Comparison of trabecular bone structure in individuals with healthy periodontium and stage III/IV, grade C periodontitis by fractal analysis

OBJECTIVE

The aim was to perform fractal analysis (FA) to compare differences in trabecular microarchitecture in interdental and antegonial regions on panoramic radiographs in periodontally healthy patients and those with stage III/IV, grade C periodontitis, and to compare the effects of patient age and sex on FA results.

STUDY DESIGN

Clinical and radiographic records from 33 periodontally healthy individuals and 28 individuals with aggressive periodontitis were obtained from the faculty archives. Three regions of interest (ROIs) were chosen bilaterally from interdental bone around the mandibular first molar and canine and the antegonial region. The mean fractal dimension (FD) values of the ROIs were calculated. Significance of differences was established at P < .05.

RESULTS

FD values of all 3 ROIs in the periodontitis group were significantly lower than values in the control group (P ≤ .004). FD was not affected by patient age (P = .357) or sex (P = .216). There were no significant correlations between FD and age in either group (P ≥ .093). FD values differed significantly between sexes in only one ROI.

CONCLUSIONS

FA can effectively detect trabecular microarchitectural differences in patients with aggressive periodontitis compared to periodontally healthy individuals. This technique might be useful in predicting the susceptibility of patients to periodontal disease.

Five-year results of nonsurgical treatment to manage severe generalized aggressive periodontitis

It is challenging for clinicians to carry out successful periodontal therapy and maintain a full dentition in young patients with generalized bone loss of 90%. Due to advanced attachment loss and the young age of patients, fixed or removable prosthetic treatment options are compromised. Implant therapy would be complex and expensive. The presented case shows the successful conservative periodontal therapy of advanced generalized aggressive periodontitis in a 29-year-old female. A conservative approach was applied and maintained all teeth with patient satisfaction both functionally and esthetically. This case was followed over 5 years.

Clinical Case Report on Treatment of Generalized Aggressive Periodontitis: 5-Year Follow-up

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease associated with considerably more rapid periodontal tissue destruction than chronic periodontitis. This study presents the 5-year follow-up of a patient with GAgP. A 29-year-old man reported experiencing increasing gingival recession. He was treated using cause-related therapy, provisional splints, and flap surgery combined with allograft grafting and was followed up for 5 years. This case study shows that elimination of infectious microorganisms and meticulous long-term maintenance provide an effective treatment modality for aggressive periodontitis cases. This treatment modality can restore the masticatory function and provide the GAgP patient with improved quality of life.

[Complete dental care of patients suffering from localized aggressive periodontitis. Case report]

A 34 years old male patient was referred to our clinic for restorative dental treatment. During detailed consultation and dental examination a relatively rare form of periodontal disease had been diagnosed. Intraoral examination included recording of dental and periodontal status. Based on patient's dental history, measurements of probing pocket depths (PPD), clinical attachment level (CAL), and also the X-ray findings, Localized Aggressive Periodontitis (LAP) unknown by the patient was diagnosed. After patient's consent the comprehensive treatment plan covered the dental prevention, periodontal non-surgical and surgical therapy and rehabilitation. The treatment started with oral hygienic instruction, motivation then supra- and subgingival scaling and rootplaning. Later extraction and elective root canal treatment were performed, followed by open flap periodontal surgery combined with hemisection of two molars. After a full mouth conservative restorative therapy, function and esthetics were restored by fix dental prostheses. This case is a good example to underline the importance of periodontal examination during the dental screening and dental status recording for each patients showing up at dental clinics. Otherwise in many cases this asympthomatic disease can remain undetected.

[Evaluation of the degree and pattern of alveolar bone defect inaggressive periodontitis using cone-beam CT]

OBJECTIVE

To evaluate the degree and pattern of alveolar bone defect in aggressive periodontitis (AgP) using cone-beam CT (CBCT), and to investigate the distribution of alveolar bone defects in aggressive periodontitis.

METHODS

Forty AgP patients (age: 14-36 years, male: 15 cases, female: 25 cases) were selected by simple random method and scanned by CBCT. NNT software was applied to measure the average degree of alveolar bone defects and bone loss types in different regions.

RESULTS

In forty AgP patients, 86.6% (3,769/4,352) sites presented moderate and severe alveolar bone defects. In the maxilla, the molar areas presented the heaviest alveolar bone defect [(6.3±0.7) mm], the canine areas showed the lightest bone loss [(4.8±0.8) mm]. In the mandible, the incisal areas presented the heaviest alveolar bone defect [(5.9±0.9) mm], the canine areas showed the lightest bone loss[(5.1±0.7) mm]. The degree of alveolar bone defect in the areas of maxillary canine, maxillary molars, mandibular premolar was significantly different (P<0.05). The degree of alveolar bone defect in mandibular canine and mandibular molars was significantly differenct (P<0.01). The most serious alveolar bone defect was in the mesial side of maxillary molar [(6.9±0.7) mm] and the mesial side of mandibular incisor [(6.5±1.1) mm]. The oblique bone defects were found in the mesial part of the first molars in mandibula [13.6% (42/308)], the first molars in maxilla [12.0% (39/316)] and the first premolar in maxilla [10.8% (34/316)].

