Effect Of Initial Periodontal Therapy Research Articles

The use of shear wave elastography to monitor changes in gingival elasticity associated with initial periodontal therapy in patients with advanced periodontitis: A prospective pilot study

Background/purposeGingival tissue firmness cannot be objectively assessed or monitored in real-time in existing examinations. This study was designed to examine the potential utility of shear wave elastography (SWE) as a means of evaluating and monitoring gingival inflammation in an effort to assess the effects of initial periodontal therapy in patients with advanced periodontitis. Materials and methodsThis pilot study included analyses of 66 sites in 6 advanced periodontitis patients. Patients underwent the SWE examination of the gingiva at the mid-labial and interdental papillae at baseline and at 2, 4, and 6 weeks following initial periodontal therapy. Measured periodontal parameters in these patients include Plaque index (PI), Gingival bleeding index (GBI), Probing depth (PD), and Clinical attachment loss (CAL). ResultsRespective baseline SWE values at the mid-labial gingiva and interdental papilla 25.68 ± 6.82 kPa and 26.78 ± 6.20 kPa, with no significant differences between these two measures. A significant negative correlation between SWE and both PI (r = −0.350, P = 0.004) and GBI (r = −0.287, P = 0.020) was observed at baseline. Initial periodontal therapy contributed to significantly higher SWE values and tougher gingiva, particularly during the first two weeks. Postoperative changes in SWE were negatively correlated with SWE values at baseline (r = −0.710, P < 0.001). ConclusionThese results establish SWE as a sensitive noninvasive approach to quantitatively assessing changes in gingival elasticity in real-time.

Study on the dynamic changes of oral microbiota in type 2 diabetes patients with periodontitis after initial periodontal therapy

Objectives: To clarify the effect of initial periodontal therapy on the dynamic changes of oral (saliva, dorsal tongue and subgingival plaque) microbiota in periodontitis patients with or without type 2 diabetes mellitus (T2DM). Methods: A total of 14 patients with chronic periodontitis (CP group) and 14 CP patients with T2DM (CP-T2DM group) were included from Department of Periodontology, School and Hospital of Stomatology,Cheeloo College of Medicine, Shandong University. The microbial samples were collected from saliva, dorsal tongue and subgingival plaque of first molars at baseline, 1.5 and 3 months after initial periodontal therapy, and were detected by 16S rRNA (V3-V4 region) gene sequencing. The sequencing data were analyzed to obtain microbial distribution and community structure information. The same professional periodontist evaluated the periodontal status of patients according to periodontitis detection indices before and after initial periodontal therapy. Meanwhile, patients' blood samples were collected and related metabolic indices were evaluated. Results: After initial periodontal therapy, the glycosylated hemoglobin levels [(7.46±1.69)%] in CP-T2DM group were significantly improved than that at baseline [(7.65±1.34)%] (t=0.52,P=0.610). The probing depth of the sampling sites [CP group: (2.94±0.46) mm, CP-T2DM group: (2.95±0.35) mm] and bleeding index (CP group: 1.91±0.42, CP-T2DM group: 1.67±0.49) at 3 months after treatment were significantly decreased than the probing depth [CP group: (3.99±0.77) mm, CP-T2DM group: (3.80±0.76) mm] (F=25.61, P<0.001; F=17.63, P<0.001) and bleeding index (CP group: 3.03±0.52, CP-T2DM group: 2.54±0.65) (F=28.43, P<0.001; F=20.21, P<0.001) at baseline. The flora analysis showed that the α and β diversity indices of the same sites in the CP and CP-T2DM groups did not change significantly before and after the initial therapy, but the bacterial abundance at each site changed. There were commonalities and differences in the microbial composition of each site in the CP and CP-T2DM groups. Among them, the relative abundance of Proteobacteria in saliva and dorsal tongue samples of the two groups after treatment was basically consistent with the change trend in the subgingival plaque microbes. In the subgingival plaque of the CP group, the relative abundance of Proteobacteria showed a gradual increase with the prolongation of initial periodontal therapy; while in the CP-T2DM group, it showed a trend of first increase and then decrease. Syntrophy, Dethiosulfate, Methanobacteriaceae and TG5 in CP and CP-T2DM groups were all significantly dominant bacteria in subgingival plaque at baseline (P<0.05). Moreover, in the CP-T2DM group Spirochetes also showed a significant advantage. At 1.5 months after treatment, Rhizobacteria, Alcaligenes, Comamomons, Delftia, Blautella, etc. were dominant in subgingival plaque (P<0.05). Firmicutes, Clostridia/Clostridiales, Enterococci and Ruminococci showed significant differences at 3 months (P<0.05). Conclusions: Plaques in saliva and tongue dorsal could reflect the effects of initial periodontal therapy on the dynamic changes of microorganisms to a certain extent. CP and CP-T2DM patients had differences in microbial composition and responses to initial periodontal therapy.

