Showing papers in "Journal of Periodontal Research in 1987"
TL;DR: This review is based on a discussion at the 1986 Annual Meeting of the American Association of Dental Research of recent literature in this field which primarily concerned all of the relevant papers that were available to me and that had been published in the last 2 years.
Abstract: There is a perception of conflicting data and opinions among research laboratories that are studying periodontal microbiology. In response to this perception I was asked to discuss recent literature in this field at the 1986 Annual Meeting of the American Association of Dental Research. This review is based on that discussion which primarily concerned all of the relevant papers that were available to me and that had been published in the last 2 years (1984 and 1985). In order to determine what the data (rather than what our biases) may tell us, accurate comparisons of published reports in this field require an appreciation of the reasons for different results in different laboratories. Therefore, before we compare data, let's consider some of the reasons why results from different laboratories may differ. The periodontal flora is complex. We have found over 325 distinct bacterial species in the human gingival crevice (1). Many of these species have never been formally described, most of them are ignored by some laboratories, identified differently by others, or lumped together in various groups by still others. Some of the predominant species have special growth requirements and are not detected on some media that are widely used. Identification criteria differ among laboratories. Even with rigorous testing, identification of some species is questionable. With minimal testing it is even less reliable.
517 citations
TL;DR: The ability of 10 investigators to detect the presence or absence of simulated periodontal lesions was superior from subtraction radiographs produced from cephalostat-based images when compared to stent- based images (p < .02).
Abstract: The use of a cephalostat to stabilize projection geometry for subtraction radiography was investigated. Six replicate repositionings of patients within a cephalostat indicated that the mean angular disparity between repositioning was 0.33 ± 0.10 degrees. Subtraction images produced from films of a phantom with artificial periodontal defects exposed using the cephalostat or stent technique were compared. There was no significant difference in the standard deviations of the gray level histograms obtained using the two methods. However, the ability of 10 investigators to detect the presence or absence of simulated periodontal lesions was superior from subtraction radiographs produced from cephalostat-based images when compared to stent-based images (p < .02). Sets of radiographs taken of 6 patients on the same day or 3 months apart indicate that the cephalometric technique may be used to stabilize projection geometry.
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TL;DR: Assays for acid and alkaline phosphatase levels in gingival fluid have been evaluated for their use as possible indicators of periodontal disease activity and presented as models of how substances can enter theperiodontal pocket by different routes.
Abstract: Microtiter assays for acid and alkaline phosphatase levels in gingival fluid (GF) have been evaluated for their use as possible indicators of periodontal disease activity. Alkaline phosphatase concentration was shown to be positively associated with periodontal disease activity, while acid phosphatase showed no relation to disease activity. When a series of timed gingival fluid samples was taken from several sites in one subject's mouth, reproducible differences in volume, alkaline phosphatase concentration, and total acid phosphatase were found between the first and subsequent samples. Acid and alkaline phosphatase are presented as models of how substances can enter the periodontal pocket by different routes.
125 citations
TL;DR: SDS-PAGE of total cell proteins appeared to be the most sensitive and accurate method to identify isolates, although many strains were successfully identified using serology, and biochemical tests including sensitivities to inhibitors were the least reliable.
Abstract: The fastidious gram negative asaccharolytic rods Wolinella recta, Campylobacter concisus, Bacteroides gracilis, and Eikeneila corrodens have been isolated from lesions of advanced periodontal disease. In this investigation, three methods were compared for their ability to identify fresh isolates of these species: 1) biochemical tests and sensitivities to dyes and other inhibitors, 2) serological reactions, and 3) sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). SDS-PAGE of total cell proteins appeared to be the most sensitive and accurate method to identify isolates, although many strains were successfully identified using serology. Biochemical tests including sensitivities to inhibitors were the least reliable. W. recta, B. gracilis, and E. corrodens were found more frequently and in higher numbers in progressive (active) disease sites of many of the subjects. E. corrodens was also found to be significantly elevated in inactive sites of certain subjects. After successful treatment with Widman flap surgery and systemically administered tetracycline, the proportions of W. recta and E. corrodens were reduced, while those of C. concisus were elevated.
