RESUMEN
AIM: A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy. MATERIAL AND METHODS: Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (> or =6 mm) and with > or =6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3-4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of > or =5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of > or =2 mm at > or =4 teeth), he/she was exited from the study and given additional treatment. RESULTS: It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1-3 year period following active therapy than SU-treated subjects. CONCLUSION: In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy.
Asunto(s)
Enfermedades Periodontales/cirugía , Enfermedades Periodontales/terapia , Adulto , Pérdida de Hueso Alveolar/cirugía , Pérdida de Hueso Alveolar/terapia , Raspado Dental , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Orales , Índice Periodontal , Bolsa Periodontal/cirugía , Bolsa Periodontal/terapia , Estudios Prospectivos , Recurrencia , Resultado del TratamientoRESUMEN
OBJECTIVE: The present study was performed to assess the effect of topically-applied PVP-iodine, used as an adjunct both during basic non-surgical therapy and at re-treatment during the long-term maintenance of patients with advanced periodontal disease. MATERIAL AND METHODS: 223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non-molar teeth, (ii) probing pocket depth of > or = 6 mm at > or = 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (RxBL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self-performed plaque control measures. Non-surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP-iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re-examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL > or = 2 mm at > or = 4 teeth were exited from the study and referred for re-treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations. RESULTS: It was demonstrated that non-surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP-iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re-examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group. CONCLUSION: PVP-iodine, topically applied during subgingival instrumentation, may improve the outcome of non-surgical periodontal therapy.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Yodóforos/uso terapéutico , Periodontitis/prevención & control , Povidona Yodada/uso terapéutico , Administración Tópica , Adulto , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/terapia , Análisis de Varianza , Antiinfecciosos Locales/administración & dosificación , Enfermedad Crónica , Placa Dental/prevención & control , Índice de Placa Dental , Raspado Dental , Femenino , Estudios de Seguimiento , Gingivitis/prevención & control , Gingivitis/terapia , Humanos , Yodóforos/administración & dosificación , Estudios Longitudinales , Masculino , Higiene Bucal , Pérdida de la Inserción Periodontal/prevención & control , Pérdida de la Inserción Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/prevención & control , Bolsa Periodontal/terapia , Periodontitis/terapia , Povidona Yodada/administración & dosificación , Estadística como Asunto , Resultado del Tratamiento , Terapia por UltrasonidoRESUMEN
BACKGROUND: Subjects with periodontal disease exist who either (i) respond poorly to initial mechanical therapy ("refractory" periodontitis) or (ii) fail to adopt adequate self-performed plaque control techniques and hence develop recurrent disease ("recurrent" periodontitis) at multiple sites during the supportive treatment phase (SPT). Various systemic antibiotic regimens have been tried as adjuncts to the mechanical (re-) treatment of such "difficult to treat"-patients. While most studies indicated a positive outcome of the adjunctive therapy, some clinical investigators reported that this additional measure provided little or no benefit. AIM: The aim of the present investigation was to study the more long term effect of adjunctive antibiotic therapy in the re-treatment of patients with a well defined history of recurrent periodontitis. MATERIAL AND METHODS: 17 subjects with recurrent advanced periodontal disease were, following a baseline examination, subjected to non-surgical therapy including the use of systemic antibiotics (amoxicillin and metronidazole). They were placed in a careful SPT program and re-examined after 1, 3 and 5 years. The examinations included both clinical and microbiological assessments. RESULTS: It was demonstrated that in subjects with advanced and recurrent periodontitis, re-treatment including (i) comprehensive scaling and root planing (SRP), (ii) systemic administration of antibiotics and (iii) meticulous supragingival plaque control by both mechanical and chemical means established periodontal conditions that in the short term (3 years) and in the majority of subjects could be properly maintained by traditional SPT measures. Between 3 and 5 years, however, only 5 of the 17 subjects exhibited stable periodontal attachment levels. CONCLUSIONS: Some deep pockets and furcations were most likely inadequately instrumented during the active treatment phase. Microorganisms residing in biofilms left in such locations were probably not sufficiently affected by the 2 weeks of adjunctive antibiotic therapy. It is suggested that removal of certain subgingival deposits, therefore, may require surgical intervention.
