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Biomedical subjects

N F Bissada

Publications and source records attributed to N F Bissada.

At least 19 recordsLinked to original sources
PubMed1995

Comparative effectiveness of various regenerative modalities for the treatment of localized juvenile periodontitis.

The objective of this study was to assess the effectiveness of surgical debridement versus various guided tissue regeneration techniques for the treatment of localized juvenile periodontitis (LJP). Seven patients, 14 to 18 years old, were selected on the basis of having; 1) vertical bone loss on at least 3 first molars; 2) probing attachment loss > or = 5 mm; 3) presence of Actinobacillus actinomycetecomitans (Aa) as determined by the DNA probe test; 4) no systemic diseases; and 5) not taken antibiotics for 6 months prior to treatment. Each patient was randomly assigned by first molar involvement to one of four treatment modalities: 1) surgical debridement alone (DEBR); 2) ePTFE membrane alone (G); 3) ePTFE membrane plus root conditioning (G + D); or 4) ePTFE membrane plus root conditioning plus composite graft (G + D + B). Standardized clinical attachment level measurements (CAL) were taken at baseline, 6, 12, and 18 months. Hard tissue measurements were evaluated radiographically (RAD) at baseline, 6, 12, and 18 months, and volumetrically at baseline and 12 months post-surgery. At 12 months re-entry, all residual defects were re-treated with a composite graft consisting of calcium sulfate + DFDBA + doxycycline. Results were evaluated 6 months post-retreatment using CAL and RAD measurements. Statistical analysis of the data showed: 1) a significant gain in clinical attachment as well as increased volumetric bone fill of the defects 12 and 18 months following the various treatment modalities when compared to baseline (P < 0.05); and 2) no statistically significant differences among the tested treatment modalities and surgical debridement alone for all parameters (P > 0.05).

Adolescent↗
PubMed1994

Symptomatology and clinical features of hypersensitive teeth.

Tooth hypersensitivity is associated with exposure of the dentine to the external environment of the mouth. This exposure can result from loss of enamel by processes including abrasion and erosion, or by denudation of the root surface as a result of gingival recession or periodontal treatments. Dentine hypersensitivity can be described as an adverse reaction or pain in one or more teeth resulting from either a thermal, chemical, bacterial or mechanical stimulus. Painful symptoms arising from exposed dentine are a common finding in adults and reportedly affect as many as one in every seven patients attending for dental treatment. Although predisposition to dentinal hypersensitivity is multifactorial, enamel loss as well as gingival recession may be more severe with advancing age. Because of the greater longevity of people who are also keeping their teeth longer, hypersensitivity is a growing concern. Clinical studies show that individuals with less than adequate plaque control experience more root hypersensitivity to air stimuli than others with better oral hygiene. Although plaque does not alter the pulpal threshold, i.e. has no effect on the pulp, it seems that microbial plaque has an effect on root sensitivity.

Dental Plaque↗
PubMed1993

Short-term sequential administration of amoxicillin/clavulanate potassium and doxycycline in the treatment of recurrent/progressive periodontitis.

The systemic use of a single antibiotic was compared to that of a sequential antibiotic regimen in the treatment of A. actinomycetemcomitans and/or P. gingivalis-associated periodontitis. Eleven patients with recurrent/progressive periodontitis and demonstrating subgingival infection with A.a. and/or P.g. were selected. Six patients received oral administration of doxycycline (Do), 200 mg the first day and 100 mg for 4 days thereafter, and then amoxicillin/clavulanate potassium (Au), 500 mg 3 times daily for 5 days. The other 5 patients received only doxycycline for 10 days. Eight sites with > or = 5 mm probe depth per patient were selected, of which 4 received root planing at time 0. Clinical measurements (GI and PI, probing pocket depth, probing attachment level, and bleeding upon probing/suppuration) and microbial infection levels (2 sites/patient as per DNA probe) for A.a. and P.g. were recorded at 0, 4, 12, and 25 weeks. Clinical data were subjected to statistical analysis of variance and t-tests for significance. The Do + Au groups produced significant reduction in probing pocket depth (PPD) at 4, 12, and 25 weeks (1.1, 1.3, and 1.1 mm, respectively). The Do group produced significant reduction in PPD only at 4 and 12 weeks (0.8 and 0.8 mm); the Do + Au group produced significant gain of 0.8 mm in probing attachment level at 4 and 12 weeks; and the Do + Au group in conjunction with root planing produced the most sustained reduction in PPD and gain in PAL. These findings suggest that the sequential use of multiple antibiotic agents may offer greater promise as an adjunctive treatment approach for the management of recurrent and/or progressive periodontitis than a single antibiotic regimen.