113 citations
TL;DR: Since the trypsin-like protease is able to degrade the basement membrane collagen (type IV) in the presence of human serum, this enzyme may be a potent virulence factor of Bacteroides gingivalis in relation to invasiveness and connective tissue destruction.
Abstract: Extracts of cell sonicates of Bacteroides gingivalis were shown to contain proteo-lytic enzymes capable of degrading connective tissue proteins In this study, neutral proteolytic enzymes, ie collagenase and a trypsin-like protease, were isolated The trypsin-like protease was readily separated from collagenase by affinity chromatography on Benzamidine-Sepharose Proteases were further purified by gel filtration on Sephacryl S-200; apparent molecular weights of 35 kDa and 70 kDa were obtained for a trypsin-like protease and collagenase, respectively Further characterization of the potent trypsin-like protease showed that the enzyme was inhibited by serine protease inhibitors phenylmethylsulfonyl fluoride and benzamidine and by metalloprotease inhibitor EDTA, as well as ascorbic acid Activation of the enzyme was observed with reducing agents and human serum The trypsin-like protease was found to be capable of degrading native type IV collagen and denatured type I collagen but not native type I collagen Thus, we conclude that in addition to collagenase a potent trypsin-like protease from Bacteroides gingivalis may be involved in the etiopathogenesis of periodontal disease Since the trypsin-like protease is able to degrade the basement membrane collagen (type IV) in the presence of human serum, this enzyme may be a potent virulence factor of Bacteroides gingivalis in relation to invasiveness and connective tissue destruction
112 citations
TL;DR: The Collagenolytic enzyme was shown to be a genuine vertebrate collagenase derived from unidentified host cells that was correlated with clinical disease parameters using both the site and the patient as sampling units.
Abstract: Collagenolytic activity in gingival crevicular fluid (GCF) sampled from 25 healthy control subjects, 25 gingivitis, 25 chronic adult periodontitis (CAP) and 8 LJP patients was correlated with clinical disease parameters using both the site and the patient as sampling units. Among patients collagenase activity increased with the severity of the disease in the order: healthy < gingivitis < periodontitis. Among sites, significant correlation was found between GCF collagenase activity and pocket depth in CAP and LJP, but not in gingivitis patients. Enzyme activity was also correlated with GI score in LJP, but not in CAP and gingivitis patients. In a subset of 10 patients in each of the healthy, gingivitis and CAP groups the association of enzyme activity and crevicular fluid volume (flow) was examined. Significant correlation was found between fluid volume and pocket depth in CAP patients, and between fluid volume and GI score in gingivitis patients, but no association was observed between collagenase activity and fluid volume. The Collagenolytic enzyme was shown to be a genuine vertebrate collagenase derived from unidentified host cells. The concentration of the enzyme in crevicuar fluid from CAP patients was in the order of 10 μg/ml.
111 citations
106 citations
TL;DR: To directly demonstrate both the presence and in vivo activity of tissue collagenase (EC 3.4.7) during gingival inflammation, tissue extracts from 54 specimens of variously inflamed human gingiva were analyzed individually for collagenase-specific collagen degradation products and collagen-bound collagenase.
Abstract: To directly demonstrate both the presence and in vivo activity of tissue collagenase (EC 3.4.24.7) during gingival inflammation, tissue extracts from 54 specimens of variously inflamed human gingiva were analyzed individually for: a) collagenase-specific collagen degradation products, and b) collagen-bound collagenase. The TCA collagen degradation product, identified using SDS-PAGE, was shown in 13/19 (68.4%) of insoluble tissue-residue fractions extracted from moderate-to-severely inflamed gingiva, but in only 2/21 (9.6%) slight-to-mildly inflamed gingival specimens, suggesting differences in the in vivo collagenase activity between the two groups. Using in vitro collagenase assays, gingival collagenase (as bound to insoluble collagen) was demonstrated in 92.8% of the moderate-to-severely inflamed gingival specimens and in 50% of the slight-to-mildly inflamed gingival specimens. A relationship was established between the active and latent forms of the enzyme and the degree of inflammation. Active enzyme was present in 78% of the moderate-to-severely inflamed specimens and in 14% of the slight-to-mildly inflamed gingiva. In contrast, latent collagenase was predominant in the slight-to-mildly inflamed group (86% of coliagenase-positive samples) compared with 46% of coliagenase-positive moderate-to-severely inflamed gingival samples. The collagen-bound gingival collagenase was inhibited by metal ion chelators, sulphydryl reagents and 10% FBS, but not by serine nor thiol-proteinase inhibitors and is therefore a neutral metalloproteinase.