Effect of Initial Periodontal Therapy on Serum Nitric Oxide Levels in Chronic Periodontitis Patients with or without Type 2 Diabetes Mellitus

To evaluate the effect of initial periodontal therapy on serum NO levels in chronic periodontitis (CP) patients with or without type2 diabetes mellitus (T2DM) Materials and methods: A total of 90 subjects (group I-30 healthy controls, group I-30 CP and group III-30 CP with T2DM) participated in this study. Groups II and III subjects received initial periodontal therapy. Clinical periodontal parameters (OHI-S, GI, PPD, and CAL) and serum NO levels were evaluated at baseline and 4 weeks after initial periodontal therapy. Serum NO levels were determined by the Spectrophotometric assay based on the Griess colorimetric reaction. Four weeks after initial periodontal therapy both groups II and III exhibited improvement in clinical periodontal parameters (OHI-S, GI, PPD, CAL) and reduction in serum levels of NO from its baseline values (Baseline-Group II: 3.64 ± 0.53, 1.93 ± 0.30, 3.29 ± 0.42, 3.60 ± 0.42, 89.21 ± 1.46 respectively, group III: 3.66 ± 0.44, 2.03 ± 1.32, 3.57 ± 0.40, 3.65 ± 0.45, 85.54 ± 1.54 respectively. Post-treatment-Group II: 1.73 ± 0.42, 1.27 ± 0.23, 3.16 ± 0.46, 3.47 ± 0.58, 70.91 ± 1.68 respectively, group III: 2.39 ± 0.49, 1.71 ± 0.33, 3.44 ± 0.42, 3.61 ± 0.48, 68.69 ± 1.17 respectively). However, statistically significant differences were observed only with OHI-(S) and serum NO values in both groups II and III (p < 0.05). When the baseline values of groups II and III were compared the differences were non-significant except for GI (p < 0.05). However, when the post-treatment clinical periodontal parameters and serum NO level of groups II and III were compared, statistically significant differences (p < 0.05) were observed except for PPD and CAL between the groups. NO can be utilized as a good indicator of the inflammatory status of the periodontium. Initial periodontal therapy is effective in reducing serum levels of NO in CP patients with or without T2DM. A bidirectional relationship exists between periodontal disease and diabetes mellitus. NO is found to play a significant role in the pathobiology of both CP and T2DM. Initial periodontal therapy seems to be beneficial in reducing serum NO levels along with periodontal parameters in CP patients with or without T2DM. However further studies are warranted to enhance our knowledge about the role of NO in periodontal diseases in the course of diabetes.

PC257: Effect of initial periodontal therapy in conjunction with injectable platelet‐rich fibrin (i‐PRF) on treatment of chronic periodontitis

PC257: Effect of initial periodontal therapy in conjunction with injectable platelet‐rich fibrin (i‐PRF) on treatment of chronic periodontitis

Effect of Initial Periodontal Therapy on Salivary Trefoil Factor (TFF3) in otherwise Healthy Patients with Gingivitis and Chronic Periodontitis.