CONCLUSIONS

The alveolar bone defects of generalized AgP patients were serious. The most serious areas were located in the mesial side of maxillary molars and the mesial side of mandibular incisor.

Clinical and histological characterization of an aggressive periodontitis case associated with unusual root canal curvatures

The article presents the histological and clinical characteristics in a severe generalized aggressive periodontitis case associated with multiple root curvatures and the complex therapeutic approach of the severe periodontal destructions. The patient received a complex therapy, including periodontal non-surgical, regenerative and reconstructive approaches, and also endodontic and prosthetic treatments. Recall appointments were fixed at 3-month intervals. One year after the finalization of the active therapy, a hyperplasic, inflamed interdental papilla associated with a recurrent clinical attachment loss was diagnosed at the mesial aspect of the right maxillary second premolar. A biopsy was harvested for histological examination and the recurrent site was treated. The histological study revealed important modifications of the epithelial layer and of the connective tissue of the gingiva. An extremely accentuated pattern of the gingival rete ridges at the epithelial-connective tissue junction, the presence of inflammatory cells infiltrating the epithelial layer and lamina propria and the disorganization of the fascicules of collagen fibers were observed. The inflammatory infiltrate was dominated by plasma and monocytic-like cells as immunohistochemical analyses highlighted. The complex therapeutic approach led to a satisfactory aesthetic and functional outcome. The severe root curvatures may be an unusual trait in this generalized aggressive periodontitis case substantially increasing the amount and the costs of non-periodontal procedures. In this case, the cell make-up of the inflammatory infiltrate and the paucity of collagen in the infiltrated tissue portions are considered to correspond to a fully developed recurrent lesion.

[Alveolar bone loss in nuclear families of aggressive periodontitis and the heredity of root shape]

OBJECTIVE

To evaluate the status of residual alveolar bone in aggressive periodontitis (AgP) nuclear families and to investigate the influence of teeth with root abnormity on residual alveolar bone and the heredity of root abnormity, the premolar cone-root and proportion of crown and root.

METHODS

Nineteen AgP probands (9 males and 10 females) at average age of 24.5 and 38 parents at average age 51.0 were included. A full set of periapical radiographs of all the subjects were taken. The residual alveolar bone of each tooth was measured by the ratio (shown as percentage) of the distance between apical and the alveolar bone crest to the whole root length. The abnormity of roots was detected on a full set of periapical radiographs. All the roots and crowns of teeth were measured. The relationship between the residual bone and the ratio was studied. The heredity grade of the premolar cone-root, proportion of crown and root, and root abnormity were computed.

RESULTS

The average residual alveolar bone of probands was less than that of their parents.In 11 families, the father's residual alveolar bone was less than that of the mother's. The average residual alveolar bone of the teeth with root abnormity was less than that of normal teeth. The average residual alveolar bone of the teeth with abnormity of roots and the normal teeth were (67.5 ± 22.2)% and (73.1 ± 18.7)% respectively, with statistical significance (P < 0.001). The heredity grade of the premolar cone-root was 40.1%, the heredity grade of proportion of crown and root was 46.8%, the heredity grade of root abnormity was 30.3%.

CONCLUSIONS

The residual alveolar bone of the teeth with root abnormity was less than that of normal teeth in nuclear families. The heritability of the root abnormity, the cone-root and proportion of crown and root in our sample was 0.3-0.5, which means that genetic factors accounted for about one third to half of the efficiency for AgP.

Apoptotic activity of gingival crevicular fluid from localized aggressive periodontitis

INTRODUCTION

The aim of this study was to examine a potential link between apoptotic biomarkers in gingival crevicular fluid (GCF) and periodontal destruction in four cases of localized aggressive periodontitis (LAP), diagnostically enhanced by cone beam computed tomography.

CASE SERIES

This study examined the GCF in four patients diagnosed with LAP (formerly localized juvenile periodontitis) at a routine periodontal examination. The LAP diseased sites had attachment loss ranging from 5-12 mm. Atotal of 62 samples of GCF were collected from diseased sites and from contralateral, matched healthy sites with minimal or no attachment loss. All samples were assayed for apoptotic markers, including Fas/FasL, DNAfragmentation, and nitric oxide. The GCF samples were analyzed utilizing enzyme-linked immunosorbent assays for DNA fragments and nitric oxide levels, whereas Western blotting was used for Fas/FasL analyses. Our results showed a significant increase in the apoptotic markers Fas/FasL and DNA fragmentation when comparing GCF from diseased versus non-diseased sites in patients with LAP.

