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Background: This study used a tissue-engineering approach, which combined autologous periosteal cells with a scaffold material, to promote bone augmentation under an occlusive titanium barrier that was placed on the skull of rabbits. Because the cell–matrix interaction is of key importance in tissue engineering, two different calcium phosphate–based scaffolds were seeded with autologous periosteal cells. One scaffold contained hydroxyapatite, tricalcium phosphate, and collagen; the other scaffold was a b-tricalcium phosphate structure. Methods: The experiment involved 38 rabbits divided into five groups: the two different scaffolds with and without cells and a blood clot only. Prior to implantation, autologous periosteal cells were harvested from the tibia by stripping the periosteum. Cells were cultured, and 1 day before the implantation ;20 million cells were collected and seeded onto the scaffolds. Two preformed dome–shaped full titanium barriers were placed subperiosteally onto the frontal and parietal bones of each rabbit. Before placement of the barriers, the different scaffolds, seeded with or without cells, were put on top of the skull. As a negative control, autologous blood was injected into the barriers. Histologic evaluation and histomorphometric analysis were performed after 12 weeks of undisturbed bone growth. Measurements involved the amounts of newly formed tissue and of new bone distinguishing between trabecular bone and osteoid. Results: No significant differences were found between the four treatment groups (scaffolds with or without cells). However, the amount of new bone tissue found underneath the titanium barriers with scaffolds was significantly higher (P

Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP).In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option.One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P0.001). Post-procedure problems were significantly less with the gel than with injection (P0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment.The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.

Morning breath odor is an often-encountered complaint. This double-blind, crossover, randomized study aimed to examine the bad breath-inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control.Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX-Alc (a 0.2% chlorhexidine [CHX] solution); CHX-NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX-CPC-Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%). After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12-day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations.Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHX-Alc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX-NaF remained unchanged, while for the CHX-Alc and CHX-CPC-Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX-Alc, CHX-CPC-Zn, and CHX-NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-CPC-Alc and CHX-NaF because of a better taste and fewer side effects.The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX-Alc and CHX-CPC-Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva.

Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth.A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re-examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set-up.No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth.The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation.

The present study compared 2 different methods (direct versus indirect evaluation) for the quantification of the adhesion of Porphyromonas gingivalis strains to in vitro cultured mono-layers of pocket epithelium.The indirect culture viability assay (calculation of colony forming units) was compared to a direct microscopic evaluation using a novel fluorescent stain. The fluorescent kit was found to stain both bacteria and epithelial cells and enabled a differentiation between dead and living cells.Comparing the visual to the culture data, a high and significant correlation was found (Pearson's correlation = 0.75; P0.001). The adhesion capacity was in general higher for dead epithelial cells than for living cells (P0.01). Although comparable numbers of bacteria of 2 P. gingivalis strains (Pg 4 and Pg 5) were applied, Pg 4 showed a significantly lower adhesion capacity. This intra-strain variability was observed by the culture assay (2.3 x 10(6) versus 7.8 x 10(6)+/-2.7 x 10(6); P0.01) and by the direct microscopy (P0.01) for both live and dead epithelial cells. A second goal was to see whether there was a difference in the amount of bacterial adherence to mono- and multi-layers of in vitro cultured epithelium. No significant differences were found for the 5 examined P. gingivalis strains. However, interstrain differences in adhesion capacity were evident for both tissues.This study highlights the reproducibility of a direct microscopic evaluation of bacterial adhesion to in vitro cultured epithelial cells, and suggests both intrastrain (P. gingivalis) and inter-cell (live versus dead) variation in adhesion capacity. Studies are needed to determine the extent to which P. gingivalis strain variation is reflected in variation of other strains in humans.

Recent studies showed the clinical benefits of a one stage full-mouth disinfection, when compared to the worldwide standard treatment strategy of consecutive root planings per quadrant without proper disinfection of the remaining intraoral niches. The purpose of this study was to investigate the microbiological benefits of such a one stage full-mouth disinfection with special attention to all intraoral niches for periodontopathogens and to evaluate the perception by the patients of the new treatment strategy.Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given oral hygiene instructions. The test group received the one stage full-mouth disinfection treatment. At baseline and after 1, 2, 4, and 8 months, microbiological samples were taken from all niches (tongue, mucosa, saliva, and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media. Patient perception of the treatment was evaluated using a questionnaire.In comparison to the standard therapy, the one stage full-mouth disinfection resulted in significant additional microbial improvements. The test group showed larger reductions in the proportions of spirochetes and motile organisms in the subgingival flora, and more significant reductions in the density of key pathogens, with even the eradication of P. gingivalis. The beneficial effects in the other niches were primarily restricted to the number of colony-forming units/ml of black-pigmented bacteria, especially on the mucosa and in the saliva and to a lesser extent on the tongue. Both treatments were well tolerated by the patients and the overall severity rating for both therapies was comparable, although 4 quadrants were treated within 24 hours in the test group versus only 1 in the control group. The full-mouth disinfection approach resulted more frequently in a slight increase of body temperature, especially after the second day.These findings support the benefit of a one stage full-mouth disinfection in the treatment of patients with either chronic adult or early-onset periodontitis.

