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Biomedical subjects

J Goultschin

Publications and source records attributed to J Goultschin.

At least 19 recordsLinked to original sources
PubMed2005

A 2-year follow-up of root coverage using sub-pedicle acellular dermal matrix allografts and subepithelial connective tissue autografts.

BACKGROUND: Coverage of roots exposed by gingival recession is one of the main objectives of periodontal reconstructive surgery. A large variety of mucogingival grafting procedures are available. However, the long-term effectiveness of this procedure is still not clear. This study compared the effectiveness of sub-pedicle acellular dermal matrix allografts with subepithelial connective tissue autografts in achieving root coverage 2 years postoperatively. METHODS: One hundred one (101) patients were treated with dermal matrix allografts (mean age, 28.4+/- 0.7 years; mean recession, 4.2 mm) and 65 patients treated with connective tissue graft (mean age, 30.1+/- 1.4 years; mean recession, 4.9 mm). All patients underwent full periodontal evaluation and presurgical preparation, including oral hygiene instruction and scaling and root planing. The exposed roots were thoroughly planed and covered by a graft without any further root treatment or conditioning. There were no differences in the average age, time of follow-up, or gender between the two groups. Patients were evaluated periodically between 1 and 2 years. Residual recession and defect coverage were assessed. RESULTS: Mean residual root recession after root coverage with acellular dermal matrix allograft was 0.2 +/- 0.04 mm, with defect coverage of 95.9% +/- 0.9%. Frequency of defect coverage was 82.2%. Root coverage was 98.8% +/- 0.2%, resulting in a frequency of root coverage of 100%. Gain in keratinized gingiva was 2.2+/- 0.04 mm and attachment gain was 4.5+/- 0.1 mm per patient. Connective tissue autografts resulted in mean residual root recession of 0.1+/- 0.04 mm, with percent defect coverage of 97.8%+/- 0.6% and frequency of defect coverage of 95.4%. Root coverage was 99.1%+/- 0.2%, and frequency of root coverage was 100%. Gain in keratinized gingiva was 3.0+/- 0.1 mm and attachment gain was 5.3+/- 0.2 mm per patient. No significant differences in final recession and root coverage between the two treatment methods were found. However, autografts resulted in significant increases in defect coverage, keratinized gingival gain, attachment gain, and residual probing depth. The clinical results were stable for the 2-year follow-up period. CONCLUSIONS: These results indicate that coverage of root by sub-pedicle acellular dermal matrix allografts or subepithelial connective tissue autografts is a very predictable procedure which is stable for 2 years postoperatively. However, subepithelial connective tissue autografts resulted in significant increases in defect coverage, keratinized gingival gain, attachment gain, and residual probing depth.

Adult↗
PubMed2003

[The relationship between osteoporosis, osteopenia and periodontitis].

A review of the literature on the reciprocal influence of osteoporosis and periodontitis. The imbalance in coupling of bone remodeling causes skeletal osteopenia and osteoporosis. Does the remodeling imbalance influence the oral bone? Both diseases are chronic, multifactorial and result at bone loss. In addition, the diseases share common risk factors such genetics, dietary, environmental and systemic factors. Different studies indicate that the skeletal bone loss in osteoporosis accelerate the decrease in bone density in oral bone. Although the differences in etiology between the two diseases some studies showed that treatment of osteoporosis improved the periodontal health. Further investigation of the mechanisms behind the relationship between osteoporosis and periodontitis may lead to common treatment strategies.

Alveolar Bone Loss↗
PubMed2003

[The role of Matrix Metaloproteinases in the progression of periodontitis, and the use of specific inhibitors to these enzymes in the treatment of the periodontal disease].

