Martin Wohlfeil

Degree of gingivitis correlates to systemic inflammation parameters

BACKGROUND Investigation of interrelations between periodontal and systemic inflammatory parameters in periodontal health. METHODS 40 periodontally healthy (probing pocket depths [PPD]<3.6 mm and from 3.6 mm to 4 mm without bleeding on probing [BOP]; up to 2 sites with a PPD from 3.6 mm to 5 mm and BOP or up to 4 sites with a PPD from 3.6 mm to 5 mm without BOP were accepted; BOP<or=14%) probands 23 to 44 years of age without any known actual infectious or inflammatory diseases were examined. Clinical parameters and blood samples were obtained. The blood was analyzed for C-reactive protein (CRP), elastase, and leukocyte counts. Regression models were calculated to explain the variation of the dependent variables serum CRP, elastase, and leukocytes (independent variables: sex, age, PCR, BOP, smoking, PPD). RESULTS The sample was characterized as: GBI: 2.9+/-2.0%; PCR: 14.9+/-8.2%; PPD: 2.0+/-0.2 mm; AL: 0.4+/-0.3 mm; BOP: 7.0+/-1.9%; leukocytes: 6.2+/-1.1/nl; (median/interquartile range) CRP: 0.062/0.04-0.107) mg/dl; elastase: 9.075/7.375-12.2 ng/ml. Inflammatory parameters were influenced by the following factors: CRP: female (p=0.008), PPD (p=0.15); elastase: female (p=0.002), PPD (p=0.005), BOP (p=0.141); leukocytes: female (p=0.061), pack years (p=0.061), PCR (p=0.082). CONCLUSIONS The levels of all investigated systemic inflammation parameters were higher in females than in males. Both serum CRP and elastase correlated even in periodontally healthy with mean PPD.

Regenerative therapy of infrabony defects with or without systemic doxycycline. A randomized placebo‐controlled trial

AIM Comparison of regenerative therapy of infrabony defects with and without administration of postsurgical systemic doxycycline (DOXY). METHODS In each of 61 patients one infrabony defect was treated with enamel matrix derivative (EMD), EMD plus filler or membrane at two centres. By random assignment patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Prior to and 6 months after surgery probing pocket depths (PPD) and vertical attachment level (PAL-V) were obtained. RESULTS Fifty-four patients (DOXY: 27; PLAC: 27) were re-examined after 6 months and had been treated exclusively with EMD. Seven to 8 days after surgery 81% of defects in both groups showed complete flap closure. In both groups significant (p < 0.001) PPD reduction (DOXY: 3.87 ± 1.44 mm; PLAC: 3.67 ± 1.30 mm) and PAL-V gain (DOXY: 3.11 ± 1.50 mm; PLAC: 3.32 ± 1.83 mm) were observed. However, the differences failed to be statistically significant (PPD: 0.20; p = 0.588; PAL-V: 0.21; p = 0.657). CONCLUSIONS Two hundred milligram systemic DOXY administered for 7 days after therapy of infrabony defects with EMD failed to result in better PPD reduction and PAL-V gain compared with PLAC which may be due to low power (50%) and, thus, random chance.

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.

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.

Enamel Matrix Derivative in Propylene Glycol Alginate for Treatment of Infrabony Defects With or Without Systemic Doxycycline: 12- and 24-Month Results

BACKGROUND This aim of this study is to compare regenerative therapy of infrabony defects with and without administration of post-surgical systemic doxycycline (DOXY) 12 and 24 months after therapy. METHODS In each of 57 patients, one infrabony defect (depth ≥ 4 mm) was treated regeneratively using enamel matrix derivative at two centers (Frankfurt am Main and Heidelberg). By random assignment, patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Twelve and 24 months after surgery, clinical parameters (probing depths [PDs] and vertical clinical attachment level [CAL-V]) and standardized radiographs were obtained. Missing data were managed according to the last observation carried forward. RESULTS Data of 57 patients (DOXY: 28; PLAC: 29) were analyzed (26 males and 31 females; mean age: 52 ± 10.2 years; 13 smokers). In both groups, significant (P <0.01) PD reduction (DOXY: 3.7 ± 2.2 mm; PLAC: 3.4 ± 1.7 mm), CAL-V gain (DOXY: 2.7 ± 1.9 mm; PLAC: 3.0 ± 1.9 mm), and bone fill (DOXY: 1.6 ± 2.7 mm; PLAC: 1.8 ± 3.0 mm) were observed 24 months after surgery. However, the differences between both groups failed to be statistically significant (PD: P = 0.574; CAL-V: P = 0.696; bone fill: P = 0.318). CONCLUSIONS Systemic DOXY, 200 mg/day for 7 days, after regenerative therapy of infrabony defects did not result in better PD reduction, CAL-V gain, or radiographic bone fill compared with PLAC 12 and 24 months after surgery, which may be attributable to low power and, thus, random chance.

Interdisciplinary Cooperation Exemplified by Two Complex Cases of Enamel Erosion

Objective:Students of the Frankfurt am Main University Hospital participate in an interdisciplinary instructional unit in which they are presented with complex interdisciplinary findings and previous diagnostic records that are discussed in the patient’s presence.We have recently observed a growing number of patients presenting defects of dental hard tissue in the form of erosions, defined as a loss of dental hard tissue due to the frequent and direct effect of acids not involving micro-organisms. These patients also presented marked malocclusions. For the most part, the diagnoses involve operative dentistry, dental prosthetics, orthodontics, oral, maxillofacial and plastic surgery. The clinicians discuss causes and therapeutic alternatives, at which point the therapeutic course is determined in consultation with the patient.Case Histories:We present herein two exemplary cases complex in etiology, as well as in treatment planning and realization. The case descriptions illustrate the importance of interdisciplinary agreement and cooperation in difficult courses of therapy, illustrating that, in the interest of the patient, it makes sense to establish interdisciplinary networks.ZusammenfassungHintergrund:Den Studierenden der Universitätsklinik Frankfurt am Main werden in einer interdisziplinär angelegten Unterrichtsveranstaltung komplexe, fachübergreifende Befunde vorgestellt, die unter persönlicher Anwesenheit des Patienten und mit allen erforderlichen, vorab erstellten diagnostischen Unterlagen erörtert werden.In letzter Zeit stellten sich gehäuft Patienten mit Zahnhartsubstanzdefekten in Form von Erosionen vor. Erosionen sind als Zahnhartsubstanzverlust durch häufige direkte Säureeinwirkung ohne Beteiligung von Mikroorganismen definiert. Gleichzeitig wiesen diese Patienten eine ausgeprägte Dysgnathie auf. Grundsätzlich stellen die Disziplinen Zahnerhaltungskunde, Zahnärztliche Prothetik, Kieferorthopädie, Oralchirurgie und Mund-, Kiefer- und Plastische Chirurgie gemeinsam die Diagnose, diskutieren Ursache und therapeutische Alternativen und legen im Anschluss den genauen Therapieweg in Absprache mit dem Patienten fest.Fallberichte:An zwei Behandlungsberichten wird die Komplexität der Ätiologie sowie der Therapieplanung und Durchführung beispielhaft veranschaulicht. Die kasuistischen Darstellungen verdeutlichen die Bedeutung der interdisziplinären Absprache und Kooperation bei schwierigen Behandlungen. Sie zeigen, dass es im Interesse der Patienten sinnvoll ist, fachüberbergreifende Netzwerke zu etablieren.