The purpose of this study was to evaluate the safety and clinical efficacy of controlled-release tetracycline-containing fibers in patients with refractory periodontitis versus the preceding classical treatment. One hundred twenty-one sites in 20 patients were followed from baseline to 6 months after fiber insertion. Each selected site was > or = 5 mm deep and bled on probing. All 20 patients had at least one site > or = 7 mm which bled on probing. Those pockets remained after intense and repeated conventional therapy (scaling and root planing and often surgery), often including the use of systemic antibiotics. This treatment period, the so-called control period, preceded the experimental period by at least 3 years, when the fibers were placed. Both treatments (in control and test period) were performed in the Department of Periodontology at the University Hospital in Leuven. At the start of the experimental period, all pockets > or = 5 mm were treated by the placement of fibers impregnated with 25% tetracycline. The fibers were removed after 10 days. Probing depth, clinical attachment level, gingival recession, and bleeding on probing were recorded at baseline, and at 1, 3, and 6 months following treatment. Analysis of data from all sites indicated that a significant decrease in probing depth and gain in attachment were present at all follow-up visits. The mean probing depth reduction for sites > or = 7 mm was 3.2 mm at month 6, with a gain in attachment of 2.7 mm, while this was -1.0 mm and -1.9 mm, respectively, during the preceding control period. The fraction of bleeding pockets was reduced from 77% to 27% and from 80% to 77% during the experimental and control periods, respectively. No significant adverse side-effects were observed, except for a transient redness at fiber removal in 2 sites. Fiber insertion appeared to be time-consuming even when the operator was familiarized with the procedure. The results of this study prove that tetracycline-impregnated fibers can reduce probing depth significantly for a period of 6 months in patients not responding to thorough and repeated classical periodontal treatment.

The influence of surface free energy on supra- and subgingival plaque microbiology was examined in 9 patients with functional fixed prostheses supported by endosseous titanium implants. Two abutments (trans-mucosal part of the 2 stage implant) were replaced by either a new titanium abutment or a fluor-ethylene-propylene (FEP) coated abutment per subject. After 3 months of habitual oral hygiene, plaque samples were taken. Supragingival plaque was examined by means of differential phase-contrast microscopy, whereas for the subgingivial plaque additional analyses (DNA probes analysis, culturing) were performed. The subgingival samples were taken by paper-points and by scraping of the subgingival abutment surface. Differential phase-contrast microscopy showed a significant difference in plaque composition, especially when supragingival plaque was considered (P = 0.05). FEP coated abutments frequently harbored more coccoid microorganisms, whereas spirochetes or motile organisms were only detected around titanium abutments. Subgingivally, the number of colony forming units (CFU) in paper-points was comparable for both types of abutments. If the to-the-abutment-adhering plaque was considered, the number of CFU was 5 times higher on the titanium abutments than on the FEP coated abutments. However, this difference did not reach a statistical level of significance (P = 0.38). The DNA probe analysis of the subgingival plaque collected with paper-points showed a slightly higher frequency and concentration of perio-pathogens around the titanium abutments. However, the inter-substratum differences were smaller than the inter-subject differences. The latter seemed to be related to patient's dental status.(ABSTRACT TRUNCATED AT 250 WORDS)

This multicenter prospective study on the use of an implant system involved 9 centers and reports on the periodontal aspects after 3 years of observation. A total of 558 implants in 159 patients with 197 bridges all independent from natural teeth were originally included. Because of failures and patient withdrawals the number of implants was reduced to 460 and bridges to 174. The cumulative success rate for implants, starting from implant placement, is 94.3% after 2 years and 93.9% after 3 years indicating a leveling of implant loss. Failures concentrated in patients with a high plaque index. The loss of marginal bone was during the second and third years only 0.03 mm per year as an average while it was 0.4 mm during the first year. There were no reports of intense gingival inflammation in any of the patients and the plaque and gingivitis index behaved similarly around abutments and teeth. The probing pocket depth was significantly reduced over the observation time. The resistance towards marginal bone loss around these implants confirms the previous studies on fully edentulous patients.

