Pocket Elimination Research Articles

Effectiveness of local delivery of alendronate in reducing alveolar bone loss following periodontal surgery in rats.

Mucoperiosteal flaps are used to access bone and root surfaces for debridement, pocket elimination, management of periodontal defects, and in regenerative procedures, as well as in implant surgery. Many reports show that periodontal surgery stimulates osteoclast activity with varying amounts of alveolar bone loss. Alendronate given intravenously significantly reduced alveolar bone loss in mucoperiosteal flap procedures. In the present study, we explored the effectiveness of different concentrations of alendronate, delivered at the surgical site at the time of surgery, in distant delivery in reducing alveolar bone loss. Following elevation of a mucoperiosteal flap next to molars of the rat mandible, a gelatin sponge soaked with different concentrations of alendronate (0, 1, 5, 20, or 40 mg/ml; experiment A) was applied to exposed bone on the experimental side. In the second group (experiment B), alendronate (0, 50, 200, or 400 microg) was topically delivered in the cheek submucosa on the left side (distant to the surgical site) in a small cut into which the gelatin sponge soaked with the drug was placed. Topical application of 200 microg and 400 microg doses of alendronate at the time of surgery was significantly effective (P <0.001) in reducing bone loss. Generally, the percentage of sections with mild bone loss (V1, V2) increased with an increase in the dose of alendronate, while the percentage of sections with severe bone loss (H1, H2) decreased with an increase in alendronate dose. Topical application of 400 microg of alendronate had a systemic effect. This study implies that topical delivery of alendronate at the time of surgery reduces bone loss in periodontal procedures involving mucoperiosteal flap surgery. The most effective dose is 200 microg for topical delivery at the surgical site and 400 microg for distant sites.

Composite graft tympanoplasty.

Seventy six ears with chronic suppurative otitis media and fit for tympanoplasty were subjected to grafting with combination of perichondrium and cartilage (composite graft) for restoration of sound conducting apparatus and reconstruction of canal wall. A comparison with temporal fascia grafting has been done. Composite graft procedure gave better functional improvement, helped in reconstruction of canal wall and was also useful in elimination of retraction pockets.

The Influence of Molar Furcation Involvement and Mobility on Future Clinical Periodontal Attachment Loss

The purpose of this study was to determine the influence of furcation involvement (FI) and mobility (MO) on change in probing periodontal attachment level (AL) on molar teeth. Twenty-four patients were selected from The University of Michigan longitudinal periodontal clinical trial. The patients who met the entry criteria received a baseline examination and were treated by periodontal scaling and root planing followed by different periodontal surgical approaches in a split-mouth design. Patients were placed on a 3-month interval for maintenance prophylaxis and had yearly periodontal scorings for a period of 8 years. The scorings included determination of AL, FI, MO, and tooth loss (TL). Data for molar teeth from three different time periods (at entry (A) and at 1 (B) and 8 (C) years) were analyzed. The results demonstrated that teeth with FI were 2.54 times more likely to be lost when compared to teeth without FI during the maintenance period. By using paired t test approach to the probing attachment level data, molars with FI had significantly more loss between times B and C but not between A and B or A and C. Teeth with increased MO demonstrated significantly more AL between times A and C and B and C. When the interaction between MO and FI was analyzed, teeth with both FI and MO had significantly more attachment loss during the maintenance period (B to C). No statistically significant difference was found among the three different therapeutic approaches (pocket elimination, curettage, and modified Widman flap) during any of the time periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors Influencing Periodontal Therapy for the Geriatric Patient

Anatomic changes in the periodontium occur with aging. There is no indication that these changes predispose to periodontal breakdown. In the United States, there is evidence that older individuals are retaining more teeth and that these teeth have less periodontal disease than previous generations of seniors. Studies comparing the healing of older and younger patients have clearly demonstrated that both groups of patients respond equally well to therapy. Proven methods of periodontal therapy include modified Widman surgery, pocket elimination surgery, or nonsurgical scaling and root planing. Surgical treatment may be used with confidence unless there are medical contraindications. In these cases, nonsurgical therapy may be preferred. If there are physical or mental disabilities that make effective home care difficult, antimicrobial agents, such as the extensively tested chlorhexidine rinse, may be valuable adjuncts. In the future, senior adults can look forward to the benefits of regenerative periodontal procedures that seek to regain lost periodontal support. Age alone should not diminish an individual's right to care because the practitioner has qualms about his or her longevity. Successful treatment of periodontitis by surgical and nonsurgical methods has been extensively documented. Senior patients can benefit from these treatments as much as younger patients, and age is not a barrier to effective periodontal therapy.

Periodontal Preparation of the Adult Patient Prior to Orthodontics

Evaluation of periodontal status and proposed orthodontic therapy must be made prior to initiating tooth movement. Teeth with a compromised periodontium can be treated. Prior to initiation of orthodontic therapy, it may be necessary to perform periodontal surgery for pocket elimination or reduction, to perform mucogingival surgery, or to correct gross occlusal discrepancies.

