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Third Molar Periodontal Pathology in the Third Decade and Periodontal Pathogens
Oral Abstract Session 5
Third Molar Periodontal Pathology in the Third Decade and Periodontal Pathogens Paige E. Nance, DDS, OMFS, UNC School of Dentistry, Chapel Hill, NC 27599-7450 (White Jr. RP; Offenbacher S; Phillips C; Blakey GH; Haug RH) Statement of the Problem: Increased periodontal probing depth in the 3rd molar region is common for young patients. High levels of pathogens detected on the distal of second molars at baseline might predict periodontal pathology. This study assessed the association between follow-up periodontal probing depths in the 3rd molar region and the baseline levels of periodontal pathogens for patients in a longitudinal trial. Patients and Methods: Data derived from healthy patients with four asymptomatic 3rd molars. Panoramic radiographs were analyzed for 3rd molar angulation as compared to the long axis of the 2nd molar (mesial/ horizontal ⱖ25 degrees) and eruption to the occlusal plane. Full mouth periodontal probing (PD) was conducted at follow-up. The baseline levels of bacteria were determined using whole chromosomal DNA probes and DNA checkerboard hybridization. Detected bacteria were grouped into “orange” and “red” complexes according to Socransky. A level of “orange” and “red” complex microorganisms at ⱖ105 was considered clinically important. Method of Data Analysis: The follow-up PD in the 3rd molar region, the distal of 2nd or around 3rd molars, were compared to baseline levels of “orange” and “red” complex microorganisms. Level of significance for Chi2 statistics was set at P ⫽ 0.05. Results: Data from 240 patients were available. Median follow-up was 2.2 y (IQ 2.0, 3.7 y). Baseline median age was 25.9 y (IQ 22, 32.8 y). More were female, 53%, and Caucasian, 82%. At follow-up 12% maxillary mesial/horizontal impacted 3rd and 28% mandibular 3rd molars had a PD ⱖ4 mm. Similarly affected were 11% of the maxillary vertical/distal impacted 3rd and 32% of the mandibular 3rd molars. Only 11% maxillary erupted 3rd molars had a PD ⬎4 mm, but 51% of the mandibular erupted 3rd molars were affected. If a patient had a PD ⱖ4 mm at follow-up and baseline periodontal pathogens ⱖ105, the pathogens ⱖ105 were likely to be detected in the same quadrant, 45 of 51 (88%). With a PD ⱖ4 mm in the maxilla at follow-up, 43% of patients had baseline pathogen levels detected in the same quadrant ⱖ105, as compared to 30% with follow-up PD ⬍4 mm. For the mandible a PD ⱖ4 mm in the 3rd molar region at follow-up was associated more often with baseline quadrant levels of pathogens ⱖ105, compared to 3rd molar PD ⬍4 mm, 29% vs. 26%. Differences were not statistically significant. Perhaps the short time interval from baseline to follow-up did not allow for high levels of pathogens at 68
baseline to influence follow-up PD. Of the 3rd molar regions in the maxilla with ⱖ105 pathogens at baseline, 22% had PD ⱖ4 mm at follow-up. In the mandible with ⱖ105 pathogens at baseline, 63% had PD ⱖ4 mm at follow-up. Conclusion: If pathogens ⱖ105 are detected with increased PD, both are likely in the same quadrant. Patients continue to be followed to determine how often baseline levels of pathogens predict increased PD. References Socransky SS, Haffajee AD, Cugini MA, et al: Microbial complexes. Haffajee AD, Cugini MA, Tanner A, et al: Subgingival microbiota in healthy. Blakey GH, Marciani RD, Haug RH, Phillips C, Offenbacher S, Pabla T, White RP Jr. Funding Source: OMFS Foundation, AAOMS, Dental Foundation of NC
Arterial Stents to Assist in Sialoendoscopy: An Animal Study Maria Papadaki, DDS, MD, One Emerson Place, Apt 10E, Boston, MA 02144 (Kaban L; Kwolek C; Keith D; Troulis M) Statement of the Problem: Sialolithiasis of the parotid and submandibular glands is a frequently encountered clinical problem. Due to a high recurrence rate, ablative surgery is often required and carries some risk for facial nerve paresis (Marchal et al 2003). Sialoendoscopy is a novel minimally invasive technique to visualize the lumen of the ducts and to allow stone removal with a high degree of success (Nahlieli et al 1997). Dilatation of the duct through the natural orifice is accomplished and the endoscope is navigated through the ductal system. Complications include inability to retrieve or break up the stone and damage to the duct from manipulation of the endoscope and instruments. The purpose of this study is to assess the feasibility of using expandable cardiovascular stents to protect the parotid and submandibular ducts during sialoendoscopy. Materials and Methods: The sialoendoscopy procedure was performed on pig cadaver heads (n ⫽ 10): the parotid (n ⫽ 20) and submandibular ducts (n ⫽ 20) were identified and dilated using salivary gland dilators. In 10 parotid and 10 submandibular ducts the Cypher™ coronary stent was inserted and expanded to 3mm. The scope was inserted and navigated to the hilum of the gland. Navigation of the duct system was repeated 5 times. In 10 additional parotid and submandibular ducts (controls), the endoscope was inserted and navigated to the hilum immediately after dilatation (and repeated 5 times), without the placement of a coronary stent. AAOMS • 2005
