Periodontal Maintenance Patients Research Articles

Long-Term Effect of Diode Laser Irradiation Compared to Sodium Fluoride Varnish in the Treatment of Dentine Hypersensitivity in Periodontal Maintenance Patients: A Randomized Controlled Clinical Study

The aim of this clinical study was to evaluate and compare the desensitizing effects of a gallium?aluminum?arsenide (GaAlAs) laser and sodium fluoride (NaF) varnish on dentine hypersensitivity (DH) in periodontal maintenance patients. The use of lasers opens a new dimension in the treatment of DH. Forty-eight patients with 244 teeth affected by DH were included in the trial. To be included in the study, the subjects had to have 4 or more hypersensitive teeth at different quadrants. Selected teeth were randomly assigned to a GaAlAs laser group, placebo laser group, NaF varnish group, or a placebo NaF varnish group. Laser therapy was performed at 8.5?J/cm(2) energy density. In the placebo laser group, the same laser without laser emission was used. In the NaF varnish group, the varnish was painted at the cervical region of the teeth. In the placebo NaF varnish group, the same treatment procedures were performed with a saline solution. DH was assessed with a visual analog scale (VAS); immediately, at 1 week, and at 1, 3, and 6 months after treatments. Intra-group time-dependent data were analyzed by Friedman's test, and Wilcoxon's rank sum test was used to evaluate the differences within groups. GaAlAs laser and NaF varnish treatments resulted in a significant reduction in the VAS scores immediately after treatments that were maintained throughout the study when compared to the baseline and placebo treatments. In the NaF group, there was a significant increase in the VAS scores at 3 and 6 months compared to at 1 week and 1 month. The placebo treatments showed no significant changes in VAS scores throughout the study period. Within the limits of the study, GaAlAs laser irradiation was effective in the treatment of DH, and it is a more comfortable and faster procedure than traditional DH treatment.

Long‐term outcomes for cross‐arch stabilizing bridges in periodontal maintenance patients – a retrospective study

Cross-arch bridges are used to stabilize teeth for patients with reduced periodontal support. Little is known about technical or biological complications, whether teeth and implants can be combined in this type of bridge and the long-term effects on tooth loss. All patients treated in a specialist periodontal practice who received cross-arch stabilizing bridgework and were subsequently maintained for at least 7 years were included in the study. The patients were selected from all patients who underwent initial periodontal therapy after 1986 in a Norwegian periodontal practice. The bridges were assessed for biological and technical complications. Bridges retained by teeth or by a combination of teeth and implants were included in the study. Ninety-four rigid fixed bridges (77 teeth supported, 17 teeth and implant supported) in 80 patients (46 females, 34 males) were observed for an average of 10 years (range 7-22 years). In four patients, a bridge became loose and had to be re-cemented, and in one case the metal framework of a bridge fractured and the bridge had to be remade. In total, eight abutment teeth were lost from five patients but no implant abutments were lost. Overall, a higher rate of tooth loss was observed for patients provided with stabilizing bridges compared with control maintenance patients not treated with bridgework (p<0.0001); however, the rates in both groups were very low. Cross-arch stabilizing bridges constructed for periodontal patients as part of their periodontal maintenance therapy had few complications and were associated with low rates of abutment tooth loss. Combining teeth and implants did not affect the performance of these bridges.

Tooth Loss in 776 Treated Periodontal Patients

The most common form of periodontitis is a variably progressive dynamic pathologic process that causes attachment loss, destroys the alveolar bone supporting a tooth, and terminates with tooth loss. We evaluated the loss of teeth of treated periodontal patients categorized by severity and risk. Each of nine periodontists evaluated 100 consecutive periodontal maintenance patients. The disease severity and risk level were determined from data at the initial examination. The number of teeth lost was determined from data at the initial and maintenance visits. A stepwise regression analysis showed that disease (P = 0.0000478) and risk (P = 0.00129) scores predicted the mean tooth loss rate. The adjusted R(2) statistic was 88.56%. The ordinal logistic regression model showed that only the disease score (P <0.0005) was significantly associated with the probability of patients losing a specific number of teeth. Categorizing a patient by severity may be beneficial in the management of the periodontal patient. The disease score can be used to establish a criterion and target for care. For example, treatment can result in nearly no lost teeth when the severity is low, and this benefit is lost when the severity is high. The disease score provides an objective means to quickly determine severity. An increase in the disease score provides evidence that a new treatment plan is needed. Therefore, the effect of the routine use of the disease score could result in fewer patients with severe disease and reduce the number of teeth lost.