Background:The search for an ideal biomarker which can determine the current disease status that predicts the sites and individuals with increased susceptibility to periodontal disease has been going on since a long time. One such group of molecules which have been investigated recently are the trefoil factors, and the present study aims to determine the role of salivary trefoil factor 3 (TFF3) in periodontitis and gingivitis patients.Materials and Methods:A total of fifty participants, of which 25 were diagnosed with moderate-to-severe periodontitis and 25 with chronic gingivitis were included in the study. The routine periodontal parameters were recorded at baseline and at 6 weeks which included plaque index, gingival index, bleeding index, probing depth, and clinical attachment level. The saliva samples were collected from both the groups at baseline and 6 weeks after nonsurgical periodontal therapy and analyzed by enzyme-linked immunosorbent assay to estimate the concentration of trefoil factor 3.Results:All the periodontal parameters improved at 6-week reevaluation in both the groups. There was a significant change in the TFF3 levels in the periodontitis group from baseline to 6 weeks, and the concentrations were found to be higher following nonsurgical therapy, whereas the quantum of change in the gingivitis group was negligible. The levels of TFF3 remained unchanged in those periodontitis participants who required surgical intervention at the 6th-week reevaluation.Conclusion:The estimation of TFF3 levels may aid in decision-making in the treatment strategy of patients with moderate-to-severe periodontitis.

Clinical usability of aspartate aminotransferase to evaluate the prognosis of periodontal regeneration therapies: prospective, longitudinal study.

To evaluate the degree of periodontal tissue destruction, aspartate aminotransferase (AST) levels in the gingival crevicular fluid (GCF) are utilized as a predictor of periodontal therapy. We have previously shown that the usefulness of AST activities [periodontal tissue monitor (PTM) values] using a PTM-kit to evaluate the effects of initial periodontal therapy and periodontal regeneration therapy by enamel matrix derivative (EMD). This prospective, longitudinal study was conducted using 38 healthy and 80 periodontitis sites with probing depth (PD) of 5-10mm for guided tissue regeneration (GTR) and EMD from 36 patients. GCF samples were used to evaluate PTM values at base line (BL) and after 6months of surgeries (re-evaluation: RE), and periodontal examinations were performed concurrently. PTM values at BL were statistically improved at RE, accompanied by the improvement of periodontal parameters in both groups. PTM values and PD, and the clinical attachment level (CAL) showed high correlations. PD, CAL and bleeding on probing (BOP) were highly correlated with PTM values in both groups, whereas only PD showed a significant correlation with PTM values at RE in the GTR group. Change in the amounts of PD, CAL and BOP between BL and RE in both groups showed no correlation with PTM values. In the negative PTM value sites at BL in EMD group, the mean PD was significantly reduced at RE compared with positive PTM sites at BL. PTM values are able to be utilized as the biochemical predictor of prognosis after periodontal regeneration therapy.

Effect of initial periodontal therapy on gingival crevicular fluid cytokine profile in subjects with chronic periodontitis.

