Recurrence Of Periodontitis Research Articles

Risk assessment of recurrence of disease during supportive periodontal care

Although it is accepted that the primary cause of periodontitis is bacterial infection of long duration, there are a number of risk factors which may increase the probability of recurrence of periodontal disease during supportive periodontal care. The risk may in such cases be caused by other factors than poor oral hygiene measures per se. Cross-sectional and longitudinal studies show conflicting results concerning age as a risk factor for periodontal disease. The effect of smoking on the periodontal tissues has been discussed for decades and only lately has it been possible to demonstrate that smokers definitely have more periodontal problems than non-smokers. Another important risk factor for periodontitis relates to the insulin dependent and non-insulin dependent forms of diabetes mellitus. Poorly-controlled long-duration diabetics have more periodontitis and tooth loss than well-controlled or non-diabetics. Finally, the issue of compliance deserves attention. The medical literature has suggested that patients with chronic illnesses tend to comply poorly, especially if the disease is not perceived to be particularly threatening, if the therapy is time-consuming, or if the symptoms are non-disturbing. Suggestions for improved compliance are called for.

Host response assessment in recurring periodontitis.

Data derived from periodontitis patients have provided support for a relationship between the distribution of selected members of the periodontopathic microbiota and antibody levels to the intact bacteria in both serum and GCF. These data are consistent with the systemic antibody as a reflection of the host response to an infectious process associated with an episode of disease activity. The purpose of this report is to address the concept that the host antibody responses may help to elucidate the specific etiologic agents and be used to model the risk for future periodontal disease progression in recurring periodontitis. These findings from one study in adult periodontitis patients indicated that elevations in certain antibody specificities are most closely associated with patients exhibiting a risk of disease recurrence. Furthermore, analysis of the frequency of antibody elevations suggested that patients capable of maintaining elevated antibody to these pathogens post-treatment, may be indicative of an individual at less risk. A 2nd investigation was implemented to address questions concerning host-parasite interactions in A. actinomycetemcomitans-associated recurring periodontitis. The results showed distinctive characteristics of local and systemic antibody responses and A. actinomycetemcomitans infection in patients with varying extents of recurrent disease. These longitudinal studies developed evidence for the potential of local and/or systemic antibody responses as indicators of periodontal disease recurrence.

The effect of periodontal therapy in diabetics. Results after 5 years.

The present investigation was performed to study the frequency of recurrence of periodontitis in diabetic subjects, who, prior to the initiation of a 5-year period of monitoring, were treated for moderate to advanced periodontal disease. 20 patients with diabetes, type 1 (IDDM) or type 2 (NIDDM) and 20, sex and age matched, controls with similar amounts of periodontal tissue destruction, were selected for the study. Following a screening examination, all patients were subjected to non-surgical periodontal therapy (oral hygiene instruction, supra- and subgingival scaling). 3 months later, the baseline examination for the study was performed. This included assessments of several parameters such as: number of teeth, plaque, gingivitis, probing pocket depth and probing attachment level. 6 months after the baseline examination, all 40 subjects were recalled for a 2nd examination. Sites which at this 6-month examination exhibited bleeding on probing, and had probing depth > 5 mm, were scheduled for additional surgical therapy (modified Widman flap). Following this selective additional therapy, the main period of monitoring was initiated. During this period, a plaque control program was repeated every 3 months. Re-examinations regarding plaque, gingivitis, probing depth and probing attachment level were performed 12, 24 and 60 months after the baseline examination. The findings from the examinations disclosed that diabetics and non-diabetics alike, treated for moderately to advanced forms of adult periodontitis, during a subsequent 5-year period, were able to maintain healthy periodontal conditions. Thus, the frequency of sites which exhibited signs of recurrent disease was similar in the 2 study groups.

OVERDENTURES: Principles and Procedures

Although advances in methods and improved materials have contributed to better treatment results, caries and periodontal problems still remain significant threats to overdenture service life. The prevention of caries and recurrent periodontal disease thus becomes a most important aspect of postinsertion care. Undoubtedly, there are a number of successful overdenture methods. This article outlines two treatment sequences previously described by Brewer and Morrow2 that continue to be effective (Fig. 23). Common to most overdenture techniques is that an overdenture may be the only treatment that permits retention using the patient’s last few retainable teeth. A conservative approach to root preservation still is a valid and practical measure in preventative dentistry.