Asunto(s)
Antibacterianos/uso terapéutico , Periodontitis/prevención & control , Adulto , Aggregatibacter actinomycetemcomitans/crecimiento & desarrollo , Pérdida de Hueso Alveolar/prevención & control , Amoxicilina/uso terapéutico , Biopelículas , Placa Dental/microbiología , Placa Dental/prevención & control , Índice de Placa Dental , Raspado Dental , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Penicilinas/uso terapéutico , Pérdida de la Inserción Periodontal/prevención & control , Bolsa Periodontal/prevención & control , Periodontitis/tratamiento farmacológico , Periodontitis/microbiología , Porphyromonas gingivalis/crecimiento & desarrollo , Prevotella intermedia/crecimiento & desarrollo , Recurrencia , Reproducibilidad de los Resultados , Retratamiento , Aplanamiento de la Raíz , Estadística como AsuntoRESUMEN
AIM: In the present study both the short- and the long-term effects were evaluated of a treatment that, during the phase of basic therapy, included administration of systemic tetracycline and non-surgical intervention. MATERIAL AND METHODS: 35 adult human subjects with advanced periodontitis, 19 females and 16 males, aged between 24 and 60 years, were included in a test group. 80 age- and sex-matched adult periodontitis subjects were recruited for a control group (42 females and 38 males). A baseline examination included assessment of the following parameters: number of teeth, plaque, bleeding on probing, probing attachment level, probing pocket depth. In radiographs, the distance between the cemento-enamel junction and the alveolar bone crest was determined at all interproximal sites. The subjects were given oral hygiene instruction. The members of the test group were provided with tablets with 250 mg of tetracycline hydrochloride and were instructed to take 1 tablet 4x per day for a period of 3 weeks. No antibiotic was given to the subjects in the control group. During the 3-week interval, all participants received 4-6 sessions of non-surgical periodontal therapy. All subjects were subsequently enrolled in a maintenance care program and were provided with supportive periodontal therapy (SPT) 3-4x per year. Clinical re-examinations were performed after 1, 3, 5 and 13 years. RESULTS: The present investigation demonstrated that tetracycline administered during a 3-week period concomitant with non-surgical treatment enhanced the outcome of mechanical therapy. At the re-examination 1 year after active therapy, there was in the test group an average gain in probing attachment that was almost 3x higher than the gain that occurred in an age and sex matched Control group. Re-examinations after 3, 5, and 13 years of SPT disclosed that this short-term benefit was not maintained in the longer perspective. CONCLUSION: The beneficial effect of systemically administered tetracycline on probing attachment level occurred in the first year post-therapy. Annual rates of probing attachment level change from 1 to 13 years did not differ between groups.
