depth, probing attachment level, gingival recession, and bleeding on probing. One quadrant in each patient was randomly assigned to 1 of the following 4 treatments: 1) scaling and root planing; 2) pocket reduction through osseous surgery and apically-positioned flap; 3) modified Widman flap; and 4) modified Widman flap and topical application of saturated citric acid at pH 1 for 3 minutes. All 4 treatments were rendered in one appointment using local anesthesia. No postoperative antibiotics were used, but patients rinsed with 0.12% chlorhexidine for the first 3 months postoperatively and received a prophylaxis every 3 months. This investigation revealed: 1) 30.0% of the sites were infected by at least 1 species at 3, 6, and 12 months postoperatively. 2) Failing sites were infected by a high number of both Pg and Bf These sites had a mean of 24.2+/-9.0 x 10(3) Pg and 93.1+/-42.0 X 10(3) Bf while stable sites had a mean of 6.8+/-0.5 x 10(3) Pg and 7.2+/-1.2 x 10(3) Bf (P = 0.06 and P = 0.05, respectively). 3) The infected sites lost significantly more mean clinical attachment at 12 months (1.5+/-0.5 mm compared to a loss of 0.2+/-0.3 mm for uninfected sites, P = 0.017). 4) The infected sites had a significantly greater BOP (67+/-14% versus 25+/-8% for uninfected sites at 12 months, P = 0.012). 5) The choice of treatment modality did not affect the prevalence of the target species at 1 year post-treatment. These results suggest that prevalence of microbial pathogens negatively affects the 1 year outcome of periodontal surgical and nonsurgical therapy.     

Reduced serum IgG reactivities with bacteria from dental plaque in HIV-infected persons with periodontitis

Serum samples were obtained from 44 HIV-seropositive (HIV+) and 37 HIV-seronegative (HIV-) persons that were grouped according to periodontal status. Serum IgG and IgA reactivities towards Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis. Prevotella intermedia, Prevotella nigrescens and Fusobacterium nucleatum were measured by means of ELISA. HIV+ persons with chronic marginal periodontitis showed significantly lower IgG reactivities to the periodontal pathogens A. actinomycetemcomitans, P. gingivalis, P. intermedia and F. nucleatum as compared with their HIV- counterparts (p < 0.05). Specific serum IgA reactivities were similar in the two periodontitis groups, except for P. nigrescens where the HIV+ group with chronic marginal periodontitis had lower values than their systemically healthy counterparts (p < 0.05). The results indicate that HIV infection affects the humoral serum immune responses against bacteria in dental plaque; the depressed antibody responses may contribute to the increased susceptibility for periodontal infections in HIV-infected patients.     

Tripeptide growth hormone secretagogues

The purpose of the present study was to compare in untreated patients suffering from moderate to severe periodontitis the efficacy of dental floss (DF) and interdental brushes (IDB) in the reduction of plaque, gingival inflammation, and probing depth in a 6-week period prior to subgingival debridement. Twenty-six patients (12 female, 14 male; mean age 37.4 years; range 27 to 72 years) were instructed to use DF for one side of the dentition and IDB for the other side as an adjunct to the daily toothbrushing for 6 weeks. Oral hygiene instructions for toothbrushing and the use of the two devices were given at baseline and at week 3. Measurements were carried out at baseline and at 6 weeks including plaque scores, probing depth, and 2 bleeding scores (periodontal pocket bleeding index and angulated bleeding index). With the IDB, the approximal plaque score at baseline of 3.09 reduced to 2.15 at 6 weeks and with DF from 3.10 to 2.47, respectively. IDB proved to remove significantly more plaque than DF. Baseline probing depth of 5.84 mm for IDB sites and 5.59 mm for DF sites was reduced to 5.01 mm at 6 weeks for both regimens. Analysis showed that the use of IDB resulted in a greater pocket reduction. Both bleeding indices were slightly reduced with IDB and DF, but no differences between devices were found. In relation to patient acceptance, more problems were observed with DF, and IDB were felt to be more efficacious. In conclusion, the results of the present study indicate that in combination with a manual toothbrush, the use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss. Although the differences were small, they indicate, in combination with patient preferences, that interdental brushes are to be considered preferable to floss for interdental plaque removal in patients suffering from moderate to severe periodontitis.     

Clinical and microbiological effects of minocycline-loaded microcapsules in adult periodontitis

Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.     

