The aim of this retrospective study was to evaluate the influence of interleukin (IL)-1 genotype on the clinical parameters pocket probing depth and tooth loss in periodontally treated and regularly maintained patients. Only data from non-smokers were included.Patient mean data on pocket probing depth (PPD) and tooth loss from 53 Caucasian patients treated for generalized chronic periodontitis and maintained for an average of 15.5 years at the university of Kiel were analysed. All patients were genotyped and subjects with at least one copy of the variant allele 2 at positions IL-1A-889 and IL-1B +3954 were classified IL-1 genotype positive.12 patients (22.6%) were IL-1 genotype positive. IL-1 genotype positive/negative patients were on average 46-3/45.8 years old with a mean of 23.8/23.9 teeth, resp., at baseline (TO). A total of 86 teeth were lost initially, resulting in an average of 21.5/22.5 teeth after active treatment (T1). The corresponding values after 13 years of supportive periodontal care (T2) were 20.7/21.6 teeth. Corresponding mean PPD values for IL-1 genotype positive/negative patients decreased from 4.7 mm/5.3 mm (To) to 2.9 mm/2.9 MM (T1) and increased slightly to 3.3 mm/3.4 mm at T2. Intergroup differences of PPD and tooth loss were not significant.Regarding pocket probing depth and tooth loss, there were no significant differences related to IL-1 genotype.

The influence of systematic dummy-head training with Periopolishe (PP, group A) and Gracey instruments (GRA, group B) on the effectiveness of root debridement was evaluated by Rühling et al., 2002 (9). Their results indicate that independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of effectiveness. It was possible to increase effectiveness to a high level through systematic training in both groups. The aim of the present study was to assess the role of operator motivation and self-assessment on scaling effectiveness. Before baseline, operators were asked to answer a questionnaire rating the expectation of the instrument performance. Four groups of inexperienced operators (n = 11 each) received 10 weeks dummy-head training. In groups A (GRA) and B (PP), training was combined with a motivational programme. Groups C (GRA) and D (PP) received the same training, but no additional motivational programme. In a dummy-head, 10 test teeth were debrided and operators were asked to estimate their effectiveness of debridement at each test day. Effectiveness was calculated as percentage of debrided root area on 10 test teeth at different time points with an image analysis programme (NIH Image) and ANOVA. Two groups were compared using the Mann-Whitney U-test (unpaired) and the Wilcoxon signed ranks test (paired). Motivated groups (A and B) reached about 25% higher debridement results (p < 0.001) and were able to estimate their effectiveness more precisely compared to groups C and D. In the low motivation groups (C and D), overestimation of more than 20% was evident (p < 0.001). The questionnaires revealed underestimation of the GRA instruments and overestimation of PP instruments. Operator motivation and self-assessment greatly influence learning of effective root debridement.

OBJECTIVES The aim of this in vivo study was to compare the anti-plaque effect of warm and cold chlorhexidine gluconate irrigation on matured human plaque. METHODS In a split-mouth design, the antibacterial effect of 47 degrees C "warm" 0.2% chlorhexidine solution was compared with that of 18 degrees C "cold" rinse at the same concentration on newly-formed supragingival plaque that had been left undisturbed for 72 h. Before and 1 h after a 1-min rinse procedure, plaque was sampled from 10 test persons and vitality determined using vital fluorescence technique. RESULTS Cold and warm 0.2% chlorhexidine solution reduced plaque vitality significantly from 99.63% to 77.81% (p=0.014) and from 98.98% to 51.77% (p<0.001), respectively. Rinsing with warm chlorhexidine solution reduced plaque vitality to a significantly greater degree (p=0.003) than did cold chlorhexidine. CONCLUSION In this study, warm 0.2% chlorhexidine rinse showed a significantly more intensive anti-plaque effect than cold chlorhexidine solution at the same concentration.

Background/aims: This retrospective study determined the treatment outcomes of 142 compliant periodontal patients observed for at least 10 years at the University of Kiel. All patients had been treated for moderate to advanced periodontitis and regularly received supportive periodontal therapy (SPT).Methods: Patient- and tooth-related variables [tooth loss and pocket probing depth (PPD)] were analysed.Results: Of a total of 3353 teeth, 167 were extracted during active treatment and 99 during SPT, mainly for periodontal reasons. Forty-five per cent of the patients did not lose any teeth during 11.7 years of observation. Thirty-seven per cent underwent extractions during active treatment or SPT, 18% both during active periodontal therapy and SPT. Mean tooth loss per patient was 0.07 teeth/year during SPT. Mobility, furcation involvement, smoking, and prescription antibiotics had a negative impact on prognosis. Intraindividual differences in PPD were significant between single- and multirooted teeth with initial PPD greater than or equal to 4 mm at baseline, following active treatment and at the end of SPT, and between firm and mobile teeth at baseline. Interindividual differences in mean PPD were only significant between smokers and non-smokers at the end of the observation period.Conclusions: Long-term maintenance of our patients was effective. Periodontal disease represented the major cause of tooth loss in a minority of the population.

