BACKGROUND:The aim of this study was to evaluate the clinical outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel.METHODS:Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing, a total of 40 sites, 2 in each patient, with probing depth > or = 5 mm were selected. One site randomly selected was treated with metronidazole gel (test) and the other site with a placebo gel (control). Baseline and follow-up measurements included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL).RESULTS:There were no statistically significant differences in PI, GI, BOP, PD, or CAL between test and control sites.CONCLUSION:This study showed that local treatment with 25% metronidazole gel did not seem to influence the clinical healing in this group of subjects with recurrent periodontal disease.

The aim of this study was to investigate the correlation of cervical enamel projection (CEP) with furcation involvement (FI) and compare the healing response of molars with or without CEP after surgery. A total of 30 patients contributing 78 maxillary and mandibular first or second molars were included. Plaque Index (PII), Gingival Index (GI), probing pocket depth (PPD) and probing attachment level (PAL) were measured before surgery and 1 and 3 or 6 months postoperatively. During surgery, CEPs were identified and classified with a modified grading system from Masters & Hoskins (24). FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest mm. Any measurement > or = 1 mm was considered as FI. CEPs were found in 33 molars (42%). Grade III CEPs were found in 14 teeth, Grade IIIb in 4 teeth, Grade II in 1 tooth and Grade I in 14 teeth. The results showed no significant correlation of CEP with FI. Nor was CEP significantly affecting the PPD and PAL 3 or 6 months after surgery. However, FI was a significant factor in the further loss of PAL after surgery. Further studies, involving larger sample size may be necessary in order to give more conclusive results.

OBJECTIVES:The aim of this multicenter trial was to compare the clinical and radiographical outcome of a ready-to-use Emdogain-gel (test) with the marketed Emdogain (control).METHODS:Subjects with bilateral infrabony defects > or =4 mm deep and > or =2 mm wide according to radiographs were selected. 88 subjects with probing pocket depth (PPD) > or =6 mm > or =1 month after supervised oral hygiene and scaling participated. At baseline plaque index, bleeding on probing, PPD and probing attachment level were recorded and reproducible radiographs for computer-based bone level measurements were taken. In each subject, 1 tooth was randomly treated with the test and 1 tooth with the control gel. Examinations were repeated 8 and 16 months post-operatively.RESULTS:After 16 months, the mean test PPD was 4.1 mm and the mean control PPD 4.2 mm. The mean gain of attachment was 2.7 mm for test and 2.9 mm for the control sites, and the radiographic measurements demonstrated a mean gain of 1 mm for both test and control sites.CONCLUSION:This series of cases demonstrated a statistically significant reduction of pocket depths and gain of attachment and bone after 8 and 16 months with no difference between the 2 preparations.

The protocol for this study was designed to evaluate the effects of supportive recall treatments provided with different frequencies, viz. at 3-, 6-, 12- and 18-month intervals. The subjects for the study were recruited from patients attending a public, general dentistry clinic. Prior to baseline, the subjects were given necessary dental treatments to provide a proper baseline for the study. Baseline, intermittent and final recordings included scores of dental plaque, bleeding on probing, probing depth and probing attachment level. Results were evaluated statistically by intergroup comparisons of changes for the various parameters from baseline to final examination after 5 years. The analyses showed some advantage to shorter recall intervals for plaque and bleeding scores. Although not statistically significant, there was a trend suggesting some rebound of sites > or =6 mm deep at the end of the study for the 18-month group, but not for the other groups. Similarly, there was a trend that the 18-month group showed a higher percentage of buccal/lingual furcation sites with attachment loss > or = 1.0 mm than the other groups. Apart from these trends, the analyses failed to demonstrate differences between the groups for either changes of probing depths or probing attachment levels. The negative observations included identification of individuals with 'disease progression' in the various groups, using a series of arbitrary definitions for this parameter. The results of this trial suggest that recall intervals extended to a year may be acceptable for the purpose of reducing periodontal disease progression in individuals with a history of limited susceptibility to the disease.

The aim of this clinical study was to compare the treatment outcome following root surface conditioning using an EDTA gel preparation in conjunction with surgical therapy with that following conventional flap surgery in periodontal intraosseous defects. 36 patients, each of them contributing one intraosseous defect greater than or equal to 4 mm in depth participated. Defect sites had a probing pocket depth greater than or equal to 5 mm and bled on probing following hygienic treatment phase. No furcation involvement or endodontic complications were present. In the EDTA group, 18 consecutive patients, defects were treated by root conditioning with EDTA gel for 3 minutes in combination with surgical therapy. In the control group, 18 patients, conventional flap surgery was performed without root conditioning. Chlorhexidine rinsings 0.2% were prescribed following surgery for 2-3 weeks with modified oral hygiene instruction. A strict recall program was implemented including professional prophylaxis and oral hygiene reinforcement every 4-6 weeks until 6-month re-evaluation. Baseline probing pocket depths and defect depths of 7.1+/-1.3 mm and 6.9+/-1.6 mm in the EDTA group and 7.6+/-1.9 mm and 6.6+/-1.7 mm, respectively, in the control group were measured. 6-month clinical results showed a significant probing attachment level gain of 1.8+/-1.5 mm and 1.0+/-1.7 mm in the EDTA and control groups respectively. A probing bone gain of 1.0+/-1.3 mm in the EDTA group was measured with a non-significant gain of 0.4+/-1.2 mm in the control group. Radiographic analysis confirmed these results. There were no statistically significant differences in treatment outcome between the group treated by root conditioning in combination with flap surgery and conventional flap surgery alone.