Asunto(s)
Antibacterianos/uso terapéutico , Periodontitis/tratamiento farmacológico , Tetraciclina/uso terapéutico , Adulto , Pérdida de Hueso Alveolar/tratamiento farmacológico , Pérdida de Hueso Alveolar/terapia , Antibacterianos/administración & dosificación , Estudios de Casos y Controles , Terapia Combinada , Índice de Placa Dental , Raspado Dental , Femenino , Estudios de Seguimiento , Hemorragia Gingival/tratamiento farmacológico , Hemorragia Gingival/terapia , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Higiene Bucal , Pérdida de la Inserción Periodontal/tratamiento farmacológico , Pérdida de la Inserción Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/tratamiento farmacológico , Bolsa Periodontal/terapia , Periodontitis/terapia , Aplanamiento de la Raíz , Estadística como Asunto , Comprimidos , Tetraciclina/administración & dosificación , Resultado del TratamientoRESUMEN
AIM: The aim of the study was to evaluate disease progression during supportive periodontal therapy in (i) a group of 225 subjects with "normal" (NG) and (ii) a group with high susceptibility (HSG; n= 109) to periodontal disease (based on their baseline disease status). MATERIAL AND METHODS: The following variables were recorded at the baseline examination (1 year after they received non-surgical periodontal therapy) and at the re-examination after 12 years of maintenance: number of teeth, plaque, probing pocket depth, probing attachment level, bone level in full mouth radiographs. All assessments were performed in a standardized manner and by well-trained and calibrated examiners. Supportive periodontal therapy was delivered 3-4 x per year and included repeated oral hygiene instruction and debridement. In addition, sites that bled on probing and had a PPD value of > or = 5 mm received subgingival instrumentation. RESULTS: A comparison between the findings at baseline and after 12 years revealed that in the NG, most subjects maintained their periodontal condition unchanged during the maintenance period; only a few subjects experienced tooth loss and the figures describing the mean amount of bone and attachment loss were small (0.5 mm and 0.3 mm respectively). The HSG patients experienced some tooth loss and also lost significant amounts of bone and attachment during the 12 years of SPT. Thus, in this group of subjects, the mean overall PAL loss amounted to 0.8 mm, i.e., 0.06 mm/tooth surface/year. In the NG, the overall attachment loss was significantly smaller: 0.5 mm, i.e. 0.04 mm/tooth surface/year. CONCLUSION: In subjects with a high susceptibility for periodontal disease who had been treated for this condition by non-surgical means, an SPT program including regularly repeated oral hygiene instruction and subgingival debridement, made it possible to maintain bone and attachment levels at a reasonably stable level over a 12-year period. A similar SPT provided to a group of subjects with normal susceptibility to periodontal disease, on the other hand, prevented almost entirely major tooth, bone and attachment loss.
Asunto(s)
Enfermedades Periodontales/terapia , Adulto , Pérdida de Hueso Alveolar/fisiopatología , Pérdida de Hueso Alveolar/terapia , Índice de Placa Dental , Profilaxis Dental , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Femenino , Estudios de Seguimiento , Hemorragia Gingival/fisiopatología , Hemorragia Gingival/terapia , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Higiene Bucal , Pérdida de la Inserción Periodontal/fisiopatología , Pérdida de la Inserción Periodontal/terapia , Enfermedades Periodontales/fisiopatología , Bolsa Periodontal/fisiopatología , Bolsa Periodontal/terapia , Reproducibilidad de los Resultados , Estadística como Asunto , Curetaje Subgingival , Pérdida de Diente/etiologíaRESUMEN
BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.
Asunto(s)
Antibacterianos/administración & dosificación , Minociclina/administración & dosificación , Bolsa Periodontal/tratamiento farmacológico , Bolsa Periodontal/microbiología , Periodontitis/tratamiento farmacológico , Periodontitis/microbiología , Adulto , Aggregatibacter actinomycetemcomitans/efectos de los fármacos , Análisis de Varianza , Campylobacter/efectos de los fármacos , Canadá , Enfermedad Crónica , Recuento de Colonia Microbiana , Índice de Placa Dental , Raspado Dental , Método Doble Ciego , Eikenella corrodens/efectos de los fármacos , Europa (Continente) , Femenino , Fusobacterium nucleatum/efectos de los fármacos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pomadas , Índice Periodontal , Porphyromonas gingivalis/efectos de los fármacos , Prevotella intermedia/efectos de los fármacos , Estadísticas no Paramétricas , Resultado del Tratamiento , Treponema/efectos de los fármacosRESUMEN
