Showing papers in "Journal of Periodontology in 1981"
TL;DR: It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing and pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5mm were the most difficult.
Abstract: The study presents an evaluation of the effectiveness of subgingival scaling and root planing related to depth of pocket and type of teeth. A total of 199 teeth in 25 patients were selected; 62 were scaled and 57 were used as controls. All teeth were initially scored using the calculus index of the P.D.I. (Ramfjord). Six surface locations were probed to determine pocket depth. The levels of the gingival margin were marked on the teeth to locate supra and subgingival calculus after extraction. The experimental teeth then were scaled. Both scaled and unscaled teeth were extracted immediately after the experimental procedures. The teeth were washed with water and stained with methylene blue. They were viewed under a stereomicroscope which had a tenth grid on its eyepiece. Percent of surface covered by calculus was assessed on both scaled and unscaled teeth. The results demonstrated a high correlation between percent of residual calculus and pocket depth. It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult. Tooth type did not influence the results.
301 citations
TL;DR: Tooth position has been suggested to be an important factor in gingival recession and the effects of labial tooth movement on changes in the marginal periodontium were examined.
Abstract: Tooth position has been suggested to be an important factor in gingival recession. Due to conflicting reports in the literature, this study was undertaken to examine the effects of labial tooth movement on changes in the marginal periodontium. Orthodontic tooth movement was performed in five monkeys (Macaca nemistrina). Oral health was established and exploratory surgery was performed to assess the level of the connective tissue attachment and marginal bone. Measurements of the gingival margin and mucogingival junction were taken and orthodontic forces were applied. The central incisors were moved labially a mean distance of 3.05 mm. Posttherapy measurements were performed to assess the change which occurred as a result of tooth movement. Significant recession of the gingival margin, connective tissue level and marginal bone was found.
289 citations
TL;DR: Results of various modalities of periodontal therapy were studied in 90 subjects with moderate to severe periodontitis and there was no significant difference in attachment results among the four methods.
Abstract: Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. Initial measurements of pocket depth and clinical attachment levels were compared with measurements obtained after the initial hygienic phase of the treatment and measurements of the same areas 1 and 2 years after four different types of periodontal treatment had been applied on a randomized basis to each of the four quadrants of the dentition. These treatments were: (1) surgical pocket elimination or reduction, (2) modified Widman flap surgery. (3) subgingival curettage, (4) scaling and root planing only. The patients were recalled for prophylaxis every 3 months, and rescored annually. One-way analysis of variance and Scheffe's method were used to test the hypothesis of equal treatment effects. The results were analyzed both with initial pocket depth as the baseline and with pocket depth at the hygienic phase as the baseline using a grouping of pockets 1 to 3 mm, 4 to 6 mm, and greater than or equal to 7 mm. For the 1 to 3 mm pockets there was a slight reduction in depth at the hygienic phase, with only minor changes after the various modalities of treatment over 2 years. However, significant losses of attachment after all modalities of periodontal therapy, including scaling alone, were observed at both the 1-year an 2-year intervals. For pockets 4 to 6 mm deep, the main reduction in pocket depth occurred at the hygienic phase, but the pockets also were reduced by further treatment, most by pocket elimination and modified Widman surgery. However, this reduction in pocket depth after surgery had no beneficial influence on maintenance of the attachment level, which actually was maintained best by scaling alone. For deep pockets greater than or equal to 7 mm, significant reduction in pocket depth occurred both at the hygienic phase and 1 to 2 years after treatment, with the greatest initial reduction after pocket elimination surgery. However, again there was no significant difference in attachment results among the four methods.
254 citations
TL;DR: Clinical studies employing the malachite green bacitracin medium revealed a significant association between the presence of the organism, A. actinomycetemcomitans and juvenile periodontitis.
Abstract: A selective medium, malachite green bacitracin agar, was developed for the isolation of Actinobacillus actinomycetemcomitans from subgingival plaque of periodontally diseased patients. The medium consisted of Trypticase soy agar 40 gm/liter, bacitracin 128 μg/ml, malachite green 8 μg/ml and 5% defibrinated sheep blood. The medium, when incubated in an atmosphere of air plus 10% CO2 for 5 days, permitted greater than 80% recovery of pure cultures of A. actinomycetemcomitans when compared with a nonselective medium. The most frequent contaminant in plaque samples from different clinical conditions was Haemophilus aphrophilus. Decomposition of H2O2 was useful in differentiating these two species. Clinical studies employing the malachite green bacitracin medium revealed a significant association between the presence of the organism, A. actinomycetemcomitans and juvenile periodontitis.