Matrix Metaloproteinases (MMPs) play a crucial role in the pathogenesis of the periodontal disease. This group of enzymes can degrade most of the proteins that compose the extracellular matrix. Recently a new concept of treatment, the "host modulating therapy" (HMT) was developed. The rationale behind this concept is to inhibit the production of the inflammatory mediators and/or to block the production of the host MMPs and thus inhibiting disease production. In the recent years it was found that Tetracyclines (TC) decrease the levels of TNF-alpha, IL-1, Nitric Oxide, and prostaglandins, and via intra and extra cellular mechanisms inhibit the production and activation of the MMPs. A capsule of 20 mg Doxycycline, called later Low Dose Doxycycline (LDD), was the first HMT in the periodontal disease. In a 9 month study it was found that LDD bid after supragingival scaling statistically increased pocket reduction and attachment gain compared to supragingival scaling alone. However, this improvement was found only in pockets of 7 mm or more, and was not compared yet to periodontal supportive therapy every three month. There is a need for more basic and clinical research in the field of HMT in the treatment of periodontal disease, to expand our knowledge and clinical experience that will enable us to decide when and how to use medications to modulate host response.

Anti-Bacterial Agents↗
PubMed2002

Coverage of previously carious roots is as predictable a procedure as coverage of intact roots.

BACKGROUND: Coverage of roots exposed by gingival recession is one of the main objectives of periodontal reconstructive surgery. A variety of highly predictable and esthetically acceptable mucogingival grafting procedures are available for treating intact root surfaces. One of the indications for root coverage procedures is prevention of root caries. However, little is known about the ability to treat previously carious roots by mucogingival grafting, and even less is known about the outcome of such treatment. METHODS: Sixty patients with gingival recession were treated with subepithelial connective tissue grafts. During initial examination, 33 intact teeth with longstanding gingival recessions of 4.09 +/- 0.16 mm (mean +/- SEM) and 27 teeth with carious roots (restored and unrestored) and longstanding gingival recessions of 3.44 +/- 0.22 mm (mean +/- SEM) were found. Prior to grafting, any carious dentin and plastic restorations were removed. The exposed roots were thoroughly planed and covered by a subepithelial connective tissue graft without any further root treatment or conditioning. Patients were evaluated periodically between 1 and 6 years. Residual recession, defect coverage, and caries incidence were assessed. RESULTS: Recession was reduced to a similar extent on all teeth whether root caries was present (0.31 +/- 0.11 mm) or not (0.15 +/- 0.04 mm). This resulted in comparable defect coverages of 92.41 +/- 2.38% for previously carious roots and 97.46 +/- 0.79% for intact roots. In 44 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were found during the periodic evaluations. CONCLUSIONS: These results indicate that coverage of previously carious roots with subepithelial connective tissue grafts is a very predictable procedure with results similar to those found on intact roots. This procedure may provide a definitive biological alternative for conventional restorative treatment modalities for root caries. Moreover, the results are more esthetic, biologically acceptable, and maintainable.

Adult↗
PubMed2002

[Treatment of multiple recession-type defects in a young patient with esthetic demands].

Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic demands from patients. Frequently, gingival recessions affect groups of adjacent teeth. In order to optimize the esthetic result all the contiguous recessions should be treated at the same time. The purpose of this article is to compare some techniques of root coverage in a patient with Miller class 1 recessions. A mean of 80% of root exposure was covered using the free gingival graft and free connective tissue graft with repositioned flap compared to 67% using coronally positioned flap over a connective tissue graft. In conclusion, partial root coverage and gingival augmentation with a good esthetic appearance were obtained by a one-step connective tissue graft procedure.

Adult↗
PubMed2002

[Periodontal disease--an additional risk factor for cardiovascular diseases?].

In 1989, a case-control study was published, linking between coronary heart disease and periodontal disease in the studied population. Since then, a number of additional studies, focused the attention to the possible role of dental infections in the pathogenesis of atherosclerosis. Some of these newer cohort studies, are prospective in nature, measuring incidence of the two diseases in large patient populations. The present article reviews these studies, and the proposed mechanisms which might explain the relationships between these two systemically distinct diseases.

