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Biomedical subjects

J G Caton

Publications and source records attributed to J G Caton.

At least 19 recordsLinked to original sources
PubMed2001

Subantimicrobial dose doxycycline as an adjunct to scaling and root planing: post-treatment effects.

BACKGROUND/OBJECTIVE: Subantimicrobial dose doxycycline (SDD 20 mg bid) plus scaling and root planing (SRP) significantly improved clinical attachment level (CAL) and reduced probing depth (PD) compared with placebo plus SRP in a double-blind, placebo-controlled, multicenter study of patients with adult periodontitis (AP). In a study conducted as a follow-up, the post-treatment effects of SDD were assessed in patients who completed the SRP study. METHODS: The SRP study was a 9-month, active-treatment study and the follow-up was a 3-month, no-treatment study. In the SRP study, tooth sites in qualifying quadrants were scaled and root planed and patients were randomized to receive twice daily SDD 20 mg or placebo. In the follow-up, patients received no study drug; investigators and patients remained blinded to the previous treatment group assignments. Efficacy measures included the change in CAL and PD from baseline values determined at the start of the SRP study in tooth sites stratified by baseline PD (i.e., 0-3 mm, 4-6 mm, > or =7 mm). Safety was evaluated using adverse event data and the results of clinical laboratory tests, oral pathology examinations, and microbiological assessments. RESULTS: Within each disease stratum, the incremental improvements in PD and CAL demonstrated in the SDD group over 9 months of active treatment were maintained through 3 additional months of no treatment. Treatment cessation did not result in an accelerated regression of periodontal health. No differences in the incidence of adverse events (including those related to infection) or laboratory or microbiological parameters were noted between the SDD group and the placebo group. CONCLUSIONS: The administration of SDD 20 mg bid for a period of up to 9 months is not associated with rebound effects or delayed or negative after-effects for a 3-month period after cessation of therapy.

Adult↗
PubMed2001

Doxycycline dosing.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed2000

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis.

BACKGROUND: In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP. METHODS: Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline RESULTS: In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events. CONCLUSIONS: The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.

Adult↗
PubMed1999

Evaluation of Periostat for patient management.

The cause of adult periodontitis involves complex bacteria-host interactions, with modifying influences exerted by genetic and environmental factors. Current thinking indicates that successful, long-term management of adult periodontitis requires a treatment approach that takes into account the various etiologic components of the disease. Recently, a formulation containing a subantimicrobial dose of doxycycline (Periostat) was approved for use as an adjunct to scaling and root planing (SRP) in the treatment of adult periodontitis. As an inhibitor of matrix metalloproteinases that have been implicated in the pathologic degradation of connective tissue collagen in periodontal support structures, Periostat in conjunction with SRP was shown to significantly improve clinical attachment and reduce probing depth compared with placebo in conjunction with SRP. This article reviews the clinical trial results leading to US Food and Drug Administration approved of Periostat and discusses the potential use of this host-modulatory agent as a complementary systemic pharmacotherapy in periodontal management programs.

Adult↗
PubMed1997

The reversal line may be a key modulator of osteoblast function: observations from an alveolar bone wound-healing model.

The reversal line demarcates the cessation of osteoclast activity from the commencement of osteoblast activity at a remodeling site in bone. It is a seam between segments of bone that are formed at different times. We believe that the reversal line contains regulatory signals that, in part, control osteoblast activity. We have conducted a pilot study to examine the fate of reversal lines during abnormal bone remodeling in alveolar bone. A surgical periodontal defect was created in a Cynomolgus monkey (Macaca fascicularis), allowed to heal in the presence of plaque, and evaluated histologically. In this model, there is an acute inflammatory reaction followed by compromised bone formation. Woven bone rather than lamellar bone was deposited in the defect. A striking finding in this wound-healing model was the disruption of the carbohydrate material along the reversal line. This supports our theory that disruption of the signaling molecules in the reversal line may be responsible for uneven woven bone formation.

Alveolar Bone Loss↗
PubMed1997

Overview of clinical trials on periodontal regeneration.