This study aimed to compare, in vivo, a conventional pocket probe with an automatic, computerized, constant force, electronic probe with a discrimination ability up to 0.1 mm. Sixteen adults with moderate chronic periodontitis and free of supra- and subgingival calculus participated in this study. Eight patients were examined by 2 investigators who used both the conventional and the automatic probes, for a total of 4 probings per subject. The remaining 8 patients were examined 4 times by investigator 1, twice with each probe. For each patient the Ramfjord teeth were examined and 6 sites were considered per tooth. Although the pocket depth measurements recorded by the manual probe were consistently deeper than those of the electronic probe, a good correlation was found between both recordings. Moreover, intra- and inter-examiner comparisons showed comparable standard deviations for both probes and small differences in absolute scores. The conventional probe was slightly more reproducible whereas the automated probe had the advantage of automatic registration. The results indicate that both probes can be considered as valuable in clinical practice.

Since smoking is an established risk factor for the development of periodontitis, the present study investigated whether nicotine and cotinine can make epithelial cells more prone to colonization by periodontopathogens.Primary epithelial cell mono-layers were inoculated with nicotine and cotinine prior to adhesion experiments with Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The number of bacteria associated with cells inoculated or not with nicotine or cotinine were assessed by an indirect culture viability assay. The same experimental set-up was used for assessing HeLa cells exposed to cigarette smoke extract (CSE).Primary epithelial cells inoculated with concentrations of nicotine and cotinine, found in smokers and non smokers, did not show significant differences (P0.05) in colonization susceptibility to A. actinomycetemcomitans. When these concentrations were increased to 1 mg/ml, a significant (P0.05) and species-specific effect of the colonization susceptibility of epithelial cells was observed: It increased for A. actinomycetemcomitans, while it decreased for P. gingivalis. For both species the effects were more pronounced for nicotine, although this was not statistically significant. The change in colonization susceptibility did not result from alterations of the bacterial viability due to nicotine or cotinine. Treatment of HeLa cells with CSE also led to a species-specific variation in colonization tendency; i.e., increased for A. actinomycetemcomitans (P0.05), but not for P. gingivalis.The susceptibility of epithelial cells to become colonized by either A. actinomycetemcomitans or P. gingivalis could be altered by nicotine, cotinine, or CSE in a time-dependent, species-specific manner. Whether these findings that support the hypothesis of an increased patient susceptibility for bacterial adhesion to epithelial cells in smokers are clinically relevant remains to be proven.

Bad breath is often caused by periodontitis and/or tongue coating. This study followed the impact of initial periodontal therapy on several halitosis-related outcome variables over a 6-month period. Organoleptic ratings are often uncomfortable for the patient and have several disadvantages. They are, for instance, influenced by external parameters (e.g., food intake and cosmetics) and need to be calibrated among researchers worldwide. A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording.In this double-blind, randomized, medium-term, parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled. Besides a one-stage, full-mouth disinfection and oral hygiene improvement (including daily tongue scraping), patients were instructed to rinse daily for 6 months with one of the following products (randomly allocated): chlorhexidine (CHX) 0.2% + alcohol, CHX 0.05% + cetyl pyridinium chloride (CPC) 0.05% without alcohol (a new formulation), or a placebo solution. At baseline and 3 and 6 months, a series of parameters were recorded including: concentration of volatile sulfide compounds (VSC), tongue coating, and an estimation of the microbial load (at anterior and posterior parts of the tongue, saliva, dental plaque). The intraoral VSC ratings were compared to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva (0.5 ml, 37 degrees C, anaerobic chamber).Even though the initial VSC values were not high (+/-90 ppb with only 18 patients revealing more than 100 ppb), significant (P0.05) reductions could be achieved in the CHX and CHX + CPC group, and to a lower extent in the placebo group (P = 0.10). Tongue scraping resulted in a significant reduction (Por =0.05) of the tongue coating up to month 6 in the placebo and CHX + CPC group, but not in the CHX group (confusion due to staining). The CHX and CHX + CPC group showed, in comparison to baseline, significant (P0.001) reductions in the number of anaerobic species in the supragingival plaque, in the saliva, and on the anterior part of the tongue. For the posterior part of the tongue the microbial changes remainedor =0.3 log values (P0.05). For the placebo group, the microbial changes never reached a level of significance (or =0.3 log values). A strong correlation was found between the intraoral VSC ratings and the 1-hour (r = 0.48, P0.0001; r = 0.54, P = 0.0003 for baseline data only) and 2-hour (r = 0.43, P0.0001) VSC production of incubated saliva. The latter also correlated very strongly (r = 0.71) with the number of anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other (r = 0.64 for 1-hour and 0.73 for 2-hour incubation).The results of this study indicate that in patients with moderate periodontitis, initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level, except when combined with a mouthrinse. Saliva incubation can be used as an indirect way to score breath odor. It offers simplicity, objectivity, and is less invasive.

