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Eggmann F, Schiavone F, Amato J, Vahle A, Weiger R, Zitzmann NU. Effect of repeated ultrasonic instrumentation on single-unit crowns: a laboratory study. Clin Oral Investig 2021; 26:3189-3201. [PMID: 34820725 DOI: 10.1007/s00784-021-04301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This laboratory study aimed to assess the effects of ultrasonic instrumentation, simulating 10 years of supportive periodontal therapy (SPT), on single-unit crowns. MATERIALS AND METHODS Standardized crowns were fabricated from porcelain-fused-to-metal (PFM) (n = 12), zirconia (ZrO2) (n = 12), lithium disilicate (LDS) (n = 12), feldspar ceramic (FSFC) (n = 6), and polymer-infiltrated ceramic network material (PICN) (n = 6). The crowns, luted on PICN abutments with resin-based luting material (RBLM), and if applicable glass ionomer cement (GILC), underwent thermal cycling and trimonthly ultrasonic instrumentation. After 1 and 10 years of simulated SPT, restoration quality assessments were performed, comprising profilometric surface roughness measurements, marginal integrity evaluations, and scores for luting material remnants and visible cracks. The statistical analysis included multiple logistic regressions with nested designs (α = 0.05). RESULTS During simulated SPT, bulk fractures (n = 2) and a de-cementation failure (n = 1) of LDS and ZrO2 crowns were observed. No significant change in roughness was detected after 10 years (p = 0.078). Over time, marginal defects increased (p = 0.010), with PFM crowns showing the highest rate of chippings at sites with a narrow shoulder. Fewer marginal defects were detectable on crowns luted with RBLM compared with GILC (p = 0.005). Luting material remnants decreased during SPT (p < 0.001). Ultrasonic instrumentation caused cracks in most crown materials, in particular at sites with a narrow shoulder and in PFM crowns. CONCLUSIONS Repeated ultrasonic instrumentation may damage single-unit crowns. PFM crowns with a narrow, all-ceramic margin are especially prone to defects. CLINICAL RELEVANCE Frequent ultrasonic instrumentation of restoration margins of fixed dental prostheses, PFM crowns in particular, ought to be avoided.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland.
| | - Fabio Schiavone
- Department of Reconstructive Dentistry, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Julia Amato
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Annika Vahle
- VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
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Wang CY, Yang YH, Li H, Lin PY, Su YT, Kuo MYP, Tu YK. Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1496-1510. [PMID: 33010026 DOI: 10.1111/jcpe.13379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
AIM This systematic review and network meta-analysis aimed to evaluate the efficacy of adjunctive locally delivered antimicrobials, compared to subgingival instrumentation alone or plus a placebo, on changes in probing pocket depth (PPD) and clinical attachment level (CAL), in patients with residual pockets during supportive periodontal care. MATERIALS AND METHODS Literature search was performed with electronic databases and by hand until 31 May 2020. Primary outcome was the changes in PPD. The treatment effects between groups were estimated with weighted mean differences (WMD) with 95% confidence intervals (CI) and prediction intervals (PI) by using random-effects network meta-analysis. RESULTS Twenty-two studies were included. Significantly greater PPD reduction was achieved in chlorhexidine chip group (WMD: 0.65 mm, 95% CI: 0.21-1.10) and tetracycline fibre group (WMD: 0.64 mm, 95% CI: 0.20-1.08) over 6-month follow-up. Other adjunctive antimicrobial agents achieved non-significant improvements compared to scaling and root planing alone. All differences between adjunctive therapies were statistically non-significant. Similar findings were observed for CAL gain. CONCLUSION Adjunctive local antimicrobial agents achieved small additional PPD reduction and CAL gain in residual pockets for a follow-up of up to 6 months. Tetracycline fibre and chlorhexidine chip achieved better results than other antimicrobials.
