Journal of the International Academy of Periodontology最新文献

Type 2 diabetes mellitus (T2D) is becoming increasingly prevalent worldwide and complications of T2D cause significant systemic and dental morbidity in the susceptible individual. Although T2D has been linked as a significant risk factor for chronic periodontitis (CP), molecular mechanisms explaining the pathogenesis and inflammatory impact of CP in T2D are lacking. iPLA2 is the calcium-independent form of phospholipase A2. In previous studies, we demonstrated that iPLA2 enzyme activity is altered in T2D. The purpose of this study was to elucidate the level of the iPLA2 abnormality in T2D by measuring messenger RNA levels in T2D-associated CP. A total of 53 healthy and T2D subjects with CP were recruited for this study. The clinical periodontal exam included probing pocket depth, clinical attachment levels and bleeding on probing. Peripheral venous blood was collected and neutrophils were isolated. Real time polymerase chain reaction was used to quantify iPLA2 mRNA in neutrophils from healthy controls and people with diabetes. Results revealed that the prevalence of moderate to severe CP was increased in people with T2D. The iPLA, mRNA levels in diabetics with different severity of CP were not significantly different compared to healthy controls; 1.07 vs 0.97 (mild CP), 1.07 vs 0.85 (moderate CP) and 1.07 vs 1.05 (severe CP). Collectively, the data suggest that levels of iPLA2 mRNA in T2D are not different than in health and are not directly influenced by periodontal disease status. The impact of inflammation on iPLA2 regulation is at the level of activation of the enzyme rather than expression at the mRNA level.

Objective: The aim of this study was to evaluate corticotomy-facilitated orthodontics (CFO) using piezosurgery versus conventional rotary instruments.

Materials and methods: Ten healthy adult male mongrel dogs of comparable age with a complete set of permanent dentition with average weights between 13-17 kilograms were used. CFO using conventional rotary instruments versus piezosurgery was performed on each dog in a split mouth design. For every dog, mandibular 2nd premolar retraction on each side was attempted after extracting 3rd premolars followed by corticotomy-facilitated orthodontics using conventional rotary surgical burs on the left side and an ultrasonic piezosurgery system on the right side of the same animal. Intraoral measurements of the rate of tooth movement were taken with a sliding caliper. Measurements were performed by the same operator at the time of surgery (appliance delivery) and every month for six months. The dogs were sacrificed after six months from initiation of tooth movement to evaluate the amount of tooth movement for both conventional rotary and piezosurgery corticotomy techniques.

Results: A statistically significantly higher mean amount of tooth movement for conventional rotary instrument versus the piezosurgery corticotomy technique was observed at all time intervals.

Conclusions: Tooth movement was 1.6 times faster when CFO was done using conventional rotary instruments as compared to a piezosurgery device.

Objective: The aim of this study was to evaluate the effect of the depth of curette sample collection from periodontal lesions on the recovery of putative periodontal pathogens using real-time polymerase chain reaction (PCR).

Methods: Twenty-two periodontal pockets 6 to 8 mm deep with bleeding on probing at a single-rooted tooth were sampled, yielding 66 separate samples. Curette samples were obtained at three different levels of the periodontal lesion (orifice, shallow--2 mm into the pocket; or base of lesion), and processed using PCR to identify 10 periodontal pathogens. The chi-square procedure was used to determine whether probe depth affected the distribution of bacterial counts observed. A repeated measures analysis of variance tested the hypotheses related to level of probe and microorganism on mean rank of bacterial counts.

Results: The effect of probe level on mean bacterial counts depends on the type of microorganism. Likewise, the effect of microorganism type on mean bacterial counts significantly depends on probe level, where sampling from 2 mm into the periodontal pocket was found to yield significantly higher results than sampling from the orifice. Overall mean counts of pathogenic microorganisms were found to differ significantly across the three probe depths. The microorganisms differed in their observed levels over all three probe levels. Further analysis found several significant differences that characterize the nature of the interaction between probe level and microorganism type.

Conclusion: There is significant difference in the amount of putative periodontal pathogens at varying depths of the pocket when sampled with a periodontal curette.

Aim: To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP).

Materials and methods: Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals.

Results: Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy.

Conclusion: Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

Objective: To evaluate and compare the efficacy of platelet-rich fibrin (PRF) with enamel matrix derivative (EMD; Emdogain) in the treatment of periodontal intrabony defects in patients with chronic periodontitis, six months after surgery.

Methods: Forty-four (44) intrabony defects in 30 patients (15 males) were randomly allocated into two treatment groups: EMD (n = 22) and PRF (n = 22). Measurement of the defects was done using clinical and cone beam computed tomography at baseline and 6 months. Clinical and radiographic parameters such as probing depth, clinical attachment level, intrabony defect depth and defect angle, were recorded at baseline and 6 months post-operatively. Within group change was evaluated using the Wilcoxon signed rank test. Intergroup comparisons were made using the Mann-Whitney U test.