232 citations
TL;DR: The results indicate that both procedures were effective in treating moderate to advanced periodontitis, however, the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets.
Abstract: The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery. Seventeen subjects with moderate to advanced periodontitis received through scaling and root planing as well as oral hygiene instruction. A modified Widman flap was then randomly performed for one-half of each subject's dentition. Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy. Shallow crevices (1--3 mm)subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements. Moderately deep pockets (4--6 mm) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level. Pockets initially greater than or equal to 7 mm exhibited the greatest reduction in depth and attachment gain. Gingivitis was reduced following either procedure for moderate and deep pockets. No difference in supragingival plaque retention was noted and both procedures reduced calculus. The results indicate that both procedures were effective in treating moderate to advanced periodontitis. However, the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets.
228 citations
TL;DR: The periodontal status of three groups of women; pregnant, taking oral contraceptives, and nonpregnant, were evaluated clinically and microbiologically for changes in their gingiva and any corresponding changes in the subgingival microbial plaque, specifically the percentage of Fusobacteria species and Bacteroides species.
Abstract: The periodontal status of three groups of women; pregnant, taking oral contraceptives, and nonpregnant, were evaluated clinically and microbiologically for changes in their gingiva and any corresponding changes in the subgingival microbial plaque, specifically the percentage of Fusobacterium species and Bacteroides species. Overall, the women had relatively good gingival health. However, statistically significant increased scores were observed in the Gingival Index and the gingival crevicular fluid flow in the pregnant group compared with the nonpregnant group. The most dramatic microbial changes were the increased proportions of Bacteroides species both in the pregnant group and the group taking oral contraceptives over the nonpregnant group. Increased female sex hormones substituting for the napthaquinone requirement of certain Bacteroides were most likely responsible for this increase. No statistically significant clinical difference was noted between the group taking oral contraceptives and the nonpregnant group, although a 16-fold increase in Bacteroides species was observed in the group taking oral contraceptives.
216 citations
186 citations
TL;DR: It was concluded that both observed signs of inflammation and bleeding after probing can be used to detect inflammatory lesions in the gingiva and bleeding determinations using controlled insertion pressures provided an objective diagnostic method for detecting the presence of an inflammatory lesion.
Abstract: This study was designed to characterize histologically the gingival lesion associated with visual signs of inflammation and bleeding after probing. Sixty midfacial gingival sites in 26 persons were evaluated for visual presence of absence of inflammation and bleeding after probing using a controlled insertion pressure of 25 gm. In order to delineate the area for histologic analysis, a reference incision was made on the facial surface of the gingiva which corresponded to the depth and mesio-distal extent of the area probed and evaluated for signs of inflammation. Gingival biopsy specimens were morphometrically analyzed to determine the percentages of cell rich--collagen poor connective tissue and blood vessel lumens. Histometric data were grouped and compared with respect to the presence or absence of inflammation and bleeding. Specimens associated visually with inflammation had significantly greater percentages of both cell rich--collagen poor connective tissue and blood vessel lumens. Bleeding upon probing was associated with a significantly greater percentage of cell rich--collagen poor connective tissue without an increase of blood vessel lumens. It was concluded that both observed signs of inflammation and bleeding after probing can be used to detect inflammatory lesions in the gingiva. However, in areas inaccessible for evaluation of inflammation, bleeding determinations using controlled insertion pressures provided an objective diagnostic method for detecting the presence of an inflammatory lesion.
177 citations
TL;DR: A study was undertaken to evaluate the long term results of root resections of patients who had undergone root resection 10 years prior to the study and found that the immediate postoperative results were gratifying, they were not always lasting.
Abstract: A study was undertaken to evaluate the long term results of root resections. Records of 100 patients who had undergone root resections 10 years prior to the study were reviewed. Although the immediate postoperative results were gratifying, they were not always lasting. Eighty-four per cent of the failures occurred after 5 years. Most failures were in the mandibular arch and derived from reasons other than inflammatory periodontal disease. Suggestions are made as to how to improve the prognosis of resected teeth.