Periodontal regeneration means healing after periodontal surgery that results in the restoration of the tooth-supporting tissues; namely, cementum, alveolar bone, and periodontal ligament. The response of the periodontium to conventional periodontal flap surgery is primarily repair. Regenerative flap procedures involve modifications intended to alter variables in the normal wound healing response to shift the outcome from repair to regeneration. Technical manipulations, devices, pharmacological agents, and biologicals have been used to obtain regeneration. Evaluation of periodontal therapy is done by clinical and histological assessments. Human clinical trials depend on probing, re-entry, and radiographic measurements which cannot distinguish between periodontal repair and regeneration. Histological studies are difficult in humans because they require the retrieval of tissue blocks containing the teeth and their surrounding tissues, and for this reason these studies have largely been done in animal models; however, the use of animal models creates problems of interpretation when applying the information to the human. There are other fundamental problems related to assessment of new methods of periodontal regeneration. Ideally, periodontal regeneration is attempted after resolving the periodontitis that produced the loss of periodontal support. Does the type of periodontal disease affect the outcome? If it does, then separate clinical trials would be indicated to manage defects produced by different diseases. Furthermore, certain types of periodontal defects apparently respond better than others (for example, intrabony defects versus suprabony defects). Does each type of defect require a separate trial? Do subjects respond differently and, if so, how should this be factored into selection of the study population and sample size? There appear to be more questions than answers concerning the design of clinical trials for periodontal regeneration. This is not surprising since regeneration has been possible for only a few years, is apparently unpredictable, and the origin and nature of the new tissue are poorly understood. These factors make it important that the design of clinical trials be openly and thoroughly discussed so that practical solutions are forthcoming.

Animals↗
PubMed1997

Comparison of a bioabsorbable GTR barrier to a non-absorbable barrier in treating human class II furcation defects. A multi-center parallel design randomized single-blind trial.

This multi-center single-blind study compared clinical outcomes following guided tissue regeneration (GTR) treating human Class II furcation defects with a new polylactic-acid-based bioabsorbable barrier (test treatment) or a non-absorbable ePTFE barrier (control treatment). Clinical parameters evaluated were change in vertical attachment level (VAL), horizontal attachment level (HAL), probing depth (PD), and gingival margin location (REC). Surgical treatment resulted in clinically and statistically equivalent changes when comparisons were made between test and control treatments. VAL gain was 2.0 mm for test and 1.6 mm for control groups; HAL gain was 2.1 mm for both test and control groups. PD reduction was 2.3 mm for the test group and 2.1 mm for the control group. Test sites experienced an additional 0.3 mm of recession beyond baseline; control sites, 0.5 mm. Within-group comparisons showed that the amount of recession was not significantly different from baseline in the test group. Recession in the control group was significantly different from baseline. All other parameters in both the test and control groups were significantly different from baseline. Evaluation of safety data indicated no significant differences between test and control treatments, although there was a strong trend for the control group to have more postoperative abscess or suppuration than test sites (control = 11; test = 4; P = 0.06).

Absorption↗
PubMed1997

Clinical results with exposed polyglactin 910 resorbable membranes for guided tissue regeneration.

Three cases are presented where early exposure of a resorbable membrane occurred during guided tissue regeneration therapy. An antimicrobial regimen was selected to determine whether infection of exposed membranes could be controlled to the point of achieving acceptable clinical results without membrane removal. The results suggest that with the use of the antimicrobial regimen: (1) exposure is compatible with successful clinical results, and (2) removal is not necessary.

Absorbable Implants↗
PubMed1996

A prospective multi-center study evaluating periodontal regeneration for Class II furcation invasions and intrabony defects after treatment with a bioabsorbable barrier membrane: 1-year results.

The purpose of this prospective multi-center study was to evaluate a resorbable barrier membrane designed for periodontal regeneration. Thirty-one Class II furcations and 30 two- and three-wall intrabony defects were treated by flap debridement and bioabsorbable barrier membrane augmentation. The efficacy of treatment was evaluated in terms of changes in vertical probing depth (PD), horizontal probing depth (HPD), clinical attachment levels (CAL), and recession. Five centers participated in the study. Changes in clinical parameters are reported by individual center and by the average of the centers. All patients had either one molar with a Class II furcation or an intrabony defect. Baseline data were taken on the day of surgery. Post-treatment data were collected at 6 months and 1 year. This report is based on the 1-year findings. The average initial PD for Class II furcations was 6.1 mm. At 1 year the average PD was reduced to 3.6 mm, a 2.5 mm change. These differences were clinically and statistically significant (P < 0.0001). There was an average gain of 2.1 mm of clinical attachment (P < 0.0001) and 0.4 mm of recession (P < 0.04). There was a mean of 1.8 mm change in HPD (P < 0.0001). For intrabony defects, at 1 year there was an average PD reduction of 4.1 mm (P < 0.0001) and a mean gain of CAL of 2.9 mm (P < 0.0001). At 1 year the average recession was 0.9 mm which was statistically significant. When treatment outcomes were compared between centers there were no differences for either group of treated defects. There were differences between centers when baseline PD for furcations and intrabony sites were compared. The results of this study indicate that clinically and statistically significant improvements in PD, CAL, and HPD occurred after treatment of Class II furcations and 2- to 3-wall intrabony defects with the bioabsorbable periodontal membrane.

Adolescent↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: clinical response.

The purpose of this investigation was to evaluate the clinical efficacy of controlled-release tetracycline fiber therapy in adult periodontitis patients. One hundred-twenty-two (122) adult patients from 3 dental centers were enrolled at baseline for this study. each patient provided at least one site in each of four quadrants that was > or = 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10-day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12-month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred-sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy.

