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Notes: Abstract The effect of hand or ultrasonic instrumentation on the subgingival microflora of periodontal pockets was investigated. Pockets with probing depths of 6-9 mm were selected in 12 patients and were randomly assigned per patient to the experimental and control groups. After oral hygiene instruction, instrumentation of the experimental pockets was carried out either by ultrasonic or by hand instruments in a split-mouth design. The treatment effect on the subgingival microbiota was evaluated by microscopic and culture studies of subgingival plaque samples, while in addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examinations were carried out before and 7,21 and 49 days after treatment. The hand and ultrasonic treatments were equally effective in reducing probing pocket depths and bleeding scores. At the end of the experimental period, the probing depths of 54% of the hand-treated pockets and 43% of the ultrasonic-treated pockets were reduced to 4 mm or less while the bleeding scores were reduced to 29% and 22%, respectively. The analysis of microscopical and cultural data did not show any differences between hand and ultrasonic debridement. Both treatments reduced the microscopical counts of rods, spirochetes and motiles and reduced the total colony-forming units and number of black-pigmented Bacteroides and Capnocytophaga, resulting in a subgingival microbiota consistent with periodontal health.

Notes: Abstract The clinical and microbiological effect of locally-applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied. The gels were applied 3 x within 10 min. after mechanical debridement of the pockets. The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples. In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examination were carried out before and during a period of 36 weeks after treatment. At the start, the cultured microflora consisted mainly of anaerobic Gram-positive bacteria. Following treatment, the clinical parameters were significantly reduced. Concomitantly, the %s of spirochetes, motile rods and non-motile rods decreased significantly. A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment. This suggested that the treatment resulted in a mainly facultative subgingival microflora. The % Gram-negative rods showed a significant reduction after treatment, but returned to base line at week 12. Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups. Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks. However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.

Notes: Abstract The clearance of a fluorescein gel applied with an irrigation technique in periodontal pockets was studied. In order to evaluate the time a drug remains in a periodontal pocket, the alteration in concentration of this drug in a given time period was investigated. After application of the gel in 4 pockets of 10 patients, samples were taken from 1 of the 4 pockets at 5, 10, 20 and 40 min. The results show that in the 1st phase, directly after application, most of the gel disappeared from the pocket, while in the 2nd phase, the fluorescein gel is washed out with a calculated 50% reduction time of 12.5 min. The rapid cleareance of the gel observed after irrigation might provide a partial explanation of the minor effect of pocket irrigation on the subgingival microflora.

Notes: Abstract Microbial and clinical parameters were studied in 11 subjects with chronic inflammatory periodontitis. 2 periodontal pockets per subject were studied longitudinally. The microbial parameters included counts of different subgingival micro-organisms by dark field microscopy, counts of the total colony forming units (c.f.u.) on anaerobic blood agar. the facultative anaerobic counts and counts of black-pigmented Bacteroides, Fusobacleriurn and E. corrodens. The clinical parameters were probing pocket depth, bleeding after probing and crevicular fluid production. Clinical and microbial observations were compared during 3 consecutive periods of non–treatment, debridement and metronidazole therapy. The experimental sites were debrided by deep scaling while no debridement was carried out at the control sites. The effect of this treatment was studied over a period of 3 months. Then, at the experimental sites, a 2nd session of debridement was followed by administration of metronidazole. The effect of metronidazole alone and combined with mechanical debridement was studied during a subsequent 3-month period. The disease activity did not correlate with the microbial parameters and was evident in the presence as well as in the absence of black-pigmented Bacteroides. A single session of subgingival debridement resulted in significant reductions in probing depth, spirochetes, motile organisms, black-pigmented Bacteroides and E. corrodens. Repopulation of the subgingival sites was observed. However, the composition of the subgingival microbiota remained significantly changed during the 3 months after debridement. The re-isolation of the same Bacteroides-species and the same B. gingivalis type after treatment indicated an outgrowth of micro-organisms remaining at these sites. The 2nd session of debridement and metronidazole therapy resulted in a further probeable pocket depth reduction and changes in the subgingival microbiota. At the non-debrided control sites, metronidazole therapy had a significant effect on the composition of the subgingival microbiota and at 5 of the 11 control sites, a reduction in pocket depth was observed. However, at one site, an increase in pocket depth took place in spite of reductions in black–pigmented Bacteroides, Fusobacteria, E. corrodens, spirochetes and motiles. It was concluded that metronidazole exerts an antimicrobial effect on the subgingival microbiota similar to that of mechanical debridement.

Notes: Aim: The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity.Material and Methods: In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts.A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ–BC for root proximity sites and contra-lateral sites were recorded.Results: A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ–BC distance between the root proximity sites and their contra-lateral sites.Conclusion: We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ–BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

Notes: Aim: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease.Material and Methods: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated.Results: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis.Conclusion: Root proximity must be taken into consideration as a risk marker for periodontal disease.

Notes: Abstract At present no information is available about biological effects on oral tissues of the photocuring periodontal dressing Barricaid®. This animal study examines histologically the tissue responses of surgical areas covered during 7 days with either Barricaid®. the eugenol-containing dressing Ward's Wondrpak® or the bionert control gel Carboxy Methyl Cellulose. One group was studied immediately after the removal of the dressings: in the other group, further healing was permitted for another week. Results after 7 days indicate acute inflammatory reactions in the test areas without significant differences between the 2 periodontal dressing materials. The control areas showed to a lesser degree basically the same tissue response. In the 2nd week, generally all areas healed. After 14 days, no differences between test- and control sites could be detected. From a biological point of view, these findings suggest no contra-indication for application of this photocuring dressing material after periodontal surgery.

Notes: Abstract Fifteen abutment teeth with pathologic mobility were splinted with removable telescoped bridges. Mobility was measured at the time the splints were placed and at 1- and 12-month intervals. Average mobility of the abutment and control teeth did not change significantly during the experimental period.

Notes: Abstract Background, aims: The purpose of the present case report was to present 2 ways of treating recession in a periodontal patient combined with regular pocket elimination surgery. The techniques used enabled the operator to reduce the number of surgical sessions and clinically evaluate the 3-year coverage of gingival recessions using a subpedicle connective tissue graft.Methods: Surgery consisted of pocket elimination procedures to treat adult periodontitis as a way to harvest connective tissue to be placed in the areas of recession. The grafted tissue was covered by the primary flap or left uncovered in a pouch, according to 2 different techniques described in the literature.Results: In this case, we observed that, with this approach, we were successful in reducing the number of surgical session as well as achieving objective and subjective goals of therapy in treated areas.

Notes: Abstract The short-term bactericidal effect of 2% chlorhexidine gel, 4% stannous fluoride gel or amine fluoride gel containing 1.25% fluoride on the subgingival microflora was determined in 40 periodontal pockets of 10 patients. The antimicrobial gels or placebo gel were applied in 5–9 mm deep periodontal pockets 3 times within 10 min. Before and 30 min after the applications, samples were taken of the subgingival microflora for determination of the total number of bacteria as well as the number of black pigmented Bacteroides. Reductions of the total number of bacteria were found in all test groups. The reductions found in the pockets treated with chlorhexidine gel or stannous fluoride get were significantly greater than the reduction found in the pockets treated with a placebo gel. A significant reduction of black-pigmented Bacteroides was found after treatment with chlorhexidine gel or amine fluoride gel. It is concluded that 2% chlorhexidine gel or 4% stannous fluoride gel has a more than 99% reduction effect on the microflora of periodontal pockets within 30 min after application.