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Affiliation(s)
- Chen-Ying Wang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hao Yang
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Ting Su
- Department of Dentistry, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mark Yen-Ping Kuo
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol 2000 2017; 76:85-96. [PMID: 29193304 DOI: 10.1111/prd.12147] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
The aim of this paper was to evaluate strategies for periodontal therapy from the perspective of periodontal disease being a consequence of microbial colonization of the periodontal pocket environment. In classic bacterial infections the diversity of the microbiota decreases as the disease develops. In most cases of periodontitis, however, the diversity of the flora increases. Most incriminating bacteria are thought to harm tissues significantly only if present in high numbers over prolonged periods of time. Clinical trials have repeatedly demonstrated that scaling and root planing, a procedure that aims to remove subgingival bacterial deposits by scraping on the tooth surface within the periodontal pocket, is effective. At present, for the therapy of any form of periodontal disease, there exists no protocol with proven superiority, in terms of efficiency or effectiveness, over scaling and root planing plus systemic amoxicillin and metronidazole. Some exponents advocate rationing these drugs for patients with a specific microbial profile. However, the evidence for any benefit of bacteriology-assisted clinical protocols is unsatisfactory. Treated sites are subject to recolonization with a microbiota similar to that present before therapy. The degree and speed of recolonization depends on the treatment protocol, the distribution patterns of periodontal microorganisms elsewhere in the oral cavity and the quality of the patient's oral hygiene. To limit the use of antibiotics and to avoid accumulation of harmful effects by repeated therapy, further efforts must be made to optimize procedures addressing the microbial colonization and recolonization of the periodontal pocket.
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Fekrazad R, Lotfi G, Harandi M, Ayremlou S, A M Kalhori K, Gholami GA, Nokhbatolfoghahaei H. Comparing fibroblast attachment in root surface scaling with Er, Cr:YSGG laser versus ultrasonic scaler: A SEM study. Microsc Res Tech 2017; 80:917-922. [PMID: 28467022 DOI: 10.1002/jemt.22882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The regeneration of periodontal support is the main concern in periodontal therapy. The aim of this in vitro study was to investigate the fibroblasts attachment on root surfaces after scaling with Er, Cr:YSGG laser and ultrasonic instruments using scanning electron microscopy (SEM). METHODS 72 root plates of ∼6 × 4 × 1 mm3 in dimension were prepared from 27 single-rooted human mature teeth and were then divided into four groups. One group irradiated with a G6 tip of Er, Cr:YSGG laser (2.78 µm, 0.75 W, pulse duration of 140 µs, repetition rate of 20 Hz) for 5 to 7 s, and the other groups were scaled with ultrasonic alone or laser-ultrasonic. The control group was subjected to neither laser nor ultrasonic scaling. Subsequently, Viability and proliferation rates were done using MTT assay on days 3 and 5. Finally the cell attachment was observed using SEM. RESULTS The data derived from MTT and cell-attachment analysis indicated that laser-ultrasonic scaling tended to increase cell-viability by the lapse of time (within 3-5 days), with significantly better cell-attachment compared with other groups on days 3 and 5 (p < .05). The comparison of the difference in fibroblast cell attachment rate on both the third and the fifth day with independent T-Test indicated a significant rise on the fifth day compared to the third day of study (p < .05). CONCLUSION Indeed, both Er, Cr:YSGG laser and ultrasonic scaling may promote fibroblast attachment on dentinal root surfaces more than laser or ultrasonic scaling alone.
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Affiliation(s)
- Reza Fekrazad
- Periodontist, Periodontology Department, Dental Faculty, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ghogha Lotfi
- Periodontist, Periodontology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Harandi
- Dental student, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Katayoun A M Kalhori
- Oral and maxillofacial pathologist, Iranian Medical Laser Association, Tehran, Iran
| | - Gholam Ali Gholami
- Periodontist, Periodontology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Nokhbatolfoghahaei
- Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Crespi R, Romanos GE, Cassinelli C, Gherlone E. Effects of Er:YAG Laser and Ultrasonic Treatment on Fibroblast Attachment to Root Surfaces: An In Vitro Study. J Periodontol 2006; 77:1217-22. [PMID: 16805685 DOI: 10.1902/jop.2006.050416] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to analyze the effects of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser and ultrasonic treatment on fibroblast attachment to periodontally diseased root surfaces. METHODS Thirty single-rooted human periodontally involved teeth were included in this study. A total of 60 specimens were obtained from all selected teeth and were randomly assigned to the following three groups: group A, untreated control group; group B, ultrasonic group; and group C, Er:YAG laser at 160 mJ/pulse at 10 Hz group. All of the specimens were incubated in petri dishes with fibroblast suspension and observed by scanning electron microscopy. RESULTS Laser-treated specimens showed a significantly higher cell density number, with a mean+/-SD of 3,720+/-316 cells/mm2. The ultrasonically treated group showed a lower cell density number, with a mean+/-SD of 658+/-140 cells/mm2. The untreated control group showed the lowest cell density number, with a mean+/-SD of 130+/-80 cells/mm2. Differences between all groups were significant (P<0.0001). CONCLUSION The results of the study indicate that untreated control surfaces and ultrasonically treated surfaces exhibited a significantly lower number of attached cells compared to laser-treated specimens, which showed a significantly higher cell density number.