CONCLUSION

To our knowledge, this is the first report of apoptotic biomarkers associated with patients diagnosed with LAP. Finding significantly increased levels of these markers in localized areas may help us understand the pathophysiology associated with this specific form of periodontitis, and, furthermore, may provide a basis for a quantifiably prognostic test when attempting to treat this disease.

Azithromycin as an adjunctive treatment of aggressive periodontitis: radiographic findings of a 12-month randomized clinical trial

PURPOSE

To compare the 12-month radiographic outcomes following the use of azithromycin or placebo as adjuncts to non-surgical periodontal treatment of AgP.

METHODS

17 aggressive periodontitis (AgP) subjects 13-26 years old were randomly assigned to receive scaling and root planing (SRP) with systemic azithromycin or placebo. Standardized radiographs were taken at baseline and 12 months postoperatively. Recall visits consisting of oral prophylaxis and oral hygiene instructions were performed during the 12 months. Digital image subtraction analysis and linear bone measurements were conducted by a blinded and calibrated examiner. Student t-tests were used for within and between-groups comparisons. ANCOVA was applied for between-group comparisons of changes in linear bone level adjusting for baseline values.

RESULTS

There were significant gains in linear bone levels in the azithromycin (0.55 +/- 0.10 mm) and placebo (0.42 +/- 0.07 mm) groups between the baseline and 12-month postoperative visits. There were also significant gains in bone density in the two treatment groups. No significant differences were observed between the two treatments in the amount of linear bone gain or bone density during the follow-up period. The use of azithromycin as an adjunct to SRP in the treatment of AgP did not result in significant radiographic bone level changes compared to placebo.

Aggressive periodontitis: the historic quest for understanding

Aggressive periodontitis has had many names as well as theories behind its etiology. The current paper looks to investigate this history and show the evolution of both nomenclature and understanding. Going beyond academic debates, emerging trends and conventions are also examined and placed into a clinical perspective. The aim of the paper is to recognize the origins of the elusive disease in order to form a concrete understanding of this multifactorial phenomenon.

[Combined conservative-surgical management of generalized aggressive periodontitis: case presentation]

The aggressive periodontitis is a well-defined clinical entity markedly differing from the chronic form of periodontitis. A localized and a generalized form can be distinguished. The main bacterial etiologic factor for the localized form is A. actinomycetemcomitans. It mainly starts in the first quarter of ones life. The magnitude of clinical attachment loss is not proportional to the amount of local biofilm and plaque retentive factors. The rapid, mostly vertical type of bone destruction is very characteristic. In many cases the attachment loss is localized to only a few teeth, but it may spread and progress to the generalized form, affecting practically the whole dentition. In that case a mixed Gram-negative anaerobic biofilm is present subgingivally, but the AA can also dominate the pocket flora. Its treatment is very complex and time-consuming, and needs perfect patient compliance. Predictable clinical results can only be achieved by a combined conservative-surgical therapy. The corrective phase of the comprehensive treatment and patient's rehabilitation is crucial and mainly involves certain kind of regenerative therapy. One of the most critical phases is the supportive therapy. This can give a good chance to stop the progression of attachment loss and prevent the recurrence of the active disease. The presented case is to demonstrate how time-consuming a 32-year-old female patient's comprehensive periodontal therapy was, who had suffered with active aggressive periodontitis at admittance. The extensive disease control period followed by a relatively long follow-up and finished with a series of regenerative surgery could ensure a predictable outcome that might be maintained over a long period of time with regular supportive therapy.

Alveolar bone regeneration pattern following surgical and non-surgical treatment in juvenile periodontitis

One hundred and fifty six interproximal sites, with periodontal pockets deeper than 5mm and showing loss of bone on standard dental periapical radiographs, were treated by subgingival instrumentation and open periodontal flap debridement in 12 patients properly motivated and given thorough oral hygiene instructions. The indices of gingival condition, plaque, calculus, oral hygiene and degree of mobility with loss of attachment were measured at baseline, 1,3 and 6 months after treatment. Standardized reproducible radiographs of the interproximal sites were taken before and 6 months after treatment. Alveolar bone levels pre and post treatment were measured with a grid in square millimetres using a view box (Watson and sons, London) and the Dunning and Leach gingival bone count index for both treatment procedures. Radiographic analysis showed statistically and clinically significant increases in bone fill of both the superficial and deep bone defects for the surgical technique (p < 0.05). This study has shown that surgical procedure resulted in a better bone regeneration than subgingival instrumentation.

Proximal caries in juvenile periodontitis patients

BACKGROUND

Caries is recognized as the prevalent proximal dental disease in adolescents, while proximal bone loss is minimal to non-existent in this population. Adolescents demonstrating an inverse disease pattern, i.e., minimal caries and active periodontitis, could provide powerful clues with regard to both diseases. However, data are inconsistent. This study was designed to clarify this relationship by comparing proximal caries prevalence in a juvenile periodontitis (JP) group to a matched non-periodontally diseased control group.

