Treated Root Surface Research Articles

The prevalence and severity of root surface caries across Australian generations.

The "failure of success" theory predicts that as subsequent generations of older adults retain more teeth, those additional teeth will experience more oral disease like root surface caries. The theory in relation to root surface caries has never been tested in a cross-generational study. This study aims to compare root surface caries across generations of South Australian older adults to test the theory and explore risk indicators for root surface caries. Data were from the baseline of two South Australian studies separated by 22years. In both studies, stratified random samples of people aged 60+ years from Adelaide and Mount Gambier were recruited. Dental examinations were performed by trained and calibrated dentists. One of the dental examiners from the earlier study was the gold standard examiner in the second study. Risk indicators included behavioural factors, clinical oral conditions, sociodemographic and socioeconomic status. Root surface caries was assessed as untreated root surface caries (root decayed surfaces [RDS]), treated root surface caries (root filled surfaces [RFS]) and treated or untreated root surface caries (root decayed and filled surfaces [RDFS]) and was presented as the prevalence and summed count. Multivariable models for Poisson and negative binomial distributions were used to estimate prevalence ratios (PR) and mean ratios (MR), respectively, and their 95% confidence intervals (95% CI). The current generation of South Australian older adults has significantly lower RDS (PR [95% CI]=0.65 [0.47-0.89]; MR [95% CI]=0.51 [0.35-0.73]) and RDFS (PR [95% CI]=0.84 [0.71-0.99]; MR [95% CI]=0.76 [0.65-0.90]) than the previous generation. The RFS in the previous and current generation was similar. Gingival recession, irregular brushing, dental visiting for a problem and smoking were the indicators for RDS, while age, gingival recession, tooth brushing frequency, time since last dental visit and reason of visiting were the indicators for RFS or RDFS. These results do not support the "failure of success" theory in relation to root surface caries among South Australian older adults. Despite the higher number of teeth retained, the current generation of older adults has less root surface caries than the previous generation. Behavioural factors remain the indicators of root surface caries across the generations.

Presence of an enamel matrix protein derivative on human teeth following periodontal surgery.

An enamel matrix protein derivative (EMD) has been successfully employed to restore fully functional periodontal ligament, cementum, and alveolar bone in patients with severe attachment loss. When applied to denuded root surfaces, EMD is believed to assemble into a matrix that locally stimulates regenerative responses in the surrounding tissues. Since wound healing and induction of regeneration are biological processes typically running from weeks to months after treatment, the EMD matrix must be present on the root surface over a biologically significant time period to be effective. So far, no studies have been done in humans on the persistence of EMD on the treated root surface. The aim of the present study was to investigate the persistence of the EMD-based matrix on periodontally involved human teeth treated surgically with EMD. Sixteen patients with one intrabony defect each around teeth scheduled for extraction due to advanced periodontitis were treated by means of access flap surgery with and without application of EMD. At 1, 2, 3, and 4 weeks postsurgery, the teeth were removed and processed for histology and immunohistochemistry. The slides were stained using a rabbit anti-enamel-matrix-derivative (anti-EMD) antibody and goat-antirabbit secondary antibodies labeled with horseradish peroxidase (HRP). Immunohistochemical evaluation demonstrated the presence of EMD on all test root surfaces during the entire observation period of 4 weeks. No EMD was detected on any of the control roots. The results demonstrate for the first time in humans that EMD is present on treated root surfaces for up to 4 weeks following periodontal surgery.

Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series.

This clinical study was designed to determine whether the thickness of the flap can influence root coverage when gingival recessions associated with traumatic toothbrushing are treated using a coronally advanced flap (CAF). Nineteen patients, aged from 25 to 57 years, with high levels of oral hygiene (full-mouth plaque scores <20%) were selected for the study. Each patient contributed with one Miller Class I or II maxillary or mandibular recession. A total of 19 recessions > or =2 mm were treated. After local anesthesia and before flap elevation, the exposed root surface was planed with a sharp curet. A trapezoidal full- and partial-thickness flap was then elevated, displaced coronally, and sutured to cover the treated root surface. Before suturing, flap thickness was measured in the alveolar mucosa with a gauge. After surgery, all patients were recalled for control and professional prophylaxis once a week during the first month and monthly up to the third month. The mean initial recession depth was 3.0+/-0.9 mm. Mean flap thickness (FT) was 0.7+/-0.2 mm. Three months later, mean recession depth was 0.6+/-0.6 (P <0.0001) and mean recession reduction was 2.4+/-0.7 mm. Mean root coverage was 82+/-17%. Flap thickness >0.8 mm was associated with 100% of root coverage. The results of this study indicate that there is a direct relation between flap thickness and recession reduction (P <0.0001).

An in vitro study of oscillating instruments for root planing

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

Epithelial Cell Kinetics With Atelocollagen Membranes: A Study in Rats

A recent development in guided tissue regeneration procedures is the use of resorbable membranes, which eliminate the need for subsequent surgical removal. In this study we performed flap surgery in rats with (experimental) or without (control) implantation of one of the newer materials, atelocollagen. We observed the gingival epithelial cell kinetics using 3H-thymidine and examined the extent of gingival epithelium migration. Histological observations at day 1 on the experimental side demonstrated regenerated epithelium apposed to the collagen membrane with an intervening layer of necrotic tissues and/or fibrinous exudate. There was no observable proliferation of regenerated epithelium toward the root apex. On day 14, the regenerated epithelium migrated apically along the treated root surface in the control group. By contrast, on day 14 in the experimental group, the regenerated epithelium contacted the root surface at the cemento-enamel junction (CEJ). Apical to the CEJ, there was new cementum formation with inserting connective tissue fibers. Autoradiographs from day 1 experimental sides demonstrated labeled cells in the basal cell layers from oral, crevicular, and junctional epithelium. From day 1 to day 5, labeling indices of oral epithelium and regenerating crevicular epithelium on experimental sides were lower than on control sides. These histological and autoradiographic findings suggest that atelocollagen membrane inhibits apical migration of regenerating epithelium and accelerates connective tissue reattachment in part by inhibiting the mitotic function of basal epithelial cells in early stages of wound healing.

Effects of TiF4 solutions on root surfaces in vitro after different application periods.

Topical application of aqueous solutions of TiF4 to root surfaces has been shown to result in a rapid uptake of fluoride. The purpose of this study was to assess whether the application period and/or the ionic strength of the TiF4 solution can be reduced without a corresponding reduction in the fluoride uptake. Root halves from human teeth were exposed to (a) 1% TiF4 for 10 sec and 1, 2, and 4 min, and (b) 3.4% TiF4 for the same application periods. Root surface areas protected by nail polish served as controls. Transverse ground sections through the treated root surface areas were then prepared and analyzed for F by electron microprobe analysis. Most treated specimens showed F concentrations in the 0.60-1.94% range, whereas control surfaces contained less than 0.30%. Similar F concentrations were found in the surfaces treated with the two solutions. Reducing the application period resulted in a shallower penetration of F into the hard tissue but only a slight reduction of the F concentration in the surface layer. High concentrations of Ti were found on the surface of all treated specimens. This shows that both the application period and the ionic strength of TiF4 solutions can be considerably reduced and still enable a high uptake of fluoride. The results indicate that TiF4 may be an efficacious agent for F application to root surfaces under clinical conditions.