Background: Third‐generation carbon dioxide (3‐CO2) lasers have handpieces that accommodate a periodontal insert that permits irradiation directly into the periodontal pocket/sulcus. The purpose of ...this pilot study was to evaluate, by scanning electron microscopy (SEM), the surface effects of 3‐CO2 laser treatment on the root surfaces and soft tissues and to investigate the effects of 3‐CO2 laser on periodontal pathogenic bacteria compared to negative controls.
Methods: Five patients with chronic periodontitis and treatment planned for a maxillary immediate denture were included in the study. Periodontal pockets with a mean probing depth of 5.5 ± 0.8 mm were irradiated one time by CO2 laser (wavelength of 10,600 nm) at a power of 2.2 W, 50 Hz, an 80‐millisecond pulse length, and an exposure rate of 1 mm per 5 seconds. DNA analysis of eight periodontal bacteria was performed on samples collected from laser‐treated and control sites prior to and immediately following treatment and was compared between groups. In addition, block biopsies, including soft tissue, were harvested for SEM examination.
Results: SEM examination of test group specimens showed heat damage on the soft tissues in three of 17 specimens (17.6%). In addition, 11.7% (two of 17) of the 3‐CO2–treated teeth exhibited localized slight damage to root surfaces. Microbiologic results of the control sites indicated that 90.6% of the bacterial counts remained the same, 6% increased, and 3% decreased. In the test group, 71.25% of the bacterial count analyses for the eight different periodontal microbes remained the same, 12.50% increased, and 16.25% decreased.
Conclusion: A one‐time use of the 3‐CO2 laser in periodontal pockets did not sterilize or substantially reduce subgingival bacterial populations compared to negative controls.
The purpose of this study was to examine by transmission (TEM) and scanning electron microscopy (SEM) the supragingival microbial plaque overlying the ulcerated gingival papillae of necrotizing ...ulcerative periodontitis (NUP) lesions in HIV‐seropositive patients. The microbiota of NUP and HIV‐seropositive patients with periodontitis has been reported to be similar to that of conventional periodontitis in non‐infected subjects, although several investigators have also reported high recovery rates of microbes not generally associated with the indigenous oral microbial flora. Light and electron microscopic observations and microbial culture studies indicate a similar high prevalence of spirochetes in both necrotizing ulcerative gingivitis (NUG) and NUP. In addition, several studies have reported more frequent isolation of Candida albicans from diseased periodontal sites in HIV‐seropositive patients than from non‐diseased sites. Ten male and six female patients, each HIV‐seropositive and exhibiting NUP, constituted the study population. Two biopsies of involved gingival papillae from between posterior teeth were obtained from each patient and processed for examination by both TEM and SEM. Microscopic examination revealed a surface biofilm comprised of a mixed microbial flora of various morphotypes in 81.3% of biopsy specimens. The subsurface flora featured dense aggregations of spirochetes in 87.5% of specimens. Zones of aggregated polymorphonuclear leukocytes and necrotic cells were also noted. Yeasts were observed in 65.6% of specimens and herpes‐like viruses in 56.5% of the specimens. Collectively, except for the presence of yeast and viruses, the results suggest that the microbial flora and possibly the soft tissue lesions of NUP and necrotizing ulcerative gingivitis are very similar.
Evidence-based practice of periodontics Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana
The Journal of the American College of Dentists,
2010-Winter, Letnik:
77, Številka:
4
Journal Article
Recenzirano
Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes ...that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.
Root Surface Area of the Mandibular Cuspid and Bicuspids Mowry, John K.; Ching, Michael G.; Orjansen, Marc D. ...
Journal of periodontology (1970),
October 2002, 2002-Oct, 2002-10-00, 20021001, Letnik:
73, Številka:
10
Journal Article
Recenzirano
Background: The purpose of this study was to determine the total root surface area of extracted teeth by computerized image analysis and the amount of remaining attachment area assuming various ...amounts of bone loss due to periodontal disease.
Methods: One hundred fifty extracted mandibular teeth were evaluated, and measured from cusp tip to the cemento‐enamel junction (CEJ), CEJ to root apex, and cusp tip to root apex. The fulcrum point of the tooth was also measured, along with the total root surface area of attachment and total surface area of attachment remaining following simulation of attachment loss in 2 mm increments. Measurements were made on 80 teeth on one proximal surface and either the buccal or lingual surface and multiplied by a factor of 2. Measurements on 70 teeth were made on all 4 root surfaces to predict the accuracy of measuring only 2 surfaces to determine root surface area. Images of the tooth surfaces were obtained by video camera and converted to computer image with measurement of the surface areas.