Bacterial steroidogenesis by periodontal pathogens and the effect of bacterial enzymes on steroid conversions by human gingival fibroblasts in culture

Studies were performed to investigate the effect of microbial culture supernatants of periodontal pathogens on the metabolism of radiolabelled testosterone in the presence or absence of human gingival fibroblasts. Subgingival plaque samples were obtained on paper points from 3 sites with probing depth values of 6-8 mm. Samples were incubated with 14C-testosterone for 24 h in brain heart infusion (BHI) broth. Similar incubations were also carried out with strains of A. actinomycetemcomitans, P. Intermedius and P. gingivalis to study the metabolism of radiolabelled testosterone by these periodontal pathogens. At the end of a 24 h incubation period with fibroblasts and supernatants or sonicates, the radioactive metabolites were extracted with ethyl acetate, evaporated and subjected to thin layer chromatography. The separated metabolites were quantified by scanning the radioactive plates using a Berthold linear analyser. When three sub-gingival plaque samples were incubated with radiolabelled testosterone there were 50-fold, 10-12-fold and 15-17-fold increases in 5 alpha-dihydrotestosterone (DHT) synthesis over 4-androstenedione production in these mixed microbial cultures. The two strains of P. intermedius produced 3- and 20-fold increases in 4-androstenedione production and DHT synthesis respectively. Both strains of A. actinomycetemcomitans and P. gingivalis showed 3-4-fold and 12-28-fold increases respectively in 4-androstenedione synthesis over that of DHT. Culture supernatants of P. intermedius and P. gingivalis caused 3-fold and 2-fold increases in DHT synthesis by fibroblasts over controls. There was little change in the case of the third pathogen. Since DHT has implications on matrix synthesis by fibroblasts in the environment of plaque associated inflammatory periodontal disease, bacterial metabolism and the effect of bacterial supernatants on human gingival fibroblasts can influence the degree of inflammatory repair.     

Modification of cystatin C activity by bacterial proteinases and neutrophil elastase in periodontitis

AIM: To study the interaction between the human cysteine proteinase inhibitor, cystatin C, and proteinases of periodontitis associated bacteria. METHODS: Gingival crevicular fluid samples were collected from discrete periodontitis sites and their cystatin C content was estimated by enzyme linked immunosorbent assay (ELISA). The interaction between cystatin C and proteolytic enzymes from cultured strains of the gingival bacteria Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans was studied by measuring inhibition of enzyme activity against peptidyl substrates, by detection of break down patterns of solid phase coupled and soluble cystatin C, and by N-terminal sequence analysis of cystatin C products resulting from the interactions. RESULTS: Gingival crevicular fluid contained cystatin C at a concentration of approximately 15 nM. Cystatin C did not inhibit the principal thiol stimulated proteinase activity of P gingivalis. Instead, strains of P gingivalis and P intermedia, but not A actinomycetemcomitans, released cystatin C modifying proteinases. Extracts of five P gingivalis and five P intermedia strains all hydrolysed bonds in the N-terminal region of cystatin C at physiological pH values. The modified cystatin C resulting from incubation with one P gingivalis strain was isolated and found to lack the eight most N-terminal residues. The affinity of the modified inhibitor for cathepsin B was 20-fold lower (Ki 5 nM) than that of full length cystatin C. A 50 kDa thiol stimulated proteinase, gingipain R, was isolated from P gingivalis and shown to be responsible for the Arg8-bond hydrolysis in cystatin C. The cathepsin B inhibitory activity of cystatin C incubated with gingival crevicular fluid was rapidly abolished after Val10-bond cleavage by elastase from exudate neutrophils, but cleavage at the gingipain specific Arg8-bond was also demonstrated. CONCLUSIONS: The physiological control of cathepsin B activity is impeded in periodontitis, owing to the release of proteinases from infecting P gingivalis and neutrophils, with a contribution to the tissue destruction seen in periodontitis as a probable consequence.     

PC-assisted network for quality control in film development

The purpose of the present investigation was to evaluate the influence on sampling repetition of aspartate aminotransferase (AST) level with 10-minute intervals. Tests based on the composition of gingival crevicular fluid (GCF) for detection of active periodontitis and GCF require the repetition of sampling. Two 30-second samples of GCF were harvested with 10-minute intervals from 123 sites in 10 healthy subjects and 20 periodontitis patients. AST activity of the first samples in periodontitis subjects were approximately 7.8% greater than that of the second samples. The difference were not significant (P > 0.05). But in healthy subjects the difference were significant (P < 0.05). AST activity correlation positively with bleeding index (BI) and probing pocket depth (PD).