Thesis (M.S.)--University of Michigan, 1972.

Orientador: Rosemary Adriana Chiérici Marcantonio / Banca: Silvana Regina Perez Orrico / Banca: Joni Augusto Cirelli / Banca: Rui Vicente Opperman / Banca: Fábio André dos Santos / Resumo: O objetivo deste estudo foi avaliar clinicamente a influência do cálculo subgengival nas medidas de profundidade de sondagem com sonda manual e eletrônica de força controlada. Para tanto, foram avaliados 614 sítios com cálculo subgengival visível em radiografias periapicais e detectáveis clinicamente através do índice de cálculo de Greene e Vermillion, 1967. Os exames foram realizados por um profissional calibrado que avaliou o índice de sangramento gengival à sondagem e realizou a sondagem com os dois tipos de sondas em seis áreas de cada dente: mesio-vestibular, vestibular, disto-vestibular, mesio-lingual, lingual e disto-lingual, com o auxílio de um stent oclusal. As sondagens foram realizadas em dois instantes. Inicial: com a presença do cálculo subgengival, imediato: imediatamente após a remoção do cálculo subgengival. Para a análise dos dados obtidos, as profundidades de sondagens foram estratificadas em rasa (=3mm), média (4-6mm) e profunda (= 7mm). Através do teste de Wilcoxon à 5%, observou-se que as medidas de profundidades de sondagens médias (4.78mm para o momento inicial e 4.56mm para o momento imediato) e profundas (7.60mm para o momento inicial e 6.79 mm para o momento imediato) para a sonda eletrônica de força controlada apresentaram diferenças significativas entre os diferentes momentos, porém, o mesmo não ocorreu quando foi utilizada a sonda manual. Da mesma forma, quando o teste t foi empregado para avaliar a influência do sangramento à sondagem sobre as diferenças da sondagem manual e computadorizada, este não apresentou-se como um fator influenciador. Conclusão: O cálculo subgengival interfere na sondagem realizada com a sonda computadorizada, não ocorrendo o mesmo com a sonda manual. / Abstract: The present investigation assessed the influence of subgingival calculus on clinical probing measurements with manual and constant force electronic probe. The study evaluated 614 sites with visible subgingival calculus, evidenced by radiographic and clinical modified index (Greene & Vermillion, 1967). The evaluation was performed by a calibrated dental examiner, who evaluate gingival bleeding index and probing depth with manual and computarized probe, in six sites per tooth: mesio-buccal, middle-buccal, disto-buccal, mesio-lingual, middle-lingual and disto-lingual with individually acrylic stents. The probing depths measurements were performed in two moments. Inicial: In presence of subgingival calculus, immediate: immediately after removal of subgingival calculus. To data analysis, the probing depths measurements were classified in: shallow depths (=3mm), moderate (4-6mm) and deep (=7mm) and submmited to statistical analysis (Wilcoxon 5%). The results show that moderate measurement (4.78mm at inicial moment and 4.56mm for immediate), and deep measurements (7.60mm at inicial moment and 6.79 for immediate) with a computerized probe were statistically differentes significative for two moments, however, the same difference did not occurre when manual probe was used. Smilary, when the test t assessed the influence of gingival bleeding index to detect differences between computarizade and manual probe, this not represent a source of error in this measurement. Conclusion: The subgingival calculus influenced the probing depth measurements when a computarized probe was used, although that didnþt occurre with manual probe. / Doutor

This paper investigated the sensitivity, specificity, accuracy, and precision of laser fluorescence and tactile probing for the detection of subgingival calculus. The gold standard for subgingival calculus detection has always been tactile probing. In this study 27 teeth were collected and 108 surfaces investigated, one tooth was excluded (group #13) where no calculus was observed on any surface, and three surfaces because of subgingival root caries to avoid confounding data, which left a total of 101 surfaces of 26 extracted teeth that meet the investigation criteria. The presence of subgingival calculus was observed on 75 tooth surfaces (74.25%). There was a correlation between tooth surface and the presence of calculus. Subgingival calculus was from most to least frequently observed on the Distal surface (92.0%), Lingual surface (76.9%), Mesial surface (70.8%) and Facial surface (57.7%). The amount of laser fluoresce increased according to the amount of subgingival calculus. There was a correlation between the amount of subgingival calculus and the amount of laser fluorescence. The tactile probing had a similar sensitivity compared to laser fluorescence for the detection of subgingival calculus. The laser fluorescence was more specific compared to tactile probing for the detection of subgingival calculus. The tactile probing had a similar accuracy compared to laser fluorescence for the detection of subgingival calculus. The laser fluorescence had more precision compared to tactile probing for the detection of subgingival calculus. These results show that by using both tactile probing and laser fluorescence the sensitivity, specificity, accuracy, and precision of detecting subgingival calculus can be increased. An increase in the sensitivity, specificity, accuracy, and precision of detecting subgingival calculus could help in the diagnosis and treatment of patients suffering from gingival recession and periodontal disease.

