Journal of Clinical Periodontology

Krejci, Robert F.; Kalkwarl, Kenneth L.; Krause‐Hohenstein, Udo

doi: 10.1111/j.1600-051X.1987.tb01516.xpmid: 3320098

Abstract Electrosurgery has been used in dentistry for more than 50 years. Both opponents and advocates of electrosurgery have presented a variety of clinical studies in favour of their respective opinions, which are discussed in the following review. In some studies, wounds created by electrosurgical techniques were observed through the healing stages, in comparison to those following incision by a surgical blade, with no significant difference being discovered. Other studies reported that the histologic response of oral connective tissue to electrosurgery was adverse in some animal and human models. However, neither of these groups used methods that allowed documentation or control of operating variables. A critical evaluation of controlled clinical studies shows that adverse responses of (connective) tissue, epithelium, bone, cementum, and periodontal attachment are related to an excessive lateral heat production during the procedure. With electro surgery, the clinician can control the inherent variables. Waveform, frequency, size of the electrode, time of contact and cooling periods are some of those considered to be of importance in the studies. On the basis of the research reports, clinical guidelines have been developed to give practical advice to the clinician using electrosurgery. Providing that these safeguards are adhered to, scientific evidence supports the biological compatibility of electrosurgery for intraoral surgical procedures.

Addy, M.; Griffiths, G.; Dummer, P.; Kingdom, A.; Shaw, W. C.

doi: 10.1111/j.1600-051X.1987.tb01517.xpmid: 3480293

Abstract Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may. with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105. 11–12‐year‐old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long‐term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right‐handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left‐handed toothbrushers. Plaque and gingivitis also showed significant differences dependant upon arch, tooth number, and surface. The population is being followed at 4‐year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.

Wennström, Jan L.; Dahlén, Gunnar; Gröndahl, Kerstin; Heijl, Lars

doi: 10.1111/j.1600-051X.1987.tb01518.xpmid: 3320099

Abstract The purpose of this study was to evaluate the microbiological effects of repeated subgingival irrigation of deep periodontal pockets as a single measure of treatment as well as combined with mechanical debridement, and to study the concomitant radiographical changes of the alveolar bone. 2–3 interproximal sites per jaw quadrant in 10 patients showing a probing depth of ≥ 6 mm and bleeding on pocket probing were selected for the study. The pockets in the various quadrants were randomly assigned to professionally performed subgingival irrigation with 0.2% chlorhexidine gluconate, 3% hydrogen peroxide or saline or to non‐irrigation. During a first phase of treatment, the pockets were periodically irrigated (every 2nd–3rd day during weeks 1–2 and 5–6) and no subgingival mechanical debridement was performed. During a second phase, subgingival scaling and root planing were carried out with adjunctive subgingival irrigation of the pockets. During the entire trial, the patients' plaque control was carefully supervised. Sampling of the subgingival microflora was performed before and after the first and second treatment phases and 3 months after the termination of the active treatment. Dark‐field assessment and cultivation of the bacterial samples were performed. The radiographical examination was carried out at the start of each treatment phase and 3 months after the termination of phase U and the radiographs were analysed by the use of a subtraction technique. The results demonstrated that periodic subgingival antimicrobial irrigation per se had only limited and transient effects on the subgingival microflora. Repeated irrigation with chlorhexidine or hydrogen peroxide did not induce any changes in total viable counts, anaerobes, rods. Gram‐negative anaerobic rods, black‐pigmented Bacteroides, B. gingivalis or motile rods and spirochetes that were diverse from those of control sites irrigated with saline. Neither were there any differences between the treatment groups with respect to radiographical bone changes.

Simons, Paul; Watts, Trevor

doi: 10.1111/j.1600-051X.1987.tb01519.xpmid: 3480294

Abstract The validity of a hinged constant force probe (0.25 N) was compared with that of a similar but immobilised instrument, using the same interchangeable tip for both (0.64 mm diameter, 2 mm divisions). 60 sites were measured on teeth which were extracted subsequently, in patients with untreated periodontal disease, and the connective tissue attachment level was used as validity criterion, The clinical measurements of both probes correlated well with each other, but they differed significantly from the post‐extraction connective tissue attachment level measurements, indicating a. point 1.2 mm coronally, to this, on average. A companion investigation of intra‐operator probing depth reproduciability with the 2 probes, was undertaken in 14 patients, at 2 visits separated by 1 week in each case. All patients had untreated periodontal disease. A difference between probes was found at the first visit, but not at the second; the immobilised probe showed a difference between visits, reducing mean probing depth slightly at the second; when the immobilised probe was used first, there was a difference between probes. Further analysis of the results indicated that there was greatest agreement between probes when the constant force probe had been used before the immobilised probe at the second visit. The results suggested that these probes indicated a point above the connective tissue attachment level, related to pocket morphology, and that there was a moderate learning effect due to operator use of the constant force probe, which modified use of the immobilised probe.