Cytokines are thought to play an important role in the pathogenesis of periodontal disease. Because periodontal disease is known for its inhomogeneous distribution within the dentition, it is unclear to what extent the detection of various cytokines at different sites correlates with presence of disease. We evaluated whether levels of 12 cytokines in gingival crevicular fluid (GCF) discriminated periodontally diseased sites from healthy ones, or periodontally diseased persons from healthy ones, and assessed the impact of nonsurgical periodontal therapy on these readings. This study included 20 periodontally healthy persons (H) and 24 patients with chronic periodontitis (P). In every participant, we measured the plaque index, gingival index, probing pocket depth (PD), bleeding on probing, and recession at six sites of every tooth. GCF was collected with Durapore® filter strips from two healthy sites (PD<4 mm; HH) in group H, and from two periodontally diseased sites (PD≥5 mm; PP) and two periodontally healthy sites (PD≤3 mm; PH) in group P. The periodontally diseased participants underwent comprehensive nonsurgical periodontal therapy including deep scaling and root planing under local anesthesia. In these participants, GCF samples were again collected at the same sites 1 and 3 months after therapy. Twelve cytokines (il‐1β, il‐1ra, il‐6, il‐8, il‐17, b‐fgf, g‐csf, gm‐csf, ifn‐γ, mip‐1β, vegf, and tnf‐α) were assessed using the Bio‐Plex suspension array system. Mean plaque index, gingival index, bleeding on probing, PD, and recession were significantly different between groups H and P. Differences between PP and PH sites were not significant for any of the cytokines. Il‐1ra, il‐6, il‐17, b‐fgf, gm‐csf, mip‐1β, and tnf‐α differed significantly between HH sites and both PH and PP sites, whereas il‐8 was significantly higher only at PP sites. Periodontal treatment increased gm‐csf and decreased il‐1ra levels in PP sites. Il‐1ra, il‐6, il‐8, il‐17, b‐fgf, gm‐csf, mip‐1β, and tnf‐α identified patients with chronic periodontitis, rather than diseased sites, suggesting a generalized inflammatory state that is not limited to clinically diseased sites only.

Effect of Initial Periodontal Therapy on Oxidative Stress Markers in Gingival Crevicular Fluid, Saliva, and Serum in Smokers and Non‐Smokers With Chronic Periodontitis

The aim of this case-control study with an intervention arm is to determine the effect of initial periodontal treatment on oxidative stress biomarkers in smokers and non-smokers with chronic periodontitis (CP). The study included 47 patients with CP (24 smokers [S+P+] and 23 non-smokers [S-P+]) and 46 periodontally healthy individuals (23 smokers [S+P-] and 23 non-smokers [S-P-]) for a total of 93 participants. Gingival crevicular fluid (GCF), serum, and saliva samples were obtained and clinical periodontal measurements were recorded at baseline and at the first and third months after periodontal therapy. 8-hydroxydeoxyguanosine (OHdG) and 4-hydroxynonenal (HNE) and enzyme activity of glutathione peroxidase (GSH-Px) were analyzed with enzyme-linked immunosorbent assay. The level of 8-OHdD in GCF was found to be significantly higher in both periodontitis groups compared with both periodontally healthy groups. 8-OHdG and GSH-Px in saliva in both periodontitis groups were significantly increased compared with the S-P- group. In the S+P+ group, 4-HNE in GCF was found to be significantly higher than in periodontally healthy participants. After initial periodontal treatment, the levels of 8-OHdG in GCF and saliva were significantly decreased in both periodontitis groups. Initial periodontal therapy may be helpful for diminishing oxidative stress in periodontitis.

Effects of initial periodontal therapy on interleukin-1β level in gingival crevicular fluid and clinical periodontal parameters.

Inflammatory cytokines may have important roles in periodontitis. We assessed the effects of initial periodontal therapy on clinical periodontal parameters and interleukin-1β (IL-1β) level in gingival crevicular fluid (GCF) from chronic periodontitis (CP) patients. After initial screening, baseline periodontal parameters such as probing pocket depth (PPD) and bleeding on probing (BOP) were measured. GCF samples were collected from 13 shallow (≤3 mm) and deep (≥5 mm) PPD sites from 13 CP patients, and GCF volume and IL-1β concentration were determined at baseline (before scaling and root planning) and at 2 and 4 months after initial therapy. Baseline BOP rate, GCF volume, and IL-1β level were significantly higher at deep PPD sites than at shallow PPD sites. Significant improvements in PPD and BOP were observed at 2 and 4 months after periodontal initial therapy in deep PPD sites only. In contrast, GCF volume and IL-1β concentration were lower at 2 and 4 months after initial therapy at all sites. These results suggest that GCF volume and IL-1β level in samples reflect disease severity and that these variables are better than PPD and BOP as markers of gingival inflammation.