167 citations
TL;DR: This study was performed to evaluate the effects of orthodontic therapy on the width of the zone of keratinized gingiva by collecting and analyzing data from pre- and post-treatment photographic slides, plaster study casts, and cephalograms.
Abstract: This study was performed to evaluate the effects of orthodontic therapy on the width of the zone of keratinized gingiva. Pre- and post-treatment photographic slides, plaster study casts, and cephalograms were examined. The labial surfaces of 966 teeth in a sample of 100 orthodontic patients were studied. Widths of the keratinized gingiva were determined from photographic slides. Crown lengths were measured from the study casts, and measurements were performed on the cephalograms. Data were collected and analyzed in three categories: 1) The overall changes in the width of the keratinized gingiva and the lengths of the clinical crowns during the course of orthodontic therapy; 2) An analysis of grouped data with a comparison of the pre-existing widths of keratinized gingiva to the post-treatment periodontal status of the patient; and 3) A correlation analysis of the changes in the dimensions of the tissues to the changes in tooth position as measured on the cephalograms. The results of the study revealed: 1)...
161 citations
TL;DR: The function of the neutrophil, which exerts a major role in protection against bacterial infections, was assessed in patients with a family history of diabetes mellitus and severe periodontitis.
Abstract: In the present study the function of the neutrophil, which exerts a major role in protection against bacterial infections, was assessed in patients with a family history of diabetes mellitus and severe periodontitis. The neutrophil chemotactic function of two groups of patients was compared, both exhibited severe periodontitis. One group had a family history of diabetes and is therefore classified as individuals with potential for abnormal glucose tolerance (Pot-AGT Group). The other group had comparable levels of severe periodontal disease but did not have a family history of diabetes. Neither group showed evidence of systemic disease as assessed by an extensive medical history and a battery of clinical laboratory tests including CBC, SMA-12, prothrombin time, urinalysis and glycosylated hemoglobin levels. The peripheral blood neutrophil chemotactic response of patients in both groups was measured using Boyden chambers charged with the standard chemotactic agents; endotoxin activated serum, E. coli cultu...
TL;DR: The role of bacteria in the pathogenesis of Periodontitis was discussed in a series of papers beginning in 1920 by Rehnwinkel et al. as discussed by the authors, with the focus shifting away from bacteria and toward systemic host factors.
Abstract: causes. However, these observers had no idea as to the nature of systemic or host factors, and a variety of conditions were thought to be contributory to the disease.3'4 These conditions were somewhat obscure, even arcane, and included digestive derangements, contagion from unclean instruments, low vitality, diseases affecting the circulation, drugs which overstimulate the tissues, and certain systemic diseases such as tuberculosis, scurvy, and syphilis which, like Periodontitis, were common in those days. By the latter part of the 19th century, observers placed much more stress on local than upon systemic factors. For example, in 1883 Harlan5 wrote that "it will not be necessary ... to say anything of the etiology of the disease under discussion (Periodontitis), beyond the expression of the belief that it is infectious ..." and Rawls6 in 1885 wrote about "a peculiar organism of fungus growth which always fills pockets". G. V. Black, cited in Rawls, spoke of "little hot-beds of peculiar organisms" whose digestive fluids affect the tissues. However, as a consequence of the efforts of Rehnwinkel7 and others, emphasis began to swing away from the role played by bacteria and toward systemic host factors in the pathogenesis. These concepts took hold and by the turn of the century, most observers believed that Periodontitis was caused by a combination of obscure systemic or constitutional factors and mechanical irritants such as calculus, ill-fitting appliances, and rough filling margins. The possible importance of bacteria in the etiology was ignored from around 1900 until the 1960's. In a series of papers beginning in 1920, Gottlieb
TL;DR: This study was undertaken to evaluate the relationship between the severity of periodontitis and neutrophil (PMN) chemotactic abnormalities in diabetic patients and to correlate the observed PMNChemotactic defects with the degree of gingival inflammation and the amount ofperiodontal attachment loss.