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Rupf S, Brader I, Vonderlind D, Kannengiesser S, Eschrich K, Roeder I, Merte K. In Vitro, Clinical, and Microbiological Evaluation of a Linear Oscillating Device for Scaling and Root Planing. J Periodontol 2005; 76:1942-9. [PMID: 16274314 DOI: 10.1902/jop.2005.76.11.1942] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to conduct an in vitro and short-term clinical and microbiological evaluation of a linear oscillating device for scaling and root planing (SRP). A comparison was made between conventional ultrasonic scaling (US) and hand scaling (HS) with and without chlorhexidine. METHODS In vitro, SRP was carried out on human teeth with calculus. Roots and cross-sections thereof were microscopically examined for the efficacy of calculus removal, hard tissue loss, and surface smoothness. In vivo, 11 patients with chronic periodontitis and single-rooted teeth in all quadrants with probing depths of > or =5 mm were selected. One quadrant was treated with linear oscillation and compared to US with chlorhexidine irrigation in the contralateral site. The other arch was treated with HS and compared to HS followed by laser disinfection. One hundred twenty teeth were assessed for clinical attachment level, probing depth, bleeding on probing, and suppuration at baseline and 7, 28, 90, and 180 days. Microbiologically, total numbers of bacteria and six specific periodontal pathogens were determined by quantitative polymerase chain reaction prior to and 1 and 28 days after SRP. Clinical and microbiological data were analyzed statistically with respect to the SRP method, patient specificity, and time effect. RESULTS In vitro, linear oscillation preserved more root tissues but left more calculus (P <0.05). Significant improvements of all clinical and microbiological parameters were observed for all groups. However, 21 out of 24 tests demonstrated that the clinical microbiological correlations between linear oscillation and control groups did not differ (P <0.05). CONCLUSION Linear oscillation scaling was clinically acceptable and microbiologically comparable to the control groups despite microscopic remnants of calculus observed in vitro.
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Affiliation(s)
- Stefan Rupf
- Department of Conservative Dentistry and Periodontology, University of Leipzig, Leipzig, Germany
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Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. J Clin Periodontol 2004; 31:193-9. [PMID: 15016023 DOI: 10.1111/j.0303-6979.2004.00467.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of a power-driven mechanism compared with hand instruments and ultrasonic insert alone with a split-mouth design after 3 and 6 months. METHODS Healing events after initial periodontal therapy were investigated in 20 patients with moderate-to-severe adult periodontitis. Plaque index (PlI), bleeding on probing (PBI), probing pocket depth (PPD), probing attachment level (PAL) and number of moderate and deep pockets (NMP, NDP) were recorded at baseline and 3 and 6 months after treatment. Oral hygiene instruction was provided for each patient. Randomly assigned quadrants per patient were scaled and root planed with hand instrumentation (curettes, hoes and files), with reciprocating power-driven instruments, with ultrasonic scaler alone and with the combined use of ultrasonic scaler and power-driven inserts. The Friedman test was applied to test the significance of difference between the various methods of root instrumentation. Repeated measures of analysis of variance (manova) were used to analyse the time effect on the different treatments. RESULTS At the 6-month evaluation, all groups in the scaling and root planing treatment presented with an improvement in the measured clinical parameters, as compared with baseline. No statistical differences (p>0.05) were observed in the assessed periodontal indices among the study sites between the four groups for either treatment. CONCLUSIONS Under our experimental conditions, this clinical study demonstrates that mechanized root planing with power-driven instruments, as effective as the usual procedures (hand and sonic instruments), represents a satisfactory and alternative means of nonsurgical root therapy.
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Affiliation(s)
- Patrick R Obeid
- Department of Periodontology, Catholic University of Louvain, Brussels, Belgium.