Objectives: Subgingival dental calculus is recognized as an important contributing risk factor in the initiation and perpetuation of inflammatory forms of human periodontitis, and its removal from diseased tooth root surfaces constitutes a critical clinical end-point in periodontal therapy. As a result, the reliable detection of subgingival dental calculus on tooth root surfaces is of paramount importance in periodontal diagnostics. A wide range of manual dental instruments have been employed to detect by tactile sensation the presence of subgingival dental calculus deposits on teeth. However, the Old Dominion University (ODU) 11/12 dental explorer is presently used by all regional dental licensure examining boards in the United States to identify subgingival dental calculus on patients. Interestingly, little data is presently available to validate the ability of the ODU 11/12 dental explorer to reliably discriminate between dental calculus- positive and –negative tooth root surfaces. As a result, the purpose of this study was to to assess, with an in vitro typodont model system, the ability of an ODU 11/12 dental explorer to accurately identify subgingival dental calculus on tooth root surfaces. Methods: A total of 108 subgingival sites on mandibular posterior plastic teeth, of which 73 (67.6%) exhibited artificial dental calculus deposits, were mounted within on typodont models of the human oral cavity, comprised of white plastic teeth emerging from and surrounded by anatomically-accurate pink silicone gingival and palatal soft tissues. Each typodont was attached to a phantom head with simulated soft tissue mouth shrouds. Sheep blood was irrigated into subgingival and interproximal areas around ii typodont teeth to simulate gingival tissue inflammation, and artificial saliva applied onto supragingival typodont tooth surfaces to further simulate typical oral cavity conditions in humans. The 108 test subgingival surfaces were then evaluated for subgingival dental calculus with an ODU 11/12 dental explorer in duplicate by a primary examiner, who was a board-certified periodontist with 30 years of clinical specialty experience. A periodontist initially educated as a dental hygienist and possessing 45 years of combined dental hygiene-periodontics clinical experience, scored all of the test subgingival tooth surfaces once as a secondary examiner. The diagnostic performance of the ODU 11/12 dental explorer, relative to in vitro detection of subgingival dental calculus, was assessed among all test root surfaces, as well as among proximal and non-proximal root surfaces, with calculations of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood value, negative likelihood value, diagnostic odds ratio, accuracy (diagnostic effectiveness), and Youden’s Index. Results: As utilized by the primary examiner, the ODU 11/12 dental explorer yielded a sensitivity of 91.2%, specificity of 78.4%, positive predictive value of 82.5%, negative predictive value of 88.9%, positive likelihood value of 4.2, negative likelihood value of 0.1, diagnostic odds ratio of 38.5, accuracy (diagnostic effectiveness) of 85.2%, and Youden’s index value of 0.70, for in vitro detection of subgingival dental calculus. Similar diagnostic test findings for the ODU 11/12 dental explorer were found on proximal (mesial and distal) and non-proximal (buccal and lingual) root surfaces, with accuracy (diagnostic effectiveness) values attained of 82.4% and 84.3%, respectively. Good reproducibility (kappa = 0.62) was found in duplicate scoring by the primary examiner of subgingival dental calculus with the ODU 11/12 dental explorer. The iii secondary examiner produced even better performance outcomes with the ODU 11/12 dental explorer, providing a sensitivity of 91.2%, specificity of 86.3%, positive predictive value of 88.1%, negative predictive value of 89.8%, positive likelihood value of 6.7, negative likelihood value of 0.1, diagnostic odds ratio of 66.5, accuracy (diagnostic effectiveness) of 88.9%, and Youden’s index value of 0.78, for in vitro detection of subgingival dental calculus. Similar to the primary examiner, the secondary examiner also found relatively close agreement in diagnostic test findings for ODU 11/12 dental explorer on both proximal and non-proximal root surfaces, with accuracy (diagnostic effectiveness) values attained of 85.2% and 92.6%, respectively. A good level of agreement (kappa = 0.62) was found between