Administration, Oral↗
PubMed1992

The effects of the Le Fort I osteotomy on the periodontium.

Two age-matched populations of equal size (n = 40), one having orthodontic therapy and the other combined orthodontic therapy and orthognathic surgery, were evaluated for their periodontal status 1 to 10 years posttherapy. The parameters investigated were plaque index, gingival index, tooth mobility, width of keratinized tissue, probing depth, gingival recession, and attachment level. No significant differences were found (P less than .05). Within the surgery group, patients with maxillary osteotomies segmentalized between the central incisors (n = 11) and between the canines and second premolars (n = 12) were evaluated using the same parameters and compared with their nonsegmental counterparts. No significant differences were found for patients with osteotomies segmentalized between the central incisors. However, a statistically significant increase in probe depth and loss of attachment level of up to 0.3 mm was found at the sites of osteotomies segmentalized between the canine and second premolar (P less than .05). This difference was not considered clinically significant.

Adolescent↗
PubMed1991

Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advanced periodontal furcation defects.

The purpose of this study was to compare the effectiveness of a tricalcium phosphate, plaster of paris, and doxycycline composite graft to surgical debridement alone in the treatment of Class II and Class III furcation defects. Fifteen patients with adult periodontitis and at least two mandibular molars with Class II or III furcation defects were selected. A total of 40 sites were treated: 26 were Class II defects and 14 were Class III. Following initial therapy one site was randomly selected to receive the composite graft while the remaining site served as the surgically debrided control. Osseous healing was evaluated by direct measurements from an acrylic stent at the time of graft surgery and at the 6-month reentry. Following surgery each patient was placed on doxycycline 100mg/day for 10 days. The absence of clinical inflammation and infection during the healing process provided additional substantiation of the biocompatibility of the grafting materials. Results after 6 months indicated that sites treated with the composite graft had improved defect fill, defect resolution, probing depths, and clinical attachment levels when compared to the surgically debrided controls. Defect fill was 3.7 times greater in grafted sites and these sites were 4.0 times more likely to have 50% or greater defect fill. The effect of grafting was more pronounced in Class III defects where horizontal defect fill and gain of clinical attachment was achieved only in grafted sites. The plaster of paris functioned well as a binder, preventing particle scatter and facilitating graft retention. Additionally the plaster served as a vehicle to carry and retain the doxycycline at the treated site. These short-term results point to the potential of a composite graft containing tricalcium phosphate, plaster of paris, and doxycycline in promoting healing of furcation lesions.

Adult↗
PubMed1990

Pulpal and root sensitivity rated to periodontal therapy.

The purpose of this clinical investigation was to determine if periodontal treatment consisting of scaling, root planing, and periodontal surgery produced any change in pulpal or root sensitivity. Ten patients were tested, with a total of 84 observations. There were 42 periodontally treated teeth, with 42 contralateral teeth serving as control specimens. The teeth were evaluated with stimuli from an electric pulp tester, cold, and air. The electric pulp tester was found to be reliable in assessing the pulpal sensitivity. Neither the amount of periodontal destruction nor the extent of periodontal treatment had any effect on the pulp. Scaling and root planing had no significant effect on root sensitivity. Periodontal surgery was directly related to root sensitivity in terms of the extent of root surface exposure. An association was observed clinically between plaque accumulation after periodontal surgery and root sensitivity.

Adult↗
PubMed1990

Crevicular fluid iron changes in treated and untreated periodontally diseased sites.

Previous investigations have shown that crevicular fluid iron concentration (CFIC) is higher in periodontally diseased sites. The present study was conducted to determine whether periodontal treatment changes the CFIC to levels found in healthy sites in the same persons. To test the significance of iron content in gingival fluid as an indicator of periodontal disease severity or activity, CFIC was determined for healthy sites and diseased sites treated with scaling and root planing alone or in conjunction with surgery both before and after treatment. CFIC was increased in diseased sites, but the iron concentration in crevicular fluid was not a good indicator of changes in disease severity resulting from periodontal treatment. Treatments produced an increase in the CFIC that may be more related to the status of the microcirculation than to the disease process itself.