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Sasaki KM, Aoki A, Ichinose S, Ishikawa I. Morphological analysis of cementum and root dentin after Er:YAG laser irradiation. Lasers Surg Med 2002; 31:79-85. [PMID: 12210590 DOI: 10.1002/lsm.10074] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the morphology of cementum and root dentin after Er:YAG laser irradiation with and without water coolant, compared to that after CO(2) laser irradiation and an untreated surface. STUDY DESIGN/MATERIALS AND METHODS Ten extracted healthy human teeth were used. Er:YAG and CO(2) lasers were applied with energy outputs of 0.4 W, with and without coolant and 0.5 W, without coolant, respectively. Scanning electron microscopy (SEM) analysis was performed at high and ultra-high magnifications. RESULTS The surface of cementum was micro-irregular with numerous projections while that of dentin appeared scaly after Er:YAG laser irradiation. Unlike after CO(2) laser treatment, no major melting or cracking was observed with Er:YAG laser treatment. The use of water spray produced fine micro-irregularities without attached debris. Ultra-high magnification revealed similar microparticles-composed aspects for both cementum and dentin. However, the more porous structure of the surface was observed after Er:YAG laser irradiation without water spray. CONCLUSIONS Cementum and root dentin presented distinct micro-roughness after Er:YAG laser irradiation, possibly due to structural differences in the original tissue. However, under ultra-high magnifications, both cementum and dentin presented similar characteristics of the irradiated surface. In addition, the use of water spray during laser irradiation minimized thermal effects and resulted in a cleaner and less porous surface.
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Affiliation(s)
- Katia M Sasaki
- Division of Periodontology, Department of Hard Tissue Engineering, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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Rühling A, Schlemme H, König J, Kocher T, Schwahn C, Plagmann HC. Learning root debridement with curettes and power-driven instruments. Part I: a training program to increase effectivity. J Clin Periodontol 2002; 29:622-9. [PMID: 12354087 DOI: 10.1034/j.1600-051x.2002.290706.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS In a dummy-head trial, we assessed how effectively untrained operators were able to learn scaling with curettes and power-driven instruments. METHODS Two untrained operator groups (n = 11 each) received six 2-h lessons during a 10-week period following a training program. Subgingival scaling was performed with curettes (GRA) and a power-driven system (PP). At 6 test days each subject had to instrument 10 test teeth. The percentage of debrided area was assessed with an image analysis program. Learning success was measured as a percentage of debrided root area and scaling time. Furthermore, the effectivity was related to difficulty in anatomical situations and access to root surfaces. Statistical analysis was carried out with SPSS. RESULTS At baseline, effectivity was 63.1% (GRA) vs. 52.3% (PP). Between weeks 9 and 11, operators reached a plateau for group GRA at 84.7% and group PP at 81.3%. Scaling time did not differ between the two groups. Debridement of teeth with complex root shapes that were hard to access was less effective with the power-driven system. CONCLUSION Independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of efficacy. With systematical training, effective scaling with the power- driven system was as easy to learn as with hand instruments. On root surfaces with complicated shape and anatomy or difficult accessibility, the power-driven system works significantly less effectively.
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Affiliation(s)
- A Rühling
- Department of Periodontology, School of Dentistry, University of Kiel, Germany.
