Microbial Colonization in Human Periodontal Disease: An Illustrated Tutorial on Selected Ultrastructural and Ecologic Considerations

The oral cavity is populated by a prodigious microbial flora that exhibits a unique successional colonization of enamel and subgingival root surfaces. A wide range of oral sites provide different ecologic conditions and are, therefore, populated by different commensal microbial combinations. The sequence of microbial colonization, regardless of location within the oral cavity, commences with the acquisition of salivary and/or crevicular fluid-derived pellicle. As the process of successional colonization of the gingival crevice area proceeds uninterrupted, achieving critical mass between 10 and 21 days, gingivitis becomes evident at a clinical level. However, at a histologic level, gingivitis may be evident within 2-3 days of plaque accumulation. The inflammatory response sufficiently alters the ecological conditions so as to allow proliferation of supragingival plaque into subgingival areas. The subgingival plaque becomes progressively more Gram-negative and anaerobic in nature as the periodontal pocket deepens, leading ultimately to a chronic, progressive deterioration of the periodontium--adult periodontitis. Both gingivitis and adult periodontitis are characterized by the successive colonization of cocci, short and long rods, filamentous microbes with corn cob and bristle brush formations, flagellated microbes, and spirochetes. Localized juvenile periodontitis (LJP), in contrast to the adult form of periodontitis, features a comparatively sparse microbial flora. The subgingival microbial colonization characteristically features cocci, short rods, coccobacilli, and spirochetes

The Effect of Locally Delivered Controlledâ Release Doxycycline or Scaling and Root Planing on Periodontal Maintenance Patients Over 9 Months

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142157/1/jper0022.pd

Two Multiâ Center Studies Evaluating Locally Delivered Doxycycline Hyclate, Placebo Control, Oral Hygiene, and Scaling and Root Planing in the Treatment of Periodontitis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142011/1/jper0490.pd

Adjunctive Use of a Subgingival Controlled‐Release Chlorhexidine Chip Reduces Probing Depth and Improves Attachment Level Compared With Scaling and Root Planing Alone

The present studies evaluated the efficacy of a controlled‐release biodegradable Chlorhexidine (CHX) (2.5 mg) chip when used as an adjunct to scaling and root planing on reducing probing depth (PD) and improving clinical attachment level (CAL) in adult periodontitis. Two double‐blind, randomized, placebo‐controlled multicenter clinical trials (5 centers each) were conducted; pooled data are reported from all 10 centers (447 patients). At baseline, following 1 hour of scaling and root planing (SRP) in patients free of supragingival calculus, the chip was placed in target sites with PD 5 to 8 mm which bled on probing. Chip placement was repeated at 3 and/or 6 months if PD remained ≥ 5 mm. Study sites in active chip subjects received either CHX chip plus SRP or SRP alone (to maintain study blind). Sites in placebo chip subjects received either placebo chip plus SRP or SRP alone. Examinations were performed at baseline; 7 days; 6 weeks; and 3, 6, and 9 months. At 9 months significant reductions from baseline favoring the Chlorhexidine chip compared with both control treatments were observed with respect to PD (Chlorhexidine chip plus SRP, 0.95 ± 0.05 mm; SRP alone, 0.65 ± 0.05 mm, P \u3c 0.001; placebo chip plus SRP, 0.69 ± 0.05 mm, P \u3c 0.001) and CAL (Chlorhexidine chip plus SRP, 0.75 ± 0.06 mm; SRP alone, 0.58 ± 0.06 mm, P \u3c 0.05; placebo chip plus SRP, 0.55 ± 0.06 mm, P \u3c 0.05). The proportion of patients who evidenced a PD reduction from baseline of 2 mm or more at 9 months was significantly greater in the Chlorhexidine chip group (19%) compared with SRP controls (8%) (P \u3c 0.05). Adverse effects were minor and transient toothache, including pain, tenderness, aching, throbbing, soreness, discomfort, or sensitivity was the only adverse effect that was higher in the Chlorhexidine group as compared to placebo (P= 0.042). These data demonstrate that the adjunctive use of the Chlorhexidine chip results in a significant reduction of PD when compared with both SRP alone or the adjunctive use of a placebo chip. These multi‐center randomized control trials suggest that the Chlorhexidine chip is a safe and effective adjunctive chemotherapy for the treatment of adult periodontitis