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Biomedical subjects

R G Caffesse

Publications and source records attributed to R G Caffesse.

At least 19 recordsLinked to original sources
PubMed1992

A randomized trial of occlusal adjustment in the treatment of periodontitis patients.

The purpose of the randomized clinical trial was to test; (1) the influence of occlusal adjustment (OA) in association with periodontal therapy on attachment levels, pocket depth, and tooth mobility, (2) whether OA was of greater significance in non-surgically treated periodontal defects, and (3) whether initial tooth mobility or disease severity had an affect on post-treatment attachment levels following OA. After hygienic-phase therapy, 50 patients received OA/No OA according to random assignment; 22 patients received an OA and 28 were not adjusted. 2 months after OA, either modified Widman flap surgery or scaling and root planing by a periodontist were done according to random assignment within each patient in a split-mouth design. Following active treatment patients were maintained with prophylaxis done every 3 months and scored annually. For the analysis of this two-year data, a repeated measures analysis of variance was performed using attachment level change and pocket depths as outcome indicators. There was significantly greater gain of clinical periodontal attachment in patients who received an OA compared to those who did not. Both the surgically and non-surgically treated sides of the mouth responded similarly to OA. There was no affect of OA on the response in pocket depth, nor did initial tooth mobility or initial periodontal disease severity influence the response to OA.

Adult↗
PubMed1992

In vitro effects of citric acid application techniques on dentin surfaces.

The present study evaluated the in vitro effects of different application techniques of citric acid on dentin root surfaces. Ten freshly extracted, periodontally involved teeth were obtained and 4 dentin slabs, approximately 4 x 6 x 2 mm, were obtained from the roots of each tooth, for a total of 40 slabs. These slabs were identified by tooth and preserved in 1:1 anhydrous glycerol/absolute alcohol solution. Citric acid pH 1 was applied to 32 of the slabs for 5 minutes with one of 4 different techniques: 1) immersion; 2) placed with a saturated cotton pellet with no rubbing; 3) placed and burnished with a saturated cotton pellet; or 4) applied with a camel hair brush. The remaining 8 dentin slabs were used as negative control specimens, root-planed and non-acid treated. Following the various treatments, the slabs were fixed, dehydrated, critical point dried, and coated for scanning electron microscopic (SEM) evaluation. Scanning photomicrographs were obtained at 2,000, 6,000, and 40,000 magnifications. The surface characteristics of the treated dentin slabs were evaluated descriptively regarding the degree of fiber exposure; the number of exposed tubules and the surface area occupied by tubule orifices were also measured. Friedman's 2-way analysis for block designs was employed. Results demonstrated that root-planed, non-acid treated specimens had an amorphous, irregular surface which corresponded to a smear layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1991

Periodontium response to a root canal condensing device (Endotec).

Two Macaca (fascicularis) monkeys were used to study the effect of two warm endodontic condensation techniques (Endotec and vertical condensation method) on periodontal tissues. The specimens were histologically evaluated at 3 and 32 days after the endodontic treatments were completed. In this study the periodontium was divided into coronal, middle, and apical thirds. Results indicated that there was no heat-related damage to periodontal tissues from either of the two methods employed. However, some Endotec specimens generated small, reactive inflammatory infiltrates that were restricted to the root canal opening or adjacent periodontal membrane. Similarly, some vertical condensation specimens developed periapical inflammatory processes as well, but they were more extensive and comprised the alveolar bone and marrow spaces.

Animals↗
PubMed1991

Periodontal healing following guided tissue regeneration with citric acid and fibronectin application.

This study was undertaken to determine the effects of guided tissue regeneration (GTR) with and without citric acid conditioning and autologous fibronectin application. The study subjects were four female beagle dogs with spontaneous periodontitis. The dogs were given thorough root debridement and 4 weeks later, mucoperiosteal flaps were raised on both sides of the mandible involving the 2nd, 3rd, and 4th premolar and 1st molar teeth. After debridement, notches were placed on the roots at the level of supporting bone. Citric acid (pH 1) was topically applied for 3 minutes on the exposed root surfaces of one side (experimental). The roots were irrigated with normal saline solution. Both the root surfaces and the inner surface of the flap were then bathed in autologous fibronectin in saline. Following this, Gore-Tex periodontal material was adapted to the roots of each tooth and sutured. The contralateral side, serving as control, was treated by surgery and application of Gore-Tex periodontal material only. All membranes were removed 1 month after surgery, and the dogs sacrificed at 3 months. Both mesio-distal and bucco-lingual microscopic histological sections were evaluated by descriptive histology, and linear measurements and surface area determination of the furcal tissues were made. Periodontal healing following the use of GTR procedure resulted in an increase in connective tissue and alveolar bone regeneration. Adjunctive critic acid plus autologous fibronectin produced slightly better results, but these differences were not statistically significant for this sample.

