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Notes: Abstract The purpose of this proof of principle trial was to assess whether conventional periodontal therapy and systemically administrated acetylsalicylic acid (ASA) are functionally synergistic when combined in the treatment of periodontitis, A total of 30 patients with untreated moderate to severe adult periodontitis were enrolled into the study and were given placebo q.i.d. between the baseline and 6-week examination, and acetylsalicylic acid (ASA) 500 mg q.i.d. between the 6-week and 12-week examinations. In addition, they received supra-and subgingival scaling in 1 quadrant after baseline examination and in 2 further randomly selected quadrants after the 6-week examination. The study design resulted in the following 4 therapies: (1) scaling plus ASA 500 mg q.i.d.: (2) scaling plus placebo q.i.d: (3)ASA 500 mg q.i.d. alone: (4) placebo q.i.d. alone. Two-way analysis of variance showed functional synergism of ASA and scaling, resulting in a therapeutic efficacy approximately equivalent to the sum of each individual therapeutic efficacy (i.e., ASA alone and scaling alone) in reducing gingival inflammation and pocket probing depth over the 6-week observation period (interaction: p 〉0.05). Only the effect of ASA was significant m reducing the concentration of elastase-α1-proteinase inhibitor in gingival crevicular fluid (GCF E-α1-PI) (p 〉0.001), reduction in GCF E-α1-PI concentrations by ASA may indicate a decreased risk in periodontal disease progression. The results suggest that the combination of therapies and their different mechanisms of action, i.e., reduction of bacterial plaque and inhibition of destructive components of the immune responses, may result in functionally synergistic therapeutic efficacies in patients with untreated adult periodontitis.

Notes: Background: Cyclosporin A (CyA) is a potent immunomodulatory agent with a wide range of applications. Despite its therapeutic value, multiple adverse effects of CyA have been identified. This case report describes eruption cyst formation as a possible adverse effect of CyA administration during tooth eruption in a boy treated with CyA as a consequence of a cardiac transplantation. The clinical diagnosis of eruption cyst was confirmed by histopathological examination.Treatment: The periodontal treatment consisted of supragingival and subgingival scaling, followed by surgical removal of the tissues overlying the crowns of the teeth associated with eruption cysts, and flap surgery in the region of gingival overgrowth. The patient was then placed on quarterly periodontal supportive therapy and his immunosuppressive medication was switched from CyA to tacrolimus.Results: Twenty months after therapy, neither new cyst formation nor recurrence of gingival overgrowth was registered.Conclusion: Formation of an eruption cyst may be an adverse effect of CyA in children with erupting teeth.

Notes: Aim: Air-polishing devices (APDs) are highly effective in removing plaque and extrinsic staining. Their application on root surfaces, however, may result in clinically relevant substance removal, limiting the use in patients with periodontitis, where denuded root surfaces are frequently found. Therefore, the purpose of the study was to assess the influence of different working parameters on root damage and to identify those minimizing root damage.Material and methods: Defect depth and defect volume after instrumentation of roots with an APD (Dentsply Prophy-Jet®) using conventional NaHCO3 powder at instrumentation times of 5, 10 and 20 s, combinations of low, medium and high powder and water settings, distances of 2, 4 and 6 mm, and angulations of 45° and 90° were quantified laseroptically. A total of 297 roots were instrumented and parameter combinations were performed in triplicate. The influence of each working parameter on substance loss was determined by multiple regression analysis.Results: Time had the greatest influence on defect volume and depth (β-weights 0.6 and 0.57, respectively), when compared with powder setting (β-weights 0.49 and 0.3) and water setting (β-weights 0.28 and 0.3). Variations in distance affected defect depth (β-weight 0.44), but not volume (β-weight 0.04). No major differences were found at 45° and 90°. Various parameter combinations led to maximal defect depths of 473.5 ± 26.2 µm within 20 s.Conclusion: Root damage varies among combinations of working parameters. Using the APD with the assessed NaHCO3 powder, all parameter combinations led to substantial root damage. Thus, APDs using NaHCO3 may not be safely utilized on exposed root surfaces.