the primary and secondary examiners in their in vitro scoring of subgingival dental calculus with the ODU 11/12 dental explorer. Conclusions: These study findings provide important in vitro validation for continued use of an ODU 11/12 dental explorer for detection of subgingival dental calculus on dental licensure examining board examinations. The ODU 11/12 dental explorer exhibited a high level of in vitro discrimination between subgingival dental calculus-positive and calculus-negative tooth root surfaces in a typodont model system with experienced periodontist examiners. The ODU 11/12 dental explorer performed with a similar high level of diagnostic accuracy on both proximal and non-proximal tooth root surfaces, and exhibited good reproducibility in duplicate assessments made by the primary examiner, and showed good agreement between evaluations made by the primary and secondary examiners. Based on these in vitro findings, routine clinical utilization of the ODU 11/12 dental explorer in dental practice for the detection of subgingival dental calculus is recommended. / Biology

Objectives: Because subgingival dental calculus in periodontal pockets is associated in the etiopathogenesis of progressive human periodontitis, and is difficult to accurately detect with conventional manual explorers and probing instruments, there is an urgent clinical need for more reliable diagnostic methods for the detection and localization of subgingival dental calculus. A low-power ( 40). Results: A total of 50 root surfaces exhibited a modified SCI score = 0 (no root surface dental calculus detected), whereas 19 root surfaces revealed modified SCI scores = 1 (root surface dental calculus detected in thin deposits, but not in a markedly-raised ledge), and 31 root surfaces had modified SCI scores = 2 (root surface dental calculus detected in a markedly-raised ledge). A high level of both intra- and inter-examiner reproducibility of visible red laser fluorescence intensity readings was found with both tooth root evaluation protocols, despite the marked differences between the two dentist examiners in their educational backgrounds and length of clinical dental care experience, with correlation coefficient values ranging from r = 0.948 to r = 0.999 for duplicate assessments made by the two independent examiners themselves and between them. Mean visible red laser fluorescence intensity values recorded by the two independent examiners with the instrument perpendicularly directed along tooth root surfaces (first evaluation protocol) were 98.9 (standard deviation ± 0.4) and 99.0 (standard deviation ± 0.0), respectively, on dental calculus-positive root surfaces, which were significantly greater than mean values of 10.9 (standard deviation ± 6.0) and 12.3 (standard deviation ± 8.1), respectively, recorded on dental calculus-negative root surfaces (P 40 for visible red laser fluorescence intensity values offered 90% sensitivity, 100% specificity, a 100% positive predictive value, a 90.9% negative predictive value, and an odds ratio relationship of 36.6 [95% confidence interval = 16.7, 80.2] for the presence of dental calculus on tooth root surfaces. Conclusions: These in vitro findings document, for the first time, a high level of intra- and inter-examiner reproducibility of visible red laser fluorescence intensity measurements on human tooth root surfaces, regardless of the whether the instrument is directed either perpendicular or parallel to extracted tooth root surfaces. Dental calculus- positive root surfaces on extracted teeth exhibited significantly higher visible red laser fluorescence intensity scores than dental calculus-negative root surfaces, particularly when dental calculus deposits were present in markedly-raised ledges. In addition, a threshold level of > 40 for visible red laser fluorescence intensity readings offered greater diagnostic accuracy than a threshold level of ≥ 5 for identification of dental calculus on root surfaces of extracted teeth. These findings provide further in vitro validation for use of the visible red laser fluorescence-emitting instrument for detection of dental calculus on root surfaces of human teeth. Additional validation studies, conducted clinically in vivo, on the visible red laser fluorescence-emitting instrument are warranted. / Oral Biology

