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  • 1
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract The aim of the present investigation was to study some tissue characteristics of the ridge mucosa before and after implant installation. 9 partially edentulous patients were included in the study. At the time of fixture installation, 1 recipient site in each patient was selected for soft tissue biopsy. Abutment connection and restorative therapy were performed after 3–6 months. When the implants had been in function for about 6 months, a soft tissue sample was obtained from the keratinized peri-implant mucosa at the 1 implant site from which the first biopsy was obtained. Each biopsy was divided into 1 mesial and 1 distal portion. The mesial tissue portion was fixed in a buffered fixative and embedded in EPON®. Sections were produced, stained in PAS and toluidine blue and used for histometric and morphometric analyses. The distal portion of the biopsies were embedded, snap frozen in liquid nitrogen and stored in a freezer at −70°C. From each tissue portion, 15 sections were prepared in a cryostat and exposed to immunohistochemical staining. A panel of monoclonal antibodies was used and the avidin-biotin method for staining was applied. The sections were examined morphometricalty. Both tissues harbored a well keratinized oral epithelium and a connective tissue, the composition of which was close to identical in terms of collagen, cells and vascular structures. The peri-implant mucosa. however, also included a junctional epithelium which evidently allowed the penetration of products from the oral cavity. As a consequence, the periimplant mucosa in comparison to the masticatory mucosa was found to contain significantly enhanced numbers of different inflammatory cells.
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  • 2
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract The purpose of this study was to determine the distribution of black-pigmenting Gram-negative bacteria in the dentition of 10 adult periodontitis patients before and after treatment by local delivery of tetracycline. The subjects were selected based on a screening for high counts of Porphyramonas gingivalis and multiple deep pockets. Subgingival microbial samples were taken from the mesial and distal aspect of every tooth (44 to 56 sites per patient) before treatment, and after one and two months. Therapy included full mouth scaling and root planing, chlorhexidine mouth rinsing and placement of tetracycline HCI fibers (Actisite®) on all teeth. 63.4% of 524 baseline samples yielded total anaerobic viable counts 2106 CFU/ml: P. gingivalis was found in 59.2% and Prevotella intermedia in 56.9%. One month after treatment, the % of samples with 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE906:ges" location="ges.gif"/〉106 CPU/ml was reduced to 9.4%, 5.3% were P. gingivalisand 5.1%P. intermedia-positive. After 2 months, 9.6% samples yielded 106 CFU/ml, 5.2% were P. gingivalisand 9.4% P. intermedia- ositive. 20 of the 39 sites with a persistence of P. gingivalis were located on second molars. Logistic regression models were utilized to explain the persistence of P. gingivalis, using site location and other clinical parameters as indepedent variables. These analyses indicated a strong association of site location, pocket depth and bleeding on sampling with persistence of P. gingivalis. The study shows that local delivery of tetracycline is highly effective in reducing the prevalence and proportions of black-pigmenting anaerobes within a dentition. Bleeding deep pockets of second molars have an increased risk for persistence of these anaerobes.
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  • 3
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract. The aim of this randomized single-blind multicenter controlled clinical trial was to clinically evaluate the effectiveness of adjunctive local controlled drug delivery in the control of bleeding on probing in mandibular class II furcations during maintenance care. 127 patients presenting with a class II mandibular furcation with bleeding on probing were included in the study. They had been previously treated for periodontitis and were participating in supportive care programs in periodontal speciality practices. Treatments consisted of scaling and root planing with oral hygiene instructions (control) and scaling and root planing and oral hygiene combined with local controlled drug delivery with tetracycline fibers (test). The following outcomes were evaluated at baseline and 3 and 6 months after therapy at the furcation site: bleeding on controlled force probing (BOP), probing pocket depth (PD) and clinical attachment levels (CAL). Levels of oral hygiene and smoking status were also assessed. Both test and controls resulted in significant improvements of BOP and PD at 3 and 6 months. The test treatment, however, resulted in significantly better improvements: BOP decreased by 52% in the control group and by 70% in the test group at 3 months; at 6 months, however, the difference was no longer significant. The test treatment resulted in a 0.5 mm greater reduction of PD than the control at 3 months, the improvement was highly significant but its duration did not extend until the 6 months evaluation. No differences were observed in terms of changes in CAL. These data indicate that addition of tetracycline fibers to mechanical therapy alone resulted in improved control of periodontal parameters during periodontal maintenance of class II mandibular furcations. Short duration of the effect, however, requires further investigations to optimize conservative treatment of these challenging defects.
