All new patients commencing supportive periodontal therapy (periodontal maintenance) after treatment in a specialist periodontal practice from 1983 to 1986 were identified from practice records. Based on their compliance with the recommended schedule of visits, the patients were classified as either compliant or non-compliant. The results indicated that there were no significant differences between compliant and non-compliant patients with regards to age, sex, number of missing teeth, plaque score, or periodontal disease severity. More non-compliant patients than compliant patients were smokers (P less than 0.05). By contrast, more compliant patients were covered by private dental insurance (P less than 0.01) and more had periodontal surgery during treatment (P less than 0.001). Only 36% of the initial patient sample was found to be compliant at the end of 1989, with the greatest patient loss in the first year of supportive periodontal therapy of about 42%. The annual attrition rate decreased in subsequent years to average about 10% of those remaining in each year, indicating that a patient is more likely to remain compliant if he or she attends for at least 1 year of supportive periodontal treatment. Non-compliant patients were sent a questionnaire seeking reasons for their non-compliance. Forty percent of the questionnaires were returned. The most common reason given for non-compliance was that a general dental practitioner was attending to the patient's periodontal treatment needs. Many considered supportive periodontal therapy to be too expensive, while a significant proportion considered that they no longer required treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Implants in PCP with residual pocketing at follow-up had increased PPD and bone loss compared with implants placed in PHP and PCP without residual pocketing. Hence, it is the maintenance of periodontal health rather than a previous history of periodontitis that is the critical determinant of increased risk of peri-implantitis, highlighting the importance of effective periodontal therapy and maintenance in patients with a history of periodontitis.

Gingival incisions were performed distal to each of the two lower incisors on 25 adult male guinea pigs. For every animal, electrosection with an electrosurgical scalpel was used on one side, and a conventional scalpel was used on the other. The surgical instruments in all cases were brought into direct contact with periosteum. Five animals were sacrificed at each postoperative period (12, 24, 48, 72, and 96 hours), and sections of the areas of surgery were prepared by standard laboratory procedures. At 12 hours postoperatively there were far more soft tissue necrosis, a more extensive inflammatory reaction, and greater destruction of periosteum after electrosurgery. No significant changes in osteocyte viability were seen after either technique. However, by 24 hours, many empty lacunae were observed in the bone associated with electrosurgery, such necrosis being even more extensive by 48 hours. In contrast, only very minor, localised areas devoid of some osteocytes were seen after use of the conventional scalpel. By 96 hours the electrosurgical connective tissue wounds were still lined by coagulum, but repair of the scalpel wounds had begun. The periosteum and bone had the same features that were seen at 48 hours. Throughout the study, no increase in osteoclasts was seen in any section, nor were significant changes in adjacent bone marrow observed.

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Ninety-five patients with periodontal disease each had subgingival plaque samples collected from four sites (one from each quadrant) in their mouths. The relative proportions of spirochaetes, motile rods and cocci were determined using dark field microscopy and the proportion of anaerobic to aerobic micro-organisms calculated after culture. In addition, clinical recordings were made. The only significant correlations observed were between probing depth or attachment loss and the proportion of cocci in the plaque (negative association), probing depth or attachment loss and sites which were suppurating or displayed a radiolucent interdental crest (positive association), and the percentage of cocci and sites with a radiolucent interdental crest (negative association). Partial correlation analysis controlling for probing depth or attachment loss showed that a significant inverse association between the percentages of cocci and the presence of a radiolucent interdental crest remained. No significant associations were observed between clinical signs such as bleeding on probing or suppuration and the microbiological assays. Overall there was a poor correlation between many of the signs thought by some to indicate periodontal disease activity.

Thirty-four patients with periodontal disease each had subgingival plaque samples collected from four sites (one from each quadrant) in their mouths. The relative proportions of spirochaetes, motile rods and cocci were determined using dark field microscopy and the proportion of anaerobic to aerobic microorganisms was calculated after culture. In addition, clinical recordings were made at these sampled sites. The patients then underwent a course of periodontal treatment and were placed on a maintenance programme. The clinical recordings were repeated and the results examined to ascertain if the original microbiological or clinical measurements could have been used to predict the response to therapy. Of the baseline recordings, the initial probing depth, the initial attachment level and the presence of suppuration all showed a positive correlation with the degree of pocket reduction or attachment gain produced by treatment. The percentage of cocci in the subgingival plaque correlated negatively with the treatment response. Suppuration seemed to be associated primarily with the original pocket depth while the percentage of cocci in subgingival plaque showed a true relationship with the amount of attachment gained after periodontal therapy. The significance of this finding is discussed.