Holographic evaluation of the marginal fits of complete crowns loaded at the central fossa

In dentistry, a defect of cementation on the margins of crowns accumulates bacterial plaque easily. This can result in recurrent caries and periodontal disease. In this paper holographic interferometry was applied to evaluate the effect of masticatory force on various complete crowns. Four complete molar crowns made from different materials (Au alloy, Pd-Ag alloy, Ni-Cr alloy, and porcelain fused to metal) were tested. The out-of-plane displacements of the crown specimens were measured by the method of multiple observations. The displacements measured range from 6 to 10 pm under normal load (25 N). However, the marginal openings of all four crowns were estimated to be less than 0.2 μm. In addition the defect of the crown was examined.

Utility of radiographic crestal lamina dura for predicting periodontitis disease-activity.

The relationship between radiographic crestal lamina dura and periodontitis disease-activity was studied longitudinally in 51 treated adult patients on a systematic 3-month maintenance program. The presence or absence of crestal lamina dura at 1809 interproximal sites was scored from periapical and bitewing radiographs taken at baseline of a 36-month maintenance care period. Semi-annual clinical evaluations by 2 independent examiners were carried out on each patient, with disease recurrence defined as sites revealing a > or = 3 mm increase in probing depth from baseline, or a > or = 2 mm increase in probing depth together with a > or = 2 mm loss of relative attachment level from an occlusal reference stent. Over the 36-month study period, 23 (45%) patients exhibited disease recurrence at 55 (3%) interproximal tooth sites scored for baseline crestal lamina dura. Absence of detectable baseline crestal lamina dura yielded high sensitivity (87-100%), but low specificity (17%) and low positive predictive values (0.8-3.2%), for localized periodontitis recurrence. In contrast, no sites exhibiting an intact baseline crestal lamina dura demonstrated periodontitis recurrence up to 24 months from baseline (100% positive predictive values). Presence of radiographic crestal lamina dura was positively associated with clinical periodontal stability (summary odds ratio for sites = 2.6, P = 0.0004), and negatively associated with periodontitis recurrence (summary odds ratio for sites = 0.4, P = 0.0004), for the 36-month study period. Evaluation of radiographic crestal lamina dura status appears valuable for assessing the risk of periodontitis disease-activity at inter-proximal tooth sites in patients on maintenance care programs.

Tetracycline-Loaded Fibers as Adjunctive Treatment In Periodontal Disease

Fiber placed in periodontal pockets to deliver tetracycline continuously for 10 days was effective in reducing pocket depth and bleeding on probing when used as an adjunct to scaling and root planing. In this study, the combined therapy was valuable in treating adult patients who had refractory disease sites.

The correlated binomial model in the analysis of clinical diagnostic test parameters for recurrence of periodontitis.

In the present study, recall data of 29 patients with advanced periodontitis were utilized to calculate diagnostic test parameters for bleeding scores or increased residual probing depth on increase of periodontal probing depth of > or = 2 mm after 2 years, comparing the simple binomial and correlated binomial model. 5.6% of sites were identified, where the periodontal probing depth increased 2 mm or more during 2 years of maintenance. Within-patient correlation coefficient of sites were found to be small, in general (p < 0.02), with the exceptions for predictive value of a positive test for frequent (> or = 3/4 times) bleeding on probing and residual probing depth of > or = 4 mm (p = 0.137 and p = 0.086, respectively), and specificity for no bleeding (p = 0.151). Point estimates of test parameters generally did not differ between simple binomial and correlated binomial model. The respective standard deviations were either over- or underestimated in the simple binomial model. It was concluded that the suggestion of a limited diagnostic value of bleeding scores or increased residual postoperative probing depth to predict recurrence of periodontitis cannot be rejected after application of a correlated binomial model.