Acid Etching, Dental↗
PubMed1991

Principles and techniques of guided tissue regeneration.

Guided tissue regeneration is an accepted technique to promote new attachment in periodontal therapy. It is supported by sound basic research indicating that the definitive factor in the obtainment of regeneration is the source from which the cells repopulating the exposed root surface originate. These studies have indicated that cells proliferating from the periodontal ligament have the greatest potential for achieving new attachment. The use of barriers during periodontal surgery permits the possibility of periodontal ligament proliferation toward the exposed root at the same time that epithelial and gingival connective tissue proliferation is blocked. Studies in which Gore-Tex periodontal material has been used as a barrier have shown positive results in animal and clinical studies. Histologically, the formation of new cementum, bone, and periodontal ligament has been demonstrated. Clinically, beneficial results have been documented in the treatment of intrabony defects with three-wall, two- to three-wall, or funnel-shaped topography. Also, Class II furcations with or without a vertical component have been treated successfully by guided tissue regeneration.

Animals↗
PubMed1991

Correlation of periodontal probe penetration and degree of inflammation.

This histological study correlated the depth of probe penetration to periodontal health in mongrel dogs. Various probing forces were also applied with an electronic pressure-sensitive probe and compared to manual probing. Three adult mongrel dogs with naturally occurring periodontitis in at least one quadrant were selected and gross scaling was only performed in these diseased areas. Mild gingivitis was diagnosed in other areas. One half was scaled and placed on a plaque control regimen to restore clinical health, while the other half remained untreated to maintain the existing gingivitis. The Gingival Index (GI) was recorded on 24 teeth achieving equal representation of different GI values. Probe tips were inserted utilizing manual pressure as well pressures of 15 and 25 gm directed with an electronic pressure-sensitive probe. The probes were bonded to the teeth, and the specimens were sacrificed. Blocks with the probes in place were fixed and decalcified. The probes were removed prior to processing. Sections from each probing site were microscopically analyzed, and the distance was recorded from the tip of the probe to the apical termination of the junctional epithelium (ATJE). The number of inflammatory cells was documented for two fields at x200, one coronal (X) and one apical (Y) to the penetration of the probe's tip. The data were analyzed by two-sample t-test and Pearson product-moment correlation coefficient. A strong correlation was established between probe penetration and degree of inflammation, X (r = 0.6936) and Y (r = 0.7075). The difference in mean inflammation scores between probes coronal or apical to the epithelium was highly significant (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Natural history of periodontal disease in adults: findings from the Tecumseh Periodontal Disease Study, 1959-87.

The purpose of this epidemiological study was to estimate the degree of change in periodontal attachment level in a sample of adults examined in 1959 and 1987 in Tecumseh, Michigan. Out of 526 individuals between the ages of five and 60 years in 1959, a sample of 325 resided within an 80-km-radius area in 1987. Of those, 167 were re-examined. Loss of periodontal attachment (LPA) was determined with a Michigan #0 probe on four tooth sites (disto-buccal, mid-buccal, mesio-buccal, mid-lingual) for all teeth present. Of the individuals contacted, 28 had lost all their teeth during the 28 years. Of the 167 adults examined, two refused periodontal probing. Out of the 165 adults with LPA measurements in 1987, only 22 (13.3%) had an average increased loss of 2 mm or more per person between 1959 and 1987; five adults (3.0%) had an average LPA increase of 3 mm or more, and only two adults (1.2%) had an average LPA increase of 4 mm or more. The attachment level in 59.3% of all the tooth sites examined in 1959 in the 165 individuals either did not change or changed within +/- 1.0 mm. On the basis of bivariate analyses, the individuals with high LPA increase (greater than or equal to 2 mm) had the following characteristics significantly different from those with low LPA increase: They were older, smoked, had tooth mobility at baseline, higher gingivitis, plaque, calculus, and tooth mobility scores at follow-up, lower education level, and irregular dental attendance.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1990

Furcation defects in dogs treated by guided tissue regeneration (GTR).