The present study examined whether the daily use of a triclosan/copolymer dentifrice enhanced healing following non-surgical periodontal therapy at sites with progressive attachment loss in periodontitis-susceptible subjects: 60 subjects who had been (i) treated for advanced periodontal disease using nonsurgical means and (ii) had been enrolled, for at least 3-5 years, in a maintenance care program that called for prophylaxis once every 3 months. During the course of this maintenance period, all 60 subjects had suffered recurrent periodontitis at > or = 2 sites at several intervals. Following a baseline examination, all 60 subjects received, on an individual basis, detailed instruction in proper self-performed plaque control methods. They were stratified in 2 balanced groups (test and control groups). The members of the test group were assigned to use a triclosan/copolymer/fluoride-containing dentifrice, while the control group used a placebo dentifrice. During the following 3 years, all participants were recalled every 3 months for an evaluation of their oral hygiene standard. Re-examinations were performed after 6, 12, 24 and 36 months. In conjunction with the re-examinations, sites (loser sites) which exhibited additional probing attachment loss (> or = 2 mm) were identified. The loser sites were exposed to professional therapy. Thus, the site was anaesthetized and the surface carefully scaled and root planed (S/RP). Alterations regarding probing pocket depth (PPD), probing attachment level (PAL), and bleeding on probing (BoP) that occurred in the interval between S/RP and 36 months were analyzed. In the control group, 126 loser sites, 67 identified at the 12-month and 59 at the 24-month examinations, were subjected to S/RP. The corresponding number of loser sites in the test group was 85 (48 at 12 months and 37 at 24 months). At the time of S/RP, about 60% of the sites were BoP (+) in both groups. Following treatment, there was a reduction in the number of sites with gingivitis. While the reduction in the control group was modest (6.8%), in the test group, the improvement was more marked (27.5%). Following S/RP, there was also a reduction of the mean PPD in both groups. This decrease amounted to 1.7 mm in the test group and was significantly (p<0.05) smaller (0.6 mm) in the control. Finally in the interval between S/RP and 36 months, there was an improvement of the probing attachment level in both groups. The mean PAL gain was, however, significantly higher in the test than in the control group (1.8 mm versus 0.7 mm; p<0.01).
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Dentífricos/uso terapéutico , Periodontitis/terapia , Triclosán/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Antiinfecciosos Locales/farmacología , Raspado Dental , Dentífricos/farmacología , Combinación de Medicamentos , Fluoruros/farmacología , Fluoruros/uso terapéutico , Humanos , Pérdida de la Inserción Periodontal/prevención & control , Índice Periodontal , Periodontitis/prevención & control , Polímeros , Prevención Secundaria , Resultado del Tratamiento , Triclosán/farmacologíaRESUMEN
The aim of the present study was to evaluate whether the presence of A. actinomycetemcomitans, P. gingivalis and P. intermedia, as revealed by culture technique, could discriminate between three distinct adult patient groups, those: with recurrent periodontal disease, with cured periodontal disease or who were periodontally healthy. Forty one patients previously treated for advanced periodontitis were divided into recurrent or cured groups, with a third periodontally healthy reference group. All subjects were sampled for the three bacterial strains under scrutiny. Although all three micro-organisms were found significantly more often in diseased sites, it was concluded that a sample positive for all three may indicate a false record of disease activity. However, a sample negative for the three bacteria strongly indicates an absence of disease activity.
Asunto(s)
Aggregatibacter actinomycetemcomitans/aislamiento & purificación , Periodontitis/microbiología , Porphyromonas gingivalis/aislamiento & purificación , Prevotella intermedia/aislamiento & purificación , Adulto , Anciano , Aggregatibacter actinomycetemcomitans/crecimiento & desarrollo , Técnicas Bacteriológicas , Biomarcadores/análisis , Recuento de Colonia Microbiana , Raspado Dental , Progresión de la Enfermedad , Estudios de Seguimiento , Hemorragia Gingival/microbiología , Humanos , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/microbiología , Bolsa Periodontal/microbiología , Periodontitis/clasificación , Periodontitis/cirugía , Periodontitis/terapia , Periodoncio/microbiología , Porphyromonas gingivalis/crecimiento & desarrollo , Prevotella intermedia/crecimiento & desarrollo , Recurrencia , Sensibilidad y Especificidad , Curetaje Subgingival , Resultado del TratamientoRESUMEN