TL;DR: Results indicate that collagen membranes prevent apical migration of the epithelium during initial stages of healing and are colonized by connective tissue cells and incorporated within the healing connectedive tissue.
Abstract: Collagen membranes were interposed between full thickness periodontal flaps and denuded root surfaces of right upper canines in 3 mongrel dogs; the left canines were sham-operated without the use of collagen membranes. Animals were killed 10 d after surgery. Tissue blocks were removed, and experimental and control sites were processed for histometric and histologic examination. The results indicate that collagen membranes: (i) prevent apical migration of the epithelium during initial stages of healing; and (ii) are colonized by connective tissue cells and incorporated within the healing connective tissue.
TL;DR: Much work remains and many questions cannot be adequately answered at this time, but the authors should not lose sight of the great progress which has been made in the area of assessing and diagnosing periodontal diseases.
Abstract: The assessment and diagnosis of periodontal diseases has become an active and controversial area of research which incorporates both new technologies and new concepts. Previous efforts have demonstrated the potential value of diagnostic testing in differentiating different diseases, in evaluating disease progression, and in monitoring the response to therapy. A few studies have even shown promise in predicting the response to therapy. Some of this work has incorporated proven diagnostic principles which allow a comparison between techniques. It is clear, however, that future work would benefit from an increased incorporation of these diagnostic principles and a recognition of the value of a sequential use of tests. Much work remains and many questions cannot be adequately answered at this time, but we should not lose sight of the great progress which has been made in the area of assessing and diagnosing periodontal diseases.
TL;DR: The ability of flurbiprofen to inhibit periodontal attachment loss, even in the presence of gross plaque accumulation, has significant implications for the potential use of flURBIProfen as an adjunctiveperiodontal therapeutic modality.
Abstract: The effect of the nonsteroidal anti-inflammatory drug flurbiprofen has been studied in the ligature-induced and spontaneous periodontitis model in the rhesus monkey, Macaca mulatta. Twenty-four adult monkeys with incipient periodontitis were divided into three disease-matched groups. Two groups received flurbiprofen at dosages of either 0.27 mg/kg/d or 7.1 mg/kg/d delivered systemically via osmotic minipump. A split-mouth approach was used, placing ligatures on one side and monitoring the progression of periodontitis at regular intervals for 6 months. Clinical measurements included standardized radiographs, Ramfjord attachment level determinations and assessments of redness, edema and bleeding on probing. There was a statistically significant inhibition of attachment loss (p < 0.05), gingival redness (p < 0.05) and bleeding on probing (p < 0.05) in ligatureinduced and spontaneous periodontitis in the flurbiprofen-treated animals at 6 months. Eight of 8 ligated control monkeys lost significant attachment (mean loss of 1.06 mm/site). Only 3 of 15 flurbiprofen-treated ligated monkeys lost any significant attachment, with an overall mean loss of 0.34 mm/site, which was significantly less than the control loss of 1.06 mm/site at p = 4.46 times 10-3. The odds of a control ligated monkey undergoing significant attachment loss in 6 months are elevated 29.3-fold, as compared to the flurbiprofen-treated, cohort monkey group. Flurbiprofen treatment also significantly inhibited spontaneous attachment loss for 6 months as compared to control monkeys, at p < 0.05. These data provide further evidence for the central role of cyclooxygenase products in the progression of periodontal disease. The ability of flurbiprofen to inhibit periodontal attachment loss, even in the presence of gross plaque accumulation, has significant implications for the potential use of flurbiprofen as an adjunctive periodontal therapeutic modality.
TL;DR: It was concluded that GI scores and GEFR reflect histologic changes in tissue and, hence, are valid indicators of gingivitis development.