Socransky, S. S.; Haffajee, A. D.; Smith, G. L. F.; Dzink, J. L.

doi: 10.1111/j.1600-051X.1987.tb01520.xpmid: 3320100

Abstract The present paper outlines some of the difficulties encountered in the search for the etiologic agents of destructive periodontal diseases. These include technical problems such as acquiring an appropriate microbial sample, as well as difficulties in the dispersion, cultivation and identification of isolates in that sample. Many of these difficulties are currently being successfully addressed. A second set of problems is more conceptual in nature. These include difficulties in distinguishing between periodontal diseases and determining the state of activity of periodontal lesions. In addition, complexes of organisms and/or sequences of species may be involved in the progress of lesions. A further problem is encountered in attempting to distinguish overgrowths of opportunistic species from increases in proportions of true pathogens. Finally, it appears likely that different infections occur at the same time in a single oral cavity. The technical and conceptual difficulties eventually filter down to the data analytical step and present numerous problems to the analyst. With all of these difficulties in mind it is not surprising that the etiologic agents of destructive periodontal diseases are not clearly defined. However, improvement in technological assessments of the microbiota and clinical evaluation of the disease should permit reasoned approaches to be taken. The delineation of the etiologic agents of destructive periodontal diseases will be, of necessity, a multistage iterative process. Etiologic agents will be suggested by predominant cultivable studies and hypotheses concerning subsets of these agents tested using more specific procedures such as selective media, immunofluorescent techniques or DNA probes. Etiologic agents will be verified or discarded by such procedures. When new lesions are found without recognized pathogens, the process will iterate back to the predominant cultivable methodology again.

Saxby, M. S.

doi: 10.1111/j.1600-051X.1987.tb01521.xpmid: 3480295

Abstract The prevalence of juvenile periodontitis was studied in a sample of 7266 school children in the cities of Coventry arid Birmingham. The subjects were aged 15 to 19 years, and represented the range of different ethnic groups seen in the population of the West Midlands. A two‐stage diagnostic procedure was used, whereby subjects were screened initially by assessment of probing depths around the incisors and first molars. Positive subjects were then diagnosed definitively by full clinical and radiographic examination. In both Coventry and Birmingham, there was an overall prevalence of juvenile periodontitis of 0,1%, with 95% confidence, which gives a range between 0.03 and 0.17‐ There was a highly significant difference in prevalence between ethnic groups, with overall prevalence figures of 0.02% for the Caucasian group, 0.8% for the Afro‐Caribbean group and 0.2% for the Asian group. There was no difference in prevalence between male and female.

Whitehead, S. P; Watts, T. L. P.

doi: 10.1111/j.1600-051X.1987.tb01522.xpmid: 2826548

Abstract Keyes' method of non‐surgical therapy was compared with modified Widman flap surgery in 9 patients with symmetrical periodontal disease. Following an initial oral hygiene programme, baseline measurements were recorded and paired contralateral areas were subjected randomly to the 2 techniques. 42 teeth receiving surgery were compared with 40 treated by Keyes' method. 6 sites per tooth were scored immediately prior to therapy and 3 months later, using a constant force probe with onlays. Consistent data were recorded for the 6 separate sites, which showed no baseline difference between treatments, slightly greater recession with surgery at 3 months, but no difference between treatments in probing depth and attachment levels. Mean data for individual patients showed similar consistency. Probing depth in deep sites was reduced slightly more with surgery, and there were no differences in bleeding on probing at 3 months. Both techniques gave marked improvements in health. Surprisingly, only 2 subjects preferred Keyes' technique of mechanical therapy, 6 preferred surgery, and 1 had no preference.

Preus, Hans R.; Olsen, Ingar; Namork, Ellen

doi: 10.1111/j.1600-051X.1987.tb01523.xpmid: 3480296

Abstract Electron microscopy revealed 2 different types of bacteriophages isolated from Actinobacillus actinomycetemcomitans colonizing exclusively diseased sites in 4 patients with localized juvenile periodontitis (LJP). All sites infected with phage were undergoing periodontal destruction, as judged from consecutive routine radiographs. The phages isolated had a wide host range as assessed from their ability to infect a series of reference strains of A. actinomycetemcomitans. A 5th patient harboured non‐infected A. actinomycetemcomitans in a surgically treated site which had undergone no bone destruction during the last 12 months. The present findings suggested that the pathogenic potential of A. actinomycetemcomitans in LJP may increase due to phage infection.

Seymour, R. A.; Smith, D. G.; Rogers, S. R.

doi: 10.1111/j.1600-051X.1987.tb01524.xpmid: 3320101

Abstract The periodontal health of 24 adult renal transplant patients was investigated in a longitudinal study. Post‐transplant patients were receiving either azathioprine or cyclosporin to prevent graft rejection. No significant difference (P>0.05) was observed for plaque scores on gingival inflammation, either between treatment groups or throughout the investigation period. However, patients on cyclosporin therapy had significantly more gingival hyperplasia and probing sites greater than 3 mm than those on azathioprine (p<0.05). In the cyclosporin group, u significant increase in hyperplasia and probing sites greater than 3 mm was observed at 3 and 6 months post‐transplant. A significant correlation (r8= 0.55, P<0.05) was observed between mean plasma concentrations of cyclosporin throughout (he 6–month investigation period and the increase in gingival hyperplasia. The finding from this study would suggest that azathioprine has no unwanted effects on the periodontal helath of post‐renal transplant patients. Cyclosporin therapy caused an increase in gingival hyperplasia, which may be related to plasma concentrations of the drug.

Tal, Halm; Landsberg, Jacob; Kozlovsky, Avital

doi: 10.1111/j.1600-051X.1987.tb01525.xpmid: 3480297

Abstract Gingival melanin pigmentation (GMP) occurs in all races of man. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair‐skinned people with moderate GMP. The present study was undertaken to test the effectiveness of Cryosurgical destruction of the gingival epithelium in the removal of gingival melanin pigmentation. The patient was a fair‐skinned Ashkenazi Jew with moderate GMP who demanded any possible “cosmetic therapy” which would convert her “black gums” to “normal”. Gingival cryosurgery was carried out by segments. A gas expansion cryoprobe cooled to −81° C was applied to the gingiva for 10 s.