Results: Postsurgical measurements revealed that there was an equal reduction in probing depth and a greater but statistically non-significant attachment gain for the Emdogain group when compared to the platelet-rich fibrin group. The Emdogain group presented with significantly greater percentage defect resolution (43.07% ± 12.21) than did the platelet-rich fibrin group (32.41% ± 14.61). Post-operatively the changes in defect width and defect angle were significant in both groups, but upon intergroup comparison they were found to be statistically non-significantly different.

Conclusion: Both Emdogain and platelet-rich fibrin were effective in the regeneration of intrabony defects. Emdogain was significantly superior in terms of percentage defect resolution.

Background: Gingival recession is both unpleasant and unesthetic. Meeting the esthetic and functional demands of patients with multiple gingival recessions remains a major therapeutic challenge. We compared the clinical effectiveness of Zucchelli's technique and tunnel technique with subepithelial connective tissue graft (SECTG) for multiple gingival recessions.

Methods: Twenty systemically and periodontally healthy subjects having 75 recession defects (Miller's class I or II, 39 test and 36 control sites) were included. After initial nonsurgical therapy, test sites were treated with Zucchelli's technique and control sites with tunnel technique with SECTG. Plaque index, bleeding index, pocket depth, recession depth, clinical attachment level, and keratinized gingiva height were evaluated at baseline, 3 and 6 months post-surgery.

Results: The mean root coverage was 89.33% +/- 14.47% and 80.00% +/- 15.39% in the test and control groups respectively, with no significant difference between groups. Statistically significant root coverage was obtained for 82.50% +/- 23.72% and 71.40% +/- 20.93% of defects in the test and control groups, respectively.

Conclusion: Zucchelli's technique is effective for the treatment of multiple adjacent recessions in terms of both root coverage and keratinized tissue gain, irrespective of the number of defects. Moreover, this technique does not require an additional surgical site as required in the gold standard SECTG.

Background: In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs).

Methods: Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth(PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy.

Results: The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites.

Conclusion: Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.

Background: Several studies have demonstrated the efficacy of periodontal maintenance (PM), but there are conflicting data regarding tooth loss following patient compliance.

Method: Seventy-two periodontal patients (52 women, 20 men), 86% of whom had been diagnosed with chronic moderate to severe periodontitis, were included in this retrospective study. Clinical variables such as tooth loss, bleeding on probing (BOP), plaque index and probing depth were collected from patients after 10 years of PM. The periodontal status of regular compliers (RCs) and erratic compliers (ECs) were compared in a private practice.

Results: The statistical analysis showed that clinical variables were not significant between RCs and ECs except for BOP (p = 0.038). During PM, 24 teeth (a mean of 1.5 teeth per participant) were lost in the RC group, and 80 teeth (a mean of 1.43 teeth per participant) were lost in the EC group. Molars were the most frequently lost teeth and canines the least. In general, those patients with less BOP lost fewer teeth (p = 0.002) and attended more recall visits (p = 0.001).

Conclusions: In the present sample, RCs and ECs did not show significant differences in rates of tooth loss. However, a significant difference between RCs and ECs in regard to BOP was observed at the final examination (p = 0.038). There was also a strong relationship between BOP and recall visits: the patients with less BOP attended more recall visits (p = 0.001).

A 54-year-old female was referred for management of a large amalgam tattoo involving the alveolar mucosa between teeth #6 and #9. The lesion had been present for over 20 years following endodontic treatment of teeth #7 and #8. A two-stage surgical approach was used to remove the pigmentation, beginning with removal of amalgam fragments from the underlying bone and placement of a subepithelial connective tissue graft and acellular dermal matrix to increase soft tissue thickness subadjacent to the amalgam. Following 7 weeks of healing, gingivoplasty was performed to remove the overlying pigmented tissue. At the 21-month follow-up appointment, the patient exhibited naturally appearing soft tissue with no evidence of amalgam tattoo.

Background: Background: With the increasing popularity of dental implants the presence of implant complications is rising, and the question of how to best manage these complications still lingers in most clinicians' minds. This paper aims to provide clinicians with an overview of the most commonly encountered biologic implant complications as well as to provide guidelines as to how to treat them.

Methods: Available English literature was reviewed, including peer-reviewed journal publications and online resources. Several treatment modalities have been proposed to manage these complications, including non-surgical mechanical debridement, antiseptics, local and/or systemic antibiotics, lasers, resection with or without implantoplasty and regenerative approaches.

Results: In this guideline, it is suggested that the treatment modalities should be chosen based on the severity of peri-implant diseases, amount of bone loss and the morphology of peri-implant bony defects. For peri-implant mucositis or peri-implant defects with less than 2 mm destruction, non-surgical treatments are recommended. For peri-implant defects with more than 2 mm destruction, surgical treatments (e.g., resection with or without implantoplasty, guided bone regeneration) are suggested that include removal of the implant if the bone loss is beyond repair.

Conclusion: The prevention of biological implant complications relies on careful planning, a thorough examination to assess etiological factors and a regular maintenance recall schedule. With early diagnosis, biological implant complications should be managed based on the severity of peri-implant disease, the amount of bone loss and the morphology of the peri-implant bony defects.