Abstract: The purpose of this investigation was to study stereologically the histopathologic alterations occurring during a human experimental gingivitis, and to establish a relationship between clinical parameters and histologic findings. Eight dental students volunteered for the study. After a prophylaxis they performed optimal oral hygiene for 3-4 weeks to reach mean plaque and gingival indices approaching zero. They then abandoned all oral hygiene procedures for a period of 21 days. At d 0, 4, 7, 14 and 21, Plaque Index (PII), Gingival Index (GI) and Gingival Exudate Flow Rate (GEFR) were assessed, and a buccal biopsy of their gingiva was taken. Point counting procedures were performed at 2 different levels of magnification to estimate the volume densities of epithelium, infiltrated and non-infiltrated connective tissue, and collagen. The percentages of polymorphonuclear neutrophilic granulocytes, lymphocytes, plasma cells, macrophages and fibroblasts were estimated by counting the number of profiles of these cells in the connective tissue area close to the apical end of the junctional epithelium. The histological picture during the entire experiment was one of an early lesion (Page & Schroeder 1976). The clinically healthy gingiva did not correspond to a histologically healthy gingiva containing only a few inflammatory cells, probably because the 3-4 wk of perfect oral hygiene were not sufficient to generate histological health. Furthermore, no chronic inflammation of the gingiva, as characterized by a predominance of plasma cells, was observed after 3 wk without oral hygiene. Thus, more than 3 wk of no oral hygiene are necessary to obtain an established gingival lesion. With increasing gingivitis scores between GI = 0 and GI = 2 there was a significant increase in the percentages of lymphocytes and a significant decrease in the percentages of fibroblasts. With increasing GEFR similar trends in percentages were observed for lymphocytes and fibroblasts. It was concluded that GI scores and GEFR reflect histologic changes in tissue and, hence, are valid indicators of gingivitis development.
TL;DR: The findings suggest that the protease produced by B. gingivalis may play a role as a periodontopathogen not only in directly destroying periodontal tissues but also in weakening the oral antibacterial mechanism.
Abstract: Caseinolytic protease was isolated and purified, with high yield, from culture supernatant of Bacteroides gingivalis 381 by procedures including acetone fractionation, gel filtration on Sepharose CL-6B, solubilization with 0.8% 1-O-N-octyl-β-D-glucopyranoside and affinity chromatography on arginine-Sepharose 4B. By the affinity chromatography, the protease was separated into three isoenzymes, one of which was unadsorbed on the arginine-Sepharose 4B, but the other two of which were adsorbed and eluted with the buffer at a different concentration of arginine. Caseinolytic activities of the latter two were highly dependent on dithiothreitol and were inhibited by both thiol-blocking reagents and some microbial protease inhibitors; but such inhibition was not found in the former isoenzyme. The higher the affinity of the enzyme to arginine-Sepharose, the stronger the thiol dependency and the inhibition by these inhibitors. Phosphoramidone and ethylenediamine tetraacetate had no effect on the activity of any of the three peaks, indicating that the enzyme is not a metaloprotease. Besides the enzymehydrolyzed synthetic substrates of trypsin, such as BApNA, TAME, substrates of chymotrypsin and kallikrein were also hydrolyzed. The salivary and egg-white lysozymes were also degraded by this enzyme. These findings suggest that the protease produced by B. gingivalis may play a role as a periodontopathogen not only in directly destroying periodontal tissues but also in weakening the oral antibacterial mechanism.
TL;DR: One-way analysis of variance was used to test the hypothesis of equal treatment effects in the three levels of pocket depth at the end of the hygienic phase and at each yearly interval following treatment, and Scheffe's method for multiple comparisons was used.