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  • 4
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract The purpose of this study was to determine the clinical response to local delivery of tetracycline in relation to clinical and microbiological conditions of the other teeth. 4 deep pockets were monitored in 19 subjects with multiple deep periodontal lesions and high counts of P. gingivalis. In 9 patients (XT) only 2 of the selected lesions were treated by placement of tetracycline fibers (Actisite®). while the rest of the dentition was left untreated. In the other 10 patients, all teeth were supragingivally scaled and then treated by application of polymeric tetracycline HCl containing fibers, the whole dentition was subject to full mouth scaling and root planing, and the patients rinsed with 0.2% chlorhexidine (FT). A significant reduction in mean PPD was observed in all treated sites after two months. This reduction was maintained over the following 4 months. The magnitude of the effect was significantly greater in the FT group (1.74 mm) than in the LT group (0.88 mm). The mean attachment level changes were similar after 2 months in locally and fully treated subjects. A tendency of relapse was noted for treated sites in LT patients from month 2 to 6. A level of statistical significance was not reached for this effect. Data from measurements recorded at 6 sites around all teeth in the full mouth treated patients were analyzed using multiple linear regression. This analysis showed local changes in PPD and AL were significantly and strongly correlated with the baseline value of the respective parameter at the same site. In addition, more pocket depth reduction was noted if a site was not bleeding on probing at 6 months, if the location of a site was not approximal and if the tooth was not a second molar. Sites located on second molars showed also less AL gain than sites located on other teeth. Smokers showed significantly less reduction in PPD and significantly less AL gain. Furthermore, if subjects had a high % of pockets deeper than 4 mm at baseline they showed significantly less attachment gain.
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  • 5
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 6
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The concentration of tetracycline in the gingival fluid was measured in the periodontal pocket following placement of controlled drug delivery monolithic fibers and subgingival irrigation. Following subgingival irrigation with 1% and 10% tetracycline HC1 solution, concentrations decayed exponentially with half times of 4.2 and 12.2 h, respectively. Tetracycline fibers maintained a constant average concentration of 1590 μg/ml in periodontal pockets over a 10-day period. The observed concentrations were in agreement with those expected from a steady-state model based on release rate characteristic of the fibers and gingival fluid flow rate. After removal of the delivery system, tetracycline concentrations decreased exponentially with half time of 4.5 h. These data describe the delivery characteristics of tetracycline-loaded ethylene vinyl acetate fibers as zero-order for 10 d; following removal, an exponential washout was observed.
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  • 7
    ISSN: 1574-6968
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology
    Notes: Abstract Volatile fatty acids (VFA) have interesting biological effects on eukaryotic cells, inducing alterations of cell shape, morphological differentiation, changes in the composition of the cytoplasmic membrane and growth inhibition. This paper describes the effects of VFA on granulocyte chemotaxis. The influences observed, usually inhibitory, were shown to depend on the concentration tested and the incubation atmosphere (anaerobic or 5% CO2).Because these metabolites are produced by several anaerobic bacteria both in vitro and at infected sites, one can speculate that they might act as potential ‘leukotoxins’ contributing to the pathogenicity of anaerobic bacteria.We suggest that the well-known ability of anaerobes to inhibit their own phagocytosis and intracellular killing, as well as that of facultative anaerobes, might be at least partially due to the impairment of granulocyte functions induced by VFA.
