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This study investigated two variables associated with scaling and planning (S&RP): operator experience level and root surface access. One hundred and fourteen periodontally involved, single-rooted teeth designated for extraction were randomly distributed among four operators of various experience levels for either an open or closed session of S&RP. Immediately after treatment, the teeth were extracted, washed, and scored for residual calculus in a blind manner. Results showed that there was no difference in S&RP effectiveness for experience level or type of procedure in shallow (1-3 mm) pockets. However, in moderate (4-6 mm) and deep (greater than 6 mm) periodontal pockets, S&RP combined with an open flap procedure was more effective than S&RP alone for both experience levels. Also, the more experienced operators produced a significantly greater number of calculus-free root surfaces than the less experienced operators in periodontal pockets with moderate and deep probing depths. Clinical application of these results suggests that surgical access is associated with thorough surface debridement in periodontal pockets with moderate-to-advanced probing depths. However, more experienced operators could be expected to render more effective soft surface debridement.

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When radiographs of maxillary molars are observed, a small, triangular radiographic shadow is sometimes noted over either the mesial or distal roots in the proximal furcation area. This study was undertaken to determine the reliability of using this radiographic image as an aid in diagnosing proximal furcation involvement. Sixty-six Degree 1, 53 Degree 2 and 43 Degree 3 proximal furcation involvements in maxillary molars in dry skulls were assessed visually with the Nyman and Lindhe classification. An additional 120 uninvolved furcations were included as controls. The involved maxillary molars were radiographed with standard periapical radiographic techniques. Projected radiographs were evaluated independently by six dentists who determined whether there was a triangular radiographic shadow ("furcation arrow") over the mesial and distal proximal areas. The association of the furcation arrow image with Degree 2 or 3 furcation involvement was significant when compared with uninvolved furcations. The image was equally apparent over mesial or distal furcations and was not affected by the existence of a buccal furcation involvement. The incidence of the image over both uninvolved proximal furcations and proximal furcations with Degree 1 involvement was low and did not differ significantly. Because the furcation arrow seldom appears over uninvolved furcations, the appearance of the image indicates that there is proximal bony furcation involvement. However, absence of the furcation arrow image does not necessarily mean absence of a bony furcation involvement because the arrow was not seen in a large number of furcations with Degree 2 or 3 involvement.

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Through a standardized procedure using clinical examination, interviews, and dental history, this 2-year study documents 100 cases of tooth fracture in 98 patients. For comparison, pertinent information was also recorded for more than 2,000 teeth in a randomly selected sample population. Two chief types of fracture were found: incomplete crown-root fractures and root fractures associated with earlier endodontic therapy.

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The study evaluated the effect of 2% sodium desoxycholate combined with whole plasma from a single donor on gingival fibroblast attachment to diseased root surfaces. Twenty extracted periodontally involved teeth were cut into halves buccolingually and sterilized by moist heat under high pressure. The diseased root surface of each control half was rubbed with a sterile cotton pellet saturated with Dulbecco's phosphate-buffered saline (PBS). The diseased root surface of each experimental half was rubbed with a sterile cotton pellet saturated with 2% sodium desoxycholate and then rubbed with a pellet soaked in human plasma. The control and experimental halves were placed in separate petri dishes, and a fibroblast cell suspension was added to each dish. The mean number of attached cells per half tooth was calculated for each group. Tooth surfaces treated with PBS (controls) showed a mean of 307 +/- 63 attached cells for 17 tooth halves; the experimental treated surfaces exhibited a mean of 650 +/- 130 attached cells for 16 halves. The difference between these numbers was statistically significant (P less than 0.01). These findings suggest that the desoxycholate/plasma combination enhanced in vitro fibroblast attachment to diseased root surfaces.

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The root surface area (RSA) per millimeter of root length was determined for 20 extracted mandibular first molars. The molars were cross-sectioned at 1-mm increments, and each section photographed, projected and measured with a calibrated opisometer. The RSA and per cent RSA were calculated for each 1 mm of root length (1-mm section), the root trunk and the individual roots. Also measured was the location of the root separations from the root trunk, the location of the first detectable root concavity, and the prevalence of "intermediate bifurcation ridges" (IBRs). Mean measurements indicated that the greatest RSA per millimeter of root length was 4 to 7 mm apical to the cementoenamel junction (CEJ) in the area of the furcation. Of the total RSA, 48.7% was located in the coronal 6 mm of a root (mean length, 14.4 mm). Root separation occurred 4.0 mm apical to the CEJ with no tooth having a root trunk longer than 6 mm. Buccal and lingual root concavities were first present 0.7 mm and 0.3 mm apical to the CEJ, respectively. Fourteen (70%) of the 20 teeth had IBRs. According to the mean measurements, the mesial root was larger than the distal root by a ratio of 1.0:0.88. Horizontal attachment loss of 6 mm affecting both the buccal and lingual surfaces of the mandibular first molar would have resulted in a through and through (grade 3) furcation involvement of all the teeth studied.

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The assumption that the palatal (PAL) root of maxillary molars has significantly greater attachment area than either the mesiobuccal (MB) or the distobuccal (DB) root was tested by documenting the root surface area of the individual roots and root trunks of 20 extracted maxillary first molars. Each molar was cross sectioned every millimeter, and the circumference of each root and root trunk section was measured with a calibrated opisometer. Mean circumferential measurements from each 1-mm section were summed to give the surface area for each root and root trunk. The DB root had significantly less surface area than either the MB or PAL root or the root trunk. There was no significant difference between the surface areas of the MB and PAL roots. The surface area of the root trunk, which was significantly greater than that of any of the three individual roots, averaged 32% of the total root surface area of the maxillary first molar.

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Controversy exists over the potential for new connective tissue attachment to dentin of endodontically-obturated teeth following periodontal therapy. The purpose of this study was to determine whether cultured human gingival fibroblasts would grow in vitro on planed dentin surfaces of endodontically-treated teeth. A model similar to that of Aleo et al. was developed using extracted endodontically-treated human teeth. This model consisted of longitudinally sectioning 10 teeth, root planing one section only, and incubating both sections with a suspension of human gingival fibroblasts. Fibroblast growth was determined by staining with neutral red and trypan blue. The criterion for growth was staining of the complete root surface. All root areas with attached periodontal fibers displayed staining, as well as the complete root surface of all planed sections. Unplaned sections did not stain on root areas formerly exposed to the oral environment owing to periodontal disease, a finding consistent with the results of Aleo et al. Our results indicate that root canal therapy does not interfere with in vitro growth of fibroblasts on planed dentin surfaces of endodontically-treated teeth. Extrapolation to a clinical situation would indicate that normal healing may be expected after periodontal surgery on tissues adjacent to root planed endodontically-treated teeth.

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