Initial Periodontal Treatment for Prevention of Chronic Obstructive Pulmonary Disease Exacerbations

Infective exacerbations in patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality. Therefore, effective management of COPD should include prevention and reduction of exacerbations. The oral cavity is an important reservoir for the respiratory pathogens and these pathogens can be aspirated into the lower respiratory tract, increasing the risk of respiratory infection. Periodontal therapy may reduce these pathogens colonized on the surfaces of teeth and thus may reduce the frequency of COPD exacerbations. The authors aim to assess the effect of initial periodontal therapy on exacerbation frequency in COPD patients. The authors conducted a prospective, controlled group trial of initial periodontal treatment in 40 patients with COPD with chronic periodontitis (CP) and a history of ≥1 infective exacerbation in the previous year. Number of exacerbations in the previous year was recorded. Patients were divided into two groups; the test group (n = 20) included patients who had initial periodontal treatment, and the control group (n = 20) included patients who did not have periodontal therapy. Number of exacerbations during the following 12 months was noted. Periodontal parameters were measured at baseline and 6 and 12 months. The test group showed a significant reduction in the exacerbation frequency during the follow-up period (P = 0.01). Although median exacerbations declined from 3 to 2 in the test group, they increased from 2 to 3 in the control group. Initial periodontal therapy in patients with COPD with CP may decrease the exacerbation frequency.

Effect of Initial Periodontal Therapy on Oral Health–Related Quality of Life in Patients With Periodontitis in Japan

It is becoming increasingly important for periodontists and dental hygienists to take a biopsychosocial approach to care when considering periodontal interventions. However, information on how patients perceive periodontitis and its treatment is limited. The purpose of the present study is to gain insight into the patient perception of oral health and the impact that periodontitis and treatment have on self-assessed quality of life (QoL). This was a prospective, two-center, clinical study in Japan. Patients with periodontitis were assessed for their perceptions of oral health by using an instrument for oral health-related QoL (OHRQL) before and after initial periodontal therapy. A total of 58 patients (mean age: 53.6 years; 23 male and 35 female) participated in the study and completed initial periodontal therapy. At baseline, 97% of the patients perceived that their oral health status impacted on their QoL in one or more ways. Pain, eating and chewing, and psychologic function were identified as compromised OHRQL domains. More than one-half of the patients rated their overall oral health as poor. Initial periodontal therapy, consisting mainly of oral hygiene instructions and scaling and root planing, significantly improved OHRQL scores (P = 0.0027). The effect size was calculated to be 0.51, indicating a moderate improvement. Compared with baseline, a significantly higher proportion of patients reported rarely or never having a problem regarding OHRQL domains such as pain (P = 0.0049) and eating and chewing (P = 0.0145) after treatment. No significant difference in the OHRQL improvement was found with respect to disease severity. Periodontitis negatively affected QoL in this population of Japanese patients with periodontitis. Conventional non-surgical periodontal therapy has a potential to ameliorate patient perceptions of oral health.

A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapy

Cytokines and chemokines play an important role in the pathogenesis of periodontal diseases. The objective of this study was to quantitatively assess the effect of initial periodontal therapy on gingival crevicular fluid levels of a comprehensive panel of cytokines and chemokines, including several less extensively studied mediators. Clinical examinations were performed and gingival crevicular fluid samples obtained from six subjects with generalized severe chronic periodontitis prior to initial periodontal therapy and at re-evaluation (6-8 weeks). Four diseased and two healthy sites were sampled in each subject. Twenty-two gingival crevicular fluid mediators were examined using a multiplex antibody capture and detection platform. Statistical analyses were performed by fitting mixed effects linear models to log-transformed gingival crevicular fluid values. Gingival crevicular fluid interleukin (IL)-1alpha and IL-1beta were the only cytokines to differ in initially diseased vs. initially healthy sites. Following initial therapy, 13 of the 16 detectable cytokines and chemokines decreased significantly in diseased sites, including IL-1alpha, IL-1beta, IL-2, IL-3, IL-6, IL-7, IL-8, IL-12 (p40), CCL5/regulated on activation, normally T cell expressed and secreted (RANTES), eotaxin, macrophage chemotactic protein-1, macrophage inflammatory protein-1alpha and interferon-gamma. At healthy sites, only three of the 16 mediators were significantly altered following therapy. This is the first study, to our knowledge, to evaluate such an extensive panel of gingival crevicular fluid mediators within the same sample prior to and following initial therapy. The results confirm that periodontal therapy effectively reduces pro-inflammatory cytokines and chemokines, including less well-described mediators that may be important in initiation and progression of periodontitis. The multiplex assay will prove useful for future gingival crevicular fluid studies.