Immediate efficacy of diode laser application in the treatment of dentine hypersensitivity in periodontal maintenance patients: a randomized clinical trial

To evaluate the immediate efficacy in the reduction of dentine hypersensitivity (DH) when applying an 810 nm diode laser (DL), and a 10% potassium nitrate bioadhesive gel (NK10%). Forty-five consecutive periodontal maintenance patients of both sexes, with a DH >or= 2 on the verbal rating scale (VRS) in one or more teeth, were randomly allocated into three equal groups: 15 patients received DL and placebo gel; 15 patients were tested with a placebo laser and NK10%; and the remaining 15 received a placebo laser and placebo gel. The DH was evaluated at the start of the study, 15 and 30 min. after the laser application, and on days 2, 4, 7, 14, 30 and 60 by a blind examiner. After 15 min., observations showed a reduction in DH after an evaporative stimulus (ES) of 36.9% (0.86), three times greater than that of the control group (0.23) (p=0.008). After 14 days, this effect was even greater [DL 71.7% (1.67)/NK10% 36.3% (1.73)/control 28.1% (0.73); p=0.004], and lasted until day 60 [65.7% (1.53)/30.4% (0.73)/25.8% (0.67); p=0.01]. The DL and NK10% gel were proven effective in the treatment of DH. A significantly greater immediate response was observed with DL.

Powered toothbrush plus triclosan only as effective as manual brush and fluoride toothpaste for periodontal maintenance patients

This randomised, controlled and single-masked clinical trial was carried out in specialist clinics in Sweden and the US. The test group were instructed to use an rotation-oscillation action (ROA) powered toothbrush (Oral-B; Gillette, Boston, Massachusetts, USA) and a triclosan/ copolymer/ fluoride-containing dentifrice (Total; Colgate, Piscataway, New Jersey, US). The control group were instructed to brush using the modified Bass technique and a conventionally designed, multitufted, soft, manual toothbrush using a standard fluoride-containing dentifrice (Protection Caries; Colgate). Both groups were to brush twice a day and clean interdentally daily with dental floss, toothpicks and/ or interdental brushes. Measurements were taken at baseline, and 1, 2 and 3 years for the following parameters: number of teeth, plaque, bleeding on probing (BoP), probing pocket depth (PPD) and level of the gingival margin (GM). GM was assessed as the distance between the soft tissue margin and the cemento-enamel junction or the border of a restoration. Relative attachment level (RAL) was calculated as PPD minus GM. Subgingival plaque samples were taken and analysed for their content of 40 bacterial species at each examination interval. Both groups showed significant reduction in BoP, PPD and in mean total counts of the 40 bacterial species between baseline and 3 years, whereas plaque score and RAL remained almost unchanged. No significant differences between the two prevention programmes were found for any of the clinical outcome variables or in mean counts of the various bacterial species. The study failed to demonstrate superior clinical and microbiological effects of powered toothbrush and triclosan dentifrice compared with manual toothbrush and standard fluoride-dentifrice in periodontitis-susceptible subjects undergoing regular maintenance therapy.