Arteriosclerosis↗
PubMed2001

Root coverage and pocket reduction as combined surgical procedures.

BACKGROUND: One of the main objectives of periodontal reconstructive surgery is the coverage of exposed roots due to gingival recession. A large variety of mucogingival grafting procedures are available that give highly predictable and esthetically acceptable results when treating intact root surfaces. However, these procedures call for a second surgery site in the palate. The present study examines a series of cases in which connective tissue, obtained from the tuberosity during pocket reduction procedures in the posterior region of the maxilla, was used for root coverage. METHODS: Forty-four teeth from 25 patients with gingival recession of 3.30 +/- 0.14 mm (mean +/- SEM) were treated with subepithelial connective tissue grafts using connective tissue obtained from the tuberosity area during pocket reduction procedures in the posterior region of the maxilla. RESULTS: The mean root coverage recession after treatment was 0.16 +/- 0.06 mm, with effectiveness of coverage at 95.0% +/- 1.84 and a predictability of 84.1%. Periodontal probing depth reduction at the donor site was 4.08 +/- 0.24 mm. CONCLUSIONS: These results indicate that the subepithelial connective tissue graft obtained from the tuberosity area during pocket reduction procedures in the posterior region of the maxilla provides a very predictable and esthetic root coverage without the need for a second surgical site.

Adult↗
PubMed2000

The relationship between peripheral levels of leukocytes and neutrophils and periodontal disease status in a patient with congenital neutropenia.

BACKGROUND: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. Oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) increases neutrophil numbers and ameliorates the periodontal status. METHODS: We report the treatment of a 22-year-old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. Diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG-CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. Root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post-treatment. RESULTS: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels. CONCLUSIONS: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG-CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia.

Adult↗
PubMed1994

Subgingival irrigation with amine fluoride-stannous fluoride gel in treated periodontal pockets.

PURPOSE: To evaluate the long-term effect of subgingival irrigations with amine fluoride mixed with stannous fluoride on the repopulation of bacteria in deep periodontal pockets (> 5 mm) following the active phase of non-surgical mechanical treatment. MATERIALS AND METHODS: A split-mouth design was utilized in eight periodontal patients and the effect of the treatment was evaluated by microbiological culturing and clinical parameters. RESULTS: Slight reduction in total anaerobe counts were detected in both treated and control sides, up to the first 5 weeks, followed by an increase in the counts reaching a plateau after 30 weeks. In contrast, black-pigmented bacteroides species (BPB) were significantly suppressed in the treated sides as compared to the control sides over the whole study period. The difference between the clinical parameters and between the tested and control sides, although in some points were found to be statistically significant, seem to have no clinical significance. The use of amine fluoride-stannous fluoride gel for irrigations of deep periodontal pockets as an adjunctive to conventional treatment, can prevent the repopulation of the pockets by BPB, which are considered to be a major group of periodontal pathogens.

Amines↗
PubMed1992

Periodontal treatment needs, by CPITN, among employees of a Jerusalem hospital.

A survey, employing the Community Periodontal Index of Treatment Needs (CPITN), was conducted among 344 employees of a Jerusalem hospital. Of the population surveyed, 2.2 per cent demonstrated totally healthy mouths, 1.5 per cent had, at the worst, bleeding symptoms, 13.3 per cent had calculus, 53.4 per cent had 4-5 mm ('shallow' according to WHO) pockets and 29.6 per cent had deep pockets (6 mm or more) as their worst CPITN scores. Results revealed an average of 0.55 edentulous sextants, 0.68 healthy sextants, 0.87 sextants with bleeding symptoms, 1.36 with calculus, 1.95 with 4-5 mm pockets and 0.61 sextants with deep pockets. In general, females were healthier than males, had a significantly greater number of healthy sextants, less sextants with calculus and less sextants with deep pockets. A deterioration in periodontal health with age was evident, according to mean number of sextants per person by CPITN scores. Associations were also analysed between CPITN and demographic variables. Few significant associations were revealed. Based on FDI and WHO estimates, the calculated periodontal treatment needs for the hospital employees was found to be about 2 hours per person. Compared with data for other countries, as reported by the WHO, this status demands serious efforts to be made towards periodontal health promotion.

