Periodontal clinical investigations : official publication of the Northeastern Society of Periodontists最新文献

Techniques for new attachment using the principle of guided tissue regeneration with barrier membranes have become accepted as a method for treating teeth with severe osseous defects and furcation involvement. After an evaluation of existing membranes and techniques, a procedure was developed using an expanded polytetrafluoroethylene soft tissue patch, 1 mm thick (W. L. Gore and Assoc., Flagstaff, AZ), in conjunction with an alloplast hydroxylapatite bone substitute (HA-500, 40-60 mesh) (Orthomatrix, Minneapolis, MN), to maintain a space for the maturation of the blood clot. An in vitro study of microbial adherence to the soft tissue patch indicated that the number of attached Streptococcus sanguis (gordonii) G9B, and Actinomyces viscosus T14 (V) cells was significantly lower (P < .005 and P < .025, respectively) than the number of bacteria that attached to Gore-Tex Periodontal Material. Two case reports are presented to demonstrate the successful use of the soft tissue patch augmented with hydroxylapatite in patients exhibiting furcation involvement and severe vertical osseous defects.

The effects of ovomacroglobulin (OMG), an alpha 2-macroglobulin-like protease inhibitor, were tested on periodontal surgical would healing in 60 Wistar rats. The animals were divided into two groups, one receiving topical application of 0.1% wt/wt OMG ointment and the other receiving ointment base (base). Rats were killed at one, three and seven days after surgery for histological and immunohistochemical observation. Compared with base group samples, OMG samples displayed enhanced capillary formation on anti-laminin-stained sections from day-3 specimens and a greater quantity of collagen fibers on Azan-Mallory-stained sections from day-7 specimens. Results were quantified using an automatic computerized pixel image analyzer. Hematoxylin-eosin-stained sections revealed that the length of regenerated junctional epithelium was shorter in the OMG group than in the base group. The data indicate that the application of OMG to surgical wounds accelerated fibroblast growth, collagen deposition, and capillary formation in granulation tissue. Thus, OMG could be a useful healing promoter for flap surgery.

The efficacy of the air-powder abrasive device (APAD) in root planing during flap surgery was assessed in vitro and in vivo. Two teeth on which full-thickness flaps were raised underwent root planing by hand-scaling alone and hand-scaling combined with APAD. One tooth extracted prior to surgery underwent unrestricted hand-scaling under a binocular microscope (control). The two teeth root planed in situ and the tooth root planed in vitro were observed by scanning electron microscopy (SEM). Then, 10 patients with periodontitis requiring flap surgery were selected for a clinical study. After raising full-thickness flaps, 29 sites from five patients underwent root planing using hand-scaling combined with APAD, whereas 22 sites from six patients underwent root planing by hand scalers only. SEM revealed that root surfaces planed in situ by hand-scaling combined with APAD were smoother than those root-planed using hand scalers alone. The control tooth surface was as smooth as those submitted to combined root planing. The clinical study showed that sites submitted to combined root planing displayed enhanced attachment level gain and pocket reduction. These results, associated with the shortened instrumentation time, suggest APAD as a useful instrument for root planing during flap surgery.

Clinical lasers are of two types. Soft lasers are essentially an aid to healing, with relatively few rigorous studies available to support their use. Surgical hard lasers, however, can cut both hard and soft tissues, replacing the scalpel and drill in many areas. After initial experiments with the ruby laser, most clinicians have been using argon, carbon dioxide, and now Nd:YAG systems. The first dental laser based on a Nd:YAG engine provides handpieces of similar size to conventional instrumentation, and being fed by a fibre-optic "cable," has the flexibility for intra-oral use that the carbon dioxide lasers, widely used in oral surgery, lack. Furthermore, extensive clinical investigation has demonstrated their safety in clinical practice, and the fact that procedures can usually be performed without a local anaesthetic is obviously seen as an advantage by patients. Sterilizing as it cuts, the Nd:YAG laser promises to find uses not only in caries removal and soft tissue surgery but also in periodontics and endodontics.

The objective of this study was to describe the surface morphology of periodontally involved root cementum and its alteration following topically applied doxycycline hydrochloride to root-planed and non-planed samples. Root surfaces were treated with 100 mg/mL doxycycline hydrochloride solution for three minutes. A control group was treated with sterile saline. Observations made by scanning electron microscopy showed that treating the periodontally diseased cementum surfaces altered the surface topography significantly. Root planed, doxycycline-treated surfaces showed characteristics similar to those reported for citric acid conditioning. An important finding of the study was that the topical application of doxycycline hydrochloride also removed and/or altered the surface integument on non-planed root surfaces.

Three siblings with familial gingival hyperplasia and abnormal feet are reported. Despite the resemblance to the Laband syndrome, where there are anomalies of the terminal phalanges, the abnormalities of the feet in these children were caused by the persistent wearing of "flip-flop" sandals. Care is required in the conduct of history and examination.