This study evaluated the effects of guided tissue regeneration (GTR) in the treatment of Class II furcation defects in beagle dogs. Gore-Tex periodontal material was used, and the amount of furcation fill and the surface area corresponding to new connective tissue attachment and new bone were evaluated. If present, epithelium was also evaluated. Six female dogs with naturally-occurring periodontitis were given thorough root debridement. Four weeks later mucoperiosteal flaps were raised, involving the mandibular 2nd, 3rd, and 4th premolar and 1st molar teeth. After debridement, notches were placed on the roots at the level of furcal alveolar bone. Gore-Tex material was adapted to the furcation and secured with sutures on two teeth of each quadrant. The flaps were sutured tightly, making sure the margin of the material was covered. Teeth receiving only surgery acted as controls. Gore-Tex material was removed 1 month following surgery. All dogs were sacrificed by exsanguination at 3 months. Mesiodistal sections were evaluated by descriptive histology. Surface area determination of the furcal tissues was carried out using a microscope attached to a computerized digitizer. Approximately 10 serial sections per tooth were evaluated. Mean values for each dog were obtained for experimental and control teeth and analyzed using paired t-tests (N = 6) to see whether different treatments had any effect on the parameters tested. Different degrees of fill were seen with epithelium, new connective tissue, and bone. Statistically, GTR gave significantly better results in the amount of connective tissue and bone fill achieved.

Alveolar Process↗
PubMed1990

Class II furcations treated by guided tissue regeneration in humans: case reports.

In the cases reported here, the response of Class II mandibular molar furcation defects to guided tissue regeneration (GTR) versus sham operation was evaluated. Base-line information, including probing pocket depth (PD) and clinical attachment level (CAL) measurements, was recorded after completion of the hygienic phase. Eleven experimental and six control furcations, randomly assigned, are included in this report. The furcations were surgically exposed, using a flap approach and the areas were debrided. On the experimental teeth, Gore-Tex periodontal material was adapted and sutured, using a suspensory suture. The flaps were then sutured tightly, assuring complete coverage to the material. For 1 month all patients were seen weekly and rinsed their mouths with an 0.12% chlorhexidine solution daily. After 4 to 6 weeks the Gore-Tex membranes were removed. Clinical measurements were repeated at 3 and 6 months following surgery. Changes from baseline in PD and CAL were calculated for each case. Results indicated that PD measurements were reduced by both procedures, but the reduction was better for GTR at 3 and 6 months. At six months the test sites showed 2.8 +/- 1.0 mm pocket reduction, while the control sites showed an average of 1.6 +/- 0.9 mm reduction in pocket depth. CAL recordings were improved by both treatments, but were better for GTR at 6 months, with an average gain in CAL of 1.8 mm for the GTR and 0.6 mm for the controls. These cases in which GTR was compared to sham-operated controls indicate that GTR can improve the response to therapy of Class II furcation defects.

Adult↗
PubMed1990

Diagnostic discrimination of bleeding on probing during maintenance periodontal therapy.

The purpose of this study was to test the diagnostic discrimination of bleeding on probing in a group of 71 patients who have been treated for periodontitis. They have been maintained over 5 years receiving prophylaxis every 3 months and clinical evaluation once a year. 1,746 teeth were used and extracted and retreated teeth were not included. The presence or absence of bleeding on probing was recorded for each tooth over the five yearly examinations. After recording the site variations between the 1st and the 5th year maintenance values, the highest value of attachment loss per tooth was selected. Teeth were considered diseased when they presented at least one site with 4 mm of probing pocket depth at the baseline (year 1) and 2 mm of attachment loss after 5 years (Criterion 1), or showed 3 mm of attachment loss after 5 years (Criterion 2). The prevalence of disease was 8.19% (143 teeth) for Criterion 1 and 19.7% (344 teeth) for Criterion 2. Bleeding on probing 2 times presented the highest sensitivity (86% Criterion 1 and 64.5% Criterion 2) and the lowest predictability (11.9% Criterion 1 and 21.4% Criterion 2). Bleeding on probing frequency = 5 times showed the highest specificity (93.6% Criterion 1 and 93.4% Criterion 2) and predictability (93.4% Criterion 1 and 81.5% Criterion 2). These results demonstrated that bleeding on probing may not be substituted for clinical attachment levels when evaluating the periodontal attachment loss over time. However, the high specificity and predictability of these tests as a negative one suggests that absence of bleeding after probing may be a good indicator of maintenance of periodontal attachment levels over time.