METHODS

Two groups (cases [JPs] and control patients [CPs]) were matched for age, sex, and race and evaluated for decayed, missing, filled teeth and surfaces (DMFS) by radiographic analysis. Statistical analysis was performed by ANOVA and Student t test. The study consisted of four phases. Phase I was based on data from a previous study that failed to include race in the analysis. Thus, the original 23 JP patients (mostly African-Americans from New York City) were rematched for race as well as sex and age with CPs from Newark, NJ. The effect of water fluoridation (found in NYC) was evaluated in Phase II by matching the 23 original CPs (mostly Caucasian from NYC) with 23 CPs from NJ. Since differences were seen, we rematched our original JPs from NYC with a new set of race-matched CPs from NYC (Phase III). Finally, 13 JP patients from the University of Medicine and Dentistry of New Jersey (UMDNJ) were matched with CPs from NJ (Phase IV).

RESULTS

Phase I and III indicated that JP patients had significantly less proximal caries than their matched CPs (P < or =0.05). Phase II confirmed the role of fluoride in caries reduction. Phase IV (NJ sample) supported our previous data and suggested that JP patients had less proximal caries than CPs (P < or =0.05).

CONCLUSIONS

JP patients had significantly less proximal caries than their matched CPs when groups were balanced and radiographic evaluations were performed. In-depth studies of JP patients could provide important clues about both caries and periodontal disease etiology and pathogenesis.

Localisation of a gene for prepubertal periodontitis to chromosome 11q14 and identification of a cathepsin C gene mutation

Prepubertal periodontitis (PPP) is a rare and rapidly progressive disease of young children that results in destruction of the periodontal support of the primary dentition. The condition may occur as part of a recognised syndrome or may occur as an isolated finding. Both autosomal dominant and recessive forms of Mendelian transmission have been reported for PPP. We report a consanguineous Jordanian family with four members affected by PPP in two nuclear sibships. The parents of the affected subjects are first cousins. We have localised a gene of major effect for PPP in this kindred (Zmax=3.55 for D11S901 at theta=0.00) to a 14 cM genetic interval on chromosome 11q14 flanked by D11S916 and D11S1367. This PPP candidate interval overlaps the region of chromosome 11q14 that contains the cathepsin C gene responsible for Papillon-Lefèvre and Haim-Munk syndromes. Sequence analysis of the cathepsin C gene from PPP affected subjects from this Jordanian family indicated that all were homozygous for a missense mutation (1040A-->G) that changes a tyrosine to a cysteine. All four parents were heterozygous carriers of this Tyr347Cys cathepsin C mutation. None of the family members who were heterozygous carriers for this mutation showed any clinical findings of PPP. None of the 50 controls tested were found to have this Tyr347Cys mutation. This is the first reported gene mutation for non-syndromic periodontitis and shows that non-syndromic PPP is an allelic variant of the type IV palmoplantar ectodermal dysplasias.

Clinical and microbiological effects of adjunctive antibiotics in treatment of localized juvenile periodontitis. A controlled clinical trial

The aim of this study was to assess the clinical and microbiologic effects of the combination of amoxicillin and metronidazole therapy as an adjunct to mechanical treatment in the management of localized juvenile periodontitis. Twenty-five localized juvenile periodontitis (LJP) patients from a Brazilian population were randomly allocated into an experimental group receiving mechanical treatment and antibiotics, and a control group receiving mechanical treatment and placebo. Clinical and radiographic assessments, as well as microbiologic sampling for Actinobacillus actinomycetemcomitans, were performed at baseline and one year after the end of the treatment. At the termination of the study A. actinomycetemcomitans could be isolated from the oral cavity of all patients in the control group who harbored the bacterium at baseline and in 4 out of 8 patients in the experimental group. Both treatment modalities resulted in significant benefit on an individual basis. The experimental group, however, displayed better results than did the control group regarding gingival index (GI), probing depth (PD), clinical attachment level (CAL), and radiographic analysis of crestal alveolar bone mass, but not with respect to plaque index (PI). No serious adverse effects of the antibiotic treatment were observed in the present study.

Localized juvenile periodontitis and Actinobacillus actinomycetemcomitans in a Brazilian population

Localized juvenile periodontitis (LJP) has been used as a model for studying periodontal disease, and its prevalence is considered to be higher in third-world countries (0.3-8%) than in industrialized countries (0.1%). Mostly, the disease has been associated with Actinobacillus actinomycetemcomitans (A.a.) but lack of association has also been reported. The aim of this study was to identify LJP patients in geographically different Brazilian populations and assess the presence of A.a. in their periodontal lesions. 7843 children, 12-19-years of age, from the cities of Rio de Janeiro, Votorantim and Belo Horizonte were screened, and LJP patients were identified by strict clinical and radiographical criteria. A final LJP prevalence of 0.3%, with a 99% confidence interval between 0.16% to 0.47%, was found. The prevalence in the subpopulations varied between 0.1-1.1% in the different areas. Subgingival bacterial samples were obtained from the oral cavity of 25 patients and their family members. 80% of these patients, 39.5% of their family members, 35.3% of their parents, and 43.9% of all siblings were culture positive for A.a. All but one of the families had at least one member in addition to the patient who was culture positive for A.a. In 3 families, > 1 member showed radiographic and clinical signs of LJP. 30% of non-LJP subjects coming from one of the areas with higher LJP prevalence harbored A.a. We conclude that LJP is highly associated with A.a. in this Brazilian population.