The aim of the study was to evaluate the clinical, radiographical and microbiological outcome after using guided tissue regeneration (GTR) with a bioabsorbable membrane, Resolut(R). Subjects with bilateral infrabony defects at single rooted teeth were selected. A total of 22 teeth, 2 in each 1 of 7 patients and 4 in 2 patients, with probing pocket depth greater than or equal to 5 mm, 3 months after scaling, participated. At baseline, assessments of plaque and gingival indices, bleeding on probing, probing pocket depth and probing attachment level were recorded and reproducible radiographs for computer-based bone level measurements were taken. Bacterial samples were collected to investigate the presence of periodontitis-associated bacteria, e.g., Porphyromonas/Prevotella- and Fusobactrium-like micro-organisms. One tooth nas randomly treated with GTR and the contralateral with an open debridement procedure as a control. Clinical, radiographical and microbiological examinations were repeated 6 and 12 months postoperatively. Both procedures demonstrated a statistically significant improvement of gingival conditions, reduction of pocket depths and gain of attachment. When evaluating the differences between test and control teeth, none of the clinical parameters yielded statistical differerence. Computer-based bone-level measurements showed only small differences in the majority of both test and control sites. The differences were not significant. Periodontitis-associated bacteria were present at baseline, but the appearance was not related to any specific site or patient and did not demonstrate any unwanted change in the 6- and 12-month samples. The findings suggest that the clinical, radiographical and microbiological improvements were not significantly enhanced with the GTR therapy.

The aim of this controlled, clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects. Forty patients, each contributing one defect > or =4 mm in depth participated. The control group (18 individuals) received conventional flap therapy, while the test group (22 individuals) was treated using the bioabsorbable membrane, Guidor. Clinical assessments were made by one examiner, blinded with respect to treatment group, at baseline, 6 and 12 months following surgery. Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured. Twelve month results showed a significant clinical attachment level gain in both control (1.1+/-1.8 mm), and membrane group (1.3+/-2.1 mm). Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups. Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites, respectively. Radiographic evaluation confirmed these results. There were no significant differences found between treatment groups for any of the tested variables. Smoking had a negative effect on healing in both groups. In conclusion, clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy.

The aim of this paper was to compare the short-term results of gingivectomy (GV) and modified Widman flap (MWF) surgery in the treatment of infrabony defects. 14 patients with 68 bilateral infrabony defects were selected. At baseline, and 3 and 6 months postoperatively, assessments of oral hygiene, gingival conditions, bleeding on probing, probing pocket depth and attachment level, were recorded. Conventional radiograps were obtained in a way that assured a reproducible projection geometry. In a split-mouth design, one jaw quadrant was randomly treated with GV, while the contralateral with a MWF. The changes of the bone tissue were assessed by means of conventional and subtraction images by 2 observers. The interobserver agreement of the conventional and subtraction technique was studied. The majority of the sites demonstrated a significant improvement in gingival conditions and a reduction in bleeding. For both treatments, probing depths were reduced by an average of 3 mm, while a mean of 1.22-1.35 mm of probing attachment gain was obtained. The GV resulted in slightly more gingival recession (1.90 mm) than the MWF (1.60 mm). The radiographic examination demonstrated gain of bone in 7 defects treated with GV and in 9 defects treated with MWF. This study demonstrated that pockets associated with infrabony defects can be successfully treated by both treatment modalities. Furthermore, bone gain can occur after treatment but not in a predictable manner.

The present study evaluated clinically and radiographically the short-term results of the healing of infrabony defects at maxillary premolars treated according to guided tissue regeneration (GTR). 9 patients with bilateral presence of infrabony defects with or without furcation involvements at maxillary premolars were selected. At baseline assessments of plaque and gingival indices, bleeding, probing pocket depth and attachment level, and furcation measurements were recorded. Conventional radiographs were obtained in a way that assured a reproducible projection geometry. One premolar was randomly treated with GTR and the contralateral with open debridement. Clinical and radiographic examinations were performed again 6 months postoperatively. The bone tissue changes were assessed by means of conventional radiographs and subtraction images. Sites treated by both procedures demonstrated an improvement of gingival conditions and a reduction of pocket depths. A statistically significant attachment gain was obtained for the test (mean 1.2 mm), but not for the control sites (mean 0.6 mm). The differences, though, were not significant between the test and control sites. Limited improvement in furcation closure was recorded. The radiographic examination demonstrated loss of bone tissue in four sites treated with GTR. The findings suggest that the regeneration of the periodontal soft and bone tissues was not significantly enhanced with the GTR therapy.

The main purpose was to study various factors with respect to predicting dental caries. From a population of 442 employees at a shipyard, 68 patients with an average age of 56 yr were selected for the present investigation. They were examined once a year during a 2-yr period with respect to: 1) number of new caries lesions, and 2) a series of caries related factors, i.e., DMFS, oral hygiene status, dietary habits, numbers of Streptococcus mutans and lactobacilli in saliva, and secretion rate and buffer effect of saliva. The median values of all studied variables as found at the baseline examination were more favorable in the caries inactive (n = 30) than in the caries active group (n = 38), but only DMFS (P less than 0.001), dietary score (P less than 0.05), and number of S. mutans in saliva (P less than 0.05) differed significantly between the two groups. Number of S. mutans showed the highest sensitivity value, followed by dietary score. The main conclusion from this study is, however, that in spite of a relationship between caries activity and unfavorable values, especially for DMFS, dietary score, and number of S. mutans in saliva, it would have been difficult to predict the caries active patients on an individual level.