Professional Documents
Culture Documents
THROUGH
PERIODONTICS
Dr. Sandip Ladani
What is Periodontics?
–“Pituita” or
Hippocr Calculus.
at es
Hippocrates
•“The doctrine of
calculus”
•Extensive formation
of tartar on the teeth
and related this to
toothache Paracelcus
Hippocrates Paracelcus
Adolph Witzel
Hippocrates Paracelcus
Anton van Leeuwenhoek Adolph Witzel
Willoughby D. Miller
Plaque
Plaque
Hypotheses
Ecological
Non- Specific
Plaque
Hypothesis
Specific
Loe H, Theilade F, Jensen SB. Experimental gingivitis in man. J Periodontology 1965:36:177-187.
P. gingivalis in News Again
• HIV – 1
– P. gingivalis strongly facilitated the reactivation of HIV-1 by high production of butyric acid.
– P. gingivalis could act as a risk factor for HIV-1 in latently infected individuals (1).
• Smoking
– In smokers the cigarette smoke is found to alter some of the genes of P.gingivalis
associated with its virulence, detoxification, DNA repair, and oxidative stress mechanism.
– This results in changes with protein expression in the cell membrane, which affects the
bacterial cell characteristics and how immune system recognizes it.
– These results could possibly explain why smokers are resistant to periodontal treatment
and are more susceptible to oral disease caused by P. gingivalis. (2)
References:
1.IADR2009, abstract #1703, "Reactivation of Latent HIV-1 by Porphyromonas gingivalis Involves Histone Modifcation", by K. Ochiai et al., of Nihon
University, Tokyo, Japan
2. Tobacco-induced alterations to Porphyromonas gingivalis–host interactions http://www3.interscience.wiley.com/journal/121659253/abstract
PERIODONTAL Disease
PROGRESSION
DIAGNOS
• is IS defined as
chronological
organization and
critical evaluation of
dental-treatment1.jpg
information obtained
from patients history,
laboratory and
radiological
examination.
Periodontal Disease
Traditional Diagnostic
Techniques
(Gold Standards)
0 -08 to +09
I +10 to +19
II +20 to +29
Ambroise Paré
• First specialist in
Periodontics
• Conservative approach to
periodontal
• Oral prophylaxis and
prevention, advocating
cleanliness of the mouth
and opposing surgery. John W. Riggs
• “Riggs’ Disease”
• Developed a surgical technique
consisting of a scalloped, continuous
gingivectomy excision, exposing the
marginal bone for subsequent curettage
and remodeling.
Salomon Robicsek
Changing trends in
Periodontal Management
• Three major concepts in Periodontal therapy which changed with
the course of history are:
Tetracycline
Fibronectin
Sodium Deoxycholate
Enzyme Lysosome
•Results from clinical trials using any type of root conditioning agent indicate
no additional improvement in clinical conditions [1].
•A recent meta-analysis systematic review confirmed that the use of citric acid,
tetracycline, or EDTA to modify the root surface provides no clinically
significant benefit of regeneration in patients with chronic periodontitis [2].
Ref:
[1] Handelsman M, Davarpanah M, Celletti R. Guided tissue regeneration with and without citric acid treatment in
vertical osseous defects. Int J Periodontics Restorative Dent 1991; 11(5):350–63.
[2] MariottA. Efficacy of clinical root surfacemodifiers in the treatment of periodontal disease. A systematic
review. Ann Periodontol 2003;8:205–26.
Non-Surgical
Therapy
Current Concept-
Full Mouth
Disinfection
Compound Loupe
Simple Loupe
Lasers
• Pocket debridement and reattachment-without traditional surgery,
we can induce the pocket to “zip up.”
• Biostimulation-
– increase soft tissue healing six-fold.
– enhances bone healing
– induces blood vessels to grow.
LANAP
LANAP
Antibiotics and periodontal therapy:
When?
Systemic Antibiotics
What?
• Tetracyclines Aggressive, Rapidly advancing
severe, adult case
• Metronidazole Severe Adult Case
• Augmentin Refractory, Aggressive
• Amoxicillin + metronidazole Aggressive,
• Augmentin + metronidazole refractory,
rapidly advancing
New in Antibiotics
• Prof Brogden from Univ of Iowa says:
"We are developing an antibiotic that can target and kill a
particular pathogen without harming or altering the composition
of the normal, more beneficial bacteria in the body. Such a
product would provide a variety of new treatments for oral
diseases as well as a means of prevention.”
• Attached a broad spectrum antibiotic to a protein that targets
the specific receptor on the cell wall of the bacteria.
• When this narrow spectrum antibiotic was tried on a mix of
bacteria, it only killed P. gingivalis, while leaving the other to
bacteria as it is.
2
Inspektor TC
This was created by a team at University of Liverpool. This is what
Professor Sue Higham Unversity's School of Dental Sciences has to say
• A biochemical agent is
added that results in a colour
change that reports the
number of oral neutrophil
present.
Ref: Bender, J.S., H. Thang, and M. Glogauer. 2006. Novel rinse assay for the quantification of oral neutrophils
and the monitoring of chronic periodontal disease. J Periodontal Res. 41:214-20.
Ozone Therapy &
Periodontics
•Nagayoshi et al
•The ozonated water strongly inhibited the formation of dental plaque
in vitro.
•These results suggest ozonated water may be useful in reducing
infections caused by microorganisms present in dental plaque. (1)
•Huth et al.
•In an in vitro study evaluated whether gaseous or aqueous ozone has
any toxic effect on human oral epithelial and gingival fibroblast cells in
comparison with established antiseptics.
•The investigators found ozone gas to be toxic to the cell lines and
aqueous ozone was more biocompatible than gaseous ozone. (2)
Ref: 1. Nagayoshi M, Kitamura C, Fukuzumi T, Nishihara T, Terashita M. Efficacy of ozone on survival and
permeability of oral microorganisms. Oral Microbiology and Immunology 2004; 19:240-6.
2. Huth KC, Jacob FM, Saugel B, Cappello C, Paschos E, Hollweck R, Hickel R, Brand K. Effect of ozone on oral
cells compared with established antimicrobials. European Journal of Oral Sciences 2006; 114:435-440.
Photodisinfection
The Future of Periodontal Therapy
Blue Light = Calculus