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Periodontology 2000 Feb 2018The conversion of junctional epithelium to pocket epithelium is regarded as a hallmark in the development of periodontitis. Knowledge of factors contributing to the... (Review)
Review
The conversion of junctional epithelium to pocket epithelium is regarded as a hallmark in the development of periodontitis. Knowledge of factors contributing to the initiation and progression of pocket formation is important and may result in the development of better preventive measures and improve healing outcomes after therapeutic interventions. The periodontal pocket is a pathologically deepened gingival sulcus. In healthy periodontal conditions, the defense mechanisms are generally sufficient to control the constant microbiological challenge through a normally functioning junctional epithelium and the concentrated powerful mass of inflammatory and immune cells and macromolecules transmigrating through this epithelium. In contrast, destruction of the structural integrity of the junctional epithelium, which includes disruption of cell-to-cell contacts and detachment from the tooth surface, consequently leading to pocket formation, disequilibrates this delicate defense system. Deepening of the pocket apically, and also horizontal expansion of the biofilm on the tooth root, puts this system to a grueling test. There is no more this powerful concentration of defense cells and macromolecules that are discharged at the sulcus bottom and that face a relatively small biofilm surface in the gingival sulcus. In a pocket situation, the defense cells and the macromolecules are directly discharged into the periodontal pocket and the majority of epithelial cells directly face the biofilm. The thinning of the epithelium and its ulceration increase the chance for invasion of microorganisms and their products into the soft connective tissue and this aggravates the situation. Depending on the severity and duration of disease, a vicious circle may develop in the pocket environment, which is difficult or impossible to break without therapeutic intervention.
Topics: Biofilms; Connective Tissue; Databases, Factual; Epithelial Attachment; Epithelial Cells; Epithelium; Gingiva; Humans; Periodontal Diseases; Periodontal Pocket; Periodontitis; Tooth Root
PubMed: 29194796
DOI: 10.1111/prd.12153 -
Periodontology 2000 Feb 2018Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket... (Review)
Review
Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket depth reduction. Therefore, in the fields of periodontology and implant dentistry, significant research effort has been placed on the etiopathogenesis, diagnosis and treatment of periodontal/peri-implant disease and as a consequence on pocket pathology. In this volume of Periodontology 2000, the in-depth reviews include topics ranging from preclinical models, anatomy and structure of tissues, and molecular and bacterial components, to treatments of pockets around teeth and implants. These reviews aim to provide the readers with current and future perspectives on the different areas of research into the periodontal pocket.
Topics: Dental Calculus; Dental Implantation, Endosseous; Dental Implants; Gingiva; Gingival Crevicular Fluid; Humans; Oral Hygiene; Peri-Implantitis; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Tooth
PubMed: 29194794
DOI: 10.1111/prd.12203 -
Therapeutic Delivery Mar 2023Periodontitis is a microbiological condition that affects the tissues supporting the teeth. The fundamental to effective periodontal therapy is choosing the suitable... (Review)
Review
Periodontitis is a microbiological condition that affects the tissues supporting the teeth. The fundamental to effective periodontal therapy is choosing the suitable antimicrobial and anti-inflammatory agent, together with the proper route of drug administration and delivery system. Intra-periodontal pocket approach with nano drug-delivery systems (NDDS) such as polymeric nanoparticles, gold nanoparticles, silica nanoparticles, magnetic nanoparticles, liposomes, polymersomes, exosomes, nano micelles, niosome, solid lipid nanoparticles, nano lipid carriers, nanocomposites, nanogels, nanofibers, scaffolds, dendrimers, quantum dots, etc., will be appropriate route of drug administration and delivery system. This NDDS delivers the drugs at the site of infection to inhibit growth and promote tissue regeneration. The present review focused on providing comprehensive information on the NDDS for periodontitis, which enhanced therapeutic outcomes via intra-periodontal pocket delivery.
Topics: Humans; Periodontal Pocket; Gold; Metal Nanoparticles; Drug Delivery Systems; Periodontitis
PubMed: 37291865
DOI: 10.4155/tde-2023-0001 -
Journal of Veterinary Dentistry Mar 2024Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series...
Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, < .0001). No statistically significant results were observed for pocket type, as values were greater than .05.
