no abstract available

Establishment of effective personal oral hygiene is a widely accepted prerequisite for therapy andprevention of periodontal disease. Long-term clinical studies have, however, to date not been ableto deliver definitive proof of a preventive periodontal effect of good oral hygiene beyond gingivitisreduction. Data derived from more recent studies have fundamentally challenged the validity of thecentral role of oral hygiene in periodontal prevention. Contrary to former concepts, the driving forcebehind the development of pro-inflammatory dental plaques is not a lack of oral hygiene, but rathera malfunction or overreaction of the oral immune system. Good oral hygiene can only, to a very lim-ited extent, alleviate the effects of such immunological deficiencies on the integrity of the periodon-tium, and it is therefore essential in periodontal patients to supplement it with regularly performedprofessional preventive measures.

Keywords: biofilm, gingivitis, immune system, oral hygiene, periodontitis

The endo-perio lesion may be defined as an infrabony, marginal pocket communicating with an inflam-mation of pulpal origin. In clinical practice, a separate endodontic and periodontal diagnosis is made,whereas treatment outcome eventually confirms the diagnosis of an endo-perio lesion. The treatmentprognosis of such teeth is poorly understood, due to diagnostic uncertainties. The purpose of this studywas to assess the 2-year survival of teeth with an endo-perio diagnosis. A total of 3,700 cases werereviewed. Inclusion criteria for the test group were teeth that had been endodontically treated for apulpal/apical condition and showed severe periodontal involvement with pocket depth >=6 mmand/or furcation involvement. Exclusion criteria were file or root fracture, accidental perforation to theperiodontium during an endodontic procedure, and internal or external root resorption. One hundredteeth that had been endodontically treated due to pulp necrosis, pulpitis and/or apical periodontitiswithout any periodontal involvement were used as a control group. One hundred and thirty-four teethcomplied with the inclusion criteria. The results showed that 20/134 (15%) of teeth in the test grouphad been extracted after 1 year and 25/134 (19%) after 2 years. The extraction rate was significantlyhigher for teeth with chronic apical periodontitis (27%), as compared with teeth without an apicallesion (10%). None of the control teeth had been extracted after 2 years. Periodontally involved teethare at high risk of being extracted after endodontic therapy, and the risk increases with increasing sever-ity of the endodontic diagnosis.

Keywords: endodontic therapy, endo-perio lesions, periodontal therapy

Plasma cell gingivitis (PCG) is characterised by a heavy plasma cell infiltration into the gingival con-nective tissue. It has been associated with the use of flavouring agents like cinnamon and mint incandy, chewing gum and herbal toothpastes. PCG secondary to khat (Catha edulis) chewing has recently been recognised. Khat is a psycho-stimulating herb that is cultivated and used in East Africaand the Arabian Peninsula. It produces a stimulating and euphoric effect on its users. Plasma cell gingivitis in a khat user is presented. A 40-year-old male presented with a generalised diffuse erythema and painful gingival enlarge-ment. He also reported bleeding upon eating and brushing. Generalised periodontal pocketing andmoderate to severe attachment loss were detected on probing. Radiographs revealed generalisedalveolar bone loss. A gingival biopsy revealed a dense infiltrate of plasma cells in the connective tissue. A histopathological diagnosis of plasma cell gingivitis was made. It was revealed that the patient was a Yemeni immigrant and a habitual khat chewer for the last 10 years. A marked improve-ment in gingival health was noted a few weeks following cessation of the khat chewing habit.Gingival erythema and swelling further diminished following initiation of oral prophylaxis.A diagnosis of plasma cell gingivitis associated with khat use was made. A worldwide populationof immigrants habituated to khat chewing could potentially increase the incidence of plasma cell gingivitis. Recognition of this habit and its implications on periodontal health is emphasised.

Keywords: gingivitis, khat, periodontitis, plasma cell

Root coverage has become an important aspect of periodontal plastic surgery. It is a challenge in thepresence of a high frenal pull and inadequate attached gingiva. This article reports two such cases ofgingival recession, which have been treated with double lateral sliding bridge flaps. The main advan-tages of this technique are that it doesn't require a separate frenectomy procedure and it can be usedto cover multiple gingival recession defects, without a second surgical site. The two treated casesdemonstrated adequate root coverage and increase in width of the attached gingiva at 6 monthsfollow-up.

Keywords: bridge flap, pedicle flap, root coverage

Aim:To investigate the relationships between metabolic control, duration of disease, type of dia-betes, diabetes-related complications, and microbiological and clinical periodontal conditions in sub-jects who have diabetes mellitus.
Study design:A cross-sectional analysis of clinical and microbiological periodontal conditions was per-formed in 41 subjects with diabetes mellitus, untreated for any form of periodontal disease.
Results:Twenty-seven subjects with type 1 diabetes mellitus (T1DM) and 14 with type 2 (T2DM)(mean duration, 17.4 years [SD 9.3], and 11.7 years [SD 4.2], respectively) were studied. The meanserum values of glycosylated haemoglobin (HbA1c) did not differ between the two groups (T1DM,7.7% [SD 1.8]; T2DM, 8.0% [SD 0.9]). Medical complications were present in 45% of the T1DMand in 71% of the T2DM subjects. Gingivitis was not correlated with mean HbA1c levels in T2DMsubjects, but was negatively correlated with the T1DM group (r2= 0.19, Pearson's coefficient r = - 0.43, p < 0.02). The presence of bacteria in periodontal pockets differed with T1DM and T2DMstatus for Campylobacter ochracea,Peptostreptococcus micros,Porphyromonas gingivalisandSelenomonas noxia. Oral bacterial load was not linked to serum HbA1c levels or the presence of diabetes-related complications.
Conclusions:Gingivitis was common and similar in both T1DM and T2DM subjects. Serum HbA1c lev-els were not related to the levels of the subgingival microbiota in T2DM, but negatively correlated withthe extent of gingivitis in T1DM. P. gingivalisappeared to be more prevalent in T2DM subjects.