Made available in DSpace on 2015-04-22T22:14:09Z (GMT). No. of bitstreams: 1 Dissertacao Samuel Lungareze.pdf: 4572476 bytes, checksum: 70070d60dc879fec996a32a20cdd90c1 (MD5) Previous issue date: 2010-01-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Periodontal disease (DP) is very strongly associated with the dental biofilm and may evolve the formation of a periodontal pocket. The propolis has been used as a medicinal product since 300 b.C, and has the following characteristics: anti-cancer activities, antioxidant, anti-inflammatory, antimicrobial, and antifungal. The propolis antimicrobial activity in face of periodontalpatogens has been investigated though in vitro and in vivo tests, mainly with the etanolic extracts. The following paper had as an objective evaluate the histological response of the inflammatory DP induced on the rats periodontal tissue after the use of a watery suspension of propolis (SAP), at 0,1%, 1%, and 10%, for subgingival irrigation. Was used 84 wistar rats (Rattus novergicus), weighting between 210 and 290g with eight weeks old. They were distributed in the following experimental groups: group I (n= 14, SAP at 0,1%), group II (n=14, SAP at 1%), group III (n=14, SAP at 10%), group IV (n=14, Tween`s solution 80 at 5%), group V (positive control, n=14, with induced DP and without treatment), group VII (n=14, chlorhexidine at 2%) and group VI (n=84, negative control, not induced contralateral teeth and not treated on animals of groups I, II, III, IV, V e VII). The inflammatory DP was induced with the technique that uses the ligation with cotton yarn during a period of 15 days on the cervical of the first left inferior molar. After the removal of the yarn the periodontal pocket was irrigated 3 times (1st, 4th and 7th days) with the tests solution and the sacrifice was done on the 15th and 30th day after treatment. Was done the test exact of Fisher (p-value 0,05). Analyzing comparatively the results you may suggest that the propolis suspension on the concentration of 0,1% is efficient considering the short term inflammatory response (15 days), associated to the presence of dense gingival fibers, blood vessels without congestion, no dental reabsorption and bone loss. There for may be used as an alternative treatment for the periodontal disease, needing further studies to demonstrate the biological viability on the use as supporting on the periodontal therapeutic. / A doença periodontal (DP) está intimamente associada com a formação de biofilme dental, podendo progredir para formação de uma bolsa periodontal. A própolis tem sido utilizada como produto medicinal desde 300 a.C., e apresenta como características: atividades anticancerígena, antioxidante, anti-inflamatória, antimicrobiana e antifúngica. A atividade antimicrobiana da própolis frente aos periodontopatógenos já foi investigada através de testes in vitro e in vivo, principalmente através de extratos etanólicos. O presente trabalho teve como objetivo avaliar histologicamente a resposta da DP inflamatória induzida no tecido periodontal de ratos após a utilização de suspensões aquosas de própolis (SAP) a 0,1%, 1% e 10%, para irrigação subgengival. Foram utilizados 84 ratos wistar (Rattus novergicus), pesando entre 210 e 290g, com oito semanas de idade, distribuídos nos seguintes grupos experimentais: grupo I (n=14, SAP a 0,1%), grupo II (n=14, SAP a 1%), grupo III (n=14, SAP a 10%), grupo IV (n=14, Solução de Tween 80 a 5%), grupo V (controle positivo, n=14, com DP induzida e sem tratamento), grupo VII (n=14, clorexidina a 2%) e grupo VI (n=84, controle negativo, dentes contralaterais não induzidos e não tratados nos animais dos grupos I, II, III, IV, V e VII). A DP inflamatória foi induzida através da técnica da ligadura com fios de algodão durante um período de 15 dias na cervical do 1º molar inferior esquerdo. Após a remoção do fio a bolsa periodontal foi irrigada 3 vezes (1º, 4º e 7º dias) com as Soluções testes e o sacrifício foi realizado com 15 e 30 dias após o tratamento. Foi realizado teste exato de Fisher (p-valor 0,05). Analisando comparativamente os resultados pode-se sugerir que a SAP foi eficiente considerando principalmente a resposta inflamatória em curto prazo (15 dias) e na concentração de 0,1%, associada à presença de fibras gengivais densas, vasos sanguíneos sem congestão, ausência de reabsorções dentárias e perdas ósseas, podendo ser uma alternativa de tratamento da DP necessitando de estudos futuros para demonstrar a viabilidade biológica na utilização como coadjuvante na terapêutica periodontal.

