Immunological aspects of periodontal diseases. Prospects for diagnosis and therapy | Immunoloigsche Aspekte marginaler Parodontopathien. Ausblick auf Diagnostik und Therapie.

Achievements in bacteriology and immunology have significantly contributed to the understanding about the etiology and pathogenesis of periodontal diseases. Studies have demonstrated that interactions between bacteria and the immune system play a central role in the etiology of periodontal disease. In the immune system four components can be distinguished according to their function in the periodontium. These include a) the secretory system; b) the polymorphonuclear leukocytes, antibody and complement system; c) lymphocytes and monocytes; d) the immunoregulatory system. Polymorphonuclear leukocytes are of utmost importance for the maintenance of periodontal health. In neutrophil defects severe periodontal diseases are frequently found. Prepubertal periodontitis, juvenile periodontitis and rapidly progressing periodontitis are examples for the periodontal manifestation of neutrophil defects. Therapy of periodontal disease that is related to immune defects requires a modified treatment plan. Efforts are being made to extend the diagnosis, prevention and therapy of periodontal diseases. Presently, biochemical, immunological and microbiological methods are being evaluated for their clinical applicability. Preliminary results indicate that, in the future, biochemical markers in the gingival crevicular fluid may be used for the diagnosis of active sites. Therapy may be enhanced by the administration of non-steroidal anti-inflammatory drugs and specific antimicrobials. However, before these methods can be applied in clinical periodontics, further long-term studies are needed.link_to_subscribed_fulltex

Efficacy of systemically administered acetylsalicylic acid plus scaling on periodontal health and elastase-α1-proteinase inhibitor in gingival crevicular fluid

The purpose of this proof of principle trial was to assess whether conventional periodontal therapy and systemically administrated acetylsalicylic acid (ASA) are functionally synergistic when combined in the treatment of periodontitis. A total of 30 patients with untreated moderate to severe adult periodontitis were enrolled into the study and were given placebo q.i.d. between the baseline and 6-week examination, and acetylsalicylic acid (ASA) 500 mg q.i.d. between the 6-week and 12-week examinations. In addition, they received supraand subgingival scaling in 1 quadrant after baseline examination and in 2 further randomly selected quadrants after the 6-week examination. The study design resulted in the following 4 therapies: (1) scaling plus ASA 500 mg q.i.d.; (2) scaling plus placebo q.i.d.; (3) ASA 500 mg q.i.d. alone; (4) placebo q.i.d. alone. Two-way analysis of variance showed functional synergism of ASA and scaling, resulting in a therapeutic efficacy approximately equivalent to the sum of each individual therapeutic efficacy (i.e., ASA alone and scaling alone) in reducing gingival inflammation and pocket probing depth over the 6-week observation period (interaction: p>0.05). Only the effect of ASA was significant in reducing the concentration of elastase-α1-proteinase inhibitor in gingival crevicular fluid (GCF E-α1-PI) (p<0.001), reduction in GCF E-α1-PI concentrations by ASA may indicate a decreased risk in periodontal disease progression. The results suggest that the combination of therapies and their different mechanisms of action, i.e., reduction of bacterial plaque and inhibition of destructive components of the immune responses, may result in functionally synergistic therapeutic efficacies in patients with untreated adult periodontitis. © Munksgaard, 1996.link_to_subscribed_fulltex

Locally delivered antimicrobials adjunctive to scaling and root planing provide additional PD reduction and CAL gain in the treatment of chronic periodontitis

Article Title and Bibliographic Information: Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. Bonito AJ, Lux L, et al. J Periodontol 2005;76(8):1227-36. Level of Evidence: 1a. Purpose/Question: The purpose of this systematic review was to assess the additional effect of locally delivered antimicrobials as an adjunct to scaling and root planing in the treatment of chronic periodontitis in adults. Source of Funding: Agency for Healthcare Research and Quality, Rockville, MD. Type of Study/Design: Systematic review. © 2006 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Adjunctive controlled topical application of tetracycline HCl in the treatment of localized persistent or recurrent periodontitis Effects on clinical parameters and elastase-α1-proteinase inhibitor in gingival crevicular fluid

