CPITN: time and cost estimates for periodontal prevention and treatment procedures.

The aim of this study was to estimate the necessary time and cost for periodontal prevention and treatment in a working population from sugar and alcohol refineries in Araraquara, SP, Brazil. A stratified sample of 528 employees aged 18-64 from administrative, industrial and agricultural staffs was examined by one examiner, previously trained, according to the community periodontal index of treatment needs (CPITN). The time required for procedures and the cost was extrapolated to the total worker population. The results showed that the estimated time required for periodontal prevention/treatment was 4527 hours. Of this time, 1783 hours were required for oral hygiene instruction, 2531 for scaling, 151 for surgery and 62 for maintenance. The cost would be US $17,655 for hiring a dentist for 8 hours/day to provide oral hygiene instruction, scaling, surgery and maintenance. However, the cost would be US $9,028 for hiring a dentist for 4 hours/day to provide surgery and maintenance and a dental hygienist for 8 hours/day to provide scaling and oral hygiene instruction. Taking into account epidemiologic, technical and economic aspects, the decision relating to manpower should be this second option.

Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.

Treatment of experimental periodontal disease by a selective inhibitor of cyclooxygenase-2 with scaling and root planing (SRP)

Lumiracoxib is a selective inhibitor of cyclooxygenase-2 (COX-2) approved for the relief of symptoms of chronic inflammatory conditions. The aim of this study was to evaluate the effects of this specific inhibitor of COX-2 as adjunctive treatment on induced periodontitis in rats. Periodontal disease was induced at the first mandibular molar of 60 rats. After 7 days, the ligature was removed and all animals were submitted to scaling and root planing (SRP) along with local irrigation with saline solution and were divided into 2 groups: SRP (n = 30)-received subcutaneous injections of 1 mg/kg of body weight/day of saline solution for 3 days and; SRP + L (n = 30)-received subcutaneous injections of 1 mg/kg of body weight/day of Lumiracoxib for 3 days. Ten animals in each group were killed at 7, 15, and 30 days. The histological description was performed and the histometric values were statistically analyzed. In Group SRP + L, the histometric analysis (0.58 ± 0.08, 0.64 ± 0.06, and 0.56 ± 0.10 mm 2) showed less bone loss (p < 0.05) than Group SRP (1.52 ± 0.08, 1.55 ± 0.09, and 1.49 ± 0.24 mm 2) at 7, 15, and 30 days, respectively. Within the limits of this study it can be concluded that subcutaneous application of specific inhibitor of COX-2 was a beneficial adjunctive treatment for periodontal diseases induced in rats. © 2010 Springer Basel AG.

Gingival recession associated with noncarious cervical lesions: Combined periodontal-restorative approach and the treatment of long-term esthetic complications

The combined periodontalrestorative approach (that is, a connective tissue graft for root coverage and NCCL restoration with RMGI cement) has demonstrated significant root coverage and a good esthetic outcome. In some cases, though, the color of an RMGI restoration can change over time, compromising esthetics. In this situation, applying composite resin over an RMGI restoration can be a conservative approach to satisfy the patient's esthetic complaint. Long-term observation is necessary to evaluate the stability of the results and establish the success of this approach over time.

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation

Objectives: The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation. Materials and methods: Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted. Results: Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them. Conclusions: Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation. © 2013 Springer-Verlag Berlin Heidelberg.

Treatment of periodontal disease with an Er,Cr:YSGG laser in rats exposed to cigarette smoke inhalation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mandibulectomy for treatment of fractures associated with severe periodontal disease

Six cases of mandibular fractures associated with severe periodontal disease that had been treated by mandibulectomy, due to intense bone loss, were evaluated retrospectively. The dogs were mainly older, small breed dogs that had suffered a traumatic event. Four dogs had a bilateral mandibulectomy and 2 a unilateral mandibulectomy.

Delayed tooth replantation after treatment of necrotic periodontal ligament with citric acid

Objective: to evaluated the effect of treating root-adhered necrotic periodontal ligament (PDL) with citric acid on the healing process in delayed rat tooth replantation. Material and Methods: Forty Wistar rats, assigned to 4 groups (n=10), had their upper right incisor extracted and kept dry on a workbench. For Group I (control), the teeth were replanted after a 5 min extra-alveolar time. For the other groups, replantation was hydroxide-based paste and the teeth were replanted with no root surface treatment. In Group III, the teeth were immersed in citric acid (pH 1) for replanted. In Group IV, instead of the immersion, the roots were scrubbed with gauze soaked in citric acid and the teeth were replanted. The animals difference (p > 0.05) was found among the groups regarding the areas difference (p < 0.05) between the control group and Group IV regarding ankylosis. The control group showed the least replacement resorption percent means compared to the other groups (p < 0.05). The root structure was more affected by replacement resorption and ankylosis in Group IV statistically (p > 0.05). Conclusion: the treatment of root surface-adhered necrotic periodontal ligament with citric acid was not able to prevent the delayed rat tooth replantation.