Epithelial Attachment↗
PubMed1989

Concentrations of fibronectin in the sera and crevicular fluid in various stages of periodontal disease.

While fibronectin (FN) has previously been demonstrated to be present in gingival crevicular fluid (GCF), its quality and quantity has not been reported. Since this information is relevant for ongoing studies on the use of FN for gingival reattachment, we performed these measurements and compared plasma levels in healthy subjects, patients with gingivitis and periodontitis, and in patients undergoing maintenance therapy. Plasma and GCF samples were obtained from 4 sites in each subject using a Periotron to permit quantification of samples. FN concentrations were determined in a microELISA using hyperimmune anti-FN antibody. Purified FN served as a reference for quantification. The functional activity of each sample was assessed by examining the natural affinity of FN for gelatin. Subjects with gingivitis and those in maintenance had significantly depressed levels of plasma fibronectin. While little fibronectin could be detected in the GCF of healthy sites regardless of patient category, examination of the most diseased sites in each group revealed that the concentration of FN in the GCF was highest in health and reduced when there was gingival inflammation. In no case was GCF FN found to be biologically active.

Adult↗
PubMed1988

Clinical effects of electromagnetic stimulation as an adjunct to periodontal therapy.

The clinical effects of electromagnetic stimulation (EMS) on periodontal soft tissues and alveolar bone level were studied among 23 patients. The sides of the arch to receive EMS were randomly selected and exposed for a period of eight weeks following periodontal surgery. The contralateral control sides received surgery only. The electromagnetic signal was a multiple pulse signal with 21 asymmetrical quasirectangular pulses per burst and a burst frequency of 16.9 Hz. The peak magnetic field strength reached 0.46 Gauss. Changes from baseline in clinical attachment level, probing depth, and radiographic alveolar bone level were assessed at six, 12, and 18 months postsurgically. A greater gain of clinical attachment level following EMS was observed only for pockets with initial depth of 1 to 3 mm. There were no consistent differences between test (EMS) and control sides in the change of clinical attachment level or probing depth for pockets deeper than 4 mm. Radiographically, the test sides demonstrated statistically significant gain of alveolar bone level compared with the control sides at six months following surgery. Hereafter, the rates of change were similar in the stimulated and unstimulated sides, and the total gain of alveolar bone level remained greater in the test side throughout the observation period. Within the limitations of this study, it was concluded that electromagnetic stimulation does not promote gains in clinical attachment or alveolar bone level to the extent that it can be recommended as an adjunct to conventional periodontal therapy.

Adult↗
PubMed1988

Clinical evaluation of the use of citric acid and autologous fibronectin in periodontal surgery.

This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy.

Adult↗
PubMed1988

New attachment achieved by guided tissue regeneration in beagle dogs.

This study tested the effects of using a Gore-Tex periodontal material on new connective tissue attachment in beagle dogs with natural periodontitis. Seven female beagle dogs with advanced periodontitis were selected and given thorough root debridement. Under general anesthesia four weeks later, mucoperiosteal flaps were raised involving all mandibular premolars and first molars. Gore-Tex periodontal material was adapted to all premolars, and the flaps were sutured tightly, keeping the material covered. The first molars acted as controls, receiving only surgery. Some material was removed in one month, while other materials were removed eight to 10 weeks after surgery. All dogs were sacrificed at three months. After processing, descriptive histology and histometrics were carried out, evaluating new connective tissue attachment, bone response and epithelial downgrowth. Results were statistically analyzed, using paired t tests. They showed new connective tissue attachment with cementum deposition in areas where the material was used. Also, the epithelial downgrowth was reduced in these areas. In the controls, minimal connective tissue attachment was found, with the area healing by a long junctional epithelium. Statistical analysis showed significant differences (P less than 0.05) favoring experimental areas both in the increase of new connective tissue attachment and in the decrease of epithelial downgrowth. No differences were found between areas where the material was removed in one month or left longer in place. No difference in bone response was found. Gore-Tex material was effective in blocking gingival epithelial downgrowth and connective tissue proliferation, promoting new attachment according to the principle of "guided tissue regeneration."

Alveolar Process↗