35 patients receiving regular supportive periodontal therapy (SPT) and showing signs of localized persistent or recurrent periodontitis were enrolled in the study. Within 1 week after SPT, each patient had a tetracycline HCl loaded ethylene vinyl acetate co-polymer fiber placed into the periodontal pocket of 1 randomly selected tooth with persistent or recurrent periodontitis (test); the fiber was removed after 9.5±2.0 days. A non-adjacent tooth with persistent or recurrent periodontitis in a separate quadrant, which received no further treatment, served as a control. A total of 28 patients completed the 6-month study. Compared to control teeth, in test teeth at 6 months significantly (p<0.01) lower scores were found for gingival index, pocket probing depths, and PMN elastase-α1-proteinase inhibitor concentrations in gingival crevicular fluid. With the exception of plaque index scores, test teeth demonstrated significant reductions from baseline to 6 months in all parameters (p<0.05). Conversely, all parameter measurements in control teeth, except bleeding on probing, showed no significant difference between baseline and 6-month values. The results suggest that the use of controlled topical application of tetracycline HCl may improve periodontal health and reduce the risk of disease progression in localized persistent or recurrent periodontitis. Moreover, the effects of this application appear to be sustained for at least 6 months. © Munksgaard, 1996.link_to_subscribed_fulltex

Basic research meets dentistry.

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Periodontitis.

The purpose of this review was to assess the scientific and clinical bases for the proposed classification of periodontitis. The clinical and histopathological signs and the etiology of periodontitis were described. Cross-sectional studies were analyzed to determine when onset of periodontitis most frequently occurs in adults. In addition, the progression rates of periodontitis have been assessed from longitudinal studies. No clinical, histopathological, or microbiological features could be identified that would characterize different disease entities of chronic periodontitis. The prevalence, extent, and severity of periodontitis were found to increase continually with higher age and there was no age when onset of disease would most likely occur. The rate of periodontitis progression varies largely between patients and there is no natural threshold for distinguishing various rates of disease progression. The incidence of periodontitis unresponsive to treatment depends on pretreatment progression rate, extent and severity of disease, tooth type, smoking, high levels of putative periodontal pathogens, a deficient immune response, and the type of therapy provided. There is no scientific basis for the classification "adult periodontitis" and "refractory adult periodontitis." Extensive clinical examinations are required for the diagnosis of "rapidly progressive adult periodontitis." It appears unrealistic that these examinations can be performed routinely in clinical practice. Therefore, the classification proposed by the Organizing Committee to define adult, rapidly progressive, and refractory periodontitis as specific disease entities was replaced with a simplified classification of periodontitis based on the scientific data available.link_to_subscribed_fulltex

Basic principles and new concepts in prevention of marginal periodontopathies | Grundprinzipien und neue Konzepte in der Prävention marginaler Parodontopathien.

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Control of oral biofilms

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Implants in the medically compromised patient

Dental clinicians are confronted with an increasing number of medically compromised patients who require implant surgery for their oral rehabilitation. However, there are few guidelines on dental implant therapy in this patient category, so that numerous issues regarding pre- and post-operative management remain unclear to the dental clinician. Therefore, the aim of the present review is to offer a critical evaluation of the literature and to provide the clinician with scientifically based data for implant therapy in the medically compromised patient. This review presents the current knowledge regarding the influence of the most common systemic and local diseases on the outcome of dental implant therapy, e.g., abnormalities in bone metabolism, diabetes mellitus, xerostomia, and ectodermal dysplasias. Specific pathophysiologic aspects of the above-mentioned diseases as well as their potential implications for implant success are critically appraised. In line with these implications, guidelines for pre- and post-operative management that may assist in the successful implant-supported rehabilitation of this patient category are proposed.link_to_subscribed_fulltex