Abstract: This study was undertaken to evaluate the relationship between the severity of periodontitis and neutrophil (PMN) chemotactic abnormalities in diabetic patients and to correlate the observed PMN chemotactic defects with the degree of gingival inflammation and the amount of periodontal attachment loss. Fourteen dentulous, insulin-dependent, adult onset diabetics and 18 nondiabetics participated in this study. Complete periodontal examinations including periodontal charting and full mouth radiography were performed, and gingival and plaque indices were recorded. Severe periodontitis was diagnosed in eight diabetics and seven nondiabetics. The remainder of the subjects including six diabetic patients and 11 nondiabetic subjects demonstrated mild or no periodontal disease and served as controls. The chemotactic assay employed a modification of the Boyden technique. Chemoattractants studied included endotoxin activated autologous plasma, endotoxin activated normal plasma, and n-formylmethionyl-leucyl-phenylala...
TL;DR: The results demonstrated that after repeated doses of tetracycline the crevicular fluid levels were typically 2 to 4 times the blood levels.
Abstract: The concentration of tetracycline in gingival crevice fluid and blood was determined using a sensitive bioassay after oral administration of repeated doses of tetracycline. Crevicular fluid was sampled by an intracrevicular technique from four gingival sites in each individual and blood was obtained by finger puncture. Four volunteers received doses of 250 mg of tetracycline-HCl either every 6 hours or every 12 hours and were sampled at hours 0 to 15, 21 to 36, 48 to 60 and 96 to 102. Volunteers given 250 mg every 6 hours had average crevicular fluid concentrations between 4 to 8 micrograms/ml and blood concentrations between 2 to 2.5 micrograms/ml after 48 hours. The levels in crevicular fluid and blood of volunteers who received 250 mg every 12 hours were 2 to 4 micrograms/ml and 0.3 to 1.4 micrograms/ml respectively after 48 hours. The results demonstrated that after repeated doses of tetracycline the crevicular fluid levels were typically 2 to 4 times the blood levels.
TL;DR: Results of the study indicate that the palato-gingival groove is associated with poorer periodontal health as measured by the GI and PDI and more plaque accumulation as measured with the PII.
Abstract: The purpose of this investigation was to determine the prevalence of the palato-gingival groove in maxillary incisor teeth and the health status of the lingual periodontal tissues adjacent to maxillary incisor teeth with and without the grooves A total of 531 individuals aged 17 to 35 years were examined for the presence or absence of palato-gingival grooves in their maxillary incisor teeth A Plaque Index (PII), Gingival Index (GI), and Periodontal Disease Index (PDI) were recorded for the lingual aspect of the four maxillary incisors Tooth mobility was also recorded The prevalence of the palato-gingival grooves in the 531 individuals examined was 85% Of the 2,099 maxillary incisor teeth examined, 233% had a palato-gingival groove Most of the palato-gingival grooves (938%) were in maxillary lateral incisor teeth Statistical analyses revealed no differences in groove prevalence on the basis of sex or race Results of the study also indicate that the palato-gingival groove is associated with poorer periodontal health as measured by the GI and PDI and more plaque accumulation as measured with the PII
TL;DR: The clinical impression at re-entry and the numerical data indicate that pure hydroxylapatite ceramic has a definite potential as an alloplastic implant in the treatment of periodontal osseous defects.
Abstract: Eight patients received a new polycrystalline ceramic form of pure hydroxylapatite (Durapatite) as a bone implant material in various types of infrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the CEJ using a standardized periodontal probe. Similarly debrided defects that were not implanted served as controls. Defect selection as either experimental or control site was based on either split-mouth or alternating defects design. Periodontal dressing and systemic tetracycline were used for 10 days. Recalls for documentation and plaque control were at 10, 20, and 30 days, and 3 and 6 months. Measurements relating to defect changes were made at the 6-month surgical re-entry. For evaluation purposes original defect depths were divided into three groups. In Group I (<3 mm) defect fill was 1.2 mm (60%) for the implanted defects and 0.6 mm (40.5%) for the control sites (significantly different at P < 0.05). ...
TL;DR: It was concluded that, in this model system, decalcified freeze-dried bone allograft is a graft material of high osteogenic potential; autogenous osseous coagulum and bone blend of less potential, and freeze-Dried boneAllograft even less.