The effect of supracrestal tricalcium phosphate ceramic-microfibrillar collagen grafting on postsurgical soft tissue levels.

In this clinical study, a combined tricalcium phosphate ceramic (TCP) microfibrillar collagen supracrestal graft was used in conjunction with pocket elimination surgery as a soft tissue space filler to maintain marginal and interproximal tissue heights. Fifteen volunteer adult patients (8 male, 7 female) aged 37 to 48 years were selected. Standardized clinical probing measurements were used to evaluate soft tissue recession, clinical attachment, and probing pocket depths. Intraoral photographs and radiographs supplemented documentation. Twenty-five paired test and control sites were evaluated. Following flap surgery and minor osteoplasty, test defects received supracrestal grafts of TCP microfibrillar collagen prior to flap closure. Intrabony defects were excluded. Treatment modalities were compared by analyzing changes in clinical probing measurements over four months using the students t test for paired samples at the 0.01 level of significance. Supracrestal grafting resulted in 16.74% less soft tissue recession than the control sites. In addition, there was a significant gain in clinical attachment levels compared with the controls. All implanted sites demonstrated an advantage in the use of supracrestal TCP-collagen grafts compared with the controls. This treatment modality may have value in reducing esthetic deformities, food impaction areas, and root exposure that often occur following periodontal surgery.

Surgical periodontal pocket elimination: still a justifiable objective?

The two articles in this month’s Perspectives section offer varied opinions in regard to periodontal disease—points of view that, in some instances, depart from traditional approaches. In the first paper, Dr. Sigurd Ramfjord assesses the value of surgical elimination of pockets in maintenance of periodontal support. In the study by Dr. Howard Bailet and others, the authors suggest that advanced periodontal disease is not a major cause of tooth loss but rather that most teeth are extracted in association with construction of prostheses. Neither The Journal nor the American Dental Association necessarily endorses the opinions expressed in these two papers, but offers these authors’ concerns in the goal of progress in dentistry through continual education. The two articles in this month’s Perspectives section offer varied opinions in regard to periodontal disease—points of view that, in some instances, depart from traditional approaches. In the first paper, Dr. Sigurd Ramfjord assesses the value of surgical elimination of pockets in maintenance of periodontal support. In the study by Dr. Howard Bailet and others, the authors suggest that advanced periodontal disease is not a major cause of tooth loss but rather that most teeth are extracted in association with construction of prostheses. Neither The Journal nor the American Dental Association necessarily endorses the opinions expressed in these two papers, but offers these authors’ concerns in the goal of progress in dentistry through continual education.

Immunobiological changes in the body after the elimination of pathological periodontal pockets in periodontal disease

Periodontal disease is reasonably considered as a focus of chronic infection [2-4, 6a].

Treatment effect of pocket elimination and coronal reshaping by recording the sounds of tooth impact

Treatment effect of pocket elimination and coronal reshaping by recording the sounds of tooth impact

Clinical and Microbiologic Effectiveness of Keyes’ Method of Oral Hygiene on Human Periodontitis Treated with and Without Surgery

The objective of this study is to compare the effects of Keyes’ method with conventional oral hygiene in patients with periodontitis who are treated either by scaling and root planing alone or by scaling and root planing in combination with surgical pocket elimination. The objective of this study is to compare the effects of Keyes’ method with conventional oral hygiene in patients with periodontitis who are treated either by scaling and root planing alone or by scaling and root planing in combination with surgical pocket elimination.

Efficiency of elimination of pathological periodontal pockets in periodontal diseases

A method of sclerotherapy has been developed to eliminate pathological periodontal pockets, based on the introduction of hypertonic solutions that cause aseptic inflammation of the connective tissue. The outcome of the inflammatory process is fibrotization of the gingival wall, which leads to compaction and reduction of the gums in volume.

Tooth mobility and periodontal therapy.

Data collected as part of an 8-year longitudinal study on periodontal therapy involving 82 patients and 1974 teeth were analyzed to determine if tooth mobility influenced the result of treatment. For each patient, pocket depth, attachment level and tooth mobility were scored clinically at the initial appointment, and once a year for 8 years following periodontal therapy. The treatment consisted of scaling, oral hygiene instruction, occlusal adjustment, periodontal surgery (curettage, modified Widman or pocket elimination), followed by recall prophylaxes every 3 months. Tooth mobility data on a scale of 0--3 were related to changes in attachment levels for three grades of severity of periodontal disease, based on initial pocket depth (1--3 mm, 4--6 mm, and 7 + mm). Mean patient attachment changes were calculated from teeth in the same severity category for each patient. The data were analyzed by one-way analysis of variance and Scheffe's multiple comparison procedure to test the hypothesis of equal effects of tooth mobility on the results of the treatment for the three severity groups over 8 years. The results indicate that there is a statistically significant relationship between original tooth mobility and the change in level of attachment following treatment. Pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same initial disease severity.

