Changes In Probing Pocket Depth Research Articles

Clinical effectiveness of autologous platelet rich fibrin in the management of infrabony periodontal defects

BackgroundThis interventional controlled clinical trial with split mouth design compares the clinical effectiveness of autologous platelet rich fibrin with open flap debridement in the management of infrabony periodontal defects. MethodsFifteen patients with paired contralateral infrabony defects were treated with open flap debridement and autologous platelet rich fibrin (experimental group) or open flap debridement alone (control group). The changes in probing pocket depth, clinical attachment level, and radiographic defect depth were evaluated. Patient perception regarding pain and discomfort following the procedures and early soft tissue healing responses were assessed by visual analog scales, scored 7 days after the surgical procedures. Final reevaluation was done 1 year after surgery. ResultsBaseline clinical and radiographic measurements were comparable between the groups. Reevaluation at 1 year revealed that both treatment modalities resulted in a significant decrease in probing pocket depth, gain in clinical attachment and radiographic bone fill of the defects compared to baseline. Postoperative differences observed between the two groups were 2.27±0.29mm (P<0.001) for probing pocket depth, 3.33±0.35mm (P<0.001) for clinical attachment level and 1.29±0.32mm (P<0.001) for radiographic infrabony defect depth reduction, all in favor of the experimental group. Patient preference was greater and early healing response better for the experimental group as assessed by the visual analog scores. ConclusionWithin the limitations of this study it can be concluded that use of platelet rich fibrin is more effective than open flap debridement alone in the management of infrabony periodontal defects.

A bayesian network meta‐analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies

Guided tissue regeneration (GTR) and enamel matrix derivatives (EMD) are two popular regenerative treatments for periodontal infrabony lesions. Both have been used in conjunction with other regenerative materials. We conducted a Bayesian network meta-analysis of randomized controlled trials on treatment effects of GTR, EMD and their combination therapies. A systematic literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including June 2011. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts were treated as one group and so were barrier membranes. A total of 53 studies were included in this review, and we found small differences between regenerative therapies which were non-significant statistically and clinically. GTR and GTR-related combination therapies achieved greater PPD reduction than EMD and EMD-related combination therapies. Combination therapies achieved slightly greater CAL gain than the use of EMD or GTR alone. GTR with BG achieved greatest defect fill. Combination therapies performed better than single therapies, but the additional benefits were small. Bayesian network meta-analysis is a promising technique to compare multiple treatments. Further analysis of methodological characteristics will be required prior to clinical recommendations.

Evaluation of a porous hydroxyapatite alloplast in the management of grade II furcation defects in molars. A case series

Introduction: The present case series evaluates the efficacy of a hydroxyapatite graft material in the management of grade II furcation involvement in first molars. Material and methods: Eight patients presenting with a total of 9 grade II furcation defects in relation to the facial aspect of either maxillary or mandibular first molars were treated with a porous hydroxyapatite alloplast. The clinical outcomes were measured in terms of change in probing pocket depth and clinical attachment level (vertical and horizontal) at 6 months post-operatively. Radiographs were used as supplements. Results: At 6 months, there was a mean pocket depth reduction of 3.12±1.25 mm, a mean vertical attachment gain of 2.75±1.17 mm, and a mean horizontal attachment gain of 3.25±1.28 mm. Radiographs showed bone fill at all treated sites. The outcomes were better in mandibular teeth compared to maxillary teeth. The use of hydroxyapatite graft is effective in reducing pocket depth and bringing out gain in attachment levels when used in grade II furcation defects. Key words:Grade II furcation, bone grafts, hydroxyapatite.

Comparison of the effects of treatment of peri‐implant infection in animal and human studies: systematic review and meta‐analysis