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Abstract
Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseases. When disease does recur, despite frequent recall, it can usually be attributed to lack of sufficient supragingival and subgingival plaque control or to other risk factors that influence host response, such as diabetes or smoking. Causative factors contributing to recurrent disease include deep inaccessible pockets, overhangs, poor crown margins and plaque-retentive calculus. In most cases, simply performing a thorough periodontal debridement under local anesthesia will stop disease progression and result in improvement in the clinical signs and symptoms of active disease. If however, clinical signs of disease activity persist following thorough mechanical therapy, such as increased pocket depths, loss of attachment and bleeding on probing, other pharmacotherapeutic therapies should be considered. Augmenting scaling and root planing or maintenance visits with adjunctive chemotherapeutic agents for controlling plaque and gingivitis could be as simple as placing the patient on an antimicrobial mouthrinse and/or toothpaste with agents such as fluorides, chlorhexidine or triclosan, to name a few. Since supragingival plaque reappears within hours or days after its removal, it is important that patients have access to effective alternative chemotherapeutic products that could help them achieve adequate supragingival plaque control. Recent studies, for example, have documented the positive effect of triclosan toothpaste on the long-term maintenance of both gingivitis and periodontitis patients. Daily irrigation with a powered irrigation device, with or without an antimicrobial agent, is also useful for decreasing the inflammation associated with gingivitis and periodontitis. Clinically significant changes in probing depths and attachment levels are not usually expected with irrigation alone. Recent reports, however, would indicate that, when daily irrigation with water was added to a regular oral hygiene home regimen, a significant reduction in probing depth, bleeding on probing and Gingival Index was observed. A significant reduction in cytokine levels (interleukin-1beta and prostaglandin E2, which are associated with destructive changes in inflamed tissues and bone resorption also occurs. If patient-applied antimicrobial therapy is insufficient in preventing, arresting, or reversing the disease progression, then professionally applied antimicrobial agents should be considered including sustained local drug delivery products. Other, more broadly based pharmacotherapeutic agents may be indicated for multiple failing sites. Such agents would include systemic antibiotics or host modulating drugs used in conjunction with periodontal debridement. More aggressive types of juvenile periodontitis or severe rapidly advancing adult periodontitis usually require a combination of surgical intervention in conjunction with systemic antibiotics and generally are not controlled with nonsurgical anti-infective therapy alone. It should be noted, however, that, to date, no home care products or devices currently available can completely control or eliminate the pathogenic plaques associated with periodontal diseases for extended periods of time. Daily home care and frequent recall are still paramount for long-term success. Nonsurgical therapy remains the cornerstone of periodontal treatment. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the disease state, to reverse or arrest the progression of periodontal disease with meticulous nonsurgical anti-infective therapy.
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Affiliation(s)
- C H Drisko
- Department of Periodontics, Endodontics and Dental Hygiene, Office of Dental Research, School of Dentistry, University of Louisville, Louisville, KY, USA
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Chan YK, Needleman IG, Clifford LR. Comparison of four methods of assessing root surface debridement. J Periodontol 2000; 71:385-93. [PMID: 10776925 DOI: 10.1902/jop.2000.71.3.385] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND While there is great interest in measuring the efficacy of root surface debridement, there is little consensus on how this might be best achieved. The aim of this study was therefore to compare four different methods of assessing root surface debridement in their ability to discriminate between ultrasonically instrumented root surfaces and non-instrumented control surfaces. METHODS Single-session subgingival root debridement was performed by an experienced operator on 30 teeth prior to their extraction. Following extraction, efficacy of root surface debridement was measured by percentage of remaining calculus, instrument efficiency, modified instrument efficiency, and percentage apical plaque border. In addition, the effect of probing depth landmark (apical plaque border versus connective tissue attachment) on outcomes was assessed. RESULTS The results indicated that percentage apical plaque border demonstrated highly statistically significant differences between instrumented and control surfaces (P= 0.02). No other assessment method was able to discriminate between instrumented and non-instrumented surfaces, and this may be a function of the low amount of root surface calculus in the experimental sample. In addition, choice of probing depth landmark had a notable effect on the outcomes for instrument efficiency and modified instrument efficiency. Ninety-five percent limits of agreement of interexaminer reproducibility were found to be much higher than intra-examiner measurement for all four methods of assessment. CONCLUSIONS Percentage apical plaque border appeared to be potentially more useful than other methods for assessing the efficacy of debridement of periodontally involved root surfaces, particularly for measuring instrument penetrability.
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Affiliation(s)
- Y K Chan
- Department of Periodontology, Eastman Dental Institute, London, UK
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Abstract
Although the relationship between fluoride and dental caries has been widely studied and definitively determined, the relationship between fluoride and periodontal health and disease is not clear. Conflicting studies in the literature either suggest routine fluoride usage as an adjunct to conventional periodontal therapy or argue against topical fluoride use on periodontally involved teeth. This review summarizes the literature that addresses the utility of fluoride in patients with periodontal disease and aims to advance a rational criterion for the use of fluorides in the management of periodontal diseases.
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Affiliation(s)
- M L Paine
- Advanced Periodontics Program, University of Southern California, Center for Craniofacial Molecular Biology, Los Angeles 90033, USA
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