Bibliothek

Notizen: Abstract: Although average measurements of the biologic zone do not necessarily reflect any one clinical situation, they do establish a basis upon which clinical decisions can be made. Clinical impressions, human autopsy material, and animal studies support the concept of a biologic width. Impingement on the attachment in a susceptible host has shown adverse reactions, including gingival inflammation and alveolar bone loss. The concept is clinically important in determining the extent of osseous surgery necessary in the exposure of sound tooth structure. If the implant-abutment interface is considered to be similar to a subgingival crown margin, its importance in relation to peri-implant inflammatory disease is readily apparent. In the presence of inflammation, it is likely that epithelial migration would occur to a level apical to that source. Clinical observations indicate that, once the biologic attachment is invaded around the implant, the gingival reactions are similar to those found around natural teeth, whether the tissue is of the thick flat or thin scalloped type.

Notizen: Abstract Previous reports have suggested that persistently elevated levels of the acidic glycohydrolase β-glucuronidase (βG) in gingival crevicular fluid (GCF) can identify patients with chronic adult periodontitis who are at risk for future probing attachment loss (PAL). To comprehensively study βG activity in GCF, a multicenter trial examining the relationship of the enzyme in GCF to traditional clinical parameters of periodontal disease and PAL was conducted. In this report, the baseline data was used to evaluate the relationship of βG activity in GCF to traditional parameters of periodontal disease. The study group included 130 patients who had been treated for periodontal disease and were on a regular recall schedule, and 10 patients with chronic adult periodontitis who had never received treatment. Upon entering the longitudinal trial, the patients were examined, and a standardized 30-s GCF sample was collected from the mesiobuccal crevice of all study teeth. As a control, GCF samples and clinical data were collected from 62 patients with a healthy periodontium or mild inflammatory gingivitis without loss of probing attachment. At baseline, βG activity for the periodontitis patients ranged from 0 to 1704 Units (U), with a median of 32 U. βG could not be detected in 0.2% of samples (activity ≤2.0 U). The 90% cumulative relative frequency was 139 U. For the healthy/gingivitis subjects βG activity ranged from 0 to 504 U, with a median of 22 U. Enzyme was not detectable in 0.4% of samples. Only 0.9% of samples contained greater than 139 U. βG activity in GCF was not related to gender or age. For the periodontitis patients, elevated enzyme activity (〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE118:ges" location="ges.gif"/〉140 U) was most often associated with molar teeth, followed by maxillary bicuspids. Maxillary central incisors, and mandibular central and lateral incisors displayed the lowest frequency of elevated enzyme activity. The relationship of βG activity to the traditional parameters of probing depth and bleeding on probing was assessed. For shallow sites (1.0–1.5 mm, 2.0–2.5 mm probing depth), the large majority of GCF samples contained low enzyme activity (90% of sampies ≤U). Descriptive indicators demonstrated a trend of increased βG activity with increased probing depth. The median βG activity shifted from 15 U for the shallowest sites (1.0–1.5 mm) to 127 U for the deepest sites (5–8 mm). However, this was due to a broadening of the distribution rather than representing a shift in the distribution profile. The relationship of bleeding on probing to βG activity was assessed on a tooth basis (bleeding at 0 to 6 sites). Teeth with no bleeding sites demonstrated a median βG activity of 22 U, while teeth with 5–6 bleeding sites had a median βG activity of 86 U. Again, this was the result of a broadening and flattening of the distribution observed with increased occurrence of bleeding on probing. These data suggest that while sites and teeth with increased severity of periodontal disease demonstrate greater βG activity, quantitative assessment of this enzyme in GCF provides a different measure of periodontal pathology than traditional clinical parameters of disease.

Notizen: Abstract Analysis of gingival crevicular fluid (GCF) offers a non-invasive means of studying the host response in periodontal disease, and may provide an early-indication of the patient at risk for active periodontitis. A number of host markers have been studied for their relationship to disease activity (probing attachment loss or PAL). GCF levels of the acid glycohydrolase β-glucuronidase (βG), a marker of primary granule release from polymorphonuclear leukocytes (PMN), have been shown to identify patients with periodontitis at risk for additional PAL. In this multicenter trial, we evaluated (a) the short-term effect of conservative periodontal therapy on βG activity in GCF, and (b) the relationship of persistently elevated βG activity to PAL in patients who were monitored for 6 months. The study population included a total of 140 patients with chronic adult periodontitis. 130 patients were on a regular recall schedule, and 10 were previously untreated. After collection of baseline clinical data at all sites, and analysis of βG in GCF from one site (mesiobuccal) per tooth, the patients received a scaling and prophylaxis. Two weeks later patients were seen for collection of GCF. If elevated enzyme activity was found at 2 weeks, the patients were seen at 3 months for a clinical exam and GCF collection. Clinical parameters were collected from all patients at 6 months. Therapy tended to reduce βG activity in GCF. Allowing ± 20 units of βG activity for sampling and assay variability. 2 weeks after therapy, 24.5% of patients had lower βG levels, 8.6% of patients had higher levels and 66.9% of patients did not change. Using patients as the unit of observation, algorithms were created relating persistently elevated βG activity to PAL. The algorithms were based on analysis of βG data at baseline, 2 weeks and 3 months, or baseline and 2 weeks. For the algorithms using βG data collected at 3 examinations, the risk ratio ranged from 7X to 14X, total predictive value ranged from 83% to 88%, sensitivity ranged from 65% to 77%, specificity ranged from 85% to 89% and the K statistic ranged from 0.41 to 0.44. If only the baseline and 2-week GCF data was used, accuracy decreased slightly, but a strong association between elevated βG activity and PAL remained (i.e., risk ratio of 6x to 10X). These data support our earlier findings that elevated levels of BG in GCF, indicative of increased PMN activity in the crevice, is associated with PAL in patients with chronic adult periodontitis. The role of the PMN in destruction of periodontal tissue may relate to release of lysosomal enzymes, and generation of reactive oxygen metabolites in the crevicular environment.