These results might indicate a link between periodontopathogens entering the cardiovascular system and cardiovascular disease.
The results suggest that a relationship between periodontal disease and coronary heart disease exists, although P. intermedia was the only periodontopathogen related to CAD.
This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis. Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure. Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth. Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure. Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline. Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter. The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05). The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4. The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants. Neither the GI nor the PI revealed any significant difference between teeth and implants. Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm. Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location. Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient. Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants. The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years. These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis. The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies.
The aim of this study was to compare the topical application of a metronidazole 25% dental gel with subgingival scaling. 30 patients from the recall program participated in this open randomised study with split-mouth design. Pocket probing depths (PPD) and bleeding on probing (BOP) were measured before and 2, 12 and 24 weeks after the end of the treatment period. In addition, subgingival plaque samples were taken from all mesial sites and analysed with dark-field microscopy. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more that should bleeding on probing, when entering the study. The treatment consisted of 2 applications of the dental gel in 2 randomly selected quadrants (on days 0 and 7) as well as simultaneous subgingival scaling of the remaining quadrants. Oral hygiene instruction was given on day 21. The average PPD and the average frequency of BOP were calculated for all sites with an initial PPD of 5 mm or more and continued at each examination, using the same sites. The statistical analyses showed that both treatments were effective in reducing PPD and BOP over the 6-month period. At the end of the follow-up period, the mean reduction in PPD was 1.3 mm after gel treatment and 1.5 mm after subgingival scaling. BOP was reduced by 35% and 42%, respectively. No significant differences between the 2 treatments were detected. Dark-field microscopy showed a shift toward a more healthy microflora for both treatment modalities; this persisted throughout the 6-month period. Application of a 25% metronidazole dental gel on recall patients seems to be as effective on the investigated clinical and microbiological parameters as subgingival scaling.
The results show that only minor advantages are to be gained from the application of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling. The distinctly better results of combined therapy in previously-untreated patients calls for more thorough investigation.
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