Periodontal conditions in patients after molar uprighting

Fifteen patients who had mandibular molars uprighted unilaterally and seven patients who had mandibular molars uprighted bilaterally were examined an average of 3 ½ years after treatment had been completed. The investigation focused on differences in clinical observations between the treated teeth and the controls on the contralateral side at the time of the recall examination. Pretreatment radiographs provided longitudinal observations. After elimination of significant but unrelated factors, including surgical pocket elimination and the presence or absence of subgingival margins, the following appeared. Changes in alveolar bone height mesial to the uprighted molars were not different from changes mesial to control teeth. Gingival inflammation scores around uprighted molars were not different from those around control teeth. Pockets mesial to uprighted molars were shallower than those mesial to control teeth. Observations on pocket depth distal to the teeth considered were inconclusive.

Treatment of compromised teeth: A multidisciplinary approach

Treatment for uprighted abutment teeth that may have infrabony pockets can be considered complete when the following criteria are met: 1. 1. The uprighted tooth is in its proper vertical axis. 2. 2. There is a significant decrease in soft-tissue pocket depth. 3. 3. Crestal leveling is evident radiographically. 4. 4. Adequate space has been created to accommodate a pontic (minimally 6.5 mm.). The advantages of employing this orthodontic-periodontal technique are as follows: 1. 1. Leveling of the osseous crest fosters pocket elimination obviating the necessity for removal of a great deal of supporting bone. Concomitantly, a significant decrease in pocket depth usually eliminates the need for periodontal surgery. 2. 2. The resulting occlusal forces are placed in favorable axial inclinations. 3. 3. There is an improved crown-to-root ratio, since the uprighted and extruded tooth is reduced to the level of the occlusal plane. This reduction is sufficient to improve considerably the prognosis of a questionable abutment tooth. 4. 4. A pontic space is created for an esthetic and properly contoured pontic. 5. 5. Parallelism is attained, so that the marginal integrity is more easily accomplished. 6. 6. The orthodontic procedures are relatively uncomplicated, efficient, and esthetic, provided there is little or no lower anterior crowding. 7. 7. The restorative dentist has a proper abutment tooth with a good prognosis for his prosthesis.

Longitudinal therapeutic effects on the periodontal attachment level and pocketdepth in beagle dogs

Thirteen healthy Beagles, 3 1/2–5 years of age with moderate to advanced periodontal discase received a thorough scaling and prophylasis followed by four weeks of daily tooth cleaning. After one month, each of the fourposterior quadrants of each dog was subjected to one of the following treatments: 1) subgingival curettage, 2) modified Widman flap surgery with root planing, 3) apically repositioned flap and bone surgery for pocket elimination and 4) scaling and root planing as a control. Toothbrushings was carried out daily. In addition, every 14 days the dogs received a rubber cup and pumice prophylaxis throughout the entire length of the study. At the baseline, 1, 6, 12, 24 and 36 months following treatment, oral hygiene and gingival health were scored and the level of periodontal attachment and pocket depth were measured. The results at one Month suggested an increase in attachment levels which was grater after scaling or subgingival curettage than after flap procedures. Up to 36 months, the established attachment levels were maintained for all treatment groups and no significant difference was found between any of the treatments and the scaled controls. However, in advanced periodontal lesion attachment levels were not maintaned with scaling alone.The present study has shown that the more conservative approaches to the treatment of periodontal disease such as subgingival curettage and Widman flap surgery may be as effective in maintaining clincal attachment levels as elaborate surgical procedures involving osteoectomy.

INFLUENCE OF PRESSURIZATION ON BINDING STRENGTH OF TURKEY MEAT ROLLS STUFFED IN MEMBRANE CASINGS

ABSTRACTThe influence of pressurization on binding strength between meat pieces stuffed into membrane casings was evaluated using a pneumatic pressurization device. This device simulated the action of a pneumatic machine that is commercially available and is now used by the industry. The contents of a stuffed casing were pressurized when the open end was twisted and inserted through a 1 cm diameter opening on a fixed aluminum ring and pulled by an air cylinder piston to which the casing was attached. Using theoretical considerations, an equation was derived for determining internal pressure in a stuffed roll based on the principle that the pressure developed is a function of the unit strain on the casing. This principle was verified experimentally by monitoring internal pressures in a casing filled with a viscous fluid and connected to a mercury manometer. The internal pressure was linear in a plot against the reciprocal of the outside diameter of the roll The regression equation was used to calculate internal pressures in a casing stuffed with meat from the measured outside diameter. Interfacial binding evaluated as failure force in uniaxial tension decreased slightly with increasing pressures in the roll in excess of 5.7 psig. The decrease was insignificant in rolls ma from frozen meat but was significant in rolls made from fresh meat. In unpressurized rolls, increased incidence of pockets filled with cookout fluid was observed. Pressurization to 2–5 psig internal pressure appears to be optimal in terms of elimination of pockets filled with cookout fluid and maximum interfacial binding between meat pieces.