Age Factors↗
PubMed1991

Effect of glycyrrhizin-containing toothpaste on dental plaque reduction and gingival health in humans. A pilot study.

Glycyrrhizin, the main saponin of licorice, a surfactant producing aqueous gel, was tested for its effect on gingival health, as a supplemental agent in a toothpaste. 40 male and female volunteers brushed their teeth twice daily, with a toothpaste containing 0.25% and 0.50% glycyrrhizin, or a control toothpaste, respectively. All 3 toothpastes contained sodium lauryl sulfate as detergent. The subjects of the 3 groups were examined at days 0, 7, 14, 28, 35 and 42 for plaque, gingival and bleeding indices. The examiner was unaware of subject assignment. None of the brushing regimens with the experimental toothpastes induced significant changes in the examined indices, that were distinct from those observed with the control toothpaste. The decrease (insignificant) in the indices of the study period from 0 to 14 days may be considered as an increased oral hygiene awareness by the subjects examined. Possible explanations for the lack of efficiency in improvement of plaque, gingival and bleeding indices, may have been an insufficient glycyrrhizin concentration and/or chemical incompatibility in a toothpaste containing a mixture of an anionic detergent and an organic antibacterial surface agent.

Adult↗
PubMed1991

Enamel softening with Coca-Cola and rehardening with milk or saliva.

Rehardening effects by cow's milk and by secreted saliva were investigated, in situ, following softening of human enamel with an acidic beverage (Coca-Cola). Volunteers wearing orthodontic removable appliances participated in the study. The intra-oral test was chosen for measuring microhardness of enamel slabs inserted into the dental appliance. The softening and the rehardening degrees were defined as the alterations between initial- and experimental-microhardness value at the enamel surface. In addition, SEM photos were prepared from the initial and experimental stages. Exposure of enamel slabs to the acidic beverage during 1 hour had a softening effect as expressed by the hardness decrease and visualized by the SEM photo. Rehardening effects following milk or saliva exposures respectively were evident, presumably due to deposited organic and mineral material on the enamel surface.

Adult↗
PubMed1991

Multiple therapy approach to juvenile periodontitis: a case report.

Various therapeutic techniques for the treatment of juvenile periodontitis are reported in the literature, with occasional contradictory results. One of the reasons for the contradictory results may be differences in patient selection and/or response to treatment. The following report describes the results of various treatment modalities, in different sites in the same individual, on localized juvenile periodontitis.

Adult↗
PubMed1990

Association of smoking with periodontal treatment needs.

A total of 344 Jerusalem hospital personnel participated in the present survey which examined periodontal needs according to CPITN (a measure of treatment needs) and smoking habits. Females and younger subjects were found to be generally periodontally healthier than their male and older counterparts. The effect of both smoking and the number of cigarettes smoked were shown to have a clearly deleterious effect on periodontal status when assessed using the CPITN. Younger women were found to be most susceptible to this effect.

Adolescent↗
PubMed1989

The interleukin concept and the periodontal diseases.

The interleukins are hormone-like substances found at sites of inflammation such as in rheumatoid arthritis and periodontal disease. The present article analyzes a hypothetical mechanism of periodontal pathogenesis, whose etiology is still unclear despite its high prevalence.

Bone Resorption↗
PubMed1989

Familial gingival fibromatosis; no correlation with HLA-antigen. A family study.

Familial gingival fibromatosis is generally reported to be inherited as an autosomal dominant trait. We investigated 2 families with few siblings affected with gingival fibromatosis. No linkage between HLA antigen and the phenomenon was found. These results support the idea of the autosomal dominant nature of familial gingival fibromatosis.

Female↗