Tooth loss and implant outcomes in patients refractory to treatment in a periodontal practice

The aim of this study was to investigate the factors associated with continued significant tooth loss due to periodontal reasons during maintenance following periodontal therapy in a specialist periodontal practice in Norway. A case-control design was used. Refractory cases were patients who lost multiple teeth during a maintenance period of 13.4 (range 8-19) years following definitive periodontal treatment in a specialist practice. Controls were age- and gender-matched maintenance patients from the same practice. Characteristics and treatment outcomes were assessed, and all teeth classified as being lost due to periodontal disease during follow-up were identified. The use of implants in refractory cases and any complications relating to such a treatment were recorded. Only 27 (2.2%) patients who received periodontal treatment between 1986 and 1998 in a specialist practice met the criteria for inclusion in the refractory to treatment group. Each refractory subject lost 10.4 (range 4-16) teeth, which represented 50% of the teeth present at baseline. The rate of tooth loss in the refractory group was 0.78 teeth per year, which was 35 times greater than that in the control group. Multivariate analysis indicated that being in the refractory group was predicted by heavy smoking (p=0.026), being stressed (p=0.016) or having a family history of periodontitis (p=0.002). Implants were placed in 14 of the refractory patients and nine (64%) of these lost at least one implant. In total, 17 (25%) of the implants placed in the refractory group were lost during the study period. A small number of periodontal maintenance patients are refractive to treatment and go on to experience significant tooth loss. These subjects also have a high level of implant complications and failure. Heavy smoking, stress and a family history of periodontal disease were identified as factors associated with a refractory outcome.

Locally Delivered Doxycycline During Supportive Periodontal Therapy: A 3‐Year Study

Adjunctive locally delivered antibiotics during maintenance may favor the control of periodontal infections. This study evaluated the long-term clinical and microbiologic effects of yearly locally delivered controlled-release doxycycline as an adjunct to mechanical debridement. A total of 128 periodontal maintenance patients having at least four teeth with probing depth (PD) > or =5 mm were randomly assigned to local application of doxycycline gel at baseline and 1 and 2 years as an adjunct to mechanical debridement (test) or mechanical debridement only (control). Supportive periodontal therapy (mechanical debridement, polishing, and oral hygiene reinforcement) was provided every 6 months. Plaque, bleeding on probing (BOP), PD, and relative attachment level (RAL) were scored at baseline; 3 months; and 1, 2, and 3 years. Subgingival plaque samples were taken at each examination and analyzed for their content of 40 bacterial species. Data analyses were performed on an intention-to-treat basis with the subject as the statistical unit. Significant reductions in BOP, PD, RAL, and the mean counts of a number of target species between baseline and 3 years were documented for both treatment groups, whereas plaque scores remained unchanged. A statistically significant difference in favor of the adjunctive doxycycline therapy was found between the two groups only at the 3-month examination for BOP, PD, and RAL and for a minority of bacterial species at 2 years. Although short-term effects on clinical parameters were found with the adjunctive use of locally delivered doxycycline, repeated applications annually had no clinical or microbiologic effects beyond those observed with mechanical debridement alone in maintenance patients.

Long‐term effect of the combined use of powered toothbrush and triclosan dentifrice in periodontal maintenance patients

To test the hypothesis of a superior clinical and microbiological effect of the combined use of powered toothbrush+triclosan-containing dentifrice compared with manual toothbrush+regular fluoride-containing dentifrice in periodontal maintenance patients. A total of 128 periodontitis subjects involved in recall programmes were randomized to use either powered toothbrush with triclosan-dentifrice (test) or manual toothbrush and standard dentifrice (control). Supportive periodontal treatment was provided at baseline and every 6 months. Plaque, bleeding on probing (BoP), probing pocket depth (PPD) and relative attachment level (RAL) were scored at baseline, 1, 2 and 3 years. Subgingival plaque samples were taken and analysed for their content of 40 bacterial species at each examination interval. All analyses were performed by "intention-to-treat" protocol. Both groups showed significant reduction in BoP, PPD and in mean total counts of the 40 bacterial species between baseline and 3 years, while plaque score and RAL remained almost unchanged. No significant differences between the two prevention programmes were found for any of the clinical outcome variables or in mean counts of the various bacterial species. The study failed to demonstrate superior clinical and microbiological effects of powered toothbrush+triclosan dentifrice compared with manual toothbrush+standard fluoride-dentifrice in periodontitis-susceptible patients on regular maintenance therapy.

