Role of “diseased” root cementum in healing following treatment of periodontal disease

Abstract

This clinical trial was undertaken to examine whether root debridement in the treatment of periodontal disease must include the removal of the exposed cementum in order to achieve peridontal health. The study included 11 adult patients with moderate to advanced periodontal disease. In a split-mouth design, the dentition of each patient was by random selection divided into test- and control quadrants comprising the incisors, canines and premolars. Following a baseline examination, all patients were given a case presentation and a detailed instruction in self-performed oral hygiene measures. The patients were then subjected to periodontal surgery. Following reverse bevel incisions, buccal and lingual mucoperiosteal flaps were elevated and all granulation tissue was removed. In 2 jaw quadrants (control quadrants) in each patient, the denuded root surfaces were carefully scaled and planed in order to remove soft and hard deposits as well as all cementum, using hand instruments and flame-formed diamond stones. In the contralateral quadrants (test quadrants) the roots were not scaled and planed but soft microbial deposits were removed by polishing the root surfaces with the use of rubber cups, interdental rubber tips and a polishing paste. Calculus in the test quadrants was removed by the use of a curette, but precaution was taken to avoid the removal of cementum. The flaps were repositioned to their original level and sutured. The patients were following active treatment enrolled in a surpervised maintenance care program including "professional tooth cleaning" once every 2 weeks for a 3-month period. From this time point until the final control, 24 months after treatment, the interval between the recall appointments was prolonged to 3 months. The results showed that the same degree of improvement of periodontal health was achieved following both types of treatment. A low-frequency of gingival sites which bled on probing or had a gingival index score of 2 and 3 was obtained in all jaw quadrants as well as a high frequency of sites with shallow pockets. Between the baseline examination and the follow-up examinations (after 6, 12 and 24 months), there was some gain of probing attachment for both treatment modalities. This gain was most pronounced in the initially deeper pockets and was similar for both treatment modalities.