Abstract: The purpose of the study was to compare, over 5 yr, the results following four conventionally used modalities of treatment for moderate-to-advanced periodontitis. Ninety subjects (53 females and 37 males), age 24 to 68 yr (mean 45) were selected for the study from persons seeking dental care or who were referred for periodontal treatment at The University of Michigan School of Dentistry. To be included, the subjects had to have at least 20 treatable teeth, and some periodontal pockets extending at least 4.0 mm or more apically to the cementoenamel junction. Plaque, gingivitis, calculus, depth of pockets, clinical loss of attachment from the cementoenamel junction and tooth mobility were scored. For the present paper, only pocket depth and attachment level scores were considered. All of the patients then had scaling, root planing and instruction in oral hygiene by a dental hygienist for a total of 5 to 8 h over about 4 wk. A periodontist checked the completeness of calculus removal and did occlusal adjustment if he considered it to be indicated. A rescoring was done 4 wk after completion of the scaling and root planing. Then four types of periodontal treatment were provided by a periodontist. Each quadrant of the patient's dentition was assigned randomly to one of four treatment types: (1) surgical pocket elimination or reduction, including bone surgery, (2) modified Widman flap surgery, (3) subgingival curettage following scaling and root planing, and (4) scaling and root planing only. The teeth were polished once a week for 3 to 4 wk after the periodontal treatment. Then the patients were placed on recall prophylaxis and topical fluoride every 3 months, and scored annually prior to prophylaxis. If, at the time of the routine prophylaxis, pocket exudate could be expressed by moving a ball burnisher against the surface of the gingiva and/or overt bleeding resulted from pocket probing, the patient was rescheduled in 2 to 3 wk for examination and possible retreatment by a periodontist. Data for pocket depth and attachment level were arranged on the basis of the initial measurements in groups of 1-3 mm depth, 4-6 mm and >7 mm depth. One-way analysis of variance was used to test the hypothesis of equal treatment effects in the three levels of pocket depth at the end of the hygienic phase and at each yearly interval following treatment. The test was performed on patient means for changes in pocket depth and attachment level. If the hypothesis of equal treatment effect was rejected at the 0.05 level of significance using ANOVA, Scheffe's method for multiple comparisons was used to determine which of the pairs of treatment differed. Percentage distribution of sites with loss of >2 mm and >3 mm for the various groups also were compared. The measurements for the teeth that were lost were included until the teeth were lost. Seventy-two of the original 90 patients completed the 5-yr study.
TL;DR: Strains of black-pigmented Bacteroides examined for their ability to degrade collagen, albumin and benzoyl-D-L-arginine-p-nitranilide showed activity against collagen and BAPNA, indicating that B. gingivalis has cell-bound thiol proteinase activity dependent on metal ions.
Abstract: Strains of black-pigmented Bacteroides were examined for their ability to degrade collagen, albumin and benzoyl-D-L-arginine-p-nitranilide (BAPNA). B. gingivalis was the only species that showed activity against collagen and BAPNA. This activity was cell-bound, stabilized by dithiothreitol and inhibited by sulphy-dryl-modifying reagents such as mercuric, cupric and zinc ions, 5.5′-dithiobis-2-nitrobenzoic acid, p-chloromercuriphenylsulfonic acid and hydrogen peroxide. The activity was also inhibited by the chelating agents EDTA and EGTA. This indicated that B. gingivalis has cell-bound thiol proteinase activity dependent on metal ions.
TL;DR: A TEM study was made of the response to synthetic hydroxyapatite prepared in powder form and implanted for 6 and 12 months respectively in infrabony lesions in 2 adult patients with chronic periodontitis and tooth mobility.
Abstract: A TEM study was made of the response to synthetic hydroxyapatite prepared in powder form and implanted for 6 and 12 months respectively in infrabony lesions in 2 adult patients with chronic periodontitis and tooth mobility. Round or oval-shaped crystal aggregates, ranging in diameter from 1 to 20 μm, were surrounded by connective tissue free of inflammatory cells. The aggregates were made up of loosely-packed individual synthetic hydroxyapatite crystals, with a mean diameter of 128.12±14.57 nm, separated by an amorphous matrix containing few collagen fibrils. In the 6-month implants small apatite crystals, of a size similar to those found in adjacent alveolar bone and giving similar diffraction patterns, appeared in the center of the aggregates between the relatively large crystals of synthetic hydroxyapatite. These new apatite crystals filled the amorphous matrix progressively from the center to the periphery of the aggregate. The latter was surrounded either by fibroblasts or by osteoblasts and osteoid tissue. In the 12-month samples a calcified collagenous bone matrix enveloped the crystal aggregates. Typical osteoclasts, lacking a brush border, were evident around certain aggregates. Some osteoclasts contained large vacuoles filled with synthetic hydroxyapatite crystals.
