The purpose of this report is to provide further information regarding oral changes in patients with chronic renal disease who are undergoing hemodialysis. Quantitative changes in salivary flow rate and alterations in the composition of stimulated and unstimulated sliva were studied along with the rate of formation of supragingival calculus. Results revealed a lower salivary flow rate and increased salivary urea concentration in the dialysis group. Dialysis patients also formed more heavy calculus.
The healing response of the periodontium was evaluated after periodontal flap and debridement procedures in patients with different levels of postsurgical plaque control. Thirty-one sites in 19 patients were included. Measurements were performed from a fixed reference point presurgically and before reentry surgery. All reentries were performed 24 to 28 weeks after surgery. Surgery consisted of elevating an inverse bevel mucoperiosteal flap, debriding root accretions and osseous defects, penetrating into the marrow, and suturing with interrupted sutures at or near the presurgical level. All patients were recalled at least once every 4 weeks after surgery fof professional maintenance. The number of postsurgical maintenance visits and plaque scores (NPI) before reentry were recorded for each surgical site. Average pocket depth at the 31 sites was 7.4 mm initially and 4.1 mm at the time of reentry. This reduction in pocket depth consisted of gingival recession, which averaged 2.0 mm, and a gain in attachment level, which averaged 1.4 mm. At no site was there a loss in attachment level. Average osseous depth of the 31 defects was 3.7 mm presurgically and 1.7 mm at reentry. In addition, there was an average crestal resorption of 0.8 mm and an average osseous fill of 1.2 mm. A significant positive correlation (P less than 0.001) was found between gain in attachment, osseous fill and number of postsurgical maintenance visits. A significant negative correlation was found between the amount of plaque (NPI) at the study site and both gain in soft tissue attachment and osseous fill. Multiple measurements at various points within several osseous defects revealed that osseous remodeling and fill varied significantly at different locations within the same defect.
The healing response following implantation of a nonresorbable ceramic (durapatite) into human periodontal osseous defects was evaluated clinically and histologically. Four tooth-containing blocks were obtained from four patients who had received durapatite implants in osseous defects, each exceeding 4 mm in depth. Each patient was seen for 5 to 13 postsurgical maintenance visits. Teeth in block section were removed between 8 weeks and 8 months postgraft surgery. Clinical evaluation of the repair process demonstrated that pocket depth decreased in all four cases. Histological evaluation of the repair process showed no indication of new periodontal attachment, osteogenesis or cementogenesis, in the host tissues adjacent to the graft particles. Pocket closure appeared to occur by means of a long junctional epithelium and connective tissue adhesions. There was minimal or no evidence of inflammation in all sections associated with the implant. The graft material therefore acted as a biocompatible foreign body within the gingival tissue.
A clinical evaluation was undertaken to compare regeneration of osseous defects following implantation of either osseous coagulum-bone blend from intraoral sources or autogenous iliac marrow-cancellous bone. Thirty-two transplants were performed in 15 male patients. The intraosseous defects in which marrow was placed (initial average depth = 7.18 mm) filled 60.7% (average fill = 4.36 mm). Defects in which osseous coagulum-bone blend was placed (initial average depth 4.0 mm) filled 73% (average fill = 2.93 mm). The difference in results between the two materials was not statistically significant. Therefore, similar levels of osseous regeneration apparently took place regardless of graft material used.
A clinical investigation was undertaken to compare regeneration of osseous defects following either osseous coagulum-bone blend grafts or open debridement procedures. Seventy-five sites in 28 patients were treated by the two procedures. The average fill in the 37 intraosseous defects treated by graft procedures (initial average depth = 4.22 mm, S.D. 1.73) was 2.98 mm, S.D. 1.44. The average fill in the 38 intraosseous lesions treated by open debridement procedure (initial average depth = 3.03 mm, S.D.0.80) was 0.66 mm, S.D. 0.80. Statistical analysis showed a significant difference (P greater than 0.01) in fill patterns between the bone blend and open debridement responses in favor of graft treated sites. Therefore greater levels of osseous regeneration apparently took place in our cases following osseous coagulum-bone blend autogenous graft procedures than following open debridement procedures in all types of defects studies.
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