Results: The total root surface area for the mandibular cuspids and first and second bicuspids was 275.88 mm2, 251.45 mm2, and 271.81 mm2, respectively. The 2‐sided and 4‐sided measurements for the mandibular first bicuspid were 252.55 mm2 and 247.02 mm2, respectively (P >0.05).
Conclusions: This study found the total root surface area to be greater than that in most previous studies. Increasing attachment loss is related to decreasing root surface area; however, this relationship is not directly proportional. No statistical difference was found between measuring 4 surfaces versus only 2 surfaces. J Periodontol 2002;73:1095‐1100.
Background: Stress and anxiety alter respiratory rate and thereby alter oxygen saturation in the blood. Management of psychological stress in the dental office may help maintain blood gas ...homeostasis. One method of stress management is through the use of preoperative oral sedation.
Methods: The study population consisted of 13 patients scheduled to receive two quadrants of periodontal surgery at two different appointments. A randomized split‐mouth crossover design was used with one quadrant of surgery involving preoperative oral sedation (diazepam) and local anesthetic, and the second using local anesthetic only. Oxygen saturation was monitored by pulse oximetry, which recorded the number of times saturation dropped below 95% in a given time period. Data were recorded at 5 time periods: 1) baseline; 2) from time of anesthetic administration to 20 minutes into surgery; 3) 21 to 40 minutes; 4) 41 to 60 minutes; and 5) 61 to 80 minutes into the surgery. Data were analyzed by a two‐factor repeated measures ANOVA. The two within‐group factors were treatment group and time.
Results: Results indicated no significant interaction between time and treatment (P>05). However, data for groups over time suggested a trend supporting an interaction. The η2 value of 0.124 suggested a moderate effect favoring the diazepam treatment. No significant difference was noted for the main effect of treatment and time. However, the η2 value of 0.24 for treatment effect (diazepam versus no diazepam) suggested a meaningful difference between groups. Similarly the η2 value of 0.135 for time suggested a moderate effect over time within‐subjects.
Conclusions: This study indicates that diazepam given orally in adult dosages does not cause significant respiratory depression, and is generally safe for those healthy patients who may require slight to mild sedation during periodontal surgery. J Periodontol 2003;74:1056‐1059.
The Nd:YAG and CO2 lasers have been shown to be bactericidal at relative low energy densities. However, at energy densities exceeding 120 J/cm2(CO2) and 200 J/cm2 (Nd:YAG). laser irradiation also ...causes irreparable root surface damage. The purpose of this study was to determine, in vitro, the energy density threshold at which microbial ablation could be achieved while inflicting the least amount of damage to the root surfaces of human teeth. Pairs of Escherkhia coli colonies cultured on broth agar were treated with a CO2 laser using a pulsed waveform at approximate energy densities ranging from 3 to 110 J/cm2. One of each colony‐pair was then examined by scanning electron microscopy (SEM) and the other subcultured for viable microbes. Roots of extracted teeth were lightly scaled and treated by CO2 laser, again with pulsed beam using approximate energy densities of 3 to 110 J/cm2: and examined by SEM. Regardless of the level of energy density, residual bacteria could be subcultured from all laser treated microbial colonies. The inability of the laser to completely obliterate microbial colonies was likely due to: depth of energy penetration, difficulty in precisely overlapping beam focal spots, irregular beam profile, and presence of microbes at the periphery of the beam focal spot. The threshold energy density for bacterial obliteration was determined to be 11 J/cm2 and that for root damage was 41 J/cm2. Root damage was evident by charring, crater formation, meltdown and resolidification surface mineral, and increasing surface porosity. The results of this in vitro study indicate that when used at an energy density between 11 and 41 J/cm2: the CO2 laser may destroy microbial colonies without inflicting undue damage to the tooth root surface.
Introduction: Single or multiple cavernous hemangiomas involving the lips can be disfiguring and are subject to traumatic hemorrhage and ulceration. Furthermore, the cavernous hemangiomas may ...increase in size over time. The lip is a unique body tissue because of the vermilion color. Thus, surgical removal of lesions involving the vermilion borders present esthetic concerns.
Case Presentation: A 51‐year‐old male presented with a chief complaint of a “red–blue puffy” and protruding lower lip of several years duration. Clinical examination revealed four raised soft tissue lesions ranging from 0.4 to 1 cm in diameter. Similar lesions were noted on the dorsal tongue surface. All lesions blanched on palpation but were not pulsatile. The preliminary diagnosis was cavernous hemangioma. Given the range in size, distribution, and esthetic concerns, the two largest lip lesions were surgically excised and the smallest was ablated by carbon dioxide laser irradiation. A small lesion involving both lips at the commissure was not treated because of lack of esthetic and functional concerns.
