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Porphyromonas gingivalisis an important oral pathogen with a strong association with adult periodontitis. Significant titers of specific IgG antibodies to P. gingivaliscan be found in the sera of both gingivitis and periodontitis patients. Since IgG subclasses have different biological characteristics, the present study dealt with the serum IgG subclass response to outer membrane antigens of P. gingivalis. Western blot analysis of P. gingivalisouter membrane was carried out using 20 adult periodontitis and 20 age‐ and sex‐matched gingivitis patients. Antibodies in sera of both adult periodontitis and gingivitis patients recognized 38 antigen bands, ranging in molecular mass from 11.1 to 161 kDa. IgG2 was the predominant antibody subclass response in both patient groups in terms of the numbers of outer membrane antigens recognized, followed by IgG3, IgG1, and IgG4. More antigens in all IgG subclasses except IgG4 were recognized in adult periodontitis cases. Of the 23 antigens identified by IgG2 antibodies, 9 were recognized predominantly in adult periodontitis and 3 in the gingivitis group. In the IgGl subclass, 4 antigens were recognized predominantly in the adult periodontitis group while only 1 antigen was recognized significantly more in the gingivitis group. The IgG3 response identified 14 antigens ranging in molecular mass from 11.1 to 61.2 kDa in both groups. Ten antigens were recognized significantly by the adult periodontitis group. The lowest response was seen by IgG4 antibodies, with only 3 antigens of molecular mass 61.2, 52.3, and 38.8 kDa recognized, the latter two significantly in the adult periodontitis group. Overall, the results demonstrate that adult periodontitis patients respond to a greater number of antigens on the outer membrane of P. gingivalisthan do gingivitis patients. Furthermore, the greatest response is seen in the IgG2 subclass, suggesting a stronger response to carbohydrate antigens. J Periodontol 1995; 66:363–368.

The complete removal of accretionsduring closed scaling and root planing in moderatedeep pockets is difficult, presumably due to inadequate mechanical and visual access. The purpose of this study was to evaluate the effect of minimal papilla reflection and illumination with a prototype fiber optic unit on root planing efficiency. Nonmolar teeth with moderatedeep interproximal pockets (>3 mm) in four patients scheduled to receive immediate complete dentures were randomly divided into groups for treatment: Group I—interproximal root planing augmented by papilla reflection and fiber optic illumination (n = 26 surfaces); Group II—interproximal root planing with papilla reflection only (n = 24); Group III—untreated controls (n = 23). Immediately after treatment, the experimental teeth were extracted, stained with toluidine blue and interproximal areas were evaluated for remaining accretions with a microscope‐digitizing pad‐computer system. Significantly less (P< 0.01) root surface was covered by deposits in Group I than Group II (0.57 ± 0.29% vs. 2.42 ± 0.63%), and both treatment groups had fewer (P< 0.0005) accretions than untreated controls (57.72 ± 3.40%). These results suggest that root planing with papilla reflection produces an interproximal surface with few remaining deposits, and fiber optic illumination and transillumination further enhance this effect.

The purpose of this study was toevaluate lymphocyte subset densities and distributions within gingival biopsies from active sites (>2 mm clinical attachment loss within three months of biopsy) versus clinically similar but stable or healthy sites. Small interproximal gingival biopsies representing at least one of each of the above categories were obtained from each of 20 periodontal maintenance patients. Serial cryostat sections displaying a cross section of the gingiva were labeled with monoclonal antibodies for (1) pan T cells, (2) T cytotoxic/suppressor cells, (3) T helper/inducer cells and (4) pan B cells and were developed using an avidin‐biotin‐peroxidase system. Lymphocyte populations were enumerated in repeatable fields from the sulcular, middle and oral one‐third of each section. Relative proportions of the same lymphocyte subsets were analyzed in peripheral blood samples from the same patients using direct immunofluorescence. Pan B cells were significantly more prevalent in infiltrates from active sites than in stable (P< 0.05) or healthy (P< 0.01) sites. The T/B cell ratio was also significantly lower in active than stable biopsies (P< 0.05), and in active biopsies versus blood (P< 0.05). The T helper/T suppressor cell ratio did not vary significantly between blood and any gingival tissue disease group or location, but a trend toward lower relative numbers of T helper cells in the sulcular infiltrates of active sites was noted. These results support the premise that active periodontal sites display elevated B cell populations and abnormal immune regulation possibly involving the T helper cell subset.

Long acting local anhsthlticshave been used successfully during third molar extractions and endodontic procedures. They were shown to provide longer duration of anesthesia and contribute to less postoperative pain. This study evaluated the effectiveness of one long acting local anesthetic agent (etidocaine) for periodontal flap procedures. A double‐blind, split mouth design treated 17 matched contralateral pairs of posterior sextants. One region was treated following administration of 1.5% etidocaine HCl with 1:200,000 epinephrine. The matched control region was treated following administration of 2% lidocaine with 1:100,000 epinephrine. The results indicate that, while etidocaine provided a longer duration of anesthesia (P< 0.005), no difference was noted in the number of pain pills patients took or the period of time over which they took them. Inadequate hemostasis was a recurrent problem with etidocaine anesthesia. The use of 1.5% etidocaine HCl with 1:200,000, epinephrine offers no significant advantages over traditional anesthetic solutions.