The present multicenter study aimed to survey the patients' experiences in relation to the diagnosis and non-surgical treatment of periodontitis according to current treatment routine.Patients (N = 268) treated for plaque-related periodontitis were enrolled in two groups: group 1 received primary probing of pocket depths (PD 1) and/or primary scaling and root planing (SRP 1); group 2 consisted of patients who were scheduled in the different centers for recall PD/scaling/subgingival instrumentation. Data collection included a full periodontal status, anesthesia employed, procedure time, and patient self-completed questionnaires to assess their previous and current experience of pain and discomfort during anesthesia and periodontal treatment.Ninety percent of the patients received infiltration anesthesia during primary SRP, compared to only 2% during recall scaling/instrumentation and none during PD. Many patients (40% in SRP group 1 and 52% in the recall scaling/instrumentation group) were most bothered by the scaling procedure, while others (35% in the primary SRP patients) by the anesthetic injection. Painful experiences during previous primary PD and present SRP were highly correlated (r = 0.6).From these results, it is evident that subgingival instrumentation causes pain and discomfort, an aspect that should be considered in periodontal therapy. Unfortunately, the use of local infiltration anesthesia to reduce pain is in itself a cause of discomfort. Attractive alternatives for anesthetic applications are much needed.

937 Background: Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and especially lack international calibration. Portable sulphide monitors are relatively expensive and neglect several major malodorous molecules (e.g., butyric and propionic acids, putrescine, and cadaverine). Gas chromatography necessitates expensive devices and experienced technicians. This pilot study explored the applicability of a new technique (saliva incubation) by comparing its discrimination power, in a morning bad breath inhibition study of antiseptics, to those of hydrogen sulphide (H2S) measurement devices and organoleptic ratings. Methods: After a professional cleaning, 8 periodontally healthy students abstained from all means of mechanical plaque control for 5 experimental periods of 7 days, with intervening washout periods of at least 2 weeks. During each experimental period, the students rinsed only twice daily with different antiseptics. At day 7, morning breath was scored clinically (volatile sulphide compound [VSC] level and organoleptic ratings), and 1.5 ml of saliva was collected and divided between 3 glass tubes that were sealed and incubated (37°C, anaerobic chamber). Immediately after collection and after 3 and 6 hours of incubation, the headspace air in one of the tubes was examined for VSC production and organoleptic measurements. Results: The investigations of the incubated saliva correlated well with the 7-day intraoral VSC recordings and organoleptic ratings (P ≤0.005). Moreover, evaluations showed a similar interproduct ranking for their efficacy in malodor control. The power analyses indicated a higher discrimination power for the saliva incubation test than for the intraoral registrations. Conclusions: The strong correlation between odor production of incubated saliva and clinical assessments suggests that the saliva incubation test may be used as an indirect method to measure oral malodor and can be employed to investigate the antimalodor effectiveness of oral hygiene products. J Periodontol 2003;74:937-944.

Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved.A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment.In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment.No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment. J Periodontol 2004;75:176-181.