Notes: Objectives:  The purpose of this systematic review was to determine the efficacy of machine-driven compared with manual subgingival debridement in the treatment of periodontitis.Background:  Mechanical debridement of the periodontal pocket plays a pivotal role in the treatment of periodontitis.Methods:  A literature search for controlled clinical trials with at least 6 months' follow-up comparing machine-driven instruments with hand instruments for the treatment of chronic periodontitis was performed up to April 2001. Screening of titles and abstracts as well as data extraction was conducted independently by two reviewers (J.T. & T.F.F.). As primary outcome variable, the prevention of tooth loss was used; secondary outcome variables were the prevention of disease progression, the resolution of anatomical defects and the resolution of gingival inflammation. Efficiency was assessed by mean time needed to treat one tooth.Results:  From a total of 419 abstracts, 27 articles were included for the review. The weighted kappa score for agreement between the two reviewers was 0.77, 95% CI: 0.65–0.89, indicating substantial agreement. No study reported on the selected primary outcome variables. Using clinical attachment gain, probing pocket depth reduction or bleeding on probing reduction as outcome variables, there appeared to be no differences between ultrasonic/sonic and manual debridement. No major differences in the frequency or severity of adverse effects were found. However no meta-analysis could be performed on any of the previously mentioned parameters. Ultrasonic/sonic debridement was found to take significantly less time, i.e. 36.6%, than debridement using hand instruments (P = 0.0002, 95% CI of the standardized effect estimate: 0.39–1.37, heterogeneity P = 0.77).Conclusions:  With respect to clinical outcome measures, the available data do not indicate a difference between ultrasonic/sonic and manual debridement in the treatment of chronic periodontitis for single-rooted teeth; however, the evidence for this is not very strong. In addition, ultrasonic/sonic subgingival debridement requires less time than hand instrumentation. Further research is needed to assess the efficacy of machine-driven debridement on multirooted teeth and clinical outcome variables having tangible benefit to the patients should be used.

Notes: Objectives:  The purpose of this study was to determine the relative impact of various predictors responsible for the variability in treatment outcome after guided tissue regeneration (GTR) in intraosseous periodontal defects.Patients and methods:  30 patients with chronic periodontitis and at least one intraosseous periodontal lesion (≥4 mm) were enrolled. Following full-mouth scaling, GTR using polylactic acid membranes was performed at one site in each patient. Main periodontal pathogens, defect morphology, membrane exposure and smoking habit were assessed as predictor variables. Alveolar bone level change served as the primary outcome variable in a multiple regression analysis.Results:  After 12 months, the 29 patients completing the study showed alveolar bone changes ranging from 4 mm bone gain to 1 mm bone loss (mean: 1.6±0.4 mm gain). Active smoking (β-weight:-0.49, P=0.003) and persistence of subgingival infection with P. gingivalis (P.g.) (β-weight:-0.25, P=0.11) were associated with poor treatment outcome. Deep initial intraosseous defects (β-weight: 0.32, P=0.045) were associated with favorable treatment outcome, and membrane exposure had no impact on bone gain.Conclusion:  Active smoking was the strongest predictor variable negatively affecting alveolar bone gain following GTR in the treatment of periodontal defects. It was followed by a positive influence of a deeper intraosseous defect and by a negative effect by persistent subgingival infection of P. gingivalis. The relative impact of these factors may be useful in assessing the prosgnosis of GTR in intraosseous periodontal defects.

Notes: Aim of the study: Though efficient in stain and plaque removal, air polishing is highly abrasive on root cementum or dentin even if working parameters are adjusted to minimize damage. As abrasiveness is also influenced by the physical properties of the powders used, the aim of the study was to evaluate the safety of novel low abrasive air polishing powders in vitro.Material and methods: Using four novel air polishing powders (A, B, C and D) and a standard sodium bicarbonate (NaHCO3) powder, roots of 126 extracted teeth were air polished under standardized conditions at various working parameter combinations (distance: 2 mm, 4 mm and 6 mm; powder and water setting: low, medium and high) at an angulation of 90° for 20 s. Instrumentation was performed in triplicate; resulting root defects were quantified laser-optically.Results: Mean defect depths after application of powders A, B, C and D were significantly lower than with standard powder (A: 17.9 ± 10.9 µm, B: 48.2 ± 32.7 µm, C: 92.5 ± 57.9 µm, D: 33.9 ± 19.6 µm, NaHCO3: 163.1 ± 71.1 µm) (Kruskal–Wallis test). Among the experimental powders, D was transported most reliably in the air polishing unit and allowed complete removal of disclosed plaque as assessed on freshly extracted teeth.Conclusion: The novel air polishing powder D is of low abrasiveness to root cementum and dentin while being effective in removing dental plaque. Thus, it may be useful for safe and efficient plaque removal on exposed root surfaces.

