[Periodontal disease in Belgian adults]

BACKGROUND

To date, no epidemiological study has been published on the periodontal health of the Belgian population. The aim of this study was to rectify this situation and determine the extent of the problem in Belgium.

METHODS

A prevalence survey was carried out in a representative sample of employees of the Catholic University of Louvain. A total of 402 people aged between 35 and 65 were examined. Periodontal suffering was estimated using the CPITN index (WHO), which determines the most affected sextant of a mouth in order to assign a code to the mouth as a whole. At the same time, treatment needs were evaluated.

RESULTS

Only one subject was considered healthy, i.e. there was no bleeding of the gums in any part of the mouth. At the same time, 41.4% of the subjects examined exhibited a deep periodontal pocket in at least one sextant of the mouth likely to progress to the loss of the teeth. Many mouths (28.5%), which were free from moderate or deep pockets, had to be scaled and polished or to be treated in order to eliminate other factors which could lead to a build-up of tartar.

CONCLUSION

In this study population representative of a socio-economically favored stratum of the Belgian population, we observed a high prevalence of periodontal diseases, grading from mild chronic gingivitis to the deep cavities which are observed when the bone supporting the tooth has been lost. At the same time, we uncovered many needs for periodontal care, ranging from instruction on how to control the dental plaque to specialized periodontal care via careful scaling and polishing.

Treatment with removable partial dentures: a longitudinal study. Part I

The aim of this study was to evaluate the effectiveness of an oral rehabilitation by removable partial denture (RPD). Between 1983 and 1994, 629 patients were provided with an RPD at the Dental School of the Université catholique de Louvain. All the RPDs were constructed with a cobalt-chromium framework. All the treatments were provided by dental students under the supervision of clinical instructors. At recall time (1998-2000), 269 patients could not be reached neither by telephone nor by mail and 27 had died. Consequently, 333 patients were called for clinical examination and 254 of these (76.3%) actually attended. For a total of 292 RPDs fitted for these 254 patients, 218 (74.7%) were still being worn at the time of the check-up. Seventy-four dentures were considered to be 'failures', either because they were replaced by another RPD or by a complete denture, or because they had actually never been worn. The statistical analysis (Mantel-Haenszel and Kaplan-Meier) shows that the number of failures is significantly higher at the lower jaw compared with the upper jaw. Most of the failures are attributable to RPDs with free-end saddles and, in particular, to class I mandibular dentures. The patients are wearing their denture(s) mostly continuously (63.6%) and award a high degree of satisfaction to their denture. In general, the results recorded may be considered as very satisfactory, all the more so as we have no regular recall procedures established at our school and as check-up asked for spontaneously by the patients in the course of the period of observation are most of the time occasional or non-existent.

Treatment with removable partial dentures: a longitudinal study. Part II

The aim of this study was to evaluate the effectiveness of an oral rehabilitation by removable partial denture (RPD). Between 1983 and 1994, 629 patients were provided with an RPD at the Dental School of the Université catholique de Louvain. All the RPDs were constructed with a cobalt-chromium framework. All the treatments were provided by dental students under the supervision of clinical instructors. At recall time (1998-2000), 269 patients could not be reached neither by telephone nor by mail and 27 had died. Consequently, 333 patients were called for clinical examination and 254 of these (76.3%) actually attended. For a total of 292 RPDs checked 1893 persistent teeth were listed, with 804 serving as abutments; more than half (57.6%) of these were crowned, for which 51 debondings were recorded. For the period of observation we listed 79 abutments lost (37 at the upper jaw and 42 at the lower jaw), i.e. 9.8% of the total number of abutments. No relation could be established between the type of the abutments (natural or crowned teeth) and the losses observed (Test of Mantel-Haenszel: P=0.9496). In the upper jaw, the percentage of abutments lost was significantly higher in the presence of free-end edentulous areas as compared with bounded edentulous areas (Test of Mantel-Haenszel: P=0.0002); this difference does not appear for the lower jaws (P=0.9558). If we deduct the 25 abutments related with the 11 non-worn RPDs and the 79 abutments lost, no change becomes apparent for 92.2% of the maxillary abutments and for 85.8% of the mandibular abutments. For the 1089 other teeth, we observed the loss of 40 teeth and the appearance of caries or new fillings for 95 teeth. The fractures of cast clasps represent 3.4%.