Topics: Animals; Humans; Dogs; Periodontal Pocket; Dental Scaling; Lasers, Semiconductor; Retrospective Studies; Root Planing; Dog Diseases
PubMed: 36945868
DOI: 10.1177/08987564231164493 -
British Dental Journal Mar 1993Traditional views on pocket instrumentation in periodontal therapy have centred upon the thorough scaling and planing of root surfaces, which aim to remove all calculus... (Review)
Review
Traditional views on pocket instrumentation in periodontal therapy have centred upon the thorough scaling and planing of root surfaces, which aim to remove all calculus and substantial amounts of 'necrotic' and 'contaminated' cementum. The lack of scientific evidence for removing calculus in periodontal therapy, was highlighted by Frandsen and recent studies have also questioned the need for extensive root planing to remove 'substantial' amounts of cementum. The need for some degree of pocket instrumentation during periodontal therapy however, is beyond doubt, as clinical studies on the efficacy of nonsurgical periodontal treatment published during the last decade have clearly shown. A review of this important topic is therefore timely and this paper aims to elucidate some of the concepts which are currently the subject of debate. A resume of the formation and characteristics of the subgingival environment is a necessary starting point.
Topics: Dental Cementum; Dental Plaque; Humans; Periodontal Pocket; Root Planing; Subgingival Curettage
PubMed: 8443021
DOI: 10.1038/sj.bdj.4808111 -
BMC Oral Health Jan 2020The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time...
BACKGROUND
The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket.
METHODS
Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured.
RESULTS
Clearance of radioactivity was 67.1 ± 16.9, 83.1 ± 13.9, 90.4 ± 10.4, 93.39 ± 8.0% at 30, 60, 90 and 120 min, respectively. Half-life of wash-out was determined as 20.3 ± 10.2 min.
CONCLUSION
The results of this study demonstrate that the half-life of the cationic solution applied subgingivally was approximately 20 min and labelling of oral irrigants with radiotracers may be used to determine their clearance in further research.
Topics: Half-Life; Humans; Metabolic Clearance Rate; Periodontal Pocket; Periodontitis; Radionuclide Imaging; Thallium Radioisotopes; Therapeutic Irrigation; Time Factors
PubMed: 31914986
DOI: 10.1186/s12903-019-0998-8 -
Journal of the American Dental... Oct 1990It is not possible within the scope of this paper to describe in any detail each of the aforementioned procedures. These can be found in the various textbooks and...
It is not possible within the scope of this paper to describe in any detail each of the aforementioned procedures. These can be found in the various textbooks and journals on clinical periodontology. Instead, the objectives of treatment, the spectrum of techniques available, and the rationale for their use have been described. Periodontal surgery should be performed only under certain conditions: the patient must be physically and mentally competent to undergo any type of surgery, and should understand and agree to the procedure and to postoperative management. Finally, periodontal surgery should only be considered when nonsurgical therapy will not accomplish the desired result. When periodontal surgery for pocket elimination is performed for selected defects that have been properly evaluated after a debridement and healing period, and is executed with technical competence and proper postoperative care, it can preserve the dentition affected by periodontal disease.
Topics: Humans; Periodontal Pocket
PubMed: 2212340
DOI: 10.14219/jada.archive.1990.0206 -
Journal of Periodontology Jan 2000Periodontal probing is one of the most common methods used in diagnosing periodontal disease. The purpose of this study was to determine the importance of the diameter... (Comparative Study)
Comparative Study Review
BACKGROUND
Periodontal probing is one of the most common methods used in diagnosing periodontal disease. The purpose of this study was to determine the importance of the diameter of periodontal probing tips in diagnosing and evaluating periodontal disease.
METHODS
The literature discussing periodontal probe diameters in human, dog, and monkey studies was reviewed and compared. Tip diameters varied from 0.4 to over 1.0 mm in these studies. Probe advancement between the gingiva and the tooth is determined by the pressure exerted on the gingival tissues and resistance from the healthy or inflamed tissue. The pressure is directly proportionate to the force on the probe and inversely proportionate to the probe tip diameter. The larger probing diameters reduced probe advancement into inflamed connective tissue. This effect of change in probe diameter reduced the pressure in a greater manner than an increase of similar change in probe force.