The main objective of this systematic review is to compare the effects of treatment of peri-implant infection between animal and human studies. A literature search was conducted using the Medline, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature databases up to and including May 2008. In addition, bibliographies of systematic reviews on peri-implant diseases were searched manually. Non-surgical and surgical treatments of peri-implantitis/mucositis in animal models or human studies were compared. Meta-analysis was conducted to investigate the difference between the reported treatment effects in animal and human studies. Changes in probing pocket depth (PPD) and probing attachment level (PAL) from baseline measurements were used as measures of outcome. Single-level and multilevel meta-regression analysis was performed by taking into account the different follow-up times of the studies included. The single-level and multilevel random-effects meta-analysis showed that the difference in PPD reduction [0.31 mm, 95% confidence interval (CI): -0.27, 0.88] and in PAL gain (0.21 mm, 95% CI: -0.47, 0.88) between animal and human studies was not statistically significant. The random-effects meta-regression suggested that studies with longer follow-up times revealed greater PPD reduction (0.25 mm per month, 95% CI: 0.14, 0.35). However, when the different follow-up times were taken into account, these differences became greater. Substantial heterogeneity between studies was found in the meta-analyses (I(2)=97.6% for animal studies and 99.9% for human studies). There was great heterogeneity between human and animal studies in terms of study designs and treatment procedures. Therefore, the results from this meta-analysis should be interpreted with caution. Heterogeneity between studies and its causes merit further investigations.

Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta‐analysis of randomized‐controlled trials

Network meta-analyses of randomized-controlled trials were undertaken to investigate whether enamel matrix derivatives (EMD) in conjunction with other regenerative materials yield better treatment outcomes than EMD alone in the treatment of infrabony defects > or =3 mm. A literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including December 2008. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts (or barrier membranes) were first treated as a group and then separately. Twenty-eight studies were included in the review. EMD plus bone grafts and EMD plus membranes attained 0.24 mm [95% high probability density (HPD) intervals: -0.38, 0.65] and 0.07 mm (95% HPD intervals: -1.26, 1.04) more PPD reduction than EMD alone, respectively. For CAL gain, EMD plus bone grafts and EMD plus membranes attained 0.46 mm (95% HPD intervals: -0.17, 0.83) and 0.15 mm (95% HPD intervals: -1.37, 0.30), respectively. When different types of bone grafts and barrier membranes were treated separately, EMD with bovine bone grafts showed greater treatment effects. There was little evidence to support the additional benefits of EMD in conjunction with other regenerative materials.

A new approach for increasing the width of attached gingiva by modified apically repositioned flap

20 subjects were enrolled in this study. 10 were treated with apicially repositioned flap technique (control group) and 10 with modified apically repositioned flap technique (experimental group). The width of attached gingiva, keratinized gingiva, probing pocket depth and gingival recession is measured at day 0 and at 3 months postoperatively on the mid-bucçal aspect of the treated teeth. Statistical analysis was performed using't' test. Significant increase in width of attached and keratinized gingiva were observed in both the groups (p<0.05). The experimental group has shown slight reduction in gingival recession as compared to control group in which gingival cecession has increased. No significant change in probing pocket depth was found in experimental group. There is slight reduction in probing pocket depth in control group. The experimental and control group is equally effective in increasing the width of attached gingiva. The advantage of modified apically repositioned tlap technique is in terms of esthetics as it prevents gingival recęssion which is commonly seen with apically repositioned flap technique.

Probing pressure, a highly undervalued unit of measure in periodontal probing: a systematic review on its effect on probing pocket depth

To investigate the influence of probing pressure on the probing pocket depth (PPD) in diseased and healthy periodontal tissue conditions through a systematic review. In addition, to facilitate comparison of the study outcomes, an attempt was made to provide a correction factor that compensates for the different probing pressures used. The MEDLINE-PubMed and Cochrane Central Register of controlled trails (Central) were searched up to June 2008 to indentify appropriate studies. The search yielded 3032 titles and abstracts. In total, five papers fulfilled the eligibility criteria. These studies provided data with probing pressures ranging from 51 to 995 N/cm(2). For the evaluation of the results a distribution was made between diseased and healthy/treated sites. The incremental change in PPD in healthy/treated sites decreased as the pressure increased above 398 N/cm(2). In diseased sites, this phenomenon was already present at pressures above 100 N/cm(2). At healthy/treated sites, a mean increase of PPD of 0.002 mm per increase of 1 N/cm(2) in probing pressure could be calculated whereas at diseased sites this value amounted to 0.004 mm. The results show that with increasing probing pressure, the PPD increases. The dimensions of the increase are dependent on the periodontal tissue conditions.

