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PubMed1979

The attachment between tooth and gingival tissues after periodic root planing and soft tissue curettage.

Utilizing a nonhuman primate model, a study was carried out to determine the nature of the attachment between the tooth and the gingival tissues following periodic root planing and soft tissue curettage. Under the conditions of this investigation, periodic root planing and soft tissue curettage combined with thrice weekly plaque control resulted in the formation of a long junctional epithelium with no new connective tissue attachment. In eight of the 22 experimental pockets, however, this procedure produced discontinuities or "windows" in the junctional epithelium. The coronal attachment of gingival tissues to the root surface (increased resistance to probing) commonly reported following root planing and soft tissue curettage appears to result from the formation of a long junctional epithelium rather than new connective tissue attachment.

Animals↗
PubMed1992

Apical closure of an immature root subsequent to apical curettage.

A 7-year-old female presented with a history of trauma to the mandibular central incisor resulting in pulpal necrosis and soft tissue swelling. During apexification treatment, an ultrasonic file was separated and lodged in the periapical tissues. Surgical retrieval of the broken instrument resulted in complete curettage of the periapical tissues. Apical closure occurred following intracanal calcium hydroxide therapy. The findings suggested that hard tissue barrier formation occurred despite the absence of Hertwig's epithelial root sheath and local periapical tissues.

Calcium Hydroxide↗
PubMed1978

Evaluation of student performance in the four-year study of expanded functions for dental hygienists at the University of Iowa.

A comparison was made of the quality of selected operative and periodontal procedures completed by expanded-function dental hygiene and senior dental students. Each student group included 48 students selected from all academic quartiles of their respective classes. The evaluated operative procedures included a Class II preparation and amalgam restoration and a Class III preparation and composite restoration. Both operative procedures were completed twice, once on a patient and once on a Dentoform. The periodontal procedures were completed on patients and included a periodontal examination, a periodontal treatment plan, and one quadrant of root planing and soft tissue curettage. Three examiners independently rated each student's performance in an examiner-blind situation. Examiners judged numerous criteria for each procedure as satisfactory or unsatisfactory. In addition, an overall rating of excellent, clinically acceptable, or unacceptable was given to each procedure. Comparisons between student groups of the time required to complete procedures showed that dental students completed cavity preparations of all operative procedures and quadrants of root planing and curettage in significantly less time than did dental hygiene students. For restorations, periodontal examinations, and treatment plans, there was no significant difference between student groups in the time required to complete procedures. In general, the results of the study showed that the dental hygiene students were able to perform selected operative and periodontal procedures at a comparable level to that of senior dental students.

Clinical Competence↗
PubMed1976

Apical curettage as a treatment of acute periapical inflammation.

In 16 incisors, one canine, and one premolar with an acute periapical infection which had perforated the cortical bone, an apical curettage was carried out. During the treatment and the following 5 days, the patients were protected with antibiotic therapy. The curettage was performed through a slightly arched incision, convex toward the gingival margin. At the same sitting, a guttapercha root filling was made in the conventional way. Irrespective of operation, which involved a somewhat larger than normal incision, no spread from local to general infection was found in any of the cases. The patients were free from pain and other symptoms of infection after one treatment. In the radiographic examinations carried out from 6 to 12 months and 3 years later, it was found that 50% of curetted roots showed complete healing, 33% were uncertain and 17% were unsatisfactory. Bone formation was most rapid during the first postoperative year, after which it decreased. The bone formation was also most rapid in larger lesions but decreased, even in these, when it advanced to the vicinity of the root.

Acute Disease↗
PubMed1979

The effect of splinting on tooth mobility. I. During initial therapy.

The purpose of this study was to assess whether fixed splinting aided in the reduction of posterior tooth mobility during initial therapy. A "split-mouth" approach was used in order to compare splinted segments with similar unsplinted segments. Seven patients were selected, all of whom demonstrated chronic destructive periodontitis and mobile teeth. Initial therapy, consisting of oral hygiene instruction, root curettage and occlusal adjustment, was performed over a 2-week period. At the time of initial therapy, teeth in contralateral segments were splinted with an intracoronal wire-and-acrylic splint. Tooth mobility and gingival inflammation were recorded in all four segments every 3 weeks for a 15-week monitoring period following initial therapy. The splints were removed before each data recording session and then replaced and the occlusion refined. Prophylaxis and oral hygiene instruction were repeated every second week throughout the monitoring period. The reduction in the mobility of teeth splinted during the entire therapy period did not differ from the reduction observed in the unsplinted segments. The reduction in tooth mobility observed in both the splinted and unsplinted segments over the 17-week period can be attributed to the improved occlusal relationships and reduction in inflammation.