Abstract: The purpose of this study was to make a direct histological comparison of new bone formation evoked by decalcified freeze-dried bone allograft, freeze-dried bone allograft, autogenous osseous coagulum, and autogenous bone blend. Defects were surgically created in the calvaria of 35 guinea pigs. The graft materials were placed in porous nylon chambers and implanted into the defects. Implanted empty nylon chambers served as controls. The animals were sacrificed at 3, 7, 14, 21, 28, 35, and 42 days. New bone formation was determined quantitatively from histologic preparations. It was concluded that, in this model system, decalcified freeze-dried bone allograft is a graft material of high osteogenic potential; autogenous osseous coagulum and bone blend of less potential, and freeze-dried bone allograft even less.
TL;DR: The angiographic study demonstrated that rapid revascularization can be expected when uniform grafts of thin to intermediate thickness are placed on a periosteal recipient site which has been carefully freed of loose connective tissue and muscle attachments.
Abstract: The purpose of this clinical investigation was to determine what effect the thickness of a free gingival graft has on the processes of revascularization and shrinkage. With the aid of a Mucotome®, very thin, thin, and intermediate thickness grafts were excised from the palate. These were placed in the mandible or maxilla of patients with insufficient attached gingiva. Vertical graft shrinkage was measured at 15, 30, 90, and 360 days after surgery. Angiographic studies were made on 24 healing grafts. From the day of grafting to 360 days afterward the percentages of shrinkage were: very thin, 45%; thin, 44%; intermediate, 38%. The angiographic study demonstrated that rapid revascularization can be expected when uniform grafts of thin to intermediate thickness are placed on a periosteal recipient site which has been carefully freed of loose connective tissue and muscle attachments. An uneven, thick graft placed on a site of denuded bone favored a prolonged period of revascularization and delayed healing.
TL;DR: In this article, the authors determined if the depth of probe penetration into the gingival sulcus was related to bleeding after probing with a standardized force, visual signs of gingiva inflammation, and histological parameters of Gingival inflammation.
Abstract: The purpose of this study was to determine if the depth of periodontal probe penetration into the gingival sulcus was related to bleeding after probing with a standardized force, visual signs of gingival inflammation, and histological parameters of gingival inflammation. Sixty midfacial gingival sites in 26 persons were evaluated for presence or absence of visible inflammation and bleeding after probing using a controlled insertion pressure of 25 gm. In order to delineate the area for histologic analysis, a reference incision was made on the facial surface of the gingiva which corresponded to the depth and mesio-distal extent of the area probed and evaluated for visual signs of inflammation. Gingival biopsy specimens were histometrically analyzed to determine the depth of probe penetration and percentage of inflamed connective tissue. Statistical analysis of the data demonstrated that probe penetration was significantly greater in the presence of visible inflammation, but not with bleeding after probing. Furthermore, only a weak correlation existed between depth of probe penetration and percentage of inflamed connective tissue adjacent to the area probed.
TL;DR: It was concluded that in this model system decalcified freeze-dried bone allograft is a graft material of high osteogenic potential while autogenous bone blend and osseous coagulum were of less potential, and freeze-Dried boneAllograft even less.
Abstract: The purpose of this study was to obtain a direct comparison of the bone forming abilities of autogenous osseous coagulum, autogenous bone blend, freeze-dried bone allograft, and decalcified freeze-dried bone allograft. Defects were created in the calvaria of 35 guinea pigs. The graft materials were placed in porous nylon chambers and implanted into the defects. Empty nylon chambers served as the controls. Three days prior to sacrifice, each animal received an injection of 85Sr. The animals were killed in groups of five at 3, 7, 14, 21 28, 35, and 42 days. At sacrifice, a small section of ilium was removed from each animal. The samples were recovered, weighed, and the uptake of 85Sr into new bone determined. An osteogenic index was obtained by dividing cpm/mg for each sample by cpm/mg of ilium. It was concluded that in this model system decalcified freeze-dried bone allograft is a graft material of high osteogenic potential while autogenous bone blend and osseous coagulum were of less potential, and freeze-dried bone allograft even less.
TL;DR: It was concluded that subgingival plaque formation can be prevented in areas accessible to the toothbrush.
Abstract: The purpose of the present study was to find out to what extent subgingival plaque formation may be prevented by toothbrushing. The experiment was carried out on a total of 28 molars in four monkeys. On day 0 all supra- and subgingival deposits were removed, and during the following year, the teeth on the left side were carefully brushed three times a week, employing the Bass' method. The right side was kept as unbrushed control. The histologic sections, which were cut in a bucco-lingual direction, showed that subgingival plaque almost invariably had developed on the unbrushed teeth. Although all of the brushed teeth were free of subgingival plaque, a mild to moderate cellular infiltration prevailed for some distance below the gingival margin. These inflammatory reactions were assumed to have been induced by the bristles of the toothbrush, which were shown to penetrate as far as 0.9 mm below the gingival margin, when employing the Bass method. It was concluded that subgingival plaque formation can be prevented in areas accessible to the toothbrush.
