The utilization of implants requires a close interrelationship between the prosthodontist and the surgeon who performs the implant procedure. The choice of abutments and other aspects of the work should be in the domain of both individuals. After the surgical procedures, the prosthodontist can wait until soft tissue healing occurs before deciding the type and length of the abutments that will be utilized for the reconstruction. If necessary, the surgeon can perform mucogingival surgery to enhance the implant-gingival environment.

Epidemiologic methods can be used for the diagnosis of periodontal disease and the evaluation of its progression. Indices can be used to check the frequency of pathogenic events, the location of etiologic agents and the effectiveness of therapy. Such techniques can be employed in everyday practice and could conceivably be used to motivate patients.

The use and limitation of mucogingival surgery to cover denuded root surfaces is discussed in terms of the necessity of the procedures and what technique to employ. Four classical techniques are described along with case reports demonstrating their usage. Once it is established that the procedure is of value to the patient, a suitable form of therapy can be utilized.

The beneficial effects of chlorhexidine on plaque formation have been well documented. This study was undertaken to evaluate the dual effects of chlorhexidine irrigation and root planing with an ultrasonic scaler. The parameters measured were plaque and gingival indices and bleeding on probing. A statistically significant decrease in all indices measured was demonstrated when compared with the test group of patients who received ultrasonic scaling and irrigation with sterile water.

The pathogenesis of the various periodontal diseases cannot only be explained on the basis of the relationship of specific bacteria to the clinical features of the disease. The microbiologic examination of various members of the same family, either by culturing or by the use of the DNA probe often showed similarities among several individuals in the same family. This could be accounted for on the basis of bacterial transmission or by contamination. These observations suggest the incidence of familial and genetic factors in the etiology of some forms of periodontitis.

Bactericidal activities of five mouthrinses containing cetylpyridinium chloride, hexetidine or chlorhexidine have been tested in vitro, against the main microorganisms involved in buccal affections. Mouthrinses containing hexetidine or chlorhexidine are effective, but chlorhexidine activity appears more extensive and homogeneous.

In periodontal therapy, frenectomy is indicated when the frenum exerts tension on the gingival margin and interferes with proper oral hygiene. The procedure is also employed when the frenum prevents closure of a diastema during orthodontic therapy. Frenectomy should be done after the canines have erupted and before retention is started to prevent separation of the teeth. For an improved surgical and cosmetic result, the authors propose a triangular-shaped gingival graft after the frenum has been excised. The advantage of the procedure is to create an area of attached gingiva and enhance healing.

An unusual case of spontaneous and rapidly destructive lesions involving the periodontal structures is described in a 54 year old, bi-sexual patients suspected of having AIDS. Concomitant with the periodontal breakdown, the patient developed a severe case of Herpes Zoster involving the area of the face innervated by the 5th cranial nerve. The dermal lesions involved the face, nose, eyes and scalp. Similar lesions were noted on the gingival and palatal mucosa on the same side of the jaw as the skin lesions. The differences between this type of periodontal destruction and more conventional forms of periodontitis are discussed.

The treatment of an exposed root surface may be indicated for an aesthetic improvement of a gingival recession. The surgical technic depends on the type of the recession, the quality and the quantity of the keratinized gingiva apically or laterally from the recession. The purpose of this study is to evaluate the minimal quantity of keratinized gingiva necessary to obtain a root coverage. 10 recessions on maxillary cuspids were treated with coronally repositioned flap. Less than 3 mm of keratinized gingiva was present apically to the exposed root surface. All patients received oral hygiene instructions, plaque control and scaling and root planing. Gingival recession, width of keratinized gingiva and loss of attachment were measured at the time of surgery and three months postoperatively. The mean recession was 5.20 mm (+/- SE = 0.36) prior to treatment and the keratinized gingiva was 1.70 mm (+/- 0.16) high at T0. The mean gain of root coverage was 3.43 mm (+/- 0.29) at three months post-operatively. At T0 and 3 months post-operatively, the measures of recessions showed a statistically difference confirming the validity of the technic. The absence of correlation between initial height of keratinized gingiva and the coverage result (r = 0.05) indicates that initial width of keratinized gingiva does not affect the coverage results.

Destructive periodontal diseases are characterized by tissue breakdown partly mediated by various enzymes originating from bacteria and/or tissue. Collagen and fibronectin are two of the main substrates available for enzyme activity. Since chlorhexidine is largely used during and after periodontal therapy, we have investigated the effects of chlorhexidine upon some bacterial proteases. Our data indicate that chlorhexidine inhibits, on a dose-dependent manner, both fibronectin and collagen hydrolysis mediated by either bacteroides (porphyromonas) gingivalis or bacteroides intermedius. Thus, it might be hypothesized that a side from its bactericidal activity, chlorhexidine helps to prevent periodontal tissue destruction directly by enzyme inhibition.

A solution of formaldehyde and tyrothricin was placed in periodontal pockets of 14 patients. One maxillary quadrant was used as the experimental side, while the contralateral quadrant was employed as the control. A placebo solution was placed in the pockets of the control side. Both the experimental and control sides were treated on days -3, 0, +4, +7, +11 and +14. Scaling and root planing was accomplished on day 0. Plaque and gingival indices, and gingival fluid volume were recorded on all of the treatment days, as well as on day +28. Pocket depths were noted on days -3, 0, +14 and +28. Improvements were noted in all parameters measured on both the experimental and control sides, although statistical analyses revealed that plaque and gingival indices were slightly better in the experimental side. The author concludes that placing a Formaldehyde-Tyrothricin solution in periodontal pockets offers some therapeutic gain over scaling and root planing alone.

A more or less important alveolar gap is often seen after the surgical treatment of clefts. The connective tissue autograft corrects the functional and aesthetic defect of the residual lesion and a fixed prosthetic restoration can be realized.

A resorbable mesh (Polyglactin 910) coated with collagen was employed to test its biocompatibility and its possible role in new attachment procedures.

A patient with adult periodontitis was treated for a 2 and 3-walled intrabony lesion on tooth n degrees 27. After scaling and root planing, the defect was surgically exposed and filled with a micro-porous resin. Following healing, there was a reduction in pocket depth as a result of gingival recession and a gain in probing attachment levels. This was confirmed 13 months post-operatively by clinical observation on re-entry. A biopsy of the treated site was taken at that time and undecalcified sections were studied by light microscopy and microradiography. New bone formation was noted inside and on the surface of the resin granules and at a distance from the particles. From a clinical and histologic point of view, the material seemed to be well tolerated by the host.

The effect of various types of synthetic hydroxyapatites (HA), coated or not with collagen or human plasmatic fibrin, has been studied after 3 month implantation either in freshly extracted alveoli in miniature pigs or in experimentally induced periodontal lesions in beagle dogs. The best histological results were observed in HA without organic coating. The Bioapatite consisting in crystals with a mean size of 146 nm +/- 47 nm were well integrated in the alveolar bone. Similar results were obtained with micro-sized hydroxyapatite, with a mean crystal size of 38 nm +/- 16 nm. But at 3 months, this HA type was still actively integrated in bone with osteogenesis. When these 2 types of HA were coated with collagen or plasmatic fibrin, they were less well incorporated in alveolar bone and were even able to develop localized and moderate inflammatory reactions. The main purpose of synthetic HA is to promote alveolar bone formation in periodontal lesions. For an improved tissular regeneration, it is recommended to use simultaneously in the future synthetic HA together with resorbable biocompatible synthetic membranes.