The distribution and quantitation of cementum-bound lipopolysaccharide on periodontally diseased root surfaces of human teeth

A re-evaluation of scaling and root planing

BACKGROUND

Extensive reviews on the role of scaling and root planing (SRP) in the treatment of periodontitis have been previously published. This commentary will address the importance of subgingival calculus in the progression and treatment of periodontitis and addresses factors that make the execution of a "definitive" SRP a critical part of therapy.

METHODS

A search for articles, using keywords relevant to the subject , (e.g., periodontitis, dental scaling, root planing, dental calculus, biofilm, inflammation) was conducted using PubMed, Ovid Medline, Cochrane Reviews and the ADA Center for Evidence Based Dentistry data bases. Additionally, references cited in relevant articles were also considered.

RESULTS

Surfaces of subgingival calculus are covered with a biofilm of metabolically active bacteria. Periodontal inflammation is clearly related to the presence of calculus and biofilm. The primary goal of SRP is removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden. Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health.

CONCLUSION

SRP is still critical to the treatment of periodontitis. SRP involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities, regardless of the type of instrumentation, requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance. Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP, should be considered for surgical intervention.

Clinical evaluation of ultrasonic subgingival debridement versus ultrasonic subgingival scaling combined with manual root planing in the treatment of periodontitis: study protocol for a randomized controlled trial

BACKGROUND

Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by 57.3% from 1990 to 2010. Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. Root planing, in order to eliminate the "infected cementum," has been an important step in the treatment of periodontitis since the 1970s. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried. Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments. Hence, an increasing number of dentists prefer to do scaling with ultrasonic instruments only. However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment. Therefore, this study is devoted to compare the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing, which takes the implementation of root planing as the only variable and is more in line with the current clinical situation, thus hoping to provide some valuable reference to dentists.

METHODS/DESIGN

Forty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology (Beijing, China). By means of randomization tables, one quadrant of the upper and lower teeth is the test group and the other is the control group. Test group: ultrasonic subgingival scaling combined with manual root planing.

CONTROL GROUP

ultrasonic subgingival debridement. In a 24-week follow-up period, plaque index, probing depth, clinical attachment loss, bleeding index, furcation involvement, mobility, and patient-reported outcome (Visual Analog Scale for pain and sensitivity) will be observed and documented.

DISCUSSION

This study evaluates the effectiveness of ultrasonic subgingival scaling combined with manual root planing and ultrasonic subgingival debridement alone in the nonsurgical treatment of periodontitis with a split-mouth design after 1, 3 and 6 months. The result of the trial should potentially contribute to an advanced treatment strategy for periodontitis with an ideal clinical outcome.

TRIAL REGISTRATION

International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR1800017122. Registered on 12 July 2018.

Minimally-invasive non-surgical periodontal therapy

Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings.

CLINICAL RELEVANCE

This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.

EDTA Gel Root Conditioning: Lack of Effect on Clinical and Radiographic Outcomes of Intrabony Defect Treatment With Enamel Matrix Derivative

BACKGROUND

The adjunctive use of enamel matrix derivative (EMD) in the surgical therapy of intrabony defects results in improved outcomes compared to surgical debridement alone. However, the role of EDTA root conditioning in EMD therapy has not been investigated. The purpose of this study was to compare the 12-month outcomes of EMD application with and without EDTA root conditioning in intrabony defect surgical therapy.

METHODS

Twenty-eight chronic periodontitis patients, each contributing a 2- or 3-wall intrabony defect (> or = 4 mm deep and > or = 2 mm wide), participated. Patients consecutively received surgical treatment with either EMD alone (first 13 patients) or EMD + EDTA (subsequent 15 patients). Probing depth (PD), clinical attachment level (CAL), and gingival margin position, i.e., recession (REC) were the clinical parameters recorded. Recorded radiographic parameters were the distances from 1) cemento-enamel junction to bone crest (CEJ to BC), 2) CEJ to base of the defect (CEJ to BD), and 3) BC to BD.

RESULTS

Intragroup analysis showed that both EMD alone and EMD + EDTA led to significant PD reduction, CAL gain, and REC increase 1 year postoperatively. Both groups had >60% mean radiographic defect resolution (change in BC to BD). None of the recorded parameters were significantly different between the two groups, either at baseline or postoperatively.

CONCLUSIONS

These results suggest that clinical and radiographic outcomes of intrabony defect EMD therapy do not depend on the use of EDTA gel root conditioning. The potential contribution of EDTA gel root conditioning to the histological outcomes reported with EMD therapy remains to be determined.

Open flap debridement with or without intentional cementum removal: a 4-month follow-up

OBJECTIVES

The aim of this study was to investigate the influence of cementum removal on periodontal repair.

MATERIAL AND METHODS

Forty subjects with chronic periodontitis and presenting, at least, two proximal sites in anterior teeth (upper or lower) with probing depth > or =5 mm were selected. After oral hygiene instructions and ultrasonic supragingival instrumentation, the subjects were randomly assigned for one of the following groups: CIC, scaled with Gracey curettes; CIUS, scaled with ultrasonic device; CDC, calculus deattachment with Gracey curettes and brushing with saline solution; and CDUS, calculus deattachment with ultrasonic device and brushing with saline solution. Full-thickness flaps were reflected and the instrumentation was performed with a clinical microscope. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) were registered at five experimental periods: baseline and 30, 60, 90 and 120 days postoperative.