Conclusions: Treatment was successful in that no complications were incurred and the esthetic result was pleasing to the patient. This case demonstrates that laser ablation of a cavernous hemangioma with good hemostasis is possible and should be considered a viable treatment option.
Background: Although fibronectin (FN) is an important extracellular glycoprotein involved in periodontal wound healing, it is not clear whether the application of exogenous fibronectin (ExoFN) offers ...any clinical benefit. The purpose of this preliminary in vitro study was to determine the binding of FN from three different sources, viz. endogenous EDTA‐plasma, endogenous serum and exogenous commercial purified human fibronectin in PBS buffer, to demineralized and non‐demineralized root powder.
Method: The binding of FN to a known quantity of mineralized and non‐demineralized root powder by overnight incubation at 15°C was studied by enzyme immunoassay (EIA) technique. The criteria for optimal performance of EIA procedure for the determination of FN was established. Particle size of powdered root structure was standardized using a Vibratory Sieve Shaker.
Results: The EDTA‐plasma and the serum FN exhibited binding of (17.8 ± 2.1 µg) and (6.5 ± 4.5 µg), respectively, to the non‐demineralized root powder. However, the binding was only significant for the EDTA‐plasma FN (p < 0.01) when compared to controls. In the demineralized group there was no ascertainable binding of FN from either endogenous or exogenous sources. ExoFN in buffer exhibited no binding at all to the non‐demineralized or demineralized root powder.
Conclusion: The preliminary data suggest that additional plasma and serum factors may facilitate the binding of FN to root powder. High levels of FN in blood do not necessarily indicate that FN is available for binding to the root surface during periodontal surgery.
Zusammenfassung
Kann die Applikation von exogenem Fibronektin die parodontale Regeneration verbessern? Eine vorlaufige in vitro evaluation
Hintergrund:Obwohl Fibronektin (FN) ein wichtiges extrazelluläres Glykoprotein ist, dass in die parodontale Wundheilung involviert ist, ist es nicht geklärt, ob die Applikation von exogenem Fibronektin (ExoFN) irgendwelchen klinischen Nutzen erbringt. Der Zweck dieser vorläufigen in vitro Studie war die Bestimmung der Bindung von FN von drei unterschiedlichen Quellen, nämlich endogenes EDTA‐Plasma, endogenes Serum und endogenes kommerziell gereinigtes menschliches Fibronektin in PBS‐Puffer, zu entkalktem und nicht entkalktem Wurzelmehl.
Methoden:Die Bindung von FN zu einer bekannten Menge von mineralisiertem und nicht entkalktem Wurzelmehl durch Inkubation über Nacht bei 15° C wurde mit einem Enzymimmunoassay (EIA) studiert. Die Kriterien für die optimale Durchführung des EIA für die Bestimmung von FN wurden hergestellt. Die Partikelgröße der zerkleinerten Wurzelstrukturen war unter Nutzung eines Vibrator Sieve Mixers standardisiert.
Ergebnisse:Das EDTA‐Plasma und das Serum FN zeigten eine Bindung von (17.8 ± 2.1 g) und (6.5 ± 4.5 g) zu nicht entkalktem Wurzelmehl. Jedoch war die Bindung nur für das EDTA‐Plasma signifikant (p < 0.01), wenn zu den Kontrollen verglichen wurde. In der entkalten Gruppe konnte keine feststellbare Bindung von FN weder von endogener noch von exogener Quelle festgestellt werden. Gepuffertes ExoFN zeigte keine Bindung zu allen nicht entkalkten oder entkalkten Wurzelmehlen.
Zusammenfassung:Die vorläufigen Daten suggerieren, dass zusätzliche Plasma‐ und Serumfaktoren die Bindung von FN an Wurzelmehl ermöglichen können. Hohe Level von FN im Blut zeigen nicht notwendigerweise an, dass FN für die Bindung an die Wurzeloberfläche während der parodontalen Heilung verfügbar ist.