Postoperative bleeding tendency as a risk factor in Actinobacillus actinomycetemcomitans‐associated periodontitis

Frequent bleeding on probing (BOP) has been considered a risk factor for recurrence of periodontitis. In the present study, 29 patients with Actinobacillus actinomycetemcomitans-associated periodontitis were enrolled in a carefully performed recall system. At 6 sites per tooth, periodontal probing depth (PPD), gingival index (GI), plaque index (PlI) and BOP was assessed 6 weeks, 6 months, 1 and 2 years after comprehensive therapy. Professional toothcleaning and subgingival scaling at sites with PPD > or = 5 mm and BOP was carried out every 2nd or 3rd month. Subgingival samples from 2 sites, a pooled subgingival sample, cheek mucosa, saliva and tongue samples were selectively cultivated for A. actinomycetemcomitans after 2 years. Following active therapy, 8% sites had a PPD of > or = 4 mm, whereas 21% sites bled on probing. After 2 years, respective figures were 12 and 27%. During maintenance, frequent BOP (> or = 3 times at 4 visits) had a predictive value of 0.133 to indicate an increase in PPD of > or = 2 mm and a negative predictive value of 0.947. The predictive value of no bleeding to indicate a stable site was 0.972, the negative predictive value 0.078. There was evidence for heterogeneity of associations between increase in PPD of > or = 2 mm and > or = 3 times BOP among patients (chi 2(28) = 41.45, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical, microbiological and immunological studies on recurrent periodontal disease

Abstract. The present study was performed to evaluate the clinical, microbiological and immunological aspects in the early stages of recurrent periodontal disease. After clinical monitoring of pockets with recent evidence of disease recurrence, microbiological samples for cultural analysis, serum and gingival crevicular fluid (GCF) samples were taken for IgG antibody analysis from 14 sites, 7 in 6 recurrent periodontitis patients and 7 in 7 periodontally healthy control subjects. IgG responses of serum antibody to 8 gram-negative bacterial strains were compared with those of GCF sampled from the recurrent site. The results clearly demonstrated the predominance of Bacteroides gingivalis in most subgingival plaque samples during the early stages of disease recurrence; the mean proportions of B. gingivalis were significantly different from those of the healthy sites (p<0.05). 4 out of 6 serum samples showed the elevated antibody responses to B. gingivalis 381: and this was closely correlated to homologous infection by this micro-organism in recurrent sites. Elevated serum antibody responses were also noted to Eikenella corrodens 1073 and Actinobacillus actinomycetemcomitans Y4. However, no relationship with homologous infection was found for A. actinomycetemcomitans. 3 out of 6 GCF samples had greater antibody titers than the serum, suggesting local antibody synthesis by the gingival cells in the recurrent pockets. The present study showed that B. gingivalis might play an important role in the pathogenesis of disease recurrence in its early stages.

Incidence of Periodontitis Recurrence in Treated Patients With and Without Cultivable

A total of 98 adults previously treated for moderate to advanced periodontitis and on a trimonthly recall schedule were screened for the presence of critical levels of Actinobacillus actinomycetemcomitans, Prevotella (Bacteroides) intermedia, and Porphyromonas (Bacteroides) gingivalis. Patients with at least 2 positive sites were placed in a positive group and patients without or with low levels of these bacteria in a negative group. During the 30-month study the incidence of disease recurrence was greater in the positive group, but did not reach statistical significance. Positive patients with deeper pockets tended to be at greater risk of developing recurrent disease than those with shallower pockets. In the positive group only, both A. actinomycetemcomitans recovery and antibody levels to A. actinomycetemcomitans strain NCTC 9710 (serotype c) were inversely correlated with disease recurrence. The presence of A. actinomycetemcomitans and P. intermedia above critical levels did not reliably predict future episodes of disease recurrence in this population. The sparse recovery of P. gingivalis did not permit us to assess its diagnostic value. With the exception of P. gingivalis, for which insufficient data were available, the results indicate that the presence or absence of the above bacterial species cannot of itself serve as a reliable predictor of future episodes of recurrent disease in a population of treated patients on a regular trimonthly recall schedule.

