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Notes: Aim: The purpose of this retrospective analysis was to examine what effect, if any, the time elapsed between an individual’s last episode of scaling and root planing and subsequent treatment with a sustained-release doxycycline hyclate gel (DH) alone or scaling and root planing alone (SRP) would have upon adult periodontitis.Methods: A total of 207 subjects were included in the DH group and 210 patients in the SRP group. Periodontitis was defined as those sites which presented with pocket depths 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE281205:ges" location="ges.gif"/〉5 mm and exhibited bleeding upon probing. In both DH and SRP groups, 3 sub-groups of subjects were identified according to their last episode of scaling and root planing prior to the study baseline: within 2 to 6 months, 〉6 but 〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE281205:les" location="les.gif"/〉12 months, and one or more times in their life but not within the last 12 months. Each study site was treated twice over a 9-month study period, once at baseline and again at 4 months. Data from the study sites at 4, 6, and 9 months were then evaluated for changes in probing depth, clinical attachment level, and bleeding upon probing.Results: At the 9-month evaluation, all sub-groups in the DH and SRP treatment arms presented with improvement in the measured clinical parameters, as compared to baseline. No significant differences were observed in the measured periodontal indices among the study sites between the three sub-groups for either treatment.Conclusions: It is concluded that the time interval since the last episode of scaling and root planing had no observable effect on the results achieved when treating periodontitis sites with locally delivered doxycycline hyclate alone or scaling and root planing alone. The treatment of periodontitis sites with locally delivered doxycycline hyclate resulted in clinical improvement comparable to scaling and root planing irrespective of the patient’s prophylaxis frequency.

Notes: Background, aim: The effect of subgingival calculus on the clinical outcomes of the local delivery of antimicrobials is unknown. This study examines the clinical outcomes of treatment with locally delivered controlled-release doxycycline (DH) or scaling and root planing (SRP) in subsets of adult periodontitis patients with known baseline levels of subgingival calculus.Methods: The data examined were obtained from 393 patients who participated in 2 multi-center trials. All patients had baseline subgingival calculus levels assessed and were then treated at baseline and month 4 with either DH or SRP. Clinical attachment levels (CAL), pocket depth (PD) and bleeding on probing (BOP) were assessed at baseline and months 1, 2, 4, 5, 6, 8 and 9.Results: Treatment with either DH or SRP resulted in significant statistical and clinical improvements in CAL, PD and BOP. These clinical outcomes were equivalent regardless of the extent of subgingival calculus present at baseline.Conclusions: The results indicate that the primary clinical effects of these therapies are the result of a disruption and reduction of the subgingival plaque and not the effect of the removal of subgingival calculus and contaminated cementum.

Notes: Abstract. The present study was undertaken to clarify whether visual inflammation or gingival bleeding on probing is the earlier indicator of gingivitis. A dental prophylaxis was given to 90 male students and 1 month later the gingiva adjacent to the mesio-buccal, mid-buccal and mid-lingual surfaces of all teeth was evaluated. Two subsequent examinations were done at 1-month intervals. Each gingival margin was examined visually and classified as either non-inflamed or inflamed and these same surfaces were then probed for bleeding. The number of gingival surfaces at each examination was 6990 and, at the first examination, 16798 of these combined absence of visual inflammation and bleeding (healthy). One month later only 766 of these surfaces were still healthy. Inspection of the data from the surfaces which had changed since the first examination showed that there were a significantly greater number of surfaces which bled after probing compared to either a color change only or combined both a color change plus bleeding. The same trend was seen between the second and third examinations. It was concluded that substantial changes in healthy gingival surfaces occur in as brief a period as 1 month. When healthy gingival surfaces (no visual inflammation and no bleeding) developed clinically detectable signs under investigation, a significantly greater number manifested bleeding alone compared to either visual inflammation alone or a combination of visual inflammation plus bleeding. These findings support an emphasis on gingival bleeding indices for detection of early deviations from health.

Notes: Abstract The present investigation was undertaken to quantitate the osseous changes which occur throughout the entire circumferential extent of infrabony periodontal defects in patients with optimal plaque control. Fifteen defects were selected in nine patients. Periodontal surgery was scheduled after each patient had shown an ability to practice efficient plaque removal. Muco-periosteal flaps were raised and the osseous defects debrided. The dimensions of each defect were measured at several specific location points within the defect. The flaps were replaced at their original location and, post-operatively, optimal plaque control was maintained in the area (Mean Plaque Index 0.04). Six to 8 months after the initial surgery all areas were re-operated and the osseous defects were remeasured at the same specific location points. Each defect showed osseous regeneration at every location point. The mean initial osseous defect depth at a location point was 3.5 mm and the mean amount of bone regeneration which occurred was 2.5 mm. Crestal alveolar bone resorption occurred at almost half of the location points and averaged 0.7 mm. Eleven of the 15 deefcts had resolved completely. There were isolated areas where a shallow defect persisted in the remaining four defects. The behavior of an osseous defect throughout its circumferential extent was characterized by a combination of coronal hone regeneration (mean 77%) and marginal bone resorption (mean 18%). Infrabony periodontal defects may predictably remodel after surgical debridement and establishment of optimal plaque control.