The present investigation was performed to examine if triclosan and a copolymer, incorporated in a dentifrice and used by periodontitis-susceptible subjects could influence clinical symptoms characteristic of recurrent periodontitis. 60 subjects, 34 to 67 years of age, were recruited for the study. They were randomly selected from a group of patients previously treated for advanced periodontal disease. This treatment had included oral hygiene instruction, subgingival debridement, but no surgical therapy. The patients had, during a 3-5 year period following active therapy, been enrolled in a maintenance care program but had, at various intervals, exhibited signs of recurrent periodontitis. The patients were stratified into 2 balanced groups with respect to mean probing pocket depth. The test group, included 30 individuals who used a dentifrice containing triclosan/copolymer/fluoride, i.e. 0.3% triclosan, 2% copolymer and 1100 ppm F from 0.243% sodium fluoride (Colgate Total). The control group also included 30 subjects who used a dentifrice identical to the one used in the test group but without the triclosan/copolymer content. Following the baseline examination, including clinical and radiographical assessments, all volunteers received detailed information on how to brush their teeth in a proper way. This information was repeated on an individual need basis during the course of the subsequent 36 months. No professional subgingival therapy was delivered between the baseline and the 36-month examinations, but the subjects were recalled every 3 months. Re-examinations were performed after 6, 12, 24, and 36 months of the trial. A 2nd set of radiographs was obtained at the final examination, i.e., at 36 months. The results demonstrated that in subjects susceptible to periodontal disease, meticulous, self-performed, supragingival plaque control maintained over a 3-year period failed to prevent recurrent periodontitis. In a similar group of subjects and plaque control program, however, the daily use of a triclosan-containing dentifrice reduced (i) the frequency of deep periodontal pockets, and (ii) the number of sites that exhibited additional probing attachment and bone loss.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Cariostáticos/uso terapéutico , Dentífricos/uso terapéutico , Periodontitis/prevención & control , Fluoruro de Sodio/uso terapéutico , Triclosán/uso terapéutico , Adulto , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/prevención & control , Antiinfecciosos Locales/administración & dosificación , Cariostáticos/administración & dosificación , Placa Dental/prevención & control , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Higiene Bucal , Educación del Paciente como Asunto , Pérdida de la Inserción Periodontal/diagnóstico por imagen , Pérdida de la Inserción Periodontal/prevención & control , Bolsa Periodontal/diagnóstico por imagen , Bolsa Periodontal/prevención & control , Periodontitis/diagnóstico por imagen , Polímeros , Radiografía , Recurrencia , Fluoruro de Sodio/administración & dosificación , Curetaje Subgingival , Cepillado Dental , Triclosán/administración & dosificaciónRESUMEN
The present study evaluated the long-term effect of (i) meticulous self-performed, supragingival plaque control and (ii) the use of a triclosan/copolymer containing dentifrice in adult subjects susceptible to destructive periodontitis. 40 individuals were recruited into the trial. 3-5 years prior to the baseline examination, they had all been treated by nonsurgical means- for advanced periodontal disease. During the subsequent maintenance phase, all subjects had at different time intervals exhibited sites with recurrent periodontitis. At a baseline examination, 6 surfaces per tooth were examined regarding bleeding on probing, probing pocket depth, and probing attachment level. The deepest pocket site in each quadrant (i.e. 4 sites per subject) was selected and samples of the subgingival bacteria were taken. At baseline, all volunteers received detailed information on proper oral hygiene techniques. This information was repeated on an individual need basis during the course of the subsequent 36-months. No professional subgingival therapy was delivered between the baseline and the 36-month examinations. The subjects were randomly distributed into 2 equal groups of 20 individuals each, 1 test and 1 control group. The members of the test group were supplied with a fluoridated dentifrice containing triclosan/copolymer (Total, Colgate), while the controls received a corresponding dentifrice but without triclosan/copolymer. The findings demonstrated that in subjects with advanced and recurrent periodontitis, carefully practiced supragingival plaque control had some effects on the subgingival microbiota, but also that this was insufficient to prevent disease progression. In a corresponding group of subjects, however, who used a triclosan/copolymer dentifrice, the subgingival microbiota was reduced in both quantitative and qualitative terms and recurrent periodontitis was almost entirely prevented.