The role of the prosthodontist in restoring root-resected molars: A study of 70 molar root resections

Root resection is a complex, multidiscipline technique to eliminate molar furcation invasions. In the short term of 3 or 4 years it has been highly successful, but after 10 years approximately one third fail. A substantial number of failures were attributed to recurrent periodontal disease. This study examined 70 root resected molars in 62 patients for the quality of the resections. Twenty-one (30%) of the resections were considered faulty when subgingival, residual roots, furcal lips, and/or ledges were present. Failures were more frequent in maxillary molars (33.3%) than mandibular molars (22.7%). Clinically hidden roots/lips and ledges in mandibular molars were readily observed in radiographs, but were seen radiographically only 37.5% of the time in maxillary molars. Since subgingival defects are believed to encourage future periodontal disease, it is important that the dentist detect these structures and correct them before proceeding with the permanent restoration.

Clinical, microbiological and immunological studies on recurrent periodontal disease

The present study was performed to evaluate the clinical, microbiological and immunological aspects in the early stages of recurrent periodontal disease. After clinical monitoring of pockets with recent evidence of disease recurrence, microbiological samples for cultural analysis, serum and gingival crevicular fluid (GCF) samples were taken for IgG antibody analysis from 14 sites, 7 in 6 recurrent periodontitis patients and 7 in 7 periodontally healthy control subjects. IgG responses of serum antibody to 8 gram-negative bacterial strains were compared with those of GCF sampled from the recurrent site. The results clearly demonstrated the predominance of Bacteroides gingivalis in most subgingival plaque samples during the early stages of disease recurrence; the mean proportions of B. gingivalis were significantly different from those of the healthy sites (p less than 0.05). 4 out of 6 serum samples showed the elevated antibody responses to B. gingivalis 381; and this was closely correlated to homologous infection by this micro-organism in recurrent sites. Elevated serum antibody responses were also noted to Eikenella corrodens 1073 and Actinobacillus actinomycetemcomitans Y4. However, no relationship with homologous infection was found for A. actinomycetemcomitans. 3 out of 6 GCF samples had greater antibody titers than the serum, suggesting local antibody synthesis by the gingival cells in the recurrent pockets. The present study showed that B. gingivalis might play an important role in the pathogenesis of disease recurrence in its early stages.

Treatment of recurrent periodontal disease by root planing and Ornidazole (Tiberal). Clinical and microbiological findings.

The purpose of this study was to evaluate the use of Ornidazole as an adjunct to root planing in the therapy of patients suffering from recurrent periodontal disease. In 10 individuals who had previously been treated with scaling, root planing and periodontal surgery and who had followed a regular maintenance program including recall visits every 3-5 months for 1-7 years, 2 sites with recurrent periodontitis and 1 shallow site were selected. Reinfected sites had a record of losing clinical attachment of more than 3 mm since the completion of initial therapy, were bleeding upon probing and had a mean pocket probing depth of 7.85 +/- 1.31 mm. They had been reinstrumented several times by a registered dental hygienist, when clinical signs of recurrence of disease had appeared and the root surfaces were judged to be smooth and free of deposits. Clinical parameters were recorded and microbial samples were collected twice prior to retreatment. Then, 500 mg Ornidazole, to be taken twice a day for 10 days, was administered, and the whole dentition was thoroughly scaled and root planed. At day 10 as well as 2, 5, 8 and 11 months thereafter, samples were again obtained. At baseline, reinfected sites showed over 20% spirochetes, over 20% motile rods and over 9% fusiform organisms in darkfield preparations of subgingival plaque samples. Culturally, over 1/10 of organisms were identified as black pigmenting Bacteroides and in 18% of all baseline samples collected, B. gingivalis was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined antibiotic (metronidazole) and mechanical treatment effects on the subgingival bacterial flora of sites with recurrent periodontal disease.