Notes: Abstract A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces were superimposed upon an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. In order to clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal responses were evaluated after removing combinations of traumatic and inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components; however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. After resolution of inflammation, remaining tooth mobility does not result in increased loss of connective tissue attachment. On a clinical level for periodontal disease treatment, the findings place decreased emphasis upon management of tooth mobility and increased emphasis upon resolution of marginal inflammation.

Notes: Abstract A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament consequent to either single or jiggling displacing forces result in morphologic alterations in the ligament and alveolar bone. These changes do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces have been produced subjacent to an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. To clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal response was evaluated after removing traumatic and/or inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components, however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. Resolution of marginal inflammation is of prime importance in the management of periodontal disease. After resolution of inflammation, bone regeneration may occur around mobile teeth and, furthermore, any residual tooth mobility does not result in increased loss of connective tissue attachment.

Notes: Abstract This report details some preliminary observations regarding cell morphology and behavior during early phases of in vivo attachment to demineralized surfaces. Rectangular dentin specimens prepared from beneath calculus-covered areas of root surfaces were treated with citric acid and implanted vertically into the skin of rats such that one end of the implant protruded above the skin. The implants were removed after 1 day and the dentin surface—connective tissue interface examined using scanning electron microscopy. A dynamic series of biological events seemed to be in progress. Numerous cells were attached lo the dentinal root surface. Cell processes extended a considerable distance along the root surface and into dentin tubules. Cell processes in dentin tubules are discussed.

Notes: Abstract The rationale for periodontal treatment in this case was that inflammatory perio-dontal disease can be arrested by creating a dento-gingival anatomy which is accessible for daily plaque removal techniques and that hypermobility per se does not mandate splinting to adjacent, less mobile teeth. These principles were applied to the management of a maxillary molar with advanced furcation involvement. In order to resolve the furcation problem it was necessary to amputate the palatal and disto-buccal root which resulted in retention of the mesio-buccal root. Although this retained root was hypermobile, this was not reason in itself to justify splinting. Splinting would be necessary only if the mobility interfered with masticatory function or increased progressively. Since this would not be known until the behavior of the tooth was observed in function, the root was restored as an independent unit. The occlusion was designed so that the crown had no premature contacts in the retruded or intercuspal positions and no non-working side contacts in lateral excursion. The margins of the crown were kept supragingival. In the weeks following crown placement, no increase in mobility occurred although the tooth was in full masticatory Function. One year later there had been no change in the mobility status. It was concluded that the retained mesio-buccal root which had reduced periodontal support and a degree of hyper-mobility was capable of independent function. No periodontal breakdown occurred due to this mobility. Furthermore, efficient removal of plaque prevented recurrence of inflammatory periodontal disease and, in the presence of this plaque control, root caries did not develop after placing the crown margins in a supragingival location.

Notes: Abstract Although specific subgingival microflora are being associated with active tissue destruction in periodontitis, little information exists on the relationship between subgingival flora and histological evidence of tissue destruction. The present study was undertaken to explore these relationships during experimental marginal periodontitis in squirrel monkeys.In 4 squirrel monkeys, experimental periodontitis was induced around bicuspids and molars using silk ligatures. The buccal part of the subgingival ligature was removed for bacterial sampling 3, 7, and 14 days after ligature placement. Dark-field microscopy was used to quantify motile forms, spirochetes, straight and curved rods, filaments, cocci and fusiforms. Subgingival plaque prior to periodontitis induction was dominated by cocci, but fusiforms and straight rods were also present. Spirochetes, filaments, curved rods and motile forms were absent. 3 days after induction of periodontitis, there were marked increases in spirochetes, motile forms, filaments, curved and straight rods. The proportions of coccoids and fusiforms decreased. The bacterial proportions stayed at approximately the same levels through 7 and 14 days. Histometric quantification of periodontal destruction showed loss of connective tissue attachment and crestal alveolar bone. A positive correlation was found between periodontal tissue destruction and both total number of subgingival bacteria and spirochetes.

Notes: Abstract The present investigation was undertaken to evaluate the periodontal response after resolution of inflammation in a situation of established marginal periodontitis, but in the presence of active, continued tooth hypermobility. Periodontitis was induced unilaterally around mandibular second and third bicuspids in 4 squirrel monkeys by tying plaque retentive silk ligatures at the gingival margins. Jiggling trauma to the periodontium between these bicuspids was begun 5 weeks later and continued for the remaining 20 weeks. Ligatures were removed 15 weeks after placement, whereupon regular oral hygiene was begun and continued. Periodontitis and trauma were produced around the corresponding contralateral teeth (control) so that the interproximal area represented the situation immediately prior to ligature removal. Infiltrated connective tissue, loss of connective tissue attachment and alveolar bone, and percentage of bone were determined histometrically for each coronal interproximal periodontium. In control specimens, 58 % of the supracrestal tissue was infiltrated with inflammatory cells compared to 19% in experimental specimens. There were no differences in levels of connective tissue attachment or crestal alveolar bone. However, bone repair occurred in the experimental specimens which increased bone volume from 11 to 18% (P 〈 0.05). It was concluded that osseous repair occurred in the presence of active, continued tooth hypermobility after resolution of inflammation.