A case of localized juvenile periodontitis: treatment and 3 years follow-up with superimposable radiographs

A 17-year-old male patient with localized juvenile periodontitis was treated by subgingival instrumentation with full thickness flap on the lower molars, combined with a 3-week course of systemic tetracycline, and a programme of supervised oral hygiene. The treatment was rapidly followed by dramatic clinical and microbiological improvement. However, despite good oral hygiene, gingival inflammation recurred at regular intervals. It was necessary to maintain the clinical results by periodic subgingival instrumentation with an ultrasonic scaler. Healing of alveolar bone was monitored in the lower 1st molar regions over 3 years by using superimposable radiographs. Quantitative analysis of bone density performed with a high-resolution digitalisation technique showed a considerable improvement 1 year after therapy. However, continuous remodelling, probably related to variations in inflammation, occurred during the 3 postoperative years.

[The GTR technic within the framework of combined periodontal-orthodontic treatments. A case report]

Periodontal defects in adolescents or young adults are often an incidental finding within the framework of orthodontic treatment. Often these patients are suffering from a special form of periodontal disease, juvenile periodontitis. Guided tissue regeneration (GTR) offers a technique for long-term therapy in such cases. In the case presented here, the periodontal problems were aggravated by malpositioning of the affected teeth. Orthodontic and periodontal treatment enabled the malpositioning to be corrected and the osseous defects to be largely regenerated. Controls on regular bases up to now revealed a stable status over 2 years.

Incidence of early periodontitis in a group of young individuals during 8 years: associations with selected potential predictors

The aim of the present study was to assess the incidence of early radiographic bone loss in a birth cohort over 8 years and to assess possible associations between incidence of bone loss and reported dental behavior, ethnic background, and previous orthodontic treatment. In a case control study comprising a proportion of the study population, the detection of black pigmented Bacteroides and Actinobacillus actinomycetemcomitans and their association with early radiographic bone loss was assessed. At the beginning of the study in 1984, there were 2,767 subjects. In 1992 sets of bite-wing radiographs were obtained from 215 subjects, who also filled out a questionnaire concerning their present and past dental behavior, ethnic background, and orthodontic treatment. Radiographic alveolar bone loss was recorded if the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm. Thirteen subjects (6%) showed new sites with bone loss over the 8-year period. Subgingival plaque was sampled from these 13 subjects and from 13 control subjects. None of the independent variables could be associated with the observed incidence of radiographic bone loss in this cohort, with the possible exception of the presence of A. actinomycetemcomitans which was detected in about 50% of the new sites with bone loss.

Rapid bony healing in localized juvenile periodontitis: a case report

A 16-yr-old man with localized juvenile periodontitis was treated in one single surgical treatment visit. No adjunctive chemotherapy, implant material, or guided tissue regeneration (GTR) was used. Excellent bone repair was seen after 14 wk at the sites of the vertical periodontal lesions. The rapid healing could have been due to the treatment method, the youth of the patient, or the type and form of the bony defects. Radiographic control seems to be indicated 12-14 wk after surgical treatment.

Metronidazole in the treatment of localized juvenile periodontitis

Systemic metronidazole and tetracycline were compared as adjunctive agents in the treatment of localized juvenile periodontitis (LJP). 27 patients with Actinobacillus actinomycetemcomitans-positive (Aa) LJP were treated with scaling and rootplaning, control of oral hygiene and periodontal surgery if indicated. The patients were randomly divided into 3 equal groups: the 1st group had metronidazole 200 mg x 3 x 10 days, the 2nd tetracycline 250 mg x 4 x 12 days, the 3rd group received no medication and served as a control. 6 patients had periodontal surgery. 4 sites with the most advanced bone loss as determined on radiographs were selected in each subject for test sites. Gingival index, gingival bleeding after probing (GB), probing depth (PD), suppuration, and radiographic bone loss were registered, and subgingival Aa was selectively cultured. GB and PD > or = 4 mm were registered in the whole dentition as well. All parameters were monitored at baseline and at 6 and 18 months after treatment. By the end of the study, Aa was suppressed to below detection level at all test sites only in the metronidazole group, at 17/26 sites (4 patients) in the tetracycline group and at 19/26 sites (6 patients) in the control group. Clinically, all groups showed improvement. In conclusion, metronidazole was more effective than tetracycline in the suppression of Aa and the suppression of Aa appeared to produce better clinical results.