Adult↗
PubMed1975

A comparative clinical study of three periodontal surgical techniques.

A comparative 4-month trial was performed after initial preparation. The procedures used were curettage, replaced flap and apically repositioned flap procedures with osseous recontouring respectively in a split-mouth technique in 17 male and 23 female patients, 22 to 65 years old. Changes were assessed with plaque and gingival indices, and measurements of pocket depths, attachment levels and tissue contours. All procedures reduced pocket depths. Apically repositioned flaps were the most successful, reducing overall mean pockets from 3.5 to 1.9 mm. Changes in attachment levels post-operatively showed only a small degree of variation among the three surgical procedures, and would not affect the choice of the apically repositioned flap as the most effective method for pocket reduction. A marked improvement in tissue contour was obtained in those areas treated by apically repositioned flap procedures and osseous recontouring. Despite failure to improve tissue contour, replaced flap procedures showed an equal degree of success in maintaining plaque control when compared to apically repositioned flaps, as evidenced by static plaque indices. Replaced flap procedures were also the only group to show improved gingival health over the 4-month post-operative period with lower gingival indexes. It would seem that good healing, followed by a high standard of oral hygiene, may overcome the presence of gingival and marginal osseous deformities.

Adult↗
PubMed1978

Induced reattachment in periodontic-endodontic lesions by root demineralization in situ.

A new method of root preparation to enhance reattachment of gingival tissues to root dentin has been developed through extensive animal research. The improved technique may aid periodontists and endodontists in the management of deep combined lesions. This article reviews essentials of experimental animal data and presents case reports of three different clinical approaches to combined lesion closure attempts utilizing surgical and chemical root preparation.

Adolescent↗
PubMed1979

Dental management of leukemic patients.

Three cases involving the oral management of patients with acute leukemia are described. Of particular interest is that the patients had abnormal responses to oral disease, probably related to their compromised host defenses. Because of the difficulty in treating oral disease in leukemic persons while they are undergoing chemotherapy, it is extremely important that such patients have dental evaluations and, if possible, treatment prior to initiation of medical management for their neoplasia.

Acute Disease↗
PubMed1975

The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease.

The present clinical study was initiated in 1969 to test the hypothesis that microbial plaque is the cause of periodontal disease and that hence even advanced cases of periodontitis can be cured in patients willing to exercise optimal plaque control. The material consisted of 75 patients with severe destruction of the periodontal tissues. The patients were selected for the study because of their ability to maintain plaque-free dentition. Following an initial examination, a preliminary treatment plan was presented to the patients. This plan included detailed instructions in plaque control measures, scaling, root planning and emergency dental care, including endodontic therapy and extractions. Three to six months after the termination of the so-called presurgical treatment, surgical elimination of pathologically deepened pockets was performed. The patients were recalled every 3 to 6 months after the end of the treatment. At these reexaminations the following parameters were assessed: Plaque Index, Gingival Index, Pocket Depths, Marginal alveolar bone topography and height. The results demonstrate that it is possible to treat periodontal disease successfully, even in advanced stages, in patients willing to maintain plaque-free dentition.

Adult↗
PubMed1977

Influence of "time of day", pocket depth and scaling on gingival fluid flow.

Gingival fluid was sampled from the orifices of the gingival crevices in five male subjects with clinically healthy gingiva. The sampling was performed at 0915 h, 1215 h and 1515 h of the same day. Variation in "time of day" did not seem to influence the rate of gingival fluid flow. A total of 144 pockets (2-11 mm) in 19 patients were sampled for gingival fluid at the orifices. The adjacent gingiva was evaluated accordingly to the Gingival Index (GI). Gingival fluid flow was much more influenced by the degree of gingival inflammation than by pocket depth. Scaling with curettes was performed in five patients. Gingival fluid was sampled at the orifices immediately before scaling and on days 1, 14 and 28 after scaling. The flow rate decreased to a minimum on day 14 after scaling for all pocket depths and remained at almost the same level until day 28. Pockets less than 5 mm deep were more frequently without measurable amounts of fluid than pockets deeper than 5 mm on days 14 and 28.