Periopathogens and cariogenic species survive more than 48 hours on toothbrushes even under dry storage. This study examined a decontamination of toothbrushes by means of the bactericidal effect of different toothpastes or a special coating of the tufts.Eight untreated periodontitis patients were professionally brushed, using a new toothbrush per quadrant and 3 different toothpastes containing either amine/stannous fluoride (AmF/SnF2), amine fluoride (AmF), or a mild surfactant as major antibacterial component (excipient), or no paste (C). The brushes were rinsed and stored dry at room temperature. At different time intervals, 4 tufts per toothbrush were processed for selective and non-selective culturing procedures. The protocol was repeated comparing AmF/SnF2 and C with 2 toothbrushes with coated tufts (coat1 and coat2).At baseline, C brushes (n = 16) harbored 10(7), 10(8), and 10(6) colony forming units (CFU) of aerobic, anaerobic, and black pigmented species, respectively. After 24 hours 10(6) CFU of aerobic and anaerobic species could still be cultured from 14 of the 16 brushes. Black-pigmented species remained detectable up to 4 hours; detection frequencies for Fusobacterium nucleatum and Streptococcus mutans at 24 hours were 5/16. With AmF/SnF2 and AmF toothpaste the number of adhering bacteria was already 2 log lower at baseline (P0.05), but not for the excipient (0.5 log, P = 0.7). With AmF/SnF2 no vital species could be detected after 8 hours. AmF reduced the bacterial survival rate significantly more than the excipient, but less than AmF/SnF2 (P0.05). The bactericidal effect of coat1 and coat2 was negligible when compared to C (P0.20), and clearly inferior to the AmF/SnF2 paste (P0.0001). After 24 hours these brushes still harbored10(5) CFU.Toothpastes can significantly reduce contamination of toothbrushes, but their bactericidal activity is dependent on their composition. Coated tufts failed to limit the bacterial contamination.

Recent studies reported significant, additional clinical and microbiological improvements when severe adult periodontitis was treated via the one-stage full-mouth (OSFM) disinfection approach, instead of a standard treatment scheme with staged instrumentation per quadrant. The OSFM disinfection involves dealing with the remaining oropharyngeal niches such as tonsils, saliva, tongue, and mucosa. The OSFM disinfection procedure involves scaling and root planing of all pockets within 24 hours in combination with chlorhexidine application to all oropharyngeal niches (chairside and at home for 2 months). This study aimed to compare the microbiological shifts with the OSFM approach versus standard therapy.Nineteen patients with advanced chronic periodontitis (AP) and 12 patients with early-onset periodontitis (EOP) were randomly assigned to the test and control groups. The control group (9 AP patients, 6 EOP patients) was scaled and root planed, per quadrant, with 2-week intervals. The test group (10 AP patients and 6 EOP patients) underwent OSFM disinfection treatment. At baseline and after 2, 4, and 8 months, pooled subgingival plaque samples were taken from single- and multi-rooted teeth. The presence and levels of 30 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization.Both treatments resulted in important reductions of the pathogenic species up to 8 months after therapy, both for their detection level and frequency. The OSFM disinfection resulted in an additional improvement, especially in the AP group. P. gingivalis and B. forsythus were reduced below detection level. The number of beneficial species remained nearly unchanged.The OSFM disinfection results in supplementary reductions of periodontal pathogens even after 8 months in the treatment of patients with advanced or early-onset periodontitis.

In order to study inter-individual differences in bacterial adhesion/invasion of periodontal tissues, an in vitro model for culturing multi-layered pocket epithelium without feeder layers or stromal equivalents (including the evaluation of their cytokeratin profiles) was developed.Pocket epithelium was collected and grown until confluent in Falcon flasks using keratinocyte-serum free medium (KSFM), without a feeder layer. In the second passage, oral keratinocytes were re-grown in a 2 compartment system using either a clear polyester (transwell-clear [TCL]) or a collagen (transwell-col [TCO]) membrane as culture surface. After the first week, the calcium concentration was raised to 1.2 mM and in half the wells, the KSFM was supplemented with 10% fetal calf serum (FCS). Histology and immunohistochemistry were performed after 1, 2, and 3 weeks of additional growth.In general, all conditions resulted in a structured epithelium consisting of 3 to 5 layers, but important differences were observed between the membrane types and between the media. CK4 was rarely and only lightly expressed while CK18 and 19 (characteristic of junctional epithelium) were very strongly expressed in the older (2 and 3 weeks) cultures. CK13 and 14 (characteristic of any stratifiable epithelial cell) also tended to increase over time; CK13 seemed to be stronger in KSFM with FCS while the contrary was true for CK14. The multi-layer created by the combination TCL/KSFM + 10% FCS resembled a junctional epithelium most, while that grown on TCO without FCS mimicked the sulcular epithelium.It seems possible to create a histiotypic culture resembling either periodontal pocket or junctional epithelium without the use of stromal equivalents or feeder layers which make this approach more cumbersome. This multi-layered culture offers a model to investigate the permeability of pocket epithelium and the adhesion and penetration of bacteria under well-defined environmental conditions.