BACKGROUND/AIMS:In a dummy-head trial, we assessed how effectively untrained operators were able to learn scaling with curettes and power-driven instruments.METHODS:Two untrained operator groups (n = 11 each) received six 2-h lessons during a 10-week period following a training program. Subgingival scaling was performed with curettes (GRA) and a power-driven system (PP). At 6 test days each subject had to instrument 10 test teeth. The percentage of debrided area was assessed with an image analysis program. Learning success was measured as a percentage of debrided root area and scaling time. Furthermore, the effectivity was related to difficulty in anatomical situations and access to root surfaces. Statistical analysis was carried out with SPSS.RESULTS:At baseline, effectivity was 63.1% (GRA) vs. 52.3% (PP). Between weeks 9 and 11, operators reached a plateau for group GRA at 84.7% and group PP at 81.3%. Scaling time did not differ between the two groups. Debridement of teeth with complex root shapes that were hard to access was less effective with the power-driven system.CONCLUSION:Independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of efficacy. With systematical training, effective scaling with the power- driven system was as easy to learn as with hand instruments. On root surfaces with complicated shape and anatomy or difficult accessibility, the power-driven system works significantly less effectively.

The removal of implant coatings may be necessary if rough implant surfaces are exposed subgingivally due to progressive peri-implant bone loss or if they are also supragingivally exposed because of progressive gingival recession, thus facilitating plaque formation and impairing tooth cleaning done at home. The aim of this experimental study was to develop diamond-coated files and rubberized polishers for machine-driven instrumentation of implant cylinders, and present an instrumentation concept for the complete removal of rough titanium plasma spray (TPS) and hydroxylapatite (HA) layers and polishing exposed titanium surfaces. The surface structure and its possible contamination by the instrumentation process was investigated using laser profilometry, scanning electron microscopy, and x-ray fluorescence analysis. The effect of impurities on the growth of human fibroblasts was tested in cell culture. The results show that TPS and HA implant coatings can be removed with the modified implant files. After polishing the exposed titanium surfaces, roughness depths of Rz=4.6 microm (TPS) and Rz=5.7 microm (HA) and, for implant cylinders, 3.4 microm were found. During the instrumentation of implant surfaces, contamination with the material of the instrument must be expected. It was shown that, in principle, growth of human gingival fibroblasts on the instrumented surfaces is possible. The cells were intimately associated with one another and, compared to culture controls, demonstrated good adhesion with strict orientation to the microstructure of the scoring left by instrumentation. The biological consequences and mechanisms of cell adhesion on instrumented surfaces require further investigation.

Background: The aim of this retrospective study was to evaluate if patients with moderate to advanced periodontitis had comparable periodontal conditions at baseline and during supportive periodontal therapy (SPT) whether they were compliant or not.Method: Patient-related variables were compared: age, tooth mobility, furcation involvement, number of teeth, pocket probing depth, plaque index. Compliant patients (n = 142) received complete periodontal treatment and were followed over at least 10 years (group A). Non-compliant patients either discontinued supportive periodontal therapy (n = 42, group B) or dropped out before or during periodontal surgery (n = 44, group C).Results: At baseline, there were no significant differences between the 3 groups except for mobility. During SPT, mean pocket probing depth and plaque index differed significantly.Conclusion: These results indicate that non-compliant patients compared to compliant patients had similar periodontal conditions at baseline, but responded less favourably to periodontal surgery and maintenance.

BACKGROUND, AIMS The aim of this retrospective study was to assess the effect of regular supportive periodontal treatment on disease progression in patients with moderate to advanced periodontitis. METHOD We compared radiographic change of interdental bone level and number of teeth at 2 time points in 3 patient groups (mean age 46 years): group A, periodontally untreated patients (n= 14) who dropped out during initial therapy; group B, non-compliant patients (n=26), who discontinued supportive periodontal therapy after ca. 2 years of maintenance; group C, compliant patients (n=27), who regularly attended the maintenance program for 7 years. Periodontal treatment was performed as scaling and root planing or flap surgery in groups B and C. All 3 groups were re-examined ca. 7 years after the initial examination. RESULTS Patients in group A lost 3.8 teeth (0.5 teeth/year), those in group B 3.2 (0.4 teeth/year), and in group C, patients lost 2.0 teeth (0.2 teeth/year). About half of the patients lost no teeth (group A 43%, B 42%, C 55%), and only 17 subjects lost more than 3. At the 2nd examination, an increase in interdental bone was found only in group C (+0.13 mm), while groups A and B lost 0.57 mm and 0.31 mm of alveolar bone level, respectively (p<0.05 group C versus A and B). CONCLUSIONS Systematic periodontal treatment stops interdental bone loss and decreases the rate of tooth loss in most cases. Periodontal surgery without regular follow-up care cannot prevent further periodontal destruction, but it can delay it.