TL;DR: This review leads to a concept in which the tissues of the dentogingival junction are dynamic rather that static, even when they are pathologic, they can be reconstituted by repair.
Abstract: This review leads to a concept in which the tissues of the dentogingival junction are dynamic rather that static. Even when they are pathologic, they can be reconstituted by repair. Both their cellular and extracellular components exhibit a high rate of turnover. Some of the cells are specialized for specific functions, such as attachment formation, and do not generate additional cells, but generative pools are always nearby. The cells are capable of movement and of positional change. The junctional epithelium can advance and retract. The cuticle width is alterable. The entire tissue is capable of regeneration after wounding. This dynamic group of tissues is well adapted for the healing of direct injuries produced during mastication. The tissues do remarkably well, over long periods, in their response to periodontal disease, whether due to direct bacterial or toxic damage, or to indirect damage via the migration of inflammatory cells into the lesion. The tissues show a capacity for repair and regeneration following the elimination of plaque formation and the resultant resolution of the inflammatory infiltrate. The complete story is not yet developed. The past 60 years are replete with fine contributions by distinguished workers. Additional contributions continue to be made. The inheritance from our predecessors has been used well and our expanded knowledge in this area now serves as the conceptual framework for further study.
TL;DR: Data indicate that tetracycline is inhibitory at levels achieved in crevicular fluid for bacteria currently implicated in destructive periodontal disease.
Abstract: The sensitivity to tetracycline of 345 bacterial isolates from periodontal lesions was determined. Most species of bacteria, including those thought to be involved in the initiation and progress of destructive periodontal disease, were inhibited in vitro by tetracycline concentrations of 4 to 8 μg/ml. This concentration is equivalent to crevicular fluid levels of tetracycline at dosages of 1 gm/day. These data indicate that tetracycline is inhibitory at levels achieved in crevicular fluid for bacteria currently implicated in destructive periodontal disease.
TL;DR: This review will consider other points of view and later research findings in different zones on the tooth side and the periodontal tissue side, and their applications to new attachment therapy.
Abstract: more coronal attachment of the periodontal tissues to the tooth, after the natural attachment has been destroyed by trauma or disease—most often by the chronic inflammatory periodontal disease, Periodontitis. This is distinguished herein from reattachment, or healing by scar,1 subsequent to surgical detachment. Following his review of the world literature on periodontal therapy,2 Ratcliff1 proposed an analysis of repair systems in periodontal therapy. He stated, "There are four basic forms of periodontal therapy used for elimination of pockets. These are: (1) shrinkage, (2) excision, (3) healing by scar, and (4) new attachment." Essentially, this meant either accepting the existing dentogingival junction, or cutting it away and growing a new one. Shrinkage was considered the elimination of the edema developed as a part of the inflammatory reaction to irritants; and with a constant position of the epithelial attachment, shrinkage after hygienic procedures would reduce the pocket depth. Excision, such as gingivectomy, and healing by scar, such as with apically repositioned flaps, produce little or no regeneration of a new attachment. For purposes of analysis of new attachment, the tooth side of the periodontal lesion (Fig. 1) was considered to have four zones. After the dissection and removal of the pocket lining (Fig. 2), the contributions of the zones to new attachment were discussed.1 Acknowledging Ratcliffs contribution1 to our understanding, this review will consider other points of view and later research findings in different zones on the tooth side and the periodontal tissue side, and their applications to new attachment therapy.
TL;DR: Elimination of lesions diagnostic of trauma from occlusion is an essential part of complete periodontal therapy and restoration of health in the masticatory system for such patients, and splinting of hypermobility of self-limiting trauma from Occlusions is not indicated.