Magister Scientiae Dentium - MSc(Dent) / The epidemiology of periodontal disease in the Republic of South Africa has received only scant attention in the past and consequently the available information is limited. The present study was therefore planned with the primary goal being to establish base-line information regarding periodontal disease in a portion of the population. The adolescent age group was selected as the target for the survey in that destructive periodontal disease (periodontitis) probably commences in many instances during the teenage years and therefore the group would be the one most likely to derive maximum benefit from preventive care and simple treatment measures which could be realistically provided by existing community dental health services. To translate the result into practicality a simple method of treatment needs estimation was also incorporated. In view of the diverse nature of the inhabitants of the Republic of South Africa and in keep with previously conducted studies, the presedt survey was confined to a single ethnic group. The population comprised all 3 .684 white pupils in Standard VIII attending the 34 schools in the Cape Peninsula during 1977. A random sample of 500 was selected for investigation. The average age of the sample was 15 years 9 months and the two sexes were equally represented. Only 7,2% were classified in the lower grade socio-economic class and thus were considered not to have a significant effect on the results. METHOD A team of three, consisting of the author and two assistants, visited each school. Portable equipment included a reclining chair, lighting, compressed air, and hand instruments. The investigation began with a questionnaire to establish the attitude to and experience of symptoms, prevention, and treatment of periodontal disease within the sample. Each subject was then examined and at each of 12 sites, on the 8 incisors and 4 first molars, recordings were made of plaque, gingivitis, supragingival calculus, subgingival calculus, and loss of attachment (periodontitis) according to defined criteria. A standard statistical package was used to analyse the recordings. RESULTS The questionnaire: This showed that almost all the subjects (98%) were interested in the prevention and treatment of periodontal disease in order to achieve and maintain oral health. Not with standing this.The overall prevalence of plaque was 97% and the mean Plaque Index (Pl.I) was 0,94 with 75% of the subjects having a mean Pl.I=0,5. The site prevalence data revealed that out of 12 sites, on average, 4 had Pl.I~O, 4 had Pl.I~l, and 4 had Pl.I~2. In the maxilla the molar sites had the higher plaque levels, whilst in the mandible the incisor sites had higher plaque levels. The sex-specific data showed the males to have higher mean plaque levels than the females, but in 50% of sample with a mean PI.I 0,5 to 1,45 there was ) had had any appurtenant treatment. The overall prevalence of plaque was 97% and the mean Plaque Index (Pl.I) was 0,94 with 75% of the subjects having a mean Pl.I=0,5. The site prevalence data revealed that out of 12 sites, on average, 4 had Pl.I~O, 4 had Pl.I~l, nd 4 had Pl.I~2. In the maxilla the molar sites had the higher plaque levels, whilst in the mandible the incisor sites had higher plaque levels. The sex-specific data showed the males to have higher mean plaque levels than the females, but in 50% of sample with a mean PI.I 0,5 to 1,45 there was no difference.

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No description available.

