Lopez, N.J.; Belvederessi M.; De La Sotta, R.: Inflammatory Effects of Periodontally Diseased Cementum Sudied by Autogenous Dental Root Implants in Human. J. Periodontal., 51(10): 582, 1980.

Aim:

• To determine in vivo the inflammatory effects of the dentinal wall cementum of the pocket of periodontally involved teeth.

Methods and materials:

1. 56 patients were selected that have advanced marginal periodontitis and had never received periodontal treatment.
2. The control group were 15 patients who had teeth scheduled for extractions (prosthetic) and the teeth were periodontally healthy.
3. Implants of root pieces with diseased cementum were prepared.
4. At the extraction site, a small vertical incision was made apical to the MGJ to produce a pouch within the connective tissue.
5. The implant was inserted into the pouch with the cementum surface directed toward the mucosal epithelium.
6. Implant were divided into groups:
   • Group A, implants obtained from teeth that were scaled (allowing the diseased cementum to remain).
   • Group B, implant were subjected to the same treatment as group A, but were autoclaved at 121C for 10 min.
   • Group C, implants were root planed until the surface was hard and glass-like to touch, and autoclaved like group B.
7. A total of 70 root pieces were implanted.
8. The endotoxin of the teeth was extracted using the phenol-water procedure.
9. The Limulus lysate assay was used to determine whether the product obtained resulted in a reaction positive for endotoxin.
10. The impalnts were surgically removed after time intervals of 7, 14, and 21 days.
11. Biopsies were made and were examined under the microscope.

Results:

Clinical findings:

1. In group A:
   • on the 3rd day this group presented iinfalmmation of the oral mucosa covering the implants.
   • 7 days later the inflammation persisted but to a smaller degree.
   • 14-21 days later the inflammation had disappeared.
2. In group B:
   • 9 out of 20 patients showed inflammation on the 3rd day.
   • on the 7th day the inflammation disappeared.
3. Group C:
   • 4 of the 20 patients showed inflammation on the 3rd day.
   • On the 7th day the inflammation disappeared.
4. Group D (implant of healthy cementum):
   • None of the cases presented clinical signs of inflammation.

Histological findings:

1. Group A:
   • 7 days: Severe acute inflammation, neutrophils and abscessed areas were observed.
   • 14 days: Some acute inflammatory features but tended toward chronic inflammation, decreased neutrophils, increase in mononuclear cells, and granulation tissue.
   • 21 days: Chronic inflammation was present but the nunber of inflammatory cells was smaller.
2. Group B:
   • 7 days: Moderate acute inflammation, greater number of neutrophils.
   • 14 days: Chronic inflammation fo the connective tissue.
   • 21 days: Chronic inflammation persisted but in a smaller degree, smaller number of neutrophils, and granulationtissue with a grater tendency to repair.
3. Group C:
   • 7 days: Moderate acute inflammation in 4 of 10 cases, the remaining 6 cases presented chronic inflammation. A direct relationship was observed between the amount of remaining cementum in the implant and the degree of inflammation fo the connective tissue adjacent to the cementum.
   • 14 days: There was inflammation to a lesser degree than that of the 14 day implants of the groups that were only scaled.
   • 21 days: 2 of the cases were free of inflammation, the remaining presented a mild chronic inflammation localized insmall areas of the connective tissue. The repair of the connective tissue was at a more advanced stage.
4. Group D:
   • 7 days: There was a mild chronic inflammation, 3 cases showed no inflammation.
   • 14 days: No inflammation
   • 21 days: No inflammation

Histological findings of samples removed at periods of time other than scheduled:

1. Group A; implants removed at 7-8 weeks showed a thin fibrous capsule, at 16 weeks there was a smaller extension of the granulation tissue, and active resorption of the dentin
2. Group B; implants removed 7-8 weeks showed athin fibrous capsule; at 31 weeks there was microfocal inflammation.

Conclusions:

The inflammation found in implants of group A indicates that this procedure alone was not adequate to eliminate the endotoxins from the roots. The degree of inflammation caused by the diseased cementum of the roots wich were planed before surgery apparently was in direct relation to the amount of cementum remaing in the impalnt. This suggests that root planing is not adequate to eliminate the endotoxin of diseased cementum unless all the cementum of the root surface is eliminated. In the healthy autoclaved roots a close contact of connective tissue with cementum and dentin was found, and resorption of the cementum and dentin had begun in the third week. In the diseased roots, it was found that connective tissue came into contact with the dentin surface and initiated resorption by the 7th week.

Bottom line:

In advanced periodontal disease it is necessary to remove all the cementum exposed to the pocket to eliminate its potential for inducing inflammation.

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