Adult↗
PubMed1977

Root surface roughness in response to periodontal instrumentation studied by combined use of microroughness measurements and scanning electron microscopy.

Root surface roughness, resulting from calculus removal by hand curette, ultrasonic curette and rotating diamond or Roto-Pro points, was examined by combined use of microroughness measurements and scanning electron microscopy (SEM). Mandibular incisors were placed in a jaw model with a rubber "gingiva" in an attempt to simulate a clinical situation. After cleaning with the various instruments, the surface roughness was measured by an industrial profilometer followed by SEM evaluation. A microroughness index (MRI) was developed and showed that the instruments could be separated into three groups, where the hand curette produced least roughness, followed by the Roto-Pro instrument, while the ultrasonic curette and the diamond left the most uneven surfaces. A SEM roughness index (SRI) based on defined criteria, corresponded well with the results from the profilometer measurements, except that using this index the diamond scored higher than the ultrasonic curette. This was probably due to considerable calculus remnants remaining in the ultrasonic specimens. Characteristic features of the root surface morphology of the cleaned teeth are described. It is concluded that the combined use of microroughness measurements and SEM is of considerable value in this type of studies since more information may be obtained than by any of these methods used separately.

Dental Calculus↗
PubMed1979

Clinical improvement of gingival conditions following ultrasonic versus hand instrumentation of periodontal pockets.

A study utilizing a split-mouth design in 18 subjects and with four operators was performed in order to compare the effect of hand and ultrasonic instrumentation of periodontal pockets. Contralateral pairs of teeth with pockets of comparable depth were treated by either hand or ultrasonic instruments. Instrumentation was repeated after 4 weeks. Pocket depth, bleeding on probing and gingival fluid measurements were used for evaluation. A gradual reduction of pocket depth and number of bleeding points took place throughout the 8-week experimental period. Clinically significant differences were not observed comparing the effect of hand instruments to ultrasonics for any of the operators. The amounts of gingival fluid were similar for both methods of instrumentation at the final examination. Thus, the present study failed to demonstrate any significant differences between the effect of ultrasonic root debridement and hand instrumentation in the treatment of 4-6 mm deep periodontal pockets.

Adult↗
PubMed1976

Periodontal health following fibrotomy of the supra-alveolar fibers.

A clinical follow-up study has been carried out in order to study the periodontal health of orthodontically derotated teeth where the supra-alveolar fibers have been severed by an incision through the bottom of the marginal pocket to the border of the alveolar bone in order to reduce the tendency towards a posttreatment relapse. The material consisted of 30 rotated teeth treated orthodontically in 27 patients between the ages of 9 and 22 years. Following an average retention period of 8.3 months, the supra-alveolar fibers were severed down to the alveolar bone border. The control material consisted of untreated, banded contralateral teeth in the same jaw. The patients were examined for plaque, gingival health and depth of the marginal pockets. No significant difference in periodontal health could be found on comparison between, on the one hand, teeth treated with fibrotomy and, on the other hand, untreated teeth.

Adolescent↗
PubMed1978

Ultrastructure of the subgingival microflora in juvenile periodontitis.

The ultrastructure of the subgingival deposits on the root surfaces of teeth affected by juvenile periodontitis was studied on 12 teeth from nine individuals, 15--30 years of age. The deposits consisted of either microbial masses associated with a pellicle, or of a cuticular material almost free of bacteria. Gram-negative rods and filaments were the predominant microorganisms. "Corncob" configurations consisting of filamentous bacteria surrounded by Gram-positive cocci, and "bristle brush" formations comprising corncobs surrounded by long rods were observed in the superficial layer of the plaque. Spirochetes and flagellated rods constituted a major segment of the microflora. The present data indicated that the deep pockets in juvenile periodontitis harbor a sparse but relatively characteristic microbial population.

Adolescent↗