Penetration depths with an ultrasonic mini insert compared with a conventional curette in patients with periodontitis and in periodontal maintenance

The aim of the study was to test whether a slim Ultrasonic Tip reaches a more apical position when penetrating a periodontal pocket compared with the working blade of a conventional Gracey Curette in both untreated periodontitis and periodontal maintenance patients. Twenty untreated and 15 periodontal maintenance patients were selected based on the presence of at least one site a pocket of > or =5 mm in each quadrant. Recordings were made at the four approximal sites of four experimental teeth in each patient. First, the probing pocket depth was measured with the Jonker Probe. Second in randomized order, the penetration depth was assessed with an EMS PS Ultrasonic Tip and a Gracey Curette. In the periodontitis group, the Ultrasonic Tip penetrated significantly deeper than the Jonker Probe and the Gracey Curette. In the maintenance group, no differences were observed. Comparing the penetration of the instruments between groups, as related to the Jonker Probe measurements, only in the periodontitis group did the Ultrasonic Tip reach a significantly more apical level. The results of the present study show that in untreated periodontitis patients, the Ultrasonic Tip penetrated the pocket deeper than the pressure-controlled probe and the Gracey Curette.

Variation in tobacco use profiles obtained from periodontal maintenance patients

Objectives To compare methods of tobacco use profiling in patients undergoing maintenance treatment for periodontitis. Methods The smoking status of 108 subjects attending a university-based specialist periodontics clinic was assessed by examination of referring records, patient-completed questionnaires, clinician-administered interviews and by salivary cotinine and expired-air carbon monoxide (ECO) measurement. Results Ten percent of the detected smokers (salivary cotinine > 14.2 ng ml −1) reported to be non-smokers in the clinician-administered interview. 4.2% of the smokers detected by ECO analysis (ECO > 8 ppm) reported to be non-smokers in the clinician-administered interview. Systematic under reporting of tobacco use was also apparent in patient-completed questionnaires from the periodontics clinic and, to a larger degree, in the referring clinic records when compared to the clinician-administered interview. Conclusions By biochemically analyzing recent cigarette smoke exposure, our data show that clinician assessment is the most accurate means by which to obtain anamnestic data concerning tobacco use. ECO analysis using portable CO monitors is inexpensive and simple with no requirement for laboratory support. The combination of ECO measurement and clinician-administered tobacco use interview represents a clinically applicable method to improve the detection of an important, periodontally susceptible population—regular smokers who deny smoking.

Comparison of two automated periodontal probes and two probes with a conventional readout in periodontal maintenance patients

The aim of the present study was to test in periodontal maintenance patients whether the systems for pressure control that have been commercially developed contribute to more reproducible probing depth measurements as compared with a manual probe. In 12 patients duplicate measurements were made at day 0 and 1 week later. In each patient four teeth with the deepest pockets were measured at six sites. In total 288 sites were available for comparisons. The Florida Probe (FP) (159 N/cm(2)), the Jonker Probe (JP) (153 N/cm(2)), the Brodontic probe (BP) (255 N/cm(2)) and the manual probe (MP) were used in a randomized scheme. Mean probing measurements showed for the FP and the JP lower recordings than for the BP and manual probe. The FP, the BP and the MP showed no differences between the duplicate measurements, except for the JP where the second measurement was deeper. Correlation coefficients between measurements at day 0 and 1 week show for the BP and the MP are 0.90 and 0.89, respectively, while for the FP and the JP they are 0.76 and 0.75, respectively. The BP and the MP appear to be reliable tools for reproducible pocket depth measurements in periodontal maintenance patients.

