We assessed the presence and extent of calculus on subgingival root surfaces of teeth that received scaling and root planing (S/RP) alone, S/RP with modified Widman flap, or no treatment. After extraction, each surface was examined to determine the pocket depth (PD), area of root surface exposed to the pocket (A), and amount of pocket area showing retained calculus (C). Calculus-positive teeth (CPT) and surfaces (CPS) and percentage of pocket area occupied by calculus (C/A) were derived for each group. In general, CPT and CPS were significantly lower after S/RP with flap (37% and 14%, respectively) than after S/RP alone (62% and 24%). The advantage of S/RP with flap was greatest for facial and lingual surfaces and for anterior and premolar teeth. In both treatment groups CPS were similar over a pocket depth range of 0 to 6 mm. But in deeper pockets, CPS in teeth treated by S/RP with flap remained constant at 17% while after S/RP alone CPS increased linearly to approximately 45% at greater than 8 mm. The mean C/A was essentially equal in both treatment groups (11%) and was not related to pocket depth.

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.

To determine the effect on periodontal health of a daily self-administered irrigation with 0.02% stannous fluoride (SnF2) solution, 28 subjects who had moderate to advanced periodontitis were randomly divided into 3 groups: a control group (n = 9) which used no irrigation, a group (n = 8) which used a self-administered water irrigation device (Water Pik) daily with water (H2O group) and a group (n = 11) which used the Water Pik in a similar manner but with SnF2 solution (SnF2 group). All subjects were instructed in routine tooth brushing and flossing but received no other periodontal treatment. 4 study sites were selected from each patient which had pocket depths greater than 4 mm and bleeding upon probing. Plaque index, gingival index, bleeding tendency, pocket depth, loss of attachment, and microbiologic samples of subgingival plaque for morphologic determinations were collected from all study sites at baseline, 2, 6, and 10 weeks. A cross-over was then initiated for 2 additional monthly checks in which the H2O group changed to SnF2 and the SnF2 group was divided into 2 subgroups which either continued to use SnF2 or changed to H2O. The control group completed the study at the beginning of the crossover. The clinical data showed significantly more improvement in periodontal health during the first 10 weeks for the SnF2 group (p less than 0.01). After cross-over, the clinical data indicated the group that changed from H2O to SnF2 significantly improved their periodontal health, while the group that changed from SnF2 to H2O became worse. The microbiologic data showed trends which agreed with the clinical data during the first 10 weeks but were less significant. After cross-over, the %s of motile rods and spirochetes were too small (0-7%) to establish statistically significant changes considering the accuracy of the technique used.

To determine the sensitivity and specificity of the radiographic detection of calculus, 275 proximal tooth surfaces from 18 patients were evaluated. Standardized periapical radiographs obtained before extraction were coded, batch processed, and evaluated independently by two investigators under optimum viewing conditions. After extraction, the teeth were photographed and evaluated both microscopically and by planimetry on 40 X linear projections. Evaluation of calculus by conventional radiography showed low sensitivity: radiographic deposits were detected on only 44% of surfaces that demonstrated calculus microscopically. Specificity was high and the rate of false positives was only 7.5%. Detection of calculus was influenced by the thickness of calculus, the percentage of root surface occupied by calculus, and by tooth type; but not by attachment loss, probing depth, proximal surface, or arch location. These results show that present radiographic techniques are not appropriate for detecting calculus on root surfaces.

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