A standard treatment strategy for periodontal infections often consists of 4 consecutive sessions of scaling and root planing (per quadrant, at 1- to 2-week intervals), without proper disinfection of the remaining intra-oral niches for periodontopathogens. This could theoretically lead to a reinfection of previously disinfected pockets by bacteria from an untreated region/niche. This study aimed to investigate, over an 8-month period, the clinical benefits of a one stage full-mouth disinfection in the control of severe periodontitis.Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given standard oral hygiene instructions. A one stage full-mouth disinfection (test group) was sought by scaling and root planing the 4 quadrants within 24 hours in combination with the application of chlorhexidine to all intra-oral niches for periodontopathogens. Besides oral hygiene, the test group also rinsed twice daily with a 0.2% chlorhexidine solution and sprayed the tonsils with a 0.2% chlorhexidine spray, for 2 months. The plaque index, gingival index, probing depth, bleeding on probing, gingival recession, and clinical attachment level were recorded at baseline and at 1, 2, 4, and 8 months afterwards.The one stage full-mouth disinfection resulted, in comparison to the standard therapy, in a significant (P0.001) additional probing depth reduction and gain in attachment up to 8 months. For initial pocketsor =7 mm, the "additional" probing depth reduction at the 8 month follow-up was 1.2 mm for single-rooted and 0.9 mm for multi-rooted teeth, with corresponding additional gains in attachment of 1.0 mm and 0.8 mm, respectively. The additional improvements were observed for all subgroups (adult periodontitis, generalized early-onset cases, smokers), with the largest differences in the non-smoking adult periodontitis patients.These findings suggest that a one stage full-mouth disinfection results in an improved clinical outcome for the treatment of chronic adult or early-onset periodontitis as compared to scaling and root planing per quadrant at 2-week intervals.

In patients with severe peridontitis, lower incisors are prone to terminal breakdown. This study assessed the longevity of composite-bonded resin/natural teeth (reinforced only with a stainless steel mesh) as replacements for periodontally lost lower incisors.Besides the longevity of the restoration, the periodontal condition of the abutment teeth, and the general satisfaction of the patient were evaluated retrospectively via a phone interview, in combination with an analysis of the patient's clinical dental file.The cumulative proportion of survival rate of these composite restorations was 80% after 5 years of function. No statistically significant difference was found between the survival distribution of one- and two-pontic bridges (P = 0.66). The abutment teeth demonstrated stable probing depths and a negligible loss in attachment (0.1 mm/year). The satisfaction ratings were also favorable.The data seem to suggest that composite bonding of 1 or 2 teeth can be considered a semi-permanent rehabilitation for the replacement of 1 or 2 periodontally lost lower incisors.

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 undisturbed supragingival plaque formation was recorded twice over a 100 hours period in 14 healthy dental students; first after induction of gingival inflammation and a second time starting from a healthy gingiva. During each experimental segment plaque formation was recorded on 42 randomly selected and clean teeth at the start and after 6, 12, 24, 30, 36, 48, 54, 60, 72, 84, and 96 hours. Four hours later all teeth up to the first molars were examined. The presence of disclosable plaque was calculated planimetrically as percent of the total labial surface area of the tooth. The rate of plaque formation was found to be significantly greater (P = 0.001) in the presence of gingival inflammation (+ 29.0%). Moreover, this study indicates an important variation in the plaque growth rate within the dentition; the highest scores were found for the upper premolars, the upper molars, and the lower front teeth. Finally, the rate of plaque formation was found to decrease during the night.

Since plaque plays a major role in the development of periodontal inflammation, special attention is paid to its composition and quantity. Several indices have been designed for the quantification of the supragingival plaque. The aim of the present study was to compare the utility and discriminating power of five such plaque indices. In 14 subjects, three teeth were selected randomly on which the undisturbed plaque formation was studied over a period of 96 hours. This examination was performed twice, the first time after induction of gingivitis and a second time starting with a healthy gingiva. It is known that in the presence of gingival inflammation, the plaque growth rate slightly increases. Plaque formation was estimated at several visits with the following indices: Harrap index, Quigley and Hein index, Navy index modified by Clemmer and Barbano, Navy index modified by Hancock and Wirthlin, and a planimetrical plaque scoring system. The path of the plaque growth curve was found to depend on the selected plaque index, going from an exponential curve (planimetry) over an sigmoidal curve (Harrap index, Navy index modified by Hancock and Wirthlin) to a nearly linear relation (Quigley and Hein, Navy index modified by Clemmer and Barbano). By comparing the plaque scores on patients with healthy gingiva with those from patients with inflamed gingiva, it was found that the planimetrical plaque index had a clearly higher discriminating power. It was concluded that the choice of an index for the measurement of the plaque extension depends on the goals of the study.