Interviews and assessments of returning non‐compliant periodontal maintenance patients

Periodontal therapy without a maintenance programme has been shown to be of doubtful value. Most studies show a low-level of compliance with periodontal maintenance therapy. Many suggestions as to the reasons for this have been put forward, but it has been difficult to confirm these, as the patients are not available to be interviewed. To identify, interview and assess returning non-compliant periodontal maintenance patients. All patients who had undergone periodontal therapy between 1986 and 2004 but not complied with the maintenance therapy were interviewed and assessed when they later returned to the specialist office for treatment. Sixty-one patients with an average age of 56.4 years (SD 11,1) were studied. There were 18 males and 43 females. The patients were compliant for 3.4 years (SD 3.2) before leaving and returning after 5.5 years (SD 3.3) of non-compliance. Average tooth loss while non-compliant was 1.6 teeth (SD 2.8). The interviews revealed that 37 patients attended their own dentist's office exclusively for maintenance therapy, eight patients gave health reasons and seven patients lack of motivation or failure to cooperate. Thirty-six patients were re-referred by their own dentist, 13 changed dentist and were referred by this dentist, while 12 patients contacted the specialist office directly. Fifty-three patients claimed to have been fully compliant with their own dentist while non-compliant with the specialist office. The main reason for non-compliance was that the patients did attend their own dentist exclusively for maintenance therapy. Tooth loss and periodontal deterioration was more marked in this group than patients who in addition attended the specialist office for maintenance therapy.

Conclusive support for mechanical nonsurgical pocket therapy in the treatment of periodontal disease

Sources of studies were the Cochrane Oral Health Group List of Systematic Reviews in Dentistry, Database of Abstracts of Reviews of Effectiveness, Medline, Embase, and Scisearch. No date or language restriction was imposed. Reference lists of located reviews were checked for additional references. Twelve reviews addressing the question were included. A narrative appraisal of the reviews was conducted. A number of implications for clinical practice were identified. These are as follows:Initial therapy: In people who have periodontitis, mechanical nonsurgical pocket therapy reduces inflammation and pocket depth and increases clinical attachment level. The magnitude of pocket depth reduction correlates with greater pocket depth before treatment. Nonsurgical mechanical debridement may cause loss of attachment in shallow pockets (</=3 mm). There is no evidence of any difference in efficacy between machine-driven (ultrasonic and sonic) and hand instruments in single-rooted teeth. Machine-driven instruments may be faster than hand instruments. Adjunctive therapies have been developed and investigated but, to date, no therapy exists as a stand alone replacement for mechanical nonsurgical pocket therapy.Maintenance therapy: In periodontal maintenance patients, mechanical debridement reduces inflammation and disturbs the bacterial biofilm, which is thought critical to disease control including prevention of progression. The effect of mechanical nonsurgical pocket therapy on pocket depth reduction and clinical attachment gain in maintenance patients is unclear; maintenance or stability of pocket probing depth and clinical attachment level, however, has been demonstrated and meets the goal of maintenance therapy. There is not clear evidence to form recommendations over time taken, thoroughness and frequency of mechanical debridement for periodontal maintenance care. Existing evidence in the form of systematic reviews - the highest level of evidence for evaluating a therapy - provides conclusive support for the beneficial effect and efficacy of mechanical nonsurgical pocket therapy in the treatment of periodontal diseases.

Amine fluoride/stannous fluoride and incidence of root caries in periodontal maintenance patients

The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF2) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience. In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/SnF2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months. An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p<0.05). The mean number of active caries lesions at baseline was 2.1 and 1.8 for the test group and control group, respectively. At 24 months, the corresponding values were 1.8 for the test and 2.2 for the control group. An increase of the mean number of restored surfaces was noted for the AmF/SnF2 group (from 7.3 to 13.4) and the control group (from 7.9 to 14.7) during the course of the study. This increase was found to be statistically significant for both groups in comparison with the baseline values (p< or =0.01). No statistically significant differences were noted between groups. Further analysis of the restored surfaces revealed that the major increase in number of the restorations was associated with restorations involving three to four root surfaces in the same tooth. Molars and premolars were the teeth receiving most new restorations. The present study did not detect a difference in terms of root caries development between the two groups. Root caries development is a common finding associated with surfaces developing recession in patients once treated for periodontal problems.