Clinical Evaluation of Freezedried Bone Allografts in Periodontal Osseous Defects‐Part II

Freeze-dried crushed cortical bone allografts were implanted into widemouthed three-wall, two-wall, one-wall, combination, and furcation defects. One hundred eighty-nine sites were reentered in 97 patients and of these 60% had osseous regeneration of greater than 50%. A total of 231 sites were evaluated for pocket elimination, of which 63% demonstrated greater than 50% pocket reduction. This study presented additional evidence indicating that freeze-dried bone allografts have definite potential as grafting material in certain periodontal osseous defects. Information from additional cases is being tabulated as it becomes available and will supplement the current data.

Periodontal surgery in plaque‐infected dentitions

A clinical trial was performed to study the result of periodontal treatment following different modes of periodontal surgery in patients not recalled for maintenance care. The material consisted of 25 patients distributed into 5 groups. Following an initial examination, all patients underwent presurgical treatment including case presentation and instruction in oral hygiene measures. This instruction was given once. The various patient groups were then subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects 2) the apically repositioned flap operation including curettage of bony defects but without removal of bone 3) the "Widman flap" technique including elimination of bony defects 4) the "Widman flap" technique including curettage of bony defects but without removal of bone 5) gingivectomy including curettage of bony defects but without removal of bone. Six, 12 and 24 months after completion of the treatment, the patients were recalled for assessment of their oral hygiene standard and periodontal conditions. The results showed that case presentation and oral hygiene instruction given once, only temporarily improved the patient's oral hygiene habits. Renewed accumulation of plaque in the operated areas resulted in recurrence of periodontal disease including a significant further loss of attachment. All five different techniques for surgical pocket elimination were equally ineffective in preventing recurrence of destructive periodontitis.

Short Term Results of Three Modalities of Periodontal Treatment

Short term data were obtained from 74 patients who recieved comprehensive periodontal treatment using a split mouth approach to test three variables; subgingival curettage, pocket elimination surgery, and modified Widman flap procedure. The patients initially had an average interproximal loss of attachment of 3.2 mm and an average interproximal pocket depth of 3.9 mm. Evaluation of the data indicate that after 4 to 6 weeks: 1. All three surgical procedures reduce pocket depths. In order of effectiveness they are: pocket elimination surgery, modified Widman flap, and subgingival curettage. 2. Pocket elimination surgery reduces pockets more than subgingival curettage on the buccal, lingual and interproximal, and more than the modified Widman flap on the lingual. The modified Widman flap procedure reduces pockets more interproximally than subgingival curettage. 3. Subgingival curettage results in a gain of attachment interproximally, and on the lingual side, while the modified Widman flap resulted in a gain of attachment interproximally only. 4 Pocket elimination surgery resulted in a loss of attachment buccally. 5 Subgingival curettage results in a more favorable postoperative attachment level on all surfaces than did pocket elimination surgery.

A Comparison of Tooth Accumulated Materials from Quadrants Treated Surgically or Nonsurgically

The objective of this study was to test the validity of the clinical concept that periodontal surgery is beneficial in aiding the patient to reduce the amount of tooth accumulated materials in moderate to advanced cases of periodontal disease. Twelve arches in eight patients with moderate to severe bone loss were selected for this investigation. Using a split-mouth technique, 12 quadrants were subjected to pocket elimination by the use of osseous and soft tissue recontouring, and 12 quadrants received thorough deep scaling, root planing, and polishing. These patients were seen at 1,2, and 4 weeks after surgery for root planing and more oral hygiene instructions. At 6 weeks they received a prophylaxis, including root planing if indicated, throughout the mouth. The patients returned in 2 weeks, at which time plaque accumulations were then removed and collected by quadrant to be subjected to analysis using wet weights, dry weights and ash weights. The quantity of tooth accumulated debris on the surgically-treated quadrants was significantly greater than on those treated nonsurgically, as determined by the wet weight (P less than 0.01) and dry weight (P less than 0.05). There was, however, no significant difference with ash weight comparisons. The dry weight was the more accurate indicator of tooth accumulated materials. The mean ash weight on the surgically-treated mandibular quadrants (2.21 mg) was significantly greater (P less than 0.05) than from those treated nonsurgically (1.35 mg). The investigators' hypothesis that there would be more accretions on the side not involved in osseous surgery and pocket eradication was not supported in this study. Several possible reasons for this were elucidated and discussed.