Subgingival Débridement Appears as Effective as More Complex and Expensive Therapies for Peri-Implantitis

Systematic review conclusion. Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis.Critical summary assessment. There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis.Evidence quality rating. Limited. Systematic review conclusion. Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis. Critical summary assessment. There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis. Evidence quality rating. Limited. What are the most effective treatments for peri-implantitis, the progressive marginal bone loss around dental implants induced by bacterial plaque infection? For this systematic review, the authors selected for inclusion randomized controlled trials (RCTs) involving patients with at least one stable implant demonstrating marginal bone loss who were treated for peri-implantitis. The authors included studies in which surgical and nonsurgical procedures aimed at treating peri-implantitis were evaluated. Outcome measures included change in probing pocket depth (PPD) and probing attachment level (PAL), as well as implant failure. The authors conducted an all-language search of several electronic databases (from as early as 1966 through January 2008) and relevant dental journals. They contacted selected authors and dental implant manufacturers to locate unpublished or ongoing RCTs. Two of the authors served as reviewers and independently duplicated the selection of studies for inclusion, evaluation of study quality, and data extraction. The authors identified seven studies (146 patients total) that met their inclusion criteria. In these studies, investigators evaluated the following treatments:use of topical antibiotic (metro-nidazole gel) versus ultrasonic débridement;manual débridement with and without use of topical antibiotic (10 percent doxycycline hyclate gel);different techniques of subgingival débridement;laser versus manual débridement with chlorhexidine (applied either via irrigation or in gel form);apical flap–repositioning surgery with and without implant polishing;augmentation with either nanocrystalline hydroxyapatite or bovine-derived xenograft and resorbable membrane. The only statistically significant differences between treatment outcomes were in two trials judged by the authors to be at high risk of bias. The addition of doxycycline to manual débridement provided an additional 0.6 millimeters&apos; improvement in PAL and PPD in patients demonstrating at least 50 percent bone loss. And although both augmentation procedures improved PAL and PPD, the bovine-derived xenograft/membrane group gained an additional 0.5 mm in PAL and PPD. The majority of studies in which more complex and expensive therapies for treating peri-implantitis were evaluated did not show statistically or clinically significant advantages for these treatments versus simple subgingival débridement. For treatments having similar degrees of effectiveness, there is no information on which have fewer adverse effects or are simpler or less expensive to use. The lack of reliable evidence demonstrating which treatments are most effective for treating peri-implantitis does not mean that treatments used are ineffective. Local antibiotics and bone augmentation may provide additional benefit in treatment of peri-implantitis, but large, well-designed RCTs are needed to address this question adequately.

Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial

Recent preclinical and clinical data have suggested the potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, currently, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy. Twenty-four patients receiving regularly supportive periodontal therapy were randomly treated with either subgingival scaling and root planing followed by a single episode of PDT (test) or subgingival scaling and root planing alone (control). The following parameters were evaluated at baseline and at 3 months and 6 months after therapy: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), bleeding on probing (BOP) at experimental sites, probing pocket depth (PPD), gingival recession (REC), and clinical attachment level (CAL). Primary outcome variables were changes in PPD and CAL. Microbiological evaluation of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythensis (T.f.), Treponema denticola (T.d.), Peptostreptococcus micros (P.m.), Fusobacterium nucleatum (F.n.), Campylobacter rectus (C.r.), Eubacterium nodatum (E.n.), Eikenella corrodens (E.c.), and Capnocytophaga species (C.s.) was also performed at baseline and at 3 months and 6 months after therapy, using a commercially available polymerase chain reaction test. No differences in any of the investigated parameters were observed at baseline between the two groups. At 3 months and 6 months after treatment, there were no statistically significant differences between the groups in terms of PPD, CAL and FMPS. At 3 months and 6 months, a statistically significantly higher improvement of BOP was found in the test group. At 3 months after therapy, the microbiological analysis showed a statistically significant reduction of F.n. and E.n. in the test group. At 6 months, statistically significantly higher numbers of E.c. and C.s. were detected in the test group. The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain, but it resulted in significantly higher reduction of bleeding scores than following scaling and root planing alone.

Effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy

The purpose of the present study was to evaluate clinically the effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy. A total of 19 patients with chronic periodontitis were enrolled in the study. Each subject had three sites in each of two contra-lateral jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding on probing (BoP+). All teeth received scaling and root planing under local anesthesia followed by irrigation with sterile saline. An oily calcium hydroxide suspension (Osteoinductal) was applied subgingivally to the test sites at random. All sites were reexamined after 1, 2 [gingival index (GI) and BoP], and 3 weeks (GI, BoP, and PPD). Treatment success was defined as no signs of GI (GI=0), no BoP (BoP-), and pocket closure (PPD< or =4 mm). At all three different points in time, there were improvements in both GI and BoP at the control and test sites, which were in favor of the test therapy (p<0.05). For PPD change, no differences were found between the test and the control sites. The results of the study suggest that the topical application of an oily calcium hydroxide suspension (Osteoinductal), after nonsurgical periodontal therapy, improves early periodontal wound healing.