Effect of initial periodontal therapy on chronic periodontitis patients with stable coronary heart disease

To investigate the clinical results of initial periodontal therapy on chronic periodontitis patients with stable coronary heart disease. Thirty-two chronic periodontitis patients with stable coronary heart disease were included in this prospective study. All subjects received oral hygiene instruction, scaling and root planing and clinically monitored for 3 months. The clinical parameters, including plaque index (PLI), probing depth (PD), attachment loss (AL) and bleeding index (BI), were recorded at baseline and 3 months after treatment. Serum levels of high-sensitivity C-reactive protein (hs-CRP), cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and glucose (GLU) were also measured. At 3 months after initial periodontal therapy, the mean PD of patients reduced from (3.95 +/- 0.15) mm to (2.93 +/- 0.21) mm (P < 0.01), the mean AL from (3.08 +/- 0.43) mm to (2.43 +/- 0.37) mm (P < 0.01), the percentage of sites with PD > or =5 mm from (22.37 +/- 6.88)% to (3.00 +/- 1.80)% (P < 0.01). hs-CRP significantly decreased at 3 months after treatment compared with baseline [(2.71 +/- 2.69) mg/L vs. (1.99 +/- 2.14) mg/L, P < 0.05]. CHO,TG, HDL, LDL and GLU decreased slightly (P > 0.05). Initial periodontal therapy is effective for chronic periodontitis patients with stable coronary heart disease. After initial periodontal therapy, periodontal parameters improved significantly and serum levels of hs-CRP decreased.

Decreased Lipid Peroxidation Following Periodontal Therapy in Type 2 Diabetic Patients

Although diabetes mellitus and periodontal disease promote atherosclerosis, the relation of oxidative stress with these diseases remains unclear. To investigate the influence of periodontal disease on oxidative stress, we assessed the effects of initial periodontal therapy on lipid peroxide (LPO), an oxidative stress index, in type 2 diabetic and non-diabetic patients. Seventeen subjects with or without type 2 diabetes were enrolled in this intervention study. No patient had a history of cardiovascular or peripheral vascular disease. Five type 2 diabetic and six non-diabetic patients, all with moderate to severe periodontal disease, received and completed the initial periodontal therapy and examination. Before and after the therapy, patients underwent medical examinations and blood determinations, including LPO. Before the therapy, the periodontal probing depth and bleeding on probing (BOP) were similar between groups. LPO, triglyceride, and white blood cell counts were significantly higher in diabetic than non-diabetic patients. Therapy improved the periodontal parameters in both groups and significantly decreased LPO in diabetic patients. Anti-malondialdehyde-modified low-density lipoprotein (MDA-LDL) antibody, a marker of oxidized LDL, significantly decreased with treatment in both groups. Overall, Spearman rank correlation showed no significance between periodontal parameters and LPO or anti-MDA-LDL antibody, but BOP tended to correlate with LPO in diabetic patients (r = 0.585; P = 0.0791). Although this is a small and preliminary study, and the changes of LPO and anti-MDA-LDL antibody were within the normal range, the initial periodontal therapy significantly decreased LPO, an oxidative stress index, in type 2 diabetic patients with periodontal disease.