TL;DR: The enzyme activity was inhibited by p-chloromercuribenzoic acid (PCMB), leupeptin and antipain, suggesting that it is a thiol protease, and B. gingivalis Gly-Pro peptidase was inhibition by DFP, suggest that it represents a serine protease.
Abstract: Bacteroides gingivalis produces large amounts of proteolytic enzymes which may play a role in its virulence. These enzymes may participate in the tissue destruction of the inflammatory process. In this study, the characteristics of two such enzymes, N-CBz-glycyl-glycyl-arginyl peptidase (N-CBz-Gly-Gly-Arg peptidase) and glycyl-prolyl peptidase (Gly-Pro peptidase) were investigated. The enzymes eluted in different peaks from an anion exchange column. N-CBz-Gly-Gly-Arg peptidase was associated with cells up to 48 h in culture. If cultured longer, it also released in the supernatant. It exhibited optimal activity between pH of 7.0 and 7.5 and was readily inactivated by heat treatment (45°C for 15 min). The enzyme activity was inhibited by p-chloromercuribenzoic acid (PCMB), leupeptin and antipain, suggesting that it is a thiol protease. The B. gingivalis N-CBz-Gly-Gly-Arg peptidase was different from the serum enzyme that digests the same substrate. The serum enzyme was more resistant to heat treatment and was inhibited by diisopro-pylfluorophosphate (DFP). B. gingivalis also produced Gly-Pro peptidase that is released in the supernatant. The enzyme has an optimal pH range between 7.5 and 8.0. The B. gingivalis Gly-Pro peptidase was inhibited by DFP, suggesting that it represents a serine protease. The serum Gly-Pro peptidase did not differ from the bacterial enzyme with respect to its sensitivity to inhibitors; however, they were markedly different in heat sensitivity. The bacterial enzyme was completely inactivated at 60°C for 30 min, whereas the serum enzyme was not inactivated even at 1 h at 60°C.
TL;DR: Correct use of the system for taking standardized radiographs can provide a sufficient number of pairs of radiographs for the study of patients with severe periodontitis using subtraction radiography.
Abstract: The methodology for the use of subtraction radiography in the study of human periodontal disease is described in detail to include: 1) design and fabrication of a system for taking standardized radiographs; 2) generation of interpretable subtraction images; 3) adjunctive, quantitative methods for analyses of digitized radiographic images; 4) reference standard for periodontally healthy individuals. Correct use of our system for taking standardized radiographs can provide a sufficient number of pairs of radiographs for the study of patients with severe periodontitis using subtraction radiography. Changes in bone mass observed on subtraction images can be quantified by measurement of their areas and their relationship to the alveolar crest.
TL;DR: The data indicate that both flurbiprofen and indomethacin inhibit alveolar bone loss in beagles compared to untreated controls and that with the dosages employed flurbIProfen is overall more effective.
Abstract: The effect of two non-steroidal anti-inflammatory drugs, indomethacin and flurbiprofen, on the progression of periodontal disease was studied in 16 beagle dogs over a 12-month period. Standardized radiographs were used to measure the rate of bone loss. Following a 6-month pretreatment baseline period, 5 dogs were dosed daily with 1.0 mg/kg indomethacin, 5 dogs were dosed daily with 0.02 mg/kg flurbiprofen, and 6 dogs were dosed with empty gelatin capsules for a 6-month period. In the untreated control dogs, the rate of bone loss in the treatment period significantly increased from baseline. In contrast, the rate of bone loss significantly decreased from baseline in the flurbiprofen-treated dogs. In the indomethacin-treated dogs, rate of bone loss in the treatment period was not significantly different from baseline. The data indicate that both flurbiprofen and indomethacin inhibit alveolar bone loss in beagles compared to untreated controls. The data also indicate that with the dosages employed flurbiprofen is overall more effective.