Third Molar Periodontal Pathology in the Third Decade and Periodontal Pathogens Paige E. Nance, DDS, OMFS, UNC School of Dentistry, Chapel Hill, NC 27599-7450 (White Jr. RP; Offenbacher S; Phillips C; Blakey GH; Haug RH) Statement of the Problem: Increased periodontal probing depth in the 3rd molar region is common for young patients. High levels of pathogens detected on the distal of second molars at baseline might predict periodontal pathology. This study assessed the association between follow-up periodontal probing depths in the 3rd molar region and the baseline levels of periodontal pathogens for patients in a longitudinal trial. Patients and Methods: Data derived from healthy patients with four asymptomatic 3rd molars. Panoramic radiographs were analyzed for 3rd molar angulation as compared to the long axis of the 2nd molar (mesial/ horizontal ⱖ25 degrees) and eruption to the occlusal plane. Full mouth periodontal probing (PD) was conducted at follow-up. The baseline levels of bacteria were determined using whole chromosomal DNA probes and DNA checkerboard hybridization. Detected bacteria were grouped into “orange” and “red” complexes according to Socransky. A level of “orange” and “red” complex microorganisms at ⱖ105 was considered clinically important. Method of Data Analysis: The follow-up PD in the 3rd molar region, the distal of 2nd or around 3rd molars, were compared to baseline levels of “orange” and “red” complex microorganisms. Level of significance for Chi2 statistics was set at P ⫽ 0.05. Results: Data from 240 patients were available. Median follow-up was 2.2 y (IQ 2.0, 3.7 y). Baseline median age was 25.9 y (IQ 22, 32.8 y). More were female, 53%, and Caucasian, 82%. At follow-up 12% maxillary mesial/horizontal impacted 3rd and 28% mandibular 3rd molars had a PD ⱖ4 mm. Similarly affected were 11% of the maxillary vertical/distal impacted 3rd and 32% of the mandibular 3rd molars. Only 11% maxillary erupted 3rd molars had a PD ⬎4 mm, but 51% of the mandibular erupted 3rd molars were affected. If a patient had a PD ⱖ4 mm at follow-up and baseline periodontal pathogens ⱖ105, the pathogens ⱖ105 were likely to be detected in the same quadrant, 45 of 51 (88%). With a PD ⱖ4 mm in the maxilla at follow-up, 43% of patients had baseline pathogen levels detected in the same quadrant ⱖ105, as compared to 30% with follow-up PD ⬍4 mm. For the mandible a PD ⱖ4 mm in the 3rd molar region at follow-up was associated more often with baseline quadrant levels of pathogens ⱖ105, compared to 3rd molar PD ⬍4 mm, 29% vs. 26%. Differences were not statistically significant. Perhaps the short time interval from baseline to follow-up did not allow for high levels of pathogens at 68
baseline to influence follow-up PD. Of the 3rd molar regions in the maxilla with ⱖ105 pathogens at baseline, 22% had PD ⱖ4 mm at follow-up. In the mandible with ⱖ105 pathogens at baseline, 63% had PD ⱖ4 mm at follow-up. Conclusion: If pathogens ⱖ105 are detected with increased PD, both are likely in the same quadrant. Patients continue to be followed to determine how often baseline levels of pathogens predict increased PD. References Socransky SS, Haffajee AD, Cugini MA, et al: Microbial complexes. Haffajee AD, Cugini MA, Tanner A, et al: Subgingival microbiota in healthy. Blakey GH, Marciani RD, Haug RH, Phillips C, Offenbacher S, Pabla T, White RP Jr. Funding Source: OMFS Foundation, AAOMS, Dental Foundation of NC
Arterial Stents to Assist in Sialoendoscopy: An Animal Study Maria Papadaki, DDS, MD, One Emerson Place, Apt 10E, Boston, MA 02144 (Kaban L; Kwolek C; Keith D; Troulis M) Statement of the Problem: Sialolithiasis of the parotid and submandibular glands is a frequently encountered clinical problem. Due to a high recurrence rate, ablative surgery is often required and carries some risk for facial nerve paresis (Marchal et al 2003). Sialoendoscopy is a novel minimally invasive technique to visualize the lumen of the ducts and to allow stone removal with a high degree of success (Nahlieli et al 1997). Dilatation of the duct through the natural orifice is accomplished and the endoscope is navigated through the ductal system. Complications include inability to retrieve or break up the stone and damage to the duct from manipulation of the endoscope and instruments. The purpose of this study is to assess the feasibility of using expandable cardiovascular stents to protect the parotid and submandibular ducts during sialoendoscopy. Materials and Methods: The sialoendoscopy procedure was performed on pig cadaver heads (n ⫽ 10): the parotid (n ⫽ 20) and submandibular ducts (n ⫽ 20) were identified and dilated using salivary gland dilators. In 10 parotid and 10 submandibular ducts the Cypher™ coronary stent was inserted and expanded to 3mm. The scope was inserted and navigated to the hilum of the gland. Navigation of the duct system was repeated 5 times. In 10 additional parotid and submandibular ducts (controls), the endoscope was inserted and navigated to the hilum immediately after dilatation (and repeated 5 times), without the placement of a coronary stent. AAOMS • 2005