RESULTS

All the approaches were able to markedly reduce the PD values from the baseline to the other evaluation periods (p<0.0001). The increase in RGML values was statistically significant only for the CDUS group. There were no statistically significant differences between the baseline and postoperative values in all groups for the RAL changes. The changes in RAL were statistically significant only among the groups CDC and CDUS (p<0.0001).

CONCLUSION

The conventional scaling and root planing and the calculus deattachment were effective in reducing the probing depth values, regardless of the instrumentation method.

Effect of cigarette smoking on human PDL fibroblasts attachment to periodontally involved root surfaces in vitro

BACKGROUND/AIM

Cigarette smoking is one of the most significant risk factors in the development and further advancement of inflammatory periodontal disease. However, no study has been performed to investigate the effect of smoking on the attachment of human periodontal ligament fibroblasts to either periodontally diseased or healthy roots. The present study was conducted to evaluate the attachment of fibroblasts derived from healthy human periodontal ligament (PDL) to periodontally diseased root surfaces of smokers.

METHOD

The subjects included 14 smokers and seven nonsmokers with at least a single periodontally involved anterior tooth planned for extraction. In addition, seven impacted third molars, which had been removed from nonsmoking adolescents, were used as a healthy control. The smoking status of each patient was determined by classifying the volunteers into four groups according to their level of cigarette consumption at the initial examination (seven patients each). Nonsmoking subjects who had never smoked cigarettes and had healthy periodontium were called healthy control (G1). In subjects with periodontal diseases, nonsmoking subjects who had never regularly smoked cigarettes (< 2 cigarettes/week) were called positive control (G2), smokers consuming <or=19 cigarettes/day were placed in group G3, and smokers consuming >or=20 cigarettes/day were located in group G4. To exclude the effects of all local irritants except for the adsorbed tobacco products, all teeth were subjected to thorough scaling and root planing 1 week before extraction. After 1 week of meticulous home care and continued smoking experience, teeth were extracted and the periodontally involved test areas were prepared for PDL culturing. PDL cells were cultured on root segments for 24 h. Samples were prepared for SEM viewing, photographing and counting at x750 in a standard area.

RESULTS

The results of this study indicated that smokers' data (G3, G4) revealed a significant reduction of attached PDL cells when compared to that of nonsmokers' healthy and positive controls (G1, G2). No significant difference in the mean number of attached cells was found between data derived from smokers' groups (G3 vs. G4). The attached cells in all groups varied in shape; they were flatter in the control groups, while they were round in smokers' groups, with no dose-dependent effect.

CONCLUSION

The present results suggest that cigarette smoking compromises PDL cell adhesion to root planed surfaces, which might affect periodontal regeneration following therapy.

Removal of hard tooth structure by ROOTSHAPE root planing files used with a modified EVA contra-angle

The results of numerous recent investigations indicate that root contamination with bacteria and endotoxins is limited to the root surface only. Therefore, methods on root surfaces instrumentation that preserve root substance should be focused on. Newly available instruments or treatment systems should be evaluated for their root substance-removing potential. The devices for root planing presented here comprised specific files (Rootshape) (with diamond-coating on their convex working surfaces used in conjunction with a water-spray-cooled contra-angle head transforming rotational movements into translatory oscillations. The substance-removal potential of rigid and flexible files with diamond coatings of 2-4, 15, 25 and 40 microns compared with that of regular hand curettes, was evaluated under various working forces. The results demonstrated, that depending on the grit size of the diamond coating, the Rootshape files removed less and in no instance greater amounts of root surface substance than did hand instruments.

The periodontally-involved root surface

Recent years have seen much research on the periodontally-involved root surface. Many of these studies have produced results which suggest that plaque contaminants of the root surface are only superficially placed, and capable of being removed by gentle means. Further research has attested to the difficulties in rendering periodontally-involved root surfaces free of calculus deposits by instrumentation, yet clinical studies show that periodontal disease can be managed by root planing. It is concluded that root surface debridement is best assessed on the basis of the healing response and that it should aim to disrupt plaque on and remove plaque from the periodontally-involved root surface rather than to remove part of the root surface itself.

Fatty acids of healthy and periodontally diseased root substance in human teeth

In this comparative study, samples of root substance from healthy and periodontally diseased human teeth were analyzed for fatty acids by means of a gas-chromatographic technique. The sample preparation procedure allowed specimens from individual teeth to be analyzed. The content of the fatty acids C16:0, C16:1, C18:0, and C18:1 in the superficial layer of the periodontally diseased teeth was significantly higher than that of healthy teeth. In the inner layer, there was no such difference. Four different 3-hydroxy fatty acids (3-OH C14:0, 3-OH C15:0, 3-OH C16:0, and 3-OH C17:0) were identified by combined gas-chromatography/mass-spectrometry in the tooth substance of periodontally diseased teeth. This indicates the presence of lipid A, which is the toxic component of bacterial lipopolysaccharides.