[Review of currently used periodontal indexes]

Several commonly used indices to assess periodontal and dental health are reviewed. A comparison is made between the different methods of scoring the signs, symptoms and etiologic factors of periodontal diseases.

[Periodontal health and care needs in a sample of the Belgian population]

An epidemiological survey was carried out of among staff members of the Catholic University of Louvain. A total of 402 subjects, age 35 to 65, were examined. Periodontal lesions were estimated using the CPITN index (WHO). Only one subject presented no signs of gingival bleeding in any part of the mouth. 41.4% of the subjects presented a deep periodontal pocket in at least one sextant. Many subjects, although not presenting deep or moderately deep periodontal pockets (28.5%) needed scaling and rootplanning or other treatments to eliminate plaque retentive factors. In this sample, representing a socio-economically favoured segment of the population, we revealed a significant prevalence of periodontal disease from mild chronic gingivitis to deep pockets. Requirements in terms of care are considerable, ranging from oral hygiene instruction to control plaque to specialised care.

Influence of removable partial denture on periodontal indices and microbiological status

Thirty patients (19 men and 11 women) were provided with a removable partial denture (RPD) and assigned randomly to two groups: 15 patients were called back twice a year for plaque control, reinforcement of instructions, denture hygiene control and professional prophylaxis; the other 15 were not called back. The 30 patients were examined after 2-3 weeks following the end of the prosthetic treatment, after 1 and 2 years. At each examination, the following parameters were recorded [gingival inflammation, plaque index (Pl I), tooth mobility, attachment level, pocket depth] and a bacteriological examination of subgingival plaque was carried out. Few differences appeared between the two groups; the values observed show a relatively low level of hygiene and but little motivation with regard to prophylaxis techniques.

Endodontic and periodontal treatments of a geminated mandibular first premolar

AIM

To describe a rare case of gemination involving a mandibular first premolar.

SUMMARY

The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands.

[Incidence and primary prevention of complications related to the placement of dental implants]

Despite high success rate with endosseous titanium implants, failures inevitably occur. At an early stage, lack of primary stability, surgical trauma, peroperative contamination and occlusal overload seem to be the most important causes of implant failure. Many authors have reported that implant failures after primary healing and osseointegration are mainly due to peri-implant infection and/or excessive occlusal stress. Like periodontal disease, peri-implant inflammatory lesions develop as a result of plaque accumulation and exhibit similar clinical and microbiological signs as encountered for periodontitis. Clinicians should therefore enforce preventive measures to decrease the prevalence of such causative agents. Therapeutic attempts should have their rationale in the restoration of a biomechanical and/or host-bacterial equilibrium. The major limitation at this point seems to be the detection of a pathological process. Aside from clinical evaluation, the interpretation of radiographic images is one of the most frequently applied diagnostic procedures in patients with osseointegrated implants. Post-therapeutic maintenance care is an integral part of the entire implant treatment approach.

Effects of smoking on periodontal health: a review

Cigarette smoking is a risk factor for several diseases, and recent evidence strongly suggests an adverse effect on periodontal health. Nevertheless, the nature of the relationship between smoking and periodontal disease is not clear. Smoking causes defects in neutrophil function, impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Smoking is associated with an increased rate of periodontal disease in terms of alveolar bone loss and attachment loss, as well as pocket formation. Nicotine, the major component of cigarette smoke, may weaken host defenses to the bacterial invasion induced by plaque.

[Is periodontal guided tissue regeneration a reproducible technic? A review of the literature]

Guided tissue regeneration (GTR) has been developed as a surgical technique enabling the complete regeneration of the periodontal attachment apparatus. Among various periodontal tissues, the root, cementum and the alveolar bone, as well the Sharpey collagenic fibers linking the cementum to the bone, are of particular interest. As demonstrated in this literature review, we could globally conclude to date, that most of the publications confirm the biological and clinical potential of GTR, although in some publications, this opinion is not being shared. A number of factors influence the outcome of the regenerative therapy, some relating to the patient such as the smoking habits and the level of oral hygiene, others relating to the type of implanted biomaterial or the surgical technique. A better understanding of the periodontal healing mechanisms as well as the continuous research and progress in the field of biomaterials, chemical mediators and growth factors, are likely to further increase the predictibility of the periodontal regenerative treatments.