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  • 8
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The safety and efficacy of periodontal disease treatment by intrapocket placement of tetracycline (TC) fibers was investigated in a 60-day multicenter study conducted by selecting 4 sites in each subject with 6–10 mm pockets that bled on probing. Sites were randomly assigned to 1 of 4 test groups: TC fiber therapy, scaling, control fiber (fibers without drug), or untreated. TC fibers and control fibers were placed to fill the pocket and were maintained with a cyanoacrylate adhesive for 10(±2) d. Scaling was performed for a minimum of 5 min under local anesthesia. Following initial tooth cleaning procedures, pocket depth, attachment level and bleeding on controlled-force probing were measured at baseline and at 30 d, and 60 d following therapy. Analysis of data from 107 subjects who had complete clinical data sets indicated that TC fiber therapy significantly decreased pocket depth, increased attachment level, and decreased bleeding on controlled-force probing to a greater extent than observed in all other test groups including scaling. These effects were greater than, and in addition to, effects that occurred due to prophylaxis and improved home care. No serious adverse side-effects attributed to TC fiber therapy were observed. No TC fiber-treated sites abscessed and superinfection was not noted. A transient redness at fiber removal was seen at 21% of the sites. Although fibers were placed without anesthesia, mild pain on initial placement was infrequent (19%) and abated rapidly. The results indicate that TC fiber placement provides a safe and effective means for treatment of periodontal infections.
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  • 9
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A new local delivery device (LDD) capable of releasing silver in periodontal pockets has been developed and tested pre-clinically. Silver has potent antimicrobial effects on Gram-negative periodontal pathogens with a mean in vitro minimum bactericidal concentration (MBC) ≤0.5 μg/ml. This phase 1 study assessed the safety, pharmacokinetics and bioavailability of silver ions delivered intracrevicularly with a resorbable LDD (PocketGuardTM) in a group of 9 volunteers affected with periodontitis. In each subject, a PLGA/PEG LDD loaded with 12% silver nitrate (w/w) was inserted in each of 4 selected pockets ≥5 mm. Serum, gingival fluid and subgingival plaque samples were evaluated before and at various time points after LDD placement for 21 days. At each time point, the concentration of silver in gingival crevicular fluid (GCF) was quantified with an Inductively Coupled Plasma-Mass Spectrometer. Subgingival plaque samples were processed for evaluation of total anaerobic and aerobic counts (CFU/ml). The maximum mean silver concentration in GCF was 1493±709 μg/ml (range 589–2245). It decayed exponentially with a half-life of 7.1±6.1 days (2.7–20.4). Average silver concentrations in excess of 10 μg/ml were detected in each patient for 14 days after LDD placement with the average concentration for all patients in excess of 25 μg/mL at day 21. Total anaerobic counts decreased an average of 1.7±1.9×106 CFU/ml (p=0.0078) from baseline to day 7, indicating that the silver was biologically active. A mild increase in cervical root discoloration was observed at day 21: 0.25±0.31 stain index units. Discoloration that did not resolve spontaneously could be removed at the end of the study with polishing. No systemic effects were observed. It is concluded that local silver concentrations above the MBC in serum were maintained for at least 21 days. A specific microbiologic effect was also observed.
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  • 10
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Expression of vascular cell adhesion molecules (HEV-CAMs) by capillary loops represents an early step necessary for leukocyte extravasation and subsequent migration to sites of inflammation. The purpose of this investigation was to compare, the presence and distribution of ICAM-1, ELAM-1, VCAM-1 and PECAM-1 expression in the microvasculature of healthy gingiva and periimplant keratinized mucosa. The selected HEV-CAMs were detected by a three stage immunoperoxidase technique in serial sections from clinically characterized sites. Biopsies were qualitatively and quantitatively analyzed. All biopsies displayed a small inflammatory infiltrate subjacent to the most coronal extension of the junctional epithelium. HEV-CAMs were expressed both in the sulcular and oral aspects of biopsies. Intensity of ICAM-1, ELAM-1 and VCAM-1 staining, however, was consistently higher in the region of the infiltrated connective tissue subjacent to the most coronal extension of the junctional epithelium. Only a fraction of microvascular loops were positive for ICAM-1, ELAM-1 or VCAM-1 when compared to the constitutively expressed PECAM-1. No significant differences were observed between gingiva and keratinized peri-implant mucosa. It was concluded that in healthy gingiva or peri-implant mucosa 1. HEV-CAM expressing capillary loops were in close topographic association with the inflammatory infiltrate; 2. only a fraction of capillary loops are activated to express ICAM-1 ELAM-1 and VCAM-1 at any given time; and 3. HEV-CAM expression in the periodontium may be influenced by local factors.
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