Notes: Abstract. 48 adult patients with untreated periodontitis harboring subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to receive full mouth scaling alone (control) or scaling with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). Subgingival plaque and swab samples from tongue, tonsils, and buccal mucosa were taken at baseline, 10 days and 3, 6, 9, and 12 months. A. actinomycetemcomitans was detected in the oral cavity, i.e., subgingival plaque and/or mucous membranes. Less frequently in test patients compared to controls at 9 and 12 months (p〈0.01. whereas, the intraoral detection frequency of P. gingivalis was significantly reduced only 10 days following therapy (p〈0.001). At any time after therapy. A. actinomycetemcomitans was not detected intraorally in 5 of 10 (50%) test and 1 of 13 (8%) control patients harboring this pathogen at baseline; P. gingivalis was not detected in only 1 of 18 (6%) test and none of the 17 control patients harboring this pathogen at baseline. Although the data indicated that the assessed antimicrobial therapy may suppress A. actinomycetemcomitans from the entire oral cavity below detectable levels over a minimum of 12 months. P. gingivalis persisted or reoccurred.

Notes: Abstract. The purpose of this study was to assess the prognostic value of the IL-1 haplotype on the progression of periodontal disease following therapy. 48 adult patients with untreated periodontitis harboring Actinobacillus actinomycetem-comitans and/or Porphyromonas gingivalis were randomly assigned to receive full-mouth scaling alone (control) or in combination with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). All patients received supportive periodontal therapy at 3 to 6 months intervals. In 33 patients, lymphocyte DNA was analyzed for polymorphism in the IL-1A gene at position –889 and IL-1B gene at position +3953. Overall, 16 of 33 patients (7 of 17 test and 9 of 16 control) carried the IL-1 haplotype. 2 years following initial periodontal therapy, no differences in the survival rates of sites or teeth not exhibiting probing attachment loss of 2 mm or more compared to baseline, were found between patients who tested positive (85% sites, 53% teeth) and patients who tested negative (89% sites, 56% teeth) for the IL-1 haplotype. The results indicated that the IL-1 haplotype may be of limited value for the prognosis of periodontal disease progression following non-surgical periodontal therapy.〈section xml:id="abs1-1"〉〈title type="main"〉ZusammenfassungInterleukin-1-Haplothyp und Progression der Parodontalerkrankung nach der TherapieDer Zweck dieser Studie war es, den prognostischen Wert des IL-1-HapIotyps bezüglich der Progression einer Parodontalerkrankung nach der Behandlung zu bestimmen. Achtundvierzig erwachsene Patienten mit unbehandelter Parodontitis und Vorhandensein von Actinobacillus actinomycetemcomitans und/oder Porphyromonas gingivalis wurden randomisiert, entweder mit ausschließlichem Scaling des gesamten Gebisses behandelt (Kontrolle) oder in Kombination mit systemischem Metronidazol plus Amoxicillin und supragingivaler Spülung mit Chlorhexidin-Diglukonat (Test). Alle Patienten erhielten in 3 bis 6-monatigen Intervallen eine parodontale Erhaltungstherapie. Bei 33 Patienten wurde die DNA der Lymphozyten hinsichtlich Polymorphismus der IL-1A-Gene in der Position -889 und IL-1B-Gene in der Position +3953 analysiert. Ingesamt trugen 16 von 33 Patienten (7 von 17 Test und 9 von 16 Kontrolle) den Il-1-Haplotyp. Zwischen den Patienten die IL-1-Haplotyp-positiv getestet wurden (85% Flächen, 53% Zähne) und Patienten, die negativ getestet wurden (89% Flächen, 56% Zähne), wurden zwei Jahre nach initialer Parodontalbehandlung keine Unterschiede in den Überlebensraten von Flächen oder Zähnen, die bezüglich Ausgangssituation keinen klinischen Attachmentverlust von 2 mm oder mehr aufwiesen, vorgefunden. Die Ergebnisse zeigten, daß der IL-1-Haplotyp von eingeschränktem Wert für die Prognose der Progression der Parodontalerkrankung nach der konservativen Therapie sein könnte.〈section xml:id="abs1-2"〉〈title type="main"〉RésuméHaplotype d'interleukine-1 et progression de la maladie parodontale après traitementLe but de cette étude est d'évaluer la valeur pronostique de l'haplotype d'interleukine-1 (IL-1) pour la progression de la maladie parodontale après traitement. 48 patients adultes avec parodontite non traitée, abritant Actinobacillus aclinomycetemcomitans et/ou Porphyromonas gingivalis, ont été répartis au hasard dans des groupes de traitement devant recevoir un détartrage de toute la bouche, soit seul (groupe témoin) soit combiné avec l'administration systémique de métronidazole+amoxicilline et l'irrigation susgingivale avec le digluconate de chlorhexidine (test). Tous les patients ont reçu un traitement de maintenance parodontale à des intervalles de 3 à 6 mois. Ches 33 patients l'ADN de lymphocyte a été analysé en ce qui concerne le polymorphisme dans le gène d'IL-1A en position -889 et dans le gène d'IL-1B en position +3953. Dans l'ensemble, 16 des 33 patients (7 des 17 tests et 9 des 16 témoins) étaient porteurs de l'haplotype d'IL-1. Deux ans après le traitement parodontal initial, aucune différence dans le taux des sites ou dents ayant survécu, ne présentant pas de perte d'attache de 2 mm ou plus par rapport au début, n'a été trouvée entre les patients dont le test pour l'haplotype d'IL-1 était positif (85% des sites, 53% des dents) et les patients dont le test était négatif (89% des sites, 56% des dents). Les résultats indiquaient que l'haplotype dTL-1 peut avoir une valeur limitée pour le pronostic de la progression de la maladie parodontale après un traitement parodontal non chirurgical.