Abstract: Elimination of lesions diagnostic of trauma from occlusion is an essential part of complete periodontal therapy and restoration of health in the masticatory system for such patients. This can be achieved by orthodontic treatment, temporary splinting, bite-planes, occlusal adjustment and permanent splinting of teeth. Occlusal therapy may be required during periodontal treatment for trauma from occlusion and to enhance occlusal stability at any stage of periodontitis, but is most often needed in advanced periodontitis. Splinting of hypermobility of self-limiting trauma from occlusion is not indicated. Splinting may be required in addition to occlusal adjustment in moderate to severe periodontitis when trauma from occlusion is progressive.
TL;DR: It is concluded that the bleeding time index may be used by itself as an accurate and objective clinical tool to evaluate gingival inflammation.
Abstract: Recent studies have supported an emphasis on gingival bleeding indices for detection of inflammation. The purposes of the present study were: (1) to evaluate the relationships between the time necessary for stimulated gingival bleeding to occur and both gingival fluid flow and Loe's gingival index; and (2) to develop a clinical index based on gingival bleeding time. In the first part of the study, the elapsed time for gingival bleeding to first occur after sulcular stimulation was correlated with the gingival index and fluid flow on 150 gingival units. A high correlation was found between bleeding time with both the gingival index and exudate flow. A bleeding time index based on a scattergram of the data obtained in part I of the study was then formulated and evaluated in a similar fashion on an additional 172 gingival units. Results indicate a high correlation between the bleeding time index and the other indices. It is concluded that the bleeding time index may be used by itself as an accurate and objec...
TL;DR: The clinical, radiographic and histopathologic features of spontaneously occurring periodontitis in adult dogs were studied and the presence of a large population of PMNs appears to be associated with highly active and destructive disease.
Abstract: The clinical, radiographic and histopathologic features of spontaneously occurring periodontitis in adult dogs were studied. Periodontitis in these animals is not an analogue of the human disease; the disease in humans and dogs has common features, but there are also remarkable differences. In both species there is a dense lymphoid cell infiltrate with a variable population of polymorphonuclear neutrophilic leukocytes (PMNs), conversion of junctional epithelium to pocket epithelium, an early and continuing loss of collagenous tissue, and bone and root resorption. In both species the pattern of bone loss is bilaterally symmetrical and the presence of a large population of PMNs appears to be associated with highly active and destructive disease. On the other hand, the disease in the dog begins as an infiltration of the connective tissues at the gingival margin rather than subjacent to the gingival sulcus and it is characterized by proliferation of the gingival tissue and conversion to granulation tissue. Bo...
TL;DR: The investigations reported here indicate that desquamative gingivitis is a clinical manifestation of several diseases and that patients with pemphigus should be referred to a dermatologist immediately.
Abstract: Previous reports, as well as the investigations reported here, clearly indicate that desquamative gingivitis is a clinical manifestation of several diseases. Correct identification of the underlying etiology is very important since approximately one-third of the patients with desquamative gingivitis may have cicatricial pemphigoid or pemphigus. These two diseases have broad and sometimes systemic medical implications. In cicatricial pemphigoid, not only the oral mucosa but also the conjunctiva may be involved with subsequent blindness. Because of this, patients with cicatricial pemphigoid should also be examined by an ophthalmologist and may require care of a dermatologist for systemic treatment. In pemphigus, 50% of the cases start with only oral lesions with later development of skin lesions. Because of the life-threatening nature of this disease, patients are usually placed on high systemic doses of corticosteroids. Patients with pemphigus should be referred to a dermatologist immediately.
TL;DR: The purpose of the study was to determine the composition of the microbiota in periodontally diseased pockets by dark field microscopy prior to treatment, after scaling and root planing, and after periodontal surgery.
Abstract: The purpose of the study was to determine the composition of the microbiota in periodontally diseased pockets by dark field microscopy prior to treatment, after scaling and root planing, and after periodontal surgery. Eighteen patients with untreated chronic periodontitis were selected. Preoperative or baseline clinical data included Plaque Index (PlI), Gingival Index (GI) and Probing Depth (PD). Subgingival microbial debris from the surface with the deepest probing depth in each of the six sextants was collected and the pooled microbial sample was examined by differential dark-field microscopy. The relative proportions of bacterial forms were classified into four groups: coccoid cells, motile rods, spirochetes and others. The patients were instructed in oral hygiene and received several sessions of scaling and root planing, some of these in conjunction with occlusal therapy. The clinical and microbial status was reevaluated prior to the surgical treatment phase. At least 6 weeks after the last surgical i...