Full‐mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis

To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.

Periodontal dressing (Vocopac®) influences outcomes in a two‐step treatment procedure

It is not clear if periodontal dressing influences the long-term results in a non-surgical treatment procedure. The periodontal parameters (pre-baseline) of 36 patients with aggressive periodontitis were obtained before the patients were treated initially (1st step) by a dental hygienist, who completely removed the supra- and subgingival concrements. Baseline parameters were raised 3 weeks after the 1st step, before the 2nd therapy step was conducted. It consisted of a non-surgical procedure, which comprised a closed full-mouth manual root curettage (root planing), immediate systemic application of metronidazole, and the placement of a periodontal dressing (Vocopac, Voco). The patients were randomized to two test groups having their periodontal packs removed after 3-4 days (group 1, n=12) and 7-8 days (group 2, n=12), respectively and a control group (n=12) without periodontal dressing. Clinical parameters were raised again after 6 and 24 months. Six and 24 months later, changes in probing pocket depth (PPD) and probing attachment level (PAL) were observed in all three groups compared with baseline, but the difference was significant in group 2 only. In addition, group 2 showed a greater reduction in mean PPD and also a significantly greater gain of attachment in comparison with the controls. Wound dressing has a positive effect on clinical long-term results using a two-step non-surgical procedure. Moreover, removing the dressing after 7-8 days leads to clearly better results than removing it earlier.

Long‐term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6–7 years

To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6-7 years, and to disclose factors that may influence the long-term outcome of the treatment. Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6-7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6-7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing > or =2 mm in PAL was evaluated with Fisher's exact test. At baseline, a mean PPD of 8.7+/-1.1 mm and a mean PAL of 9.8+/-1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6-7 years after GTR treatment. An average residual PPD of 3.8+/-1.1 mm and a mean PAL gain of 3.8+/-1.4 mm were observed after 1 year. After 6-7 years the corresponding values were 4.7+/-1.3 and 3.6+/-1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6-7-year values. At the 6-7-year control, only 16% of the sites had lost > or =2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6-7 years from treatment. Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis.

Systemic antimicrobials offer an additional benefit over scaling and root planing alone in the treatment of periodontitis

Data sources Medline, the Cochrane Oral Health Group Trials Register and EMbase were data sources. Reference lists from relevant articles were also hand-searched and a further search was made by hand of selected journals dated up to April 2001. Study selection Randomised controlled clinical trials or controlled clinical trials of at least 6 months’ duration were selected in which systemically healthy patients with either aggressive periodontitis (AgP) or chronic periodontitis (CP) were treated by scaling and root planing (SRP) plus systemic antimicrobials, or by SRP alone or with placebo, for a minimum of 6 months. Clinical attachment level (CAL) change and probing pocket depth (PPD) change were the main outcome measures. Data extraction and synthesis Information regarding quality and study characteristics was extracted independently by two reviewers. Kappa scores determined their agreement. Results were collated by drug, disease and PPD category. Data was pooled (when mean differences and standard errors were available), using either a fixed-effects or random-effects model for meta-analysis. Results A total of 25 papers were included in the analysis. Overall, SRP plus systemic antimicrobial groups demonstrated better results in CAL and PPD change than SRP alone and than placebo groups. Randomisation and allocation-concealment methods were seldom reported and blindness was usually not defined clearly. The studies showed high variability and insufficient relevant information for an adequate assessment. As a result only limited meta-analyses could be performed. These showed a statistically significant additional benefit of spiramycin (PPD change) and amoxicillin/metronidazole (CAL change) in deep pockets. Conclusions Systemic antimicrobials in conjunction with SRP can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of CAL and PPD change and reduced risk of additional CAL loss. Differences in study methodology and lack of data, however, precluded an adequate and complete pooling of data for more comprehensive analyses. It was difficult to establish definitive conclusions, although people who had greater pocket-depth, progressive or active disease, or a specific microbiological profile, may benefit more from this adjunctive therapy.

A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients.

