The purpose of this study was to compare the clinical and microbiological (microscopic) parameters during the development of experimental gingivitis and experimental peri-implant mucositis. Twenty partially edentulous patients were treated for moderate to advanced periodontal disease. Following active periodontal therapy consisting of motivation, instruction in oral hygiene practices, scaling and root planing and periodontal surgery where indicated, IMZ oral implants were incorporated in posterior edentulous areas. After 3 months of healing, the prosthetic abutments were connected, and the patients were closely supervised for another 2 months of healing. At this time, baseline data were obtained. Re-examinations were scheduled at 3 and 6 months. Following this, the patients were asked to refrain from oral hygiene practices for 3 weeks. At all examinations including the end of the period of no oral hygiene, the following clinical parameters were obtained: Plaque Index, Gingival Index and Sulcus Bleeding Index, all modified by Mombelli et al. (1987), probing pocket depths and recession in mm. Furthermore, submucosal/subgingival plaque samples were obtained and analyzed using phase contrast microscopy. At the end of the 3-week period of plaque accumulation, optimal oral hygiene was reinstituted. There were no statistically significant differences between the mean values of all parameters at implant compared to tooth sites at any observation periods. The period of no oral hygiene demonstrated a similar cause-effect relationship between the accumulation of bacterial plaque and the development of peri-implant mucositis as established for the gingival units by the experimental gingivitis model.
The results of the present clinical investigation demonstrated that during a 1-year period of healing following surgical crown lengthening, the marginal periodontal tissue showed a tendency to grow in a coronal direction from the level defined at surgery. This pattern of coronal displacement of the gingival margin was more pronounced (P < 0.001) in patients with "thick" tissue biotype and also appeared to be influenced by individual variations in the healing response (P < 0.001) not related to age or gender.
This prospective multicenter intra-individual randomized controlled clinical trial was designed to compare the efficacy of guided tissue regeneration (GTR) with bioresorbable barrier membranes versus access flap surgery, in intrabony defects. 2 similar defects were selected in each of 23 patients and randomly assigned to 1 of the 2 treatments. Surgery consisted of an identical procedure except for the omission of the barrier membrane in the flap control sites. At 1-year, probing pocket depth reductions were 4.3+/-2.3 mm in GTR treated sites and 3.0+/-1.5 mm in the flap control sites (p=0.02, paired t-test). Clinical attachment level (CAL) gains were 3.0+/-1.7 mm in the GTR sites and 1.6+/-1.8 mm in the control sites (p=0.009, paired t-test). A subset analysis, performed according to the initial depth of the intrabony component of the defects (INFRA), indicated that in shallow defects (INFRA < or =3 mm) treated with the access flap alone, CAL gains were 1+/-1.5 mm, while in deep ones (INFRA > or =4 mm) they were consistently greater (1.9+/-1.9 mm). The % CAL gains, calculated as the % of the baseline intrabony component depth, however, were almost identical in the 2 subpopulations (45.8+/-64.7% in shallow and 43.8+/-37.6% in deep defects). Similarly, in the GTR sites, linear CAL gains were greater in deep (3.7+/-1.7 mm) than in shallow defects (2.2+/-1.3 mm), but no differences were observed in terms of % CAL gains (76.7+/-27.7% and 75.8+/-45%, respectively). The frequency distribution of CAL changes expressed as %s of the baseline INFRA indicates that most of the sites treated with GTR (73% in shallow and 92% in deep defects) gained 50% or more CAL. Furthermore, many defects (64% of shallow and 33% of deep defects) reached 100% of CAL gain. The present study demonstrated that: (i) GTR with bioresorbable barrier membranes resulted in a significant added benefit in comparison with access flap alone; (ii) the linear amounts of CAL gains were greater in deep than in shallow defects; (iii) CAL gains expressed as %s of the baseline depths of the intrabony component, were similar in shallow and deep defects; (iii) the regenerative procedure tested in the present study resulted in CAL gains equal to the depth of the intrabony component of the defect in some, but not in most of the instances.
The present investigation was designed to evaluate the long-term effect of root-resective therapy in the treatment of furcation-involved molars. The patient sample included 72 patients, 21-62 years of age, who presented periodontal lesions in the posteriors segments of the mouth including furcation involvement of various degrees. After an initial examination, each patient was subjected to a series of full-mouth scaling and root planing. They were recalled 1-3 months later for a presurgical examination and subsequently underwent the corrective phase of therapy. During the surgical procedure, the furcation-involved teeth were subjected to root-resective therapy in conjunction with osseous recontouring and apically positioned flaps (test sites). A surgical procedure identical to the test procedure was performed in the non-furcation-involved teeth (control sites) with the exception of the root resection. At the completion of the active phase of treatment, 175 test and 175 control sites were available for the study. After a period of 6 months of healing and plaque control supervision following surgical procedures, the patients were recalled for a baseline examination. They were then enrolled in a maintenance program including professional tooth cleaning every 26 months. The patients were re-examined 3, 5 and 10 years post-operatively. The results of the assessments demonstrated that the survival rate, during the 10-year period of observation, reached 93% at test and 99% at control sites. The positive treatment outcome at the root-resected, furcation-involved teeth as well as at non-furcation-involved teeth was probably the consequence of the reestablishment of a tissue morphology favorable for oral hygiene and careful plaque control by the patients.
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