Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human

Introduction: The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage. Methods: 62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months. Results: The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick. Conclusions: The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

OBJECTIVES: The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). MATERIAL AND METHODS: 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B Cavitron(TM) FSI - SLI(TM) ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. RESULTS: The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. CONCLUSION: Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar

The Relationship Between Bleeding on Probing and Subgingival Deposits. An Endoscopical Evaluation

none4Background: Bleeding on probing (BOP) is an indicator of tissue inflammatory response to bacterial pathogens. Because anatomical limitations the entity and physical state of microbial aggregations located under the gingival margin and their relations to BOP have been hardly investigated till now. The recent introduction of the endoscopy has allowed clinicians to view the subgingival environment in a non-traumatic way. Aim of this study is to evaluate the correlation between BOP and subgingival deposits by using this new technology. Methods: At one-month revaluation of 16 periodontal patients treated with scaling and root planning, 107 teeth (642 individual sites) were evaluated for plaque index (PI), gingival index (GI), probing pocket depth (PPD), bleeding on probing (BOP), endoscopic biofilm index (EBI) and endoscopic calculus index (ECI). Results: A linear association between BOP and PD, EBI, and ECI was detected. The BOP provided a high level of specificity but quite low sensitivity values both for ECI (sensitivity 40%, specificity 86%) and EBI (sensitivity 37%, specificity 89%). The BOP sensitivity was directly linked to the amount of subgingival deposits. Conclusions: This study demonstrates a direct relationship between BOP and presence/amount of subgingival deposits. More investigations on larger samples are however needed.noneChecchi l.; Montevecchi M.; Checchi V.; Zappulla F.Checchi l.; Montevecchi M.; Checchi V.; Zappulla F

Nonsurgical and surgical periodontal therapy in single-rooted teeth

The purpose of this study was to compare the effect of tooth related and patient related factors on the success of non-surgical and surgical periodontal therapy. In 41 patients (22 female) with untreated and/or recurrent periodontitis, no therapy, scaling and root planing (SRP), or access flap (AF) were assigned according to probing pocket depth (PPD). PPD and vertical relative attachment level (RAL-V) were obtained initially, 3 and 6 months after therapy. Baseline data were compared according to therapy, jaw, tooth type, and site. Factors influencing clinical parameters were identified using multilevel analyses. Baseline PPDs were deeper interproximally, in the maxilla and at premolars compared to buccal/oral sites, mandibular, and anterior teeth. At 6 months, PPD reduction and RAL-V gain were significantly greater at sites receiving SRP and AF as compared to untreated sites (p < 0.001). PPD reduction and RAL-V gain were significantly less (p < 0.005) in smokers as compared to nosmokers and at interproximal sites (p < 0.0001) as compared to buccal/oral sites. RAL-V gain was less in aggressive periodontitis, and PPD reduction was less in the maxilla (p < 0.001). In sites with greater bone loss and infrabony defects, a poorer response was observed regarding RAL-V gain or PPD reduction, respectively. The conclusions of the study are the following: (1) Nonsurgical and surgical periodontal therapies are effective in single-rooted teeth; (2) severe interproximal bone loss and infrabony defects deteriorate clinical results; and (3) there seem to be more defect-associated (tooth, site) factors influencing treatment outcome than patient-associated factors

Histologic probe penetration in healthy and inflamed peri-implant tissues.

Periodontal probing is commonly used for assessing both the status of gingival health and the connective tissue attachment level around teeth. The role of probing around endosseous implants still remains unclear. The purpose of this study was to determine the histological level of probe penetration in healthy and inflamed mucosal tissues around implants. Five beagle dogs were used and a total of 30 one-stage, Titanium Plasma Spary (TPS)-coated implants of the ITI type were placed in the mandibles. After the healing period with meticulous oral hygiene, the dogs were divided into 3 groups: 1) clinical healthy mucosal tissues; 2) experimental mucositis (3 dogs); and 3) experimental ligature-induced peri-implantitis (2 dogs). Four months after implant placement, respectively 6 months in the third group, 60 probes were placed with a standardized force of 0.2 N and fixed at the mesial and distal aspects of the implants. Probing depth, clinical attachment level (CAL), Plaque Index (PlI) and Gingival Index (GI) were assessed throughout the study. Tissue sections were obtained for histometrical analysis. In the healthy group, the mean PII was 0.47, the GI 0.06 and the clinical probing depth (CPD) 2.12 mm. In the mucositis group the PlI was 1.61, the GI 1.61 and the CPD 1.87 mm. In the peri-implantitis group the PlI was 1.96, the GI 2.05 and the CPD 3.73 mm. The histologic results show that the probes were able to identify the connective tissue adhesion level in the healthy group with a mean error of -0.05 mm (mean histologic probing depth (HPD): 1.75 mm) and, in the mucositis group, with -0.02 mm (mean HPD: 1.62 mm). Probe penetration increased with the degree of inflammation and in the peri-implantitis group the probe exceeded the connective tissue level by a mean 0.52 mm (mean HPD: 3.8 mm). Therefore, probing around implants represents a good technique for assessing the status of peri-implant mucosal health or disease.link_to_subscribed_fulltex

Attempts to obtain re-osseointegration following experimental peri-implantitis in dogs

The purpose of this study was to examine the healing potential and reosseointegration in peri-implant infection defects adjacent to various implant surfaces. In 7 female Beagle dogs, a total of 41 titanium oral implants (ITI, Straumann, Waldenburg; Switzerland) with a sink depth of 6 mm (diameter 2.8 mm) were placed transmucosally. Four different surface configurations (TPS: titanium plasma sprayed (10); SLA: sand blasted and acid-etched (13); M: machined and smooth (11); TPS furc.: titanium plasma sprayed with coronally placed perforation to mimic a furcation (7) were distributed among the animals and locations. Following a healing period of 3 months, silk ligatures were placed and oral cleaning procedures abolished for 4 months to induce a vertical bone loss of about 40%. Following mechanical and chemical cleansing (chlorhexidine and metronidazole) and disinfection, the lesions were either sham operated (11) or subjected to a GTR procedure using ePTFE (30). After 6 months of healing the animals were killed and the jaws histologically evaluated. Six membranes were lost TPS: (1); SLA: (2); M: (2); TPS furc: (1) and 3 membranes exposed TPS: (1); M: (2) and excluded from further evaluation. Owing to the loss of 1 implant and infection of the membranes in the TPS furc group, this implant configuration was discarded from further analysis. For TPS surfaces, bone fill was 2.6 mm (73% of the distance from the bottom of the defect to the shoulder of the implant) sites with (4 GTR) and 0.33 mm (14%) for sites without membrane (2 controls). Re-osseointegration was 0.5 mm (14%) in the test group and 0.3 mm (14%) in the control. For SLA surfaces bone fill was 2.3 mm (83%) for sites with (7 GTR) and 0.41 mm (15%) for sites without membranes (4 controls). Re-osseointegration was 0.6 mm (20%) and 0.3 mm (11%) respectively. Corresponding values for M surfaces were 2.2 mm (62%) with 4 GTR) and 0.82 mm (31%) without membranes. Re-osseointegration was 0.07 mm (2%) and 0.19 mm (7%) respectively. This study has documented that peri-implant infections defects may heal with bone fill provided that the infection is controlled through effective antibacterial therapy. However, true reosseointegration appears to be difficult to achieve. Copyright © Munksgaard 1999.link_to_subscribed_fulltex