TL;DR: The present observations indicate that EGF receptors are expressed in high amounts by the cells of the epithelial rests, and that these cells are thus potentially responsive to the actions of EGF.
Abstract: The binding of 125I-labelled epidermal growth factor (EGF) in the dental follicle was studied by autoradiography. The follicle of a surgically removed impacted premolar was cut into small pieces which were incubated in the presence of 125I-EGF. Very intense binding was localized in the epithelial cell rests of Malassez, whereas only background labelling was seen in fibroblastic cells. EGF is a hormone-like molecule which is believed to exert its effects locally and through binding to a specific cell surface receptor. The number of EGF receptors in many cells – e.g., basal epidermal cells - is related to cell proliferation. The present observations indicate that EGF receptors are expressed in high amounts by the cells of the epithelial rests, and that these cells are thus potentially responsive to the actions of EGF. It can be speculated that activation of the epithelial rest cells in various pathologic conditions is associated with a local rise in the tissue level of EGF.
TL;DR: It is suggested that the long-term effect of periodontal therapy is more related to the quality of the maintenance care program than the techniques utilized during active therapy.
Abstract: The success of periodontal therapy is evaluated not only after the termination of the comparatively short active treatment phase, but also at regular intervals during the extended maintenance phase. The main objectives of the active treatment include: (1) elimination of the inflammatory lesions present in the periodontium (2) reduction of probing pocket depth and (3) improvement of attachment levels, while the aim of the maintenance phase of therapy is the prevention of disease recurrence.
Elimination of the inflammatory lesions in the periodontium is accomplished by meticulous plaque and calculus removal performed either as a single measure or combined with one of several different surgical treatment modalities. Findings from clinical trials have demonstrated that it is not the technique - nonsurgical-surgical - used during basic therapy, but the degree of root debridement accomplished that seems to be the determining factor for success in terms of resolution of periodontitis. Furcation involved premolars/molars constitute a problem with respect to effectiveness of therapy. Reliable research data describing treatment effects in the furcation regions of multirooted teeth are scarce. As a result of the elimination of the inflammatory lesions the periodontal tissues will offer more resistance to probing. This is clinically identified as probing pocket depth reduction, attachment level imrpovements and recession of the marginal gingiva. Research findings reveal that surgical and nonsurgical methods are almost equally effective in these respects. The concept that surgical methods which include resective measures will cause more gingival recession than non-resective measures should be questioned.
Long-term clinical trials have demonstrated that patients who, following active treatment, are enrolled in carefully supervised plaque control programs only occasionally show signs of disease recurrence, while in this respect non-monitored patients frequently display signs of recurrent disease. It is suggested that the long-term effect of periodontal therapy is more related to the quality of the maintenance care program than the techniques utilized during active therapy.
TL;DR: Antibody titres reduced by half 1 year following scaling and root planing were observed in patients presumably infected with B. gingivalis, suggesting that the procedure effectively reduced the immune challenge.
Abstract: The level of systemic antibodies to B gingivalis was assessed longitudinally in a group of 11 adult patients with chronic periodontitis and in 9 periodontally healthy subjects Immunoglobulin G (IgG), IgA and IgM-specific antibodies were measured by an enzyme-linked immunosorbent assay in serum samples obtained during the natural course of the disease and following scaling and root planing A serological dichotomy was observed throughout the study in the chronic periodontitis patients A first subgroup was characterized by a virtual absence of IgA antibody and by IgG and IgM levels similar to those of healthy individuals, suggesting a low level of colonization by B gingivalis The patients of the second subgroup had detectable IgA and a significantly higher IgG antibody level that probably reflected the presence of a B gingivalis infection There was no statistical difference between the two subgroups for Plaque Index, Gingival Index, probeable pocket depth and age No cyclic pattern of the antibody levels was observed over the monitoring interval No peak level of antibody was observed in the immediate posttreatment period, suggesting that scaling and root planing may not provoke active immunization with B gingivalis Antibody titres reduced by half 1 year following scaling and root planing were observed in patients presumably infected with B gingivalis, suggesting that the procedure effectively reduced the immune challenge