Aggregatibacter actinomycetemcomitans e Fusobacterium nucleatum são microrganismos gram-negativos presentes nos processos inflamatórios e nas diferentes formas da doença periodontal. Ambos formam parte da microbiota residente da cavidade bucal humana podendo levar ao desenvolvimento de infecções endógenas ou exógenas. Neste estudo, as avaliações qualitativa, quantitativa e genotípica de A. actinomycetemcomitans e F. nucleatum isolados de pacientes com gengivite, periodontite crônica e indivíduos sadios foram realizadas. Biofilmes subgengivais de 70 pacientes com gengivite, 75 com periodontite crônica e 95 indivíduos saudáveis foram avaliados. A. actinomycetemcomitans foi isolado em 2 (2,8%) pacientes com gengivite, 4 (5,3%) com periodontite e 5 (5,3%) sadios; e F. nucleatum em 13 (18,6%) pacientes com gengivite, 20 (26,6%) com periodontite crônica e 19 (20%) sadios. Ambos os microrganismos foram isolados em 5 (7,1%) pacientes com gengivite, 9 (12%) com periodontite crônica e 3 (3,15%) sadios. Por PCR, os DNA de A. actinomycetemcomitans foram detectados em 23 (32,8%) pacientes com gengivite, 20 (26,6%) com periodontite crônica e 38 (40%) indivíduos saudáveis; e de F. nucleatum em 17 (24,3%) pacientes com gengivite, 11 (14,6%) com periodontite e 19 (20%) sadios. Em associação esses microrganismos foram detectados em 23 (32,8%) pacientes com gengivite, 40 (53,3%) com periodontite crônica e 17 (17,8%) sadios. A. actinomycetemcomitans isolados de pacientes com gengivite pertenceram aos biotipos I, II, IV, V e X, e aos sorotipos a, c, e e. Em pacientes com periodontite foram encontrados os biotipos II, VI e X, e os sorotipos a, b, e c, sendo o sorotipo c o mais predominante (80%); e em indivíduos sadios os biotipos II e X, e os sorotipos b e c. Os valores quantitativos de A. actinomycetemcomitans para os três grupos analisados variaram em número de cópias de 0 a 1,14 x 108, e de F. nucleatum de 0 a 3,98 x 106. Os resultados obtidos por AP-PCR mostram a heterogeneidade dos isolados de A. actinomycetemcomitans e de F. nucleatum nos diferentes grupos clínicos de pacientes avaliados. Esses resultados comparativos poderão ser levados em consideração pelos clínicos para melhor direcionar o tratamento da doença periodontal, colaborando de forma efetiva para o seu monitoramento. / Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum are gram-negative microorganisms observed in inflammatory processes and different forms of periodontal disease. Both are part of the human oral resident microbiota which may cause endogenous or exogenous infections. In this study, a qualitative, quantitative and genotypic analysis of A. actinomycetemcomitans and F. nucleatum isolated from patients with gingivitis, chronic periodontitis and healthy subjects were determined. Subgingival biofilms of 70 patients with gingivitis, 75 with chronic periodontitis and 95 healthy subjects were evaluated. A. actinomycetemcomitans was isolated in 2 (2,8%) patients with gingivitis, 4 (5,3%) with periodontitis and 5 (5,3%) healthy individuals; and F. nucleatum in 13 (18,6%) patients with gingivitis, 20 (26,6%) with chronic periodontitis and 19 (20%) healthy. Both microorganisms were identified in 5 (7,1%) patients with gingivitis, 9 (12%) with chronic periodontitis and 3 (3,15%) healthy. By PCR, DNA of A. actinomycetemcomitans were detected in 23 (32,8%) patients with gingivitis, 20 (26,6%) with chronic periodontitis and 38 (40%) healthy individuals; and F. nucleatum 17 (24,3%) patients with gingivitis, 11 (14,6%) with periodontitis and 19 (20%) healthy. In association, microorganisms were detected in 23 (32,8%) patients with gingivitis, 40 (53,3%) with chronic periodontitis and 17 (17,8%) healthy. A. actinomycetemcomitans isolated from patients with gingivitis belonged to biotype I, II, IV, V, X, and serotypes a, c and e. In patients with periodontitis biotypes II, VI and X and serotypes a, b, and c were found and serotype c was the most predominant (80%); and healthy individuals biotypes II and X, and serotypes b and c. Quantitative values for A. actinomycetemcomitans in the three patients groups were ranged from 0 to 1.14 x 108 and F. nucleatum 0 to 3.98 x 106. The results of this study by AP-PCR showed the heterogeneity of A. actinomycetemcomitans and F. nucleatum in the different clinical status. These comparative results can be considered by dentists for the treatment of periodontal disease and its effective monitoring.