Katrin Nickles

Ten-Year Results After Connective Tissue Grafts and Guided Tissue Regeneration for Root Coverage

BACKGROUND This study clinically evaluates the 10-year results of connective tissue graft (CTG) and guided tissue regeneration (GTR) therapies using bioabsorbable barriers for root coverage (i.e., the reduction of recession depth). METHODS In 15 patients, 38 Miller Class I and II recessions were treated. Recession defects received a CTG or GTR by random assignment. At baseline (immediately prior to surgery) and 6 and 120 +/- 12 months after surgery, clinical parameters were obtained. RESULTS Nine patients, who contributed 24 recession defects, were available for re-examination at 120 +/- 12 months. Six and 120 +/- 12 months after receiving a CTG, statistically significant (P <0.05) root coverage was observed compared to baseline root coverage (6 months: 3.07 +/- 1.74 mm; 120 +/- 12 months: 2.07 +/- 1.89 mm). The GTR therapy resulted in statistically significant root coverage compared to baseline root coverage only after 6 months (2.28 +/- 1.77 mm; P <0.05). Both groups experienced a statistically significant loss of coverage from 6 to 120 +/- 12 months (CTG: -1.0 +/- 0.78 mm; GTR: -2.03 +/- 2.24 mm). At 120 +/- 12 months after CTG surgery, the stability of root coverage was statistically significantly better than 120 +/- 12 months after GTR surgery (P = 0.002). The CTG caused more post-surgical discomfort (P <0.05), but it resulted in a better treatment outcome (P <0.05) than GTR as perceived by patients. CONCLUSION The long-term stability of root coverage (i.e., the reduction of recession depth) and esthetic results perceived by patients were significantly better 10 years after CTG surgery, statistically, than after GTR surgery using bioabsorbable barriers.

Open flap debridement and guided tissue regeneration after 10 years in infrabony defects

OBJECTIVE Evaluation of the 10-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) therapy of infrabony defects in a randomized controlled clinical trial. MATERIALS AND METHODS In 16 periodontitis patients OFD or polylactide acetyltributyl citrate barriers (GTR; n=23) were assigned randomly to 44 infrabony defects. In a subgroup of 10 patients exhibiting 2 contra-lateral defects each OFD and GTR was assigned to either side (split-mouth). At baseline, 12, and 120 +/- 12 months after surgery clinical parameters were obtained. RESULTS Fifteen patients (41 defects) were available at 120 months. Twelve and 120 +/- 12 months after therapy both groups showed statistically significant (p<0.01) attachment gain (split-mouth: OFD: 12 months: 3.60 +/- 2.67 mm; 120 months: 3.65 +/- 3.36 mm; GTR: 12 months: 3.50 +/- 1.90 mm; 120 months: 2.85 +/- 2.24 mm; parallel: OFD: 12 months: 3.47 +/- 2.80 mm; 120 months: 3.41 +/- 2.75 mm; GTR: 12 months: 3.67 +/- 2.11 mm; 120 months: 2.89 +/- 2.12 mm). From 12 to 120 months both groups experienced insignificant attachment changes, however, six teeth (two OFD, four GTR) were lost (all for prosthodontic reasons). The study failed to show statistically significant attachment gain differences between both groups after 120 months. CONCLUSIONS Ten years after OFD and GTR in infrabony defects 35 of 41 teeth were still in place.