Effect of interleukin‐1 gene polymorphisms on gingival inflammation assessed by bleeding on probing in a periodontal maintenance population

Bleeding on probing (BOP) is the most significant clinical parameter for the assessment of periodontal inflammation. The aim of this prospective longitudinal trial was to study the association between allelic variants of the IL-1 gene complex and gingival inflammation. Three hundred and twenty-three randomly selected periodontal maintenance patients (64.4% females) received a periodontal examination that included probing depth measurements and BOP at each of 4 supportive periodontal therapy (SPT) appointments. A blood sample taken from each subject was analysed for the presence of specific allotypes of the IL-1 gene complex. Two polymorphisms located at +4845 bp in the IL-1 alpha region and at +3954 bp in the IL-1 beta region were evaluated by a polymerase chain reaction method; 35.3% of the examined subjects were positive for specific combinations of allotypes of the IL-1 gene complex previously associated with an increased risk for severe periodontitis. The population consisted of 90 current smokers and 94 former smokers. An analysis of the association between the IL-1 genotype and BOP in the whole population (including smokers) did not reach statistical significance because of the overriding effect of smoking. A subset analysis of the 139 never smokers indicated that genotype positive patients had a significantly elevated chance of presenting an increase in the BOP% over a 4-appointment recall period (p = 0.03) after correcting for oral hygiene. In fact, patients who were genotype-negative had a 50% smaller chance of showing increases in BOP% during SPT. A further analysis explored the relationship between the genotype and the level of BOP% at the most recent recall visit. A generalized linear model showed a statistically significant effect of the genotype status after correcting for plaque accumulation and prevalence of residual pockets (> or = 5 mm). Genotype-negative subjects had significantly lower BOP% (p = 0.0097). It is concluded that the increased BOP prevalence and incidence observed in IL-1 genotype-positive subjects indicates that some individuals have a genetically determined hyper-inflammatory response that is expressed in the clinical response of the periodontal tissues.

A cross-sectional study into the prevalence of root caries in periodontal maintenance patients.

The aim of this cross-sectional study was to investigate cross-sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0-19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites: 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >106 mutans streptococci/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Intra - and inter-examiner reproducibility in constant force probing.

This study evaluated intra- and inter-examiner reproducibility for a conventional manual probe versus a computer-interfaced force-controlled periodontal probe. 2 examiners recorded probing depths (PD) and relative attachment levels (AL) at 1128 sites in 15 periodontal maintenance patients. Each site was evaluated 2x, 7 to 10 days apart by both examiners. Probing force for the electronic probe was 15 g. PD intra-examiner reproducibility (within +/- 1.0 mm) for shallow sites (PD < or = 3 mm) was 98.6% versus 91.5% for the conventional versus the electronic probe for examiner 1 and 98.5% versus 88.7% for examiner 2. Corresponding values for deeper sites (PD > 3 mm) were 96.4% versus 85.9% for examiner 1 and 95.1% versus 77.0% for examiner 2. Generally, AL intra-examiner reproducibility was 1 to 3% lower than for PD. PD inter-examiner reproducibility (within +/- 1.0 mm) was 99.2% versus 90.7% for the conventional versus the electronic probe, respectively, for shallow sites and 95.4% versus 76.9% for deeper sites. AL inter-examiner reproducibility (within +/- 1.0 mm) was 1 to 5% lower than for PD. Both intra- and inter-examiner reproducibility was higher for anterior than for posterior sites. Mean PD and AL were similar for both examiners. However, the electronic probe consistently recorded 0.1 to 0.2 mm higher values than the conventional probe. Standard deviations indicated a greater variability for electronic than for manual probing. The results suggest that intra- and inter-examiner reproducibility may not necessarily be higher with an electronic, force-controlled periodontal probe than with a conventional manual probe.