Notes: Abstract. 48 adult patients with untreated periodontitis harboring subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis as assessed by PCR were randomly assigned to receive full-mouth sealing alone (control) or scaling with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). In patients harboring A. actinomycetemcomitans intraorally at baseline, the adjunctive antimicrobial therapy resulted in a significantly higher incidence of probing attachment level (PAL) gain of 2 mm or more compared to scaling alone over 12 months (P〈 0.05). In addition, suppression of A. actinomycetemcomitans in subgingival plaque below delectable levels was associated with an increased incidence of PAL gain. In contrast, patients initially harboring P. gingivalis but not A. actinomycetemcomitans in the oral cavity showed a significantly higher incidence of PAL loss following adjunctive antimicrobial therapy compared to scaling alone (P〈0.05). When the presence of pathogens at baseline was disregarded in the analysis, adjunctive antimicrobial therapy did not significantly enhance clinical treatment outcome. The results indicated that adults with untreated periodontitis harboring A. actinomycetemcomitans may benefit from the adjunctive antimicrobial therapy for a minimum of 12 months, whereas, the regimen may adversely affect the clinical treatment outcome of patients harboring P. gingivalis but not A. actinomycetemcomitans.

Notes: Background: Diabetes mellitus (DM) is undiagnosed in approximately 1/2 of the patients actually suffering from the disease. In addition, the prevalence of DM is more than 2× as high in patients with periodontitis when compared to periodontally healthy subjects. Thus, a high number of patients with periodontitis may have undiagnosed DM.Aim: The purpose of this pilot study was to evaluate, whether blood oozing from gingival tissues during routine periodontal examination can be used for determining glucose levels. 32 non-diabetic and 13 diabetic patients with moderate to severe periodontitis were enrolled and subjected to routine clinical periodontal examination. Periodontal pocket probing was performed using a standard force. Blood oozing from gingival tissues of anterior teeth following periodontal pocket probing was collected with the stick of a glucose self-monitoring device (Elite® 2000, Bayer Diagnostics GmbH, Munich). As control, fingerstick capillary blood was taken. Statistical analysis was performed by Pearson's correlation coefficient.Results: The patient blood glucose levels ranged from 3.57 mmol/l to 18.01 mmol/l and the values of blood samples taken from gingiva or finger tip showed a very high intrapatient correlation (r=0.98; p〈0.0001).Conclusion: The results suggested that blood oozing during routine periodontal examination may be used for diabetes mellitus screening in a dental office setting.