Keywords: diabetes mellitus, metabolic control, oral microbiology, periodontal disease

Treatment of intrabony periodontal defects with an enamel matrix derivative (EMD) promotes peri-odontal regeneration, i.e. regeneration of cementum, desmodontium and bone, resulting in significantreduction of probing depth and also in clinical attachment gain. There is, however, at present only lim-ited information available on long-term results of this regenerative form of therapy. The aim of thepresent study was to evaluate clinical results 10 years after treatment of intrabony defects with theenamel matrix derivative Emdogain®(Straumann, BaseI, Switzerland). Twenty-one patients who eachhad one intrabony defect with a probing depth >=6 mm were treated with enamel matrix proteins. Thefollowing clinical parameters were investigated before treatment as well as 1 year and 10 years aftertreatment: probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). After oneyear, the average probing depth PD had been reduced from 8.1 ±1.7 mm to 3.5 ±1.0 mm (p < 0.0001). After 10 years, PD was 4.0 ±1.2 mm, i.e. significantly increased in comparison with the1-year results (p > 0.05). Compared with baseline there was, however, still a significant improvementin probing depth (p < 0.0001). After 1 year, GR had increased from 1.9 ±1.5 mm to 3.2 ±1.9 mm (p < 0.001). After ten years, GR was 2.8 ±1.5 mm. At this point in time, GR showed significant im-provement compared with the 1-year results, but was still significantly greater than at baseline (p < 0.001). Average CAL changed from 10.0 ±2.3 mm to 6.8 ±2.3 mm (p < 0.0001) after 1 year,and subsequently to 7.0 ±1.9 mm after 10 years. The change in CAL between 1 and 10 years was notstatistically significant. The results suggest that clinical improvements that have been achieved aftertreatment with enamel matrix proteins can be maintained over a period of 10 years.

Keywords: enamel matrix proteins, intrabony defects, long-term results, regenerative periodontal therapy

Introduction:Applying load to an ultrasonic scaler tip can affect its vibrations. Cooling water flow-ing over such tips will also act as a load - though this is rarely considered inin vitro research inves-tigations. The aim of this study was to determine the effect of water flow rate on ultrasonic scalervibration.
Study design:The vibration displacement amplitude of three designs of scaler insert, including aSlimline tip, TFI-10 and TFI-3 (Dentsply, USA), were assessed unloaded and under 0.50 N and 1.00N load and with water flow rates of 20 ml/min and 40 ml/min. Vibration analysis was performed us-ing a scanning laser vibrometer.
Results:Increasing water flow rate from 20 ml/min to 40 ml/min caused a significant decrease (p < 0.0001) in all tip vibrations. Increasing water from 20 ml/min to 40 ml/min with the unloadedSlimline tip is equivalent to applying a 1.00 N load, and for the TFI-10 tip is equivalent to applyinga 0.50 N load in vitro.
Conclusions:Water flow rate has a significant influence on scaler tip vibration characteristics and isparticularly important for lighter, thinner tips such as the Slimline design. Future in vitroresearchmust consider the loading effect that water flow over ultrasonic scaler tips will have on their per-formance.

Keywords: performance, periodontology, ultrasonic scaler, vibration

Aim:The aim of the present study was to investigate the association between periodontal disease andacute myocardial infarction (AMI).
Study design: A total number of 120 patients were selected for the study. Sixty patients who were ex-amined immediately following an episode of myocardial infarction were selected as the test group and60 patients suffering from chronic coronary heart disease were selected as the control group for thestudy. The study was conducted with the help of a medical history, periodontal examination and analy-sis of enzyme profile of the patient.
Results:Results of multiple logistic regression analysis, without adjusting for confounding factors,showed that plaque index (PI) >=2, periodontal disease index (PDI) >=4 and low density lipoproteinswere associated with AMI. Former smokers showed a significantly lower risk for AMI. After adjustingfor age, current smoking, diabetes, hypertension, low density lipoproteins and high density lipopro-teins, the results showed that PI >=2 and PDI >=4 were not significantly associated with AMI.
Conclusion:PI>=2 and PDI >=4 showed a significantly positive association with AMI, when the con-founding factors were not adjusted. However, once the confounding factors were adjusted, PI >=2 andPDI>=4 showed no association. This shows that risk factors such as smoking and hyperlipidemia havea more profound association with AMI than periodontal disease.

Keywords: association, confounding factors, lipids, periodontitis