RESULTS
In the studies reviewed, the pressure used to place the probe tip at the base of the periodontal sulcus/pocket was approximately 50 N/cm2 and at the base of the junctional epithelium, 200 N/cm2. A tip diameter of 0.6 mm was needed to reach the base of the pocket. Clinical inflammation did not necessarily reflect the severity of histological inflammation, and the recordings may not illustrate probing depth. Furthermore, probing depth did not identify anatomical locations at the base of the pocket.
CONCLUSIONS
Probe tips need to have a diameter of 0.6 mm and a 0.20 gram force (50 N/cm2) to obtain a pressure which demonstrates approximate probing depth. This pressure was needed to measure the reduction of clinical probing depth, which included formation of a long junctional epithelium as a result of therapy. In addition, different forces or diameter tips are needed to measure healthy or inflamed histological periodontal probing depths.
Topics: Animals; Dogs; Equipment Design; Gingiva; Haplorhini; Humans; Periodontal Diseases; Periodontal Pocket; Periodontics; Periodontitis; Pressure; Stress, Mechanical; Surface Properties; Tooth
PubMed: 10695944
DOI: 10.1902/jop.2000.71.1.96 -
Journal of Clinical Laser Medicine &... Aug 1995A study of 30 randomly selected cases of type II-IV periodontitis was done from a group of 130 patients who had been treated with argon laser pocket thermolysis and root... (Review)
Review
A study of 30 randomly selected cases of type II-IV periodontitis was done from a group of 130 patients who had been treated with argon laser pocket thermolysis and root planing between January 1993 and April 1994. The group consisted of 12 males and 18 females with a mean age of 47. No antibiotics were taken 6 months prior or during the treatment. A pocket charting and bleeding index was done at a mean of 4.6 months after treatment. A total of 1328 pockets were treated using a 300-microns fiber in contact at 0.4 W for 20-30 sec per pocket with coaxial irrigation. The 4-5 mm pockets were reduced by 1.62 mm, 6-7 mm pockets by 2.85 mm, and 8-9 mm by 3.30 mm. The bleeding of probing was reduced by 75%. The mean postoperative pain medication was 400 mg/day of ibuprofen for 1-2 days. Laser pocket thermolysis with subgingival thermodynamic debridement may eliminate or greatly reduce the need for additional treatment. There is a great need for further investigation.
Topics: Adult; Aged; Argon; Female; Follow-Up Studies; Humans; Laser Therapy; Male; Middle Aged; Pain, Postoperative; Periodontal Pocket; Treatment Outcome
PubMed: 10155061
DOI: 10.1089/clm.1995.13.273 -
Frontiers in Cellular and Infection... 2023Periodontitis is a biofilm-mediated disease that is usually treated by non-surgical biofilm elimination with or without antibiotics. Antibiotic treatment in periodontal... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Periodontitis is a biofilm-mediated disease that is usually treated by non-surgical biofilm elimination with or without antibiotics. Antibiotic treatment in periodontal patients is typically selected empirically or using qPCR or DNA hybridization methods. These approaches are directed towards establishing the levels of different periodontal pathogens in periodontal pockets to infer the antibiotic treatment. However, current methods are costly and do not consider the antibiotic susceptibility of the whole subgingival biofilm.
METHODS
In the current manuscript, we have developed a method to culture subgingival samples in a fast, label-free impedance-based system where biofilm growth is monitored in real-time under exposure to different antibiotics, producing results in 4 hours. To test its efficacy, we performed a double-blind, randomized clinical trial where patients were treated with an antibiotic either selected by the hybridization method (n=32) or by the one with the best effect in the growth system (n=32).
RESULTS
Antibiotic selection was different in over 80% of the cases. Clinical parameters such as periodontal pocket depth, attachment level, and bleeding upon probing improved in both groups. However, dental plaque was significantly reduced only in the group where antibiotics were selected according to the growth. In addition, 16S rRNA sequencing showed a larger reduction in periodontal pathogens and a larger increase in health-associated bacteria in the growth group.
DISCUSSION
The results of clinical and microbiological parameters, together with the reduced cost and low analysis time, support the use of the impedance system for improved individualized antibiotic selection.
Topics: Humans; Anti-Bacterial Agents; RNA, Ribosomal, 16S; Periodontitis; Periodontal Pocket; Bacteria
PubMed: 38179425
DOI: 10.3389/fcimb.2023.1307380