Résumé
L'application de fibronectine exogène peut‐elle améliorer la régénération parodontale? Evaluation préliminaire in vitro
Origine:Bien que la fibronectine (FN) soit une glycoprotéine extracellulaire importante impliquée dans la cicatrisation des plaies parodontales, on ne sait pas véritablement si l'application de fibronectine exogène (exogenous fibronectin, ExoFN) offre des bénéfices cliniques. Cette étude préliminaire in vitro avait pour but de déterminer la liaison de FN issue de trois sources différentes, à savoir plasma‐EDTA endogène, sérum endogène et fibronectine humaine commerciale purifiée (ExoFN) dans un tampon PBS, à de la poudre radiculaire déminéralisée et non‐déminéralisée.
Méthode:La liaison de FN à une quantité connue de poudre radiculaire déminéralisée et non‐déminéralisée par incubation à 15°C durant la nuit a étéétudiée par dosage immuno‐enzymatique (enzyme immunoassay, EIA). On a établi le critère de performance optimale de la technique EIA pour déterminer FN. La taille des particules de la structure de poudre radiculaire a été standardisée au moyen d'un Vibratory Sieve Shaker.
Résultats:La liaison du plasma‐EDTA et de la FN sérique à la poudre radiculaire non‐déminéralisée valait respectivement (17.8 ± 2.1 g) et (6.5 ± 4.5 g). La liaison n'était toutefois significative en comparaison avec le groupe de contrôle que pour la FN du plasma‐EDTA (p<0.01). Dans le groupe déminéralisé, il n'y avait pas de liaison vérifiable de FN issue de sources endogènes ou exogènes. Il est intéressant de noter que l'ExoFN dans le tampon ne présentait pas la moindre liaison à la poudre radiculaire non‐déminéralisée ou déminéralisée.
Conclusions:Les données préliminaires suggèrent que des facteurs plasmatiques et sériques supplémentaires pourraient faciliter la liaison de FN à la poudre radiculaire non‐déminéralisée. La présence de niveaux élevés de FN dans le sang n'indique pas nécessairement qu'elle est disponible pour se lier à la surface radiculaire au cours de la chirurgie parodontale.
Introduction: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a recently described uncommon and distinctive form of inflammatory hyperplasia. Treatment of this condition has varied from ...surgical excision to no treatment followed by spontaneous remission. This case report demonstrates successful management of the lesion using a conservative treatment approach.
Case Presentation: A 14‐year‐old male with negative medical and dental histories presented with LJSGH. The vivid red lesions involved the papillary and marginal gingiva of all maxillary anterior teeth. Initially, the lesion developed as a single red patch‐like area involving the maxillary left cuspid. Subsequently, the lesion displayed a linear pattern of spread to involve successively more teeth in the anterior sextant. Biopsy revealed hyperplastic elongated epithelial rete pegs, atrophy of the overlying stratified squamous epithelium with mild spongiosis, neutrophilic exocytosis, and a highly vascular connective tissue with a dominant infiltrate of chronic inflammatory cells. The lesion responded to treatment consisting of a mild surface cauterization followed by topical application of a 0.05% clobetasol ointment four times per day for a period of 4 weeks.
Conclusion: This case report demonstrates that LJSGH can be successfully managed by conservative therapy, thereby avoiding potential gingival margin defects that may result from a surgical ablation of the lesion.
Background: The selection of antibiotic resistance genes during antibiotic therapy is a critical problem complicated by the transmission of resistance genes to previously sensitive strains via ...conjugative plasmids and transposons and by the transfer of resistance genes between gram‐positive and gram‐negative bacteria. The purpose of this investigation was to monitor the presence of selected tetracycline resistance genes in subgingival plaque during site specific tetracycline fiber therapy in 10 patients with adult periodontitis.
Method: The polymerase chain reaction (PCR) was used in separate tests for the presence of 3 tetracycline resistance genes (tetM, tetO and tetQ) in DNA purified from subgingival plaque samples. Samples were collected at baseline, i.e., immediately prior to treatment, and at 2 weeks, and 1, 3, and 6 months post‐fiber placement. The baseline and 6‐month samples were also subjected to DNA hybridization tests for the presence of 8 putative periodontal pathogenic bacteria.
Results: PCR analysis for the tetM resistance gene showed little or no change in 5 patients and a decrease in detectability in the remaining 5 patients over the 6 months following tetracycline fiber placement. The results for tetO and tetQ were variable showing either no change in detectability from baseline through the 6‐month sampling interval or a slight increase in detectability over time in 4 of the 10 patients. DNA hybridization analysis showed reductions to unmeasurable levels of the putative periodontal pathogenic bacteria in all but 2 of the 10 patients.
Conclusions: These results complement earlier studies of tet resistance and demonstrate the efficacy of PCR monitoring for the appearance of specific resistance genes during and after antibiotic therapy.