Comprehensive Treatment of Periodontitis in Patients With von Willebrand Disease

BACKGROUND Hemophilia A and B and von Willebrand disease (VWD) belong to the most frequent congenital coagulation disorders and are a significant problem in patients who require periodontal therapy or tooth extraction. These patients need specialist management because even minor invasive procedures can precipitate a prolonged bleeding episode. However, although dental care presents major challenges in these patients, only a few studies are available. METHODS In this case series, the comprehensive periodontal treatment of four patients with hemorrhagic disorders (VWD type I and mild hemophilia B) is described. There was a close collaboration between the periodontist and the hematologist: all patients were scheduled for premedication with desmopressin and other pharmaceuticals at the hematologists office. After one session of scaling and root planing was performed in all patients, local agents such as tranexamic acid were used. In the course of periodontal therapy, access-flap surgery was performed in one of the four patients. RESULTS Before treatment, the rates of probing depths (PDs) of 4 to 6 mm (20% to 57%) or ≥ 7 mm (2% to 20%) were high. Three months after treatment, the rates of PDs of 4 to 6 mm (5% to 42%) or ≥ 7 mm (0% to 2%) decreased significantly in all patients. Attachment gains were also observed. A secondary hemorrhage did not occur in any of the patients, and wound healing proceeded without any complications. CONCLUSION Effective periodontal treatment can be provided to patients with hemorrhagic disorders with the combined efforts of the periodontist and hematologist.

IL-1-polymorphism and severity of periodontal disease

Abstract Objective. To determine the association between the interleukin (IL)-1-polymorphism and the severity of periodontal disease prior to active periodontal therapy. Materials and methods. Two hundred and six patients with obtained baseline x-rays were tested for IL-1-polymorphism. Relative bone loss before active periodontal treatment was measured with a Schei ruler and classified in five groups. Descriptive statistics and backward stepwise linear regression analyses were performed. Results. Forty-nine patients with moderate (mChP), 79 with severe chronic (sChP) and 78 with aggressive periodontitis (AgP) were included. Age correlated significantly with bone loss and number of teeth at baseline. Gender, smoking and IL-1-polymorphism were neither associated with bone loss nor with number of teeth prior to treatment. After adjusting for age as well as gender, AgP was significantly associated with more severe bone loss in untreated periodontal disease (p = 0.036). In non-smokers, mean number of teeth prior to active periodontal therapy correlated significantly with presence of IL-1 polymorphism. Conclusion. The IL-1-polymorphism is associated with lower number of teeth in non-smokers with untreated periodontal disease. Untreated AgP is associated with more severe bone loss than untreated ChP.

Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case–control study

BACKGROUND Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. METHODS Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level]. RESULTS GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP. CONCLUSION VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP.

Evaluation of two siblings with Papillon-Lefèvre syndrome 5 years after treatment of periodontitis in primary and mixed dentition.

BACKGROUND This case report describes the clinical and microbiologic long-term outcome 5 years after periodontal therapy of two siblings diagnosed with Papillon-Lefèvre syndrome (PLS) and tinea capitis. METHODS In 2005, two brothers diagnosed with PLS and tinea capitis began periodontal treatment. Both of them showed premature mobility of the primary dentition, markedly increased probing depths, and subgingival Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans; Aa). Initial therapy consisted of scaling and root planing based on the concept of full-mouth disinfection, extraction of periodontally hopeless deciduous teeth, and systemic antibiotics. Reevaluation of clinical parameters revealed a dramatic improvement. After that, the patients were enrolled in a stringent maintenance program. Microbiologic monitoring was performed 1 and 5 years after treatment. RESULTS Five years after initial treatment, the periodontal situation was stable in both patients. Residual deciduous teeth, with the exception of one tooth, could be retained and no further teeth were lost. Further disease progression on the previously involved teeth was controlled, and development of periodontitis on erupting teeth was prevented for a period of 5 years. CONCLUSIONS Even periodontally affected deciduous teeth can be treated successfully in patients with PLS. Suppression of Aa and a stringent maintenance program are of high importance.

Detection rates of presumptive periodontal pathogens in subgingival plaque samples of untreated periodontitis using either four or six pooled samples.