Reproducibility of Periodontal Probing Using a Conventional Manual and an Automated Force‐Controlled Electronic Probe

A total of 1,128 sites in 15 periodontal maintenance patients were examined twice, 7 to 10 days apart, to evaluate reproducibility of periodontal probing by a conventional manual and an automated force-controlled electronic probe. Probing depths (PD) and relative attachment levels (AL) were recorded to the nearest 0.5 mm with both instruments. At each visit, all sites were probed first with the conventional and then with the electronic probe. Reproducibility of PD at shallow sites (PD < or = 3 mm) by the manual probe was 59.1% for exact agreement and 98.6% within +/- 1.0 mm variation. For the electronic probe, corresponding values were 41.3% and 91.5%, respectively. Reproducibility of PD measurements at deeper sites (PD > 3 mm), was 33.0% for exact match and 96.4% within +/- 1.0 mm for the manual and, correspondingly, 31.7% and 85.9% for the electronic probe. Reproducibility of AL followed a similar pattern, but was consistently lower than for PD. Reproducibility was consistently higher for anterior than for posterior sites and, for some comparisons, higher in the maxilla than in the mandible. These differences were smaller for the manual than for the electronic probe. Time required to complete the probing was longer for the conventional probe than for the electronic instrument. Under the prevailing study conditions, the automated force-controlled electronic probe failed to offer significant advantages over the conventional manual probe.

The relationship between restoration and furcation involvement on molar teeth.

The purpose of this cross-sectional study was to examine the correlation between the presence of a crown (CR) or a proximal restoration (RE) and furcation involvement (FI) on molar teeth. Data were collected from 134 periodontal maintenance patients who had restored and non-restored molars present both with and without FI. A majority of the restorations that were present in these patients had been in place for at least 5 years prior to the study. First and second molars were examined clinically using the following criteria: CR, RE, FI, mobility (MO), and probing periodontal attachment level (AL). Data were analyzed with a statistical program utilizing Pearson chi-square and the pair-difference t test. The results indicated that molars with CR or RE had a significantly (P < 0.01) higher percentage of FI but no greater mobility when compared to molars without restorations. Mean probing periodontal attachment loss was greater for restored than non-restored molars but only with marginal significance (P = 0.051). There was a greater difference in mean AL between restored versus non-restored maxillary molars than for mandibular molars. This cross-sectional study provides evidence that molars with crowns or restorations involving the proximal tooth surfaces had a higher prevalence of FI and greater AL than molars without restorations.

Determining the Value of a Periodontal Diagnostic Test

The purpose of this analysis is to present a method to determine the value of diagnostic tests for evidence of bacterial activity related to periodontal disease. Five population studies are discussed: 1) screening the general population; 2) screening the patients of a general practice; 3) diagnosing initial patients referred to a periodontist; 4) monitoring periodontal maintenance patients; and 5) monitoring postsurgical refractory patients. A decision tree is constructed in which the primary decision branches are test and no test. Chance branches after the test branch were test positive and test negative. The treatment alternatives in the treatment branches were prophylaxis and oral hygiene, scaling and root planing, and advanced periodontal therapy (including surgical intervention and/or antibiotics or chemotherapies). Probabilities for the prevalence of disease in each population were obtained from epidemiological surveys. Disease activity and outcome states were estimated from clinical studies of periodontal treatment. For initial periodontal patients, using a sensitivity of .87 and a specificity of .84 the value of the test branch is .851 versus .566 for the no test branch. Assumptions on the diagnostic test's sensitivity and specificity and the utility of outcomes were tested with the decision analysis techniques of sensitivity and 2-way threshold analyses. These analyses show that using a test had a greater value than no test for older patients in the general practitioner's office, and for the 3 types of periodontal treatment patients. In contrast, using the test had a lower value than not using the test in younger dental patients in the general practitioner's office and for screening the general population. The diagnostic and treatment schemes proposed here are amendable to rigorous testing to evaluate their reliability and usefulness.