no abstract available

The majority of inflammatory periodontal diseases is caused by bacteria. Mechanical removal of bacterial deposits from the teeth by the patient (individual oral hygiene) and mechanical debridement by the dentist (professional tooth cleaning, antiinfective periodontal therapy, periodontal surgery) are effective in treatment of most cases of plaque-induced gingivitis and periodontitis. However, in particular risk patients (e.g. under elevated risk for bacterial endocarditis) periodontal procedures that cause transitory bacteremia require systemic antibiotic prophylaxis. Further, in severe cases of necrotising ulcerative gingivitis and periodontitis local therapy has to be supported by systemic antibiotics. In cases of aggressive and generalised severe chronic periodontitis that show subgingival infection with particular periodontal pathogens, especially by Actinobacillus actinomycetemcomitans, successful therapy requires systemic antibiotics adjunctively to mechanical antiinfective therapy. Therapy of persisting pockets during supportive periodontal therapy may additionally benefit from application of locally delivered antibiotic devices.

Keywords: adjunctive systemic and local antibiotic therapy, periodontitis therapy, prophylaxis of bacterial endocarditis, necrotising ulcerative gingivitis/periodontitis

Background: The TPS Hunter periodontal probe design has disposable, pressure-sensitive probe heads and claims to meet established standards for a precise probing tool.
Aims: The aim of the present study was to evaluate the actual probing pressures. Furthermore, the influence of material fatigue as well as of erroneous mounting of the probe head on the probing force and pressure is investigated.
Method: Fifty TPS probe heads were analysed in vitro by loading the probe against a precision balance until two force indicator lines on the probe coincided. The resulting probing force was recorded at the time of the first loading and after 30 seconds of cyclic loadings. Dividing the probing force by the measured normal contact area of the probe tip yielded the true probing pressure. Probe heads were mounted on the handle either as recommended by the manufacturer or forcefully to the deepest possible position.
Results: The mean probing force for initial loading was 0.273 N. When accounting for the contact area the mean probing pressure was 148.6 N/cm2. Forceful mounting of the probe head significantly reduced the mean probing force to 0.193 N (p<0.0003) and the mean probing pressure to 105.3 N/cm2 (p<0.0003). Oscillating loading did not largely alter the observed probing force or probing pressure.
Conclusions: The Hunter TPS periodontal probe meets established clinical standards. However, only a forceful mounting of the probe head into the handle resulted in a mean probing force close to approximately 0.2 N, as suggested by the manufacturer.

Keywords: probing pressure, periodontal, probing, probe, probing force

As with natural teeth, controversy exists with regards to the need for keratinized mucosa around dental implants. Most clinicians find that a healthy zone of keratinized mucosa circumventing dental implants facilitates restorative procedures and improves patient comfort relative to plaque control and professional maintenance. It has been found that the quantity of keratinized mucosa in a planned implant site may vary significantly, due to local anatomy and/or local procedures. This is especially true in edentulous posterior regions where significant bone resorption has occurred. Keratinized mucosa may also be reduced or eliminated during the surgical phase of implant dentistry due to the incisions needed for flap elevation during first or second stage procedures. Concerns related to the absence of keratinized mucosa around dental implants are most often observed during the maintenance phase of treatment. These considerations include mucosal pouching, gingival hyperplasia, gingival fistulas and gingivitis. Schroeder et al (1981) postulated that the establishment of a circumferential sealing effect by a dense connective tissue collar at the site of implant penetration into the contaminated environment of the oral cavity was a prerequisite for long-term implant success. It is critical that the implant surgeon remain knowledgeable regarding the treatment of peri-implant tissues as it relates to the development of keratinized mucosa. By reconstructing keratinized mucosa at the time of implant placement the surgeon can reduce treatment time and patient expense, minimize marginal tissue recession and improve esthetics. Part I of this series focused on the development of keratinized mucosa around non-submerged dental implants with vascularized flaps. This installment focuses on techniques involving non-vascularized soft tissue grafts, specifically the sub-epithelial connective tissue graft and the free gingival graft.

Keywords: dental implants, peri-implant keratinized mucosa, connective tissue graft, free gingival graft

Occurrence of halitosis, breath malodour or 'bad breath' may indicate certain medical problems (e.g. periodontitis) and may cause social problems. In only 10% of all cases halitosis is caused by an internal (e.g. diabetes mellitus, oesophagitis) or ear-nose-throat problem. For the remaining 85-90% quite a wide range of different oral causes (e.g. gingivitis, periodontitis, necrotising ulcerative gingivitis and periodontitis, caries lesions with food impaction, fissurated tongue) exists. Halitosis may be assessed clinically (organoleptic) or by using instrumental devices. Together with patient history, careful examination provides information about the most likely case of malodour. With a dental cause, an effective individual oral hygiene programme should be rendered. Therapy will be targeted at reduction of oral micro-organisms, reduction of bacterial nutrients, transformation of volatile sulphur compounds into non-volatile molecules and, if required, rinsing solutions to mask halitosis. Harbouring approximately 60% of all oral bacteria, the tongue should be cleaned by the patient on a daily basis. If halitosis is caused by periodontitis, a systematic anti-infective periodontal programme eventually followed by periodontal surgery should solve the problem.

Keywords: breath malodour, organoleptic assessment,volatile sulphur compounds

Recently the use of enamel matrix derivative proteins (EMD) has been introduced as a treatment alternative for periodontal regeneration. However, its clinical effects in human Class II furcations are still poorly investigated. The aim of this study was to compare the clinical results obtained for Class II furcations treated with guided tissue regeneration (GTR) to those obtained with the application of EMD. Twenty paired Class II mandibular furcations were treated in 10 non-smoker patients included in this study. Each defect was randomly treated with an e-PTFE membrane (GTR) or with EMD. Following basic therapy, baseline measurements were recorded, including probing depth (PD) and relative clinical attachment level (CAL-R). Hard-tissue measurements were performed during surgery to determine vertical (BDL-V) and horizontal bone defect level (BDL-H). At the 12-month re-entry procedures soft and hard-tissue measurements were reevaluated. Both procedures resulted in statistically significant PD reduction and gain in CAL-R with no significant differences between the groups. BDL-V resolution was statistically significant in both groups (GTR: 2.5 ± 1.14 mm and EMD: 1.5 ± 0.77 mm), as well as BDL-H resolution (GTR: 3.3 ± 1.82 mm and EMD: 2.2 ± 1.75 mm), without significant differences between the groups. Based on this, GTR and EMD therapies may be recommended for the treatment of Class II furcations, producing similar soft and hard-tissue improvements. However, once the GTR technique achieved numerically better results in hard-tissue parameters, it seems to provide a slight advantage for this procedure when dealing with these defects.

Keywords: guided tissue regeneration, enamel matrix derivative proteins, furcation lesions, randomized clinical study

Necrotizing gingivitis (NG), necrotizing periodontitis (NP) and necrotizing stomatitis (NS) are well documented oral diseases associated with HIV infection, and might represent a spectrum of clinical manifestations of a single infectious process. While NG is a relatively common periodontal disease mainly observed in early HIV infection, NS is less common, and is usually associated with a well-established HIV infection and deterioration in the immune status. However, all three conditions may arise in non-HIV affected individuals. A case is presented of NS occurring simultaneously with NG, but not on contiguous areas, leading to the diagnosis of HIV infection in a patient unaware of her HIV status, and the literature of NG and NS is reviewed.

Keywords: necrotizing stomatitis, necrotizing gingivitis