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: microbiological response.

In a 12-month multi-center study of 116 adult periodontitis subjects, six putative periodontal pathogens were monitored by DNA probe methods in a subset of 31 subjects. Monitored species included Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Eikenella corrodens (Ec), Campylobacter rectus (Cr), and Actinobacillus actinomycetemcomitans (Aa) with an average detection limit of 1.8 x 10(4) bacterial colony forming units/sample. The microbiological response to four periodontal treatments was studied, one treatment in each quadrant; scaling and root planing (S), scaling and root planing with tetracycline (TC) fiber (SF), a single application of TC fiber (F) and two serial applications of TC fiber (FF). Generally two sites were sampled in each quadrant, however, in some quadrants only one site was selected. These treatments were evaluated at baseline; immediately following therapy; and post-treatment at 1, 3, 6, and 12 months. The study was conducted with a split-mouth design with no maintenance therapy over a 12-month period. At baseline, 70.8% of sites had detectable Fn; 42.9% Pg; 63.5% Pi; 29.7% Ec; 28.3% Cr; and 5.5% Aa. No significant differences were seen in baseline proportions of these species between centers. Numbers and proportions of detectable pathogens (with the exception of Pg) exhibited a triphasic temporal response: a precipitous initial decrease immediately following therapy; a rise in proportions in the 1- to 3-month post-therapy period; and a spontaneous decline in the absence of therapy over the 3- to 12-month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Evaluation of periodontal treatments using controlled-release tetracycline fibers: maintenance response.

The purpose of this investigation was to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled-release tetracycline fibers. One-hundred-twenty-two (122) adult volunteers with at least one bleeding pocket > or = 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12-month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1, 3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as > or = 1 mm mean attachment loss at a site during the 3- to 12-month period. One-hundred-sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P < 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care.

Adult↗
PubMed1993

Comparison between mechanical cleaning and an antimicrobial rinse for the treatment and prevention of interdental gingivitis.

This study compared the efficacy of an antimicrobial mouthrinse (0.12% chlorhexidine gluconate) plus toothbrushing (mouthrinse group), mechanical interdental cleaning plus toothbrushing (mechanical group), and toothbrushing alone (control group), at reducing and preventing interdental gingival inflammation. 92 male subjects were examined for interdental inflammation using the Eastman interdental bleeding index at baseline, then monthly for 3 months after using one of the above oral hygiene regimens. The mechanical cleaning group had significant reductions in bleeding sites compared to baseline at 1 month (56.90% versus 13.17%) that persisted throughout the study (2 months = 6.65%, 3 months = 5.70%). The other regimens showed no significant bleeding reduction at any time point in the study. The mechanical interdental cleaning group showed improvement over baseline at 1 month with the full benefit apparent after 2 months. The effect of location in the mouth on bleeding reduction was also assessed. The % of posterior sites which bled was always higher than anterior sites. Analysis of maxillary versus mandibular, and buccal versus lingual sites showed no significant differences. Additional observations of the data demonstrated that sites which bled at baseline were more likely to stop bleeding in the mechanical cleaning group. Also, sites which did not bleed at baseline were unlikely to bleed subsequently when mechanical cleaning was used. Neither of these observations were true for the other cleaning regimens. These data show that only mechanical interdental plaque removal combined with toothbrushing is effective at reducing or preventing interdental inflammation. This underscores the importance of instituting mechanical interdental cleaning to eliminate interdental inflammation.

Adolescent↗
PubMed1993

Oriented cell and fiber attachment systems in vivo.

This investigation was undertaken to evaluate whether an oriented cell and fiber attachment system would develop if demineralized dentin surfaces were approximated in vivo. The approximated surfaces consisted of the internal, parallel surfaces of dentin cylinders. The experimental group was demineralized on both the external and internal surfaces of the dentin cylinder with citric acid, pH 1.0, for 3 minutes, but only the external surface of the control dentin cylinder was demineralized. Specimens were implanted transcutaneously into the backs of rats with one end protruding through the surface of the skin. Three specimens in each group were available for analysis at 1 and 10 days after implantation. The groups were compared using histologic and histometric analysis and the following conclusions were made. There were marked differences in the initial cellular response between the groups, and demineralization with citric acid prior to implantation predisposed towards a greater cell attachment at 1 and 10 days. An oriented fiber attachment developed between the demineralized approximated surfaces by 10 days, but did not develop between nondemineralized approximated surfaces. The morphology of the fiber attachment system was structurally similar to a periodontal ligament, with inserting fibers perpendicular to the implant surface. The findings of this study suggest that spatial approximation of appropriate substrates facilitates development of cell and fiber orientation. Thus, to regenerate a functionally oriented attachment system in the clinical setting, it may be beneficial to provide substrates that are appropriately approximated.

Acid Etching, Dental↗