Marginal bone loss in the primary dentition of patients with juvenile periodontitis

118 patients with juvenile periodontitis (JP), diagnosed when the patients were 13-19 years old, were studied retrospectively with respect to radiographic marginal bone loss in the primary dentition, experienced when the patients were 5-12 years old. 168 other 13-19 year old patients without any signs of bone loss in the permanent teeth were used as a reference group. The JP patients were classified into 2 groups according to the number of sites with bone loss in the permanent dentition: JP group I having 1 site with bone loss (n = 45) and JP group II having > or = 2 sites with bone loss (n = 73). It was found that 35 patients (52%) of JP group II displayed 1 or more sites with bone loss in the primary dentition during the age of 5-12 years. The corresponding numbers for JP group I and the reference group were 9 (20%) and 8 (5%) respectively. These findings indicate that juvenile periodontitis, at least in some individuals, may have its onset already in the primary dentition.

Prevalence of juvenile periodontitis in a circumpubertal population

A cross-sectional radiographic screening was performed on bite-wing pairs (BW) from 1872 10-12 year old schoolchildren in the Greater Worcester, Massachusetts area to assess the prevalence of juvenile periodontitis (JP). The 3-stage screening process entailed: (1) visual identification of possible cases based upon a visual assessment of BW for interproximal crestal bone levels greater than or equal to 2 mm from the cemento-enamel junction (CEJ) on greater than or equal to 1 permanent first molar; (2) identification of probable cases based upon BW from possible cases measured with a transparent ruler calibrated in millimeters; (3) finally, clinical confirmation of JP in consenting probable cases. A total of 1038 subjects were eligible to be included in the study (greater than or equal to 3 mesial sites readable). Of the 1038 eligible subjects, 117 possible and 103 probable cases were identified in stage 1 and stage 2, respectively. A total of 99 probable cases could be contacted and 43 were examined clinically. Two cases of JP were confirmed clinically in stage 3, yielding a prevalence rate of 4.6/1000. Specifically, this report defines a rate of JP in 10-12 year-old schoolchildren for the first time. In addition, these results indicate that BW can be used to identify children with JP from large data sets. However, further studies including complete clinical and radiographic examinations are necessary to determine whether this method is adequate for large epidemiologic studies.

[The indications for the surgical treatment of chronic periodontitis of the permanent teeth in children and adolescents of different health groups]

Chronic granulating and granulomatous periodontitis of 250 permanent teeth was treated in children and adolescents aged 7 to 17, surgery had to be resorted to in 44 (18%) cases. Three groups of indications for radical treatment of chronic periodontitis in children were distinguished: difficulties in or impossibility of conservative treatment, inefficacy of conservative treatment, and somatic indications. The conservative and surgical methods together are most often indicated for patients in whom the adverse conditions of treatment (the first group of indications) are associated with an aggravated somatic status. Radical methods of treatment helped attain bone tissue recovery sooner (in 5-6 months) than after conservative therapy alone (in 8-9 months) and completely liquidate chronic foci of odontogenic infection.

Destructive forms of periodontal disease in adolescents. A 3-year longitudinal study

We studied the periodontal disease progression and the relationship between some forms of destructive periodontitis in a group of Brazilian adolescents with high prevalence of periodontal destruction, and evaluated the adequacy of reducing data by limiting the measurement of disease to first molars and by aggregating and pooling site-scores into subject-level scores. Over a period of 3 years 222 adolescents were examined annually by bite-wing radiographs. Individuals displaying arc-shaped bone lesions adjacent to greater than or equal to 2 first molars were diagnosed as juvenile periodontitis (JP) patients, while those with greater than or equal to 1 first molars showing vertical lesions were regarded as periodontal risk subjects. Teenagers with greater than or equal to 2 first molars exhibiting longitudinal bone loss were defined as high-risk patients. At the ages of 13 and 16 years, 3 (1.3%) and 4 (1.8%) subjects had JP, while 12 (5.4%) and 28 (12.6%) were regarded as periodontal risks; 8 (3.6%) subjects were assigned to the high-risk group; 4 (1.8%) 13-year olds had greater than or equal to 1 first molars missing; hence, no loss of posterior teeth occurred over a period of 3 years. Analyzing the data at the site-level revealed progressive loss and little fluctuation in the alveolar bone height in the high-risk group, and a more pronounced bone loss at the mesial than at the distal surfaces. Simpler data sets were constructed by aggregating some of the site-scores or by pooling these into subject-level scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Early-onset periodontitis: radiographic patterns of alveolar bone loss in 55 cases from a selected Malaysian population