Delayed tooth repalantetion after treatment of necrotic periodontal ligament with citric acid

Objective: to evaluated the effect of treating root-adhered necrotic periodontal ligament (PDL) with citric acid on the healing process in delayed rat tooth replantation. Material and Methods: Forty Wistar rats, assigned to 4 groups (n=10), had their upper right incisor extracted and kept dry on a workbench. For Group I (control), the teeth were replanted after a 5 min extra-alveolar time. For the other groups, replantation was done after 60 min. In Group II, the root canals were filled with a calcium hydroxide-based paste and the teeth were replanted with no root surface treatment. In Group III, the teeth were immersed in citric acid (pH 1) for 3 min, the canals were filled with calcium hydroxide and the teeth were replanted. In Group IV, instead of the immersion, the roots were scrubbed with gauze soaked in citric acid and the teeth were replanted. The animals were sacrificed 60 days postoperatively. Results: Regarding replacement resorption, there was statistically significant difference (p < 0.05) between the control group and the other three groups. No statistically significant difference (p > 0.05) was found among the groups regarding the areas of inflammatory resorption. There was also a statistically significant difference (p < 0.05) between the control group and Group IV regarding ankylosis. The control group showed the least replacement resorption percent means compared to the other groups (p < 0.05). The root structure was more affected by replacement resorption and ankylosis in Group IV compared to the Groups II and III, but this difference was not significant statistically (p > 0.05). Conclusion: the treatment of root surface-adhered necrotic periodontal ligament with citric acid was not able to prevent the occurrence of ankylosis, root resorption and inflammatory resorption in delayed rat tooth replantation.

Localized periodontal disease induced by bacterial plaque and palatal radicular groove: treatment and considerations

The palatal radicular groove is a morphological tooth defect, which act as local predisposing risk factor favoring accumulation of the bacterial plaque, permitting microbial invasion via root groove way, directly into periodontal structures. A patient diagnosed with palatal radicular groove and a localized periodontal disease was treated by procedures to control bacterial action and procedures to eliminate local predisposing risk factor. To treat the periodontal bone defect a sequelae of periodontal disease, a guided tissue regeneration technique was applied by using allograft and xenograft materials associated with a resorbable demineralized bovine cortical bone membrane. The objective of surgical regenerative procedure was to recover the periodontal tissues nearly as they were before periodontal disease destruction.

Treatment of experimental periodontal disease by antimicrobial photodynamic therapy in nicotine-modified rats

Background The aim of this study was to compare antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to scaling and root planing (SRP) for induced periodontitis in nicotine-modified rats. Material & Methods A total of 240 rats were evenly divided into two groups: C – saline solution treatment; N – nicotine treatment. Periodontal disease was induced in both groups at the first mandibular molar. After 7 days, the ligature was removed. All animals were submitted to SRP and were divided according to the following treatments: SRP – irrigation with saline solution; Toluidine Blue-O (TBO) – irrigation with phenothiazinium dye (100 μg/ml); LLLT – laser irradiation (660 nm; 0.03 W; 4 J); and aPDT – TBO and laser irradiation. Ten animals in each group/treatment were euthanized at 7, 15 and 30 days. The histometric and immunohistochemical values were statistically analysed. Results Intragroup analysis demonstrated that in both groups the aPDT treatment resulted in lower bone loss (BL) when compared to SRP in all experimental periods. Intergroup analysis demonstrated that aPDT treatment resulted in lower BL in Group N than in Group C treated with SRP in all experimental periods. Conclusion Antimicrobial photodynamic therapy was an effective adjunctive treatment to SRP for induced periodontitis in nicotine-modified rats.

Experimental periodontal disease treatment by subgingigval irrigation with tetracycline hidrochloride in rats

Objective: The aim of this study was to compare subgingival irrigation with tetracycline hydrochloride (TTC-HCL) as adjunctive treatment to scaling and root planning (SRP) on induced periodontitis in rats. Material and Methods: In 60 rats, periodontal disease was ligature-induced at the mandibular left first molar. After 7 days, the ligature was removed and all animals were submitted to SRP, and divided into 2 groups according to the following treatment: C (n=30) – subgingival irrigation with 1 mL of saline; T (n=30) – subgingival irrigation with 1 mL of TTC-HCL (50 mg/mL). Ten animals in each group were euthanized at 7, 15 and 30 days posttreatment. The histometric values were statistically analyzed (p<0.05). Results: In the histometric analysis, at 7, 15 and 30 days, Group T (0.72±0.05 mm2, 0.57±0.14 mm2, 0.62±0.07 mm2), showed less bone loss (p<0.05) than Group C (1.35±0.25 mm2; 1.40±0.31 mm2; 1.29±0.27 mm2), respectively. Conclusions: Subgingival irrigation with TTC-HCL was an effective adjunctive treatment for periodontal disease induced in rats.

Chitosan/Carbomer-based tablets containing Metronidazole for potential treatment of periodontal diseases

Mucoadhesive tablets with different mixtures of chitosan and carbomer homopolymer type B were prepared in order to obtain new formulations containing metronidazole for periodontal disease treatment. All tablets were characterized by swelling and erosion studies, ex vivo mucoadhesion force and in vitro drug release. The drug released mechanism was described by Korsmeyer-Peppas and Weibull models. Tablets containing increased amounts of chitosan presented higher swelling ability and the drug release was prolonged in the simulated saliva fluid. The mechanisms for the drug release from tablets were complex, including diffusion, swelling and erosion simultaneously. This kind of delivery system is suitable for formulating metronidazole mucoadhesive systems, representing a good alternative for the local treatment of periodontal diseases.