BACKGROUND, AIMS The form of the molar roots and their furcated region influence both the pathogenesis of periodontal destruction and therapeutic attempts. METHOD Using a specially-constructed measuring device, 359 1st and 2nd molars, both upper and lower, were analysed 3-dimensionally. The parameters measured were horizontal furcation concavity, height of root trunk, degree of root taper, the distance between the root prominences adjacent to the furcation entrances and the angle of root separation. RESULTS The mean horizontal furcation concavity in lower molars was 0.5 mm at a distance of 1 mm apical to the cemento-enamel-junction (CEJ) and 3 mm at the distance of 4 mm apical to the CEJ. The angle of root separation was between 16 degrees (lower jaw molars lingual) and 29 degrees (upper jaw molars distal). The vertical distance from root separation to CEJ averaged 3.3 mm in lower jaw molars and 4.8 mm in upper jaw molars. CONCLUSIONS Our findings underline the variability of furcation morphology.

Aspartate aminotransferase (AST) has been shown to be a promising host marker for periodontal disease progression. The aim of the present study was to analyze AST in the crevicular fluid (CF) of implants exhibiting peri-implantitis and to evaluate the association between AST levels and progressive attachment loss. Twenty patients who had received a total of 42 endosseous cylindric titanium implants were examined. Radiographic assessment of preexisting bone loss and clinical measurements, including electronic attachment of probing, presence or absence of plaque, bleeding on probing, and AST analysis in CF, were performed on 2 occasions 6 months apart. During this study period 13 of 168 sites in 7 patients experienced further loss of attachment greater than or equal to 1.0 mm (median 1.7 mm; interquartile range 0.4 mm). Evaluation of a positive AST test (> or = 300 microIU) in site-specific diagnosis revealed low positive (8%) and high negative predictive values (92%), with a sensitivity of 15% and a specificity of 83%. These results indicate that, in contrast to periodontal disease, the assessment of AST in peri-implant crevicular fluid may be of limited value as a diagnostic and prognostic marker for peri-implant disease.

Teeth with an apical inflammatory lesion were studied by light microscopic morphometrical procedures to estimate the volumetric density of periodontal ligament tissues by point counting. Sixty-four root surfaces were investigated from coronal to apical. The observed tissue changes were similar in groups with and without bacteria, except for an elevated volumetric density of inflammatory cells in the first group. The attachment was lost apically. Principal fibers running to the root surface and extensions in the cementum decreased from coronal to apical, but were replaced by fibers running parallel to cementum and fibers oriented in a network. We suggest that acellular extrinsic fiber cementum was lost, whereas cellular mixed stratified cementum was built. The cellular mixed stratified cementum synthesis was by inclusion of the remaining fibers from the acellular extrinsic fiber cementum. We suspect that the changes were the result of the anti-inflammatory reaction caused by the periapical lesion.

In our laboratory, we modified sonic scaler inserts to increase effectivity of root surface instrumentation of molars with furcation involvement during flap surgery. The working end of conventional sonic scaler inserts was thickened ellipsoidally and diamond coated. Inserts with variously angled shafts were designed in order to facilitate insertion into the furcation. A clinical, split-mouth study examined the debridement of molars with furcation involvement during flap surgery using either hand instruments or diamond-coated sonic scaler inserts with 15 patients. Average treatment time was cut by ca. 50%, using diamond-coated inserts as compared to hand instruments for root surface debridement during surgery. 2 years after surgery, the clinical parameters had not been influenced by type of instrument used.

We developed a sonic scaler tip with an ellipsoid diamond-coated bud and contra-angulated shafts to overcome problems resulting from furcation anatomy. In this study, extracted molars were instrumented in a dummy model without any replicated soft tissues using 3 different instrumentation methods (i) curettes, (ii) diamond-coated sonic scaler tips with normal handle and (iii) diamond-coated sonic scaler tips in 2 handles with varying power levels. 15 extracted upper and lower molars were instrumented using each of the 3 instrumentation types. Following debridement, loss of substance and % of furcation area instrumented were assessed. In both upper and lower molars, significantly more surface area was instrumented in one instrumentation run with diamond-coated tips than with curettes. Substance loss was greater with diamond-coated tips than with hand instruments. In conclusion, an effective debridement of the furcation roof seems only possible with odontoplasty. Clinical evaluation of this approach to root debridement is needed.

The purpose of this study was to determine the suitability of different scaling instruments for the debridement of furcations. 12 upper and 12 lower replicated molars with through-and-through furcations were instrumented 3x with 5 different types of instruments: (i) hand instruments; (ii) hand instruments in conjunction with diamond burrs; (iii) a conventional ultrasonic scaler insert; (iv) a conventional sonic scaler insert; (v) a set of 2 modified diamond coated sonic scaler inserts with different angulated shafts. The plastic replicas were fixed in a manikin head without replicated soft tissues. Following debridement, weight loss and % of instrumented furcation area were assessed. In the case of lower molars, it made little difference whether they were treated with hand instruments, hand instruments combined with diamond burrs, or diamond-coated sonic scaler inserts. On upper molars, however, significantly more area was instrumented with the diamond-coated inserts than with the other instruments. Substance removal was greater with diamond-coated inserts than with the other devices. In conclusion, an effective debridement of the furcation seems possible only with an odontoplasty, in which a furcation is fitted to the instrument by means of intensive instrumentation, thus leading to substance loss. To improve results with these instruments, further research is necessary.