Scaling and root planing (SRP) are the bases of non-surgical therapy in the treatment of periodontitis. However, results from this therapy are often unpredictable and dependable from many different factors. The aim of this systematic review was to evaluate the effectiveness of the adjunctive use of systemic antimicrobials with scaling and root planing (SRP) vs. SRP alone in the treatment of chronic (CP) or aggressive periodontitis (AgP). Use of computerized databases, namely MEDLINE, the Cochrane Oral Health Group Specialty Trials Register and EMBASE; reference lists from relevant articles were hand-searched; and a hand-search of selected journals until April 2001. Studies were selected if they were designed as controlled clinical trials in which systemically healthy patients with either AgP or CP were treated with SRP plus systemic antimicrobials in comparison with SRP alone or with placebo, for a minimum of 6 months. Main outcome measures were clinical attachment level (CAL) change and probing pocket depth (PPD) change. Two reviewers extracted independently information regarding quality and study characteristics, in duplicate. Kappa scores determined their agreement. Main results were collected and grouped by drug, disease and PPD category. For the quantitative data synthesis, the data was pooled (when mean differences and standard errors were available), and either a Fixed Effects or Random Effects meta-analysis was used for the analysis. After an initial selection, 158 papers were identified by the manual and electronic searches; 25 papers were eligible for inclusion. Their quality assessment showed that randomization and allocation concealment methods were seldom reported and blindness was usually not defined clearly. In general, selected studies showed high variability and lack of relevant information for an adequate assessment. Overall, SRP plus systemic antimicrobial groups demonstrated better results in CAL and PPD change than SRP alone or with placebo groups. Only limited meta-analyses could be performed, due to the difficulties in pooling the studies and the lack of appropriate data. This analysis showed a statistically significant additional benefit for spiramycin (PPD change) and amoxicillin/metronidazole (CAL change) in deep pockets. Systemic antimicrobials in conjunction with SRP, can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of CAL and PPD change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or 'active' disease, or specific microbiological profile, can benefit more from this adjunctive therapy.

Effect of periodontal treatment on the activity of chitinase in whole saliva of periodontitis patients.

Human salivary chitinase could play a role in the defence against chitin-containing oral pathogens. The activity levels of chitinase in the whole saliva of periodontitis patients were significantly higher than those in saliva from controls. Periodontal treatment for a period of 5-6 months resulted in a three- to fourfold decrease in this enzyme activity. The activity of beta-N-acetylhexosaminidase, which is another enzyme that hydrolyses glycosidic linkages, also decreased as a result of treatment, although to a lesser extent. The decrease in chitinase activity upon treatment of the disease did not correlate with the decrease that was seen in clinical attachment loss and bleeding on probing, and only a weak correlation was observed with the changes in probing pocket depth and plaque index. No correlations were found between the above clinical parameters and the decrease in beta-N-acetylhexosaminidase activity.

臨床パラメーターとポケット内細菌叢に対するスケーリング・ルートプレーニングの効果 ＩＩ ポケット減少に相関する術前の因子

Scaling and root planing is one of the most fundamental and effective procedures in periodontal therapy. The purpose of this study was to investigate statistically whether clinical or microbiological parameters before treatment are related to changes in probing pocket depth (PD). Two kinds of numerical values represented changes in PD. One was pocket difference (A-B: A; PD before the treatment and B; PD after treatment) and the other was rate of pocket decrase [(A-B)/A x 100]. Twenty four sites in six patients with periodontal pockets deeper than 4 mm were selected for this study. Clinical parameters such as PD, probing attachment level (PAL), gingival crevicular fluid (GCF) volume, gingival bleeding index (GBI) and suppurative index (SI) were recorded at each site. Subgingival plaques sampled at the same site were evaluated by phase contrast microscopy. The results obtained were as follows: 1. Of all the clinical parameters changes in PD were most positively correlated with PD before treatment. 2. The microbiological approach revealed that total bacterial count divided by PD value was more negatively correlated with changes in PD than total bacterial number. It was further, revealed that numbers of rods and motile bacteria were more closely correlated with changes in PD than the counts of bacterial groups. At sites where coccoid cells were relatively dominant, PD tended to decrease readily. Motile bacteria, on the other hand, exhibited just the opposite relationship. These results suggest that periodontal treatment should be more effective in periodontal pockets harboring both smaller numbers of rods and motile bacteria.