[Smoking and periodontal health]

The nature of the relationship between smoking and periodontal disease is not clear. However, from the information available today, the evidence, when carefully weighted, strongly suggests that smoking exerts a substantial and detrimental effect on periodontal health and disease. It is associated with an increased disease rate in terms of periodontal bone loss, attachment loss as well as periodontal pocket formation and it seems to worsen the host's defense by means of its major metabolite, nicotine. Nevertheless, new, sensitive and adequate investigations should be developed and performed in order to better explain the pathogenic mechanisms.

[An aid to decision making in the treatment of furcation diseases. Part 2: New classifications and reasoning methods]

Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

[An aid to decision making in the treatment of furcation diseases. Part 1: Results of surgical treatment of furcation diseases]

Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

Effectiveness of bromochlorophene on gingival health

The effect of a commercial toothpaste containing 0.2% bromochlorophene (BCP) on established plaque and gingivitis was compared with placebo. The two toothpastes were similar in packaging, taste, consistency, and color. Thirty-two patients with chronic gingivitis were enrolled in this randomized, double-blind comparison and were asked to brush twice a day with the given toothpaste without changing their oral hygiene habits. Plaque index, gingival index, gingival crevicular fluid, and papillary bleeding index were recorded at baseline and after 3 weeks. Significant decreases in gingival and papillary bleeding indices were noted in the BCP group, as compared with the placebo group. Plaque index significantly decreased in both groups. No significant change was noted in the volume of gingival crevicular fluid.

[Microbial diffusion by aerosol during ultrasonic scaling: descriptive study]

The aim of this study was to evaluate the bacterial spreading by using ultrasonic scaler and air-polisher. During ultrasonic scaling, bacterial spray is important near patient's mouth (30 cm), principally without good aspiration devices. In this case, clear spreading is observed at 2 m from the patient. Air-polishing compared to ultrasonic scaling produces larger microorganisms pollution.

Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study

The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis. Two groups were compared; one received the test minocycline ointment and the other a vehicle control. Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks. Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding. These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12. Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Subgingival minocycline ointment resulted in statistically significantly greater reduction of P. gingivalis at weeks 2, 4, 6, and 12; P. intermedia at weeks 2, 4, 6, and 12; and A. actinomycetemcomitans at weeks 6 and 12. Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment. Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

The effectiveness of a preventive regimen on the periodontal health of patients undergoing chemotherapy for leukemia and lymphoma

In patients with leukemia or lymphoma, the role of preventive oral hygiene in reducing infectious periodontal complications during aggressive chemotherapy is well documented. However, the effectiveness of these measures in preventing further dental or periodontal degradation remains to be demonstrated. 34 hospitalized patients with malignant heamatological diseases were observed. During chemotherapy, tooth brushing was replaced by 3 daily mouth-rinses with 0.2% chlorhexidine digluconate. The periodontal status of these patients, appears unchanged after 12 months. This suggests that the prophylactic measures do prevent a measurable periodontal degradation, even in the presence of pre-existing periodontal disease.

[Criteria for choice of an alloy for dental amalgams]

Dental amalgam is still the safest and the most utilized posterior restorative material. The amalgam weakness is the marginal leakage of the filling. This defect is the main source of failure. Creep and corrosion are the most important factors in the marginal destruction mechanism. It's suitable to determine material properties before oral use. Electrochemical methods i.e. corrosion potentials and currents are mainly utilized. In vivo techniques have been developed. Those techniques give us interesting informations on amalgam buccal behaviour in course of time. Amalgam choice is very important: the best one is a High Copper alloy with high corrosion resistance and low creep.

[Comparative effectiveness of the Interplak electric rotary toothbrush]

The purpose of this study was to compare the Interplak rotary electric toothbrush with conventional toothbrushing for its effectiveness in controlling supragingival plaque and gingival inflammation. Twenty subjects, received the same hygiene instructions, were selected and divided into two equal groups. One group used conventional toothbrushing (Control group) and the other one used only the rotary electric toothbrush (Test group) for a 4 weeks study period. The plaque index (PLI), the plaque index limited on proximal sides (PPLI), the bleeding index (PBI) and the periodontal destruction index (PDI) were recorded at base line and after 4 weeks. Test group had significantly improved scores for PLI, PPLI and PBI. No differences were found in control group. These results indicate that the rotary electric toothbrush (Interplak is more effective for plaque removal and control of gingival inflammation that classic manual brushing.

