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Background: The individual susceptibility to periodontal disease is probably the result of an interaction of multiple genetic and environmental influences. Polymorphism of the N-acetyltransferase (NAT 2) modifies the individual susceptibility to toxicity from certain therapeutic drugs or heterocyclic amines including substances from cigarette smoke. Subjects are to be classified as 'slow' or 'rapid' acetylators according to how fast their bodies metabolise such xenobiotics. Differences in their ability to detoxify these substances may contribute to an increased risk for periodontitis in subjects exposed to cigarette smoke or other xenobiotics., Objective: The purpose of this study was to assess whether the NAT2 genotype is a risk factor for periodontal disease in Caucasian patients suffering from adult periodontitis., Material and Methods: 154 Caucasian subjects were assigned to one of the 3 groups: no, moderate, and severe periodontal disease based on bone and attachment loss. In all subjects, genotyping for mutations on the N-acetyltransferase (NAT2) gene was performed by means of PCR and RFLP analysis., Results: Comparison of frequency distribution of NAT2 acetylation types between the most diseased group and not or moderately affected subjects showed a tendency to over-representation of slow acetylators with severe disease. When using bone loss as measure of periodontitis, this over-representation shows a significant association with the disease (odds ratio=2.13, p=0.025). In the logistic regression analysis, adjusted for age and smoking, NAT2 slow phenotype was significantly associated with the severity of bone loss, the odds ratio being 2.09 (95% C.I. 1.02-4.26, p=0.043). In a case-control analysis (controlled for smoking, gender and age) mean bone loss showed a significant difference between the 2 NAT2-type groups (Mann-Whitney test p=0.041)., Conclusion: The data suggest that the slow acetylator phenotype may be associated with a higher risk of periodontitis, especially in smokers. Possible explanations regarding the mechanism are discussed; however, such attempts are highly speculative at this time.

Background, Aims: Depending on the phase of periodontal treatment, power-driven inserts with different power levels are necessary: during initial treatment and flap operations, it must be possible to remove calculus which firmly adheres to the root surface with great efficiency; in contrast, gentle root-surface instrumentation has a high priority during maintenance treatment. Recently, modified sonic scaler inserts have been introduced: diamond-coated inserts for open flap operations and slim probe-shaped sonic scaler inserts for deplaqueing during maintenance., Method: We compared the substance removal by these inserts to that of a conventional insert. In a bench system which allows application force, stroke height, and width and frequency of instrumentation to be monitored and also permits assessment of the topography before and after instrumentation (yielding depth removal and removed volume), we instrumented aluminum rods in triplicate and bovine roots in a 5-fold repetition., Results: With high application forces (1.0 N), the diamond-coated inserts removed 30 to 50% more substance than the conventional one. Except for the slim inserts, there was a significant linear relationship between increasing force and removed volume. Probe-shaped inserts do not remove considerable substance even with increasing pressures., Conclusions: Diamond-coated inserts remove tooth substance very effectively and must thus be handled with care: more pressure effects more removal. Probe-shaped inserts can be used without risk during maintenance visits.

Background, Aims: The aim of the study was to assess the effect on existing plaque and gingivitis of an oral hygiene regimen which utilizes triclosan/copolymer and to compare it with a regimen which uses interdental cleaning devices to control the interdental inflammation., Method: For this investigation, 39 subjects were recruited. They were examined for plaque and gingivitis using the criteria of Turesky modification of the Quigley-Hein index and the papillary bleeding index. Plaque and gingivitis were only scored interdentally. Following the baseline examination, the subjects were randomly assigned into 2 groups. The control group used a dentifrice identical to the test dentifrice but without triclosan/copolymer; subjects in this group were taught to brush their teeth with the modified Bass technique and were instructed to additionally use appropriate interdental cleaning devices. The test group used a dentifrice containing triclosan/copolymer (Colgate Total). They were not instructed to use interdental cleaning devices., Results: Both groups were re-examined after 4 weeks, and 4 and 7 months. In both groups, plaque and gingivitis levels were modestly reduced, more pronounced in the anterior and less in the posterior teeth., Conclusions: This investigation demonstrated that a dentifrice containing triclosan in combination with a copolymer can reduce plaque and gingival inflammation to levels comparable to regular interdental cleaning.

Background, Aims: The aim of this retrospective study was to assess the effect of regular supportive periodontal treatment on disease progression in patients with moderate to advanced periodontitis., Method: We compared radiographic change of interdental bone level and number of teeth at 2 time points in 3 patient groups (mean age 46 years): group A, periodontally untreated patients (n= 14) who dropped out during initial therapy; group B, non-compliant patients (n=26), who discontinued supportive periodontal therapy after ca. 2 years of maintenance; group C, compliant patients (n=27), who regularly attended the maintenance program for 7 years. Periodontal treatment was performed as scaling and root planing or flap surgery in groups B and C. All 3 groups were re-examined ca. 7 years after the initial examination., Results: Patients in group A lost 3.8 teeth (0.5 teeth/year), those in group B 3.2 (0.4 teeth/year), and in group C, patients lost 2.0 teeth (0.2 teeth/year). About half of the patients lost no teeth (group A 43%, B 42%, C 55%), and only 17 subjects lost more than 3. At the 2nd examination, an increase in interdental bone was found only in group C (+0.13 mm), while groups A and B lost 0.57 mm and 0.31 mm of alveolar bone level, respectively (p<0.05 group C versus A and B)., Conclusions: Systematic periodontal treatment stops interdental bone loss and decreases the rate of tooth loss in most cases. Periodontal surgery without regular follow-up care cannot prevent further periodontal destruction, but it can delay it.