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Bacterias/efectos de los fármacos , Cariostáticos/uso terapéutico , Fluoruros/uso terapéutico , Periodontitis/microbiología , Triclosán/uso terapéutico , Actinomyces/efectos de los fármacos , Adulto , Aggregatibacter actinomycetemcomitans/efectos de los fármacos , Antiinfecciosos Locales/administración & dosificación , Campylobacter/efectos de los fármacos , Capnocytophaga/efectos de los fármacos , Cariostáticos/administración & dosificación , Placa Dental/prevención & control , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Fluoruros/administración & dosificación , Estudios de Seguimiento , Hemorragia Gingival/microbiología , Hemorragia Gingival/prevención & control , Humanos , Estudios Longitudinales , Higiene Bucal , Educación del Paciente como Asunto , Pérdida de la Inserción Periodontal/microbiología , Pérdida de la Inserción Periodontal/prevención & control , Bolsa Periodontal/microbiología , Bolsa Periodontal/prevención & control , Periodontitis/prevención & control , Polímeros , Porphyromonas gingivalis/efectos de los fármacos , Prevotella intermedia/efectos de los fármacos , Recurrencia , Streptococcus/efectos de los fármacos , Triclosán/administración & dosificaciónRESUMEN
This study has shown that microorganisms associated with caries (mutans streptococci, lactobacilli) and marginal periodontitis (Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans) in pure culture can be stored in VMGA or reduced transport fluid and be recovered sufficiently after 24 h. Sufficient recovery after 24 h of mail transport was also obtained in 37 saliva samples obtained from adults and 80 subgingival samples from a group of patients before and 3, 6 and 15 months after periodontal treatment. The samples transported in VMGA III showed in comparison to the samples transported in reduced transport fluid a higher recovery rate as well as a higher percentage of the total viable count for investigated anaerobic species. This was explained by the different composition of the two media and also by the gel consistency of VMGA III, which maintains a low redox-potential even during transport after transferring a sample into the medium. In a few samples aerobic bacteria increased in both media.
Asunto(s)
Medios de Cultivo , Placa Dental/microbiología , Saliva/microbiología , Adulto , Aggregatibacter actinomycetemcomitans , Bacteroides , Campylobacter , Candida , Fusobacterium nucleatum , Humanos , Lactobacillus , Persona de Mediana Edad , Compuestos Orgánicos , Porphyromonas gingivalis , Preservación Biológica , Manejo de Especímenes , Streptococcus mutansRESUMEN
The aim of the present clinical trial was to study the effect on existing plaque and gingivitis of an oral hygiene regimen which utilized a dentifrice which contained triclosan. 120 subjects were recruited for the trial. They were examined for plaque and gingivitis using the criteria of (i) the Turesky modification of the Quigley & Hein plaque index and (ii) the Löe & Silness gingival index. Plaque and gingivitis were assessed in all parts of the dentition and at 6 location points around each tooth. Following a baseline examination, the subjects were stratified in 2 balanced groups based on age, plaque and gingivitis scores. The subjects were randomly assigned to the following treatment: 1 test group used a dentifrice containing triclosan/copolymer/fluoride and 1 control group used a traditional fluoride containing dentifrice. The participants were given the assigned dentifrice and a soft-bristled toothbrush for home use. They were instructed to brush their teeth in the morning and in the evening for one minute each time. They were reexamined 6 weeks, 3 and 6 months after the baseline examination. The findings from the re-examinations revealed that an oral hygiene regimen which utilized a dentifrice which contained triclosan/copolymer significantly reduced pre-existing plaque and gingivitis above what was accomplished by a traditional fluoride containing dentifrice. The improvement of the gingival conditions occurred in all parts of the dentition and at all tooth surfaces and units. In addition, the present data support the hypothesis that triclosan may induce alterations in the quality of existing plaque.
