Root surface conditioning in periodontal treatment

Marginal periodontal healing following both invasive and non-invasive therapies is influenced by a large number of systemic and local factors. In order to optimize healing, a lot of effort is put into minimizing possible sources of infection both in performing different periodontal therapies as well as during the healing period. Mechanical root surface debridement inevitably produces an infected smear layer which covers the exposed mineralized root surface. The overall aim of the studies on which the present thesis is based, was to characterize how the nature of the root surface may modify the quality of periodontal healing tissues. The general working hypothesis was that a smear-free dentin surface in which collagen has been exposed provides a more biocompatible surface for periodontal healing compared to a mineralized and smear covered root surface. This thesis is based on experimental in vitro (I-V,X), in vivo (II,VI-VIII) and in situ (IX,X) studies. Pre-clinical confirmation of the efficacy of EDTA in removing both smear and exposing collagen on a root surface was obtained before the beneficial effect of the procedure was established in vivo as well as its clinical utility. Similarly, previously recommended etching procedures were studied and their low pH appeared to impair healing as seen both in the initial cellular event in colonization of denuded root surfaces (II) and in a necrotizing effect on healthy periodontal tissue in the vicinity of an experimental periodontal wound (VI). Marginal periodontal healing after several weeks appeared also to suffer from etching at low pH while etching at neutral pH appeared not to interfere with spontaneous healing (VII,VTII). The results from the in situ studies indicate that the different root surface debridement and etching procedures functioned along the same principles as observed in vitro with some modifications probably due to influence from the surrounding tissues, blood and the nature of the periodontitis affected root surfaces (IX,X). Two principally different areas of clinical use for EDTA etching are evident: Firstly, in conventional non-surgical and surgical periodontal therapy to remove smear in order to minimize post-surgical infection. Secondly, in regenerative procedures to expose an intact collagenous matrix which may provide for retention of implants of biologically active substances such as growth factors in addition to serving as a biocompatible surface for periodontal ligament cell colonization

Analgesic efficacy with rapidly absorbed ibuprofen sodium dihydrate in postsurgical dental pain : results from the randomized QUIKK trial

OBJECTIVE: To evaluate the onset of analgesic effect for a new formulation of ibuprofen sodium dihydrate versus conventional ibuprofen (ibuprofen acid). MATERIALS AND METHODS: In this randomized, double-blind, double-dummy, crossover trial, patients requiring surgical removal of two impacted or partially impacted mandibular third molars received: ibuprofen sodium dihydrate 400 mg plus conventional ibuprofen placebo (Group 1); or conventional ibuprofen 400 mg plus ibuprofen sodium dihydrate placebo (Group 2) following the first surgery. Patients were then crossed over to the alternative treatment. RESULTS: 72 patients were enrolled in Group 1 and 72 patients in Group 2. Ibuprofen sodium dihydrate produced faster initial pain relief than conventional ibuprofen as assessed by time to first pain relief (24.6 vs. 30.5 minutes; p = 0.004), and patient-assessed pain relief at 15 minutes ("some" to "complete" pain relief: 43% vs. 29%; p < 0.001) and 30 minutes (82% vs. 63%; p < 0.001) and pain intensity at 30 minutes (p < 0.001). Substantial pain relief with ibuprofen sodium dihydrate was twice that of conventional ibuprofen at 30 minutes (11% vs. 5%; not significant); 29% and 33% of patients did not reach substantial pain relief at 120 minutes. There were no adverse events leading to treatment discontinuation and only two serious adverse events (oral abscess and facial paresis with conventional ibuprofen) considered unrelated to treatment. CONCLUSIONS: Ibuprofen sodium dihydrate was as effective as conventional ibuprofen, but had a faster onset of initial pain relief and significantly reduced pain intensity within the first 30 minutes after administration, providing rapid clinically meaningful pain relief for patients