Adult↗
PubMed1990

Periodontics in general practice: professional plaque control.

Traditionally the primary emphasis of preventive periodontics was daily patient performed plaque control. Recent studies indicate that frequent professional subgingival toothcleaning is a mandatory treatment for prevention of recurrent periodontitis. Pathogenic subgingival bacterial complexes are disrupted by frequent cleaning and require time to reestablish. Disease progression is prevented if the recall interval does not exceed the time required for reestablishment of a pathogenic plaque. Legally, patients have acquired the duty to comply with the prescribed recall interval. Both the patient and the practitioner will benefit from a preventive program that includes frequent professional subgingival toothcleaning.

Appointments and Schedules↗
PubMed1989

Periodontics in general practice: perspectives on periodontal diagnosis.

Standardized terminology does not exist to differentiate the conditions that constitute "response diagnosis" and "disease diagnosis" described in this review. Therefore, appropriate descriptive terminology is proposed for these two periodontic diagnoses. Diagnostic terms are needed to discern stages of disease. Periodontitis is a chronic disease prone to episodic recurrence that needs a "dynamic diagnosis" that can change with each reevaluation. In addition, the legal ramifications of failing to recognize or adequately described disease recurrence are discussed.

General Practice, Dental↗
PubMed1989

The effect of local doxycycline with and without tricalcium phosphate on the regenerative healing potential of periodontal osseous defects in dogs.

The purpose of this study was to evaluate the clinical and histological effects of high concentration doxycycline on osseous regeneration in adult beagle dogs. Four 5 mm two-wall periodontal osseous defects were created in the premolar and molar area of each quadrant yielding a total of 48 defects in the three dogs. Ligature-induced periodontitis was maintained for 6 weeks. Two weeks following ligature removal, one of the following graft procedures was randomly assigned to each defect: 1) doxycycline alone (DOX); 2) tricalcium phosphate alone (TCP); 3) a combined graft of DOX plus TCP, or 4), surgically debrided control. All areas received thorough scaling and root planing at the time of surgery. Clinical parameters evaluated at 4, 12, and 20 weeks after the surgical treatment included the gingival index and probing depths. Crevicular fluid was examined at 3, 10, and 28 days postoperatively for tetracycline fluorescence. Direct clinical measurements from the CEJ to a notch placed at the base of the defect and from the CEJ to the alveolar crest were made at the time of surgical treatment and reentry. The reentry procedures were performed at 4, 12, and 20 weeks postoperatively. Immediately following reentry block sections were obtained from each quadrant and prepared for examination with the light microscope. The gingival index and probing depth measurements showed greater improvement in the DOX and DOX + TCP groups. Increased regeneration (new bone, cementum, and periodontal ligament) and reduced alveolar crest resorption were observed more frequently in DOX and DOX + TCP defects, while healing by long junctional epithelium was more common in defects not treated with doxycycline.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1989

Clinical and microbiologic changes following the irrigation of periodontal pockets with metronidazole or stannous fluoride.

The purpose of this investigation was to determine the efficacy of subgingival irrigation with 1.64% stannous fluoride or 0.5% metronidazole solutions on the clinical and microbiologic parameters of adult periodontitis as compared with scaling and root planing. Twelve patients with moderate to advanced periodontitis were selected, and one pocket of a minimum 5-mm probe depth in each quadrant received one of the following treatments: (a) one session of scaling and root planing at the beginning of the experiment, (b) stannous fluoride irrigation, (c) metronidazole irrigation, and (d) saline irrigation. Results showed that scaling and root planing provided significantly better improvement in most of the clinical parameters than did the two tested irrigants. Saline also provided a statistically significant improvement, but only during the first 4 weeks. The four methods of treatment provided a sustained decrease in spirochetes, with a concomitant increase in coccoid cells. It was concluded that although subgingival irrigation with 1.64% stannous fluoride or 0.5% metronidazole solutions improved periodontal health, they never achieved the same efficacy as scaling and root planing and, therefore, should not be substituted for fastidious mechanical subgingival plaque and calculus removal.

Fluorides↗
PubMed1989

Factors influencing periodontal therapy for the geriatric patient.