The objective of this report was to determine the radiographic patterns of alveolar bone loss in early-onset periodontitis (EOP) cases in a selected Malaysian population. The radiographs of 55 cases of EOP patients were examined and the radiographic patterns were classified as follows: Type I: bone destruction on first molars and/or incisors only; Type II: bone destruction on first molars and/or incisors and several additional teeth (less than 14 teeth); Type III: generalized bone destruction (greater than 14 teeth), but with involvement noticeably more extensive on the first molars and/or incisors; Type IV: generalized bone destruction (greater than 14 teeth), but with no more bone loss on the first molars and/or incisors than on other involved teeth. Sex, age, and missing teeth were also recorded. Out of 55 cases, 47 cases, 22 males and 25 females, were classified into the types mentioned above; the remaining 8 cases were excluded due to too many missing teeth. It was found that 7 (14.9%) were Type I; 12 (25.5%) were Type II; 7 (14.9%) were Type III; and 21 (44.7%) were Type IV. There was a predominance of first molar/incisor involvement in Types I, II, and III with the maxillary first molars most frequently involved followed by the mandibular central incisors. Type I occurred in the younger age group and Types II, III, and IV mainly in the older age group. It was concluded that EOP in this patient sample resembled that of western society.

[Prevalence of juvenile periodontitis in Ille-et-Vilaine. Study of an orthodontic population]

The incidence of Juvenile Periodontitis was studied in 1600 patients residing in Ille et Vilaine, France. The diagnosis was established by the use of panoramic radiography on orthodontic patients. Among this population of patients only 3 cases of Juvenile Periodontitis were found. This incidence of 0.187% is similar to that found in other industrialized countries.

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.

Radiographic evaluation of juvenile periodontitis (periodontosis)

Of 49,380 male naval recruits who were screened for juvenile periodontitis (JP), 270 were clinically diagnosed as having the disease. Full-mouth radiographs identified 182 of these 270 patients as having JP with extensive bone loss on permanent first molars and/or incisors. These 182 patients, 137 (75.3%) of whom were black, were further classified into Type I: bone loss involving first molars and/or incisors and up to two additional teeth; Type II: involvement of first molars/incisors and several additional teeth; and Type III: generalized involvement (more than 14 teeth) but with bone loss notably more extensive on the first molars and/or incisors. Of the 182 patients, 129 (70.9%) were Type I; 43 (23.6%) were Type II, and 10 (5.5%) were Type III. The molars were involved more frequently than the incisors; more than one molar was always involved, with or without incisor involvement. Most cases had minimal or no radiographic caries, and 46% had demonstrable calculus. Of the remaining 88 cases from the 270 with the initial diagnosis of JP, 63 demonstrated severe bone loss on more than 14 teeth, with many of the teeth being involved to the same degree. These cases were termed rapidly progressive periodontitis. Six of the 88 cases had bone loss on only one tooth surface of the dentition. These cases were termed acute localized destruction of alveolar bone. The status of the other 19 cases could not be determined.

Prevalence of incipient juvenile periodontitis at age 16 years in Switzerland

The present radiographic and clinical survey was performed to study the prevalence of "incipient juvenile periodontitis" in a population of 16-year old adolescents in Switzerland. The subjects to be screened were selected on the basis of the population distribution in the year 1980 in the territory of Switzerland. 7% of all 16-year old adolescents proportionally distributed into the different ethnic groups of Switzerland were incorporated in the study. From the school dental systems, a total of 7604 pairs of bite-wing radiographs were obtained and evaluated for fillings and iatrogenic factors, gross amounts of calculus, resorption of alveolar bone. A diagnosis of "incipient juveline periodontitis" was given if the clinical criteria of this disorder proposed by Baer were met. In 7142 pairs of bite-wing radiographs, such a diagnosis was attributed to 7 female and 12 male patients. Subsequently, they were asked if they would be examined at the University of Berne School of Dental Medicine. On the basis of history, a complete periodontal chart and full mouth radiographs, the diagnosis was confirmed or refuted. 8 patients (4 female and 4 male) were definitely diagnosed as "incipient juvenile periodontitis". This resulted in a prevalence of 0.1% with a ratio of female to male of 1:1 in the country of Switzerland at age 16. As in other industrialized countries, this prevalence seems not to be a major public health problem.