AIM A comparison of the detection frequency and number of periodontal pathogens in patients with aggressive or generalized, severe chronic periodontitis using a gene-probe analysis. METHODS In 16 aggressive and 34 generalized, severe chronic periodontitis patients, plaque was sampled from the deepest pockets per quadrant (MT4) and per sextant (MT6). After sampling two paper points simultaneously, one paper point from each pocket was pooled with three paper points of the other pockets (MT4). The remaining four paper points were pooled with two paper points from the deepest pockets from the two remaining sextants (MT6). Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola were detected by 16S rRNA gene probes. RESULTS Log-transformed counts for Aggregatibacter actinomycetemcomitans were statistically significantly higher with MT6 (aggressive: 3.21±2.94; generalized, severe chronic: 2.22±2.70) than MT4 (aggressive: 2.04±2.74; generalized, severe chronic: 1.50±2.37) (P<0.05). The detection frequency and mean counts were high for Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola (>95%/>6.0). CONCLUSION Aggregatibacter actinomycetemcomitans was detected in higher numbers for MT6 than MT4. For both MT4 and MT6, Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola were detected in >95% of all patients and with mean log-transformed numbers >6.0.

Comparison of Two Different Sampling Methods for Subgingival Plaque: Subgingival Paper Points or Mouthrinse Sample?

BACKGROUND The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control). METHODS In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens. RESULTS Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum. CONCLUSIONS There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4.

Processing of Neutrophil α-Defensins Does Not Rely on Serine Proteases In Vivo

The α-defensins, human neutrophil peptides (HNPs) are the predominant antimicrobial peptides of neutrophil granules. They are synthesized in promyelocytes and myelocytes as proHNPs, but only processed in promyelocytes and stored as mature HNPs in azurophil granules. Despite decades of search, the mechanisms underlying the posttranslational processing of neutrophil defensins remain unidentified. Thus, neither the enzyme that processes proHNPs nor the localization of processing has been identified. It has been hypothesized that proHNPs are processed by the serine proteases highly expressed in promyelocytes: Neutrophil elastase (NE), cathepsin G (CG), and proteinase 3 (PR3), all of which are able to process recombinant proHNP into HNP in vitro. We investigated whether serine proteases are in fact responsible for processing of proHNP in human bone marrow cells and in human and murine myeloid cell lines. Subcellular fractionation of the human promyelocytic cell line PLB-985 demonstrated proHNP processing to commence in fractions containing endoplasmic reticulum. Processing of 35S-proHNP was insensitive to serine protease inhibitors. Simultaneous knockdown of NE, CG, and PR3 did not decrease proHNP processing in primary human bone marrow cells. Furthermore, introduction of NE, CG, and PR3 into murine promyelocytic cells did not enhance the proHNP processing capability. Finally, two patients suffering from Papillon–Lefèvre syndrome, who lack active neutrophil serine proteases, demonstrated normal levels of fully processed HNP in peripheral neutrophils. Contradicting earlier assumptions, our study found serine proteases dispensable for processing of proHNPs in vivo. This calls for study of other protease classes in the search for the proHNP processing protease(s).

Is gingival bleeding a symptom of type 2 and 3 von Willebrand disease

Background Von Willebrand disease (VWD) is the most common inherent bleeding disorder. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also a leading symptom of plaque-induced gingivitis and untreated periodontal disease. In type 1 VWD gingival bleeding was not increased compared to controls. Thus, this study evaluated whether type 2 and 3 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. Methods Twenty-four cases and 24 controls matched for age, sex, periodontal diagnosis, number of teeth and smoking were examined hematologically (VWF antigen, VWF activity, factor VIII activity) and periodontally (Gingival Bleeding Index [GBI]), bleeding on probing [BOP], Plaque Control Record [PCR], periodontal inflamed surface area [PISA], vertical probing attachment level). Results BOP (VWD: 14.5±10.1%; controls: 12.3±5.3%; p = 0.542) and GBI (VWD: 10.5±9.9%; controls: 8.8±4.8%; p = 0.852) were similar for VWD and controls. Multiple regressions identified female sex, HbA1c, PCR and PISA to be associated with BOP. HbA1c and PCR were associated with GBI. Number of remaining teeth was negatively correlated with BOP and GBI. Conclusion Type 2 and 3 VWD are not associated with a more pronounced inflammatory response to the oral biofilm in terms of BOP and GBI.