Effect of initial periodontal therapy on sulcular/tongue sulfide level. A pilot study.

: Volatile sulfur compounds (VSC), such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide, are toxic metabolites produced by periodontal pathogens. These VSC are also released from the tongue dorsum. Currently, limited data are available on how periodontal treatments may affect sulcular/tongue sulfide level. The aim of this study was to determine effect of initial therapy including oral hygiene instruction and scaling and root planing (SRP) on sulcular/tongue sulfide level. : Thirteen subjects diagnosed with chronic periodontitis and having three representative periodontal pocket depth (PD) strata in one quadrant (PD <or= 3.0 mm: healthy, 4.0 mm <or= PD <or= 6.0 mm: moderate, and PD >or= 7.0 mm: severe disease sites) were selected. Clinical periodontal parameters were recorded at baseline and 3 weeks after completion of the initial therapy. The sulfide levels in three representative periodontal pockets (pS) and on three parts (anterior, middle, and posterior) of the tongue dorsum (tS) were measured using a commercial sulfide-monitoring device. : The pS levels of the three representative sites were reduced significantly following the initial therapy (p < 0.05). However, there was no significant reduction of the tS level in all three parts of the tongue. : The initial periodontal therapy such as oral hygiene and SRP reduces the sulcular sulfide level but not the tongue sulfide level. This suggests that sulcular sulfide level may be a possible indicator for assessing the outcome of initial periodontal treatment.

The Effect of Initial Periodontal Therapy on Salivary Platelet‐Activating Factor Levels in Chronic Adult Periodontitis

Platelet-activating factor (PAF), a potent phospholipid inflammatory mediator, is increased in the mixed saliva of subjects with periodontal disease and correlates with the extent of oral inflammation. The present study was designed to provide a longitudinal evaluation of the effect of initial periodontal therapy (home care instruction, prophylaxis, and scaling/root planing) on salivary PAF levels in chronic adult periodontitis patients (n = 15). Mixed saliva was collected prior to, during, and after initial therapy and was utilized to assess PAF levels after lipid extraction and fractionation as well as to histologically assess the number of polymorphonuclear leukocytes (PMN). PAF activity was determined in bioassay relative to authentic PAF (1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine; 16:0-alkyl-PAF). Initial salivary PAF levels (12.1 +/- 2.8 pmole equivalents of 16:0-alkyl-PAF/ml saliva; mean +/- SE) decreased following supragingival plaque control (9.6 +/- 2.4) and were further reduced following scaling and root planing (5.7 +/- 1.4). In parallel, salivary PMN levels were significantly reduced and clinical estimates of periodontal disease were significantly improved; i.e., there was a decrease in the percentage of sites with both bleeding on probing (from 46.1 +/- 4.6% of sites at pretreatment to 25.9 +/- 2.6% after scaling and root planing) and probing depths > or = 4 mm (from 16.7 +/- 1.9% of sites to 10.3 +/- 1.2%). Thus, initial periodontal therapy reduced salivary PAF levels in concert with improvements in clinical estimates of marginal and submarginal periodontal inflammation suggesting that PAF may participate in inflammatory events during periodontal tissue injury and disease.

Short‐term effects of initial periodontal therapy (hygienic phase)