Clinical and laboratory studies of a family with a high prevalence of juvenile periodontitis

The form of periodontitis with onset at puberty and affecting predominantly the first molars and incisors is called juvenile periodontitis (JP). The disease has been the object of intense study because from its analysis may come insights into understanding other, more common, forms of periodontitis. We recently had the opportunity to study an unusual family in which both parents developed JP in their teens. We did clinical examinations, measured leukocyte chemotaxis, analyzed the pocket microflora, looked for serum antibodies against a large panel of putative periodontal pathogens and correlated the results. The couple had two affected and two unaffected children. One of the unaffected children was not available for study. Neutrophil chemotaxis was abnormal in both parents and in the two affected children, but not in the unaffected child. Actinobacillus actinomycetemcomitans accounted for 17.5% of the pocket flora isolated from one affected child and 2.5% of that from the unaffected child, but was not detected in the remaining family members. Antibodies specific for A. actinomycetemcomitans, Hemophilus aphrophilus and Eikenella corrodens were present in the serum of both affected children and for Capnocytophaga sputigena and C. ochracea in the father, but no antibodies directed against any of the species studied were found in the mother and the unaffected child. The distribution of disease in this family was more compatible with an X-linked dominant than with an autosomal recessive mode of inheritance. The correlations among presence or absence of disease, abnormal neutrophil chemotaxis and presence of serum antibodies reacting with A. actinomycetemcomitans were excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical studies of one family manifesting rapidly progressive, juvenile and prepubertal periodontitis

We report clinical, radiographic and historical data on a large family with an unusually high prevalence of periodontitis. The proband, a 20-year-old black male, had the classic features of juvenile periodontitis (JP). His father was periodontally normal, while his mother had lost all her teeth at age 27 because of rapidly progressive periodontitis (RP). In addition to the 13 living children the couple had had 2 miscarriages. Of the children, one had RP, five had JP and two had prepubertal periodontitis (PP). Both maternal grandparents of the proband had become edentulous at an early age, presumably because of early-onset periodontitis. Four of 10 siblings of the proband's mother had early-onset periodontitis. In contrast, the paternal grandparents did not have early-onset periodontitis nor was periodontitis unusually prevalent in the siblings of the proband's father. The pedigree for this family is consistent with, but does not prove, an X-linked dominant pattern of genetic transmission. The natural history of early-onset periodontitis and the relationship among PP, JP and RP are not understood. The fact that the mother of the proband had RP and she had offspring with RP, JP and PP indicates a close relationship among these diseases and argues in favor of a common underlying mechanism. JP was not preceded by PP in the proband nor his affected 21-year-old brother, but one sister had PP, and at age 15 manifested JP. In her case, the alveolar bone around the deciduous molars had been destroyed, but it regenerated as the permanent premolars erupted.(ABSTRACT TRUNCATED AT 250 WORDS)

The composition of the subgingival microflora of young adults suffering from juvenile periodontitis

The composition of subgingival plaque, from healthy and periodontally diseased regions, as well as the clinical periodontal condition of 6 patients, 17 to 24-years-old suffering from juvenile periodontitis were examined. 6 older patients with rapidly progressive periodontitis served as a control. Samples of subgingival plaque were taken from first molars and central incisors and were analysed morphologically by dark-field microscopy. In the control group in healthy regions the ratio between non-motile and motile bacteria was 27:1 and about 1:1 in deep pockets. In the juvenile periodontitis group in diseased regions, motile bacteria made up only 1/4 of the bacteria present. The results clearly show that our relatively old patients with juvenile periodontitis had a completely different microflora in their periodontally diseased regions than patients with common periodontitis. As regards our observations by dark-field microscopy, one can assume, however, that with increasing age, there might be a shift of the flora associated with juvenile periodontitis lesions from a rather simple composition to a more complex composition very similar to the flora seen in rapidly progressive adult periodontitis lesions.

Prevalence of bone loss in a group of Brazilian teenagers assessed on bite-wing radiographs

Bite-wing radiographs were used to assess periodontal disease in 304 Brazilian 15-year-old schoolchildren from a population with a low socioeconomic status. The criterion for destructive periodontitis was a distance from the cementoenamel junction to the alveolar crest greater than 2 mm. 90 subjects were excluded, mainly due to missing first molars. Bone loss was diagnosed in 28% of the subjects. More males than females were affected. 50% of all lesions were observed adjacent to first molars. The juvenile periodontitis type of lesion was found in 8 subjects. It was concluded that in young populations bite-wing X-rays seem to be valuable in screening for individuals with incipient bone loss as well as for identification of subjects with juvenile periodontitis. In community programs regular use of this kind of roentgen examination is therefore recommended.

Periodontal bone loss in 15-year-old Norwegians

The prevalence of marginal bone loss was determined on bite-wing radiographs in 2,409 15-year-old schoolchildren living in the country of Buskerud, Norway. Radiographs were collected from all dentists in the area participating in the Public Dental Service. A distance exceeding 2 mm from the cementoenamel junction to the alveolar crest was recorded as bone loss. Bone loss around one or more teeth was found in 11.3% of the subjects. More males than females were affected, with prevalences of 13.7 and 9.0%, respectively. Most of the lesions were observed adjacent to the maxillary first molars. Overt infrabony pockets were found in only a very few cases (0.5%). A clinical examination of 31 of the subjects could not distinguish those with and those without bone loss. The present study has demonstrated that alveolar bone loss is a common finding in 15-year-old school children. It is concluded that bite-wing roentgenograms may be useful in the detection of early bone lesions in young individuals.