5 patients in maintenance, 1-3 years after periodontal therapy who showed sites with reinfected pockets and bleeding despite regular recall visits were selected. Darkfield microscopy from 3 sites in each patient showed an average of 41% spirochetes and 21% motile rods. Probing depths ranged from 7 to 9 mm and loss of clinical attachment from 6 to 13 mm in these sites. The patients were given 3 times 250 mg/day of metronidazole (Flagyl) for 10 days. Darkfield microscopy and microbiological cultures of the subgingival plaque were performed twice prior to the study, at the end of the medication and after 3 weeks, 3 and 6 months. The plaque and gingival indices, probing depth and loss of clinical attachment were recorded. During the medication and at 3 and 6 months, the teeth were scaled and root planed. The samples were obtained with 3 paper points and cultured anaerobically in the glove box on non-selective and selective media and representative bacterial colonies identified by aerobic growth, gram stain and rapid biochemical tests. Presumptive pathogenic micro-organisms including Bacteroides were identified. The % of spirochetes, motile rods and non-motile bacteria were enumerated by darkfield microscopy. The clinical results show that administration of metronidazole and repeated root planing significantly decreased gingival inflammation, probing depth and loss of clinical attachment in reinfected sites. After treatment, these sites harbored significantly less spirochetes and more non-motile bacteria, while motile rods tended to return to baseline levels with time. The combined antibiotic and mechanical therapy resulted in a statistically significant decrease of gram-negative rods, Fusobacteria and Bacteroides gingivalis over 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent periodontal disease and bacterial presence in the gingiva.

Previous investigations have shown that, in biopsies taken from untreated sites of periodontitis, bacteria were present between the epithelial cells and within the connective tissue. In the present study we have examined Gram-stained sections of diseased gingival sites where the disease had recurred after surgical periodontal treatment. The six subjects chosen for the study were patients who had undergone surgical therapy for the treatment of periodontitis and who, upon subsequent recall visits, showed evidence of at least one site recurrent after treatment as detected by bleeding on probing and increased pocket depth of 5 mm or more. A normal control site from the same patient was chosen, preferably contralaterally, showing positive response to treatment with no signs of disease. Sections were stained with either hematoxylin and eosin for tissue survey or Gram for assessment of bacteria and examined by light microscopy. In many specimens, the bacterial nature of Gram-stained material was substantiated. Preliminary results showed a significantly increased number of bacteria in the refractory sites when compared with control sites which responded positively to treatment. The results of this investigation provided further evidence that bacterial presence inside the periodontal tissue may be an important pathogenic factor in periodontal disease.

Topical antimicrobial therapy and diagnosis of subgingival bacteria in the management of inflammatory periodontal disease.

Bacterial specificity in human periodontal diseases suggests the possibility of diagnosing and treating periodontitis as specific infections and using microbiological diagnostic means to evaluate the efficacy of periodontal therapy. In a series of clinical trials, the usefulness of topical antimicrobial agents in combination with surgical and non-surgical conventional periodontal therapy were tested. The healing result was estimated by monitoring probing attachment levels (PAL). The usefulness of clinical and microbiological parameters to evaluate post-treatment healing result was tested. 9 of the patients exhibiting sites with recurrent periodontal disease were then evaluated for clinical and microbiological parameters to define accurate means to differentiate between active and inactive periodontal disease. The results showed that the frequency of periodontal lesions with significant loss of PAL after treatment was less in patients treated with antimicrobial agent. Specific microbiological parameters showed stronger correlation than clinical parameters with gain and/or loss of PAL post-treatment. Thus Actinobacillus actinomycetemcomitans and Bacteroides gingivalis occurred in periodontal lesions with progressing disease after treatment, but were rarely detected in samples from pockets of the same depths which did not exhibit further loss of PAL over a study period of 1 year. This study points to the usefulness of topical antimicrobial agent as an adjunct to mechanical subgingival debridement in the treatment of periodontitis in adults. The results also indicate the utility of diagnostic microbiology in the assessment of periodontal disease activity post-treatment.

