Parodontologie (Berlin, Germany)最新文献

The significant role oral prophylactic measures play in the prevention of caries and periodontal disease and the importance of continuing systematic treatment for patients suffering from periodontitis have been scientifically documented in clinical studies. Practical application of this knowledge on a day-to-day basis in dental offices has thus far been hampered by the shortage of appropriately trained personnel. In September 1989, the Zahnärztekammer Berlin founded the "Intensive Studies Seminar for Dental Prophylaxis". In a one-year, vocational course of study, participants acquire the knowledge and practical skills necessary to establish and maintain a system of prophylactic treatment capable of being integrated into the dental practice. The purpose of the following article is to give information concerning the concept behind the program, as well as to introduce the course of study and its various aspects. The experiences gained in the program's first year were positive, and graduates of the course are in demand. It is therefore to be hoped that the concept underlying this seminar will take hold.

Immunohistochemical knowledge of the distribution of the collagen types in the cementum and periodontal ligament were reported in this paper. Because of the different localization of each of these collagenous components in the two periodontal tissues its function in the matrix was explored. It was also possible to clarify the role of collagen in healthy periodontium as well as in regeneration and wound healing mechanisms.

For a proper insight in the implant/tissue interface of permucosal oral implants it is good to refer to the tooth/periodontium interface. Although there are evident differences such as the lack of a periodontal ligament with its possibilities for eruption and migration and elaborate neural endings, it seems that classical periodontal parameters are the yardstick to discriminate failure from success of oral implants. Long cone radiographs and mobility assessment seem the only available clinical tools to detect a scar tissue interposition. On the other hand, their discrimination power is insufficient to prove close bone apposition. Further studies are needed to interpret the observations that around failing implants the subgingival microflora resembles that of active adult periodontitis. Periodontologists can learn a lot from the implant/periodontium interface to get a better understanding of the tooth/periodontium complex.

The comprehensive range of functions in a dental practice with special emphasis on periodontal cure requires cooperation amongst highly qualified personnel. The dental hygienist has a special standing and is responsible for as well as in charge of important treatment stages, as much as the dentist himself. The treatment stages are of greater relevance to long-lasting therapeutic achievements.

Marginal periodontitis in humans and animals is characterized by site-specific episodes of accelerated clinical attachment loss, which are interspersed between periods of quiescence of variable length. Diagnosis of episodic periodontitis progression could allow for early interception and arrest of progression. Currently available diagnostic techniques are not sensitive enough to detect phases of periodontitis progression. Diagnostic tests should be developed which are sensitive and practical enough to determine need and success of periodontal treatment at specific sites or sections of a dentition. In a longitudinal study on untreated periodontitis in humans, progressing and nonprogressing periodontal lesions were identified and investigated using clinical, microbiological, histological and immunohistochemical methods. Ten adult patients with untreated advanced periodontitis were monitored monthly for ten months. Attachment levels and probing depth were determined at six sites of every tooth. Corresponding contralateral sites were identified where one site had lost 2 mm or more probing attachment since the previous session (P-site), and the other site had not (C-site). The results showed that bleeding on probing was positively and statistically significantly correlated with episodic clinical attachment loss. The error in probing attachment level measurements varied with the tooth type and was greatest at molars. Over time the measurement error became smaller. In deeper pockets the probing error was greater than in shallow pockets. It appears that in order to accept clinical progression of periodontitis an increase in probing attachment loss or probing depth of more than 2 mm has to be observed. Using the mean attachment loss per site in a dentition at six or nine months after initial measurements should enable the dentist to discriminate patients with a higher rate of periodontitis progression from patients with a low rate. Darkfield microscopy used for assessment of subgingival bacterial populations seems to be without diagnostic value for differentiation between P- and C-sites.

In the present study a newly developed concept for avoiding recurrences after the periodontal surgical treatment of cyclosporin A-induced gingival hyperplasia is described. Conventional gingivectomy results in restitutio per secundam, which promotes recurrences. To avoid this we tried to achieve a restitutio per primam by using a modified surgical technique. Ten patients, four treated under general anesthesia and six on an outpatient basis, were treated with this technique. Patients were monitored for 20 month. Pre- and postoperative care was performed in a standardized manner for all patients. During the surveillance, a long-term suppression of the cyclosporin-induced gingival hyperplasia could be found, but it was not possible to avoid recurrences totally.

The connective tissue (CT) is responsible for stability and function of the whole periodontium. It consists of cells, which are embedded in the extracellular matrix. Collagen plays the main role for the function of the periodontal unit. Collagen types I, III, IV, V and VI are distributed in a different pattern in all periodontal tissues, as has been here demonstrated in the gingiva and alveolar bone. Collagen type I, as a characteristic collagen type of the hard tissues, has been demonstrated by thick collagen fibers in the alveolar bone and in the gingival connective tissue. It can be differentiated from the thinner collagen type III fibers, which are localized in the gingiva (especially under the basement membrane of the epithelium) as well as only in the bone marrow stroma. The epithelium, blood vessels and nerves contain the characteristic collagen type IV in their basement membrane Filamentous (collagen type V) and microfibrillar (collagen type VI) components demonstrate different patterns of distribution, especially around the bone cells and in contrast to the other collagen types of fibrillar networks in the gingival CT. This morphological differentiation of the extracellular matrix components of the periodontium allows conclusions in the pathological and inflammatory processes as well as in the regenerative and reparative procedures.

The term osseointegration is analyzed in relation to its theoretical and clinical definitions, and comparisons are made to other implant modalities. The term osseointegration has a clear clinical meaning, but there is doubt about its precise usage in an experimental setting. Clinically, an implant can be described as osseointegrated if there is no discernable movement when force is applied to the fixture. This is in contrast to implants surrounded by fibrous connective tissue, which move within soft tissue. Newly developed laboratory techniques may be used in the future to precisely characterize osseointegration in the laboratory.