Anatomic changes in the periodontium occur with aging. There is no indication that these changes predispose to periodontal breakdown. In the United States, there is evidence that older individuals are retaining more teeth and that these teeth have less periodontal disease than previous generations of seniors. Studies comparing the healing of older and younger patients have clearly demonstrated that both groups of patients respond equally well to therapy. Proven methods of periodontal therapy include modified Widman surgery, pocket elimination surgery, or nonsurgical scaling and root planing. Surgical treatment may be used with confidence unless there are medical contraindications. In these cases, nonsurgical therapy may be preferred. If there are physical or mental disabilities that make effective home care difficult, antimicrobial agents, such as the extensively tested chlorhexidine rinse, may be valuable adjuncts. In the future, senior adults can look forward to the benefits of regenerative periodontal procedures that seek to regain lost periodontal support. Age alone should not diminish an individual's right to care because the practitioner has qualms about his or her longevity. Successful treatment of periodontitis by surgical and nonsurgical methods has been extensively documented. Senior patients can benefit from these treatments as much as younger patients, and age is not a barrier to effective periodontal therapy.

Aged↗
PubMed1987

Periodontics in general practice: perspectives on nonsurgical therapy.

Clinical studies have shown that nonsurgical treatment is a highly effective method of periodontal therapy. It can be instituted in both shallow and deep pockets; however, an objective evaluation of post-scaling soft tissue changes should be recorded to determine the response to therapy. Closed scaling and root planing has limitations as a definitive procedure for the removal of calculus from deep pockets and surgical treatment may be indicated for nonresponding sites. The condition of the tissue, not the probing depth, should dictate the course of action. During maintenance therapy all practitioners should recognize unsuccessfully treated or recurrent periodontitis and provide interceptive treatment to avoid a case of "supervised neglect." Periodontal treatments should be provided by the general practitioner. This can result in improved oral health for the patients and constitute a professionally rewarding part of dental practice.

Dental Scaling↗
PubMed1987

Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations.

The purpose of this clinical study was to evaluate the periodontal condition of teeth having submarginal restorations associated with either narrow or wide zones of keratinized gingiva. Fifty-eight teeth in 26 individuals were selected and then divided into two groups according to the width of the keratinized gingiva at the midfacial aspect of the tested tooth. Group I consisted of 30 teeth with greater than or equal to 2.0 mm, and Group II consisted of 28 teeth with less than 2.0 mm of keratinized gingiva. Each group was equally subdivided into subgroup "A" having teeth with a full coverage, subgingival type of restoration for at least 2 years, and subgroup "B" representing contralateral homologous teeth, in the same individual, with no subgingival restoration. Clinical examination of individual teeth included determination of plaque and gingival indices, gingival fluid, probing depth, bleeding tendency and bone level. Data were subjected to statistical analysis using the Student t test and a two-way analysis of variance to determine any significant differences in variables between teeth with and without subgingival restorations, in narrow and wide zones of keratinized gingiva. The findings were: (1) teeth with subgingival restorations and narrow zones of keratinized gingiva showed statistically significant higher gingival scores than teeth having submarginal restorations with wide zones of keratinized gingiva. (2) Teeth without subgingival restorations showed no statistical difference between narrow and wide zones of keratinized gingiva (P greater than 0.05).

Adult↗
PubMed1987

Clinical evaluation of porous and nonporous hydroxyapatite in the treatment of human periodontal bony defects.

The purpose of this study was to investigate the effectiveness of a synthetic nonporous hydroxyapatite graft material (OrthoMatrix HA-500), a porous replamineform hydroxyapatite graft material (Interpore 200), and a debrided control with respect to defect fill. Twelve adult patients having periodontitis and three similar angular osseous defects as verified by radiographic analysis and clinical probe depths greater than or equal to 5 mm were selected. Clinical parameters gathered prior to surgical intervention and at identified postoperative visits included plaque index, probing depth, and standardized radiographic examination. Customized acrylic stents were used as fixed reference guides for the insertion of endodontic silver points to the base of each defect during both initial and 6-month reentry surgeries. A total of 36 defects were randomly assigned to one of three treatment modalities such that 12 defects received OrthoMatrix HA-500, 12 received Interpore 200, and 12 served as debrided controls. Comparison of nonporous hydroxyapatite, porous replamineform hydroxyapatite, and debrided control treatment modalities revealed a statistically significant improvement (P less than 0.05) in the mean per cent of defect resolved in only those sites treated with nonporous hydroxyapatite. Similar positive trends were seen in the sites treated with nonporous hydroxyapatite for mean reentry defect depth and mean defect fill although these were not statistically significant (P greater than 0.05). No other significant differences were noted.

Adult↗