Asunto(s)
Placa Dental/tratamiento farmacológico , Gingivitis/tratamiento farmacológico , Triclosán/uso terapéutico , Adulto , Análisis de Varianza , Placa Dental/microbiología , Índice de Placa Dental , Dentífricos , Humanos , Persona de Mediana Edad , Índice Periodontal , Resultado del Tratamiento , Triclosán/administración & dosificaciónAsunto(s)
Interpretación de Imagen Asistida por Computador , Enfermedades Periodontales/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Técnica de Sustracción , Proceso Alveolar/diagnóstico por imagen , Diseño de Equipo , Humanos , Periodoncio/diagnóstico por imagen , Técnica de Sustracción/instrumentación , Película para Rayos XAsunto(s)
Cálculos Dentales/prevención & control , Difosfatos/uso terapéutico , Furanos/uso terapéutico , Anhídridos Maleicos/uso terapéutico , Polivinilos/uso terapéutico , Fluoruro de Sodio/uso terapéutico , Adulto , Combinación de Medicamentos , Femenino , Humanos , Masculino , Éteres Metílicos/uso terapéutico , Persona de Mediana EdadRESUMEN
Bacterial specificity in human periodontal diseases suggests the possibility of diagnosing and treating periodontitis as specific infections and using microbiological diagnostic means to evaluate the efficacy of periodontal therapy. In a series of clinical trials, the usefulness of topical antimicrobial agents in combination with surgical and non-surgical conventional periodontal therapy were tested. The healing result was estimated by monitoring probing attachment levels (PAL). The usefulness of clinical and microbiological parameters to evaluate post-treatment healing result was tested. 9 of the patients exhibiting sites with recurrent periodontal disease were then evaluated for clinical and microbiological parameters to define accurate means to differentiate between active and inactive periodontal disease. The results showed that the frequency of periodontal lesions with significant loss of PAL after treatment was less in patients treated with antimicrobial agent. Specific microbiological parameters showed stronger correlation than clinical parameters with gain and/or loss of PAL post-treatment. Thus Actinobacillus actinomycetemcomitans and Bacteroides gingivalis occurred in periodontal lesions with progressing disease after treatment, but were rarely detected in samples from pockets of the same depths which did not exhibit further loss of PAL over a study period of 1 year. This study points to the usefulness of topical antimicrobial agent as an adjunct to mechanical subgingival debridement in the treatment of periodontitis in adults. The results also indicate the utility of diagnostic microbiology in the assessment of periodontal disease activity post-treatment.
Asunto(s)
Ácido Acetrizoico/administración & dosificación , Antiinfecciosos Locales/administración & dosificación , Placa Dental/microbiología , Periodontitis/tratamiento farmacológico , Actinobacillus/aislamiento & purificación , Administración Tópica , Adulto , Bacteroides/aislamiento & purificación , Terapia Combinada , Placa Dental/patología , Hemorragia Gingival/patología , Humanos , Persona de Mediana Edad , Bolsa Periodontal/patología , Periodontitis/microbiología , Periodontitis/terapia , Distribución AleatoriaRESUMEN
We studied the association between post-treatment periodontal disease activity and subgingival Bacteroides gingivalis, Bacteroides intermedius, spirochetes and motile rods. 20 adults, 22-62 years, with moderate-to-severe periodontitis participated in a split-mouth treatment study. All individual quadrants received supragingival cleaning and in addition, subgingival scaling and a NaHCO3-NaCl-H2O2 slurry, subgingival scaling alone, slurry alone, or no subgingival treatment. Post-treatment periodontal disease status was determined over a period of 12 months by changes in probing periodontal pocket depth and probing periodontal attachment level. Subgingival specimens obtained by paper point-sampling were evaluated for B. gingivalis and B. intermedius using indirect immunofluorescence and for spirochetes and motile rods using bright light phase contrast microscopy. A total of 142 periodontitis lesions representing all 4 quadrants of the 20 subjects were studied. The relationship between clinical data and bacteria was analyzed using logistic regression. The probability of the study organisms being present in subgingival sites at 3 to 6 months after treatment increased with increased residual pocket depth. The presence of B. gingivalis showed a strong positive association (p less than 0.004) with loss