Failure of a microbial assay to reliably predict disease recurrence in a treated periodontitis population receiving regularly scheduled prophylaxes

The purpose of this study was to evaluate the reliability of differential dark-field microscopy (DDFM) of subgingival bacteria to correctly predict the recurrence of periodontitis in treated patients on 2 different recall schemes. The results are based on data from 51 patients on 3-month recalls (C group) and 39 patients (T group) who received periodontal prophylaxes according to a customized regimen based on DDFM of subgingival bacterial morphotypes. No significant differences were detected in the rate of recurrence of periodontitis between the 2 groups, although the incidence of disease recurrence tended to be greater in the C group. The proportions of spirochetes and motile rods observed at base line, or the average of the values observed at base line, 3 months and 6 months, were compared between subjects with and without disease recurrences. Significantly elevated proportions of these bacterial morphotypes were observed in patients of the T group who demonstrated evidence of disease recurrence during the first year as compared to subjects without disease recurrence. No significant differences could be detected in bacterial morphotypes between patients resistant to disease recurrence and those who developed recurrences at some time during the 3-year period covered by this report. The ability of DDFM of subgingival bacterial morphotypes to predict future disease occurrence was tested for 1- and 3-year periods, in both the C and T groups. The test appears to be reliable only for subjects on the experimental maintenance regimen (group T) and for prediction of disease recurrence for the initial 1-year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term maintenance of patients treated for advanced periodontal disease.

The aim of the present investigation was to evaluate the periodontal conditions of a group of patients who, following active treatment of extremely advanced periodontal disease, had been maintained for 14 years in a well-supervised maintenance care program. The present sample included 61 subjects out of an initial group of 75 individuals who in 1969 were referred to and treated by the authors. Following an initial examination, the patients were given detailed instructions in proper plaque control measures and were subjected to scaling and root planning and surgical elimination of pathologically deepened pockets. After the termination of the active treatment phase, the patients were placed in a maintenance care program including recall appointments every 3-6 months. At the initial examination, immediately after the completion of the active treatment phase and then once a year, all patients were examined regarding oral hygiene, gingival conditions, probing depths and clinical attachment levels. In addition, the interproximal alveolar bone height was determined from full mouth radiographs obtained before active treatment, at the completion of active therapy and 1, 3, 5, 8, 10, 12 and 14 years after treatment. The results from the repeated examinations demonstrated that treatment of advanced forms of periodontal disease resulted in clinically healthy periodontal conditions and that this state of "periodontal health" could be maintained in most patients and sites over a period of 14 years. It was also demonstrated that the treatment and maintenance programs described were equally effective in young and older patients. The individual mean values describing probing depths, attachment levels, and bone heights did not vary significantly over the 14 years of observation. A more detailed analysis of the data revealed, however, that a small number of sites in a few patients lost a substantial amount of attachment. This attachment loss occurred at different time intervals during the course of the maintenance period. Thus, 43 surfaces in 15 different patients were exposed to recurrent periodontal disease of a significant magnitude. This recurrent inflammatory periodontal disease caused the loss of 16 teeth in 7 different patients during the maintenance period. The data reported question the validity of using individual mean values to describe alterations of the periodontal conditions during maintenance following active periodontal therapy.

Technical and biophysical aspects of fixed partial dentures for patients with reduced periodontal support

1 reatment of advanced periodontal disease often involves loss of teeth. This implies that an insufficient number of teeth may remain for the maintenance of basic oral functions following periodontal therapy. Moreover, the remaining teeth may be hypermobile or may show signs of progressive mobility. In such patients, there is an obvious need for prosthodontic treatment to restore lost oral functions, improve esthetics, and stabilize mobile teeth. The principles of periodontal therapy and the biologic rationale for splinting in the treatment of periodontitis have been adequately reported.‘.’ The result of the combined periodontal and prosthetic treatment of 251 patients with advanced periodontal disease 5 to 8 years after active treatment was recently published.” The limiting criterion for acceptance of patients for this study was that their dentition had lost at least half of the,periodontal support. In addition, the patients were capable of maintaining optimal plaque control and were willing to appear for recall appointments every 3 to 6 months for additional maintenance care. The result showed that it was possible to prevent recurrence of gingivitis of clinical importance and to arrest further progression of periodontal pathosis by proper periodontal therapy and postoperative plaque control. No abutments were lost during the observation period as the result of recurrence of periodontal disease. However! technical failures in 26 of the 332 fixed partial dentures (7.8%) did occur. These failures were caused by loss of retention of retainers (3.3%), fracture of metal components (2.1%), and fracture of abutments (2.4%). A further analysis revealed that fundamental principles regarding design and construction had been overlooked in the unsuccessful prostheses.