The effect of sodium hypochlorite and citric acid solutions on healing of periodontal pockets

The survival rate of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus following 4 randomized treatment modalities

The overall goal of this clinical study was to determine the short-term anti-infective effects of four randomized treatment modalities on Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Bacteroides forsythus (Bf) and determine the effects of bacterial survival on treatment outcomes in patients with adult periodontitis. Twelve adult patients requiring therapy for moderate periodontitis were selected for this study. All patients had at least one tooth in each quadrant that had an inflamed pocket of probing depth > or =5 mm with probing attachment loss that harbored at least one of the following three periodontal pathogens: Aa, Pg, or Bf. The number of target organisms per site was determined pre-operatively, at 1 week, and 1 month and 3 months postoperatively utilizing DNA probes. One quadrant in each patient was randomly assigned to each one of the following four treatment groups: 1) scaling and root planing (SRP group); 2) pocket reduction through osseous surgery and apically-positioned flap (OS group); 3) modified Widman flap (MWF group); and 4) modified Widman flap and topical application of saturated citric acid at pH 1 for 3 minutes (CA group). The 4 treatment modalities were performed in one appointment. No postoperative antibiotics were used. Patients were instructed to supplement their daily oral hygiene with chlorohexidine oral rinse during the study. The results of this investigation indicated that: 1) none of the treatment modalities was effective in eliminating the target species; 2) the incidence of infected sites for all groups was 100% preoperatively; 62.5%, 33.3%, and 31.3% at 1 week, and 1 and 3 months postoperatively, respectively; 3) these infected sites lost 1.1 +/- 0.4 mm of probing attachment compared to gain of 0.0 +/- 0.3 mm for uninfected sites; 4) the infected sites had higher plaque and bleeding on probing 0.9 +/- 0.3, 73 +/- 12%, respectively, compared to 0.3 +/- 0.1 and 30 +/- 8% for the uninfected sites; and 5) no statistically significant differences were detected among the infected sites in regard to gingival index (1.0 +/- 0.2 vs. 0.8 +/- 0.1) or probing depth (3.5 +/- 0.4 vs. 3.0 +/- 0.1 mm). These results indicate that bacterial survival negatively affects the short-term clinical outcomes of non-surgical and surgical periodontal therapy.

Sorption of fibronectin to human root surfaces in vitro

The purpose of this study was to determine the conditions that favor the sorption and retention of human plasma fibronectin to cementum. Rectangular root segments prepared from teeth extracted for orthodontic reasons were mounted on a capillary pipette and immersed in solutions of 125I fibronectin for assay of cementum sorption under various conditions. Kinetic studies showed sorption to be rapid, with 77% of the maximum fibronectin sorption occurring within 1 minute. Fibronectin sorption was reduced when added in conjunction with serum and was inhibited by monovalent ions (such as sodium), but enhanced in the presence of divalent cations (such as calcium). Exposure of cementum to serum partially blocked subsequent sorption of fibronectin, while cementum bound fibronectin was eluted by subsequent exposure to serum. Treatment of cementum with citric acid pH 1.1 (4 minutes) followed by 5% sodium hypochlorite (5 minutes) caused a significant increase in fibronectin sorption with maximum retention upon subsequent exposure to serum (P less than 0.05). Fibronectin sorption to cementum was: rapid, electrostatic in nature, competitive, reversible, Ca+(+)-facilitated, and maximized by prior treatment of the root with citric acid and sodium hypochlorite. It is concluded that sorption of fibronectin to cementum can be achieved for clinical gain; however, conditions of application can significantly influence both accumulation and subsequent release of root sorbed material.

Mucoperiosteal flaps with and without removal of the pocket epithelium

The purpose of this study was to clinically evaluate the need for elimination of the pocket epithelium during mucoperiosteal flap surgery aimed at reattachment or readaptation. A split mouth design was used in 13 patients with two bicuspids and two molars included in each quadrant. Two surgical techniques were compared. One of the quadrants received a modified Widman flap with removal of the pocket epithelium, while the contralateral side received a crevicular flap without removing the pocket epithelium. One month after the hygienic phase was completed, the following measurements were taken: Gingival Index, Plaque Index, gingival crevicular fluid flow, mobility, furcation involvement, level of attachment, pocket depth and gingival recession. In addition to these measurements, which were taken immediately prior to the surgery (baseline), 1- and 3-month postsurgical measurements were also taken. Gingival recession was recorded immediately after the flaps were replaced and sutured. All data were analyzed statistically using paired t test and sign test. The biometric results showed that without the removal of the pocket epithelium, good clinical results relative to gain in clinical attachment levels and reduction in probing depth were achieved. Greater gingival recession occurred on the crevicular flap side postsurgically when compared to the modified Widman flap. The other clinical parameters remained the same at the three time intervals. This was true within each technique and when both techniques were compared.

The impact of research on scaling and root planing

The research expanding our knowledge of the periodontally involved root surface and its treatment is reviewed. To improve communication in the clinic and classroom, definitions are suggested for the terms "scaling" and "root planing." The objective and limitations of root planing procedures are discussed.

Effect of retention of gingival sulcular epithelium on attachment and pocket depth after periodontal surgery

Both the modified Widman flap and the intrasulcular incision technique produced significant and similar reductions in pocket depth and increases in attachment. Loss of attachment occurred where the initial pocket depth was less than 3 mm. Both techniques resulted in significant and similar increases in gingival recession. Neither technique affected tooth mobility or plaque scores to a clinically important degree. Historically, the necessity for removal of the sulcular epithelium in the course of periodontal therapy is a widely accepted tenet. This study fails to clinically validate this concept.

Pocket epithelium removal via crestal and subcrestal scalloped internal bevel incisions

This study assessed the extent of pocket epithelium removal by crestal and subcrestal scalloped inverse bevel incisions during mucoperiosteal flap surgery. Fifty-six gingival biopsies were obtained from 52 participants, who had extractions of periodontally involved teeth. Sulcular incisions which severed the epithelial attachment served as controls. Experimental scalloped internal bevel incisions were made: (1) at the gingival crest extending apical to the osseous crest (crestal incision) and (2) 1 to 2 mm apical to the gingival margin extending apical to the osseous crest (subcrestal incision). In the two procedures the initial incisions were followed by sulcular incisions to sever the epithelial attachment. After both crestal and subcrestal incisions full thickness flaps were reflected, pocket contents were removed, and flaps were replaced against the teeth. Gingival biopsies were then obtained from control and experimental sites followed by extraction of teeth. All specimens were processed, embedded in paraffin, sectioned, stained with hematoxylin and eosin and examined for residual pocket epithelium. Control incisions eliminated pocket epithelium in two of 20 specimens. Crestal incisions eliminated pocket epithelium in 11 of 25 areas, while subcrestal incisions eliminated pocket epithelium in 13 of 25 areas. All 10 papillary areas treated by crestal incisions and 8 of the 10 papillary areas treated by subcrestal incisions displayed residual pocket epithelium. Neither crestal nor subcrestal scalloped internal bevel incisions consistently eliminated all pocket epithelium.