of periodontal attachment. A significant association was also found for spirochetes (p less than 0.008) but not for motile rods (p greater than 0.35) or B. intermedius (p greater than 0.13). Similar results were obtained at 12 months after therapy, except that the presence of motile rods was significantly associated with loss of periodontal attachment (p less than 0.03). Caution must be exercised when using B. gingivalis or spirochetes to evaluate treatment efficacy. If the presence of these organisms was utilized to indicate progressing periodontitis, many active lesions could be identified, and only 1 to 17% and 13 to 43% of sites in remission at 3-6 months after therapy would be expected to harbor B. gingivalis and spirochetes, respectively. The consequences of treating periodontal sites in remission would mainly be limited to cost and inconvenience. However, since several active periodontitis lesions did not reveal the organisms, treatment decisions based solely on the absence of the organisms may result in the omission of needed therapy. As a practical consideration, periodontal treatment should be continued as long as B. gingivalis and maybe spirochetes are detectable in the subgingival microflora. In the absence of these organisms, and until additional periodontal pathogens have become known, the decision to continue or conclude periodontal therapy must b
Asunto(s)
Bacteroides/aislamiento & purificación , Inserción Epitelial/fisiología , Encía/microbiología , Bolsa Periodontal/patología , Periodontitis/patología , Periodontitis/terapia , Periodoncio/fisiología , Adulto , Bacteroides/fisiología , Inserción Epitelial/anatomía & histología , Inserción Epitelial/microbiología , Gingivitis/microbiología , Humanos , Persona de Mediana Edad , Bolsa Periodontal/microbiología , Bolsa Periodontal/fisiopatología , Periodontitis/microbiología , Periodontitis/fisiopatología , Spirochaetales/aislamiento & purificación , Spirochaetales/fisiología , Factores de Tiempo , Cicatrización de HeridasRESUMEN
Since Actinobacillus actinomycetemcomitans appears to be a key etiologic agent in localized juvenile periodontitis, this study determined the effectiveness of different treatment modalities in suppressing A. actinomycetemcomitans in localized juvenile periodontitis lesions. A total of 25 deep periodontal lesions from 7 patients with localized juvenile periodontitis were included in the study. The test periodontal lesions either received scaling and root planing alone, scaling and root planing together with soft tissue curettage, or modified Widman flap surgery. Subgingival A. actinomycetemcomitans were enumerated using selective culturing. Clinical measurements included changes in probing periodontal attachment level, probing periodontal pocket depth, gingival index, plaque index, and digital subtraction of standardized serial radiographs. The microbiological and clinical effects of treatment were monitored over a period of 16 weeks. All periodontal lesions studied demonstrated high numbers of A. actinomycetemcomitans prior to treatment. Scaling and root planing alone did not markedly change the subgingival A. actinomycetemcomitans counts, nor any of the clinical parameters studied. In contrast, soft tissue curettage as well as modified Widman flap surgery suppressed A. actinomycetemcomitans to undetectable levels immediately after therapy in more than 80% of the lesions studied. A total of 5 periodontal lesions exhibited gain of probing periodontal attachment after subgingival curettage or Widman flap treatment; 3 of these sites revealed no detectable A. actinomycetemcomitans, and the remaining 2 sites harbored only low levels of A. actinomycetemcomitans. 5 periodontal lesions which lost probing attachment after treatment all demonstrated high numbers of subgingival A. actinomycetemcomitans. Changes in alveolar bone, assessed by digital subtraction of serial radiographs, correlated with changes in probing periodontal attachment level, confirming the clinical results. The present study revealed a close relationship between post-treatment A. actinomycetemcomitans levels and the clinical response to treatment, which supports the concept that A. actinomycetemcomitans is an important organism in the etiology of localized juvenile periodontitis. This study also showed that a substantial suppression of subgingival A. actinomycetemcomitans cannot be achieved by periodontal scaling and root planing alone, but can be accomplished by surgical removal of periodontal tissues.(ABSTRACT TRUNCATED AT 400 WORDS)