HLA: a review of actual knowledge and perspectives in periodontology

The Major Histocompatibility Complex is a relatively poorly explored research area among the various immunological aspects of periodontal diseases. After a recall of general concepts, the authors first describe the general HLA-pathology association and then, the reported HLA-periodontal disease associations. HLA theoretical potential interests are multiple. Typing results show, on one hand, no clear correlation with juvenile periodontitis (diminution of A 2, augmentation of A 9, A 28, Bw 15 and Bw 35) but on the other hand, a more constant correlation between HLA A 9 and rapidly progressive periodontitis. Besides, three resistance factors have been reported: A 10, B 5 and A 28.

[Release of fluoride by fluoridated amalgams and its incorporation by dental enamel]

Liberation of stannous fluoride incorporated in the alloy powder before amalgamation was demonstrated for all the amalgams tested in this study. This liberation was observed for stannous fluoride concentrations of 0.5% and 1%. Clear differences were noted in relation to the type of amalgam studied. Through the use of a non destructive method (activation with charged particles) it was possible to measure the fluoride concentration in enamel before and after the contact with the fluoridated amalgam. This analysis demonstrated that the fluoride liberated from the amalgam was trapped by enamel in contact with alloys containing 0.5% or 1% of stannous fluoride. The enrichment in fluoride was very important in the first weeks and remained high after four months. No significant difference appeared between alloys fluoridated at 0.5% and 1%. The dissolution of calcium fluoride through a KOH treatment showed that the amount of stable fluoride (fluorapatite) formed was important.

[Scanning electron microscopy of dental plaque and tartar on the surface of human cementum]

Supragingival plaque covering cementum, exposed through withdrawal of the epithelial attachment, presented the same bacterial polymorphism as nature dental plaque. Rounded, filamentous and rod-shaped organisms were observed. In some areas, the presence of extracellular material corresponded to plaque matrix. Corn cob configurations consisting of central filamentous bacteria associated with peripheral cocci were often seen in the supragingival plaque overlaying the cementum. The observation of cementum calculus allowed the differentiation of supragingival and subgingival calculus. The first consisted mostly of calcified dental plaque. The calcification started more often in the interbacterial matrix, but sometimes an initial calcification of the bacterial bodies was noted. Beside this calcified bacterial plaque, crystalline inorganic deposits devoid of micro-organisms were observed. The same differences were noted in subgingival calculus but the proportion was clearly reversed. Amicrobial crystalline deposits were more frequent and calcified bacteria were more uncommon.

[Scanning electron microscopy of the surface of human cementum in various physiological and pathological conditions]

In scanning electron microscopy (SEM) of the dental root surfaces human cementum resorption by giant multinucleated cells appeared similar in temporary and permanent teeth. Thus the resorbed zones were formed by associated Howship lacunae. On the lacunae walls, the openings of numerous tubules of the cementocytic lacunae were seen. Such aspects were noted during the physiological resorption of temporary teeth. The cementum surface of permanent teeth without pathology, presented frequently such resorption aspects around their apical regions as well as on other regions, the resorbed areas being more often not widespread. Similar resorption zones were observed in contact with paradental granulomas and along granulation tissue in cases of chronic periodontitis. Orally exposed cementum, after gingival recession, was mainly characterized by the disappearance of the typical dappled aspect of the cellular cementum and by the presence on the smoothed surface of numerous striate. The cementum wall of the periodontal pockets showed always the dappled aspect with the occasional presence of incipient calculus formation as well as calcified fibrillar elements. These calcified fibrils were either short covering the whole surface or were longer being disposed parallel to the surface in interwoven networks or in tufts. Cementum curetage followed by root planning removed the calculus completely. Before root planning, the presence of numerous striae were noted. They disappeared following the action of a rubber cup and an abrasive polishing paste. Ultrasonic scaling gave a relatively clean root surface. However, the cementum surface, apparently devoid fo calculus under visual examination, showed in places the presence of thin calculus layers under the SEM.

Correlation between calculus index and acid and alkaline pyrophosphatases activities of dental plaque and saliva

The activities of acid and alkaline pyrophosphatases were measured in human plaque of thirty subjects and saliva of twenty-two subjects. A study of correlation and analysis of variance were done between the pyrophosphatasic activity and the calculus index. A significant positive relationship has been established.