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy on probing pocket depths and probing attachment levels using a patient group with moderate to advanced periodontitis. 68 patients with moderate to advanced periodontitis underwent hygienic phase therapy including oral hygiene instructions, scaling and root planing and elimination of plaque retentive factors. Assessments of the plaque control record (PCR), bleeding on probing (BoP), probing depths and probing attachment levels were performed at baseline examination and 3 to 5 months following active treatment. The measurements were obtained at 4 interproximal aspects of each tooth with a thin calibrated probe. Mean BoP values decreased from 63.2 +/- 21.9% at baseline to 16.6 +/- 7.3% after therapy, and mean PCR decreased from 78.6 +/- 16.4% to 12.7 +/- 7.1%, respectively. A reduction in mean probing pocket depth from 3.96 +/- 1.39 mm at baseline to 3.30 +/- 1.16 mm after therapy was noted. Sites with initial probing depths of 1-3 mm showed no change, sites with initial values of 4-6 mm revealed a reduction of 1.03 +/- 1.04 mm, while initial pockets of 7-9 mm decreased in depth by 2.28 +/- 1.62 mm. A gain in the mean probing attachment level from 4.16 +/- 1.80 mm to 3.74 +/- 1.71 mm was observed as a result of treatment. The group with the shallow initial probing depths of 1-3 mm showed no alteration in probing attachment level. Pockets with baseline values of 4-6 mm showed gain of clinical attachment of 0.69 +/- 1.43 mm. The greatest gain in clinical attachment of 1.51 +/- 1.75 mm was obtained in sites with initially deep pockets of 7-9 mm. From the results of this study, it can be concluded that non-surgical periodontal therapy is an effective means to reduce probing pocket depths and to improved clinical attachment levels in patients with moderate to advanced periodontitis.

Digital subtraction of radiograph in evaluating alveolar bone changes after initial periodontal therapy

The purpose of this study was to determine the effect of initial periodontal therapy on crestal bone remineralization with the use of a digital subtraction method for quantitative analysis. Fifteen crestal sites randomly selected from five patients were examined at the initial visit, after completion of oral hygiene instruction, and 1, 3, and 6 months after scaling and root planing with standardized radiographs. The radiographs were digitized by means of a drum-scanning microdensitometer with a sampling aperture of 50 μm producing 256 gray levels and corrected for difference of contrast between image pairs. Results were as follows: (1) statistically significant changes were observed even 1 month after the therapy and (2) the extent of changes was quantitatively expressed and monotonically increased with time. These results indicate that subtraction radiography may be a reproducible and quantitaive method for the evaluation of periodontal therapy.

歯周病原菌の酵素活性を指標とした迅速診断法（ＳＫ‐０１３） 歯周初期治療の効果判定への応用

The purpose of the present study was to examine the diagnostic value of the SK-013 (Sunstar, Osaka) in evaluating the effect of initial preparation. The SK-013 is a highly sensitive reagent to measure peptidase activity specifically produced by Bacteroides gingivalis. Bacteroides forsythus, and Treponema denticola. Thirty-six sites in 16 periodontitis patients were monitored in this study. The clinical status of each site was assessed using the clinical indices such as gingival index (GI), plaque index (PII), probing depth (PD), and bleeding on probing (BOP). The composition of subgingival microflora in samples was determined using phase contrast microscopy. Clinical, microbiological, and enzymatic examinations were made at five separate appointments, as follows: (1) at baseline prior to plaque control instruction; (2) 4 weeks following plaque control instruction; and (3) 2, 4, 8 weeks following scaling and root planing of periodontal sites. The results of these examinations were compared statistically. The correlation was positive between the total counts of bacteria including spirochetes and motile rods and the enzymatic activity identified using the SK-013. Also the enzymatic profile was highly correlated with microbiological findings other than clinical indices. These results show that the SK-013 is a clinically useful diagnostic method for assessing the effect of initial periodontal therapy.

Radiographic evaluation of the effect of initial periodontal therapy on thickness of the maxillary sinus mucosa.

The thickness of the radiographic image of the maxillary sinus mucosa on intraoral radiographs was evaluated in 13 patients with advanced periodontal disease, prior to and 12 months following initial periodontal therapy. Before treatment, a relationship was observed between the thickness of the sinus mucosa and the mean probing depths of the teeth in the involved sextant. As many as 79% of the available sextants showed swelling of the mucosa prior to periodontal therapy, compared to only 17% after treatment. This report supports previous studies indicating that advanced periodontal disease may cause swelling of the maxillary sinus mucosa and that periodontal therapy will significantly reduce such swelling.