The purpose of this studywas to characterize histologically the gingival lesion associated with suppuration in advanced Periodontitis. Thirty‐three bleeding, suppurating (S) and 23 bleeding, nonsuppurating (NS) interproximal biopsies were obtained from nine patients and processed for light microscopy. Pocket depths (mean ± SD) were 6.7 ± 1.6 mm (S) and 5.4 ± 2.2 mm (NS). Six‐micron serial sections were stained with (1) hematoxylin/eosin and (2) van Gieson. Quantitative cell types were determined by a grid intersection counting technique at × 1000. Volumetric analysis of collagen‐poor (inflammation) areas was conducted using a computer biometrie system that revealed three histologie patterns: Type I sites showed mild to moderate inflammation (<50% infiltrate, S = 15, NS = 20); Type II sites showed intense inflammation (>50% infiltrate, S = 17, NS = 3); and only one(S) site had a large connective tissue abscess (Type III). The mean percentage of collagen‐poor area was significantly larger in suppurating (42.1 ± 25.5%) versus nonsuppurating (27.7 ± 20.4%) sites (P= 0.02). In both S and NS sites, plasma cells (x = 66%) and lymphocytes (x = 27%) predominated in the inflammatory infiltrates. Histologically, suppuration appeared to be associated with increased gingival inflammation and a slight increase in connective tissue neutrophils.

Since IgG subclasses are commonImmunoglobulins associated with the periodontium and have different biological characteristics, these subclasses were measured in gingival crevicular fluid (GCF) from periodontally active (≥2 mm clinical attachment loss within three months of sample) versus clinically similar but stable or healthy sites. A sandwich enzyme‐linked immunosorbent assay (ELISA) using monoclonal antibodies was performed to quantitate IgG subclass and albumin concentrations in serum and interproximal GCF samples from at least one each of the three disease categories from each of 20 periodontal maintenance patients. Although much variability existed among sites, mean IgG1(p < 0.05) and IgG4(p < 0.01) concentrations were higher in GCF from active Periodontitis areas than stable sites, even though both had similar clinical characteristics. When IgG subclass concentrations were adjusted per mg albumin, both IgG1and IgG4levels in GCF from active sites were still significantly elevated over stable areas (p < 0.05). Mean adjusted concentrations in GCF were generally greater than in serum, especially for IgG4(active site GCF:serum = 24.2:1). GCF IgG4concentrations may be useful as an indicator of the immunopathological changes which occur in active Periodontitis.

Several factors, including access and visualization problems, make total deposit removal during scaling and root planing procedures extremely difficult. This study examined the effectiveness of a mode of therapy designed to improve access and visualization for sonic scaling compared to closed sonic instrumentation. Teeth with moderate to deep probing depths in six patients scheduled to receive immediate dentures were divided into three experimental groups: Group I, sonic scaling with access augmented by interdental papilla reflection and fiber optic illumination/ transillumination (34 surfaces); Group II, closed sonic scaling (34 surfaces); and Group III, untreated controls (35 surfaces). Immediately after treatment the experimental teeth were extracted, stained with toluidine blue, and interproximal areas evaluated for remaining accretions with a microscope‐digitizing pad‐computer system. Group I had a significantly lower percentage (P< 0.01) of remaining subgingival accretion coverage than Group II (1.30 ± 0.25% vs 6.35 ± 1.08%), and both Group I and II demonstrated significantly (P< 0.01) fewer deposits than the control surfaces (46.61 ± 4.32%). These findings suggest that minimal tissue reflection and fiber optic illumination/ transillumination are beneficial adjuncts to deposit removal in moderate to deep periodontal pockets.

The contributionof nonsterile water irrigation during ultrasonic scaling to postoperative blood stream contamination was evaluated. Thirty human volunteers were subjected to a random split‐mouth technique comparing sterile and municipal tap water irrigation with ultrasonic root preparation on contralateral mandibular quadrants. Scaling was performed by a single operator using a premeasured quantity of irrigant. Postoperative blood samples were obtained immediately and cultured aerobically and anaerobically in tryptic soy broth and on BHI agar plates for enumeration of colony forming units. Positive blood cultures were inoculated onto selective media for presumptive identification. The difference in the bacteremia incidence after scaling with sterile water (50%) versus scaling with tap water (53.3%) was not significant. The degree of the bacteremias (less than 1 colony forming unit/ml) was similar between groups. Therefore tap water irrigation used in ultrasonic scaling did not appear to be a significant causative agent in postoperative bacteremias.